6531 Combined midterm and final review

Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3-4) 0.2 uIU/L 4.2 uIU/L 0.4 uIU/L 2.4 uIU/L

0.2 uIU/L

Which medication is associated with weight gain?

Antidepressants

Which cranial nerve (CN) is affected in sensorineural or perceptive hearing loss? A. CN II B. CN IV C. CN VIII D. CN XI

C. CN VIII

How would you grade tonsils that touch the uvula? A. Grade 1+ B. Grade 2+ C. Grade 3+ D. Grade 4+

C. Grade 3+

The most frequent cause of laryngeal obstruction in an adult is A. A piece of meat B. A tumor C. Mucosal swelling from an allergic reaction D. Inhalation of a carcinogen

A. A piece of meat

Which risk assessment for coronary artery disease is recommended for all female patients?

Framingham risk score

Which type of tremor is goal directed, more prominent with willful action, and may be located in proximal as well as distal extremities? A. Cerebellar B. Physiological C. Parkinsonian D. Essential

Answer A

A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with the diagnosis?

Spontaneous horizontal nystagmus

A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans? "Are you wearing your usual shoes?" "Do you also have chest pain when you have leg pain?" "Is your leg pain relieved by rest?" "Do you ever have the same pain in the other leg?"

"Is your leg pain relieved by rest?"

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: "It is the most common cause of death in patients with skin cancer." "It can be cured with surgical excision or radiation therapy." "It is a slow growing skin cancer that rarely undergoes malignant changes." "It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks."

"It can be cured with surgical excision or radiation therapy."

Acute bacterial sinusitis should be treated with broad-spectrum antibiotics for:

10-14 days

The National Cholesterol Education Program's Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than: 160 mg/dL 130 mg/dL 100 mg/dL 70 mg/dL

100 mg/dL

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.

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

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

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.

Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? Under 3 years of age Preschool children 6 to 12 years of age Adolescents

6 to 12 years of age

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.

A patient has nasal congestion, fever, purulent nasal discharge, headache, and facial pain and begins treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next course of action for this patient? A trial of azithromycin A CT scan of the paranasal sinuses A second course of amoxicillin-clavulanate A referral to an otolaryngologist

A second course of amoxicillin-clavulanate

During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion? Immediate surgery is recommended This is most likely malignant A biopsy should be performed It is benign and will not need intervention

A biopsy should be performed

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? A long-acting bronchodilator An inhaled corticosteroid and cromolyn Theophylline and a short acting bronchodilator A bronchodilator PRN and an inhaled corticosteroid

A bronchodilator PRN and an inhaled corticosteroid

Which of the following can result from chronic inflammation of a meibomian gland? A chalazion Uveitis Keratitis A pterygium

A chalazion

Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial antibiotic therapy? A 36 month old with fever of 38C, mild otalgia, and red, non- bulging ™ A 6 month old with fever of 39.2C, poor sleep and appetite and bulging ™ A 5 year old with fever of 38.0 C, severe otalgia, and red, bulging ™ A 4 year old, afebrile child with bilateral otorrhea

A 36 month old with fever of 38C, mild otalgia, and red, non- bulging ™

Which patients should be referred immediately to an ophthalmologist after eye injury and initial treatment? (Select all that apply.) A patient who was sprayed by lawn chemicals A patient with irrigation secondary to wood dust A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration A patient with a corneal abrasion

A patient who was sprayed by lawn chemicals A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient's dysphagia is: Esophageal cancer Chest pain GERD A and C All of the above

A and C

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

The most appropriate treatment for a child with mild croup is: A bronchodilator An antibiotic A decongestant A cool mist vaporizer

A cool mist vaporizer

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate? An antihistamine intranasal spray A decongestant nasal spray Ipratropium Omalizumab

A decongestant nasal spray

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

Jill presents with symptoms of hay fever and you assess the nasal mucosa of her turbinates to be pale. What diagnosis do you suspect? A. Allergic rhinitis B. Viral rhinitis C. Nasal polyps D. Nasal vestibulitis from folliculitis

A. Allergic rhinitis

Aortic stenosis can be a contributing cause of coronary artery disease. Which of the following heart sounds is suggestive of aortic stenosis?

A systolic murmur loudest at the second intercostal space, right sternal border

Harvey has had Meniere's disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? Pharmacological therapy A labyrinthectomy A vestibular neurectomy Wearing an earplug in the ear with the most hearing loss

A vestibular neurectomy

The differential diagnosis for a patient complaining of a sore throat includes which of the following? Gonococcal infection Thrush Leukoplakia B only A, B, and C

A, B, and C

Treatment of H.pylori includes which of the following? Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate A and B A, B, and C

A, B, and C

Which of the following is a diagnostic finding in hypertensive retinopathy

A-V nicking, copper or silver wiring, cotton-wool patches, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macro-aneurysms

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

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

The normal ratio of the artery-to-vein width in the retina as viewed through the ophthalmoscope is A. 2:3 B. 3:2 C. 1:3 D. 3:1

A. 2:3

Sylvia has glaucoma and has started taking a medication that acts as a diuretic to reduce the intraocular pressure. Which medication is she taking? A. A carbonic anhydrase inhibitor B. A beta-adrenergic receptor blocker C. A miotic D. A mydriatic

A. A carbonic anhydrase inhibitor

The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is A. A cataract B. Retinoblastoma C. Persistent hyperplastic primary vitreous D. Retinal detachment

A. A cataract - Some infants require no treatment, however, surgery may be performed

When you are assessing the internal structure of the eye, absence of a red reflex may indicate A. A cataract or a hemorrhage into the vitreous humor B. Acute iritis C. Nothing, this is a normal finding in older adults D. Diabetes or long-standing hypertension

A. A cataract or a hemorrhage into the vitreous humor

In a young child, unilateral purulent rhinitis is most often caused by A. A foreign body B. A viral infection C. A bacterial infection D. An allergic reaction

A. A foreign body

Manny, age 16, was hit in the eye with a baseball. He developed pain in the eye, decreased visual acuity, and injection of the globe. You confirm the diagnosis of hyphema by finding blood in the anterior chamber. What treatment would you recommend while Manny is waiting to see the ophthalmologist? A. Apply bilateral eye patches B. Have Manny lie flat C. Refer him to an ophthalmologist within a week D. Make sure Manny is able to be awakened every 30 minutes

A. Apply bilateral eye patches

In older adults, the most common cause of decreased visual functioning is A. Cataract formation B. Glaucoma C. Macular degeneration D. Arcus senilis

A. Cataract formation

You note a completely split uvula in Noi, a 42 year old Asian. What is your next course of action? A. Do nothing B. Refer Noi to a specialist C. Perform a throat culture D. Order a CBC

A. Do nothing

Microtia refers to the size of the A. Ears B. Skull C. Pupils D. Eyes

A. Ears

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

A. Epiglottitis

Regular ocular pressure testing is indicated for older adults taking A. High-dose inhaled glucocorticoids B. NSAIDs C. Angiotensin converting enzyme (ACE) inhibitors D. Insulin

A. High-dose inhaled glucocorticoids

Which is the most common localized infection of one of the glands of the eyelids? A. Hordeolum B. Chalazion C. Bacterial conjunctivitis D. Herpes simplex

A. Hordeolum

Tara was born with a cleft lip and palate. When should treatment begin for this condition? A. Immediately after birth B. At age 3 months C. At age 6 months D. When Tara is ready to drink from a cup

A. Immediately after birth

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected? A. Maxillary sinus B. Ethmoid sinus C. Temporal sinus D. Frontal sinus

A. Maxillary sinus

The first-line antibiotic therapy for an adult with no known allergies and suspected group A beta-hemolytic streptococcal pharyngitis is A. Penicillin B. Erythromycin (E-Mycin) C. Azithromycin (Zithromax) D. Cephalexin (Keflex)

A. Penicillin

The most common offending allergens causing allergic rhinitis are A. Pollens of grasses, trees and weeds B. Fungi C. Animal allergens D. Food sensitivity

A. Pollens of grasses, trees, and weeds

Which of the following refractive errors in vision is a result of the natural loss of accomodative capacity with age? A. Presbyopia B. Hyperopia C. Myopia D. Astigmatism

A. Presbyopia

David, age 32, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? A. Prescribe nasal steroids and oral decongestants B. Prescribe antibiotic eardrops C. Prescribe systemic eardrops D. Refer David to an ear, nose, and throat specialist

A. Prescribe nasal steroids and oral decongestants

A client come in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed? A. Recent trauma B. Difficulty swallowing C. Stiffness in the right shoulder D. Changes in sleeping habits

A. Recent trauma

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

A. Retinal detachment

A 22 year old client who plays in a rock band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the "club." These symptoms are most characteristic of which of the following? A. Sensorineural loss B. Conductive loss C. Tinnitus D. Vertigo

A. Sensorineural loss

What significant finding(s) in a child with otitis media with effusion would prompt more aggressive treatment? A. There is a change in the child's hearing threshold to less than or equal to 20 decibels (dB) B. The child becomes a fussy eater C. The child's speech and language skills seem slightly delayed D. Persistent rhinitis is present

A. There is a change in the child's hearing threshold to less than or equal to 20 decibels (dB)

Which fo the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? A. Trigeminal neuralgia B. TMJ C. Goiter D. Preauricular adenitis

A. Trigeminal neuralgia

June, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthus. She is concerned that they may be cancerous skin lesions. You tell her they are probably A. Xanthelasmas B. Pingueculae C. The result of arcus senilis D. Actinic keratoses

A. Xanthelasmas

In treating diabetic patients with hypertension, which class of anti-hypertensive agent is considered the preferred first-line therapy:

ACE inhibitors/ARB's

Barbara, age 36, presents with episodic attacks of severe vertigo, usually with associated ear fullness. Her attacks usually last several hours and she feels well before and after the attacks. To what might you attribute these symptoms? A. M é ni è re ' s disease B. Vestibular neuronitis C. Benign paroxysmal positional vertigo D. Otosclerosis

Answer A A client with M é ni è re ' s disease presents with episodic attacks of severe vertigo, usually with associated ear fullness or hearing loss

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Apply a topical antibiotic and warm compresses. Apply cool compresses and avoid touching the hordeolum. Use an oral antibiotic and eye flushes. Apply light palpation to facilitate drainage.

Apply a topical antibiotic and warm compresses.

Which of the following interventions can significantly slow the decline in performing activities of daily living (ADLs) in clients with Alzheimer ' s disease living in a nursing home? A. A simple exercise program B. Ginkgo biloba C. Doing crossword puzzles D. Improving nutritional state

Answer A A simple exercise program, 1 hour twice a week, has been shown to significantly slow the decline in performing ADLs in persons living in a nursing home

Risk factors for acute arterial insufficiency include which of the following? Recent myocardial infarction Atrial fibrillation Atherosclerosis All of the above

All of the above

When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. You are trying to differentiate between a sprain and a strain. You know that a sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. does not result in joint instability.

Answer A A sprain is defined as an injury to the ligaments that connect bone to bone in a joint that results from a twisting motion and may cause joint instability

You are considering a diagnosis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout in a 72-yearold man who presents with complaints of pain and stiffness in his wrists and knees. The most useful diagnostic test to assist you in making this diagnosis would be A. synovial-fluid analysis and x-ray. B. bacterial culture. C. bone scan and MRI. D. anticitrullinated protein antibody (ACPA) test and RA factor.

Answer A CPPD disease (pseudogout) may appear clinically similar to gouty arthritis however, in CPPD crystals form in the cartilage and lead to inflammation.

Clients with senile dementia of the Alzheimer ' s type often die of A. pneumonia. B. suicide. C. pressure sores. D. malnutrition.

Answer A Clients with senile dementia of the Alzheimer ' s type (SDAT) commonly die of pneumonia (the most common cause of death of clients with Alzheimer ' s disease).

Alan, age 46, presents with a tender, red, swollen knee. You rule out septic arthritis and diagnose gout by confirming A. an elevated WBC. B. hyperuricemia. C. a significant response to a dose of ceftriaxone (Rocephin). D. a positive antinuclear antibody test.

Answer B To diagnose gout, there should be a negative joint culture and hyperuricemia. A septic joint would likely cause an elevated white blood count (WBC) and a positive bacterial joint culture

Which of the following statements concerning developmental dysplasia of the hip (DDH) is correct? A. It is often associated with being the firstborn female child. B. It results from an orthopedic malformation in utero. C. It has no genetic predisposition. D. It is more common in males.

Answer A Developmental dysplasia of the hip (DDH), previously referred to as congenital hip dislocation, occurs in approximately 1% of live births and is more common in females than males

Diana, 55, complains of ear pain, right facial weakness, and loss of taste. What diagnosis would you consider? A. Lyme disease B. Stroke C. Ear infection D. Brain tumor

Answer A Some Lyme disease cases involve the nervous system, causing paralysis of facial muscles, pain in the ear, and loss of taste due to swelling of the auricular nerve

When your teenage client Shane asks you about what to do for his knee, which is sprained from playing ice hockey, you tell him to use A. heat for 30 minutes every hour for the first 48 hours. B. ice for 20 minutes and then remove for 30 - 45 minutes for the first 48 hours. C. alternately heat for 15 minutes followed by ice for 20 minutes for the first 72 hours. D. ice for 40 minutes followed by heat for 20 minutes for the first 24 hours.

Answer B

Which of the following exercises would you recommend as being the best for your client with osteoporosis? A. Swimming B. Walking C. Chair aerobics D. The client should avoid any exercise that might cause an injury.

Answer B

What are the two most common causes of dementia in older adults? A. Polypharmacy and nutritional disorders B. Alzheimer ' s disease and vascular disorders C. Metabolic disorders and space-occupying lesions D. Infections affecting the brain and polypharmacy

Answer B The two most common causes of dementia in older adults are dementia of the Alzheimer type (Alzheimer ' s disease) and vascular disorders such as hypertension, atherosclerosis, vasculitis, embolic disease, and cardiac disease

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

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

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.

Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Chronic sinusitis Acute bronchitis Bacterial pneumonia Acute exacerbation of chronic bronchitis

Acute bronchitis

A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis?

Acute otitis externa

A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? Otitis media with effusion Acute otitis externa Acute otitis media Chronic otitis externa

Acute otitis externa

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: Acute otitis media (AOM) Otitis media with effusion Mucoid otitis media Serous otitis media

Acute otitis media (AOM)

Of the following choices, the least likely cause of cough is: Asthma Gastroesophageal reflux Acute pharyngitis Allergic rhinitis

Acute pharyngitis

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today's visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet's blood pressure? Increase her Lisinopril to 20mg daily Add a thiazide diuretic to the Lisinopril 5mg daily Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker Discontinue the Lisinopril and start a diuretic

Add a thiazide diuretic to the Lisinopril 5mg daily

Which of the following is not a risk factor for coronary arterial insufficiency? Hyperhomocysteinemia Smoking Genetic factors Alcohol ingestion

Alcohol ingestion

A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? Administering two more doses of albuterol Taking an oral corticosteroid Coming to the clinic for evaluation Going to the emergency department

Administering two more doses of albuterol

An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Increase the dose of the thiazide medication Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment Prescribe a calcium channel blocker

Admit to the hospital for evaluation and treatment

A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient? Administer three more nebulizer treatments and reassess Give epinephrine injections and monitor response Admit to the hospital with specialist consultation Prescribe an oral corticosteroid medication

Admit to the hospital with specialist consultation

Risk factors for acute otitis media (AOM) include all of the following except: Household cigarette smoke Group daycare attendance Sibling history of acute otitis media African-American ethnicity

African-American ethnicity

A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient's eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely? Allergic Bacterial Chemical viral

Allergic

An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient's symptoms? Allergic conjunctivitis Bacterial conjunctivitis Gonococcal conjunctivitis Viral conjunctivitis

Allergic conjunctivitis

Mr. Turner visits your office with complaints of clear, watery nasal discharge; frequent coughing to clear throat; sneezing and itchy eyes for several days. On examination, you detect pale, boggy mucous membranes and conjunctival injection. The remainder of the physical examination is unremarkable. The most likely diagnosis is:

Allergic rhinitis

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 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe? Ibuprofen Erythromycin Amoxicillin Acetaminophen

Amoxicillin

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? A calcium channel blocker A beta blocker An ACE Inhibitor No hypertension medication

An ACE Inhibitor

A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? Avoidance of weight bearing exercises Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until values normal Parathyroidectomy

Annual monitoring of calcium, creatinine, and bone density

Mrs. Moore brings her 3-year-old son to your primary care office for evaluation. She is very upset and reports that, after eating dinner last evening, her son seemed to lose consciousness for a brief period. She states that he was sitting up but that his head drooped and he did not respond to calls from her. She could not recall exactly how long this episode lasted but reports that he returned to normal as the evening progressed and is also acting normally today. You suspect that the child had a(n) A. absence seizure. B. tonic-clonic seizure. C. myoclonic seizure. D. atonic seizure.

Answer A

Sandy, age 9, has seizures with brief, jerking contractions of her arms, legs, and trunk. Which seizure type is this? A. Myoclonic B. Clonic C. Tonic D. Tonic-clonic

Answer A

The system that is affected in about 75% of all clients with systemic lupus erythematosus and has one of the most serious systemic sequelae, leading to significant morbidity and mortality, is the A. renal system. B. cardiovascular system. C. neuromuscular system. D. integumentary system.

Answer A

What is the most common cause of progressive dementia in persons older than 55? A. Alzheimer ' s disease B. Vascular disease C. Huntington ' s disease D. Parkinson ' s disease

Answer A

Which of the following symptoms is typical in fibromyalgia? A. Widespread pain at multiple sites B. Sleeping deeply for greater than 8 hours C. Afternoon fatigue D. Difficulty with fine motor tasks

Answer A

Trevor, age 4, has an apparent hypertrophy of the calf muscles, which seem doughy on palpation. His mother is concerned because Trevor is unable to raise himself from the floor without bracing his knees with his hands. What do you suspect? A. Duchenne muscular dystrophy B. Cerebral palsy C. Legg-Calv é -Perthes disease D. Multiple sclerosis

Answer A Duchenne muscular dystrophy, inherited in a sexlinked recessive pattern, afflicts boys, with the onset usually occurring around ages 3 - 5. The inability of the child to raise himself without supporting his knees because of weakness beginning primarily in the calf muscles, quadriceps, and hip extensor muscles is characteristic.

Pregnant women should know that folic acid can help to prevent neural tube defects. For folic acid to be most effective, women should take it A. before becoming pregnant. B. during the second trimester. C. during the third trimester. D. soon after a positive pregnancy test.

Answer A Folic acid should be taken before getting pregnant and during the first few weeks of pregnancy, often before a woman may even know she is pregnant.

In teaching a client with multiple sclerosis, the provider should emphasize all of the following points except A. taking a daily hot shower to relax. B. exercising to maintain mobility. C. getting plenty of rest. D. seeking psychological and emotional support.

Answer A Hot showers may exacerbate the symptoms of multiple sclerosis. For the same reason, fevers should be controlled

If you suspect that your client abuses alcohol, the most appropriate action would be to A. confront the client. B. obtain further confirmatory information. C. consult with family members. D. suggest Alcoholics Anonymous (AA).

Answer A If you suspect that your client abuses alcohol, the most appropriate action would be to confront the client.

Management of fibromyalgia would include A. giving psychotropic drugs, such as amitriptyline (Elavil), in a low dose at bedtime. B. instructing clients to keep as busy as possible to keep their minds off the symptoms. C. using high doses of NSAIDs. D. avoiding exercise.

Answer A Management of fibromyalgia includes giving tricyclic antidepressants such as amitriptyline (Elavil) in a low dose at bedtime

Which of the following is a major risk factor associated with osteoporosis and fragility fractures? A. Body weight less than 127 lb B. Alcohol intake greater than 2 drinks/day C. Estrogen deficiency occurring before 45 years of age D. Low physical activity

Answer A Many major risk factors are associated with osteoporosis and fragility fractures. The major risk factors are body weight less than 127 lb, personal history of fracture as an adult, history of fracture in a first-degree relative, oral corticosteroid therapy of longer than 3 months, and current smoking

Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? A. Musculoskeletal pain B. Difficulty sleeping C. Depression D. Fatigue

Answer A Musculoskeletal pain is not characteristic of chronic fatigue syndrome; rather, it is characteristic of fibromyalgia.

Obsessive-compulsive disorder symptoms usually occur A. before age 15. B. during midlife crises. C. during late adolescence and early adulthood. D. in later life.

Answer A Obsessive-compulsive disorder symptoms usually occur before age 15. Young people in their early teens with obsessive-compulsive disorder are inflexible, lack spontaneity, are ambivalent, and are in a constant state of conflict while harboring hostile feelings

James, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given a diagnosis of Osgood-Schlatter disease and asks you about his treatment options. You tell him that the initial treatment is A. relative rest; he could benefit from hamstring stretching, heel cord stretching, and quadriceps stretching exercises. B. immobilization; a long-leg knee immobilizer is recommended. C. surgical intervention; removal of the bony fragments is necessary. D. bedrest for 1 week.

Answer A Osgood-Schlatter disease is an overuse injury that results from excessive tension and pull of the patellar tendon on the tibial tuberosity.

Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis A. develops when loss of bone matrix (resorption) occurs more rapidly than new bone growth (deposition). B. is a degenerative joint disease characterized by degeneration and loss of articular cartilage in synovial joints. C. is a chronic, systemic inflammatory disorder characterized by persistent synovitis of multiple joints. D. is a metabolic bone disorder characterized by inadequate mineralization of bone matrix.

Answer A Osteoporosis develops when bone resorption occurs more rapidly than bone deposition. Osteoarthritis is a degenerative joint disease characterized by degeneration and loss of articular cartilage in synovial joints

Which of the following can assist in the diagnosis of myasthenia gravis? A. Repetitive nerve stimulation B. The presence of cogwheel rigidity C. Chvostek ' s sign D. Trousseau ' s sign

Answer A Repetitive nerve stimulation (RNS) is the most frequently used electrodiagnostic test for myasthenia gravis

Which of the following is true regarding scoliosis? A. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. B. Functional scoliosis is fixed; the curvature shows both on standing and bending forward. C. Structural scoliosis is fixed; the curvature shows both on standing and bending forward. D. Functional scoliosis is permanent, whereas structural scoliosis can result from outside influences such as leg length discrepancy or muscle spasms.

Answer A Scoliosis is a curve in the spine. It is prominent beginning between ages 8 and 10 years through adolescence and is more common in females than in males. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending

Diane is the mother of a child diagnosed with autism. After the clinician recommends the seasonal flu vaccine for the family, Diane asks, "Does the flu vaccine contain thimerosal"? The clinician knows that A. the nasal spray does not contain thimerosal. B. multidose vials do not contain thimerosal. C. all flu vaccine vials do not contain thimerosal. D. trace amounts of thimerosal are found in singledose units.

Answer A Seasonal influenza vaccine is produced in large quantities for annual immunization campaigns

Mary, age 82, appears without an appointment. She is complaining of a new, unilateral headache; fever; and muscle aches. She denies any precipitating event. On further examination, you note that her erythrocyte sedimentation rate is over 100 mm/min. What do you suspect? A. Temporal arteritis B. Meningitis C. Subarachnoid hemorrhage D. Intracerebral hemorrhage

Answer A Temporal arteritis, also called giant cell arteritis, presents as a systemic illness with generalized symptoms such as fever, myalgia, arthralgia, anemia, and elevated liver function tests.

Which of the following screening instruments is quick and easy to use and has a high level of diagnostic accuracy to detect alcohol abuse? A. The CAGE questionnaire B. The HEAT instrument C. The DRINK tool D. MMSE

Answer A The CAGE instrument is a widely used questionnaire that has a high degree of accuracy for identifying clients who abuse alcohol. CAGE is an acronym for four questions: the C stands for " Have you ever felt you should c ut down on drinking? " ; the A for " Have people a nnoyed you by criticizing your drinking " ; the G for " Have you felt bad or g uilty about your drinking " ; and the E for " Have you had a drink first thing in the morning (an " e ye opener " ) to steady your nerves or to get rid of a hangover? "

Bone mineral density (BMD) testing is recommended by the National Osteoporosis Foundation for which of the following client populations to assess whether they are at high risk for osteoporosis? A. All women age 65 and older regardless of risk factors B. All men age 65 and older regardless of risk factors C. All women in their 30s for baseline D. All women of menopausal age

Answer A The National Osteoporosis Foundation recommendations indicate that bone mineral density (BMD) testing should be performed on all women age 65 and older regardless of risk factors, on postmenopausal women under age 65 with risk factors, on women of menopausal age with risk factors, and on individuals who present with fractures after age 50 to confirm underlying disease and severity.

Diane, age 35, presents with weakness and numbness of the left arm, diplopia, and some bowel and bladder changes for the past week. She states that the same thing happened last year and lasted for several weeks. What diagnosis is a strong possibility? A. Multiple sclerosis B. Subdural hematoma C. Pituitary tumor D. Myasthenia gravis

Answer A The diagnosis of multiple sclerosis (MS) is often difficult given the large variety of symptoms, but it is a strong possibility in this case. Generally, it occurs in clients ages 20 - 40.

Colchicine may be used to terminate an acute attack of gouty arthritis, as well as to prevent recurrent episodes. The mechanism of action is to A. interrupt the cycle of urate crystal deposition and inflammatory response. B. increase serum uric acid levels. C. potentiate the excretion of uric acid. D. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid.

Answer A The mechanism of action of colchicine is to interrupt the cycle of urate crystal deposition and inflammatory response

Which of the following symptoms related to memory indicates depression rather than delirium or dementia in the older adult? A. Inability to concentrate, with psychomotor agitation or retardation B. Impaired memory, especially of recent events C. Inability to learn new material D. Difficulty with long-term memory

Answer A The prevalence of depression (5% - 10%) does not change with age, but depression is often overlooked in the older adult. The diagnosis requires a depressed mood for 2 straight weeks and at least four of the following eight signs (which can be remembered using the mnemonic SIG E CAPS [like prescribing energy caps]): S for sleep disturbance, I for lack of interest, G for feelings of guilt, E for decreased energy, C for decreased concentration, A for decreased appetite, P for psychomotor agitation or retardation, and S for suicidal ideation.

To diagnose fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender-point sites, which would include A. the occiput, low cervical, trapezius, and supraspinatus. B. the proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints of the hands, and the metatarsophalangeal (MTP) and PIP joints of the foot. C. the facet joints of the cervical, thoracic, and lumbar spine. D. the radial and ulnar styloids and the medial and lateral malleoli.

Answer A To diagnose fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender-point sites, including the occiput, low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and knee

When wrist and finger extension causes pain over the extensor carpi radialis brevis tendon, the extensor carpi radialis longus tendon, and the extensor digitorum communis, you would suspect A. tennis elbow. B. golfer ' s elbow. C. de Quervain ' s disease. D. intersection syndrome.

Answer A With tennis elbow, wrist and finger extension causes pain over the extensor carpi radialis brevis tendon, the extensor carpi radialis longus tendon, and the extensor digitorum communis

A classic symptom of carpal tunnel syndrome is acroparesthesia, which is A. the relief of tingling and numbness of the fingers by shaking or rubbing the hands. B. awaking at night with numbness and burning pain in the fingers. C. wrist pain with repetitive motions. D. pain on percussion of the median nerve.

Answer B

Abnormal bony growths on the distal and proximal interphalangeal joints are associated with A. rheumatoid arthritis. B. osteoarthritis. C. scleroderma. D. Lyme disease.

Answer B

Abnormal bony growths on the proximal interphalangeal joints are referred to as A. Heberden ' s nodes. B. Bouchard ' s nodes. C. subcutaneous nodules. D. tophi.

Answer B

Jennifer, age 36, has systemic lupus erythematosus. She exhibits erythematous raised patches with adherent keratotic scaling and follicular plugging. This is characteristic of A. a malar rash. B. a discoid rash. C. photosensitivity. D. an oral ulcer.

Answer B

Jeremy, age 18, comes in for a visit. His left arm is in a cast, and he tells you that he has a comminuted fracture of his humerus. This means that A. the bone is crushed. B. bony fragments are in many places. C. bone breaks cleanly but does not penetrate the skin. D. broken ends of the bone protrude through the soft tissues and skin.

Answer B

Rose, age 66, comes in with an intractable headache accompanied by weakness, difficulty chewing, and visual changes. You note some swelling and tenderness on her left forehead. What do you suspect? A. A migraine headache B. Temporal arteritis C. A cluster headache D. A cerebral aneurysm

Answer B

Jim, a 45-year-old postal worker, presents for the first time with a sudden onset of intense apprehension, fear, dyspnea, palpitations, and a choking sensation. What is your initial diagnosis? A. Anxiety B. Panic attack C. Depression D. Agoraphobia

Answer B A panic attack is characterized by its episodic nature. It is manifested by the sudden onset of intense apprehension, fear, or terror and the abrupt development of some of the following symptoms: dyspnea, palpitations, chest pain or discomfort, choking or smothering sensations, dizziness, a feeling of being detached, diaphoresis, trembling, and nausea.

You are assessing Mike, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the A. lateral meniscus. B. cruciate ligament. C. medial meniscus. D. collateral ligament.

Answer B A positive anterior or posterior drawer sign indicates an injury to the anterior or posterior cruciate ligaments, respectively. The drawer test, or Lachman test, are both utilized to assess for cruciate ligament injury.

The use of tricyclic antidepressants in the elderly increases the risk of A. suicide. B. cardiac arrhythmias. C. reactive depression. D. shortness of breath.

Answer B A study by the Heart and Lung Institute of the National Institute of Health in the mid-1980s showed that class 1 antiarrhythmic drugs given to patients with ventricular arrhythmias following myocardial infarction, instead of preventing deaths, actually increased the number of patients dying

The use of tricyclic antidepressants in the elderly increases the risk of A. suicide. B. cardiac arrhythmias. C. reactive depression. D. shortness of breath.

Answer B A study by the Heart and Lung Institute of the National Institute of Health in the mid-1980s showed that class 1 antiarrhythmic drugs given to patients with ventricular arrhythmias following myocardial infarction, instead of preventing deaths, actually increased the number of patients dying.

Jim, age 45, has two small children. He states that his wife made him come to this appointment because she thinks he has been impossible to live with lately. He admits to being stressed and depressed because he is working two jobs, and he says he sometimes takes his stress out on his family. About twice a week he complains of palpitations along with nervous energy. What is the most important question to ask him at this time? A. " How is your wife handling stress? " B. " Have you thought about committing suicide? " C. " Do you and your wife spend time alone together? " D. " Tell me more about what you think is causing this. "

Answer B Although all the questions are important, suicidal ideation is an emergency situation, and if it is present, the client needs immediate admission, preferably to a psychiatric hospital

Black men have a relatively low incidence of osteoporosis because they have A. increased bone resorption. B. a higher bone mass. C. wide and thick long bones. D. decreased bone deposition.

Answer B Black men have a relatively low incidence of osteoporosis because they have higher levels of bone mass and are protected by the bone-resorptive effects of parathyroid hormone

You assess for cogwheel rigidity in Sophia, age 76. What is cogwheel rigidity a manifestation of? A. Alzheimer ' s disease B. Parkinson ' s disease C. Brain attack D. Degenerative joint disease

Answer B Clients with Parkinson ' s disease may exhibit " cogwheel rigidity, " a condition in which there is an increased resistance in muscle tone when the nurse practitioner moves the client ' s neck, trunk, or limbs. The muscle is stiff and difficult to move.

Deficiency of which nutritional source usually presents with an insidious onset of paresthesias of the hands and feet that are usually painful? A. Thiamine B. Vitamin B 12 C. Folic acid D. Vitamin K

Answer B Deficiency of vitamin B 12 usually presents with an insidious onset of paresthesias of the hands and feet that are usually painful

Which of the following conditions is most responsible for developmental delays in children? A. Cerebral palsy B. Fetal alcohol syndrome C. Down syndrome D. Meningomyelocele

Answer B Fetal alcohol syndrome is most often responsible for developmental delays in children. In descending order, the others are cerebral palsy, Down syndrome, and meningomyelocele.

In an infant, when you flex the hips and knees at a 90° angle and attempt to slip the femur heads onto the posterior tips of the acetabulums by lateral pressure of the thumbs and by rocking the knees medially with the knuckles of the index fingers, you are testing for normal hip movement. This test or maneuver is known as A. Ortolani's maneuver. B. Barlow's test. C. Spock's test. D. Moro maneuver.

Answer B Flexing the hips and knees at a 90° angle in an infant and attempting to slip the femur heads onto the posterior tip of the acetabulums by lateral pressure of the thumbs and by rocking the knees medially with the knuckles of the index fingers is known as Barlow's test.

How can you differentiate between a ganglion cyst and a neoplasm? A. A neoplasm is more painful. B. Ganglia transilluminate. C. Ganglia cause more swelling. D. A neoplasm may fluctuate in size.

Answer B Ganglia can be distinguished from neoplasms by their ability to transilluminate. Large ganglia and neoplasms may both restrict joint motion

Ginny, age 48, has rheumatoid arthritis and gets achy and stiff after sitting through a long movie. This is referred to as A. longevity stiffness. B. gelling. C. intermittent arthritis. D. molding.

Answer B Gelling refers to the achiness and stiffness that occur in clients with rheumatoid arthritis after a period of inactivity

Cass, age 67, tells you that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis but she knows that it is caused by urate crystals that " get stuck in the joint and cause pain. " Joan is on hydrochlorothiazide (HCTZ) for management of her hypertension. You suspect a diagnosis of A. septic arthritis. B. gout. C. rheumatoid arthritis. D. Charcot neuro-osteoarthropathy.

Answer B Gout is a disorder that involves abnormal metabolism of uric acid and results in hyperuricemia

Jessie, age 49, states that she thinks she has rheumatoid arthritis. Before any diagnostic tests are ordered, you complete a physical examination and make a tentative diagnosis of osteoarthritis rather than rheumatoid arthritis. Which clinical manifestation ruled out rheumatoid arthritis? A. Fatigue B. Affected joints are swollen, cool, and bony hard on palpation C. Decreased range of motion D. Stiffness

Answer B In osteoarthritis, the affected joints are swollen, cool, and bony hard on palpation. With rheumatoid arthritis, the affected joints appear red, hot, and swollen and are boggy and tender on palpation

Marian, age 39, has multiple sclerosis (MS). She tells you that she heard that the majority of people with MS have the chronic-relapsing type of disease and that she has nothing to live for. How do you respond? A. " The majority of people have this response to MS." B. " There are many different clinical courses of MS, and the chronic-relapsing type is only one of them. " C. " The chronic-relapsing type of MS is in the minority. " D. " There is an even chance that you have this type."

Answer B It is expected that Marian might be depressed because of her multiple sclerosis (MS). Focusing more on what she has " going for her " rather than the type of MS she has should be the first response

You are caring for a patient that has a history of psoriasis and now is showing signs of musculoskeletal signs and symptoms with joint involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PsA). Your initial treatment choice for management of the patient is A. disease-modifying antirheumatic drugs (DMARDs). B. NSAIDs. C. tumor necrosis factor - alpha inhibitors (TNF- α inhibitors). D. uricosuric.

Answer B NSAIDs are the first-line treatment for musculoskeletal signs and symptoms with joint involvement. DMARDs such as methotrexate are used for early-stage treatment of active disease with structural damage and inflammation

You have just completed a work-up on Michael, age 13, and confirmed Osgood-Schlatter disease. You should A. refer to orthopedics for early surgical correction. B. recommend physical therapy for quadricepsstrengthening exercises. C. advise him to temporarily discontinue all sports activities until his growth plates have completely fused. D. tell Michael that he can resume his usual activities immediately without concern and should begin aggressive exercises to increase muscle bulk and strength.

Answer B Osgood-Schlatter is usually a benign, self-limited knee condition in adolescent boys and girls. Treatment consists of ice, analgesics, NSAIDs, and temporary avoidance of pain-producing activities

Some providers have successfully induced remission in clients with multiple sclerosis by using adrenocorticotropic hormone therapy or other pharmacological therapy along with A. chelation therapy. B. plasmapheresis. C. bone marrow transplantation. D. intravenous lipids.

Answer B Plasmapheresis, or plasma exchange, when used with adrenocorticotropic hormone therapy or other pharmacological therapy, has successfully induced remission in some clients with multiple sclerosis

Anna, age 42, is pregnant and was just given a diagnosis of carpal tunnel syndrome. She is worried that this will affect her in caring for the baby. What do you tell her? A. " Don ' t worry, we ' ll find a brace that is very malleable. " B. " After childbirth, your carpal tunnel syndrome may resolve. " C. " If we do surgery now, you ' ll be recovered by the time the baby arrives. " D. " You should prepare yourself for the probability of being unable to care for your baby. "

Answer B Pregnant women have an increased incidence of carpal tunnel syndrome (CTS) but often have their carpal tunnel syndrome resolve after delivery.

Grace, age 82, has Alzheimer ' s disease. Her daughter states that she is agitated, has time disorientation, and wanders during the afternoon and evening hours. How do you describe this behavior? A. Alzheimer ' s dementia B. Sundowning C. Deficits of the Alzheimer ' s type D. Senile dementia

Answer B Sundowning is a common behavioral change in clients with Alzheimer ' s disease. It is characterized by increased agitation, time disorientation, and wandering behaviors during the afternoon and evening hours.

Carol, age 62, has swollen, bony proximal interphalangeal joints. You describe these as A. Heberden ' s nodes. B. Bouchard ' s nodes. C. Osler ' s nodes. D. Murphy ' s nodes.

Answer B Swollen, bony proximal interphalangeal joints are Bouchard ' s nodes. Bony enlargements of the distal interphalangeal joints are Heberden ' s nodes

The most widely accepted screening tool for psoriatic arthritis (PsA) is the A. ACR (American College of Rheumatology) Criteria B. CASPAR (Classification of Psoriatic Arthritis) Criteria C. Psoriasis Area and Severity Index D. Rome Criteria

Answer B The CASPAR Criteria is the most widely accepted tool and has a 91.4% sensitivity and 98.7% specificity rate. It assigns points from five categories: current psoriasis, personal history of psoriasis, family history of psoriasis; typical psoriatic nail dystrophy; negative rheumatoid factor; current dactylitis or history of dactylitis; and radiographic evidence of juxta-articular new bone formation.

The CAGE screening test for alcoholism is suggestive of the disease if two of the responses are positive. What does the E in CAGE stand for? A. Every day B. Eye opener C. Energy D. Ego

Answer B The E stands for eye opener, or the need for a drink early in the day

Jim, age 64, has rheumatoid arthritis (RA). Which of the following drugs would be of the least benefit? A. Disease-modifying antirheumatic drugs (DMARDs) B. Acetaminophen (Tylenol) C. NSAIDs D. Glucocorticoids

Answer B The client with rheumatoid arthritis (RA) benefits from DMARDs, NSAIDs, and steroids because they all treat the disease of RA as well as the pain.

Sally, age 52, presents with a rapidly progressive weakness of her legs that is moving up the trunk. She also has absent reflexes and no sensory change. What do you suspect? A. Peripheral neuropathy B. Guillain-Barr é syndrome C. Myasthenia gravis D. Radiculopathy

Answer B The diagnosis of Guillain-Barr é syndrome is confirmed by a rapidly progressive weakness, usually in an ascending pattern from the legs up to the trunk and then to the arms and face.

Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? A. " Caffeine has no effect on osteoporosis. " B. " A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly. " C. " Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix. " D. " Caffeine increases bone resorption. "

Answer B The effect of caffeine in causing osteoporosis is controversial, but it is postulated to result from caffeine ' s diuretic effect that causes calcium to be excreted more rapidly

What is the main overall goal of therapy for the client with Parkinson ' s disease? A. To halt the progression of the disease B. To keep the client functioning independently as long as possible C. To control the symptoms of the disease D. To ease the depression associated with the disease

Answer B The main overall goal of therapy for the client with Parkinson ' s disease is to keep the client functioning independently as long as possible

When teaching Alice, age 67, to use a cane because of osteoarthritis of her left knee, an important point to stress is to tell her to A. carry the cane in the ipsilateral hand. B. advance the cane with the ipsilateral leg. C. make sure that the cane length equals the height of the iliac crest. D. use the cane to aid in joint protection and safety.

Answer B When teaching clients about using a cane, tell them to advance the cane with the ipsilateral (affected) leg. The cane should be carried in the contralateral hand and the cane length should equal the height of the greater trochanter

You suspect adolescent idiopathic scoliosis in Victoria, age 15, who is in her growth spurt. You perform the Adams forward-bending test and note a right-sided rib hump. What is this indicative of? A. Right lumbar shifting B. Right thoracic curvature C. Right truncal shift D. Spondylolysis

Answer B When you have a client bend forward to assess the spine (the Adams forward-bending test) and you note a right-sided rib hump, this is indicative of a right thoracic curve

Delirium in the older adult typically presents with which of the following behaviors? A. Agitation and wandering behavior B. Acute change in mental status and apathy, lack of response to stimuli C. Agitation and restlessness D. Absence of purpose and apathy

Answer C

John, age 18, has a seizure disorder. He has been taking a combination of phenytoin (Dilantin) and phenobarbital (Luminal) to treat his seizures. He reports a new rash. You know that A. the phenobarbital should be discontinued. B. the phenytoin should be discontinued. C. either of these drugs could cause a rash. D. you must begin John on an entirely new drug regimen.

Answer C

Maura, age 36, has just been given a diagnosis of Bell ' s palsy and asks you about her chances for a complete recovery. How do you respond? A. " Don ' t worry; I ' m sure you ' ll have a complete recovery. " B. " You have about a 50-50 chance of complete recovery; otherwise, you may have some minor problems. " C. " About 80% of clients have a complete recovery within 2 months. " D. " Although you won ' t recover completely, the residual effects are minor. "

Answer C

Mavis, age 76, comes to the office with a unilateral throbbing headache in the periorbital region. She states that the pain has been gradually increasing over the past several hours and when she went out into the cold weather, the pain was extremely bad. What do you suspect? A. Trigeminal neuralgia B. A migraine C. Giant-cell arteritis D. A transient ischemic attack

Answer C

You suspect that Marcia has an eating disorder because she is 5 ft 6 in. tall, weighs 110 lbs, and seems disgusted with herself when you weigh her. During your examination, you suspect bulimia rather than anorexia because of her A. sensitivity to cold. B. hair loss. C. swollen salivary glands. D. statement regarding irregular menstruation.

Answer C

A Baker ' s cyst is A. an inflammation of the bursa. B. a form of tendinitis. C. the buildup of synovial fluid behind the knee. D. the result of a " swollen " ligament.

Answer C A Baker ' s cyst, also called popliteal cyst, is the buildup of synovial fluid behind the knee. It usually results from inflammation resulting from knee arthritis or a cartilage (especially meniscal) tear and consists of local pain, inability to extend the knee, and symptoms related to compression of surrounding structures

Mark, age 29, tells you that he has thought about suicide. Which should you say next? A. " How long have you felt this way? " B. " Tell me more about it. " C. " Do you have a plan? " D. " Have you told anyone else? "

Answer C A client ' s intent or commitment to the act of suicide by means of a plan suggests a high risk of actually committing the act

A thymectomy is usually recommended in the early treatment of which disease? A. Parkinson ' s disease B. Multiple sclerosis C. Myasthenia gravis D. Huntington ' s chorea

Answer C A thymectomy is performed in approximately 75% of clients with myasthenia gravis because of dysplasia of the thymus gland

Shana shares concerns about her unborn child. She states, "My sister's child is diagnosed with autism." The clinician knows the following to be true about autism spectrum disorder (ASD): A. There is no genetic predisposition to autism. B. Females are four times more likely to have an ASD than males. C. About 20%-30% of children with an ASD develop epilepsy by the time they reach adulthood. D. Mental retardation occurs in all cases.

Answer C About 20%-30% of children with an autism spectrum disorder (ASD) develop epilepsy by the time they reach adulthood. Males are four times more likely to have ASD than females

Jenna has been diagnosed with a generalized anxiety disorder (GAD). You know that she may experience which of the following? A. She may be worried or anxious about having a panic attack. B. She may be worried about being separated or about being away from home or close relatives. C. She may have been excessively anxious and worried on most days for more than 6 months. D. She may have multiple physical complaints or believe she has a physical illness.

Answer C According to DSM-IV, the diagnostic manual from the American Psychiatric Association (APA), generalized anxiety disorder (GAD) is present if excessive anxiety and worry (apprehensive expectation) occurs more days than not for 6 months about a number of events or activities such as work or school performance, if the client finds it difficult to control the worry, and if three or more of the following six symptoms are present: restlessness, fatigability, difficulty in concentration, irritability, muscle tension, and sleep disturbances.

Mrs. Matthews has rheumatoid arthritis. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? A. Antigen-antibody formation B. Lymphocyte response C. Immune complex formation D. Lysosomal degradation

Answer D Lysosomal degradation results when leukocytes produce lysosomal enzymes that destroy articular cartilage in rheumatoid arthritis

Karen, who is postmenopausal, is taking 1,500 mg of calcium but does not understand why she also needs to take vitamin D. You tell her that A. a deficiency of vitamin D results in an inadequate mineralization of bone matrix. B. all vitamins need to be supplemented. C. vitamin D increases intestinal absorption of dietary calcium and mobilizes calcium from the bone. D. vitamin D binds with calcium to allow active transport into the cells.

Answer C Advise clients taking calcium supplements that they also need to take vitamin D because vitamin D raises serum calcium levels by increasing the intestinal absorption of dietary calcium and mobilizing calcium from the bone.

Bob, age 49, is complaining of recurrent, intrusive dreams since returning from his Marine combat training. You suspect A. depersonalization. B. schizophrenia. C. post-traumatic stress disorder. D. anxiety.

Answer C Although Bob is experiencing anxiety with his unpleasant dreams, they are a component of post-traumatic stress disorder (PTSD).

What is the first symptom seen in the majority of clients with Parkinson ' s disease? A. Rigidity B. Bradykinesia C. Rest tremor D. Flexed posture

Answer C Although rigidity, bradykinesia, and flexed posture are associated with Parkinson ' s disease, rest tremor is usually the first symptom seen

Anorexia nervosa is a steady, intentional loss of weight with maintenance of that weight at an extremely unhealthy low level. Which statement is true regarding anorexia nervosa? A. The poor eating habits result in diarrhea. B. It may cause tachycardia. C. It may occur from prepubescence into the early 30s. D. It may cause excessive bleeding during menses.

Answer C Anorexia nervosa may occur from prepubescence into the early 30s and occurs most commonly from early to late adolescence

A 68-year-old woman presents to your office for screening for osteoporosis. Sandy states that her grandmother and mother both lost inches in their old age. Sandy has been postmenopausal for the past 15 years and never took any hormone replacement medications. She is Caucasian, weighs 108 lb, and is 5 ft 1 in. tall on today's measurement. When do women lose the greatest amount of bone density? A. During adolescence B. The first year of menopause C. The first 10 years after menopause D. Bone loss occurs continuously at the same rate from menopause to death.

Answer C Bone loss begins at a rate of 0.5% a year in a woman's middle to late 40s. When menopause occurs, the rate increases up to 7% a year for the first decade after menopause

Which of the following drugs used for parkinsonism mimics dopamine? A. Anticholinergics B. Levodopa (l-dopa) C. Bromocriptine D. Tolcapone

Answer C Bromocriptine and pergolide mimic dopamine. The other mechanisms of antiparkinsonian treatments are as follows: anticholinergics restore acetylcholine-dopamine balance; levodopa restores striatal dopamine; and tolcapone and entacapone reduce systemic degradation of oral dopamine

Which statement is accurate regarding a client who is at highest risk for an eating disorder? A. The client is male B. The client is usually 25 - 35 years of age C. The client has low self-esteem D. The client has a bipolar personality

Answer C Clients with eating disorders tend to have low selfesteem. Other factors that appear to increase the risk for an eating disorder include female gender, young age, perfectionist personality, family history of eating disorders, attempts to diet, depression, and living in cultures in which thinness is a standard of beauty.

Which of the following criteria is not diagnostic for a child with attention deficithyperactivity disorder (ADHD)? A. The child frequently blurts out the answer to a question before the question is finished. B. The child has difficulty following directions. C. The child talks very little but is very restless. D. The child often engages in physically dangerous activities.

Answer C Diagnostic criteria for the child with ADHD include frequently blurting out answers before a question is finished, difficulty following directions, engaging in physically dangerous activities (often without thinking of the consequences of actions), tending to talk excessively, and often interrupting others.

Jan's mother has Alzheimer's disease. She tells you that her mother's recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, "Is this as bad as it gets?" You tell her that her mother is in which stage of the disease? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

Answer C Families of persons with Alzheimer's disease (AD) need to know that AD is a progressive disorder of the brain affecting memory, thought, and language.

Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to A. refer her to a hand surgeon. B. take a more complete history. C. try neutral position wrist splinting and order an oral NSAID. D. order a nerve conduction study such as an electromyography (EMG).

Answer C For the client who has just been given a diagnosis of carpal tunnel syndrome, your next step is to try neutral position wrist splinting and order an oral NSAID

Marta asks you how pregnancy will affect her rheumatoid arthritis. You respond, A. "There is a one-third rule: One-third get better, onethird remain the same, and one-third get worse." B. "Pregnancy will have no effect on your rheumatoid arthritis." C. "Seventy-five percent of women experience remission of the disease during pregnancy." D. "It is advised that you don't get pregnant with this condition."

Answer C For women with rheumatoid arthritis, 75% will experience remission of their disease during pregnancy.

Which peripheral nervous system disorder usually follows a viral respiratory or gastrointestinal infection? A. Cytomegalovirus B. Herpes zoster C. Guillain-Barr é syndrome D. Trigeminal neuralgia

Answer C Guillain-Barr é syndrome (GBS) is an acute demyelinating disorder. It is a peripheral nervous system disorder that usually follows a viral respiratory or gastrointestinal infection

Which of the following objective data are associated with significantly better long-term outcomes in children born with open spina bifida? A. A higher APGAR score B. Presence of Babinski ' s reflex C. Perineal sensation D. A higher score on the Glasgow Coma Scale

Answer C In infants with open spina bifida, the presence of perineal sensation is associated with significantly better long-term outcomes

In the depressed client, antidepressants are most effective in alleviating A. suicidal feelings. B. interpersonal problems. C. sleep disturbances. D. anxiety disorders.

Answer C In the depressed client, antidepressants are most effective in alleviating sleep and appetite disturbances. Psychotherapy is most effective in dealing with suicidal feelings and interpersonal problems.

Current pharmacological therapy for relapsing-remitting multiple sclerosis involves A. high-dose steroids. B. baclofen (Lioresal) or diazepam (Valium). C. interferon B (Betaseron). D. benzodiazepines.

Answer C Interferon B (Betaseron) is used for the treatment of multiple sclerosis because it decreases the frequency of exacerbations in clients with the relapsing-remitting type of multiple sclerosis. Before the early 1990s, highdose steroids were used for acute exacerbations, and baclofen (Lioresal) or diazepam (Valium) was used for excessive spasticity and spasms. Benzodiazepines are ordered in a small dosage for anxiety.

Mary, age 72, has severe osteoarthritis of her right knee. She obtains much relief from corticosteroid injections. When she asks you how often she can have them, how do you respond? A. Only once a year in the same joint B. No more than twice a year in the same joint C. No more than three to four times a year in the same joint D. No more than five to six times a year in the same joint

Answer C Intra-articular corticosteroid injections provide much needed pain relief in weight-bearing joints of clients with osteoarthritis; however, they should be limited to no more than three to four in the same joint per year because of potential damage to the cartilage if given more frequently

Which of the following is a modifiable risk factor for osteoporosis? A. Low alcohol intake B. Low caffeine intake C. Smoking D. Excessive exercise

Answer C Modifiable risk factors for osteoporosis include smoking, high caffeine intake, high alcohol intake, sedentary lifestyle, calcium deficiency, and estrogen deficiency

Which of the following antiepileptic drugs are associated with spina bifida? A. Dilantin B. Lamictal C. Depakote D. Keppra

Answer C Mothers who have taken Depakote during pregnancy have given birth to babies with spina bifida. Safer medications during pregnancy include Keppra and Lamictal, but they are still considered pregnancy-risk category C.

What disorder affects older individuals, particularly women, and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, weight loss, sweats, and low-grade fever? A. Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica D. Reiter ' s syndrome

Answer C Myalgias in the cervical spine and shoulder and hip girdle with polymyalgia rheumatica (PMR) can be profound and are commonly accompanied by systemic symptoms. Arthralgias may also occur which are similar to those found in patients with rheumatoid arthritis. Fibromyalgia also occurs more commonly in women but is associated with a more chronic widespread musculoskeletal pain and trigger points.

Which of the following tests is highly specific and fairly sensitive for myasthenia gravis? A. Electromyography nerve conduction tests B. Magnetic resonance imaging scan of the brain and brainstem C. Serum acetylcholine receptor antibody level D. Lumbar puncture

Answer C Of clients with generalized myasthenia gravis, 80% - 90% have antibodies to acetylcholine receptors

When you elicit a painful Finkelstein ' s sign, you are testing for A. carpal tunnel syndrome. B. bursitis of the shoulder. C. de Quervain ' s tenosynovitis. D. tennis elbow.

Answer C Pain elicited when the Finkelstein ' s test is performed indicates de Quervain ' s tenosynovitis at the base of the thumb.

Postmenopausal women who are not on hormone replacement therapy need how much calcium per day to help prevent osteoporosis? A. 1,000 mg B. 1,200 mg C. 1,500 mg D. 1,800 mg

Answer C Postmenopausal women who are not taking hormone replacement therapy need 1,500 mg of calcium a day to help prevent osteoporosis. Because treatment for osteoporosis is limited, prevention is necessary to reduce the occurrence

Anne Marie states that she has a maternal history of rheumatoid disease but that she has never been affected. Today she presents with complaints of dryness of the eyes and mouth. What do you suspect? A. Rheumatoid arthritis B. Systemic lupus erythematosus C. Sj ö gren ' s syndrome D. Rosacea

Answer C Sj ö gren ' s syndrome, which affects the salivary and lacrimal glands, causes clients to have dry eyes and mouths. It is an inflammatory disease of the exocrine glands and may be an isolated entity or may be associated with other rheumatic disease, such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).

A 13-year-old obese (BMI greater than 95%) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent " horseplay " with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and knee flexion causing external hip rotation. Based on the above scenario, you suspect A. left meniscal tear. B. left anterior cruciate ligament (ACL) tear. C. slipped capital femoral epiphysis (SCFE). D. Osgood-Schlatter disease.

Answer C Slipped capital femoral epiphysis (SCFE) is a displacement of the femoral head relative to the femoral neck that occurs through the physis (growth plate) of the femur

Karen Ann, age 52, has four children and a very stressful job. After you perform her physical, which was normal, she tells you she has insomnia. You make several suggestions for lifestyle changes that might assist in promoting helpful sleep. You know she misunderstands when she states which of the following? A. " I ' ll wind down before bedtime by taking a warm bath or by reading for 10 minutes. " B. " I ' ll try some valerian extract from the health food store. " C. " I ' ll exercise in the evening to tire myself out before bed. " D. " I won ' t read or watch television while in bed. "

Answer C Suggestions for making lifestyle changes that might assist a client in promoting helpful sleep include advising the client to wind down before bedtime by taking a warm bath or by reading for 10 minutes, to try some valerian extract (obtainable from a health food store), and not to read or watch television while in bed.

Which statement about gender disparities and suicide is true? A. Women take their own lives more often than men. B. Men attempt suicide more often than women. C. Suicide rates for males are highest among those aged 75 and older. D. Poisoning is the most common method of suicide for both sexes.

Answer C Suicide rates for males are highest among those aged 75 and older. Suicide rates for females are highest among those aged 45-54

Shelley, age 47, is complaining of red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is A. Eye discomfort B. Slow progression C. A ciliary flush D. No change in or slightly blurred vision

C. A ciliary flush

Alexander, age 18, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What do you tell him? A. " Use continuous heat for the first 12 hours, then use heat or cold to your own preference. " B. " Use continuous cold for the first 12 hours, then use heat or cold to your own preference. " C. " Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. " D. " Alternate between cold and heat for 20 minutes each for the first 24 - 48 hours. "

Answer C Tell a client who has sprained his ankle to apply cold for 20 minutes, then take it off for 30 - 45 minutes, and repeat that procedure for the first 24 - 48 hours while awake

Which appropriate test for the initial assessment of Alzheimer ' s disease provides performance ratings on 10 complex, higher-order activities? A. MMSE B. CAGE questionnaire C. FAQ D. Holmes and Rahe Social Readjustment Scale

Answer C The FAQ (Functional Activities Questionnaire) is a measure of functional activities. There are 10 complex, higher-order activities that are appropriate for the initial assessment of Alzheimer ' s disease

Which individuals does the U.S. Preventive Services Task Force (USPSTF) recommend screening for depression? A. Adults who are experiencing gender issues B. Adults who have already tried unsuccessfully to commit suicide C. All adults D. If a provider suspects depression, the individual should be referred to a specialist rather than screening in the primary care office

Answer C The USPSTF recommends screening all adults for depression in practices that have systems in place to assure accurate diagnosis, effective treatment, and adequate follow-up

Mr. McKinsey was recently given a diagnosis of degenerative joint disease. Which assessment test would you use to check for effusion on his knee? A. Thomas test B. Tinel ' s sign C. Bulge test D. Phalen ' s test

Answer C The bulge test assesses for an effusion of the knee. If effusion is present, a bulge will appear to the sides of or below the patella when the practitioner compresses the area above the patella. The Thomas test is used to assess for hip problems. Both Tinel ' s sign and Phalen ' s test assess for carpal tunnel syndrome

June, age 79, comes to your office with a recent onset of depression. She is taking several medications. Which medication is safe for her to take because depression is not one of the side effects? A. Antiparkinsonian agents B. Hormones C. Cholesterol-lowering agents D. Antihypertensive agents

Answer C The diagnosis of depression in an older adult is especially difficult when a medical illness is present

What is the medication of choice for obsessive-compulsive disorders? A. Alprazolam (Xanax) B. Carbamazepine (Tegretol) C. Clomipramine (Anafranil) D. Buspirone (Buspar)

Answer C The medication of choice for obsessive-compulsive disorders is clomipramine (Anafranil), a tricyclic antidepressant. It seems to have a much better effect than alprazolam (Xanax), an antianxiety agent; carbamazepine (Tegretol), an anticonvulsant; or buspirone (Buspar), a nonbenzodiazepine anxiolytic.

Herbert, age 58, has just been diagnosed with Bell ' s palsy. He is understandably upset and has questions about the prognosis. Your response should be A. " Although most of the symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard or mustache. " B. " Unfortunately, there is no cure, but you have a mild case. " C. " The condition is self-limiting, and most likely complete recovery will occur. " D. " With suppressive drug therapy, you can minimize the symptoms. "

Answer C The peripheral facial palsy of Bell ' s palsy is selflimiting, and complete recovery usually occurs in several weeks or months in the majority of cases

Which type of urinary incontinence results from Parkinson ' s disease and multiple sclerosis? A. Overflow incontinence B. Stress incontinence C. Urge incontinence D. Functional incontinence

Answer C There are five types of urinary incontinence: overflow, stress, urge, and functional, which are considered established causes of incontinence, and transient or potentially reversible causes of urinary incontinence

Lynne, age 72, presents for the first time with her daughter. Her daughter describes some recent disturbing facts about her mother. How can you differentiate between depression and dementia? A. You might be able to pinpoint the onset of dementia, but the onset of depression is difficult to identify. B. A depressed person has wide mood swings, whereas a person with dementia demonstrates apathetic behavior. C. The person with dementia tries to hide problems concerning his or her memory, whereas the person with depression complains about memory. D. The person with dementia has a poor self-image, whereas the person with depression does not have a change in self-image.

Answer C To help differentiate between depression and dementia, keep in mind that the person with dementia tries to hide problems concerning memory, whereas the person with depression complains about memory and discusses the fact that there is a problem with memory

Ben, age 72, is complaining of insomnia and asks your advice. You recommend that he A. take alprazolam (Xanax) at bedtime. B. go for a walk before bedtime. C. eat a large meal before bedtime for relaxation. D. refrain from napping during the day.

Answer D

Delirium is often acute and reversible. Reversible causes of delirium include A. depression, deafness, and use of nitrates. B. psychosis, vitamin B 12 deficiency, and migraine headache. C. sepsis, syphilis, and use of warfarin (Coumadin). D. subdural hematoma, depression, and use of anticholinergics.

Answer D

Joan, age 24, has chronic fatigue syndrome. She is so frustrated with her family and friends thinking that it is all in her head that she tells you that she has actually thought about suicide. Knowing which of the following would be most helpful in assessing Joan ' s suicidal risk? A. If there is a history of suicide in the family B. If Joan lives alone C. If Joan uses any alcohol or recreational drugs D. If Joan has developed a plan for the suicide

Answer D

When diagnosing seizures in a child, despite an appropriate work-up, the etiology remains undetermined 50% of the time. Differential diagnoses for seizure disorders in a child include which of the following? A. Autism B. Benign paroxysmal vertigo C. Drug reaction D. Labyrinthitis

Answer D

Which of the following conditions includes weakness, muscle atrophy, muscle fasciculations, mixed hyper- and hyporeflexia, and spares the ocular muscles? A. Parkinson ' s B. Alzheimer ' s C. Multiple sclerosis D. Amyotrophic lateral sclerosis

Answer D

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

Answer D A biopsy of the temporal artery is usually required to confirm the diagnosis of temporal arteritis.

The persistent and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the dreaded object, activity, or situation is defined as A. depression. B. obsession-compulsion. C. agoraphobia. D. phobia.

Answer D A phobia is the persistent and irrational fear of a specific object, activity, or situation that results in the compelling desire to avoid the dreaded object, activity, or situation

Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? A. Order physical therapy. B. Order a lumbar/sacral x-ray. C. Order extensive lab work. D. Refer to a neurosurgeon.

Answer D A prompt referral to a neurosurgeon is required when a diagnosis of cauda equina syndrome is suspected

Which medication should be avoided in clients with Alzheimer ' s disease who have concurrent vascular dementia or vascular risk factors? A. Acetycholinesterase inhibitors like donepezil (Aricept) B. N -methyl-d-aspartate (NMDA) receptor antagonists C. Anxiolytics like bupirone (Buspar) D. Atypical antipsychotics like risperidone (Risperdal)

Answer D Atypical antipsychotics such as risperidone should be avoided in clients with Alzheimer ' s disease who also have vascular risk factors because they may increase the risk of stroke

Marie, age 17, was raped when she was 13. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis? A. Depression B. Panic disorder C. Anxiety D. Post-traumatic stress disorder

Answer D Clients with post-traumatic stress disorder (PTSD) have experienced some severe catastrophic event (in this case, rape) and reexperience the event by having recurrent, often intrusive images of the trauma and recurrent dreams or nightmares of the event.

Dan, age 82, recently lost his wife to breast cancer. He presents with weight loss, fatigue, and difficulty sleeping. What should your first response be? A. " Do you have a history of thyroid problems in your family? " B. " Do you think a sleeping pill might help you sleep at night? " C. " Things might look up if you added nutritional supplements to your diet. " D. " Have you thought of suicide? "

Answer D Direct confrontation should be used when suspecting depression and the possibility of suicide. Fatigue, loss of weight, and insomnia, in combination with the client ' s history of the death of his spouse, should point in the direction of depression with a suicidal potential.

Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily? A. Drink all the soda you like—it has no effect on your bone density. B. It has not been proved that smoking affects bone loss. C. Replace estrogen when you reach menopause. D. Perform aerobic exercise at least three times a week.

Answer D Emily is only 26 years old and has not reached her peak bone mass yet. It has been proven that aerobic exercise increases bone mass. Smoking and soda drinking both have been shown to decrease bone mass.

One of the major criteria for diagnosing chronic fatigue syndrome is A. generalized headaches. B. unexplained, generalized muscle weakness. C. sleep disturbance. D. fatigue for more than 6 months.

Answer D Fatigue for more than 6 months and absence of other clinical conditions that may explain such fatigue are the two major criteria the client must demonstrate to be diagnosed with chronic fatigue syndrome

Which of the following is characteristic of a manic episode? A. Weight loss or gain B. Insomnia or hypersomnia C. Diminished ability to think or concentrate D. Grandiose delusions

Answer D Grandiose delusions are exaggerated beliefs of one ' s importance or identity, one of the criteria for a manic episode

Emily, age 21, presents today with another muscle strain from one of her many sports activities. You think that she was probably never taught about health promotion and maintenance regarding physical activity. What information do you include in your teaching? A. " After an activity, if any part hurts, apply ice for 20 minutes. " B. " You must first get in shape with a rigorous schedule of weight training and then you can participate in any activity once you are physically fit. " C. " After any strenuous activity, you must completely rest your muscles before beginning your next activity. " D. " Stretching and warm-up exercises are an important part of any exercise routine. "

Answer D Health promotion and maintenance information regarding physical activity that should be included in client teaching includes reminding the client that stretching and warm-up exercises are an important part of any exercise routine

Julie, age 15, is 5 ft tall and weighs 85 lb. You suspect anorexia and know that the best initial approach is to A. discuss proper nutrition. B. tell Julie what she should weigh for her height and suggest a balanced diet. C. speak to her parents before going any further. D. confront Julie with the fact that you suspect an eating disorder.

Answer D If you suspect anorexia, the best initial approach is to confront Julie with the fact that you suspect an eating disorder

In assessing an infant for developmental dysplasia of the hip (DDH), the practitioner places the infant supine, flexes the knees by holding the thumbs on the inner midthighs, with fingers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test. B. Lasègue ' s sign. C. the McMurray test. D. Ortolani maneuver.

Answer D In performing Ortolani ' s maneuver to assess for developmental dysplasia of the hip (formerly referred to as congenital hip dislocation), the practitioner places the infant supine, flexes the knees, places thumbs on the medial proximal thighs and fingers on the greater trochanters, and stabilizes one thigh while the other thigh is gently abducted

Which method can be safely used to remove cerumen in a 12 month old child's ear? A. A size 2 ear curette B. Irrigation using hot water from a 3cc syringe C. A commercial jet tooth cleaner D. Cerumen should not be removed from a child this young

C. A commercial jet tooth cleaner - Only if no suspicion of perforated tympanic membrane

Joan, age 76, has been give a diagnoses of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. You have educated her about the importance of increasing calcium and vitamin D in her diet and starting a low impact weight bearing exercise program. You are also going to start her on medial management. Joan asks you about a drug called a " SERM " that she has heard has been shown in studies to prevent vertebral factures. Which of the following pharmacological therapies for osteoporosis is classified as a selective estrogen receptor modulator (SERM)? A. Alendronate B. Risedronate C. Salmon calcitonin D. Raloxifene

Answer D Raloxifene is a selective estrogen receptor modulator. Intranasal salmon calcitonin has been shown effective for pain management of osteoporotic fracture, but data on fracture incidence with this treatment is not available

Martin, age 58, presents with urethritis, conjunctivitis, and asymmetric joint stiffness, primarily in the knees, ankles, and feet. Which condition do you suspect? A. Syphilis B. Gonorrhea C. HIV D. Reactive arthritis

Answer D Reactive arthritis (formerly Reiter ' s syndrome) is arthritis of the lower extremities and is more common in white men. Associated symptoms include the classic triad of conjunctivitis, nongonococcal urethritis, and arthritis

Major depression occurs most often in which of the following conditions? A. Parkinson ' s disease B. Alzheimer ' s disease C. Myocardial infarction D. Stroke

Answer D Sixty percent of clients suffer major depression during their first year after a stroke. Other depressive symptoms, as well as major depression, may also occur, although usually less often, with thyroid disorders, Parkinson ' s disease, heart disease, and dementia.

In analyzing synovial fluid, a yellow-green color may indicate which of the following? A. Trauma B. Gout C. A bacterial infection D. Rheumatoid arthritis

Answer D Synovial fluid that is turbid and yellow-green on analysis indicates an inflammation, such as one that occurs in rheumatoid arthritis

Janine, age 69, has a class III case of rheumatoid arthritis. According to the American Rheumatism Association, her function would be A. adequate for normal activities despite a handicap of discomfort or limited motion of one or more joints. B. largely or wholly incapacitated, bedridden, or confined to a wheelchair permitting little or no self-care. C. completely able to carry on all usual duties without handicaps. D. adequate to perform only few or none of the duties of usual occupation or self-care.

Answer D The American Rheumatism Association has identified functional classes I - IV depending on the client ' s ability to accomplish activities of daily living

What is the most sensitive diagnostic test for identifying an alcoholic client? A. Aspartate transaminase (AST, also called serum glutamic-oxaloacetic transaminase [SGOT]) B. Mean corpuscular volume C. Alkaline phosphatase D. γ -glutamyltransferase (GGT)

Answer D The most sensitive diagnostic test for identifying an alcoholic client is the γ -glutamyltransferase (GGT) test. GGT is an enzyme produced in the liver after consumption of five or more drinks daily.

Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, having osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological compromise D. Spinal fracture

Answer D The red flags for spinal fracture include major trauma or a direct blow the back in adults, a minor fall or heavy lifting in a potentially osteoporotic or elderly person, prolonged steroid use, and age over 70.

A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner's next step? Application of topical fluorescein dye Administration of antibiotic eye drops Irrigation of the eye with normal saline Instillation of cyclopegic eye drops

Application of topical fluorescein dye

Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? Aspirin NSAIDs Opioids Antihistamines

Antihistamines

Which choice below is least effective for alleviating symptoms of the common cold? Antihistamines Oral decongestants Topical decongestants Antipyretics

Antihistamines

Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient? Xanthines Antihistimines Steroids Anticholinergics

Antihistamines

A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms? Bronchodilator treatment Mucokinetic agents Antitussive medication Antibiotic therapy

Antitussive medication

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.

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed? Any recent trauma Difficulty swallowing Stiffness in the right shoulder Change in sleeping habits

Any recent trauma

The presence of angina, syncope, and heart failure in a patient with an aortic valve murmur should raise the suspicion of:

Aortic stenosis

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 patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner's next step?

Application of topical fluorescein dye

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).

Which assessments of care providers are performed as part of the Value Based Purchasing initiative? (Select all that apply.) Appraising costs per case of care for Medicare patients Requiring advanced IT standards and minimum cash reserves Evaluating available evidence to guide clinical care guidelines Monitoring mortality rates of all patients with pneumonia Assessing patients' satisfaction with hospital care

Appraising costs per case of care for Medicare patients Monitoring mortality rates of all patients with pneumonia Assessing patients' satisfaction with hospital care

Dependent rubor is a physical finding associated with

Arteriosclerotic occlusive disease

A patient who has a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated? Artificial tears and cool compresses Topical antibiotic eye drops Antihistamine-vasoconstrictor drops Topical corticosteroid drops

Artificial tears and cool compresses

A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient's tympanic membrane. What is the initial action? Irrigate the canal with normal saline Ask the patient about previous problems with that ear Use a curette to attempt to dislodge the mass Prescribe a ceruminolytic agent for that ear

Ask the patient about previous problems with that ear

A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient? Clear the blood with suction to identify site of bleeding Have the patient sit up straight and tilt the head forward Apply firm, continuous pressure to the nostrils Assess airway safety and vital signs

Assess airway safety and vital signs

A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)? Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial infarction Determination of pulselessness or bradycardia Assessment of gasping breaths or not breathing

Assessment of gasping breaths or not breathing

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

A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?

Audiogram and MRI

A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?

Atrial fibrillation

A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms? Atrial fibrillation Anemia Extrasystole Paroxysmal attacks

Atrial fibrillation

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

An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient? Pertussis vaccine booster Azithromycin daily for 5 days Isolation if paroxysmal cough develops Symptomatic care only

Azithromycin daily for 5 days

You observe a mother showing her infant a toy. You note that the infant can fixate on, briefly follow, and then reach for the toy. You suspect the infant is A. 2 months old B. 4 months old C. 6 months old D. 8 months old

B. 4 months old

A 65 year old man presents complaining of left sided deep, throbbing headache along with mild fatigue. On examination the client has a tender, tortuous temporal artery. You suspect temporal arteritis. How do you confirm your diagnosis? A. MRI fo the head B. Erythrocyte sedimentation rate (ESR) C. EEG D. Otoscopy

B. Erythrocyte sedimentation rate (ESR)

You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? A. Maxillary B. Ethmoid C. Frontal D. Sphenoid

B. Ethmoid - Maxillary sinus pain is over the cheek and into the upper teeth - Frontal sinus pain is over the lower forehead - Sphenoid sinus pain is in the occiput, vertex, or middle of the head

The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? Scalp Nails Feet B and C All of the above

B and C

With a chronic allergy, a client's nasal mucosa appear A. Swollen and red B. Swollen, boggy, pale and gray C. Hard, pale, and inflamed D. Bright pink and inflamed

B. Swollen, boggy, pale and gray

When a practitioner places a vibrating tuning fork in the midline of a client's skull and asks if the tone sounds the same in both ears or is better in one, the examiner is performing A. The Rinne test B. The Weber test C. The caloric test D. A hearing acuity test

B. The Weber test

Mavis is 70 years old and wonders if she can donate her corneas when she dies. How do you respond? A. "As long as you don't have any chronic illness, you corneas may be harvested." B. "They will use corneas only from persons younger than age 65." C. "What makes you feel like you are dying?" D. "Don't think about such terrible things now."

B. "They will use corneas only from persons younger than age 65."

When Judith, age 15, asks you to explain the 20/50 vision in her right eye, you respond A. "You can see at 20ft with your left eye what the normal person can see at 50ft." B. "You can see at 20ft with your right eye what the normal person can see at 50ft." C. "You can see at 50ft with your right eye what the normal person can see at 20ft." D. "You can see at 50ft with the left eye what the normal person can see at 20ft."

B. "You can see at 20ft with your right eye what the normal person can see at 50ft." - If vision is greater than 20/30, refer the client to an ophthalmologist or optometrist

Your client is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect A. Bell's palsy B. A lesion affecting the trigeminal nerve C. A stroke D. Shingles

B. A lesion affecting the trigeminal nerve

Mark, age 18, has a persistent sore throat, fever, and malaise not relieved with penicillin therapy. What do you order next? A. A throat culture B. A monospot test C. A rapid antigen test D. A Thayer-Martin plate test

B. A monospot test

Matthew, age 52, has allergic rhinitis and would like some medicine to relieve his symptoms. He is taking cimetidine (Tagamet) for gastroesophageal reflux disease. Which medication would you not order? A. A first-generation antihistamine B. A second-generation antihistamine C. A decongestant D. A topical nasal corticosteroid

B. A second-generation antihistamine

The antibiotic of choice for beta-lactamase coverage of otitis media is A. Amoxicillin (Amoxil) B. Amoxicillin and potassium clavulanate (Augmentin) C. Azithromycin (Zithromax) D. Prednisone (Deltasone)

B. Amoxicillin and potassium clavulanate (Augmentin)

Jill states that her 5 year old daughter continually grinds her teeth at night. You document this as A. Temporal mandibular joint malocclusion B. Bruxism C. A psychosis D. An oropharyngeal lesion

B. Bruxism

How do you test for near vision? A. By using the Snellen eye chart B. By using the Rosenbaum chart C. By asking the client to read from a magazine or newspaper D. By testing the cardinal fields

B. By using the Rosenbaum chart - Hold it about 12-14 inches from the client's eyes.

Which manifestation is noted with carbon monoxide poisoning? A. Circumoral pallor of the lips B. Cherry-red lips C. Cyanosis of the lips D. Pale, pink lips

B. Cherry-red lips

Monique brings her 4 week old infant into the office because she noticed small, yellow-white, glistening bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as A. Bednar's aphthae B. Epstein's pearls C. Buccal tumors D. Exostosis

B. Epstein's pearls

When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, this indicates A. Conductive deafness B. Perceptive deafness C. A normal finding D. Nerve damage

C. A normal finding

Maggie, a 56 year old woman, comes to the office requesting a test for thyroid disease. She has had some weight gain since menopause and she read on the internet that all women should have a thyroid test. Based on the recommendations from the U.S. Preventive Service Task Force, which one of the following statements should be considered in this woman's care? A. All adults should be screened for thyroid disease B. Evidence is insufficient for or against routine screening for thyroid disease in asymptomatic adults C. All adults older than 50 should be screened for thyroid disease D. All perimenopausal women should be screened for thyroid disease

B. Evidence is insufficient for or against routine screening for thyroid disease in asymptomatic adults

Which of the following symptom(s) is (are) most indicative of mononucleosis (Epstein-Barr virus)? A. Rapid onset of anterior cervical adenopathy, fatigue, malaise, and headache B. Gradual onset of fatigue, posterior cervical adenopathy, fever and sore throat C. Gradual and seasonal onset of pharyngeal erythema D. Rapid onset of cough, congestion and headache

B. Gradual onset of fatigue, posterior cervical adenopathy, fever and sore throat

Tee, age 64, presents with a sore throat. Your assessment reveals tonsillar exudate, anterior cervical adenopathy, presence of a fever, and absence of a cough. There is a high probability of which causative agent? A. Haemophilus influenzae B. Group A beta-hemolytic streptococcus C. Epstein-Barr virus D. Rhinovirus

B. Group A beta-hemolytic streptococcus - When the four symptoms present as a cluster, there is a high probability that the infection is caused by group A beta-hemolytic streptococcus

Purulent matter in the anterior chamber of the eye is called A. Hyphema B. Hypopyon C. Anisocoria D. Pterygium

B. Hypopyon

Maury, age 52, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? A. Conjunctivitis B. Iritis C. Subconjunctival hemorrhage D. Acute glaucoma

B. Iritis

Sara, age 92, presents with dry eyes, redness, and a scratchy feeling. You note that this is one of the most common disorders, particularly in older women, and diagnose this as A. Viral conjunctivitis B. Keratoconjunctivitis sicca C. Allergic eye disease D. Corneal ulcer

B. Keratoconjunctivitis sicca

A 42 year old stockbroker comes to your office for evaluation of a pulsating headache over the left temporal region and he rates the pain as an 8 on a scale of 1-10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent headaches for many years but not as severe and they are usually relieved by over the counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headaache? A. Tension B. Migraine C. Cluster D. Temporal arteritis

B. Migraine

Marnie, who has asthma, has been told that she has nasal polyps. What do you tell her about them? A. Nasal polyps are usually precancerous B. Nasal polyps are benign growths C. The majority of nasal polyps are neoplastic D. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma

B. Nasal polyps are benign growths

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

B. Normal age-related changes

What condition occurs in almost all persons beginning around age 42-46? A. Arcus senilis B. Presbyopia C. Cataracts D. Glaucoma

B. Presbyopia

Joy, age 36, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102 F. You diagnose influenza (flu). What is your next course of action? A. Order amoxicillin (Amoxil) 500mg every 12 hours for 7 days B. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive C. Order a complete blood count D. Consult with your collaborating physician

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

Ty, age 68, has a hearing problem. He tells you he is ready for a drastic solution to the problem because he likes to play bingo but cannot hear the calls. What can you do for him? A. Refer him to a hearing aid specialist B. Refer him for further testing C. Perform a gross hearing test in the office, then repeat in 6 months to determine if there is any further loss D. Nothing. Tell him that a gradual hearing loss is to be expected with aging

B. Refer him to further testing

Marty has a hordeolum in his right eye. You suspect that the offending organism is A. Herpes simplex virus B. Staphylococcus C. Candida albicans D. Escherichia coli

B. Staphylococcus

While doing a face, head, and neck examination, you note that the palpebral fissures are abnormally narrow. What are you examining? A. Nasolabial folds B. The openings between the margins of the upper and lower eyelids C. The thyroid gland in relation to the trachea D. The distance between the trigeminal nerve branches

B. The opening between the margins of the upper and lower eyelids

Nathan, age 19, is a college swimmer. He frequently gets swimmer's ear and asks if there is anything he can do to help prevent it other than wearing ear plugs, which don't really work for him. What do you suggest? A. Use a cotton-tipped applicator to dry the ears after swimming B. Use eardrops made of a solution of equal parts of alcohol and vinegar in each ear after swimming C. Use a hair dryer on the highest setting to dry the ears D. Tell Nathan he must change his sport

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

How should Tommy, age 2 1/2, have his vision screened? A. Using a Snellen letter chart B. Using the Allen test C. Using a Snellen E chart D. Using a Rosebaum chart

B. Using the Allen test

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.

The most common cancer found on the auricle is:

Basal Cell Carcinoma

Appropriate therapy for peptic ulcer disease (PUD) is: Primarily by eradication of infection Based on etiology Aimed at diminishing prostaglandin synthesis Dependent on cessation of NSAID use

Based on etiology

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.

A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single laceration away from the iris that involves the anterior but not the posterior segment. What is the prognosis for this injury?

Because the posterior segment is not involved, the prognosis is good

Treatment of acute vertigo includes: Bedrest and an antihistamine Fluids and a decongestant A sedative and decongestant Rest and a low sodium diet

Bedrest and an antihistamine

Harry, age 69, has had Meniere's disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? A. A labyrinthectomy B. Pharmacological therapy C. A vestibular neurectomy D. Wearing an earplug in the ear with the most hearing loss

C. A vestibular neurectomy

Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? ACE Inhibitor Beta Blocker Calcium channel blocker Diuretic

Beta Blocker

A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Radioiodine therapy Surgical resection of the thyroid gland Beta blocker medications Thionamide therapy

Beta blocker medications

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 smooth tongue may indicate A. A normal finding B. Alcohol abuse C. A vitamin deficiency D. Nicotine addiction

C. A vitamin deficiency

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that "there is something in my eye." What is the diagnosis and how should it be treated? Hordeolum; treat with a topical antibiotic and warm compress Conjunctivitis; treat with topical antibiotic and warm compresses Blepharitis; treat with warm compresses and gentle debridement with a cotton swab Chalazion; refer to an ophthalmologist for incision and drainage

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? Standards for minimum cash reserves Care coordination for chronic diseases Strict requirements for financial reporting Bonuses based on achievement of benchmarks

Bonuses based on achievement of benchmarks

An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient's dyspnea? Opioid medications Anxiolytic drugs Supplemental oxygen Breathing exercises

Breathing exercises

Acute bacterial conjunctivitis is generally treated with which of the following as a first-line therapy

Broad-spectrum antibiotic drops

Which are causes of pleural effusions? (Select all that apply.) Bronchiectasis Breast Cancer Dehydration Congestive Heart failure Allergies

Bronchiectasis Breast Cancer Congestive Heart failure

Which intervention listed below is safe for long term use by an adult with constipation? Bulk-forming agents Stool softeners Laxatives Osmotic agents

Bulk-forming agents

A patient reports "something flew in my eye" about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except: Purulent drainage Tearing Photophobia A positive fluorescein stain

Purulent drainage

The immediate goal of myringotomy and tube placement in a child with recurrent episodes of totis media is to A. Prevent future infections B. Have an open access to the middle ear for irrigation and instillation of antibiotics C. Allow removal of suppurative or mucoid material D. Relieve pain

C. Allow removal of suppurative or mucoid material

An asymptomatic 63-year-old female has a low-density lipoprotein level of 135 mg/dL. Which test is beneficial to assess this patient's coronary artery disease risk?

C-reactive protein

Mattie says she has heard that it is not good to let a baby go to bed with a bottle. She says that she has always done this with her other children and wonders why it is not recommended. How do you respond? A. "A bottle in the baby's mouth forces the baby to breathe through the nose. If the nose is clogged, the baby will not get enough oxygen." B. "A nipple, when placed in the mouth for long periods of time, can cause toothe displacement." C. "Normal mouth bacteria act on the sugar in the bottle contents to form acids, which will break down the tooth enamel and destroy the teeth even before they come in." D. "This encourages the baby to continually want to drink at night. When the child is older, it will become a habit, and the child will end up wearing diapers into the preschool years."

C. "Normal mouth bacteria act on sugar in the bottle contents to form acids, which will break down the tooth enamel and destroy the teeth even before they come in."

Mycostatin (Nystatin) is ordered for Michael, who has an oral fungal infection. What instructions do you give Michael for taking the medication? A. "Don't swallow the medication because it's irritating to the gastric mucosa." B. "Take the medication with meals so that it's better absorbed." C. "Swish and swallow the medication." D. "Apply the medication only to the lesions."

C. "Swish and swallow the medication."

Natasha, age 4, has amblyopia. How do you respond when her mother asks about treatment? A. "We'll wait until she's 7 years old before starting treatment." B. "Treatment needs to be started now. We'll cover her 'bad' eye." C. "Treatment needs to be started now. We'll cover her 'good' eye." D. "No treatment is necessary. She'll outgrow this."

C. "Treatment needs to be started now. We'll cover her 'good' eye."

How do you respond when Diane, age 29, asks why she gets sores on her lips every time she sits out in the sun for an extended period of time? A. "You are allergic to the sun and must wear sunblock on your lips." B. "Your lips are dry to begin with and you must keep them moist at all times." C. "You have herpes simplex that recurs with sunlight exposure." D. "You're probably allergic to your lip balm."

C. "You have herpes simplex that recurs with sunlight exposure."

A child's head circumference is routinely measured at each well-child visit until age A. 12 months B. 18 months C. 2 years D. 5 years

C. 2 years

A child's central visual acuity is 20/30 by age A. 18 months B. 2 years C. 3 years D. 4 years

C. 3 years

Mavis has persistent pruritus of the external auditory canal. External otitis and dermatological conditions such as seborrheic dermatitis and psoriasis have been ruled out. What can you advise her to do? A. Use a cotton tipped applicatory daily to remove all moisture and potential bacteria B. Wash daily with soap and water C. Apply mineral oil to counteract dryness D. Avoid topical corticosteroids

C. Apply mineral oil to counteract dryness

Jim, age 49, comes to the office with a rapid-onset complete paralysis of one-half of his face. He is unable to raise his eyebrow, close his eye, whistle, or show his teeth. You suspect a lower motor neuron lesion resulting in cranial nerve VII paralysis. What is your working diagnosis? A. Cerebrovascular accident B. Trigeminal neuralgia C. Bell's Palsy D. Tic douloureux

C. Bell's Palsy

Sara, age 29, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by A. Herpes simplex B. Aphthous ulcers C. Candidiasis D. Oral cancer

C. Candidiasis

What therapy has proved beneficial for long-term symptom relief of tinnitus? A. Aspirin B. Lidocaine C. Cognitive behavioral therapy D. Corticosporin otic gtts PRN

C. Cognitive behavioral therapy

The leading cause of blindness in persons age 20-60 in the United States is A. Macular degeneration B. Glaucoma C. Diabetic retinopathy D. Trauma

C. Diabetic retinopathy

Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to A. Refer him to an ophthalmologist B. Order antibiotics C. Do nothing other than provide reassurance D. Consult with you collaborating physician

C. Do nothing other than provide reassurance

Leah, 4 months old, has both eyes turning inward. What is this called? A. Pseudostrabismus B. Strabismus C. Esotropia D. Exotropia

C. Esotropia

Which of the following signs of thyroid dysfunction is a sign of hyperthyroidism? A. Slow pulse B. Decreased systolic BP C. Exophthalmos D. Dry, coarse, cool skin

C. Exopthalmus

Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect? A. Acute otitis media B. Chronic otitis media C. External otitis D. Temporomandibular joint syndrome

C. External otitis

Acute otitis media is diagnosed when there is A. Fluid in the middle ear without signs or symptoms of an ear infection B. A diagnosis of three or more episodes of otitis media within 1 year C. Fluid in the middle ear accompanied by otalgia and fever D. Fluid within the middle ear for at least 3 months

C. Fluid in the middle ear accompanied by otalgia and fever

Cydney, age 7, is complaining that she feels as though something is stuck in her ear. What action is contraindicated? A. Inspecting the ear canal with an otoscope B. Using a small suction device to try to remove the object C. Flushing the ear with water D. Instilling several drops of mineral oil in the ear

C. Flushing the ear with water

A 62 year old obese woman comes in today complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally she will awake at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements. She does not drink or smoke. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal with no abdominal tenderness, and the stool is OB negative. What is the most likely diagnosis? A. Esophageal varices B. Esophageal cancer C. Gastroesophageal reflux disease (GERD) D. Peptic ulcer disease

C. Gastroesophageal reflux disease (GERD)

When you are assessing the corneal light reflex, an abnormal finding indicates A. Possible use of eye medications B. A neurological problem C. Improper alignment of the eyes D. Strabismus

C. Improper alignment of the eyes - It is noted when the reflections of the light are on different sites on the eyes

Clonazepam (Klonopin) is occasionally ordered for temporal mandibular joint (TMJ) disease. Which of the following statements applies to this medicine? A. It is ordered for inflammatory pain B. It is ordered for neuropathic pain C. It is ordered for a short course of therapy for 1-2 weeks only D. It is ordered for muscle relaxation

C. It is ordered for a short course of therapy for 1-2 weeks only

The trachea deviates toward the affected side in all of the following except A. Aortic aneurysm B. Unilateral thyroid lobe enlargement C. Large atelectasis D. Pneumothorax

C. Large atelectasis

Your neighbor calls you because her son, age 9, fell on the sidewalk while playing outside and a tooth fell out. She wants to know what she should put the tooth in to transport it to the dentist. You tell her that the best solution to put it in is A. Salt water B. Saliva C. Milk D. Water

C. Milk

A sexual history of oral-genital contact in a client presenting with pharyngitis is significant when which of the following organisms is suspected? A. Escherichia coli B. Haemophilus influenzae C. Neisseria gonorrhoeae D. Streptococcus pneumoniae

C. Neisseria gonorrhoeae - Neisseria gonorrhoeae pharyngitis is a common sexually transmitted disease

Darren, age 26, has AIDS and presents with a painful tongue covered with what looks like creamy-white, curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue depressor, which assists you in making which of the following diagnoses? A. Leukoplakia B. Lichen planus C. Oral candidiasis D. Oral cancer

C. Oral candidiasis

Samantha, age 12, appears with ear pain. When you begin to assess her ear, you tug on her normal appearing auricle, eliciting severe pain. This leads you to suspect A. Otitis media B. Otitis media with effusion C. Otitis externa D. Primary otalgia

C. Otitis externa

When you examine the tympanic membrane, which of these structures is visible? A. Stapes B. Cochlea C. Pars flaccida D. Round window

C. Pars flaccida

Greg, age 72, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Greg reports that his vision is "like looking through a veil." He also sees floaters and flashing lights but is not having eye pain. What do you suspect? A. Cataracts B. Glaucoma C. Retinal detachment D. Iritis

C. Retinal detachment

Clients with allergic conjunctivitis have which type of discharge? A. Purulent B. Serous or clear C. Stringy and white D. Profuse mucoid or mucopurulent

C. Stringy and white

Which assessment test is a gross measurement of peripheral vision? A. The cover test B. The corneal light reflex test C. The confrontation test D. The Snellen eye chart test

C. The confrontation test - It compares the client's peripheral vision with the practitioner's, assuming that the practitioner has normal peripheral vision.

Which manifestation of the buccal mucosa is present in a client with mumps? A. Pink, smooth, moist appearance with some patchy hyperpigmentation B. Dappled brown patches C. The orifice of Stensen's duct appearing red D. Koplik's spots

C. The orifice of Stensen's duct appearing red

Sharon, age 29, is pregnant for the first time. She complains of nasal stuffiness and occasional epistaxis. What do you do? A. Order lab tests, such as a CBC with differential, hemoglobin and hematocrit B. Prescribe an antihistamine C. You do nothing except for client teaching D. Refer the client to an ear, nose and throat specialist

C. You do nothing except for client teaching - Can occur with pregnancy because of increased vascularization in the upper respiratory tract

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

A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is: CBC/diff Erythrocyte sedimentation rate Abdominal ultrasound CT scan

CT scan

A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.) BUN and creatinine CBC with platelets PT/INR PT and PTT Liver function tests

CBC with platelets PT/INR PT and PTT

A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings? Pulmonary infection Congestive heart failure Pulmonary embolus Hepatic disease

CHF

A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? D-dimer CT angiography Arterial blood gases Electrocardiogram

CT angiography

A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? CT angiography D-dimer Arterial blood gases Electrocardiogram

CT angiography

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

Calcium antagonists Aspirin Benzodiazepines

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Herpes simplex Aphthous ulcers Candidiasis Oral cancer

Candidiasis

A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup. The provider notes that the patient has dry skin in the ear canal. Which preparation is FDA approved for this use? Mineral oil Liquid docusate sodium Carbamide peroxide Hydrogen peroxide

Carbamide peroxide

A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What the does provider suspect as the cause for these symptoms? Buerger's disease Cauda equina syndrome Diabetic neuropathy Peripheral arterial disease

Cauda equina syndrome

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.

An elderly patient is being seen in the clinic for complaint of "weak spells" relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? Assist the patient to a standing position and take her blood pressure. Assess the patient's cranial nerves. Compare the patient's blood pressure lying first, then sitting, and then standing. Compare the amplitude of the patient's radial and pedal pulses.

Compare the patient's blood pressure lying first, then sitting, and then standing.

An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3-4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has: Acute diarrhea Chronic diarrhea Irritable bowel Functional bowel disease

Chronic diarrhea

The most common correlate(s) with chronic bronchitis and emphysema is(are): Familial and genetic factors Cigarette smoking Air pollution Occupational environment

Cigarette smoking

A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered? Cipro HC Neomycin Vinegar and alcohol Fluconazole

Cipro HC

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? Erythromycin Clarithromycin (Biaxin) Doxycycline (Vibramycin) Penicillin

Clarithromycin (Biaxin)

Which physical examination finding suggests viral rather than bacterial parotitis?

Clear discharge from Stensen's duct

Which physical examination finding suggests viral rather than bacterial parotitis? Clear discharge from Stensen's duct Unilateral edema of parotid glands Gradual reduction in saliva production Enlargement and pain of affected glands

Clear discharge from Stensen's duct

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

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

Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment Left ventricular hypertrophy Renal calculi Perioral paresthesias Chvostek's sign

Cognitive impairment Left ventricular hypertrophy Renal calculi

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 young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Chest radiograph Complete blood count Computerized tomography Spirometry

Complete blood count

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

A patient reports has been using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment?

Compresses, lid scrubs, and antibiotic ointment

A patient reports has been using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment? Compresses, lid scrubs, and antibiotic ointment

Compresses, lid scrubs, and antibiotic ointment

A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated? Coagulation studies Computerized tomography Fiberoptic bronchoscopy Needle biopsy

Computerized tomography

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

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.

A patient who has an inflamed pterygia lesion has been using loteprednol topical steroid drops for 7 days. The patient shows no improvement in symptoms. What is the next course of action? Prescribe a systemic corticosteroid Consult with an opthamologist Refer the patient to the emergency department Continue the medication for 7 more days

Consult with an opthamologist

A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do? Reassure the patient that these findings are expected Continue to monitor the patient every 3 years Admit the patient to the hospital for evaluation and treatment Consult with cardiology to determine appropriate diagnostic tests

Consult with cardiology to determine appropriate diagnostic tests

A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do?

Consult with the cardiologist to determine appropriate diagnostic tests

A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by the primary care provider is indicated for management of this patient? Consulting with a nephrologist Prescribing an antihypertensive medication Referring to an ophthalmologist Limiting protein intake

Consulting with a nephrologist

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

When assessing Lenore, age 59, who has a sore throat, you note that she has a positive history of diabetes and rheumatic fever. These facts increase the likelihood that which of the following agents caused her sore throat? A. Neisseria gonorrhoeae B. Epstein-Barr virus C. Haemophilus influenzae D. Group A beta-hemolytic streptococcus

D. Group A beta-hemolytic streptococcus

Signs and symptoms of acute angle-closure glaucoma include A. Painless redness of the eyes B. Loss of peripheral vision C. Translucent corneas D. Halos around lights

D. Halos around lights

A school age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year. The child's parent asks the provider if the child needs a tonsillectomy. What will the provider tell this parent? If there is one more episode in the next 6 months, a tonsillectomy is necessary Current recommendations do not support tonsillectomy for this child. The child should have radiographic studies to evaluate the need for tonsillectomy Tonsillectomy is recommended based on this child's history

Current recommendations do not support tonsillectomy for this child.

Henry is having difficulty getting rid of a corneal infection. He asks you why. How do you respond? A. "We can't determine the causative agent." B. "Antibiotics have difficulty getting to that area." C. "Because the infection was painless, it was not treated early enough." D. "Because the cornea doesn't have a blood supply, an infection can't be fought off as usual."

D. "Because the cornea doesn't have a blood supply, an infection can't be fought off as usual."

Mandy was given a diagnosis of flu 2 days ago and wants to start on the "new flu medicine" right away. What do you tell her? A. "The medication is effective only if started within the first 48 hours after the symptoms begin." B. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week." C. "The medicine has not proven its effectiveness." D. "I'll start you on zanamivir today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

D. "I'll start you on zanamivir today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

Barbara, age 72, states that she was told she had atrophic macular degeneration and asks you if there is any treatment. How do you respond? A. "No, but 5 years from the time of the first symptoms, the process usually stops." B. "Yes, there is a surgical procedure that will cure this." C. "If we start medications now, they may prevent any further damage." D. "Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss."

D. "Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss."

Marian, age 79, is at a higher risk than a middle-aged client for developing an eye infection because of which age-related change? A. Increased eyestrain B. Loss of subcutaneous tissue C. Change in pupil size D. A decrease in tear production

D. A decrease in tear production

Judy, age 67, complains of a sudden onset of impaired vision, severe eye pain, vomiting, and a headache. You diagnose the following condition and refer for urgent treatment A. Cataracts B. Macular degeneration C. Presbyopia D. Acute glaucoma

D. Acute glaucoma

How do you describe the cervical lymphadenopathy associated with asymptomatic HIV infection? A. Movable, discrete, soft, and nontender lymph nodes B. Enlarged, warm, tender, firm, but freely movable lymph nodes C. Hard, unilateral, nontender, and fixed lymph nodes D. Firm but not hard, nontender, and mobile lymph nodes

D. Firm but not hard, nontender, and mobile lymph nodes

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

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

A client complain of frequent bouts of severe, intense, disabling left sided facial pain accompanied by excessive left eye lacrimation (tearing) and worsening anxiety. The pain wakes him at night and he has even contemplated harming himself during these episodes due to the intensity and unrelenting nature of the pain. What kind of headache is he describing? A. Classic migraine B. Tension headache C. Sinus headache D. Cluster headache

D. Cluster headache

If a client presents with a deep, aching, red eye and there is no discharge, you should suspect A. Bacterial conjunctivitis B. Viral conjunctivitis C. Allergic conjunctivitis D. Iritis

D. Iritis

John, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? A. The offending organism is bacteria and should be treated with antibiotics B. Convalescence is usually only a few days and John should be back to normal in a week. C. Mono is rarely contagious D. John should avoid contact sports and heavy lifting.

D. John should avoid contact sports and heavy lifting

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

D. Ophthalmological consultation

A common cause of conductive hearing loss in adults age 20-40 is A. Trauma B. Otitis media C. Presbycusis D. Otosclerosis

D. Otosclerosis

The most common cause of sensoineural hearing loss is A. Trauma B. Tympanic membrane sclerosis and scarring C. Otosclerosis D. Presbycusis

D. Presbycusis

Risk factors for oral cancers include A. A family history, poor dental habits, and use of alcohol B. Obesity, sedentary lifestyle, and chewing tobacco C. A history of diabetes, smoking, and a high fat intake D. Smokine, use of alcohol, and chewing tobacco

D. Smoking, use of alcohol, and chewing tobacco

You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergeny room. Which of the following symptoms would indicate that an airway obstruction is imminent? A. Reddened face B. Screaming C. Grabbing her throat D. Stridor

D. Stridor

Jessica, an 8 year old third grader is broght to the office by her grandmother, who is the child's babysitter. She has complained of fever and sore throat for the past 2 days. Five other children in her class have been sick with sore throats. She denies difficulty swallowing and has been drinking fluids but has no appetite. ROS reveals that she has clear nasal drainage, hoarseness, and nonproductive cough. She denies vomiting but has had mild diarrhea. On examination she has a temperature of 101.5 F, 3+ erythematous tonsils, and palpable, tender cervical lymph nodes. Based on these findings, what is the most likely diagnosis? A. Mono B. Sinusitis C. Strep pharyingitis D. Viral pharyngitis

D. Viral pharyngitis

What is the easiest way to differentiate between otitis externa and otitis media? A. With otitis media, tender swelling is usually visible B. With otitis media, there is usually bilateral pain in the ears C. With otitis media, there is usually tenderness on palpation over the mastoid process D. With otitis externa, movement or pressure on the pinna is extremely painful

D. With otitis externa, movement or pressure on the pinna is extremely painful

An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications? Dexamethasone Chloramphenicol Metronidazole Clindamycin

Dexamethasone

What are factors associated with acute suppurative parotitis? (Select all that apply.) DM Allergies Hypervolemia Radiotherapy Anticholinergic medications

DM, Radiotherapy, anticholingrics

A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? A respiratory fluoroquinolone antibiotic Empiric treatment with a macrolide antibiotic Hospitalization for intravenous antibiotics A B-lactam antibiotic plus a fluoroquinolone

Empiric treatment with a macrolide antibiotic

Which of the following is NOT associated with leg ulcers caused by venous insufficiency

Deep ulcers with well-circumscribed borders

A patient with allergic conjunctivitis who has been using a topical antihistamine-vasoconstrictor medication reports worsening symptoms. What is the provider's next step in managing this patient's symptoms? Consider prescribing a topical mast cell stabilizer Prescribe a non-sedating oral antihistamine Refer the patient to an ophthalmologist for further care Determine the duration of treatment with this medication

Determine the duration of treatment with this medication

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 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 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.

Which of the following heart murmurs warrants the greatest concern? Systolic murmur Venous hum murmur Diastolic murmur Flow murmur

Diastolic murmur

Which are risk factors for developing otitis externa? (Select all that apply.) Cooler, low-humidity environments Exposure to someone with otitis externa Having underlying diabetes mellitus Vigorous external canal hygiene Use of earplugs and hearing aids

Difficulty sleeping Tugging on ears Appetite

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

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 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition? Diverticulosis Diverticula Diverticulitis Diverticulum

Diverticulitis

An elderly female without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms?

Doppler ankle, arm index

A patient complains of "an aggravating cough for the past 6 weeks." There is no physiological cause for the cough. Which medication is most likely causing the cough? Methyldopa Enalapril Amlodipine Hydrochlorothiazide

Enalapril

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

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.

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.

A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain? Pleural pain Cardiac pain Aortic dissection pain Esophageal pain

Esophageal pain

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

An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minute. What will the provider do next? Order an electrocardiogram and exercise stress test Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital signs Reassure the patient that the symptoms are non-cardiac in origin

Evaluate the patient's orthostatic vital signs

An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What will the provider do next?

Evaluate the patient's orthostatic vital signs

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? Every 5 years Every 2 years Every year Whenever blood work is done

Every 5 years

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

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 are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.) High blood pressure Diabetes Smoking GERD Liver disease

HTN, diabetes, smoking

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

Movement of the auricle will usually elicit pain with:

External otitis

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices? It is important to "undercode" so that one does not get charged with Medicare fraud The practice of "overcoding" is essential in this age of decreasing reimbursements Failing to bill for billable services will lead to unnecessarily low revenues Time spent with the patient is a very important determinant of billing

Failing to bill for billable services will lead to unnecessarily low revenues

An adult patient is seen in clinic with fever, sore throat, and dysphagia. Which diagnostic test will the provider order to confirm a diagnosis of epiglottitis? Lateral neck film Blood cultures Fiberoptic nasopharyngoscopy Complete blood count

Fiberoptic nasopharyngoscopy

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 patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient? Intranasal steroids Oral antihistamines Antihistamine spray Intranasal cromolyn

Intranasal steroids

A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which measure may help with symptomatic relief for patients with underlying allergic rhinitis? Intranasal steroids Topical decongestants Oral mucolytics Saline solution rinses

Intranasal steroids

A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: Alcohol Gallstones Medications Pregnancy

Gallstones

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

A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this patient, what is the best initial action?

Gather and record a three-generation pedigree

A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?

Give the patient a beta blocker medication

A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action? Prescribe a calcium channel blocker medication Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication Administer a second nitroglycerin tablet

Give the patient a beta blocker medication

A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones Injection of rapid-acting insulin

Giving a rapid-acting carbohydrate

Loss of peripheral visual fields is an indication of:

Glaucoma

A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect: Viral conjunctivitis Common pink eye Gonococcal conjunctivitis Allergic conjunctivitis

Gonococcal conjunctivitis

Acute rheumatic fever is an inflammatory disease which can follow infection with: Group A Streptococcus Staphlococcus areus B-hemolytic Streptococcus Streptococcus pyogenes

Group A Streptococcus

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

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.

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

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 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 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

Surgery to reduce the nasal fracture A patient has been taking amoxicillin for treatment of a dental abscess. In a follow-up visit, the provider notes edema of the eyelids and conjunctivae. What is the next action? Hospitalize the patient for an endodontist consultation Suggest using warm compresses to the eyes for comfort Recommend follow up with a dentist in 2-3 days Prescribe amoxicillin clavulanate for 10-14 days

Hospitalize the patient for an endodontist consultation

Which symptoms may occur with vestibular neuritis? (Select all that apply.) Hearing loss Fever N/V Disequilibrium Tinnitus

Hearing loss Fever N/V Disequilibrium Tinnitus

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect? Asthma Nocturnal allergies Valvular disease Heart failure

Heart Failure

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 who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? Hemoglobin A1C Random serum glucose C-peptide level Thyroid studies

Hemoglobin A1C

A child sustains an ocular injury in which a shard of glass from a bottle penetrated into the eye wall. The emergency department provider notes that the shard has remained in the eye. Which best describes this type of injury? Intraocular foreign body Penetrating eye injury Ruptured globe injury Perforating eye injury

Intraocular foreign body

A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms? Herpes simplex virus Bacterial infection Candida albicans Human papilloma virus

Herpes simplex virus

Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect? Varicella Herpes zoster Syphilis Rubella

Herpes zoster

A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect: A common case of shingles and prescribe an analgesic and an antiviral agent A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream Herpes zoster and consider that this patient may be immunocompromised A recurrence of chickenpox and treat the patient's symptoms

Herpes zoster and consider that this patient may be immunocompromised

A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur?

Hypertrophic cardiomyopathy

A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur? Aortic stenosis Tricuspid regurgitation Hypertrophic cardiomyopathy Mitral valve prolapse

Hypertrophic cardiomyopathy

A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion?

Hordeolum

A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion? Blepharitis Chalazion meibomian Hordeolum

Hordeolum

Which clinical sign is especially worrisome in a patient with a pulmonary embolism? TachycardiaAsw Dyspnea Hypotension Abnormal lung sounds

Hypotension

A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially? Incision and drainage Topical antibiotic ointment Lacrimal bypass surgery Eyelid scrubs with baby shampoo

I&D

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

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 child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A healthcare provider at the game notes bleeding from the child's nose and displacement of the septum. What is the most important intervention at this time? Immobilize the child's head and call 911 Apply ice to the injured site to prevent airway occlusion Turn the child's head to the side to prevent aspiration of blood Place nasal packing in both nares to stop the bleeding

Immobilize the child's head and call 911

Mr. H is a 32-year old male who presents for a job-related physical. Cholesterol screening reveals serum LDL of 190mg/dl. The appropriate action would be:

Implement diet and lifestyle changes and re-assess in 3-6 months

General guidelines for managing adults with HTN may include all of the following steps EXCEPT

In patients with isolated systolic hypertension, the goal of treatment is to lower the systolic pressure by 40 mm Hg.

Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Appropriately increased PTH and low or normal serum calcium Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Prolonged inappropriate secretion of PTH with subsequent hypercalcemia

Inappropriate secretion of PTH along with hypercalcemia

Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Appropriately increased PTH and low or normal serum calcium

Inappropriate secretion of PTH along with hypercalcemia

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

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.

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

Which is not a cause of secondary hypertension?

Increased salt intake

Expected spirometry readings when the patient has chronic emphysema include: Decreased residual volume (RV) Increased vital capacity (VC) Increased forced expiratory volume (FEV-1) Increased total lung capacity (TLC)

Increased total lung capacity (TLC)

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 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 patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient's symptoms? Thromboembolism Infection Malignancy Lung abscess

Infection

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? Inferior wall Anterior wall Apical wall Lateral wall

Inferior wall

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.

A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was "fine" as long as he took the medication. The most appropriate next step is: Referral for surgical intervention such as a partial or complete fundoplication Dependent upon how sever the practitioner believes the condition To repeat the 8 week course of drug therapy while continuing lifestyle modifications Investigation with endoscopy, manometry, and/or pH testing

Investigation with endoscopy, manometry, and/or pH testing

An alert, irritable 12-month-old child is brought to the emergency department by a parent who reports that the child fell into a coffee table. The child has epistaxis, periorbital ecchymosis, and nasal edema. Nares are patent and the examiner palpates instability and point tenderness of the nasal septum. The orbital structures appear intact. What is an urgent action for this patient?

Involvement of social services

If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Iritis Allergic conjunctivitis Viral conjunctivitis Bacterial conjunctivitis

Iritis

A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which "is better." His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to: Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days Order mandibular x-rays and question the patient about physical abuse Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic Initiate a parenteral antibiotic and consider hospital admission

Initiate a parenteral antibiotic and consider hospital admission

A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Transfer to the PCI-capable institution Administer heparin Initiate fibrinolytic treatment

Initiate fibrinolytic treatment

A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin Transfer to the PCI-capable institution

Initiate fibrinolytic treatment

Which statement below is correct about pertussis? It is also called whooping cough It begins with symptoms like strep throat It lasts about 3 weeks It occurs most commonly in toddlers and young children

It is also called whooping cough

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? It is not effective during an acute asthma attack. It may take 2 to 3 days to begin working. This drug works within 10 minutes. This drug may be used by patients 6 years and older.

It is not effective during an acute asthma attack.

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

Macular degeneration is manifested by:

Loss of central vision

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect? Squamous cell carcinoma Malignant melanoma A common nevus Basal cell carcinoma

Malignant melanoma

A painful red ear in a diabetic is presumed to be which of the following until proven otherwise

Malignant otitis

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

The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an important point to discuss with this patient about taking such supplements?

Many supplements lack clear clinical evidence of efficacy

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be infected?

Maxillary

Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? Mort is black Mort also has congestive heart failure Mort has benign prostatic hyperplasia Mort has frequent migraine headaches

Mort has benign prostatic hyperplasia

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

Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Aspirin Niacin Atorvastatin Metformin

Metformin

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

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in? Mild intermittent Mild persistent Moderate persistent

Moderate persistent

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.

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.

Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? Multilobar involvement on chest x-ray with the inability to take oral medications Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home Sputum and gram positive organisms A complete blood count showing leukocytosis

Multilobar involvement on chest x-ray with the inability to take oral medications

A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient's pneumonia? S. pneumonia A virus Mycoplasma Tuberculosis

Mycoplasma

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

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

NSAIDs

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.

A patient is in the emergency department with unilateral epistaxis that continues to bleed after 15 minutes of pressure on the anterior septum and application of a topical nasal decongestant. The provider is unable to visualize the site of the bleeding. What is the next measure for this patient? Nasal Packing Electrocautery Chemical cautery Petrolatum ointment

Nasal Packing

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.

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 patient with hemoptysis and no other symptoms has a normal chest radiograph, CT, and fiberoptic bronch studies. What is the next action in managing this patient? Observation Refer to specialist Surgical intervention Prophylactic ABX

Observation

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

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

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

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

The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient? Obtain an immediate consultation with an otolaryngologist Administer empiric intravenous antibiotics and steroids Have the child lie down and administer high-flow, humidified oxygen Perform a thorough examination of the oropharynx

Obtain an immediate consultation with an otolaryngologist

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

During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding? Ocular disease requiring referral Potential infection in the "red" eye Normal physiologic variant Potential vision loss in one eye

Ocular disease requiring referral

A 58-year-old man is diagnosed with Barrett's esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient's disorder? Omeprazole Ranitidine An antacid None of the above

Omeprazole

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

Ondansetron

A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient's right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient's symptoms is: Rhus dermatitis Ophthalmic zoster Chemosis Optic neuritis

Ophthalmic zoster

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

Which are causes of secondary hypertension? (Select all that apply.) Oral contraceptives Isometic excercises NSAIDS Sleep apnea Increased salt intake

Oral contraceptives NSAIDS Sleep apnea

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

Which are potential complications of chronic or recurrent sinusitis? Orbital infection Osteomyelitis Meningitis

Orbital infection Osteomyelitis Meningitis

Mrs. Edna M., a 67-year old female presents in your office for an annual physical. During your examination, you detect a right carotid bruit. What is the first step you would take in diagnosing/treating Mrs. M.:

Order a carotid ultrasound and start on aspirin.

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

When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? Order abdominal x-rays Order an abdominal ultrasound Refer the patient to a surgeon for evaluation Prescribe pain medication

Order an abdominal ultrasound

A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient? Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels Order urinalysis, CBC, BUN and creatinine Refer to specialist for sleep study

Order urinalysis, CBC, BUN and creatinine

A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient?

Order urinalysis, CBC, BUN, and creatinine

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.

A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient? Trimethoprim-sulfamethoxazole Clindamycin Azithromycin Oseltamivir

Oseltamivir

A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? Perform a nasal swab for RT-PCR assay Administer LAIV influenza vaccine Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication

Perform a nasal swab for RT-PCR assay

A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient's symptoms? Refer to to an otolaryngologist Prescribe empiric penicillin Perform a rapid antigen detection test Order an antistreptolysin O titer

Perform a rapid antigen detection test

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.

Which of the following patient characteristics are associated with chronic bronchitis? Overweight, cyanosis, and normal or slightly increased respiratory rate Underweight, pink skin, and increased respiratory rate Overweight, pink skin, and normal or slightly increased respiratory rate Normal weight, cyanosis, and greatly increased respiratory rate

Overweight, cyanosis, and normal or slightly increased respiratory rate

A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient reports improvement in symptoms. What is the next action in treating this patient? Schedule an upper endoscopy Continue the proton pump inhibitor Refer the patient to a gastroenterologist Order esophageal pH monitoring

PPI

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

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

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.

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.

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

In order to decrease deaths from lung cancer: All smokers should be screened annually All patients should be screened annually Only high risk patients should be screened routinely Patients should be counseled to quit smoking

Patients should be counseled to quit smoking

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep? Penicillin V 500 milligrams PO every 8 hours for 10 days Ampicillin 250 milligrams PO twice a day for 10 days Clarithromycin 500 milligrams po daily for 7 days None of the above

Penicillin V 500 milligrams PO every 8 hours for 10 days

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

A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient? Increasing the dose of the antibiotics Open lung biopsy Performing diagnostic bronchoscopy Administration of the pneumonia vaccine

Performing a diagnostic broncho

A child complains that his "throat hurts" with swallowing. His voice is very "throaty" and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis? Peritonsillar abscess Thyroiditis Mononucleosis Epiglottitis

Peritonsillar abscess

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.

Lillian is a 28 year old white female presenting for an annual wellness exam. Her blood pressure is 139/85, BMI =30, and FBG on recent lab assessment was 98. Her blood pressure at last year's exam was 135/79, and her BMI was 28. There is a family history of type 2 diabetes. What is Lillian's diagnosis?

Pre-hypertension

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 has gingival inflammation with several areas of ulceration and a small amount of purulent discharge. What is required to diagnose this condition? Culture and sensitivity Microscopic exam of oral scrapings Tzanck smear Physical examination

Physical examination

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

Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? Pneumonia Asthma Sinusitis Pertussis

Pneumonia

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 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.

Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction? Powders Gels Creams Lotion

Powders

A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues w/o discharge. Which is the initial course of action by the provider?

Prescribe Amoxicillin, refer to dentist in 2-3 days

A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours. Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management. Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction. Order stool cultures.

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider? Refer to an oral surgeon for emergency surgery Perform an incision and drainage of the edematous tissue Recommend oral antiseptic rinses and follow up in one week Prescribe amoxicillin and refer to a dentist in 2-3 days

Prescribe amoxicillin and refer to a dentist in 2-3 days

A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient?

Prescribe antibiotic ear drops

A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient? Refer the patient to an otolaryngologist Prescribe antibiotic ear drops Insert a wick into the ear canal Irrigate the ear canal to remove the discharge

Prescribe antibiotic ear drops

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 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 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 provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient's pupils. What does this finding indicate? Probable benign, physiologic anisocoria A relative afferent pupillary defect Likely underlying neurological abnormality Indication of a difference in intraocular pressure

Probable benign, physiologic anisocoria

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient's problem is: Staphylococcus aureus Group A beta hemolytic streptococcus Haemophilus influenza Pseudomonas aeruginosa

Pseudomonas aeruginosa

John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Actinic keratosis Eczema Psoriasis Seborrheic dermatitis

Psoriasis

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.

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to: Quit smoking Maintain aggressive hypertension therapy Stick to a low-fat, low-sodium diet Continue with his exercise program

Quit smoking

A patient who has a central line develops respiratory compromise. What is the initial intervention for this patient? Obtaining cultures and starting antibiotics Lung ultrasonography to determine the cause Prompt removal of the central line Rapid assessment and resuscitation

Rapid assessment and resuscitation

A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed? Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet. Order a topical hemorrhoid cream along with a stool softener. Refer the patient for a barium enema and sigmoidoscopy. Refer the patient for a surgical hemorrhoidectomy.

Refer the patient for a barium enema and sigmoidoscopy.

A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most likely treatment for this condition? Prescribe ophthalmic antibiotic drops Reassure the patient that this will resolve Refer to an ophthalmologist Order lubricating drops or ointments

Reassure the patient that this will resolve

A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next? Recommend an NSAID Prescribe an antibiotic Refer to a cardiologist Order a chest radiograph

Recommend an NSAID

To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy? Reduction of payments for patients readmitted within 30 days after discharge Mandates for communication among primary caregivers and hospitalists Penalties for failure to perform medication reconciliations at time of discharge Requirements for written discharge instructions for patients and caregivers

Reduction of payments for patients readmitted within 30 days after discharge

An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the primary care provider do? Refer the patient to an otolaryngologist Prescribe empiric oral antibiotics Evaluate for possible epiglottitis Perform a rapid strep and throat culture

Refer the patient to an otolaryngologist

An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul-smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the primary care provider do?

Refer the patient to an otolaryngologist

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

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

A pediatric patient has otalgia, fever of 38.8° C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action? Treat empirically with amoxicillin 80-90 mg/kg/day Remove the cerumen and visualize the tympanic membrane Recommend symptomatic treatment for fever and pain Perform a tympanogram on the right ear

Remove the cerumen and visualize the tympanic membrane

Which of the following is not a goal of treatment for the patient with cystic fibrosis? Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water-soluble vitamins

Replace water-soluble vitamins

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.

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

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is "like looking through a veil." He also sees floaters and flashing lights but is not having any pain. What do you suspect? Cataracts Glaucoma Retinal detachment Iritis

Retinal detachment

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? Viral conjunctivitis Glaucoma Corneal abrasion Retinoblastoma

Retinoblastoma

A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: A drug interaction Hepatic dysfunction Hypersensitivity to lovastatin Rhabdomyolysis

Rhabdomyolysis

The "common cold" is caused by:

Rhinoviruses

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

SSRI

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.

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.

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 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient?

Serial ultrasonographic surveillance of the aneurysm

A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient? No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular stent grafting of the aneurysm Serial ultrasonographic surveillance of the aneurysm

Serial ultrasonographic surveillance of the aneurysm

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient's aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered? Serologic markers for hepatitis Serum bilirubin Serum cholesterol with HDL and LDL A liver biopsy

Serologic markers for hepatitis

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control Sodium restriction can cause serious adverse effects A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable Seventy-five of sodium intake is derived from processed foods

Seventy-five of sodium intake is derived from processed foods

A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is: Colonoscopy Small bowel follow-through Barium enema CT abdomen

Small bowel follow-through

Which type of lung cancer has the poorest prognosis? Adenocarcinoma Epidermoid carcinoma Small cell carcinoma Large cell carcinoma

Small cell carcinoma

A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient? Arterial blood gases ventilation/perfusion scan Spirometry Blood cultures

Spirometry

An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? Spirometry Allergy Testing Methacholine Challenge test Peak expiratory flow rate

Spirometry

What is the Gold standard for the diagnosis of asthma? Patient's perception of clogged airways Validated quality-of-life questionnaires Bronchoscopy Spirometry

Spirometry

A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a "sun worshiper." The nurse practitioner suspects actinic keratosis. This lesion is a precursor to: Squamous cell carcinoma Basal cell carcinoma Malignant melanoma Acne vulgaris

Squamous cell carcinoma

A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action?

Stat ultrasound of the mass to determine size

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

Symptomatic abdominal aortic aneurysms (AAA) generally imply impending rupture. Which of the following symptoms should alert you to impending AAA rupture:

Subjective feeling of a second heart beat

A patient who has acute suppurative parotitis has been taking amoxicillin- clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin resistant S. aureus. Which other measure may be helpful? Topical corticosteroid Discouraging chewing gum Cool compresses Surgical drainage

Surgical drainage

A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. The patient's lungs are clear and oxygen saturations are 97% on room air. What will the provider recommend? Symptomatic treatment with close follow up in clinic Referral to a specialist for evaluation and treatment Admission to the hospital for treatment of complications Empiric antibiotics to treat a possible secondary infection

Symptomatic treatment with close follow up in clinic

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? An allergic reaction Relapsing polychondritis Lymphocytoma cutis Systemic lupus erythematosus

Systemic lupus erythematosus

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with: Mitral regurgitation Systolic heart failure Cardiac myxoma Diastolic heart failure

Systolic heart failure

A patient develops a pulmonary embolism after surgery and shows signs of right-sided heart failure. Which drug will be administered to this patient? Low molecular heparin Warfarin Tissue plasminogen activator Unfractionated heparin

TPA

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 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 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.

What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient

The physician must be on-site and engaged in patient care

Which of the following statements about malignant melanomas is true? They usually occur in older adult males The patient has no family history of melanoma They are common in blacks The prognosis is directly related to the thickness of the lesion

The prognosis is directly related to the thickness of the lesion

The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this patient? The infant should have an influenza vaccine now with a booster in 1 month The infant should be given prophylactic antiviral medications The rest of the family and all close contacts should have the influenza vaccine The infant should have the live attenuated influenza vaccine (LAIV)

The rest of the family and all close contacts should have the influenza vaccine

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.

What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause increased insulin resistance. They predispose patients to dyslipidemia. They lower the risk of hypertension. They increase the risk of arterial thrombosis.

They increase the risk of arterial thrombosis.

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 postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She will need lifelong medication. A thyroidectomy will be necessary. This condition may be transient. She should be referred to an endocrinologist.

This condition may be transient.

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 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 has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o'clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What will the provider tell the patient about this lesion? UVB eye protection is especially important Artificial tear drops are contraindicated Spontaneous bleeding is likely Visine may be used for symptomatic relief

UVB eye protection is especially important

A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Serum calcitonin Radionucleotide imaging Serum TSH level Thyroid ultrasound

Thyroid ultrasound

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 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

Impetigo and folliculitis are usually successfully treated with: Systemic antibiotics Topical antibiotics Topical steroid creams Cleansing and debridement

Topical antibiotics

An adult presents with tinea corporis. Which item below is a risk factor for its development? Topical steroid use Topical antibiotic use A recent laceration Cold climates

Topical steroid use

Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Peripheral edema Weight gain Shortness of breath Nocturnal dyspnea

Weight gain

Which of the following is not a symptom of irritable bowel syndrome? Painful diarrhea Painful constipation Cramping and abdominal pain Weight loss

Weight loss

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

Which method of treatment is used for traumatic pneumothorax? Placement of a small-bore catheter Observation for spontaneous resolution Needle aspiration of the pneumothorax Tube thoracostomy

Tube thoracostomy

Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media? (Select all that apply.) Tugging on ears Difficulty sleeping Poor hearing Level of cooperation Appetite

Tugging on ears Difficulty sleeping Appetite

A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding? Pure tone audiogram Impedance audiometry Tympanogram Speech reception test

Tympanogram

A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon US of the mass to determine size Ordering CT angiography

US of the mass to determine size

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

A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary at this time? Urgent drainage of the mass CT scan of facial structures Ice packs to reduce facial swelling Surgery to reduce the nasal fracture

Urgent drainage of the mass

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 primary care provider notes painless, hard lesions on a patient's external ears that expel a white crystalline substance when pressed. What diagnostic test is indicated? Uric acid chemical profile Rheumatoid factor Endocrine studies Biopsy of the lesions

Uric acid chemical profile

What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Ursodiol Ibuprofen Prednisone Surgery is the only answer

Ursodiol

Nathan, age 19, is a college sophomore. He frequently gets swimmer's ear and asks if there is anything he can do to help prevent it other than wearing earplugs, which don't really work for him. What do you suggest?

Use eardrops made of equal parts of alcohol and vinegar in each ear after swimming.

Current American Heart Association (AHA) recommendations include: (Select all that apply.) Using a ratio of 2 rescue breaths to 30 compressions A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths Rescue breaths given during 2 seconds to allow full chest rise

Using a ratio of 2 rescue breaths to 30 compressions A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths

A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency department. What initial intervention may be attempted in the clinic? Administration of intravenous adenosine Using a vagal maneuver or carotid massage Providing a loading dose of digoxin Giving a beta blocker

Using a vagal maneuver or carotid massage

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 cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems? Congestive heart failure Varicose veins Deep vein thrombosis Arterial insufficiency

Varicose veins

The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia? Atrial flutter Ventricular fibrillation Atrial fibrillation Ventricular tachycardia

Ventricular fibrillation

A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms? Infectious mononucleosis Group A streptococcus Allergic pharyngitis Viral pharyngitis

Viral pharyngitis

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

A patient is diagnosed with PAD and elects not to have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient?

Walking to the point of pain each day

A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient? Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent clotting Walking slowly for 15 to 20 minutes twice daily

Walking to the point of pain each day

An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend? Warm compress Nasolacrimal duct probing Systemic antibiotics Antibiotic eye drops

Warm compress

A child has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment? Warm compress and massage of the lesion Surgical incision and drainage Referral to ophthalmologist Systemic antibiotics

Warm compress and massage of the lesion

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

a high dietary intake of rare cooked beef

A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient's vital signs are normal. What is the most likely diagnosis for this patient? Acute sinusitis Viral rhinitis Chronic sinusitis Allergic rhinitis

allergic rhinitis

What is the most immediate life threatening complication of severe epiglottitis?

airway occlusion

Which of the following is generally considered the "first-line" empiric drug of choice for treating acute sinusitis in an adult with no known allergies:

amoxicillin

Initial treatment of bacterial sinusitis does not include which of the following:

antihistamines

A patient develops a dry, nonproductive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms? Antibiotic therapy Bronchodilator treatment Mucokinetic agents Antitussive medication

antitussive

In autosomal dominant inheritance, the abnormality or abnormalities usually:

appear in every generation

Treatment of bacterial sinusitis may include all of the following EXCEPT:

broad-spectrum antibiotics for 5-7 days

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as: inguinal hernia epigastric hernia umbilical hernia incisional hernia

epigastric hernia

All of the following are typically associated with stable angina EXCEPT:

chest pain at rest or with minimal exertion

Down's syndrome is an example of a:

chromosomal disorder

Dot & blot hemorrhages, microaneurysms, hard exudates, cotton-wool patches, venous bleeding, and intraretinal microvascular abnormalities are seen in:

diabetic retinopathy

What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? Costs of ambulatory care Associations with area hospitals The ratio of providers to patients Ease of access to care

ease of access to care

A patient comes to the clinic complaining of acute pain and loss of vision in the right eye. The adult/gerontology nurse practitioner informs the patient that these symptoms require:

immediate referral to an ophthalmologist

In a patient presenting with oral candidiasis in the absence of diabetes or recent antibiotic use, which of the following should be suspected:

immunosuppresion

A patient is diagnosed with peritonsillar abscess and will be hospitalized for intravenous antibiotics. What additional treatment will be required? Needle aspiration of the abscess

needle aspiration

Thiazide diuretics are usually well tolerated and a good choice for the initial drug therapy for the treatment of hypertension in adults. Which statement below is UNTRUE about the advantages of using thiazide diuretics with adult patients:

orthostatic hypotension is a common side effect of thiazide diuretics

Which of the following objective findings is generally not associated with acute frontal sinusitis?

pain with movement of pinna

Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are those with a history of (Select all that apply.) previous myocardial infarction. a low-density lipoprotein (LDL) level >190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL. a 10 year risk score of 5% and an LDL of 165 mg/dL.

previous myocardial infarction. a low-density lipoprotein (LDL) level >190 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL.

A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated tympanic membrane. What is the recommended treatment? Refer the patient to an otolaryngologist for evaluation

refer

An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: defer any further dental work until his valve replacement is completed instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed. suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications.

suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis

Your patient presents with URI symptoms consistent with viral infection. What is the most appropriate course of treatment:

suggest increasing fluids, rest and symptomatic treatment

Which approaches are among those recommended by the Agency for Healthcare Research and Quality to improve health literacy in patients? (Select all that apply.) Supplementing teaching with visual aids Highlighting no more than 7 key points Empowering patients and families Giving written handouts for all teaching Repeating the instructions

supplement, empower, repeating

A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful? Cool compresses Topical corticosteroids Surgical drainage Discouraging chewing gum

surgical drainage

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 with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient: that strict diet and exercise measures may be relaxed with insulin therapy. it is necessary because the patient cannot comply with the previous regimen. this is because of the natural progression of the disease. the use of insulin therapy may be temporary.

this is because of the natural progression of the disease.