D118: OA Study Guide (Complete)

A 24-year-old black woman is found to have bilateral hilar adenopathy on a routine chest-ray. Based on this finding, which of the following is the best diagnosis? a. Brucellosis b. Sarcoidosis c. Staphlococcus d. Tuberculosis

ANS: B

A 65 year old patient presents to clinic with symptoms of Impaired memory, Low energy, Impaired ability to concentrate and Social withdrawal. What diagnosis does the FNP consider? a. Generalized anxiety disorder b. depression c. obsessive compulsive disorder d. Borderline personality disorder

ANS: B

A 65 year old patient presents to clinic with symptoms of Impaired memory, Low energy, Impaired ability to concentrate and Social withdrawal. What diagnosis does the FNP consider? a. Generalized anxiety disorder d. depression c. obsessive compulsive disorder d. Borderline personality disorder

ANS: B

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

ANS: B Bilateral epistaxis into the pharynx is more indicative of a posterior bleed which is more likely to be severe. The most important intervention is to ensure airway safety and determine stability of vital signs. Other measures are taken as needed.

A patient presents with a cough and fever. 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? a. A virus b. Mycoplasma c. S. pneumoniae d. Tuberculosis

ANS: B Atypical pneumonias, such as those caused by mycoplasma, often present with headache and sore throat and will have larger areas of infiltrate on chest radiograph. Viral pneumonias show more diffuse radiographic findings. S. pneumonia will have high fever and cough and distinct areas of infiltration.

Which is the most common cause of pancreatitis in the United States? a. Ethyl alcohol b. Gallstones c. Hyperlipidemia d. Trauma

ANS: B Gallstones are the most common cause of pancreatitis in the United States.

A patient has marked swelling of a shoulder joint with erythema and severe pain. The provider suspects a bacterial cause. Which culture will be most helpful to determine the cause of these symptoms? a. Blood culture b. Synovial fluid culture c. Urethral culture d. Urine culture

ANS: B Synovial fluid culture is the most important exam for diagnosis of septic arthritis. Blood culture may be positive in only 10% of cases. Urethral culture is performed if gonococcal arthritis is suspected. Urine culture is not helpful.

A patient presents with Paget's disease that has been stable for several yrs. recently, his serum alkaline phosphatase level has been steadily rising. you determine that it is time to start him on: a. NSAIDS b. Corticosteroids c. bisphosphonates d. Calcitonin

ANS: C

An advanced practice registered nurse (APRN) is seeing a college student who has had a fever, cough, malaise, and myalgias for the last 24 hours. Which illness should the APRN assess this patient for first? a. Tuberculosis b. Mononucleosis c. Influenza d. Meningitis

ANS: C Influenza

A patient presents to the clinic complaining of fullness in his right ear with decreased hearing. He denies pain or fever. What condition does the FNP suspect? a. Otitis externa b. Ruptured eardrum c. Otitis media with effusion d. Acute sinusitis

ANS: C OME presents with fluid and inflammation in the middle ear WITHOUT evidence of signs and symptoms of acute infection.

A patient has a UTI and will begin treatment with an antibiotic. The patient reports moderate to severe suprapubic pain. The NP should prescribe: a. ibuprofen as needed. b. bethanechol (Urecholine). c. phenazopyridine (Pyridium). d. increased oral fluid intake to dilute urine

ANS: C Phenazopyridine is a urinary tract analgesic used to treat pain via a local analgesic effect on urinary tract mucosa in conjunction with antibiotics to treat UTI. Ibuprofen may be used but does not have direct effects on the urinary tract mucosa. Bethanechol is used to treat voiding dysfunction and not pain. Increasing fluid intake should be used as adjunct therapy.

A patient diagnosed with stage 1 sarcoidosis is prescribed a nonsteroidal anti-inflammatory medication to treat joint discomfort has now developed mild dyspnea and cough. Which medication will be added to assist in treating this new symptom? a. A beta-adrenergic medication b. An antimalarial agent c. An immunosuppressant drug d. An oral corticosteroid

ANS: D Corticosteroids are begun when pulmonary symptoms develop. Beta-adrenergics are not used. Antimalarial agents are used to treat chronic skin lesions. Immunosuppressants are used when corticosteroids are no longer effective or when the disease progresses.

A patient recovering from a viral infection has a persistent cough 6 weeks after the infection. What will the provider do? a. Perform chest radiography to assess for secondary infection b. Perform pulmonary function and asthma challenge testing c. Prescribe a second round of azithromycin to treat the persistent infection d. Reassure the patient that this is common after such an infection

ANS: D Post-infection cough is common after a viral infection and may persist up to 8 weeks after the infection; this type of cough generally needs no intervention. It is not necessary to perform chest radiography unless secondary infection is suspected. Antibiotics are not indicated. Unless the cough persists after 8 weeks, asthma testing is not indicated.

A cough associated with rhinorrhea or sneezing may be: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold

ANS: E A cough associated with rhinorrhea or sneezing may be a viral syndrome or the common cold.

A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What else is likely to be present?

Decreased hematocrit This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level

A patient has an incidental finding of gallstones on an imaging study and is currently asymptomatic with normal liver function tests. Which action should the advanced practice registered nurse (APRN) take for this patient? a. Suggest psyllium intake b. Arrange for a HIDA scan c. Educate on an altered diet d. Order an abdominal CT scan

Educate on an altered diet

Which initial diagnostic test will the primary care provider order for a patient who is obese and has recurrent urinary tract infections and reports feeling tired most of the time?

Hemoglobin A1c Along with fasting plama glucose or a two-hour plasma glucose during an oral glucose tolerance test are diagnostic of DM

A patient sees an advanced practice registered nurse (APRN) at the primary practice clinic with complaints of involuntary dribbling that occurs mostly at night and has been worsening over time. Which type of incontinence should the APRN diagnose? Stress Overflow Urge Transient

Overflow

What is the best treatment for H. pylori-related peptic ulcer disease?

PPI and clarithromycin for 14 days Documented improved effectiveness over other regimens in treating H. pylori-related peptic ulcer disease

A patient presents with complaints of sudden onset hoarseness, wheezing, and an itchy throat after being stung by a bee. The advanced practice registered nurse (APRN) suspects the patient may be having an anaphylactic reaction. What should be the first-line pharmacological treatment? a. Ranitidine (Zantac) 50 mg IV over 5 minutes b. Inhaled beta2 agonists c. Aqueous epinephrine 1:1000 dilution (EpiPen) 0.2-0.5 mg IM d. H1 and H2 antagonists

ANS: C Aqueous epinephrine 1:1000 dilution (EpiPen) 0.2-0.5mg IM

The Healthy People 2020 contains new topics and objectives that correlate with emerging technologies and data that were not present in the Healthy People 2010 initiative. Which objective was newly added to the 2020 document? a. Nutrition and weight b. Mental health c. Global health d. Substance abuse

ANS: C Global Health

A 64-year-old patient comes to the office and states she found a tick on her abdomen a week or two ago which seemed engorged but she pulled it out and threw it in the garbage. She now has a circular rash that has the typical bull's-eye appearance. Treatment for this patient would be: a. Azithromycin 500 mg orally for 3 days. b. Keflex 500 mg orally for 7 days. c. Doxycycline 100 mg orally for 7 days d. Ceftriaxone 1 gm IV daily for 3 days

ANS: C If the patient had come to be seen immediately after noticing the engorged tick bite, a prophylactic one-time dose of doxycycline can be offered.

An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, a group of individuals with Type 2 diabetes are divided into two randomized groups. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive

ANS: C In an experimental research study, the participants in both the treatment and control groups are randomly assigned.

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? a. Chemical cautery b. Electrocautery c. Nasal packing d. Petrolatum ointment

ANS: C Nasal packing is used if bleeding continues after initial measures. Chemical cautery and electrocautery are used only if the site of bleeding is visualized. Petrolatum ointment is applied once the bleeding is stopped.

Which is the most appropriate research design for a Level I research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials

ANS: C Qualitative designs are useful for Level I

A 52-year-old male patient presents to the office following a brief hospitalization for pyelonephritis. He is currently on the second day of a 7-day course of antibiotic. Patient education includes which of the following? a. If you develop dysuria, increase PO fluids for two days. b. Continue your antibiotic until you are asymptomatic c. Return to the office in 7-10 days for a repeat urinalysis, as well as a urine culture and sensitivity. d. If you develop urinary frequency, decrease PO fluid intake

ANS: C The patient should complete the entire course of the prescribed antibiotic. If symptoms of cystitis develop, he should contact his health care provider immediately. The patient should return to the office for a repeat urinalysis and urine culture once the antibiotic treatment is completed. Increasing PO fluid intake is also encouraged.

While working in the northeast, a 62-year-old gardener comes to the clinic with complaints of right knee pain and inflammation for a few weeks. Which of the following responses is the best choice to be included in the differential diagnosis? a. Multiple sclerosis b. Ankylosing spondylitis c. Lyme disease d. Tularemia

ANS: C This outdoor worker is at high risk for tick bites. Complications from untreated Lyme disease includes joint swelling, effusions, and arthritic symptoms

A 28-year-old female presents to an advanced practice registered nurse (APRN) with complaints of blurred vision and irritation to her right eye for the past three days. She does not report any headaches, dizziness, fever, or chills. The patient does not complain of any pain, rhinorrhea, or sneezing. Assessment yields the following: vital signs are within normal limits left eye: sclera white, conjunctivae pink right eye: sclera red. Which treatment should the APRN recommend based on the patient's differential diagnoses? a. Apply antihistamine eye drops daily b. Use Ketorolac (Acuvail) 0.5% eye drops four times a day c. Use artificial tears as needed for irritation d. Irrigate the eye with Epinastine (Elestat) 0.05% daily

ANS: C Use artificial tears as-needed for irritation

B.W. is a 34-year-old male who complains that his left knee has been painful for three days and is getting progressively worse. He describes the pain as throbbing and rates the pain as a 7/10. ROS is positive for fever. He denies fatigue, weight loss, and rash. PMH is unremarkable. He denies past GI or GU infection. Surgical history includes previous arthroscopic surgery to left knee two years ago. Social history includes smoking 2 packs/day. On exam, the left knee is erythematous, warm and edematous. Which diagnosis is most probable? a. septic arthritis b. fibromyalgia c. reactive arthritis d. SLE

ANS: A

Bone mineral density (BMD) testing is recommended by the National Osteoporosis foundation for which for the following 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

ANS: A

Which of the following is least likely associated with dementia: a. mental status returns to pre-illness baseline b. insidious onset over months to years c. no perceptual disturbance are noted until later in the disease d. progressive loss of intellectual function

ANS: A

Which type of dementia is characterized by: Gradual onset with moderate progression. Cognitive symptoms include memory, visuospatial, hallucinations, and fluctuations. Motor symptoms are typically Parkinson's like a. lewey body dementia b. acute delirium c. Alzheimer's dementia d. vascular dementia

ANS: A

A cough associated with rhinorrhea that recurs annually at the same time of year is: A. Allergic rhinitis B. Use of lisinopril C. Psychogenic cough D. Asthma

ANS: A A cough with rhinorrhea recurs annually at the same time of year, allergic rhinitis is possible.

The nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should: a. perform a dipstick urinalysis. b. prescribe desmopressin (DDAVP) c. prescribe oxybutynin chloride (Ditropan XL). d. teach exercises to strengthen the pelvic muscles.

ANS: A A focused history with a careful physical examination is essential for determining the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can cause incontinence. Medications are prescribed after determining the cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic muscles are part of treatment.

An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, a group of individuals with Type 2 diabetes are divided into two non-randomized groups. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive

ANS: A A quasi-experimental design does not randomly assign participants to treatment or control groups for comparison.

An advanced practice registered nurse (APRN) is the manager of a rural, Medicaid-funded, family practice clinic in a farming community. The clinic services many families of migrant workers despite their limited resources. A 28-year-old male from another country comes to the office with his wife. The patient is able to communicate in limited English but struggles to understand some words. However, his wife verbally reports she understands more English than her husband. The wife informs the APRN that she is very comfortable translating for her husband and has done it many times in the past. How should the APRN plan to collect verbal assessment information from this patient? a. Have a professional interpreter translate for the patient b. Ask the patient's wife to interpret for the patient c. Speak slowly during the health interview process d. Utilize a staff member who is familiar with the language to translate

ANS: A Have a professional interpreter translate for the patient

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? a. Cipro HC b. Fluconazole c. Neomycin d. Vinegar and alcohol

ANS: A In the absence of a culture, the provider should choose a medication that is effective against both P. aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for inflammation. Fluconazole is an oral antifungal medication used when fungal infection is present. Neomycin alone does not cover these organisms. Vinegar and alcohol are used to treat mild fungal infections.

Which statement below regarding chronic cough is true? A. A postinfectious cough, by definition, lasts no longer than 8 weeks; B. Chest radiographs are abnormal in postinfectious cough C. Intervention is usually required for the postinfectious cough to resolve D. All of the above

ANS: A Rationale: A postinfectious cough, by definition, lasts no longer than 8 weeks; chest radiograph findings are normal, and the cough eventually resolves, generally without intervention.

A patient diagnosed with 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? a. Administering two more doses of albuterol b. Coming to the clinic for evaluation c. Going to the emergency department (ED) d. Taking an oral corticosteroid

ANS: A The patient is experiencing an asthma exacerbation and should follow the asthma action plan (AAP) which recommends three doses of albuterol before reassessing. The peak flow is above 70%, so ED admission is not indicated. The patient may be instructed to come to the clinic for oxygen saturation and spirometry evaluation after administering the albuterol. An oral corticosteroid may be prescribed if the patient will be treated as an outpatient after following the AAP.

When counseling a patient about the long-term effects of fibromyalgia syndrome, what is important to include in teaching? a. A multidisciplinary approach to treatment is most effective. b. Eventual damage to muscles and joints will occur. c. Exercise may cause discomfort and damage to muscles. d. Medications are useful for controlling and preventing symptoms.

ANS: A A multidisciplinary approach to FMS management can help with pain management, stress, and exercise. Although patients experience pain, damage to tissues does not occur. Exercise may be painful but does not cause damage. Medications help alleviate some, but not all symptoms.

A 45-year-old patient has mild osteoarthritis in both knees and asks about nonpharmacologic therapies. What will the provider recommend? a. Aerobic exercise b. Glucosamine with chondroitin c. Therapeutic magnets or copper bracelets d. Using a cane or walker

ANS: A Aerobic exercise helps with cardiovascular conditioning and weight reduction as well as improved range of motion, decreased pain, and strengthening of supporting structures. Randomized controlled studies have failed to demonstrate significant pain relief with glucosamine. Therapeutic magnets and copper have not been proven to be effective. A young patient with mild symptoms will not need assistive devices and should focus on conditioning.

A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes. What will the primary care provider recommend as first-line treatment? a. Acyclovir b. Famciclovir c. Topical medications d. Valacyclovir

ANS: A All three oral antiviral medications help reduce the number of occurrences and the frequency of asymptomatic shedding. Famciclovir and valacyclovir are more costly and no more effective, so should not be first-line therapy. Topical medications are not useful with recurrent, frequent genital herpes.

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? a. Complicated b. Isolation c. Uncomplicated d. Unresolved

ANS: A All urinary tract infections (UTIs) in males are considered complicated, because the infection source is not secondary to ascending infection.

A patient reports bilateral 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? a. Allergic b. Bacterial c. Chemical d. Viral

ANS: A Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema. Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI.

A patient reports severe back pain located in the lumbar spine. To evaluate whether the patient has axial pain or radicular pain, which assessment is necessary? a. Asking the patient to perform the Valsalva maneuver b. Assessing reflexes and asking about tingling or numbness c. Determining whether the pain is present with prolonged sitting d. Noting whether pain is mitigated with frequent position shifts

ANS: A Associated neurological signs are present with radicular pain and include numbness, tingling, weakness, and reflex changes. The other symptoms occur with both axial and radicular pain.

A 20-year-old female patient with tachycardia and weight loss but no optic symptoms presents with 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? a. Beta blocker medications b. Radioiodine therapy c. Surgical resection of the thyroid gland d. Thionamide therapy

ANS: A Beta blockers should be initiated for patients with Graves' disease to alleviate the alpha-adrenergic symptoms of the hyperthyroidism. Radioiodine therapy is used for patients with Graves' ophthalmopathy. Surgical resection is performed for pregnant women who cannot be managed with thioamides or for patients who refuse radioiodine therapy. Thioamide therapy is recommended for patients younger than 20 years old, pregnant women, those with a high likelihood of remission, and those with active Graves' Orbitopathy.

A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially? a. Perform a suicide risk assessment b. Prescribe a selective serotonin reuptake inhibitor c. Refer the patient for psychotherapy d. Suggest cognitive-behavioral therapy

ANS: A For any patients with symptoms of depression, the initial action is to perform a thorough assessment and evaluate potential suicide risk. SSRIs can be prescribed once a diagnosis is determined according to diagnostic criteria. Psychotherapy and cognitive-behavioral therapy may also be prescribed.

A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment? a. Administration of intraarticular corticosteroid b. Discontinuing ULT while treating the flare c. Oral colchicine for 5 days d. Therapy with NSAIDs begun with in 24 hours

ANS: A Intra-articular steroids are practical and beneficial when only one or two joints are involved and are safe for patients who cannot use NSAIDs or colchicine. NSIADs are contraindicated in patients with renal disease and colchicine should not be used in those with low glomerular filtration rates. It is not necessary to discontinue urate-lowering therapy during an acute attack.

A patient diagnosed with chronic obstructive pulmonary disease reports daily symptoms of dyspnea and cough. Which medication will the primary health care provider prescribe? a. Ipratropium bromide b. Pirbuterol acetate c. Salmeterol xinafoate d. Theophylline

ANS: A Ipratropium bromide is an anticholinergic medication and is used as first-line therapy in patients with daily symptoms. Pirbuterol acetate and salmeterol xinafoate are both beta2-adrenergics and are used to relieve bronchospasm; pirbuterol is a short-term medication used for symptomatic relief and salmeterol is a long-term medication useful for reducing nocturnal symptoms. Theophylline is a third-line agent.

A patient is diagnosed with fibrotic liver disease; a liver biopsy shows micronodular cirrhosis. What is the most common cause of this form of cirrhosis? a. Alcoholism b. Hepatitis C c. Hepatocellular carcinoma d. Right-sided heart failure

ANS: A Micronodular cirrhosis is often associated with alcoholic liver disease. Viral causes and carcinoma usually cause macronodular cirrhosis. Right-sided heart failure occurs with many other causes as part of the disease development.

A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? a. Encourage activity and exercise. b. Prescribe a selective serotonin reuptake inhibitor (SSRI). c. Recommend risperidone. d. Referral to a neurologist for evaluation.

ANS: A Patients with AD may have improvement in depression with nonpharmacologic management, including exercise and increased activity. If this is not effective, an SSRI may be prescribed. Risperidone and other antipsychotics should not be prescribed.

An adolescent patient who plays football in high school is diagnosed with Epstein-Barr virus (EBV) infectious mononucleosis and is noted to have splenomegaly. What will the provider recommend to this patient about returning to sports? a. Abdominal ultrasounds are recommended to determine safety. b. Corticosteroid therapy may help shorten the course of the disease. c. He may return to minimal contact practice in 2 to 3 weeks. d. It will be safe to play football in 3 to 4 weeks.

ANS: A Patients with splenomegaly should be encouraged to refrain from strenuous activity for 3 to 4 weeks to avoid the risk of splenic rupture. Serial US studies beginning at week 2 to 3 may be helpful in determining the risk of rupture. Corticosteroids have not been shown to reduce the severity or duration of symptoms. Strenuous activity is not recommended until 3 to 4 weeks; without an US, it is not possible to ensure absolute safety for sports.

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? a. Obtaining a CBC, serum electrolytes, and glucose b. Ordering a CBC, serum ferritin, and TIBC c. Referring the patient to a dietician for nutritional evaluation d. Referring the patient to a neurologist for evaluation for AD

ANS: A Patients with weight loss, confusion, and lethargy are often dehydrated and this should be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leading an active life, so the likelihood that recent symptoms are related to AD, although this may be evaluated if dehydration is ruled out. Anemia would be a consideration when dehydration is ruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition or AD is present.

A postmenopausal female patient has a blood test that reveals hyperuricemia, although the patient has no symptoms of gout. What will the provider do initially? a. Ask the patient about medications and medical history b. Begin therapy with colchicine and an NSAID c. Recommend a low-purine, alcohol-restricted diet d. Treat for gout prophylactically to prevent a flare

ANS: A Patients without symptoms of gout but with hyperuricemia do not need treatment, since most of these patients will never have a gout flare. It is important, however, to determine the cause of this finding and correct it if possible, since it is a risk factor for gout. Certain medications and medical conditions can predispose patients to gout. Colchicine and NSAIDs are used to treat symptoms of gout. Dietary changes are not necessary and are difficult to follow. Prophylaxis for the prevention of flares is for patients who have gout and who are between flares.

A patient reports the sudden onset of pain, redness, and swelling in one knee joint but denies a fever. The provider elicits exquisite pain with manipulation of the joint and notes no decrease in pain when the joint is at rest. Which is the likely cause of this arthritis? a. Bacterial infection b. Gout c. Lyme disease d. Rheumatoid arthritis

ANS: A Septic arthritis is usually painful both with movement and at rest and is accompanied by swelling and erythema. Fever is not always present. The other causes of arthritis are not painful at rest.

A primary care provider administers the "Newest Vital Sign" health literacy test to a patient newly diagnosed with a chronic disease. What is gained by administering this test? a. Ability to calculate data, along with general knowledge about health b. Ease of using technology and understanding of graphic data c. Reading comprehension and reception of oral communication d. Understanding of and ability to discuss healthcare concerns

ANS: A The "Newest Vital Sign" tests asks patients to look at information on an ice cream container label and answer questions that evaluate ability to calculate caloric data and to grasp general knowledge about food allergies. It does not test understanding of technology or directly measure reading comprehension. It does not assess oral communication. The "Ask Me 3" tool teaches patients to ask three primary questions about their health care and management.

A woman who has had routine Pap tests all her adult life has an abnormal Pap. What will the provider tell her about this result? a. Colposcopy with biopsy is necessary b. She may have vaginal cancer c. She most likely has early cervical cancer d. The result most likely indicates HPV infection

ANS: A The Pap test is a screen and should be followed by colposcopy with biopsy. Women who have had Pap tests routinely are less likely to have cervical cancer.

Which maneuver during a physical examination is used to assess the anterior cruciate ligament (ACL)? a. Anterior drawer test b. Posterior drawer test c. Valgus stress on knee joint d. Varus stress on knee joint

ANS: A The anterior drawer test, in which the examiner pulls the tibia forward while the knee is flexed, is used to assess anterior cruciate ligament laxity. The posterior drawer test is used to determine posterior cruciate ligament laxity. The valgus stress test assesses the medial collateral ligament (MCL) laxity and the varus stress test assesses the lateral collateral ligament (LCL) laxity.

What is the benefit of using a liquid-based medium when performing a Pap test? a. It allows genital human papillomavirus (HPV), gonorrhea, and chlamydia testing with the same specimen. b. It is a more accurate test than the slide method of Pap testing. c. It is not necessary to use endocervical cells to obtain results. d. It is predictive of the later development of cervical cancer.

ANS: A The liquid-based medium method allows testing of HPV, gonorrhea, and chlamydia using the same specimen. It is not necessarily more accurate. MIt requires use of endocervical cells. It does not predict the development of cancer.

An adult patient has been diagnosed with atopic dermatitis and seborrheic dermatitis with lesions on the forehead and along the scalp line. Which is correct when prescribing a corticosteroid medication to treat this condition? a. Initiate treatment with 0.1% triamcinolone acetonide. b. Monitor the patient closely for systemic adverse effects during use. c. Place an occlusive dressing over the medication after application. d. Prescribe 0.05% fluocinonide to apply liberally.

ANS: A Treatment with 0.1% triamcinolone acetonide is appropriate in this case, because it is a class 4 corticosteroid and may be used on the face and is suggested for use for these conditions. Systemic side effects are rare when topical corticosteroids are used appropriately. Occlusive dressings increase the risk of adverse effects and are not recommended. 0.05% fluocinonide is a class III corticosteroid and should not be used on the face.

A patient is diagnosed with rheumatoid arthritis (RA) after a review of systems, confirmatory lab tests, and synovial fluid analysis. What will the provider order initially to treat this patient? a. Disease-modifying anti- rheumatic (DMARDs) drugs b. Long-term glucocorticoid therapy c. Non-pharmacological treatments d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A Treatment with DMARDs should be initiated as soon as the diagnosis of RA is established to achieve disease modification. Long-term glucocorticoid therapy is not recommended because of adverse effects. NSAIDs are not first-line drugs and increase the risk of cardiac and renal complications. NSAIDs are used as adjunctive and not first-line therapy.

A patient presents with a tender, red, swollen knee. you r/o septic arthritis and dx 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

ANS: B

Which diagnosis will the FNP consider for the following symptoms:secondary hypertriglyceridemia,coarse, dry skin,menorrhagia,hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex,coarse hair with tendency to break easily,thick dry nails,constipation a. Graves Disease b. Hypothyroidism c. NIDDM d. Metabolic syndrome

ANS: B

A 35-year-old patient is being seen in the primary care clinic for a routine assessment. The patient had her last pap smear in conjunction with an HPV screening three years before and has no abnormal gynecological signs or symptoms. The advanced practice registered nurse (APRN) performs a physical assessment with a clinical breast exam and then provides information about recommended health screenings. Which USPTF recommendations should the APRN share with this patient? a. "We should do a chlamydia screening today." b. "We need to do a pap smear in two years." c. "We need to schedule a mammogram this month." d. "We should do a HPV screening next year."

ANS: B "We need to do a pap smear in 2 years" HPV and Pap smear done together every 5 years

A cough associated with constant throat clearing and thick mucus production, especially on rising from bed, is consistent with: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold

ANS: B A cough associated with constant throat clearing and thick mucus production, especially on rising from bed, is consistent with upper airway cough and sinusitis.

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

ANS: B Antibiotic-vasoconstrictor agents can have a rebound effect with worsening symptoms if used longer than 3 to 7 days, so the provider should determine whether this is the cause. Topical mast cell stabilizers are useful as prophylaxis for recurrent or persistent allergic conjunctivitis and results do not occur for several weeks. Oral antihistamines may be the next step if it is determined that the cause of worsening symptoms is related to the allergy. It is not necessary to refer to ophthalmology at this time.

A patient reports having urinary frequency and discomfort associated with urination. After a careful physical examination and history to determine the cause, the NP should prescribe a medication from which drug class? a. cholinergics b. antispasmodics c. anticholinergics d. urinary tract analgesics

ANS: B Antispasmodics are smooth muscle relaxants. Use of these drugs can produce increased bladder capacity and exhibit local anesthetic and analgesic actions. Cholinergic agents increase detrusor muscle tone to improve initiation of voiding and bladder emptying. Anticholinergics decrease detrusor tone to treat urge incontinence. Urinary tract analgesics are used to treat pain via a local analgesic effect on urinary tract mucosa and are used in conjunction with antibiotics to treat UTI.

A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is always out of breath and has no more energy. His only medications are bronchodilators, which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left chest. What is the most likely cause of this physical finding? A. Asthma B. Pneumonia C. Emphysema D. Pneumothorax

ANS: B Egophony is an increased resonance of voice sounds when a medical professional auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is enhanced transmission of high-frequency noise across the fluid. Similarly, bronchophony and whispered pectoriloquy can be used to assess the lungs.

A patient presents to the clinic with left ankle pain after rolling their ankle when trying to kick a ball during a soccer game. Upon examination, the advanced practice registered nurse (APRN) notes pain with movement and swelling. The patient is diagnosed with a minor left ankle sprain. Which treatment should the APRN prescribe first for this patient? a. Air cast b. Elastic wrap c. Physical therapy d. Plaster casting

ANS: B Elastic wrap

A patient has been dx with generalized anxiety disorder (GAD). What medications might be helpful in relieving symptoms long term? a. Fluoxetine b. Escitalopram c. Buproprion d. Sertraline

ANS: B Escitalopram is used to treat depression and generalized anxiety disorder (GAD). It is an antidepressant that belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines work by increasing the activity of the chemical serotonin in the brain.

Which of the following imaging modalities should be used to assess for rotator cuff tear? a. Anteroposterior x-ray of the shoulder b. MRI of the shoulder without contrast c. CT scan of the shoulder with contrast d. Axillary x-ray of the shoulder

ANS: B MRI provides useful information about tear dimension, tear depth, tendon retraction, which can influence treatment decision. In addition, MRI also provides information about tendon retraction, muscle atrophy, fatty degeneration and coracoacromial impingement, which may have important prognostic implications

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? a. Buerger's disease b. Cauda equina syndrome c. Diabetic neuropathy d. Peripheral arterial disease (PAD)

ANS: B Patients with cauda equina syndrome, which causes spinal stenosis, will often not get relief until they sit down for a period of time. Buerger's disease involves both the upper and lower extremities. Diabetic neuropathy may mask pain. PAD involves these symptoms that stop with rest.

An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, the APRN is interviewing individual patients as well as conducting focused group sessions with multiple patients. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive

ANS: B Qualitative research relies on data obtained by the researcher from first-hand observation, interviews, questionnaires (on which participants write descriptively), focus groups, participant observation, recordings made in natural settings, documents, case studies, and artifacts.

A 43-year-old male presents to the primary care clinic with complaints of a cough that has persisted for 6 weeks (1.5 month). How with the APRN classify this patient's cough? A. Acute cough B. Subacute cough C. Chronic cough D. Chronic obstructive pulmonary disease

ANS: B Rationale: coughs may be classified as acute (lasting <3 weeks), subacute (lasting 3 to 8 weeks), and chronic (persisting beyond 8 weeks).1 Most coughs are acute and self-limited; 90% are caused by viral upper respiratory tract infections, two-thirds of which clear within 2 weeks.

The FNP diagnoses a 42-year-old male with glomerulonephritis. Which potential complications will be monitored? a. bradycardia b. hypertension c. decreased cardiac output d. hypotension

ANS: B Signs and symptoms of glomerulonephritis include: hypertension, tachycardia, edema, decreased urine output (oliguria), lethargy, and other signs of fluid overload. Pre-renal causes of acute renal failure are characterized by signs of hypotension.

A patient reports lower abdominal cramping and occasional blood in stools. The provider suspects inflammatory bowel disease. Which test will the provider order to determine whether the patient has ulcerative colitis (UC) or Crohn's disease (CD)? a. Barium enema b. Colonoscopy c. Genetic testing d. Small bowel series

ANS: B Colonoscopy is useful in differentiating UC from CD. Barium enema has limited use in diagnosis, but is used to detect distension, strictures, tumors, fistulas, or obstructions. Genetic testing may be helpful in the future with further advances. Small bowel series are used infrequently to determine small bowel involvement.

An advanced practice registered nurse (APRN) is conducting the routine annual exam of a 66-year-old patient and decides that a vaccine should be recommended in addition to the typical annual influenza vaccine. Which vaccine is being recommended by the APRN? a. Tetanus, diphtheria, and pertussis b. Pneumococcal c. Measles, mumps, and rubella d. Hepatitis B

ANS: B For older clients a one-time pneumovax is given after age 65.

A patient who has never had an outbreak of oral lesions reports a burning sensation on the oral mucosa and then develops multiple painful round vesicles at the site. A Tzanck culture confirms HSV-1 infection. What will the provider tell the patient about this condition? a. Antiviral medications are curative for oral herpes. b. The initial episode is usually the most severe. c. There are no specific triggers for this type of herpesvirus. d. Transmission to others occurs only when lesions are present.

ANS: B In herpes virus outbreaks, the initial episode is generally the most severe. Antiviral medications may prevent outbreaks, but do not cure the disease. HSV-1 has several specific triggers. Transmission to others may occur even when lesions are not present.

Which symptom in a patient diagnosed with asthma indicates severe bronchospasm? a. Breathlessness with minimal activity or eating b. Pausing to breathe while attempting to talk c. Repetitive, spasmodic coughing at night d. Wheezing after exposure to a trigger

ANS: B Inability to speak a full sentence without pausing to breathe indicates severe bronchospasm. Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs of bronchospasm and do not necessarily indicate severe bronchospasm.

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? a. Administer three more nebulizer treatments and reassess. b. Admit to the hospital with specialist consultation. c. Give epinephrine injections and monitor response. d. Prescribe an oral corticosteroid medication.

ANS: B Patients having an asthma exacerbation should be referred if they fail to improve after three nebulizer treatments or three epinephrine injections, have a peak flow less than 70% and a pulse oximetry reading less than 90% on room air. Giving more nebulizer treatments or administering epinephrine is not indicated. The patient will most likely be given IV corticosteroids; oral corticosteroids would be given if the patient is managed as an outpatient.

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? a. Add a beta blocker to the patient's regimen. b. Admit to the hospital for evaluation and treatment. c. Increase the dose of the thiazide medication. d. Prescribe a calcium channel blocker.

ANS: B Patients with a blood pressure >180/120 or those with signs of target organ symptoms should be admitted to inpatient treatment with specialist consultation. Changing the medications may be done with consultation, but a hospitalization and stabilization must be done initially.

A patient diagnosed with chronic constipation uses polyethylene glycol and reports increased abdominal discomfort with nausea and vomiting. What is the initial action by the provider? a. Increase the dose of polyethylene glycol b. Obtain radiographic abdominal studies c. Perform a stool culture and occult blood d. Refer to a specialist for colonoscopy

ANS: B Patients with abdominal pain, nausea, and vomiting should have radiologic studies to exclude obstruction, ileus, megacolon, or volvulus. If those are ruled out, increasing the laxative may be warranted. Stool culture is indicated if the parasite ascariasis is suspected. Referral for colonoscopy is needed if alarm symptoms for neoplasm are present.

A patient recovering from chronic alcohol abuse reports nausea, vomiting, diarrhea, and abdominal discomfort. A physical examination is negative for jaundice or ascites. What will the provider do initially? a. Obtain a bilirubin level and prothrombin time b. Order a complete blood count and liver function tests c. Reassure the patient that this is likely a viral gastroenteritis d. Refer the patient to a specialist for evaluation and treatment

ANS: B Patients with alcoholic hepatitis may present initially with signs of gastroenteritis. Based on the history, even without jaundice and ascites, the provider should order a CBC and LFTs. Bilirubin and PT levels are performed when a diagnosis is made to determine prognosis and course of the disease. Reassuring the patient without confirmation of disease is not recommended. Referral is made if hepatitis is diagnosed.

A patient reports chronic nasal obstruction and difficulty distinguishing smells. The provider examines the nares with a nasal speculum and observes several grape-like lesions in both nostrils. What is the likely cause of this patient's symptoms? a. Chronic sinusitis b. Nasal polyps c. Squamous cell carcinoma d. Vascular benign tumor

ANS: B Polyps cause obstruction and olfactory dysfunction and appear as grape-like lesions on the nasal mucosa. Most malignant neoplasms are asymptomatic until late in the course. Chronic sinusitis characteristically produces inflammation and purulent discharge.

The primary care provider is assessing a 45-year-old postmenopausal woman who has a family history of osteoporosis. Which test will be most useful to screen for this disease in this patient? a. Biochemical markers of bone resorption and bone formation b. Bone densitometry of the hip and posteroanterior lumbar spine c. Plain radiographs of the hips and lumbar and thoracic spine d. Serum calcium and serum 25-hydroxyvitamin D

ANS: B Postmenopausal women are candidates for bone densitometry to assess for osteopenia and osteoporosis. Biochemical markers are generally ordered by specialists; their role in primary care is uncertain. Plain radiographs are used to determine fracture. Serum calcium and vitamin D levels are useful in the general population as a preventive measure.

A patient reporting dyspnea and chest pain along with occasional chills and night sweats has a chest radiograph that shows bilateral hilar lymphadenopathy (BHL) and pulmonary infiltrates. The provider suspects which classification of sarcoidosis? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

ANS: B Stage 1 sarcoidosis is classified based on bilateral hilar lymphadenopathy (BHL) only. Stage 2 presents with BHL and pulmonary infiltrates, stage 3 with pulmonary infiltrates without BHL, and stage 4 with pulmonary fibrosis.

A patient diagnosed with acute renal colic is experiencing nausea and vomiting. 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? a. Obtain a consultation with a urology specialist b. Order a narcotic pain medication and increased oral fluids c. Prescribe desmopressin and a corticosteroid medication d. Prescribe nifedipine and hospitalize for intravenous antibiotics

ANS: B Stones that are less than 1 mm in diameter will usually pass spontaneously. The provider should counsel the patient to increase fluid intake and should prescribe adequate pain medication. A consultation is not necessary unless initial measures fail. Desmopressin and corticosteroids have not been shown to be effective. Nifedipine and IV fluids may be used as a secondary option.

An elderly adult patient 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? a. Digital subtraction angiography b. Doppler ankle, arm index c. Magnetic resonance angiography d. Segmental limb pressure measurement

ANS: B The Doppler study may be performed easily to indicate the likelihood of PAD. Other tests are performed only if indicated.

Which is the most appropriate research design for a Level III research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials

ANS: B The experimental design is the most appropriate design for a Level III study. Epidemiological studies are appropriate for level II studies. Qualitative designs are useful for Level I studies. Randomized clinical trials are used for Level IV studies.

A patient presents with 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? a. Empirical treatment with antibiotics b. Hospitalization for emergent treatment c. Prescribing ursodeoxycholic acid d. Supportive care with close follow-up

ANS: B This patient has symptoms of acute acalculous cholecystitis and is critically ill. Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.

A patient presents with 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? a. Empirical treatment with antibiotics b. Hospitalization for emergent treatment c. Prescribing ursodeoxycholic acid d. Supportive care with close follow-up

ANS: B This patient has symptoms of acute acalculous cholecystitis and is critically ill. Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.

A soccer player is brought to the emergency department after twisting an ankle during a game. An examination of the affected joint reveals ecchymosis and edema of the ankle and limited joint laxity along with pain on weight-bearing, although movement with pain is intact. Which grade sprain is likely? a. Grade I b. Grade II c. Grade III d. Grade IV

ANS: B This patient probably has a grade II sprain, which involves incomplete tear of a ligament with some functional impairment, ecchymosis, and pain with weight-bearing. A grade I sprain causes only pain and edema. A grade III sprain is a full or complete tear of the ligament with loss of ligament integrity. A grade IV sprain results in severe weakness with loss of function.

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

ANS: B Urine culture is the definitive test and should be obtained in all pregnant women. Admission to the hospital is usually not necessary. Renal ultrasound is used to identify abnormalities or obstructions that may be causing recurrent symptoms. TMP-SMZ is contraindicated in pregnant women.

A patient who has symptoms of 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? a. Antihistamine-vasoconstrictor drops b. Artificial tears and cool compresses c. Topical antibiotic eye drops d. Topical corticosteroid drops

ANS: B Viral conjunctivitis accompanies upper respiratory tract infections and is generally self-limited, lasting 5 to 14 days. Symptomatic treatment is recommended. Antihistamine-vasoconstrictor drops are used for allergic conjunctivitis. Topical antibiotic drops are sometimes used for bacterial conjunctivitis. Topical corticosteroid drops are used for severe inflammation.

A 30-year-old woman presents reporting right upper quadrant abdominal pain, nausea, and vomiting. The patient had finished a meal high in fat three hours earlier. The advanced practice registered nurse (APRN) finds a positive Murphy's sign on assessment. Which diagnostic test will the provider safely order? a. Abdominal computed tomography (CT) with contrast b. Abdominal ultrasound c. Magnetic resonance imaging (MRI) of the abdomen d. Plain abdominal radiographs

ANS: B Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.

A 90-year-old patient has been brought to the clinic from the nursing home with increasing memory impairment. The advanced practice registered nurse (APRN) completes an assessment and does not note any additional symptoms. Which diagnosis should the APRN make for this patient? Dementia Delirium Dystonia Depression

Dementia

A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The primary care provider determines that these symptoms occur in relation to many events and concerns. What else will the provider question this patient about?

Headaches and bowel habits This patient has symptoms consistent with GAD in which feelings occur in relation to many events patients with GAD often have headaches and irritable bowel syndrome

A 42-year-old patient diagnosed with generalized anxiety disorder is speaking with an advanced practice registered nurse (APRN) at a follow-up visit for the condition. The patient reports a new problem with insomnia due to a "racing mind" that has increased in frequency over the last three weeks. The sleeplessness has resulted in problems concentrating at work. Which medication should the APRN prescribe for this patient? Hydroxyzine Hydrochloride (Atarax) 25 mg Olanzapine (Zyprexa) 10 mg Aripiprazole (Abilify Maintena) 5 mg Ziprasidone (Geodon) 40 mg

Hydroxyzine hydrochloride (atarax) 25 mg

An advanced practice registered nurse (APRN) is assessing a patient who has been diagnosed with hepatitis. The patient has been treated at home and had liver function tests (LFTs) completed upon diagnosis. The APRN notes that repeat LFTs remain elevated after several weeks. Which action should the APRN recommend for this patient? a. Parenteral vitamin B therapy b. Schedule an oral glucose tolerance test c. Long-term antiviral therapy d. Referral for a liver biopsy

Referral for a liver biopsy

A patient with a history of Addison's disease presents to the clinic with extreme weakness, nausea, and vomiting. The advanced practice registered nurse (APRN) assesses the patient and notes the patient is confused. Assessment findings include: Vital signs blood pressure of 102/56 apical 78 regular temperature of 101.3 F (38.5 C) Diagnostics sodium: 122 mEq/L potassium: 5.2 mEq/L WBC: 16.4 X 109/L Which action should the APRN take? Transfer the patient to an emergency department Recommend an additional dose of corticosteroid Refer the patient to the endocrinologist Administer a broad-spectrum antibiotic

Transfer the patient to the ED

A patient has bone pain and laboratory testing reveals an elevated serum alkaline phosphatase (SAP). Which test can help distinguish Paget's from malignant bone disease? a. Bone densitometry b. Bone marrow biopsy c. Bone radiograph d. Bone scan

ANS: C A plain bone radiograph will show changes pathognomonic of Paget's disease. The other tests are not necessary.

A 50-year-old woman reports pain in one knee upon awakening each morning that goes away later in the morning. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the provider tell this patient? a. A magnetic resonance imaging study is necessary for diagnosis b. That the lack of findings indicates no disease process c. To take acetaminophen 1 gram three times daily for pain d. To use a cyclooxygenase 2-selective NSAIDs to reduce inflammation

ANS: C Acetaminophen is the mainstay for initial treatment of osteoarthritis. Radiologic findings are often negative in the early stages of the disease. There are no serologic markers for OA. A COX-2-selective inhibitor has cardiovascular side effects and should not be used unless necessary. These agents are used more for pain than for inflammation.

A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract infection. After treatment for the urinary tract infection (UTI), what testing is indicated for this patient? a. 24-hour urine collection to evaluate for glomerulonephritis b. Bladder scan c. Repeat urinalysis d. Voiding cystourethrogram

ANS: C After treatment has been completed, repeated urinalysis is necessary to ensure that the hematuria has resolved. Failure to follow hematuria to resolution may result in failure to diagnose a serious condition.

An adolescent patient has fever, pharyngitis, and cervical lymphadenopathy and has a negative group A beta-hemolytic throat culture. A complete blood count shows absolute lymphocytosis, but a heterophil antibody test is negative for Epstein-Barr virus (EBV). What will the provider tell the patient about the likelihood of infectious mononucleosis (IM)? a. It will be necessary to repeat the heterophil antibody test in a few weeks. b. Liver function tests will help to confirm a diagnosis of EBV-IM. c. The likelihood of EBV infectious mononucleosis is still high. d. This IM is most likely caused by a virus other than Epstein-Barr virus.

ANS: C Because heterophil antibodies may not reach detectable levels early in the disease, it is possible to have a negative result. This patient has symptoms and the suspicion for disease remains high. Repeat testing in 7 to 10 days will help confirm the diagnosis. A positive heterophil antibody test with absolute lymphocytosis is diagnostic of acute IM. Epstein-Barr nuclear antigen is measured 6 to 8 weeks after onset of symptoms to distinguish between acute and previous infection. LFTs may be elevated in patients with IM, but this is not diagnostic.

A patient experiences a second gouty flare and the provider decides to begin urate-lowering therapy (ULT). How should this be prescribed? a. Begin with a high-loading dose and gradually decrease. b. Start ULT during the current flare for best results. c. Start ULT in 5 weeks along with an anti-inflammatory drug. d. ULT should be suspended during future gouty flares.

ANS: C Beginning therapy with a urate-lowering drug during an acute flare will prolong the flare. Typically, ULT is begun 5 to 6 weeks after a flare and should be given with an anti-inflammatory drug, since the initial period of ULT administration is associated with flares. ULT dosing should start low and gradually increase. It is not recommended to stop ULT during future flares, but to treat those flares while continuing the ULT

A child has a primary immunodeficiency and the parent asks the provider about vaccines. What will the provider tell this patient? a. Avoid all vaccines since immunizations can cause disease in this child b. Immunized with all recommended childhood vaccines to prevent serious disease c. Some vaccines are contraindicated in those with T-cell involvement only d. The child may need more vaccine boosters than other children

ANS: C Children with T-cell disorders should not receive live-virus vaccines, but children with humoral deficiency may be given the vaccine. Vaccines are important to help prevent disease and children with immunodeficiency should receive any vaccines that are safe for them. Not all vaccines are recommended, since live-virus vaccines can cause disease in certain children

What is the purpose of clinical research trials in the spectrum of translational research? a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior

ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the preclinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage.

An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease (AD) since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? a. Order brain imaging studies such as CT or MRI. b. Perform genetic testing to identify true risk. c. Prescribe a trial of an antidepressant medication. d. Recommend a trial of a cholinesterase inhibitor drug.

ANS: C Elderly patients with depression who do not have other signs of AD may be given a trial of antidepressant medications initially in order to evaluate these symptoms. Brain imaging studies are not indicated initially. Genetic testing is not indicated. Once the degree of depression is determined and if other symptoms appear, an anticholinesterase inhibitor may be ordered.

Which test is diagnostic for diagnosing myocarditis? a. Echocardiogram b. Electrocardiogram c. Endomyocardial biopsy d. Magnetic resonance imaging

ANS: C Endomyocardial biopsy is the only definitive test to diagnose myocarditis. Other tests are useful in determining symptoms but are not specific to this diagnosis.

A female patient who is from the Middle East schedules an appointment in a primary care office. What will clinic personnel do to provide culturally responsive care when meeting this patient for the first time? a. Ensure that she is seen by a female provider. b. Include a male family member in discussions about health care. c. Inquire about the patient's beliefs about health and treatment. d. Research middle eastern cultural beliefs about health care.

ANS: C It is important not to make assumptions about beliefs and practices associated with health care and to ask the patient about these. While certain practices are common in some cultural and ethnic groups, assuming that all members of those groups follow those norms is not culturally responsive.

A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice-daily ketoconazole cream prescribed by the provider. What will the provider order for this patient? a. Burrow's solution soaks once daily b. Oral corticosteroids c. Oral itraconazole (Sporanox) d. Selenium sulfide shampoo 2.5% as a daily rinse

ANS: C Itraconazole is effective for moderate to severe symptoms and is an alternative for those who do not wish to use topical treatment. Burrow's solution and selenium shampoo rinses are not indicated. Oral corticosteroids are usually not given.

What is the purpose of Level II research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables

ANS: C Level II research is concerned with describing the relationships among characteristics or variables.

A patient who is an avid long-distant runner is diagnosed with viral myocarditis. What will the provider tell this patient when asked when resuming exercising is permitted? a. Exercise is contraindicated for life. b. Exercise may resume when symptoms subside. c. He may resume exercise in 6 months. d. He must be symptom-free for 1 year.

ANS: C Patients with myocarditis should not exercise for 6 months after the onset of symptoms.

A patient with a previous history of liver disease is diagnosed with a bile duct obstruction. Which procedure will be prescribed for this patient? a. Chemical dissolution of the gallstone b. Lithotripsy c. Open cholecystectomy d. Laparoscopic cholecystectomy

ANS: C Patients with possible liver disease should have open cholecystectomy. The other procedures are contraindicated. Chemical dissolution is not reliable and may take some time.

A patient's assessment confirms the patient has otalgia, a 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? a. Perform a tympanogram on the right ear. b. Recommend symptomatic treatment for fever and pain. c. Remove the cerumen and visualize the tympanic membrane. d. Treat empirically with amoxicillin 80 to 90 mg/kg/day.

ANS: C The AAP 2013 guidelines strongly recommend visualization of the tympanic membrane to accurately diagnose otitis media and not to treat based on symptoms alone. The practitioner should attempt to remove the cerumen to visualize the tympanic membrane. A tympanogram cannot be performed when cerumen is blocking the canal. Because the child may have an acute ear infection, antibiotics may be necessary.

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

ANS: C The vomitus with peptic ulcer disease contains mostly gastric juice. Bile duct obstruction will result in bilious vomitus. Gastritis vomitus contains blood and will have a coffee-ground appearance. Small bowel obstruction produces vomitus that is feculent.

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 primary care provider do next to evaluate this patient? a. Assess serum cortisol levels b. Continue to monitor blood pressure at each health maintenance visit c. Order urinalysis, CBC, BUN, and creatinine d. Refer to a specialist for a sleep study

ANS: C This patient has prehypertension levels and should be evaluated. UA, CBC, BUN, and creatinine help to evaluate renal function and are in the initial workup. Serum cortisol levels are performed if pheochromocytoma is suspected, which would cause a headache. The patient does not have to snore, so a sleep study is not indicated at this time. It is not correct to continue to monitor without assessing possible causes of early hypertension.

A patient has sudden onset of right upper quadrant (URQ) 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? a. Acute acalculous cholecystitis b. Chronic cholelithiasis c. Common bile duct obstruction d. Infectious cholecystitis

ANS: C This patient has symptoms of cholecystitis with bile duct obstruction, which causes jaundice. The common triad of RUQ pain, fever, and jaundice occurs when a stone is lodged in the common bile duct. Acute acalculous cholecystitis is inflammation without stones. Chronic cholelithiasis does not cause acute symptoms; jaundice occurs with obstruction. Infectious cholecystitis may occur without obstruction.

A patient 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 wt 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

ANS: D

A cough that lasts for 3 consecutive months for more than 2 consecutive years is indicative of: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold

ANS: D A cough that lasts for 3 consecutive months for more than 2 consecutive years is indicative of chronic bronchitis.

What is the purpose of Level III research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables

ANS: D Level III research evaluates the nature of the relationships between two variables.

Which of the following groups should asymptomatic bacteria be treated? a. Patients with diabetes mellitus b. Patients with spinal cord injuries c. Patients with indwelling catheters d. Pregnant patients

ANS: D Pregnant women are at an increased risk of asymptomatic bacteriuria becoming acute cystitis and/or acute pyelonephritis, and the maternal and obstetric risk associated with pyelonephritis are great. However, the Infectious Disease Society of America does not recommend that the remaining groups in the list undergo treatment of asymptomatic bacteriuria.

Which is the most appropriate research design for a Level IV research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials

ANS: D Randomized clinical trials are used for Level IV studies.

An advanced practice registered nurse (APRN) is debriefing and doing a review of a workplace violence incident. The APRN is gathering feedback from participants at all levels who were involved. Which phase of emergency management is the APRN addressing? a. Preparedness b. Mitigation c. Response d. Recovery

ANS: D Recovery

A patient seeks medical attention for fatigue, sleep disturbances, and vague symptoms of pain. The advanced practice registered nurse (APRN) assesses the patient with the fibromyalgia criteria and finds that the patient meets the conditions for the health problem. Which medication should the APRN prescribe to help this patient with sleep? a. Milnacipran (Savella) b. Fluoxetine (Prozac) c. Wellbutrin (Bupropion) d. Trazodone (Desyrel)

ANS: D Trazodone (Desyrel)

A 34-year-old male with no significant past medical history. He lives at home with his wife and two children, ages 6 and 10. No known drug allergies. He presents to an urgent care clinic with a 2-day history of fever and sore throat. On exam, he is noted to have dry mucous membranes, enlarged lymph nodes, and a sore throat with exudative patches on the tonsils. The patient's Rapid Antigen Detection Tests resulted positive for Group A Strep. Which of the following is the most appropriate treatment for this patient? a. Vancomycin15 mg/kg IV q 12 hours b. Clindamycin 450 mg TID c. Azithromycin 500 mg x1, 250 mg days 2-5 d. Amoxicillin 500 mg BID

ANS: D viral etiologies do not require medication therapy -1st line= penicillin or amoxicillin *penicillin V: child 250mg BID or TID x 10 days; adult 250mg TID or QID OR 500mg BID x 10 days *amoxicillin: 50mg/kg once daily (max 1000mg) OR 25mg/kg BID (max 500mg) x 10 days *benzathine penicillin G 600000 units IM for pts<27kg x 1 dose; 1.2 million units IM for pts>27kg x 1 dose -penicillin allergy: 1st gen ceph, clinda, macrolide

An elderly patient reports experiencing syncope each morning when getting out of bed. Which assessment will the health care provider perform first to evaluate this patient's symptoms? a. Cardiac enzyme levels b. Electroencephalogram c. Fasting blood glucose d. Orthostatic blood pressures

ANS: D Orthostatic blood pressure should be measured first since this patient reports problems associated with rising from a supine position. The other tests are performed as part of the diagnostic workup only if indicated by associated symptoms or suspected causes.

A patient has both occasional "coffee ground" emesis and melena stools. What is the most probably source of bleeding in this patient? a. Hepatic b. Lower gastrointestinal (GI) tract c. Rectal d. Upper gastrointestinal (GI) tract

ANS: D Coffee ground emesis is usually old blood from an upper GI source and melena is black, shiny, foul-smelling as a result of blood degradation and is usually upper GI in origin. Lower GI and rectal bleeding will cause bright red blood in stools. Hepatic bleeding usually does not affect the GI tract.

A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the significance of this finding? a. Compression of the common bile duct b. Presence of a pancreatic pseudocyst c. Retroperitoneal hemorrhage d. Severe acute pancreatitis with peritonitis

ANS: D Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is present with compression of the common bile duct. Palpation of a mass suggests the presence of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal hemorrhage.

A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the significance of this finding? a. Compression of the common bile duct b. b. Presence of a pancreatic pseudocyst c. Retroperitoneal hemorrhage d. Severe acute pancreatitis with peritonitis

ANS: D Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is present with compression of the common bile duct. Palpation of a mass suggests the presence of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal hemorrhage.

A homeless patient who has human immunodeficiency virus (HIV-1) infection has been on antiretroviral therapy (ART) for 18 months and has had normal CD4 counts and viral loads for past year. What will the provider recommend? a. Allow for periods of time off from ART medications b. Begin monitoring viral load and CD4 counts every 6 to 12 months c. Consider beginning highly active antiretroviral therapy (HAART) d. Continue monitoring viral lNoUadRaSnId NCGDT4Bco.uCntOsMevery 3 to 4 months

ANS: D In patients who are clinically well and highly adherent, who have normal CD4 counts and viral loads, monitoring may begin at 6-month intervals and sometimes annually. Those with risk factors such as homelessness, however, must continue to be monitored every 3 to 4 months. ART medications should never be interrupted unless there are medical reasons for doing so. HAART is given only by clinicians with significant training and experience in its use to patients who meet specific criteria.

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 parent? a. The infant should be given prophylactic antiviral medications. b. The infant should have an influenza vaccine now with a booster in 1 month. c. The infant should have the live attenuated influenza vaccine (LAIV). d. The infant should not but family and all close contacts should be vaccinated.

ANS: D Infants are not given influenza vaccine until age 6 months. To protect infants younger than 6 months, it is important for other family members and close contacts to be vaccinated. LAIV is approved for use in children over age 2 years. Antiviral prophylaxis is not recommended.

A patient has an acute onset of lower back pain associated with lifting heavy objects at work. A physical examination reveals no loss of lower extremity function or neurological symptoms. What is the initial intervention for this patient? a. Magnetic resonance imaging (MRI) to evaluate soft tissue involvement b. Plain radiographs to evaluate the extent of the injury c. Traction therapy to minimize complications d. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)

ANS: D NSAIDs are appropriate as first-line treatment in patients without potential complications. Radiologic studies are performed if improvement does not occur in 4 to 6 weeks. Traction may be used for patients with radicular symptoms to help resolve neurological deficits, although systematic review of research has not clearly identified a benefit to this therapy.

A healthy 20-year-old patient reports having had 1 or 2 episodes of syncope without loss of consciousness. Which is the most likely type of syncope in this patient? a. Cardiac b. Neurogenic c. Orthostatic hypotension d. Reflex syncope

ANS: D Neurally mediated or reflex syncope is the most common cause of syncope and is primarily seen in young adults. Cardiac, neurogenic, and orthostatic syncope are generally seen in older adults.

A primary care provider is providing care for a postsurgical client who recently immigrated to the United States and speaks English only marginally. What intervention will provide the most effective means of communicating postdischarge information to the client? a. Postpone discharge until the client is fully recovered from the surgery. b. Requesting that a family member who speaks English be present during the teaching session c. Providing the necessary information in written form in the client's native language d. Requesting the services of a professional interpreter fluent in the client's native language

ANS: D Only approved, professional interpreters experienced in health care interpretation are appropriate interpreters for patients. Family members or friends should not be used as interpreters. Use of family members or friends may create misinterpretation or misunderstanding between the provider and the patient. Family members may not understand medical terms or may interpret only what they feel is important, or patients might feel uncomfortable divulging personal information to the person interpreting. Written information in the client's native language may be a means of reinforcing instructions but are not a substitute of person-to-person education. It is neither realistic nor necessary to postpone discharge for this reason.

A patient has recurrent lumbar pain which is sometimes severe. The patient reports that prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is no longer effective for pain relief. What will the provider recommend? a. Adjunctive treatment with physical therapy b. Beginning treatment with opioid analgesics c. Complementary and alternative therapies d. Referral to an interventional spine physician

ANS: D Patients with recurrent or chronic lower back pain may benefit from lumbar epidural corticosteroid injection performed by an interventional spine physician. Physical therapy is often used for acute injury if no improvement in 4 to 6 weeks. Opioid analgesics are not usually effective.

A 45-year-old patient reports a recent onset of unilateral shoulder pain which is described as diffuse and is associated with weakness of the shoulder but no loss of passive range of motion. What does the provider suspect as the cause of these symptoms? a. Acromioclavicular joint disease b. Cervical radicular pain c. Glenohumeral arthritis d. Rotator cuff injury

ANS: D Rotator cuff injury is usually characterized by diffuse pain, weakness of the joint, but no change in range of motion. Acromioclavicular joint disease is associated with anterior-superior shoulder pain. Glenohumeral arthritis has similar symptoms, but with loss of range of motion. Cervical radicular pain is characterized by pain distal to the elbow.

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? a. Administer LAIV influenza vaccine b. Begin treatment with an antiviral medication c. Observe for improvement or worsening for 24 hours d. Perform a nasal swab for RT-PCR assay

ANS: D Samples to isolate the virus should be collected within 12 to 36 hours of onset of illness and this should be performed to confirm the disease. Administration of the LAIV influenza vaccine will not prevent symptoms in this patient, is not recommended in persons over 59 years of age, and is contraindicated when also giving antiviral medications. Antiviral drugs should be started within 48 hours of onset of illness and may be started empirically while waiting on cultures because this patient is higher risk than younger patients. Because identification of the virus and effectiveness of treatment are time-limited, it is not correct to watch and wait for symptoms to worsen.

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

ANS: D Uric acid stones are more prevalent in diabetics. Citrate, cysteine, and oxalate are less common in all patients.

A previously healthy patient develops myocarditis and presents with sudden onset of dyspnea, fatigue, and orthopnea. A family history is negative. The primary care provider suspects myocarditis. What is the most likely etiology for this patient? a. Autoimmune disorder b. Bacterial infection c. Protozoal infection d. Viral infection

ANS: D Viral infection is the most common cause of myocarditis. Other infections are less likely. Although this patient may have an autoimmune disorder, the absence of family history makes this somewhat less likely.

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? a. Allergic pharyngitis b. Group A streptococcus c. Infectious mononucleosis d. Viral pharyngitis

ANS: D Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by URI symptoms of cough and runny nose. Allergic pharyngitis usually also causes dryness. GAS causes high fever, cervical adenopathy, and marked erythema with exudate. Infectious mononucleosis will cause an exudate along with cervical adenopathy.

A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding? a. Electrocardiography b. Gallbladder ultrasonography c. Mammography d. Polysomnography

ANS: D Women with a neck circumference greater than 16 cm have an increased risk of obstructive sleep apnea and should have polysomnography to assess for this complication. The other tests may be necessary for obese patients but are not specific to this finding.

A 51-year-old male is being seen in the primary care clinic for a routine assessment. The patient has not been seen in the clinic for a number of years. The advanced practice registered nurse assesses the patient and notes physical assessment and VS findings to be WNL. Which additional screening should the APRN recommend? a. Prostate screening b. Osteoporosis screening c. Colorectal screening d. Abdominal aortic aneurysm screening

c. Colorectal screening Q10 YEARS starting at age 50

A 25-year-old female comes to the outpatient clinic complaining of suprapubic pressure and burning with urination for the past two days. She denies having any chills but states that she may have had a fever yesterday. Upon further questioning, the patient denies any previous infections. The next step will be: a. Obtain a urine dipstick. b. Get a urine culture and sensitivity. c. Ascertain any drug allergies. d. Refer the patient to a urologist.

ANS: B In an uncomplicated or non-recurring urinary tract infection, a urinalysis (dipstick or microscopic) can adequately identify urinary tract infections. A urine culture and sensitivity should be performed in the following cases: (1) any patient with a first febrile infection; (2) a recurrent infection with or without fever (more than one per year); (3) a urinary calculi; and (4) a congenital defect

A patient has returned to the clinic after having received outpatient antibiotic treatment for pneumonia due to still having symptoms. The FNP determines the patient now has a CURB-65 score of 3. What next steps would the FNP take for this patient's treatment plan? a. prescribe antibiotics and supportive care for home treatment b. admit to the hospital for inpatient care c. supportive care only at home d. arrange home O2 and educate on nebulizer treatments

ANS: B Interpretation of CURB-65 score: 0-1: Probably suitable for home treatment; low risk of death. 2: Consider hospital supervised treatment. 3: Manage in hospital as severe pneumonia; high risk of death.

A patient presents with 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? a. Order an anti-streptolysin O (ASO) titer. b. Perform a rapid antigen detection test (RADT). c. Prescribe empirical penicillin. d. Refer to an otolaryngologist.

ANS: B The RADT is performed initially to determine whether Group A Beta-hemolytic Streptococcus (GAS) is present. The ASO titer is not used during initial diagnostic screening. Penicillin should not be given empirically. A referral to a specialist is not required for GAS infection.

An adult patient presents to the clinic complaining of upper to mid-abdominal pain that has been occurring off and on for two months. The pain is the right upper abdominal area that comes and goes but is increased after eating spicy food. The advanced practice registered nurse (APRN) notes the vital signs are within normal limits, and the abdomen is soft with active bowel sounds. Palpation reveals tenderness in RUQ and a positive Murphy's sign. ECG and CXR are negative. Alkaline phosphatase and total bilirubin are within normal limits. Which diagnosis should the APRN suspect? a. Acute gastroenteritis b. Pancreatitis c. Acute cholecystitis d. Diverticulitis

ANS: C Acute cholecystitis Murphy's sign is gallbladder

A patient presents to an advanced practice registered nurse (APRN). Symptoms include generalized stiffness with painful, tender, and swollen joints. These symptoms started two months before and involved bilateral upper and lower limbs. Which diagnostic studies should the APRN order for this patient? a. Uric acid level b. Lipoprotein panel c. Erythocyte sedimentation rate (ESR) d. Basic metabolic panel

ANS: C Erythrocyte sedimentation rate (ESR)

A 40 yr old woman is dx with a first episode of moderate depression. What medication would be a good initial choice for her? a. Fluoxetine (prozac) b. Paroxetine(Paxil) c. Escitalopram (Lexapro) d. Lorazepam (ativan)

ANS: C Escitalopram 10 mg/d was the optimal dose for the treatment of moderate DSM-IV MDD, while escitalopram 20 mg/d was an effective dose in patients with moderate to severe depression.

Acute adrenal insufficiency is the most serious complication of: a. Cushing's disease b. SLE c. Addison's disease d. hypothyroidism

ANS: C Hypofunction of the adrenal cortex results in an inadequate release of glucocorticoids, resulting in dangerously low BP extreme tiredness, weakness, confusion, dizziness, faintness, nausea, or vomiting. Adrenal antibody tests are performed as part of the evaluation for Addison's disease. Mineralocorticoids and glucocorticoids are given to patients with Addison's disease.

A patient was initially treated as an outpatient for pneumonia and then after 2 weeks was hospitalized after no improvement was evident. The patient continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient? a. Administration of the pneumonia vaccine b. Increasing the dose of the antibiotics c. Open lung biopsy d. Performing diagnostic bronchoscopy

ANS: D Patients who do not respond to antibiotic therapy may have opportunistic fungal or other infections, bronchogenic carcinoma, or other diseases. Bronchoscopy can exclude or confirm these. The pneumonia vaccine is preventative for pneumococcal causes and will not help this patient. Increasing the dose of the antibiotics is not recommended. Open lung biopsy may be performed if a bronchoscopy is inconclusive.

Which of the following groups should asymptomatic bacteremia be treated? a. Patients with diabetes mellitus b. Patients with spinal cord injuries c. Patients with indwelling catheters d. Pregnant women

ANS: D Pregnant women are at an increased risk of asymptomatic bacteriuria becoming acute cystitis and/or acute pyelonephritis, and the maternal and obstetric risk associated with pyelonephritis are great. However, the Infectious Disease Society of America does not recommend that the remaining groups in the list undergo treatment of asymptomatic bacteriuria.

A 43-year-old IV drug user who has been on ART treatment complains of continuous diarrhea that is watery, epigastric pain, and difficulty swallowing. His CBC shows a hemoglobin of 7.0 mg/dl, a total leukocyte count of 2900cmm, and a platelet count of 70,000. A CD4+ cell count was requested and it came out to be 90/cmm. Which of the following laboratory investigations would best help with the further evaluation of his diarrhea? A. Stool tests for oocysts of cryptosporidium B. Blood cultures for progressive disseminated histoplasmosis C. Microscopy for pseudohyphae of Candida albicans D. A stool for ova and parasites test for giardiasis

ANS: A The scenario is indicative of diarrhea due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm. The diarrhea is of chronic nature and watery. The diagnosis is based on finding acid fast oocysts in stool and also by antigen detection. With declining CD4+ counts opportunistic infections become common. Histoplasmosis usually presents with CD4+ counts usually between 100-200 cubic mm and fever, cough, dyspnea are the predominant symptoms. Giardiasis has no specific association with AIDs and presents usually with fatty diarrhea, not watery. Candida Albicans causes esophagitis at cell counts lower than 100 per cubic mm which explains the features of epigastric pain and dysphagia but has no associations with diarrhea.

An APRN is evaluating a patient with a persistent cough. The patient's chest radiograph is normal. Which condition cannot be ruled out as the cause of the cough? A. Bronchiectasis B. Sarcoidosis C. Acute Bronchitis D. Malignant lung cancer

ANS: C Rationale: A normal chest radiograph usually excludes malignant disease, bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis.

Which policy has the Centers for Medicare and Medicaid Service (CMS) implemented to reduce adverse events associated with care transitions? a. Mandates for communication among primary caregivers and hospitalists b. Penalties for failure to perform medication reconciliations at time of discharge c. Reduction of payments for patients readmitted within 30 days after discharge d. Requirements for written discharge instructions for patients and caregivers

ANS: C Reduction of payments for patients readmitted within 30 days after discharge Think of the paper you had to write in D117 that was stupid As a component of the Affordable Care Act, the CMS developed the Readmissions Reduction Program reducing payments for certain patients readmitted within 30 days of discharge

A 62-year-old patient is seen by an advanced practice registered nurse (APRN) for intermittent buzzing in the ears. The patient has no history of exposure to loud noises at work but does have a history of attending many loud rock concerts. Otoscopic inspection reveals no excess cerumen and normal tympanic membranes. Audiology testing reveals mild hearing loss bilaterally. The patient denies dizziness and has no known allergies. Review of medications includes low-dose aspirin, multivitamin, calcium supplement, and over-the-counter Ibuprofen prn for back and hip pain related to arthritis. Which treatment should the APRN recommend for this patient? a. Refer to physical therapy for canalith repositioning b. Prescribe use of an antihistamine c. Replace NSAID with a Cox2 inhibitor d. Order application of carbamide dioxide daily

ANS: C Replace NSAID with a COX2 inhibitor

A 65-year-old female patient presents to the clinic complaining of abdominal pain,n/v, distention, &constipation for the past few days. The FNP auscultates high-pitched (aka "tinkling") bowel sounds. What condition does the FNP suspect? a. Viral Gastroenteritis b. IBS c. Bowel obstruction d. Food poisoning

ANS: C Symptoms of intestinal obstruction are: Severe pain in your belly. Severe cramping sensations in your belly. Throwing up. Feelings of fullness or swelling in your belly. Loud sounds from your belly. Feeling gassy, but being unable to pass gas. Constipation (being unable to pass stool)

A 35-year old patient develops acute viral bronchitis. Which is the focus for the management of symptoms in this patient? a. Trimethoprim-sulfamethoxazole therapy b. Antibiotic therapy c. Supportive care d. Antitussive therapy

ANS: C The mainstay of treatment in acute bronchitis is directed toward symptom reduction and supportive care. Data suggest that 85% of patients diagnosed with acute bronchitis will improve without specific treatment. Trimethoprim-sulfamethoxazole is prescribed for pertussis when macrolides are not an option. Antibiotic therapy is not effective in treating viral acute bronchitis.

A patient reports recurrent headaches occurring 1 or 2 times per month that generally occur with weather changes or when sleep patterns are disrupted. They are described as severe, with throbbing on one side of the head and sometimes accompanied by nausea. What is the recommended abortive treatment for this type of headache? a. Gabapentin b. Propranolol c. Ergotamine tartrate d. Topiramate

ANS: C This patient describes migraine headache without aura and has fewer than 4 per month. An abortive medication, such as ergotamine tartrate, is recommended. The other medications are preventive medications and are used for patients having more than 4 per month.

A pregnant woman tests positive for human immunodeficiency virus (HIV-1) infection. What will the provider recommend? a. Consideration of termination of the pregnancy b. No treatment and caesarian section for delivery c. Treatment with highly active antiretroviral therapy (HAART) d. Treatment with standard antiretroviral therapy

ANS: C An absolute indication for treatment with highly active antiretroviral therapy (HAART) is the treatment of a pregnant woman to prevent mother-to-child transmission. Recommended regimens have no known significant fetal toxicity and can reduce the risk of vertical transmission from approximately 25% to less than 2%, making elective caesarean section no longer indicated in treated pregnant women.

A young, previously healthy adult clinic patient reports 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. A B-lactam antibiotic plus a fluoroquinolone b. A respiratory fluoroquinolone antibiotic c. Empirical treatment with a macrolide antibiotic d. Hospitalization for intravenous antibiotics

ANS: C This patient likely has community-acquired pneumonia. The patient has typical symptoms and, even though the chest radiograph is normal, will require outpatient treatment. For community-acquired pneumonia in a previously healthy individual, treatment with a macrolide antibiotic is the recommended first-line therapy. B-lactam plus fluoroquinolone therapy is used for patients in the ICU. Respiratory fluoroquinolones are used for patients with underlying disorders who develop pneumonia. Hospitalization is not necessary.

A 60-year-old female patient has recently lost weight and a physical examination reveals a beefy-red, sore tongue, with no neurological findings. Based on these clinical findings, what will the provider anticipate finding in the laboratory data? a. Decreased homocysteine levels b. Leukopenia and thrombocytopenia c. Low hemoglobin and elevated MCV d. Normal methylmalonic acid level

ANS: C Macrocytic anemia caused by vitamin B12 deficiency will have symptoms described above. Although folate acid deficiency causes macrocytic anemia, there are rarely any symptoms. Hemoglobin will be decreased and MCV will increase. Homocysteine levels will be increased. The patient with B12 deficiency will have leukopenia and thrombocytopenia with severe deficiency, characterized by neurologic findings, which this patient does not have. Methylmalonic acid level will decrease.

A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the provider order initially to manage this patient's symptoms? a. A trial of sulfasalazine and methotrexate b. Biologic anti-tumor necrosis factor agents c. Changing to a COX-1 inhibitor medication d. Corticosteroid injections every 3 months

ANS: C NSAIDs have been shown to reduce pain and stiffness and reduce progression of structural damage if administered continuously. Patients should try at least two NSAIDs before other medications are attempted. Sulfasalazine and methotrexate have not been shown to be significantly effective for axial disease. Biologic anti-tumor necrosis factor medications are given only after failure of two NSAIDs. Corticosteroid injections are not indicated.

What is a goal of the Healthy People initiative? a. To increase a patient's quality of life b. To create physical environments that promote proper health c. To achieve health equality by eliminating disparities d. To provide free health care to those unable to pay for care e. To promote healthy behaviors across all life stages

ANS: C Overarching goals of the Healthy People initiative are to increase quality and length of life, free of preventable disease, disability, injury, and premature death; to achieve health equality by eliminating disparities; to create social and physical environments that promote proper health; and to promote increased quality of life, healthy development, and healthy behaviors across all life stages, all goals consistent with the definition of wellness. Free health care is not a stated goal of the initiative.

A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccines? a. Country-specific guidelines are provided by individual embassies. b. Malaria vaccine is the most important vaccine for worldwide travel. c. Requirements should be reviewed at least 4 to 6 weeks prior to travel. d. There are at least five required vaccines for entry into certain countries

ANS: C Patients seeking immunizations prior to international travel should have these reviewed at least 4 to 6 weeks prior so that antibody responses and completion of vaccine series may occur. Country-specific guidelines may be found on the CDC website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines that are required.

A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient? a. Dialysis only b. Immunosuppressant therapy c. Kidney transplantation d. Palliative care

ANS: C Patients with SLE who develop renal failure may require dialysis and then kidney transplantation; most who undergo transplant do relatively well because of the immunosuppression given to prevent graft rejection. Immunosuppressant therapy is given for graft rejection and does not treat end-stage renal failure. Palliative care is not the only option for this patient.

An adult develops a chronic cough with episodes of wheezing and shortness of breath. The primary care 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? a. Allergy testing b. Methacholine challenge test c. Peak expiratory flow rate (PEFR) d. Spirometry

ANS: D Spirometry is recommended at the time of initial assessment to confirm the diagnosis of asthma. Allergy testing is performed only if allergies are a possible trigger. The methacholine challenge test is performed if spirometry is inconclusive. PEFR is generally used to monitor asthma symptoms.

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? a. Allergy testing b. Methacholine challenge test c. Peak expiratory flow rate (PEFR) d. Spirometry

ANS: D Spirometry is recommended at the time of initial assessment to confirm the diagnosis of asthma. Allergy testing is performed only if allergies are a possible trigger. The methacholine challenge test is performed if spirometry is inconclusive. PEFR is generally used to monitor asthma symptoms.

Which test is most diagnostic for chronic obstructive pulmonary disease (COPD)? a. COPD Assessment Test b. Forced expiratory time maneuver c. Lung radiograph d. Spirometry for FVC and FEV1

ANS: D Spirometry testing is the gold standard for the diagnosis and assessment of COPD because it is reproducible and objective. The forced expiratory time maneuver is easy to perform in a clinic setting and is a good screening to indicate a need for confirmatory spirometry. Lung radiographs are non-specific but may indicate hyperexpansion of the lungs. The COPD assessment test helps measure health status impairment in persons already diagnosed with COPD.

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

ANS: D Studies have demonstrated that an exercise program involving walking to the point of pain is as effective as angioplasty. Medications are useful to prevent the progression of plaque formation and to prevent myocardial infarction (MI).

A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of sadness and hopelessness and a feeling that the parent is still present, even to the point of hearing the parent's voice at times. What will the provider determine from these findings? a. There is a concern for hypermania. b. There is a possibility of manic episodes. c. These are concerning for depression. d. These are normal grief responses.

ANS: D These are short-lived symptoms at this point, lasting less than 2 months. Auditory and sensory hallucinations only in relation to the deceased are normal during intense grief. Hypermania is an acute, short-lived manic episode. Mania involves abnormal elevation of a person's mood. Depression is present when symptoms of grief are more severe and more prolonged.

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? a. Order a CBC, type and crossmatch, electrolytes, and renal function tests. b. Perform an ultrasound examination to evaluate the cause. c. Schedule the patient for an aortic angiogram. d. Transfer the patient to the emergency department for a surgical consult.

ANS: D This patient has symptoms and physical findings consistent with a ruptured aortic aneurysm and should have an immediate surgical consult. Ordering other tests is not necessary by the primary provider.

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? a. Immediate referral to a thoracic surgeon b. Ordering computerized tomography (CT) angiography c. Scheduling a magnetic resonance imaging (MRI) to evaluate for aortic disease d. Ultrasound of the mass to determine size (US)

ANS: D This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by US. Immediate referral is not necessary. MRI and CT diagnostic tests are ordered before surgery to evaluate the characteristics of the aneurysm.

A provider examines a patient who has chronic nasal obstruction, respiratory tract symptoms, and generalized malaise. An examination of the nasal mucosa reveals ulceration of the nasal septum. What is the most important action when caring for this patient? a. Administering prednisone b. Obtaining a chest radiograph c. Performing laboratory tests d. Referring to a specialist

ANS: D This patient has symptoms of granulomatosis with polyangiitis (GPA) and should be referred as soon as the disease is suspected. The other actions will be taken, but referral is the most important.

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

ANS: D Thyroid ultrasound evaluation should be performed for all patients with known thyroid nodules; high-resolution sonography can clearly distinguish between solid and cystic components. Radionucleotide imaging is not specific; many cold nodules are benign. The routine measurement of serumNcaUlcRitSoIniNnGleTveBls.iCsOnoMt useful or cost-effective. TSH levels are not specific to malignancy.

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

ANS: D Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing fluid intake will increase symptoms. PT referral may be done if other measures fail to help with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an initial therapy.

A young female has a Pap test which reveals atypical squamous cells of undetermined significance. What will the next step be in managing this patient? a. Colposcopy with biopsy b. Endometrial sampling c. Reflex HPV DNA test d. Repeat cytology in 12 months

ANS: D Young women with ASC-US may have repeat cytology testing in 12 months. Colposcopy with biopsy is performed if low-grade intraepithelial lesions or high-grade squamous intraepithelial lesions are present. Reflex HPV DNA testing is not indicated. Endometrial sampling is performed with low- or high-grade lesions in women who are older than 35 years.

A nonsmoking adult with a history of cardiovascular disease reports having a chronic cough without fever or upper airway symptoms. A chest radiograph is normal. What will the provider consider initially as the cause of this patient's cough? a. ACE inhibitor medication use b. Chronic obstructive pulmonary disease c. Gastroesophageal reflux disease d. Psychogenic cough

ANS: A About 10% of patients taking ACE inhibitors will develop chronic cough. COPD, GERD, and psychogenic causes are possible, but given this patient's cardiovascular history, the possibility of ACE inhibitor-induced cough should be investigated initially.

A 43-year-old male presents to the primary care clinic with complaints of a cough that has persisted for 2 weeks. How with the APRN classify this patient's cough? A. Acute cough B. Subacute cough C. Chronic cough D. Chronic obstructive pulmonary disease

ANS: A An acute cough is a cough that last less than 3 weeks

A patient injures an ankle while playing soccer and reports rolling the foot inward while falling with immediate pain and swelling of the lateral part of the joint. The patient is able to bear weight and denies hearing an audible sound at the time of injury. What does this history indicate? a. Likely ankle sprain with a possible fracture b. Mild ankle injury without fracture c. Mild soft tissue injury only d. Serious ankle injury with certain fracture

ANS: A Immediate swelling of the joint raises the index of suspicion for a fracture or a substantial amount of joint involvement. Without radiographs, none of these possibilities can be confirmed.

A patient reports chronic nasal obstruction and recurrent epistaxis. Which type of nasal mass is likely? a. Inverted papilloma b. Nasal polyp c. Paranasal lymphoma d. Squamous cell carcinoma

ANS: A Inverted papillomas are benign tumors of the nasal mucosa and are highly vascular with frequent bleeding. Nasal polyps typically do not bleed and are associated with allergies. Paranasal lymphoma and squamous cell carcinoma are not initially associated with bleeding.

The provider suspects that a patient has chronic pancreatitis. Which diagnostic tests will be most helpful to confirm this diagnosis? a. Blood glucose and fecal fat b. Complete blood count (CBC) c. Liver function tests (LFTs) d. Serum amylase and lipase levels

ANS: A Patients with pancreatic insufficiency will have elevated blood glucose levels and steatorrhea. The CBC, LFTs, and serum amylase and lipase are typically normal with chronic pancreatitis.

A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present? a. Decreased hematocrit b. Decreased MCV, MCH, and MCHC c. Elevated total iron-binding capacity d. Paresthesias, koilonychia, and pica

ANS: A This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level. The RBC indexes are the last to change as the anemia becomes more severe. When the ferritin level drops, the TIBC will become elevated. Paresthesias, koilonychia, and pica occur with more severe anemia.

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? a. Acute otitis externa b. Acute otitis media c. Chronic otitis externa d. Otitis media with effusion

ANS: A This patient's symptoms are classic for acute otitis externa. Chronic otitis externa more commonly presents with itching. Acute otitis media is accompanied by fever and tympanic membrane inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness but not pain.

A patient diagnosed with asthma has been prescribed three bronchodilator treatments but continues to experience wheezing and shortness of breath. The health care provider caring for the patient notes an oxygen saturation of 90% on room air. What action is indicated? a. Administer oxygen and continue to monitor the patient. b. Contact the respiratory therapist to administer another treatment. c. Notify the patient's physician immediately. d. Reassure the patient that the treatments will take effect soon.

ANS: C Patients with bronchospasm who have oxygen saturations less than 92% on room air and who fail to improve with nebulizer treatment given three times, need physician consultation. While oxygen administration and further nebulizer treatments may be indicated, it is incorrect to continue to monitor the patient without notifying the physician.

An advanced practice registered nurse (APRN) is assessing a patient who presents with a small draining wound in the left foot. The patient was previously treated with six weeks of intravenous antibiotic therapy for osteomyelitis of the right foot. The patient wants to know why the new wound occurred. How should the APRN respond to this question? a. "The antibiotic therapy wasn't prescribed for an adequate period of time." b. "This type of infection may occasionally recur." c. "You were not prescribed an appropriate steroid." d. "You were exposed to the same organism that caused the first infection."

ANS: B "This type of infection may occasionally recur"

The spouse of a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) asks about long-term care. What will the provider include when teaching the family about this disease? a. Bowel and bladder function will eventually be lost. b. Positive-pressure ventilation can prolong life. c. Preventing malnutrition is a key element in care. d. The nerves affecting sensation will die initially.

ANS: C Prevention of malnutrition may improve both the quality and length of life. Bowel and bladder function and sensation remain intact. Positive-pressure ventilation helps to relieve sleep disturbance.

Which diagnostic test is most useful when monitoring the progression of sarcoidosis over a long period of time? a. Chest radiographs b. Erythrocyte sedimentation rate (ESR) c. Pulmonary function test (PFT) d. Radionucleotide scanning

ANS: C Pulmonary function tests may be normal or may demonstrate a restrictive pattern and may be of most value in monitoring the course of the disease in individual cases. Chest radiographs may help with staging the disease initially. The ESR may be elevated with sarcoidosis but is a non-specific finding. Radionucleotide scanning is non-specific, although it can be used to locate the presence of pulmonary lesions.

A primary care provider sees a new patient who reports having a diagnosis of chronic kidney disease for several years. The patient is taking one medication for hypertension which has been prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate the status of this patient. Which laboratory finding indicates a need to refer the patient to a nephrologist? a. Albumin/creatinine ratio (ACR) of 325 mg/g b. Blood pressure of 145/85 mm Hg c. Glomerular filtration rate (eGFR) of 35 d. Urine red blood cell (RBC) count of 15/hpf

ANS: A An albumin/creatinine ratio greater than 300 mg/g warrants referral. A specialist is necessary for persistent hypertension refractory to treatment with four or more agents, a GFR of less than 30, and urine RBC greater than 20/hpf.

A 60-year-old patient is seeing an advanced practice registered nurse (APRN) for complaints of tremors in the right hand. The patient notices this most when their hand is relaxed, and it resolves when they are working on the keyboard. The patient also has difficulty starting voluntary movements, and their gait is slower and described as shuffling. Which neurodegenerative diagnosis should the APRN suspect? a. Parkinson's disease b. Multiple sclerosis c. Myasthenia gravis d. Guillain-Barré

ANS: A Parkinson's disease

What treatment management might the FNP consider for a fibromyalgia patient that is not having pain control with NSAID therapy? a. gabapentin b. opioids c. physical therapy d. cognitive behavioral therapy

ANS: A Pharm: can help reduce pain Go slow and gradually build up - we want to make them comfortable with as little amount of pain medications as possible Eat a good, healthful diet can help - but no good evidence on herbs/supplements Severe pain: duloxetine, pregabalin, gabapentin, tramadol Severe sleep problems: low dose amitriptyline, cyclobenzaprine, pregabalin at night No opioids! These make the patient worse, because they develop hyperalgesia and have to constantly increase the dose - easily to abuse these

The FNP has diagnosed a patient with PNA/pneumonia and is considering treatment options. Which antibiotic would be most appropriate? a. Azithromycin for 3-5 days b. Vancomycin for 7 days c. sulfamethoxazole/trimethoprim for 5 days d. Penicillin V for 10 days

ANS: A Pneumonia is a topic covered in the Taber's Medical Dictionary. (noo-mōn′yă) [pneumono- + -ia] ABBR: PNA Inflammation of the lungs, usually due to infection with bacteria, viruses, or other pathogens. Clinically, pneumonia is an infectious disease. azithromycin is the most commonly used antimicrobial for the treatment of atypical pneumonia.

A patient asks the advanced practice registered nurse (APRN) if there are any contraindications to receiving the influenza vaccine other than an egg allergy. Which other precaution must be taken when administering this vaccine? a. A history of thrombocytopenia within six weeks of previous flu vaccine b. A history of Guillain-Barré syndrome within six weeks of previous flu vaccine c. A history of exposure to influenza A within the past six weeks d. A history of illness with or without fever after previous flu vaccine

ANS: B A history of Guillain-Barre Syndrome within 6 weeks of previous flu vaccine Guillain-Barre syndrome attacks own immune system (neurologic), weakening motor function throughout the body. Risk of causing Guillain-Barre when administering flu shot

A 75-year-old patient is referred to the endocrinologist's office with complaints of increasing weakness in the arms and legs over the past several months. The patient also reports losing interest in activities that were previously enjoyed and slowing weight gain. Upon examination, the advanced practice registered nurse (APRN) noted multiple bruises on the arms and legs, thin skin, and a slightly protruding abdomen coinciding with the weight gain. Which diagnostic study should the APRN order for this patient? a. BNP b. ACTH c. Lipid panel d. Uric acid

ANS: B ACTH

An adult patient was seen in a clinic three times in six months and is eventually diagnosed by an advanced practice registered nurse (APRN) with recurrent urinary tract infections. The patient is compliant with the suggested medications, and the condition has improved. At a follow-up visit, the patient asks the APRN about lifestyle changes that may help prevent a recurrence. Which suggestion should the APRN make to this patient? Maintain a water intake of 2-3 liters per day and decrease caffeine and carbonated drinks Avoid eating high-cholesterol foods and limit the daily intake of dietary sodium to 2 gm per day Limit alcohol intake to 2 drinks per day and avoid smoking or second-hand smoke whenever possible Increase physical activity to 30 minutes per day and include moderate weight-bearing exercises

Maintain a water intake of 2-3 liters per day and decrease caffeine and carbonated drinks

A sudden onset of cough in the supine position with an associated sour taste in the mouth suggests: A. esophageal reflux B. upper airway cough syndrome C. a virus or common cold D. none of the above E. viral syndrome or the common cold

ANS: A A sudden onset of cough in the supine position with an associated sour taste in the mouth suggests esophageal reflux.

A patient presents with numbness and paralysis in the legs, upper body, and face. Which of the following is a possible differential diagnosis? a. myasthenia gravis b. Guillain-Barre syndrome c. CVA d. Parkinson's disease

ANS: B GB is An autoimmune disease in which the peripheral nerves become inflamed. Results in numbness and paralysis in the legs, upper body, and face. Level of independence depends on extent of paralysis.

Which of the following elements on PE would indicate the possibility of ankle fx and should be evaluated by x-ray? a. ability to bear wt on affected ankle b. tenderness over medial malleolus c. swelling of affected ankle d. bruising of affected ankle

ANS: B If your ankle hurts or is tender to the touch directly over your ankle bone, you probably have a fracture. If the pain is in the soft part of your ankle, it's more likely a sprain.

A 50-year-old, previously healthy patient has developed chronic gastritis. What is the most likely cause of this condition, assuming the patient is from the United States? a. H. pylori infection b. NSAID use c. Parasite infestation d. Viral gastroenteritis

ANS: A H. pylori accounts for most cases such as gastritis, duodenal ulcers, and gastric ulcers. NSAID use is an important cause, but not likely in a previously healthy individual. Parasites are the leading cause worldwide, but not in the United States. Viral gastroenteritis usually does not cause chronic gastritis and usually has lower GI symptoms.

Who is a chlamydia screening recommended for, according to USPSTF guidelines?

ALL SEXUALLY ACTIVE WOMEN 24 YEARS AND YOUNGER

A patient has Paget's disease of the bone. it was dx as a result of routine blood work during his annual physical, which showed an increased serum alkaline phosphate level. you know that the most serious complication of Paget's disease is: a. osteosarcoma b. nerve compression c. fracture d. bone pain

ANS: A

A patient has unexplained weight loss and the provider notes increased skin pigmentation on light-exposed skin folds along with darkened palmar creases. Which is the likely diagnosis? a. Cushing's disease b. SLE c. Addison's disease d. hypothyroidism

ANS: A

A patient presents with sxs 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

ANS: A

An autoimmune disorder characterized by abnormal stimulation of the thyroid gland by antibodies that act through normal TSH receptors is? a. Graves disease b. Hypothyroidism c. NIDDM d. Metabolic syndrome

ANS: A

A patient is diagnosed with osteoporosis. What is the recommended treatment once the diagnosis is made? a. Bisphosphonate therapy b. Calcium and vitamin D c. Estrogen replacement d. Yoga and weight-bearing exercises

ANS: A Bisphosphonates are FDA-approved treatment for osteoporosis and will help improve bone density and reduce the risk of fractures. Calcium and vitamin D may help prevent osteoporosis but must be taken from an early age. Estrogen replacement is used to prevent osteoporosis. Yoga and exercise help with balance and muscle strength to help prevent falls.

A 66-year-old patient comes to the clinic complaining of generalized malaise, fever, productive cough, and intermittent chest pain with respiration that began two days before. The symptoms have increased in severity and have not improved with the use of over-the-counter (OTC) pain and cold medication. The patient has no history of current or past smoking, is not on any routine medications, and is alert and oriented. Assessment data reveals a temperature of 102 degrees Fahrenheit; a pulse of 86; respiration of 24; and a pulse oximeter oxygen saturation of 96%. Decreased breath sounds with wheezing noted bilaterally with dullness to lung percussion are present. The advanced practice registered nurse (APRN) suspects bacterial community-acquired pneumonia. Which diagnostic test should the advanced practice registered nurse order for this patient? a. CBC b. Strep testing c. Sputum testing d. FBS

ANS: A CBC

An advanced practice registered nurse (APRN) explains to a new staff member that during times of disaster no patients will be turned away from receiving care, even during a surge capacity of patients. Which guideline supports the instruction the APRN is sharing? a. Emergency Medical Treatment and Active Labor Act (EMTALA) b. Hospital Preparedness Program (HPP) c. Health Insurance Portability and Accountability Act (HIPAA) d. Incident Command System (ICS)

ANS: A Emergency Medical Treatment and Active Labor Act (EMTALA)

Which is the most appropriate research design for a Level II research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials

ANS: A Epidemiological studies are appropriate for level II studies.

What is the purpose of Level I research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables

ANS: A Level I research is conducted to define the characteristics of groups of patients.

A patient is following up with the advanced practice registered nurse (APRN) for large, painless nodules over the metacarpophalangeal joints. The patient has a history of three prior gout attacks and takes Allopurinol (Aloprim). Which referral should the APRN make for this patient? a. Rheumatology b. Neurology c. Orthopedics d. Physical therapy

ANS: A Rheumatology

A 42 year old woman complains of palpitations, anxiety and weight loss. What two lab test would be most helpful in diagnosing this patient? a. Free T3 and T4 b. CBC c. CMP d. ESR

ANS: A Serum total triiodothyronine (T3): thyroxine (T4) ratio (ng/ug) of >20 suggests Graves' disease. In the current practice, the measurement of free thyroid hormone is more commonly used. Serum free T3/free T4 ratio of >4.4 (10−2 pg/ng) may help in differentiating the cause of thyrotoxicosis.

A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure. After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in reducing immunity. What is the next preferred step to avoid rejection? A. Prescribe tacrolimus B. Increase the dose of cyclosporine C. Prescribe amoxicillin D. Prescribe paracetamol

ANS: A Tacrolimus is efficient more than ten folds when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored cautiously as an increase in its blood concentration could cause many complications like kidney failure. • Cyclosporine, tacrolimus, and pimecrolimus are called calcineurin inhibitors because they inhibit the enzyme "calcineurin" that is responsible for T-cell activation. • Tacrolimus is used as an adjuvant to other immunosuppressive drugs to avoid organ rejection.

After history and the physical exam, the FNP suspects a 22-year-old female has infectious mononucleosis. Of the following diagnostic studies that provide the most specific test, the result will be: a. A positive heterophile antibody test. b. A modest elevation of the white blood count. c. An elevated bilirubin. d. A decreased lymphocyte count.

ANS: A The heterophile antibody test is the confirming test in IM. It is present in 40-60% patients in the first week and 78-90% of cases by weeks 3-4.

A patient presents to the clinic with complaints of itching and flaking to bilateral feet. The NP observes that there is a characteristic macerated appearance between the toes. The NP diagnoses the patient with which of the following? a. Tinea pedis b. Onychomycosis c. Tinea versicolor d. Seborrheic dermatitis

ANS: A The macerated appearance between the toes is consistent with a tinea infection and is commonly called "athlete's foot."

Which diagnostic test helps confirm a diagnosis of Guillain-Barré syndrome (GBS) in a patient who is developing muscle weakness and paresthesias? a. Lumbar puncture b. MRI imaging c. Nerve conduction studies d. Screening for systemic infection

ANS: A A lumbar puncture is the most important confirmatory test showing albuminocytologic dissociation. MRI imaging typically is not necessary unless there is concern for spine pathology but does not diagnose GBS. Nerve conduction studies are not necessary for the diagnosis. Screening for systemic infection is based on history and does not diagnose GBS.

Which type of headaches are described as typically familial, often unilateral throbbing, common to have nausea/vomiting, associated with photo and phono sensitivity, visual changes - 5% visual changes, flashing lights, strange odors or paresthesias a. cluster b. migraine with aura c. tension d. sinus

ANS: B

A pregnant woman reports not having had any vaccinations as a child but requests vaccines during her pregnancy. Which vaccines may be given? (Select all that apply.) a. Human papillomavirus (HPV) b. Inactivated influenza c. Live, attenuated influenza d. Measles, mumps, and rubella (MMR) e. Tetanus, diphtheria, and acellular pertussis (Tdap) f. Varicella

ANS: A, B, E Tdap is recommended to pregnant woman, optimally between 27- and 36-weeks gestation. Inactivated is strongly recommended and may be given at any point in the pregnancy. Hepatitis B is given to women at risk if needed. Live, attenuated influenza vaccine, MMR, and varicella vaccines are not recommended during pregnancy.

A 50 year old male patient presents to the clinic complaining of fever, nausea, vomiting, rapid onset of abd. pain that radiates to the midback, and epigastric area or upper abdomen, anorexia. He also reports that the Pain is often relieved by leaning forward. What diagnosis does the FNP consider based on these symptoms? a. Myocardial Infarction b. Pancreatitis c. Choleycystitis d. Stroke

ANS: B

A client presents to the healthcare​ provider's office with cellulitis on the lower leg. Other than the inflammation of the​ leg, the client has no other symptoms. To determine the causative​ organism, the nurse anticipates an order for which​ test? a. WBC count b. Drainage culture c. RBC count d. Blood culture

ANS: B

A patient with a history of multiple sclerosis presents to an advanced practice registered nurse (APRN) in the emergency department with complaints of urinary hesitancy, urgency, and frequent incontinence. Which treatment regimen should the APRN prescribe for this patient? a. Channel blockers b. Alpha-blockers c. H2 blockers d. Beta-blockers

ANS: B Alpha-blockers

A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has been exposed to someone with chickenpox but has not developed any skin lesions. She has no varicella-zoster antibodies. What would be the best possible treatment for her? A. Chickenpox vaccine B. Immunoglobulins C. Antivirals D. No medication is required

ANS: B An immunocompromised patient, when exposed to someone with chickenpox, is given immunoglobulins unless he develops the disease. • An immunocompromised patient, when exposed to someone with chickenpox, is given antivirals when he develops the disease. • When a pregnant patient is exposed to someone with chickenpox, and she has not developed the disease. Her varicella-zoster antibodies are checked. If she has antibodies, no further treatment is required. • If a pregnant patient is exposed to someone with chickenpox and she has developed skin lesions, then antivirals are given.

which condition is characterized by: chronic, inflammatory joint disease that causes buttocks pain, joint pain/swelling,which primarily affects the spine and SI joints; however, larger peripheral joints can also be affected a. bulging nucleus propulsus b. ankylosing spondylitis c. sciatica d. DDD

ANS: B Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply

What is the purpose of Level IV research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables

ANS: B Level IV research is conducted to demonstrate the effectiveness of interventions or treatments.

A patient with a history of frostbite presents to an advanced practice registered nurse (APRN) with three fingers that are white in color and numb. The patient's vital signs are normal, and the pain is rated as a zero. While the APRN examines the patient, the fingers change to blue and then to red. Which recommendation should the APRN make for this patient? a. Begin Pseudoephedrine (Sudafed) b. Limit exposure to cold temperatures c. Limit exposure to warm temperatures d. Begin Atenolol (Tenormin)

ANS: B Limit exposure to cold temperatures

The family nurse practitioner is taking a history of a patient who has been diagnosed with renal calculi. What information in the history would the family nurse practitioner identify as a precipitating factor in the development of renal calculi? a. Drinking 6-8 oz of milk daily b. History of fractured femur and prolonged bed rest c. Increased incidence of UTI's over the past 3 years d. High intake of citrus fruits and high fiber carbohydrates

ANS: B Long-term bed-rest-induced renal stone formation was found to be induced by increased urinary calcium and subsequent crystal formation of calcium oxalate and calcium phosphate. Exercise during bed rest for the prevention of bone mineral loss and contracture might increase the risk of renal stone formation.

A patient experiences a sharp pain just under the sternum with swallowing. This is more commonly associated with which condition? a. Hiatal hernia b. Infectious esophagitis c. Peptic stricture d. Schatzki ring

ANS: B A sharp, substernal pain with swallowing is most commonly associated with infectious esophagitis. Esophageal strictures are highly correlated with hiatal hernia and patients with stricture will report a feeling of food becoming stuck. A Schatzki ring and peptic stricture are types of strictures.

Which cause is implicated in patients with fibromyalgia syndrome (FMS)? a. Autoimmune disease b. Central nervous system dysfunction c. Muscle dysfunction d. Viral disease

ANS: B Although the cause of FMS is unclear, current research suggests a CNS cause and not muscle, autoimmune, or viral causes.

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? a. Antibiotic therapy b. Antitussive medication c. Bronchodilator treatment d. Mucokinetic agents

ANS: B Antitussive medications are occasionally useful for short-term relief of coughing. Antibiotic therapy is generally not needed and should be avoided unless a bacterial cause is likely. Bronchodilator medications show no demonstrated reduction in symptoms and are not recommended. Mucokinetic agents have no evidence to support their use.

A young adult patient develops a cough persisting longer than 2 months. The provider prescribes pulmonary function tests and a chest radiograph, which are normal. The patient denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough? a. 24-hour esophageal pH monitoring b. Methacholine challenge test c. Sputum culture d. Tuberculosis testing

ANS: B Chronic cough without other symptoms may indicate asthma. If PFTs are normal, a methacholine challenge test may be performed. 24-hour esophageal pH monitoring is sometimes performed to evaluate for GERD, but this patient does not have abdominal symptoms and this test is usually not performed because it is inconvenient. Sputum culture is not indicated. TB is less likely.

A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A rheumatoid factor (RF) test is negative. What will the primary care provider do next? a. Begin treatment with a biologic disease-modifying anti-rheumatic (DMARD) drug b. Order radiographic tests, a CBC, and acute-phase reactant levels c. Reassure the patient that the likelihood of rheumatoid arthritis is low d. Refer the patient to an orthopedic specialist for evaluation and treatment

ANS: B The patient has signs of rheumatoid arthritis (RA); the RF test may be negative initially but will become positive in 70% to 80% of patients. The provider's next step is to order tests to confirm the diagnosis and to provide a baseline to monitor disease progress and response to treatment. DMARDs may be ordered when the disease is confirmed. The PCP may treat in consultation with a rheumatologist who will order medications and will refer the patient for physical therapy, occupational therapy, and psychotherapy.

Which diagnostic test will the provider safely order for a 30-year-old woman reporting right upper quadrant abdominal pain, nausea, and vomiting? a. Abdominal computed tomography (CT) with contrast b. Abdominal ultrasound c. Magnetic resonance imaging (MRI) of the abdomen d. Plain abdominal radiographs

ANS: B Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.

A 23 year old male presents with low back pain. he lifted a heavy box yesterday at work but had no symptoms yesterday. Today however, he began to feel pain and stiffness in his lower back that hurts worse when he bends forward. On exam he has pain with flexion and extension and a negative straight leg raise test. What management plan would be appropriate for him at this time? a. order lumbar spine x rays b. refer for epidural steroid injections c. Over the counter NSAID's, ice/heat, and return to work in 2 days d. Order MRI lumbar spine

ANS: C

In Alzheimer's disease, donepezil is used to increase which chemical in the brain? a. serotonin b. norepinephrine c. dopamine d. Acetylcholine

ANS: C

John is a 16 year old boy who presents to the emergency room after hurting his knee in a football game. He describes twisting his knee and then not being able extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be the most appropriate to assess for the presence of a meniscal tear? a. Valgus stress test b. Lachman test c. McMurray circumduction test d. Varus stress test

ANS: C

The family nurse practitioner has just diagnosed a 27-year-old with Lyme disease. What is the appropriate management? a. Bactrim 400 mg b.i.d. for 14- 21 days b. Amoxicillin 100 mg t.i.d. for 10 days c. Doxycycline 100 mg b.i.d. for 14- 21 days d. Keflex 500 mg q.i.d. for 14 days

ANS: C

What is the first line tx for mild chronic shoulder pain caused by osteoarthritis? a. injection of steroids with lidocaine b. hydrocodone c. acetaminophen d. oral corticosteroids

ANS: C

Which assessment data would the nurse recognize to support the diagnosis of abdominal aortic aneurysm? a. Nausea/Vomiting b. Peripheral Edema c. Abdominal Bruit d. Cardiac Murmur

ANS: C

in prescribing levothyroxine therapy for an elderly pt with hypothyroidism, which of the following statements is true? a. elderly persons require a rapid initiation of levothyroxine therapy b. TSH should be checked about 2 days after dosage adjustment c. the levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults d. TSH should be suppressed to a nondetectable level

ANS: C

A 43-year-old male presents to the primary care clinic with complaints of a cough that has persisted for 12 weeks (3 months). How with the APRN classify this patient's cough? A. Acute cough B. Subacute cough C. Chronic cough D. Chronic obstructive pulmonary disease

ANS: C A chronic cough is a cough that persist beyond 8 weeks

A loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is associated with emotional stress may suggest: A. Allergic rhinitis B. Use of lisinopril C. Psychogenic cough D. Asthma

ANS: C A loud hacking cough during the daytime that is nonproductive leads to exhaustion, and is associated with emotional stress may suggest a psychogenic cough.

A nurse is assessing a patient for signs and symptoms of severe anemia. Besides the lab values and vital signs what observations in the physical assessment would give an indication that the patient is severely anemic? a. A bluish color over the abdomen b. pedal edema c. abnormalities in the patient's nails d. A jerking of the wrist and arm when the blood pressure cuff is applied.

ANS: C Besides lab values and vital signs, the patient with severe anemia may show abnormalities in the nails such as spoon shape, long shaped striations and clubbing. In addition, the patient may have retinal hemorrhages.

The wife of the client diagnosed with meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse Practitioner? a. "There is bleeding into his brain causing irritation of the meninges." b. "A virus has infected the brain, causing inflammation." c. "This is a bacterial infection of the meninges, causing inflammation." d. "This is an inflammation of the brain parenchyma caused by a mosquito bite."

ANS: C Meningitis is an infection of the meninges, causing inflammation. Most cases of community-acquired, new-onset meningitis are bacterial.

A 55-year-old patient presents to the advanced practice registered nurse (APRN) about increasing headaches over the course of the past several months. The patient has been taking over-the-counter (OTC) medications to relieve the headaches, but the headaches are becoming more severe and the OTCs are not working. The patient also reports profuse sweating even without physical activity, increasing weakness, and shakiness of the hands. Upon examination, the APRN notes the patient's blood pressure is 152/94. Which condition should the APRN assess for this patient? a. Hashimoto b. Gout c. Pheochromocytoma d. Diabetes

ANS: C Pheochromocytoma

The most common comorbidities that occur with type 2 diabetes mellitus are: a. Depression, cancer, obstructive sleep apnea. b. Obesity, coronary artery disease, sedentary lifestyle. c. Hypertension, hyperlipidemia, obesity. d. Hypothyroidism, hyperlipidemia, chronic kidney disease.

ANS: C The most common comorbid conditions associated with type 2 diabetes are hyperlipidemia, hypertension, and obesity. There is a strong correlation between metabolic syndrome and the development of type 2 diabetes

A 25-year-old female comes to the outpatient clinic complaining of suprapubic pressure and burning with urination for the past two days. She denies having any chills but states that she may have had a fever yesterday. The next step will be: a. Obtain a urine dipstick. b. Get a urine culture and sensitivity. c. Ask about previous infections. d. Refer the patient to a urologist.

ANS: C The next step in assessing/treating this patient will depend on whether or not this urinary tract infection is recurrent or a first occurrence.

A patient presents to the NP's office and states that there was a deer tick crawling on her one month ago. She was sick with a cold recently and is concerned that perhaps she has contracted Lyme disease. The NP gets the following results from the serology studies:Lyme AB screen: 1.38 (a positive Lyme antibody screen is > or = to 1.10)A Western blot IGG and IGM is done. All bands are negative or non-reactive.The NP correctly offers the following information: a. The patient does not have Lyme disease. No therapy is warranted. b. Order further diagnostic testing c. prescribe doxycycline d. Admit to hospital for treatment

ANS: C The patient does not have Lyme disease, so no therapy is needed. The appropriate Western blot bands are required to qualify as a positive result. No positive or reactive bands means a negative result. In addition, the complaints of a cold are not consistent with more common symptoms of Lyme infection

The nurse practitioner is reviewing the laboratory values of a 28-year-old male patient who presents to the office to establish care with a primary care provider. The lab results from the previous week indicate an A1C of 7.2. The nurse practitioner obtains a fasting blood sugar in the office of 142. The patient denies any significant past medical history and states that he "feels fine." The nurse practitioner recognizes that: a. The patient has developed type 1 diabetes. b. The patient has developed type 2 diabetes c. The patient has diabetes and further testing is required. d. The patient has pre-diabetes.

ANS: C The patient meets the criteria to be diagnosed with diabetes. The clinician would be unable to determine what type of diabetes the patient has without further testing.

A young, previously healthy adult clinic patient reports 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. A B-lactam antibiotic plus a fluoroquinolone b. A respiratory fluoroquinolone antibiotic c. Empirical treatment with a macrolide antibiotic d. Hospitalization for intravenous antibiotics

ANS: C This patient likely has community-acquired pneumonia. The patient has typical symptoms and, even though the chest radiograph is normal, will require outpatient treatment. For community-acquired pneumonia in a previously healthy individual, treatment with a macrolide antibiotic is the recommended first-line therapy. B-lactam plus fluoroquinolone therapy is used for patients in the ICU. Respiratory fluoroquinolones are used for patients with underlying disorders who develop pneumonia. Hospitalization is not necessary.

A patient who has had lesions for several days is diagnosed with primary herpes labialis and asks about using a topical medication. What will the provider tell this patient? a. Oral antivirals are necessary to treat this type of herpes. b. Preparations containing salicylic acid are most helpful. c. Topical medications can have an impact on pain and discomfort. d. Topical medications will significantly shorten the healing time.

ANS: C Topical medications may alleviate discomfort, but do not shorten healing time. Oral antivirals may help shorten healing, but are not necessary as treatment, since the disease is usually self-limiting. Salicylic acid should not be used because it can erode the skin.

A 19-year-old boy comes in for a follow-up of exudative tonsillitis with a streptococcus positive throat culture. He states that his throat feels much better but this morning his urine had a pink tinge and was very foamy. What does the FNP suspect is happening with this patient? a. Nephrolithiasis b. Hydronephrosis c. UTI d. Glomerulonephritis

ANS: D

A patient has been given a diagnosis 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 wt bearing exercise program. you are also going to start her on medical management. J. ask you about a drug called a "SERM" that she has heard has been shown in studies to prevent vertebral fx. which of the following pharmacological tx for osteoporosis is classified as a selective estrogen receptor modulator (SERM)? a. aldendronate b. risedronate c. salmon calcitonin d. raloxifene

ANS: D

Which physical examination finding is typical in in a patient with cough from COPD? A. Inspiratory wheezes B. Fine crackles C. Course rhonchi D. Expiratory wheeze

ANS: D

An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, the APRN is focusing on identifying the characteristics that makeup a population of patients with Type 2 diabetes. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive

ANS: D Descriptive Research is used to describe characteristics of a population or phenomenon being studied. It does not answer questions about how/when/why the characteristics occurred. Rather it addresses the "what" question (what are the characteristics of the population or situation being studied?).

A patient is seen by an advanced practice registered nurse (APRN) with an acute onset of epistaxis after being hit by a baseball. The APRN notes that the bleeding is originating from the area of the Kiesselbach's plexus. Which action should the APRN take to assist this patient? a. Irrigate the nostrils with a saline spray solution b. Insert packing to the posterior area of the nose with a balloon catheter c. Apply warm compresses to the bridge of the nose d. Direct pressure to the anterior pressure of the nose for 15 minutes

ANS: D Direct pressure to the anterior pressure of the nose for 15 minutes

A 58-year-old man presented to the hospital with right-sided decreased hearing for two years. His wife mentions he has started snoring recently. He has been a smoker for the last 25 years and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which key anatomical area is the pathology most likely to be situated in? A. Right Middle Meatus B. The roof of the nasal cavity C. Right vallecula D. Postnasal space

ANS: D In a patient with recent-onset unilateral hearing loss and nasal obstruction with a social history of smoking one must rule out a nasopharyngeal pathology most likely a malignancy. • Any mass in the nasopharynx can obstruct the medial ends of the eustachian tube leading to problems with the ears. • Nasopharyngeal cancer can arise from the fossa of Rosenmüller, which lies behind the eustachian tubes on either side. So a clear look at this area with a nasendoscopy in high-risk patients with unilateral middle ear effusion is mandatory. • Malignancies in the other anatomical areas mentioned are obviously possible, but will not cause unilateral middle ear effusion with conductive hearing loss.

he management plan for the patient with infectious mononucleosis will include a. A course of systemic corticosteroids. b. Bed rest for 3-5 days c. avoidance of contact sports for 3-5 days d. Increased clear fluids

ANS: D Increased fluids are an important supportive measure during the acute phase of IM. Increased activity levels increase the possibility of splenic rupture, and sports should be avoided for at least 4-6 weeks. Systemic corticosteroids are only used with complicated cases because they can affect cell-mediated immune response and may increase the risk of secondary bacterial infection.

An intermittent productive cough associated with wheezing is most probably: A. Allergic rhinitis B. Use of lisinopril C. Psychogenic cough D. Asthma

ANS: D Intermittent productive cough associated with wheezing is most probably asthma.

A patient 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

ANS: D Proteolytic enzymes are the effectors of the articular damage: their increased production by chondrocytes and synoviocytes leads to cartilage breakdown. These enzymes, whose structure and specific activities have been defined in the recent years, carry out their action in the extracellular matrix.

What is the recommended treatment for a 70-year-old male patient with an aortic aneurysm measuring 5.0 cm, poorly-controlled hypertension, and decompensated heart failure? Endovascular stent grafting of the aneurysm b. Immediate open surgical repair of the aneurysm c. No intervention is necessary for this patient d. Serial ultrasonographic surveillance (US) of the aneurysm

ANS: D Serial US surveillance of the aneurysm. Patient's aneurysm is less than 5.5cm, so repair is not necessary at this time. Serial US of the aneurysm is necessary to continue to evaluate its size

A patient is diagnosed with mild to moderate ulcerative colitis. Which medication will be prescribed initially to establish remission? a. Azathioprine b. Budesonide c. Infliximab d. Sulfasalazine

ANS: D Sulfasalazine is a 5-aminosalicylic acid used to induce remission in UC and is a first-line medication. Budesonide is a synthetic corticosteroid used for moderate to severe disease, but not as a first-line agent. Azathioprine is an immunomodulator used to minimize the need for corticosteroids. Infliximab is a biologic medication and is more useful for treating Crohn's disease.

A patient presents to the clinic reporting flu-like symptoms that started yesterday. His rapid flu test is positive for influenza A. What medication would the FNP consider prescribing? a. Amoxicillin/Amoxil b. Azithromycin/Zithromax c. Valacyclovir/Valtrex d. oseltamivir (tamiflu)

ANS: D Tamiflu can reduce complications of the flu (such as pneumonia) by 44%, and the risk of hospitalization by 63% when taken in the first 48 hours after contracting the virus, according to the makers of Tamiflu.

A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit. Her LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago and is adherent to her triple drug ART regimen with an undetectable viral load. At 35 weeks her viral load is still undetectable and she gives birth via normal vaginal delivery at 39 weeks. At discharge ART regimens for the mother and child are finalized. Which of the following recommendations about breastfeeding in HIV positive mothers is most accurate? A. There is no significant risk of HIV transmission via breastfeeding in mothers under 30 years of age. B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV transmission C. Maternal antibodies in breastmilk will protect the infant from HIV infection D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable

ANS: D The risk of HIV Transmission from breastmilk makes breastfeeding unadvisable. Rationale: 10%-14% of breastfeeding mothers transmit HIV to the uninfected infant. The US official guidelines by the panel on treatment of pregnant women with HIV infection and prevention of perinatal infection state that HIV positive women must avoid breastfeeding as transmission of HIV through breastmilk is still possible despite ART therapy. In parts of the world that lack adequate resources the benefit of breastfeeding may outweigh these risks.

A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? a. Antihypertensive therapy b. Mineralocorticoid replacement c. Oral hydrocortisone d. Pituitary tumor resection

ANS: D This patient has symptoms of Cushing's syndrome. When indicated, pituitary tumor resection is performed as the first choice. Antihypertensive therapy is initiated in patients with pheochromocytoma.

A patient presents to the clinic with a diagnosis of Cushing syndrome. The advanced practice registered nurse (APRN) wants to determine the underlying cause of the disease process and orders a Dexamethasone suppression (DS) lab test. DS Findings: low dose: no change high dose: no change ACTH is undetectable or low What should the APRN suspect related to these findings? Adrenal carcinoma Lung carcinoma Lung hyperplasia Adrenal hyperplasia

Adrenal carcinoma

Which underlying cause is possible in a patient with normal renal function who has a serum potassium level of 6.0 mEq/L?

Adrenocortical deficiency Hyperkalemia without underlying renal disorder may be caused by Addison disease, which is an adrenocortical deficiency

A primary care provider sees a new patient who reports having a diagnosis of chronic kidney disease for several years. The patient is taking one medication for hypertension, which has been prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate the status of this patient. Which laboratory finding indicates a need to refer this patient to a nephrologist?

Albumin/creatinine ratio (ACR) of 325 mg/g ACR greater than 300mg/g warrants referral

A patient presents to the primary care clinic with decreased vibratory sensation, loss of proprioception, peripheral neuropathy, and ataxia. The advanced practice registered nurse (APRN) notes a beefy-red tongue and a positive Romberg sign during assessment. A complete blood count reveals a hemoglobin of 8g/dL and MCV level of 110 fL. Which diagnosis should the APRN make for this patient? Thalassemia Iron deficiency anemia Vitamin B12 deficiency Normocytic anemia

Beefy red tongue is related to vitamin B12 deficiency Vitamin B12 deficiency is the answer

A college student is brought to a clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The primary care provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient's symptoms?

Being treatment with lithium or lamotrigine patients with symptoms of mania should begin treatment with a mood stabilizer and the primary care provider should initiate treatment for an acute episode

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?

Beta blocker medications BB should be initiated for patients with Graves disease to alleviate the alpha-adrenergic symptoms of hyperthyroidism

A patient is being seen by an advanced practice registered nurse (APRN) about recent onset symptoms including weight gain, fatigue, insomnia, and poor concentration. The APRN completes an assessment and diagnoses the patient with depression. Which medication is appropriate as a starting dose? Fluvoxamine (Luvox) 50 mg QD Citalopram (Celexa) 20 mg QD Paroxetine (Paxil) 25 mg BID Venlafaxine (Effexor XR) 50 mg BID

Citalopram (Celexa) 20 mg QD SSRI

A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the primary care provider asks about a family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both had post-surgical complications related to bleeding. Which diagnosis is possible, based on this patient's history?

Hemophilia Hemophilia is an X-linked recessive disorder affecting only males and carried by females Family history of maternal males with bleeding disorders should clue the provider that this disorder is likely

An African-American patient presents to the emergency department complaining of severe pain in the joints, back, chest, and abdomen. The advanced practice registered nurse (APRN) examines the patient and notes the following: O2 saturation of 86% on room air, Jaundice, Systolic flow murmur, and a CXR reveals cardiomegaly. The APRN suspects that the patient has sickle cell disease. Which test should be ordered to confirm the APRN's suspicion? Absolute neutrophil count Bone marrow aspiration Arterial blood gases Hemoglobin electrophoresis

Hemoglobin electrophoresis

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

Metformin IS given to reduce hyperinsulinemia and lower insulin resistance, but also lowers plasma PAI-1 levels (plasminogen activiator inhibitor)

A young woman comes to the clinic and complains to the advanced practice registered nurse (APRN) of urgency, burning upon urination, and pain in the lower back. Assessment findings include: B/P 136/80 pulse 78 respirations 14 temperature 99.0 Which initial action should the APRN take? Refer to urologist Order a renal ultrasound Prescribe Levofloxacin (Levaquin) 250 mg by mouth twice daily Perform a urine dipstick

Perform a urine dipstick

A nonpregnant adult patient presents to the clinic for an annual well-patient exam. The advanced practice registered nurse (APRN) assesses the patient and orders diagnostic tests. Diagnostic test results: oral glucose tolerance test: 142 mg/dL HbA1c: 5.9% fasting plasma glucose: 102 mg/dL In which classification should the APRN place the patient? Normal Diabetes Metabolic Prediabetes

Prediabetes

What is recommended to manage a patient with type 2 diabetes who has a low-density lipoprotein (LDL) level of 110 gm/dL?

Prescription of a moderate or high intensity statin This patient is in one of the four groups of patients identified in current guidlines as one who would benefit from statin therapy because of type 2 diabetes A moderate to high intensity statin should be prescribed