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First Exam Assessment practice questions: HEENT, CARDIAC, GI, RESPIRATORY

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. A 59-year-old patient with a history of alcoholism is admitted to the ED for hyperemesis and melena. On physical examination the nurse notes ascites and caput medusa. A likely cause for the melena is what? A. Portal Hypertension B. Pancreatitis C. Peptic ulcer disease D. Barrett's esophagus

. After conducting a history of present illness, the Advance Practice Nurse (APN) conducts a Review of Systems. The APN understands the importance of Review of Systems questions because: a) it may uncover problems that the patient has overlooked, particularly in areas unrelated to the present illness b) the APN can bill higher for the visit c) it shows the patient that the provider cares, since more questions are asked d) it provides factual, objective data

. Anakin, an 18-year-old female, presents to the primary care office reporting a 3-day history of cough and nasal congestion. Upon physical assessment, the advanced practice nurse (APN) noted lymphadenopathy to the region posterior to the ear and just superficial to the mastoid process. The APN recognizes that the name of this lymph node is: a) Posterior auricular b) Preauricular c) Submandibular d) Supraclavicular

. Nancy is a 75-year-old patient with a medical history of DM2, Atrial Fibrillation, and hypertension who comes in for an annual checkup. The APRN notices a palpable mass on the thyroid gland. All of the findings are indicative of hypothyroidism except. Patient has excessive sweating and heat intolerance Patient complaints of fatigue and lethargy Patient has dry, coarse skin and cold intolerance Patient has periorbital myxedema

. Which of the following cranial nerve innervates the lateral rectus muscle of the eye? a. Abducens nerve (CN VI) b. Trochlear nerve (CN IV) c. Oculomotor nerve (CN III) d. Optic nerve (CN II)

. While assessing the patient, the nurse practitioner palpates the pulse behind the medial malleolus. Which pulse is being palpated? a. Posterior tibial b. Dorsalis pedis c. Anterior tibial d. Saphenous

Jones is a 72-year-old female presenting to the emergency department with complaints of shortness of breath and a cough. Her vitals are as follows. Afebrile, HR 95, SpO2 88, BP 112/82, RR 22. CBC is negative, her BNP is elevated, her troponin is elevated, and her chest x-ray reveals a significant R sided plural effusion. Which of the following conditions is the most likely cause of her condition? Heart Failure Asthma Cirrhosis Malignancy

Upon reading an MRI of the head, which incidental finding might prompt the clinician to assess the patient and order labs for possible thyroid disease? Presence of bilateral extraocular muscle enlargement, with prominent bilateral inferior rectus muscles, as compared to the other extraocular muscles. Bilateral extensive opacification of the mastoid air cells. Inferior rectus herniation of the right orbit into the maxillary sinus. Mucosal thickening present in the bilateral maxillary sinuses with layering fluid.

While examining a patient, the provider notices a regular pulse but has alternating strong and weak beats. Pulsus alternans indicates: Left ventricular failure Decreased stroke volume from hypovolemia Pure aortic regurgitation COPD

rumbling murmur sound is heard between S2 and S1 using the bell of the stethoscope, which of the following can contribute to diastolic murmurs? Mitral stenosis Aortic stenosis Pulmonic stenosis Hypertrophic cardiomyopathy

A 65-year-old female comes into the Emergency Room with reported shortness of breath. The patient is an active smoker with a history of Asthma and Coronary Artery Disease. The Nurse Practitioner is writing the history of physical illness. Which symptoms would be considered a pertinent negative? A. Episode of palpitations for less than a minute followed by facial flushing B. No fever, cough with sputum production, nausea, or vomiting C. History of Coronary Heart Disease D. History of Asthma

A 66-year-old female patient presents stating that she is having some physical activity limitations. She states she is comfortable at rest, but regular physical activity causes dyspnea and fatigue. According to the New York Heart Association (NYHA) Classification of Heart Failure, what class would this patient be assigned? a. Class I b. Class II c. Class III d. Class IV

A nurse practitioner is assessing a patient's readiness to quit drinking alcohol. The patient has a history of unhealthy alcohol use and has attempted multiple times to quit drinking. In today's visit the patient states, " I am ready to quit." Based on this response, the nurse practitioner will: A Assist in quit attempt B Assess willingness to quit C Follow up with the patient's progress in a few months D Advise to quit drinking

A parent brings their one-year-old to the clinic because they notice a lump on the right side of the neck. The lump seems to be getting bigger and the antibiotics were not effective as an APRN what will you do? a) Tell the parents that is okay, and it will go away if it doesn't go away come back in a week. b) Refer the one-year-old to the HEENT for further evaluation. c) Prescribe a different antibiotic. d) Tell the parent that is a lymph node that is swollen and is normal in children.

A patient diagnosed with hyperthyroidism would most probably have what presenting symptom? Swelling of the face Weight gain Weight lost Cold intolerance

A patient is admitted for DKA. The nurse alerts you that the patient's breathing is "weird." It is described as deep, rapid, labored breathing. Based on this description, you guess the nurse is referring to which of the following? Ataxic breathing Kussmaul breathing Cheyne-stokes breathing Obstructive breathing

A patient is rushed to the ER with c/o chest pain, SOB and tachypnea after a traumatic car accident. It is determined the patient is experiencing a tension pneumothorax. The provider understands that needle insertion for decompression of a tension pneumothorax occurs at this landmark: A. Intercostal space between 7th and 8th ribs B. 2nd intercostal space C. Intercostal space between the 4th and 5th ribs D. Level of the 4th rib for the lower margin

In which of the following cases, the FNP has ordered the imaging study appropriately? Computer tomography (CT) scan of the head for a 31-year-old female with severe migraine. X-ray of the right elbow for a 49-year-old male who is a construction worker, and injured the right elbow at work and experienced severe pain. CT scan of abdomen for a 13-year-old male preoperatively before appendectomy. KUB for an 18-year-old female for dysuria, frequent urination, and bloody vaginal discharge between menstrual cycles.

Mr. Jones came in for his annual physical exam. My Jones is physically disabled and uses a wheelchair to get around. During his visit, which of the following actions are correct? A. Move the wheelchair to the back of the room to avoid a fire hazard? B. Make sure there is a clear path to access the room and assistive devices. C. Do the exam from the wheelchair D. Call for assistance as soon as he arrives to move him to the exam table.

Mr. Smith is a patient who presents today with uncontrolled pain. He continues to have pain issues unrelieved by medications or biofeedback for greater than 6 months. How would you as the nurse practitioner document this? A) Neuropathic pain B) Chronic pain C) Acute pain D) Nociceptive pain

Patient SU, a 63 year old female, is visiting her son from out of town. She reports that she had to sit on a plane for 12 hours, and this morning when she woke up she noticed that her right leg was swollen. Suspecting a DVT and Virchows triad, what diagnostics should be ordered? CXR, venous Doppler US, a CBC D-Dimer, Venous Doppler US, CXR/CT Angiogram Electrolytes, MRI, D-Dimer Biopsy, CBC, CT Angiogram

Patient's respiratory rate is measured at 25 breaths/minute. Which type of temperature is best to take? Oral Rectal Axillary Tympanic membrane

You examine the oral cavity of a 47-year-old man with HIV. He told the NP that he has not been taking his medications. Upon examining the mouth, you noticed cream-colored patches on the patient's palate. What would the NP suspect? Pharyngitis Thrush Exudative tonsilitis Petechiae

You're examining your patients' eyes with your ophthalmoscope. Which light preference would help accurately examen your patients' eyes? Bright white lighting Darkened room Doesn't matter what light Focused light directly to the pupil

Your 35-year-old male patient has come into the office for a physical. You obtain the patient's height and weight appropriately and calculate his BMI to be 31.2. Based on this finding, how would you classify this patient? Extremely Obese Obese I Overweight Normal

4. A 91-year-old patient was admitted to the ICU for sepsis due to UTI. While assessing the patient, nurse practitioner notes that the patient is too confused to answer questions about her health history. What would be the best action to do next? A. Wait until the patient is back to baseline, alert and oriented x4. B. Check if family or caregiver are present, if not a valid phone number is available. C. Ask the charge nurse about history. D. Ask the patient if she feels confused or had dementia.

4. The volume of blood ejected with each heartbeat, and it is dependent on preload, myocardial contractility and afterload is called a. Cardiac Output b. Stroke volume c. Stroke index d. Ejection fraction

5. In conclusion of your physical exam and assessment of Mr. H.G., you ask if there are any questions or concerns. H.G. asks you about an Advance Directive and if this is a necessary document and would like more information. As the ANP, you state: "No." "You're still young and do not require this type of planning." "Yes." "It's never too early to start planning ahead." "I don't like to talk about this topic with patients." "No." "You only need that if you are hospitalized."

5. Mr. Keen as mentioned in question number 4, goes on to explain that he does get intermittent pain along with the swelling in his leg. He is getting nervous and asks the APRN again "is there something wrong with me?" The APRN wants to test Mr. Keen for peripheral arterial disease, what test do you expect the APRN to provide next? Perform an abdominal ultrasound Perform the ankle-brachial index Perform the Rinne test Perform a prostate exam

5. The CAGE tool is a series of questions that assist the provider in screening for which of the following? a. Illicit drug use b. Alcohol dependence c. Sexual practices d. Behavior modification readiness

A 52-year-old patient comes into the emergency department complaining of back pain. As you do your assessment, you notice that in-between assessments the patient is short of breath and leans forward on the assessment table. The lumbar/spine CT is negative and only shows degenerative changes. Based on your observation, what other diagnosis can you identify? Asthma COPD Pulmonary embolus Cardiac tamponade

3. A 37-year-old patient presents to the clinic with c/o palpitations, excessive sweating, heat intolerance, weight loss (despite a noted increased appetite), and increasing bowel movements. Upon assessment, the provider notices tachycardia, tremor, exophthalmos, and proximal muscle weakness. A localized bruit is also heard on assessment. What should the provider consider screening for? A. Hypothyroidism B. Hyperthyroidism C. Cushing Syndrome D. Parkinson's Disease

A 60-year-old female arrived at the clinic for some episodes of shortness of breath only when sleeping at night. The FNP educates this patient to sit up, stand up, or go to a window for air because what kind of cardiac or pulmonary issue the patient may specifically have? a. Orthopnea b. Paroxysmal nocturnal dyspnea c. Nocturnal asthma attacks d. Right ventricular HF

A 60-year-old male, with history of ETOH abuse, is admitted to the ICU. The APRN goes to assess the patient after they initially get settled from the emergency room. The APRN inspects the abdomen of this patient, and she sees the patient is positive for which diagnostic sign? Rovsing sign Cullen sign Psoas sign Obturator sign

A 61-year-old male, who is hard of hearing came to see an NP which of the following is the best way to communicate with this patient? a. Ask how best to communicate with patients from family members b. Inform patients that sign language interpreting and real time-time captioning services are available c. Minimize the question you will be asking the patient. d. Come close to the patient and scream as loud as possible in other for him to hear you.

50-year-old female presents to the office for her annual physical exam with the following vital signs and measurements: blood pressure = 146/86, heart rate = 93, respiratory rate = 18, oxygen saturation = 94%, temperature = 36.8° C, weight = 82 kg, and height = 170.18 cm. Based only on the above information, what blood test should the NP order as part of the patient's routine exam? Fasting complete blood count (CBC) Non-fasting basic metabolic panel (BMP) Hemoglobin A1c (HgA1c) Thyroid-stimulating hormone (TSH)

. A 35-year-old female presents to the clinic with intermittent palpitations and shortness of breath for 2 months. The patient reports that she has been under a lot of stress with work and is currently going through a divorce. While interviewing the patient, the nurse practitioner leans forward, making eye contact and nods her head. What type of guided questioning technique is the nurse practitioner using? A) Requesting clarification B) Echoing C) Encouraging with continuers D) Questioning that elicits a graded response

4. You identify a systolic murmur from Ms. Smith. The murmur is louder in volume than S1 and S2, with palpable thrill. When the stethoscope is partly off the chest, you cannot hear the sound of murmur. According to the Levine grading system, which of the following best describes your funding? Garde 3/4 Grade 3/6 Grade 4/6 Grade 5/6

5) The NP is performing a HEENT exam on a patient. While palpating the cervical lymph nodes, the NP knows that which lymph nodes are often inaccessible to examination? Preaurical Anterior superficial cervical Deep cervical chain Supraclavicular

Which of the following symptoms are indicative of right sided heart failure? a. Cardiomegaly b. Orthopnea c. Restlessness d. Ascites

For which of the following patients would a comprehensive health history be appropriate? A. A new patient with the chief complaint of "sore throat" B. An established patient with the chief complaint of "I have an upper respiratory infection" C. A new patient with the chief complaint of "I am here to establish care" D. A new patient with the chief complaint of "I have knee pain"

How much Sodium does the average American intake? 2300 mg 1500 mg 3400 mg 4000 mg

In what order do you examine the abdomen. (Application) A.Inspect, auscultate, palpate and percuss B. Inspect, Auscultate, percuss, palpate deep then lightly. C. Auscultate, Inspect, percuss, palpate lightly, then deep D. Inspect, auscultate, percuss, palpate lightly, then deep

When auscultating the lungs of an adult patient, the nurse notes low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration longer than expiration. The nurse interprets that these sounds are: a. Normally auscultated over the trachea. b. Bronchial breath sounds and normal in that location. c. Vesicular breath sounds and normal in that location. d. Bronchovesicular breath sound and normal in that location.

When palpating for symmetric tactile fremitus, you would find more prominent vibrations if you were in which of the following anatomical locations? Posterior, lower lung fields Posterior, below the diaphragm Posterior, in the interscapular area Anterior, about the diaphragm area

When using the Wong-Baker FACES pain rating scale, the APRN: a. Should match the patient's facial expression to the one that closely matches on the rating scale b. Should only use this pain rating scale to assess cancer-associated pain c. Should ask the patient to choose the face that best describes how they are feeling d. Understands that this pain rating scale has been validated only to assess chronic neuropathic pain

Which diagnostic test would be most useful for a 35-year-old female patient who has been complaining of intermittent sharp chest pain that is worse when breathing in and relieved by shallow breathing and learning forward while sitting down? Chest X-ray Chest CT and MRI Echocardiogram Blood culture

Which is the correct location for chest tube insertion? 5th intercostal space. 3rd intercoastal space. Intercoastal space between the 4th and 5th Intercoastal space between the 5th and 6th ribs.

Which of the following counseling guideline for adults is considered a grade A recommendation by the USPSTF? Weight loss Unhealthy alcohol use Tobacco use Sexually transmitted infections including HIV

Which of the following is NOT an expected finding of a patient with large left-sided pleural effusion? Dull percussion to the left lower lobe Trachea deviation to the right Wheezing heard over the left lung Absent of tactile fremitus to the left lower lobe

Which of the following is NOT the appropriate imaging modality of choice ordered by the provider? CT neck with contrast in evaluation of suspected tonsillar or peritonsillar abscess MRI head is ordered to assess for intracranial complication of sinusitis Orbital x-ray to diagnose optic nerve damage Ultrasound neck is initially ordered for a patient with suspected thyroid nodules

You're precepting Diana, a second year NP student at Walden University and she ask you "What is responsible for the inspiratory splitting of S2"; the correct response would be? Closure of pulmonic valves, then aortic valves Closure of tricuspid, then mitral valves Closure of aortic, then pulmonic valves Closure of mitral, then tricuspid valves

4. The nurse is performing a comprehensive medical assessment. The patient says, "Once I sat up, I felt like the whole room was spinning." "Spinning?" The nurse replies. "Yes - like those teacups at Disneyland." Which technique of guided questioning is the nurse using here? A. Encouraging with continuers B. Questioning that elicits a graded response C. Empathetic response D. Echoing

5. During a routine office visit, the provider notices that the patient's pupils are unequal in both dim and bright light. There is also brisk pupillary constriction to light. The provider understands that this is: A. Horner syndrome B. Ocular nerve paralysis C. Tonic pupil D. Benign anisocoria

A patient arrives to the clinic with hope in quitting smoking. After his dad recently passed away from lung cancer, the patient says, "I am ready to quit now". Based on the Stages of Change model, what stage is the patient in? Action Maintenance Contemplation Preparation

An 88-year-old is complaining of shortness of breath that has been progressively getting worse and persistent. He states that his breathing discomfort increases with any physical activity. He has had a productive cough as long as he could remember. He used to smoke a pack of cigarette daily but has since stopped smoking. He repeatedly gets respiratory infections. What respiratory problem does he have? COPD Pneumonia Asthma Chronic bronchitis

Hematemesis may accompany in all the following conditions except? Mallory-Weiss tears Esophageal varices Peptic ulcer disease Acute bowel obstruction

In completion of your exam on Mr. H.G., the next plan of action is the recommendation for a set of baseline labs. As an ANP, you must use the approved medical abbreviations and acronyms. You recommend the following: CBC, CMP, HBA1C, LP, TP, and Vitamin D CDC, CMP, HbA1c, Lipid and Thyroid Panel, and Vitamin D CBC, CMP, HBA1C, L&T Panel, and Vitamin D CBC, CMP, HbA1c, Lipid and Thyroid Panel, and Vitamin D

Indicators of oropharyngeal dysphagia include all the following, except? Drooling Nasopharyngeal regurgitation Cough from aspiration Herpes simplex

The nurse elevates the head of the bed 30 degrees then assess her 68-year-old patient with swelling in her ankles including jugular venous pulsation 5cm above the sternal angle. The nurse knows that this finding would most likely indicate: narrowing of the jugular vein decrease fluid volume cancer metastasis elevated pressure related to heart failure

The student nurse practitioner is documenting data from a patient's physical examination, which of these would the student document as subjective data in the patient's chart? A. Sore throat B. Heart rate C. CBC levels D. MRI results

When the APRN uses her diaphragm of the stethoscope to assess the patient lung sounds she tells the patient to say "ninety-nine" she hears a loud localized sound this is indicative of? a) Pneumonia b) COPD c) Asthma d) Pleural effusion

A nurse practitioner student notes that the patient is experiencing hypoxia. What symptom is the patient exhibiting? Clubbing of the nails Sweating Bluish discoloration of the lips Pallor

A patient arrives to the clinic in immense pain. Upon assessment, you note a positive Rovsing sign, McBurney point tenderness, and a positive psoas sign. Which of the following choices are you most concerned about? Diverticulitis Pancreatitis Appendicitis Acute cholecystitis

A patient comes in for a routine check-up. She begins talking about her upcoming plans this weekend to attend a funeral service for a close friend that unexpectedly passed away. She begins to cry and verbalizes that she is unsure how she can attend. As a concerned Nurse Practitioner, your approach is a.) Redirect the conversation to issues concerning her health b.) Refer her immediately to the Psychiatrist, she is hopeless c.) Allow her to vent and give her the time and space she needs during this difficult time d.) Call in her daughter from the waiting room and have her sit with her so you can move on to your next patient who has been waiting

A patient complains of epigastric pain. Which of the following choices are you least concerned about? Pancreatitis GERD Diverticulitis Perforated ulcers

. A 20-year-old patient presents to the clinic with c/o eye redness and irritation. Upon assessment, you notice a triangular thickening of the bulbar conjunctiva growing across the outer surface of the cornea from the nasal side. Patient states that she has had this problem for years and she noticed it gradually getting worse and interfering with her vision. What is this patient likely experiencing? A. Xanthelasma B. Pterygium C. Stye D. Peripheral Cataract

. A 23 year-old patient is answering assessment questions with -yes -no responses, what is a strategy that might help? Ask a series of questions Use open ended questions Utilize more jargon in assessment questions Talk to them about their Plan of Care

Obstructive sleep apnea (OSA) is not commonly seen in which of the following diseases? Heart failure Controlled hypertension Stroke Posterior malocclusion of the jaw (retrognathia)

dentify the following type of incontinence and be quick about it because I gotta gooooo! "A patient peeing their pants after a very big LOL." A. Urge incontinence B. Stress incontinence C. Overflow incontinence D. Functional incontinence

3) Which cranial nerve is strictly involved in the production tears to lubricate the eyes? Optic Oculomotor Facial Trochlear

) A new nurse practitioner is being trained on the cardiac unit. She admits needing to "brush up" on cardiac sounds and rhythms. When assessing for heart sounds, where is the optimal location to assess for the aortic valve? Left sternum near the manubrium Posterior third intercostal space Fourth intercostal space Second intercostal space on the right

4. All of the following cause diffuse enlargement of the thyroid except: A. Graves' disease B. Hashimoto thyroiditis C. Endemic goiter D. Cyst

he Nurse Practitioner is providing education to the nursing student regarding percussion of the respiratory system. The Nurse Practitioner recognizes that further education is needed if the nursing student states which of the following? "Percussion will help determine if the underlying tissues are air-filled, fluid-filled, or consolidated." "Dullness or a dull sound is present when there is fluid or solid tissue in the pleural space." "Hyperresonance is present and heard when the lungs are overinflated." "A patient with pleural effusion will have a resonant percussion sound in the pleural space."

imothy is a 30-year-old male with no past medical history who presents to the Emergency Department (ED) with severe left shoulder pain after falling from his skateboard. An x-ray confirms a left shoulder dislocation. You are working as an APRN and discern with a physician that Timothy will require conscious sedation for a left shoulder reduction procedure. You meet with Timothy to inform him of his diagnosis, any risks, benefits, and alternatives to the recommended procedure. Which of the following core values of medical ethics are you demonstrating? a. Beneficence b. Justice c. Nonmaleficence d. Informed consent

What BMI should a physician educate the patient to have? Higher than 30.0 0-30.0 9-18.5 Less than 18.4

Select all that apply. What differentials are appropriate for chest pain. Angina Pleuritic Pain GERD Anxiety

ABCD

A 40-year-old bisexual male with a history of HIV comes into the clinic for a physical exam. Upon palpation over the medial epicondyle of the humerus you can feel enlarged nodes. Is this a normal finding given the patients PMH Yes or No? Yes No

) A 58-year-old male comes to the ER stating that his calf are painful, he feels tightness and upon assessment the calf looks dusky red, the APRN understands that this type of painful peripheral vascular disease mimic is? a) Compartment Syndrome b) Acute lymphangitis c) Buergers Disease d) Thromboangitis Obliterans

) A 66-year-old women comes to the emergency room stating that she has upper back pain, shortness of breath, nausea and fatigue. Based on her symptoms the APRN will? a) Admit her into the hospital to further evaluate her. b) Give her a breathing treatment and send her home. c) Give her a breathing treatment, antiemetics and send her home. d) Give her a breathing treatment, antiemetic and pain medication and send her home.

. A 34-year-old female arrives in the emergency room with complaints of chest pain. You order a chest X-ray, EKG, and labs including cardiac enzymes to rule out potential causes. Other potential causes of chest pain include all of the following EXCEPT: Endometriosis Gastroesophageal reflux disease (GERD) Herpes zoster Costochondritis

. A 37-year-old male patient presents with decreased hearing in his left ear. Patient reports fullness and some intermittent episodes of ringing in his ear. Which of the following would the APN do first? Assess the ears CT head Whisper test Rinne test

. A 70-year-old woman comes to the clinic for abdomen discomfort and three days of constipation. The Family Nurse Practitioner would assess the abdomen when the patient is supine. Which of the following skills order is correct? Inspect, Auscultate, Percuss, and Palpate slightly, then deeply. Percussion and then Palpation. Inspect, Palpate, Percuss, and Auscultate. Percuss posteriorly over the costovertebral angles.

. A 82-year-old female POD 5 of right hip replacement, who refuses to wear sequential compression device (SCDs) and early mobilization due to pain. What is the patient high-risk for developing? Deep Vein Thrombosis (DVT) Stroke Decrease range of motion on the right hip Varicose veins

. A patient wearing a wetsuit is brought in by ambulance to the ED complaining of severe central chest pain that came on suddenly. Upon auscultation, the NP finds precordial crackles synchronous with the heartbeat, not with respiration. The NP knows this is a common finding for? Mediastinal crunch Stridor Pleural rub Rhonchi

. After coming to the ER with complaints of lower extremity swelling in the left leg, the provider begins the bedside assessment. The provider must assess for pitting edema and discovers 4+ pitting edema. This indicates: A. More than 30 seconds for the pitting to rebound B. Slight indentation with 15 seconds to rebound C. Deep indentation with 30 seconds to rebound D. Barely detectable edema impression

. Patient presents for an annual physical and complains of palpitations, heat intolerance, and sweating. Upon your assessment, you notice the patient is tachycardic with moist skin. During your assessment of the thyroid, how would the thyroid gland feel during palpation? Soft and nodular Firm Tender upon palpation Should not be able to palpate

. Pt arrives to the clinic complaining of dyspnea and becoming easily fatigue. When auscultating the patient's heart, the NP knows that the following is the correct order of the heart sounds. Pulmonic, Atrial, Erb's point, Tricuspid, Mitral Pulmonic, Atrial, Tricuspid, Mitral, Erb's point, Erb's point, Pulmonic, Tricuspid, Mitral Atrial, Pulmonic, Erb's point, Tricuspid, Mitral

. The NP performs a physical assessment on a patient and noticed tonsillar exudates with a beefy red uvula, what does the NP suspect of this condition: Streptococcal pharyngitis Tonsillitis Gingivitis Tongue carcinoma

. You assess Ms. Smith's neck and pulsations in the right internal jugular vein. The jugular venous pressure is measured at 13cm in the total distance above the right atrium, with the head of the bed elevated to 50 degrees. Which of the following diagnosis is the least likely? Dehydration Acute heart failure Superior vena cava obstruction cardiac tamponade

.Which of the following formal clinical scoring systems do experts recommend using for patients with suspected deep venous thrombosis (DVT)? The Geneva Score The ankle-brachial index The Ballad Scoring System The American College of Cardiology/ American Heart Association ACC/AHA CVD risk calculator.

1. 19-year-old female presents with throat pain. She states her pain started abruptly with painful swallowing, fever of 102F, chills and enlarged tonsillar nodes. Identify what your next diagnostic step would be. Order a rapid strep test Order a chest x-ray Order a CT chest Order a throat culture

1. According to the 2013 Eighth Joint National Committee (JNC 8) guidelines, which blood pressure is classified as stage 1 hypertension? a. 129/89 b. 139/91 c. 140/78 d. 128/75

1. The student NP is initiating their session with a 65-year-old male named Mr. Timothy Smith, who goes by Tim and Timothy. Which of the following vocabulary would be inappropriate to use for this patient? a. Honey b. Mr. Smith c. Timothy d. Tim

1. Which of the following is not an open-ended question? a. How is your vision? b. Have you had any problems with your eyes? c. Any changes in vision? d. Is your Vision worse with close work or at distances?

1. You encounter a Spanish speaking only patient and are able to speak Spanish at a college level. You begin the assessment by introducing yourself, what is your next step? Utilize the interpreting service for the assessment Begin the assessment and ask family members at bedside to translate any words you are unable to Perform the assessment in English, slowing down as needed for the patient to comprehend Speak to family members and have them convey the information to the patient

16-year-old presents to the clinic for painful urination and painful bumps located on her vagina. When you ask when did the symptoms begin, she responds with 2 weeks ago. You ask your patient if you can examine her and she becomes tearful. She refuses your exam and begs you to prescribe her medication and wants to leave. Which of the following do you suspect? Sexual abuse Teenage immaturity She hates you personally

2. A male patient alert and oriented x4 walked into urgent care. He was observed guarding his stomach. When the student nurse gathers information for the HPI, what would be the first suggested step? Start with an opening statement Add information from other parts of the health history that are relevant Ask the patient if he had any illegal drugs in the past Call his family to find out his chief complaint (CC)

2. Jones is a 40-year-old woman with a history of anxiety that comes to your clinic for the first time. You are performing your physical exam on her and preparing to listen to her heart sounds with the diaphragm of your stethoscope. Which of the following is true regarding systole in the cardiac cycle? a. The aortic valve is open, allowing the ejection of blood from the left ventricle into the aorta b. The aortic valve is closed, preventing regurgitation of blood back into the left ventricle c. The mitral valve is open, allowing blood to flow from the left atrium into the left ventricle d. The pulmonic valve is closed, and the tricuspid valve is open

2. Mrs. Smith comes into the clinic complaining of excessive perspirations, palpitations, and increased heat sensitivity. She also notes waxy lesions on both legs. While Mrs. Smith is talking, the nurse notices that she is positive for exophthalmos. Based on this information, which of the following is the most likely cause of Mrs. Smith's symptoms? A. Grave's Disease B. Hypothyroidism C. Cushing Syndrome D. Acromegaly

2. The nurse enters the room to perform an initial assessment of a 68-year-old patient that is new to the clinic. She notices that the patient is assuming the tripod position, leaning forward with her arms braced on the office chair. Based on this observation, the nurse knows: A. The patient is having respiratory difficulties B. The patient has undiagnosed heart failure C. The patient has had a recent spine surgery D. The patient has peripheral vascular disease

2. Which of these statements is correct about Open-angle glaucoma? a. Open-angle glaucoma is Painless and gradual loss of vision b. Open-angle glaucoma is Painful loss of vision c. Open-angle glaucoma present with fixed midsized pupil d. Open-angle glaucoma doesn't cause blindness.

3. Lewis is a 78-year-old patient who presents to the ED from home with a new diagnosis of failure to thrive. She informs you that she has been experiencing low energy levels and exercise intolerance over the past few months. As a result, she has lost over twenty pounds within the last two months. You infer that Mrs. Lewis is demonstrating which of the following geriatric syndromes? a. Frailty b. Delirium c. Cognitive impairment d. Institutionalization

3. The student nurse practitioner witnesses the clinician ask the patient to identify the colored figure embedded in the background of the plate during a vision exam to rule out any damage to the optic nerve. The student nurse practitioner can distinguish the test as to which of the following A. Pseudoisochromatic color vision test B. Finger wiggle test C. Hearing test D. Swinging flashlight test

4) Which of the following is considered subjective information? A. Patient states they have 8/10 abdominal pain. B. Upon assessment, the NP observes tenderness on palpation of left upper quadrant. C. Blood pressure 80/41, heart rate 120, EKG shows sinus tachycardia D. Patient appears pale and diaphoretic

4. A patient presents to the clinic for a general check-up and after taking her vital signs, she states "I don't know why, but my blood pressure is always so high when I come to the doctor. But when I'm at home, it's good". As a provider, you know that this can be attributed to: A. White coat hypertension B. Acute alochol ingestion C. Incorrect larger cuff size D. Acute meal ingestion

A 37 y/o male walked into the ER complaining of tooth pain, pt noted to have a BP of 188/87 denies any history of hypertension, which of the following factors is most likely not going to affect his blood pressure a. He's an athlete b. 10/10 tooth pain c. Just drank 20oz of Starbucks coffee on his way here d. Tested positive for Methamphetamine

4. A patient with an addiction to alcohol wants to quit and went to his nurse practitioner for help. The NP is aware people go through different stages when getting sober. The NP also knows going through the different stages doesn't always mean it is linear. The NP knows the stages for getting sober are Precontemplation, contemplation, preparation, action, maintenance, relapse Denial, anger, bargaining, depression, and acceptance Infancy, childhood, adolescence, and adulthood Physical, behavioral, cognitive, and emotional growth and change

5-year-old Jake comes to the clinic for a sore throat on exam you see this. What test can you run quickly for your differential? Rapid Strep Viral panel Covid-19 swab

5. A 50 year-old female presents to the clinic for her yearly physical. During her interview, the patient states that she has a family history of breast cancer. The Nurse Practitioner planning for care utilizes secondary prevention by suggesting which intervention? Annual mammography screening Limit tobacco intake Attendance to breast cancer support groups Educating the patient regarding a healthy lifestyle such as exercising and maintaining healthy weight

5. Davis is a 67-year-old patient with a history of vertigo that comes to your clinic for a hearing examination. You begin examining her right ear, and she tells you that is her "good ear." Your next step is to perform the Rinne test. The Rinne test confirms that sound is heard longer in Davis's right ear. Which of the following is true regarding sensorineural hearing loss with air conduction (AC) and bone conduction (BC)? a. AC > BC b. AC = BC c. AC < BC d. BC = AC

5. Identify how the nurse practitioner can effectively adjust her environment to accommodate her elderly 70-year-old patient with a hearing deficit A. A quiet room with no distractions B. Speak in high tones C. Turn on any background noise, like the radio D. Take off the patient's glasses

5. The SBAR technique provides a concise framework for communication between health care providers about a patient's condition. What does SBAR stand for? A. Situation, Background, Assessment, Recommendation B. Situation, Background, Assessment, Reflection C. Situation, Background, Assessment, Root-Cause Analysis D. Situation, Background, Assessment, Radiology imaging

5. The female student NP checked the examination room for good lighting and positioned the bed to be comfortable for her and the patient. The patient was walked into the examination room and sat on a chair. Pt CC is abdominal pain. After gathering information about the patient's pain, the NP explained that she would need to examine her further and, if possible, lie on the bed facing up. What techniques does the student NP use to assess the patient's abdomen? Inspection, auscultate, percuss, and then palpate Examine mental status, cranial nerves, motor system, sensory system, and reflexes Inspect, palpate, and percuss Inspect, palpate, observe

78-year-old female is post-op day 2 recovering in the CCU from a coronary artery bypass graft x3. You receive a call from the primary nurse reporting critical labs. Hemoglobin 6.5 and hematocrit 19.5. The nurse also reports the patient's vital signs are stable and no visual signs of bleeding. You ask how the labs were collected and the nurse states, "I drew from the patient's cordis line." The next step to take would be: Order STAT H&H repeat labs and indicate peripheral stick only Order STAT 2 units PRBCs to transfuse Call the CT surgeon and prepare the patient to return to the OR Tell the RN to continue monitoring the patient, no orders at this time

A 12 -year-old female presents to urgent care with wheezing and chest tightness. Patient reports using her inhaler, but her breathing has not improved. Upon auscultation the nurse practitioner notes absent breath sounds bilaterally also known as "the silent chest". This assessment finding requires which of the following interventions? This is an example of severe asthma and requires immediate intervention. No intervention is needed the wheezing has improved. Reassessment in 15 minutes to see if breathing has gotten better. The patient can be discharged home.

A 15-year boy comes to the clinic for a routine visit with his mother and during your assessment, you notice that she consistently answers questions for him. The best approach of the provider in continuing this assessment would be to: A. Inform the mother she will get a chance to speak with the provider, but that the boy needs to be able to speak first. If the behavior persists, she will be asked to leave the room. B. Scold the mother and shame her for her behavior C. Make no change to the interview D. Begin directing all questions to the patient's mother

A 15-year-old female and her mother present at the clinic for a routine physical examination. When you call the patient's name, the mother stands up and proceeds with walking to the exam room. You politely inform the mother before entering that at some point she will be asked to leave to provide privacy to the adolescent patient. The Nurse Practitioner understands this assessment will obtain an adequate psychosocial history a.) HEEADSSS b.) C-SSRS c.) COWS d.) HDFS

A 15-year-old patient arrives to the clinic with respiratory distress. The chest x-ray shows an elongated cardiac silhouette with hyper inflated lungs. Upon percussion, you note bilateral hyperresonance. Which diagnosis are you suspecting? Asthma Pneumonia Hemothorax Empyema

A 16-year-old female comes to the emergency room with nausea, vomiting, and pain that started in her periumbilical region and has gradually moved to the RLQ. The nurse practitioner recognizes the patient may have acute appendicitis and orders an US of the Abdomen. The nurse practitioner notes that the pain the female is experiencing is likely classified as: a. Visceral pain b. Parietal pain c. Referred pain d. Neuropathic pain

A 17 year-old male competitive runner is at his annual physical prior to the start of his senior year of high school after a move to Boulder, CO from Los Angeles a few months prior. When analyzing the lab results from his blood work, the nurse practitioner will recognize which change as expected: a. An increase in Hbg and hematocrit b. A decrease in TSH c. An increase in urinary creatinine d. A decrease in FSH

A 19-year-old male presents with shortness of breath after working out in the morning. The patient denies any known history of asthma but has expiratory wheezing during auscultation and chest tightness. Which of the following tests would you order for your patient? Peak flow with nebulizer treatment Monitor and reassess Order a CT chest V/Q scan

A 2-day-old full-term infant is admitted to the pediatric intensive care unit with symptoms of cardiogenic shock. On auscultation, you hear a continuous murmur at the left second intercostal space. The baby still has a patent ductus arteriosus and the murmur is an expected finding. What is another situation where you would expect to find a continuous murmur? a. Pericardial friction rub b. Mitral regurgitation c. Mitral stenosis d. Ventricular Septal Defect

A 20 years-old female has had a headache for two weeks since the start of her period. The pain scale is about 6 to 7 for the scale of 1 to 10. It lasts for 20 minutes at a time and is accompanied by nausea. Which of the following categories does it belong to? A. History of Present illness B. Chief of complaint C. Personal and social history D. Review of system

A 20-year-old male presents to the health center with complaints of "really itchy eyes, and this morning my eyes had a watery discharge. The FNP examines the eyes and notes dilated conjunctival vessels with redness. The patient probably has: A. Conjunctivitis B. A Corneal injury C. Pink eye D. Acute Iritis

A 21-year-old male student verbalizes that he started experiencing lower back pain about 3 months ago. He describes it as a constant dull, aching pain that is further aggravated when he picks up things from the floor. His pain level right now is 5/10, and it does not radiate anywhere else. Advil and heat packs help alleviate his pain. Which question elicits further characterization of the patient's chief concern? Can you please tell me what you were doing when the pain first started? How severe is your pain right now? Have you sought medical attention for this issue before? How often do you exercise?

A 23-year-old female comes to the ER for cough x 4 days. When describing her cough she states, "this clear white stuff comes out every time I cough". Associated symptoms include fever, congestion, and a runny nose. She denies SOB and is speaking in full sentences. Based on the color sputum what is your differential? Viral Infection Bacterial Pneumonia Asthma Exacerbation COPD

A 25-year-old female presents to the ER with the complaint of shortness of breath. The patient has a history of asthma. The NP is listening to the breath sounds and hearing the air passing through narrowed bronchioles would produce which of these adventitious sounds? Wheezes Bronchial sounds Bronchophony Whispered pectoriloquy

A 25-year-old patient comes into the clinic complaining of a sore throat, cough, rhinorrhea, absence of fever, and exudate. Based on what you know, this is most commonly what type of pharyngitis? Viral Bacterial Fungal None of the above

A 25-year-old pregnant mom at 30 weeks gestation was recently diagnosed with gestational diabetes. The NP would like to begin treatment of Insulin to be self-administered by patient. What is the best method to assess the patient's comprehension of correct dosing and injecting Insulin? Utilized the teach-back method Provide written materials with illustrations on proper insulin injection. Show a video on medication administration. Have the patient tell you how to self-administer insulin.

A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluating this change, what does the nurse know to be true? This decline in blood pressure is the result of peripheral vasodilatation and is an expected change. Because of increased cardiac output, the blood pressure should be higher at this time. This change in blood pressure is not an expected finding because it means a decrease in cardiac output. This decline in blood pressure means a decrease in circulating blood volume, which is dangerous for the fetus

A 26-year-old female presents to the community clinic for the first time with a chief complaint of abnormal periods. As the nurse practitioner, which type of health history is most appropriate to use for this encounter? a. A comprehensive health history b. A problem-oriented health history c. A health maintenance history d. A focused patient history

A 28-year-old construction worker is concerned about a continuous roaring noise in both ears for about 2 months. To rule out Meniere disease, which of the following symptoms should the clinician ask the patient about? Vertigo Ear pain Headache Ear drainage

A 3 year old patient, BL, comes into the clinic with her father holding her arm and grimacing. When interviewing the patient, she is very shy and fearful. After a few questions are answered by the patient's father, the clinician wants to rate the child's level of pain. What is the appropriate pain scale to use on this patient? (A) Wong-Baker FACES Pain Rating Scale (B) Numeric Rating Scale (C) FLACC (D) Physical indicators/expressions of pain

A 30-year-old female presents to the clinic complaining of epigastric pain after eating for one month. After a normal EKG has resulted, what would the FNP provide as a relieving factor for this diagnosis? Antacids Hydration & bowel rest Antibiotics Tylenol

A 30-year-old female who is 26 weeks pregnant and recently travelled to Florida to visit her parents arrives to the clinic complaining of sudden dyspnea and tachypnea. You note unilateral lower extremity swelling on the physical exam. Which of the following will be the primary diagnosis? Pulmonary embolism COPD Spontaneous pneumothorax Pneumonia

A 30-year-old male patient with a history of HIV presents to you with complaints of ear pain and "clogged" ear sensation that began 2 days ago. As you examine the affected ear you notice that the auditory canal is swollen, tender and erythematous. Based on this exam and information, what is your number one differential diagnosis? A) Acute otitis externa B) Otitis media C) Acute mastoiditis D) Vertigo

A 32-year-old female was extubated after an asthma exacerbation. The APRN is teaching a student nurse to be aware for which ominous sign that could be the cause of subglottic or tracheal obstruction? a) High pitches musical sound known as stridor b) Wheezes c) Diminish lung sounds d) Rhonchi

A 36-year-old male is in urgent care due to pain he describes as "intense" and not improving over the last 24 hours with any positional changes or medication. This pain is most indicative of: A. Ischemic pain B. Colic pain C. Inflammatory pain D. Painy McMaxpaine

A 38-year-old female bus driver presents to the clinic for a routine visit six months after losing her husband from cancer. She says that she has a good support system. Suddenly, she becomes tearful when speaking about the plans her and her husband had and never fulfilled. She changes her subject rapidly whether her mammogram is due. As an APRN which of the following is an example of an empathetic response to the patient? a) Recognizing the patient's emotions by asking how she feels about the situation. b) Allow the patient to cry. c) Believing that these emotions are normal and expected due to spoused death. d) Continue with the assessment and ignore the patient's feelings.

A 40-year-old female comes into clinic with a chief complaint of a fever and productive cough with large amounts of sputum. What other descriptive factor would indicate this patient may have a lung abscess and require further work up? a. Foul-smelling, purulent sputum b.Mucoid sputum that is translucent and white or gray c. Pink, frothy sputum d. None

A 40-year-old male patient arrives to the emergency room with tachypnea, altered level of consciousness and positive toxicology screen for fentanyl. ABG results show pH 7.29, C02 55, HC03 26, 02 80. Based on the results, how would you classify this type of respiratory failure? A) Hypercapnic (ventilatory) respiratory failure B) Hypoxemic respiratory failure C) Perfusion respiratory failure D) Impaired respiratory failure

A 48-year-old female who recently traveled to Argentina is complaining of being sick for several days. She mentions a horrible cough, fever, and body aches. The CXR is unclear but indicative of pneumonia. As you percuss the patient's anterior and posterior thoracic cavity, what sound do you expect to hear? Dull Wheezing Silent due to the airways being collapsed Normal since the patient is not complaining of SOB

A 50-year-old female patient arrives with N/V, anorexia, distended abdomen and shuffling gait. You notice a bluish discoloration at the umbilicus. How would you document this finding? A) Cullen sign B) Grey Turner Sign C) Murphy sign D) Peritonitis

A 50-year-old man presented to the ED complaining of severe chest pain. As a clinician, you are assessing his pain. What other criteria should you consider to conclude a diagnosis of acute myocardial infarction related to ECG? New ST elevation at J point at least 2 continuous leads of 2mm, ST depression in leads V-1V-2; New or presumably new LBBB Fireman hat Third-degree AV block T wave depression

A 51 year-old female patient with a history of asthma presents to the clinic with complaints of productive cough and SOB on exertion for 3 days. Which assessment finding is the most pertinent in ruling out a diagnosis of bacterial pneumonia? Temperature: 98.3F Respiration: 24 Spo2: 95% Chest pain

A 53-year-old male comes into the clinic for bruising on bilateral hands. Upon inspection you note this. What phenomenon is the patient experiencing? Raynaud Disease Bruising over bilateral distal digits Burn Injury Ischemia

A 54-year-old diabetic patient comes into the emergency department complaining of a leg injury that will not heal. He admits using several forms of ointments and herbal remedies but stopped since the skin "changed colors." The patient briefly mentions that his older brother had something similar, but his leg was shiny and scaly. What is your diagnosis? Chronic venous insufficiency Arterial insufficiency Deep vein thrombosis Diabetic ulcer

A 55-year-old female patient recently diagnosed with diverticulosis presents to the emergency department with complaints of cramping pain in the left lower quadrant, low grade fever, and constipation. She reports that pain is gradual in onset, and she is able to achieve some relief with oral analgesics and bowel rest. The assessing APRN anticipates a diagnosis of diverticulitis versus appendicitis based on which associated symptom? Left lower abdominal quadrant pain Constipation Low grade fever Cramping pain

A 55-year-old male comes to the clinic stating that he is always tired and feels sleepy all the time especially during the day. The APRN ask if the patient snores or has apnea. In order for the patient to have apnea he must. a) have breathing cessation for > 10 seconds. b) have breathing cessation for >8 seconds. c) have breathing cessation for >6 seconds. d) Have breathing cessation for > 5 seconds

A 55-year-old male patient presents to the clinic with an enlarged AP diameter, current smoker, midline trachea, chronic cough and diffusely hyperresonant sounds upon percussion. Based on this information, what is most likely his diagnosis A) Chronic obstructive pulmonary disease B) Pleural effusion C) Pneumothorax D) Lung cancer

A 56 year old female patient has diabetes, hypertension and asthma. Under which category would this information be placed in the patients chart? A. Medical B. Surgical C. Obstetrics/gynecology D. Psychiatric

A 56-year-old female with a history of diabetes presents to the emergency department with a right foot ulcer worsening over the past month with a foul-smelling odor. When interviewed by the clinician, it is discovered that the patient does not take her medications as prescribed and has not seen her endocrinologist in over two years. The nurse practitioner student classifies the patient as: a. Nonadherent b. Flirtatious c. Angry d. Low literacy

A 57-year-old patient who came in for ARDS is now extubated. Patient was AAOx4, post-extubation but thirty minutes later, patient started to become restless and confused. Vital signs HR 120, RR 35, SpO2 100% on 40% FiO2 aerosol mask, BP 170/110. What is the next step in determining the cause of confusion? Assess patient, inform the doctor, and anticipate an order for blood gas level to assess PaO2 Switch patient to BiPAP machine Continue to monitor, apply restraints, and give anti-anxiety and blood pressure medications Call Respiratory Therapist and let them handle the breathing treatment.

A 58-year-old female patient was admitted into the ER for the complaint of abdominal pain x 2 days. Upon the assessment, the Nurse Practitioner (NP) noticed some signs including coughing, rebound tenderness, involuntary guarding, rigidity, and tenderness upon percussion. The NP suspects the patient has: Peritonitis Appendicitis Colitis Diverticulitis

A 58-year-old male presents to the clinic with dysphagia, weight loss, and vomiting. He has a family history of gastric cancer and has failed empiric therapy. Which of the following diagnostic test would you order for your patient? Endoscopy Colonoscopy ERCP HIDA

A 60-year-old patient comes into the clinic with a venous stasis leg ulcer on her right inner ankle with trace edema. The patient states that the pain is a 4/10 at rest that increases with touch. While assessing the ulcer, the nurse expects to find which of the following: A. Brown pigmentation around the ankle B. Preliminary signs of gangrene C. Skin surrounding the ulcer is cool to the touch D. Skin surrounding the ulcer is calloused

A 60-year-old woman sees her NP with a complaint of heartburn. The patient says heartburn has been more frequent this week, especially after two glasses of wine. The patient BMI is 37. What should the NP be concerned about? Cardiac problems Appendicitis Hepatitis Nothing

A 62-year-old male patient with abdominal pain was admitted to the hospital with a suspected diagnosis of acute pancreatitis. Which assessment findings would be consistent with acute pancreatitis? Except. a. Diarrhea b. The gray-blue color at the flank c. Abdominal guarding and tenderness d. Left upper quadrant pain with radiation to the back

A 65-year-old female patient presents to the emergency department with complaints of fever, lethargy, abdominal distention, and generalized abdominal pain rated at 8 on a scale of 0 to 10. The patient also states she underwent a colonoscopy a day ago. Upon examination, the APRN notes a firm and distended abdomen and begins to suspect a possible bowel perforation. When ordering radiographic studies, the APRN understands that: a. Oral barium sulfate contrast media is contraindicated when the integrity of the GI tract is in question b. Oral barium sulfate contrast media should be used as it defines the mucosal pattern very well c. Water-soluble iodinated contrast media produces equally informative images as barium studies d. Water-soluble iodinated contrast media is contraindicated when the integrity of the GI tract is in question

A 65-year-old female presented to the clinic to evaluate for speech impairment and discomfort of the tongue. Upon examination, the patient asked to put out her tongue. Asymmetric protrusion of the tongue was noted and pointed toward the right side. Which of the following statement is TRUE? Right-sided CN XII (hypoglossal nerve) lesion is suspected Asymmetric protrusion of the tongue is a benign finding and requires no intervention CN X (Vagus nerve) is damaged Right-sided CN X (Vagus nerve) lesion with paralysis is confirmed

A 65-year-old female presents to the clinic for a physical exam. The patient has a past medical history of hypertension, hyperlipidemia, and diabetes. The patient is 5'5 and 190 lbs. The nurse practitioner documents in the patient's electronic health record that the patient's BMI falls into which classification? A) Obesity class I B) Obesity class II C) Overweight D) Obesity class III

A 65-year-old male known case of COPD visited an outpatient clinic for a routine checkup. The nurse practitioner performing the physical examination noticed that the point of maximal impulse is challenging to palpate and is not found in the apex; which of these actions would the nurse most likely do on examination to locate the PMI? a. Palpate the xiphoid or epigastric area. b. Palpate in the fifth intercostal space, left midclavicular line. c. Palpate midsternal line. d. Palpate the right side of the chest

A 65-year-old patient presents to clinic complaining of slow, progressive dyspnea on exertion that has worsened over the past several months. He is a former smoker, with a forced expiratory time of 11 seconds. His lungs are hyperresonant. Breath sounds are distant with delayed expiratory phase and scattered expiratory wheezes. Based on this information, what is the most likely diagnosis for this patient? A. COPD B. Pneumonia C. Large Pleural Effusion D. Chronic Bronchitis

A 65-years older man visits the clinic for his annual physical exam. During the health history interview, the patient stated that he is sexually active. He denies using recreational drugs and smoking but drinks alcohol (beers) four times a week. Which category does this information belong to: A Social history B Chief complaint C Review of system D History of Presents illness

A 67-year-old Hispanic female came to see you for right clavicle pain, she is exclaiming "Oh Dios Mio," and says that she feels like she is dying of a heart attack. Following a line of questioning to eliminate myocardial and musculoskeletal involvement, you conclude that the patient has low pain tolerance and is being dramatic based on some anecdotes you heard in NP school. Assuming that the patient's pain is overstated because the patient is Hispanic is considered A. Bias B. Value C. Mood D. Racism

A 67-year-old woman presented to your clinic today concerned she might be experiencing myocardial infarction. As a student clinician, you recall during Dr. Gantioque's lecture on the atypical symptom a woman may present with. Which of the following are examples? Upper back, neck or jaw pain, shortness of breath, nausea or vomiting, fatigue Toothache, headache, blurry vision Paroxysmal nocturnal dyspnea, cramping Abdominal pain, nausea, vomiting

A 67yr old female patient was brought to the emergency room by her daughter, patient complaints of pain in her neck and upper back and shortness of breath. The patient also complained of nausea, dizziness, and fatigue. She was having the pain for a couple of days and took some Motrin, but it didn't help. Knowing her age and the type of pain she is experiencing, what kinds of tests would you order first? A. 12-lead ECG B. X-ray of the neck and shoulder C. Blood test D.CT scan of the head

A 7-year-old boy comes into the ER with his mother. His mother states that he has a history of asthma but rarely has to use his inhaler. When auscultating you hear a high-pitched inspiratory whistling sound. As the Nurse practitioner, you know this is what type of sound? Stridor Wheezing Rhonchi Fine crackles

A 7-year-old boy was brought by his mother to the ER after being found with blood all over his nose, cheeks, and mouth. You note the blood spattered over his face and clothes to be dark and has food particles. What part of the body did the blood come from? Stomach Mouth Nose Pharynx

A 70-year-old homeless male patient with a history of gastroesophageal reflux disease (GERD) presents to the emergency room (ER) with a cough and chest pain for one week. Which of the following additional symptoms best support a differential diagnosis of bacterial pneumonia? Fever, right chest pain upon inspiration, & productive cough with yellow sputum Afebrile, chest pain upon inspiration, & thick, tenacious, clear sputum Afebrile, burning chest pain in the epigastric area, & unproductive cough Fever, chest pain upon excessive coughing, & unproductive cough

A 70-year-old male with a history of uncontrolled diabetes presents to the clinic with wound discovered by his wife over the base of his right foot. The patient denies any pain. On exam you inspect this. What differential would be appropriate for this case? Neuropathic Ulcer Chronic Venous Insufficiency Chronic Arterial Insufficiency Burn Injury

A 70-year-old man visits his PCP and states last night he started seeing floaters and flashing lights, sudden vision loss but is not having pain. What do you believe the patient has: Retinal detachment Acute angle closure glaucoma Subconjunctival hemorrhage Ptosis

A 72 year-old patient presents to the clinic with complaints of cramping and discoloration to both her legs with a poorly healing wound on her left ankle for 2 months. The patient reports an 8/10 pain in both legs. On assessment, the Nurse Practitioner notes brown pigmentation to bilateral legs with 2+ pitting edema and an ulcer to the left ankle. What is the most likely diagnosis? Chronic Venous Insufficiency Deep Vein Thrombosis Chronic Arterial Insufficiency Cellulitis

A 72-year-old male comes in for a routine checkup. Which finding requires careful evaluation? Loss of arterial pulsations Systolic aortic murmur Presbycusis Decreased olfaction

A 72-year-old male with a history of HTN, depression, Bell's Palsy, and presbyopia presents to the ED with deep belly pain radiating to his back and throbbing near his belly button. The patient denies smoking and has a family history of cardiovascular disease. After screening, the patient is found to have an abdominal aortic aneurysm. Which of the following is this patient's strongest risk factor? Age and sex Hypertension History of Bell's Palsy Presbyopia

A 75-year-old female presents to the ED for assessment after fainting in the bathroom. She reports head strike with evidence of small abrasion above the left eyebrow. During your assessment, she mentions she's feeling lightheaded and nauseous. What would not be part of your differential diagnosis? Anxiety TIA Arrhythmia Vasovagal syncope

A 80 yr old patient Charles Landon, s/p Transcatheter aortic valve replacement complained of Shortness of breathing and chest pain 4/10. Vital signs are as follows: BP 86/70 (MAP 57), HR 110, temperature 97 F, RR 20, O2 saturation 90% on room air. On assessment, you see JVD, muffled heart sounds, and diminished lung sounds. What intervention should you do next? Get stat Echo to confirm cardiac tamponade and get ready to take her back to the Cath lab Get a stat EKG because the patient is having a heart attack Give patient nitroglycerin sublingual x1 to see if the symptoms resolve Put the patient on 2L NC Oxygen and wait for the anesthesia to wear off and give 500 ml of NS bolus

A 9-year-old girl is brought in by ambulance to the emergency room after an anaphylactic reaction to a bee sting. Her mother states she administered her epi-pen immediately after the sting occurred and before the ambulance could arrive. You enter the room to examine the patient, before you reach the patient you can hear a high-pitched musical sound coming from the patient and you see obvious use of accessory muscles to breath. The APRN should prepare to: Intubate the patient Order a CXR Administer albuterol breathing treatment Insert a chest tube

A PMI > 2.5CM IS evidence of left ventricular hypertrophy (True or false) a.True b.False

A female patient was brought to the ED by her boyfriend for a fractured wrist and multiple facial bruises and contusions due to a "fall". However, after further evaluation, you begin to suspect abuse. After asking the boyfriend to leave the room, the provider should state which of the following first to make the patient feel comfortable and normalized? A. "Abuse is common in many of my patients lives, so I ask about it routinely" B. "I know you're being abused by your boyfriend!" C. "If you're being abused, I have to report it by law!" D. "Is there anyone here that just left the room that you're afraid of?"

A male patient arrives to the clinic after complaining of unilateral hearing loss. During the Weber test, the patient states he hears the sound on the RIGHT ear. What can this mean? Conductive hearing loss in right ear or sensorineural hearing loss in left ear Conductive hearing loss in left ear or sensorineural hearing loss in right ear Normal Weber test Bilateral conductive hearing loss

A mother brings in her 3-year-old daughter for evaluation after swallowing a small toy. During assessment, you hear a high-pitched inspiratory whistling sound near the larynx. What is this sound? Stridor Wheezing Crackles Rhales

A novice APRN reviewing patient chest radiographs in a busy emergency department, notices that most patients diagnosed with aspiration pneumonia seem to have infiltrates in the right middle or lower lobe of the lungs. The APRN understands that one explanation for this may be: The right main bronchus is shorter, wider, and more vertical than the left main bronchus The left main bronchus is shorter, wider, and more vertical than the right main bronchus The right lung is divided into 3 major lobes Aspiration pneumonia only occurs in the right lung

A nurse practitioner is going to assess a patient's neck. Which of the following is often inaccessible? Deep cervical chain node Superficial cervical node Occipital node Supraclavicular node

A nurse practitioner talks about presbycusis to her nursing student. Which statement by the student indicates effective learning? A) It is the sensorineural loss that occurs with aging. B) It occurs due to the blockage of water in the ear after swimming. C) It is the inflammation in the ear that occurs with obstruction of the eustachian tube. D) It occurs in neonates who are fed by the bottle during the first four weeks of age.

A paradoxical pulse or pulses paradoxus can be heard in all of the following except: A. Pericardial effusion B. Acute asthma C. Pericardial tamponade D. Constrictive pericarditis

A patient came to the ER complaining of decreased in phonation and slight difficulty breathing. She mentioned that she started feeling itchy on her neck around 10pm last night after having a seafood platter. Per patient, she's been eating seafood her whole life so unsure of the cause. What would be the first diagnostic exam that can be performed? performed laryngoscopy and placed an otolarygneal consult obtain CT neck administer Benadryl and Decadron intubate for airway protection

A patient came to the outpatient clinic for a routine checkup; while examining a patient, the nurse observed abdominal pulsations between the xiphoid process and umbilicus. The nurse would suspect that these are: a. Normal abdominal aortic pulsation. b. Pulsation of the renal arteries. c. Pulsation of the inferior vena cava. d. Increased peristalsis from a bowel obstruction.

A patient comes into the ER with clenched fist over her sternum suggesting angina pectoris, what would be your initial question? Do you have any discomfort or unpleasant feeling in your chest? Don't ask any questions, get the crash cart! Before we get started, do you need to use the restroom? You look exhausted, did you just finish a marathon?

A patient comes into the clinic for a check-up and reports fatigue, weight gain, and excessive daytime sleepiness. She states she has been overworked at her new job and has not been able to establish a routine. As the ANP you further assess her sleep patterns and ask if she snores as well. The patient states yes. They are all hallmark signs of which disease? Obstructive Sleep Apnea COPD Obesity Heart Failure

A patient comes into the emergency room with RUQ pain suspicious for acute cholecysitis. The nurse practitioner deeply palpates the RUQ at the location of the patient's pain and asks the patient to take a deep breath. The patient expresses they are experiencing sharp, halting pain on inspiratory effort from the palpation. What positive sign is the nurse practitioner assessing for? a. Murphy's Sign b. Rovsing sign c. Psoas sign d. Obturator sign

A patient comes to the clinic for a routine visit. During the history, the provider discovers a number of major cardiovascular risk factors. Which of the following would not be considered risk factors for CVD? A. Cancer B. Atrial fibrillation and family history of premature CVD C. Diabetes and Unhealthy Diet D. Obesity & Hypertension

A patient comes to the clinic for runny nose that had initially improved after 5 days, but then the patient began to feel ill and symptomatic again. The patient also reports a fever, headache, and a purulent nasal discharge. When determining a differential diagnosis, the provider understands the following: A. Presumed URI can often be ABRS due to the "double sickening" experienced by the patient B. There is no need for a differential diagnosis as this is certainly a URI C. Symptoms of AVRS, URI, and ABRS are not similar D. Treatment will be antibiotics regardless of the differential diagnosis

A patient has come into the local community clinical seeking care. The family nurse practitioner has established the initial rapport by adjusting the environment as necessary, greeting the patient, and identifying their preferred title and gender. The following appropriate action determines the patient's reason for seeking care. Identify the next stage of the encounter which the nurse practitioner is entering. a. Gathering information b. Performing the physical examination c.Initiating the encounter d. Closing the encounter

A patient in the ER needs to have a thoracentesis with needle insertion. The nurse practitioner knows the safe position for it is between the: 7th and 8th ribs 6th and 7th ribs 5th and 6th ribs 4th and 5th ribs

A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The patient's chest x-ray shows a tension pneumothorax. Understanding your landmarks where would the needle be placed to decompress the tension pneumothorax? A) The second intercostal space. B) Intercostal space between the 4th and 5th C) Level of the 4th rib for the lower margin. D) The 3rd intercostal space.

A patient is brought to the ER from a SNF after increased symptoms with difficulty breathing after an episode of choking during eating a meal. A CXR is performed to determine if the patient is experiencing aspiration pneumonia. The provider understands that the likely location for this pneumonia is: A. Right middle lobe B. Left upper lobe C. Left lower lobe D. Right upper lobe

A patient is complaining of chest pain. The NP wants to get more information and is going to ask an open- ended question. Which would be the best way to ask? "Please tell me about the symptoms you are having in your chest?" "Does it wake you up at night?" "Have you fainted before?" "Do you get night sweats?"

A patient presents complaining of recurrent episodes of bilateral fingers turning pale and cool for a few minutes especially when it is cold outside. The patient denies pain and states the symptoms resolve with the warming of hands. The patient is otherwise healthy. What is the most likely cause? a. Raynaud Phenomenon b. Right arm DVT c. Peripheral arterial disease d. Acute arterial occlusion

A patient presents to the clinic complaining of diffuse aching pain in bilateral lower legs for 3 months. The patient rates pain 10/10 with prolonged sitting. +1 pitting edema and skin thickening around the ankles are noted. Small ulceration with brownish pigmentation to the left medial ankle is also noted. Which of the following statement is TRUE? The patient has chronic venous insufficiency, which arises from chronic obstruction and incompetent valves in the deep venous system Acute arterial occlusion should be suspected since the patient complains of 10/10 pain The small ulceration indicates that the patient has superficial phlebitis The patient needs to be treated with antithrombotic therapy for DVT

A patient with HIV infection complains of feeling pain and fullness in the left upper belly. The nurse practitioner should perform which of the following percussion techniques to help detect splenomegaly? percussion the left lower anterior chest wall and check for castell sign percussion the left lower anterior chest wall and check for mcburney sign percussion the right upper anterior chest wall and check for prince sign percussion the right lower anterior chest wall and check for costal sign

A six-year-old boy is brought in by his father to the clinic for left ear pain and drainage. After a thorough HEENT assessment, the FNP suspects otitis media. The FNP knows that which of the following is NOT true regarding otitis media? Movement of the auricle and tragus is painful. Tenderness behind the ears is present. Bone conduction is equal to or longer than air conduction. Sensorineural hearing is intact.

A twenty-five-year-old patient is in the clinic for an annual physical exam. The NP just finished assessing her eyes and is now inspecting her ears. When examining the ears with the otoscope, what is the correct way to straighten the patient's ear canals? Pull the auricles upward and backward Pull the auricles upward and forward Pull the auricles downward and backward Pull the auricles downward and forward

A woman presents to the emergency department with bilateral lower extremity edema. Based on her assessment, what findings would conclude that the patient has lymphedema? Non-pitting edema, thickened skin, no pigmentation nor ulceration 2+ pitting edema, thickened skin, browning pigmentation, ulceration Non-pitting edema, thickened skin, browning pigmentation, ulceration 3+ pitting edema, thickened skin, browning pigmentation, no ulceration

A. Acute pain is usually associated with surgery, trauma, and acute illness typically lasting less than 3 to 6 months. B. pain not associated with cancer or other medical condition lasting more than 3 to 6 months. C. Pain lasting more than 1 month beyond the course of an acute illness or injury D. pain recurring at intervals of months or years.

After obtaining the patient's height and weight. You determine the BMI is above 25. What additional risk factors do you assess for? Heart disease, high triglycerides, high blood sugar and A) High LDL and Low HDL B) Low LDL, high HDL C) Low LDL and low HDL D) High LDL and high HDL

Alex comes into the clinic complaining of waking up 1 or 2 hours after falling asleep and having shortness of breath. He states that sitting up or standing up helps. What does Alex have? Paroxysmal nocturnal dsypnea Orthopnea Anxiety attack Syncope

All of the following are correct steps in measuring jugular venous pressure in a patient except. Raise the head of bed to 90 degrees. Measuring in vertical distance above the angle of Louis. Have the patient turn slightly away from the side you are inspecting. Raise the head of bed to 30 degrees.

All of the following can cause obstructive breathing EXCEPT: a. Intoxication b. Asthma c. Chronic bronchitis d. COPD

Amelia is a new Family Nurse Practitioner (FNP) at a local community clinic that provides primary care to underserved populations. Amelia knows that not all the patients she will be seeing that day, or the amount of time allotted for each patient, will require that she take a detailed health history. Which patient would the FNP perform a comprehensive health history? 25-year-old female coming into the clinic for the first time for an annual physical 9-year-old male with the chief complaint of a sore throat. 72-year-old female with the chief complain of dysuria. 27-year-old female coming to the office wanting to discuss contraceptive options.

An 85-year-old female has been ill with the flu, experiencing headaches, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The Nurse Practitioner (NP) auscultates her lungs and hears diffuse crackles. How would the NP best interpret these assessment findings? It is likely that the client is developing secondary bacterial pneumonia. The assessment findings are consistent with influenza and are to be expected. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions The client has not been taking her decongestants and bronchodilators as prescribed.

An APRN in the Emergency Department is assessing a 33 year-old patient that was just brought in by family for a syncope episode. Upon interviewing and assessing the patient the APRN recognizes which of the following as subjective data. Patient states: "I felt nauseous for an hour leading up to my syncope episode". Patient blood pressure = 110/55. Patient is alert and oriented Patient's hemoglobin comes back as 7.3.

An NP assesses a 32-year-old female adult who comes to the clinic for an annual checkup. Which finding is the expected lung sounds in normal healthy adults? A) Hyper-resonant percussion tones and absent voice sounds B) Limited chest expansion and muffled voice sounds C) Dull percussion tones and increased tactile fremitus D) Symmetrical tactile fremitus and muffled voice sounds

An increase with egophony, bronchophony, and whispered pectoriloquy may be present in which of the following condition? Consolidation Pneumothorax COPD Asthma

As an NP student, you suspect your patient has cardiac tamponade and use a BP cuff to check the patient for a paradoxical pulse due to differential diagnoses below, Except? a. Hypertension b. Jugular venous distention c. Tachycardia d. Muffled heart tones

As the nurse practitioner, you are reviewing a patient's x-ray when you notice that the apex of the heart is located on the right side of the chest. What is the most likely their diagnosis? A) Dextrocardia B) Pulmonary embolism C) Myocardial infarction D) Dilated cardiomyopathy

As you are palpating a patient's abdomen in the LLQ, they become clearly distressed and complain of pain in the RLQ. How would you document this positive finding? A) Rovsing sign B) Obturator sign C) Murphy sign D) Psoas sign

Charles Xavier is a 40-year-old male who presents to the ER complaining of left lateral chest pain aggravated by deep breathing & touch. He said that the pain began when he rolled down a hill after a fall while snowboarding last weekend, but he thought the pain would go away after a few days. All the following methods can differentiate a rib fracture from a soft-tissue injury EXCEPT: Palpation of the tender area Compression of the chest in the AP plane Chest radiograph Computed tomography (CT) of the chest

Claire is a 66 year old female who comes into your clinic with complaints of paroxysmal nocturnal dyspnea, fatigue and upper back pain. All of the following are potential atypical symptoms with which diagnosis? Acute Coronary Syndrome Varicose Veins Raynaud disease Lymphedema

During an assessment a patient is notably anxious; their blood pressure was measured at 148/90. Patient denies a history of hypertension, what could explain this reading? White Coat Hypertension Patient's arm was too small for the cuff Orthostatic Hypotension Nocturnal Hypertension

During an interview, the nurse states, "You mentioned shortness of breath. Tell me more about that." Which verbal skill is used with this statement? A) Open-ended question B) Direct question C) Facilitation D) Yes/no question

During auscultation you hear a soft and low pitched during throughout inspiration and continues without pause through expiration. What sound is it? Vesicular Bronchovesicular Bronchial Tracheal

During the initial patient encounter, what type of an exam should the NP perform? A. Comprehensive assessment B. Focused assessment C. Routine assessment D. Urgent assessment

F is 67-year-old male that presents to primary care office complaining of progressive shortness of breath. He states that he first noticed it 10 months ago, but over the last month it has gotten worse and he sometimes has a dry cough associated with it. He has a history of smoker, 2 PPD x10 years, and hypertension. Based on this information, what is the most likely diagnosis for this patient? COPD Pulmonary Embolism Pneumonia Tuberculosis

Francis is diagnosed with acute arterial occlusion. You know a characteristic of this is: Sudden onset, coldness, numbness Pain on distal portions of one or more fingers Hard to determine due to lack of symptoms Chronic, increasing as the day wears on

H.G., a 68-year-old male, is in your clinic today for an initial physical. Vital signs for today are PO temperature, 98.2 degrees F. HR 72 BPM. BP 178/95. SpO2 98% on room air. Past medical history includes a hernia repair in 1997. Mr. H.G. is a poor historian and admits to avoiding seeking medical treatment throughout his life. As an ACNP, you recognize in the older adult the following: Systolic blood pressure (SBP) tends to rise with aging Systolic blood pressure (SBP) tends to lower with aging It's common for older men to avoid medical treatment H.G. is most likely "healthy" due to his lack of medical history

In acute otitis externa, the canal is often: Swollen, tender, narrowed, and moist The skin of the canal is often thickened The skin of the canal is red and itchy The tympanic membrane is bulging and red

J.G., a 42-year-old female, is in the ER today for complaints of "fluttering" felt in her chest beginning 2 weeks ago with associated fatigue and shortness of breath. You begin your physical exam and auscultate the heart. You make note of S1 and S2 heard and understand that: S1 occurs with the closure of the tricuspid and mitral valves S1 occurs with the closure of the pulmonic and aortic valves S2 occurs with the closure of the tricuspid and mitral valves S2 occurs with the closure of the atrioventricular valves (AV)

James is a five years old boy with a history of asthma. His mother brought him to the emergency room today due to asthma exacerbation. Which of the finding from lung auscultation is your priority? Silent chest Wheezing during inspiratory Fine crackles Vesicular in the lower posterior lung fields

Jenny is a 1st year FNP student in her health assessment lab class. The professor asks Jenny to step in front of the class and examine the neck of the model in front the class. Jenny is asked to palpate the posterior auricular lymph node. As the instructor, you would expect Jenny to: Palpate behind the ear and superficial to the mastoid process Palpate deep in the angle formed by the clavicle and the sternocleidomastoid muscle. Palpate in the midline a few centimeters behind the tip of the mandible. Palpate anterior and superficial to the sternocleidomastoid muscle

Jessica, 70 years old, came to the clinic complaining of pain, tightness, heaviness, and tingling in her left leg, which worsened during the day and prolonged standing. Assessment findings are as follows: pitting edema 2+, near the ankle, brownish discoloration, ulcer just above the malleolus; what should the nurse suspect? a. chronic venous insufficiency. b. Lymphedema. c. chronic arterial insufficiency. d. neuropathic ulcer.

John, a 49-year-old male with a history of leukemia and hypertension, comes in the Emergency department complaining of shortness of breath and fatigue. He also admits to having swollen hands and feet. What could these findings indicate? Right sided heart failure Effects of chemotherapy Pulmonary edema Carpal tunnel syndrome

Jones 56 years old female, smokes 1 ppd of cigarettes came into your clinic. You observed her to sit leaning forward, with lips pursed during exhalation and arms supported on her knees. What is one possible differential diagnosis based on your observation? COPD Asthma Left sided heart failure Pneumonia

Jones recently lost his wife Katherine 1 week ago. They had been married for over 50 years. Mr. Jones daughter comes into the office visit and is concerned about her dad's appearance. She states, "he's so thin now". What is the definition of a significant weight loss? 5% or more of usual body weight over a 6-month period 10% or more of usual body weight over a 2-month period 5% or more of usual body weight over a 12-month period 10% or more of usual body weight over a 6-month period

Kurt is a healthy 40-year-old male with no previous medical history who reports "feeling sick to my stomach" for the past two days. He denies dizziness and vomiting. What would you document this finding as? a. Nausea b. Anorexia c. Indigestion d. Retching

Luke Cage is a 50-year-old male with a history of hypertension, high cholesterol, and a tobacco smoking history of 30 years. He presents to the clinic with right calf pain that occurs after walking four blocks. He needs to sit and rest to alleviate the pain. Which assessment finding does NOT support a diagnosis of peripheral arterial disease (PAD)? 2+ right popliteal pulse 1+ right dorsalis pedis pulse Right lower leg feels cool Hair loss of right lower leg

MVA patient comes to the ER via ambulance. The patient is awake and alert complaining of chest pain increasing in pain with each respiration. You note a flailing chest over the patient's right anterior chest. Upon palpation of the area, you feel small pops like rice Krispy. What finding did you just assess? Crepitus Pneumothorax Hemothorax Fracture

Melinda is a 13-year-old female brought in by her mother to urgent care with the chief complaint of sore throat, poor appetite, malaise, and chills for 2 days. Melinda rates the throat pain 8/10, and 10/10 upon swallowing. Her vital signs are as follows: BP=100/60, HR=95, RR =18, O2 saturation= 98% on room air, and Temp= 101.2. Upon your assessment, you notice Melinda has red, thick white exudates on the tonsils as well as enlarged cervical lymph nodes. Decide which intervention is appropriate to implement first given Melinda's findings: Order a rapid strep test Order a chest x-ray Order a CT chest Send the patient home with over-the-counter throat medicine

Mr. Cheng, an 80-year-old patient with a history of diabetes and hypertension presents to the clinic for foot pain. The patient does not have any wounds on his feet. He states his pain is a 7/10 and feels like "pins and needles". As Mr. Cheng's NP, how would you classify this type of pain? Neuropathic pain Nociceptive pain Somatic pain Visceral pain

Mr. Garcia, a 40-year-old male patient with no previous medical history presented to the ER complaining of headache, generalized weakness, blurred vision and difficulty walking for 2 weeks. The results of his CT head showed several lesions. The patient is admitted and upon further evaluation, it is discovered that the patient has stage 4 cancer that has metastasized to the brain. Prognosis is poor. When the SPIKES protocol to disclose serious news, the APRN should: A. Start with a warning message, such as "I'm sorry to tell you that..." B. Tell the patient, "Your results show multiple malignant neoplasms in the parietal, temporal and occipital lobes that are a result of metastasis. I'm sorry". C. After sharing the bad news, immediately proceed into discussing treatment options. D. Tell the patient, "Don't worry, everything will be okay".

Mr. Harris is a 73 years old male, who is a retired police officer, presents to the clinic with complaints of fainting upon standing for 3 weeks. PMH includes HTN, CAD, NSTEMI, HLD, DM 2, and constipation. The FNP performs maneuver tests to identify murmurs. She first performs standing and the strain phase of the Valsalva maneuver. Patient reports fainting upon standing. The FNP also notes increased intensity of the systolic murmur. She then performs the squatting and release phase of the Valsalva maneuver, in which the patient reports resolution of fainting. The intensity of the systolic murmur decreases. The findings best indicate which of the following murmurs? Hypertrophic obstructive cardiomyopathy Mitral valve prolapse Aortic stenosis Ventricular septic defect

Mr. Lee is a 67 year-old male with history of COPD presents to the clinic. The Nurse Practitioner expects to hear which adventitious breath sound upon auscultation? Wheezing Fine Crackles Coarse Crackles Rhonchi

Mr. Luthor, a 35-year old male reports 2-day history of left-sided, sharp chest pain which is worse upon deep inspiration. The Advanced Practice Nurse (APN) recognizes the characteristic term for this type of pain is: a) Pleuritic pain b) Post herpetic neuralgia c) Phantom pain d) Non-specific pain

Mr. River comes into the clinic today complaining of excessive daytime sleepiness and fatigue. You suspect Obstructive sleep apnea. The risk factors for OSA include obesity and A) Male B) female C) young adult D) Lower airway abnormalities

Mr. Thomas is a 45 years old patient with no significant past medical history. His chief complaint about today is "feeling weird over the neck." When you perform a physical examination on the neck, which of the following statement is correct? a. A persistent neck mass in Mr. Thomas should raise a suspicion of malignancy. b. Enlarged tender lymph nodes are not a typical finding in patients with pharyngitis. c. The enlarged thyroid gland can only be found in patients with increased thyroid function. d. The deep cervical chain lymph node group can be easily accessed during physical examination.

Mr. Wayne is a 35-year-old male who presents to the Emergency Department reporting severe left sided chest pain and shortness of breath. He notes difficulty speaking secondary to dyspnea and pain. His caregiver, Alfred, explains that Mr. Wayne was assaulted and sustained blunt trauma to the left chest. On physical exam, the Advance Practice Nurse (APN) notes severe respiratory distress, accessory muscle use, tracheal deviation to the right, and absent breath sounds to the entire left lung field. A 100% fio2 non-rebreather supplemental o2 mask was applied. The APN anticipates doing emergent needle decompression to alleviate a tension pneumothorax. The landmark location for this emergent procedure is: a) Left 2nd intercostal space, midclavicular line b) Left 5th intercostal space, midclavicular line c) Right 2nd intercostal space, mid clavicular line d) Left 4th intercostal space, mid axillary line

Ms. Sosa is a 34-year-old patient who comes into the clinic complaining of persistent cough, runny nose, and sore throat. She states this symptom does not go away easily with prescribed medicine and this is her 5th time this year to come to the clinic with the exact same symptoms. While taking her health history, a nurse practitioner finds out she has had multiple sexual partners for the past 2 years, not always using proper protection. Based on her symptoms and health history, select all that apply to her possible differential diagnosis. Viral Pharyngitis GERD Acute HIV infection None of above

Ms. Stewart is 41 years-old transgender female, who presents to the family practice clinic with frequent heartburns. She reports that she has been taking over-the-counter heartburn medications for two months. Her symptoms got worse over the past two weeks with little to no relief from the medications. She also reports she avoids hot, spicy foods, caffeinated drinks, heavy meals, and stops eating two hours before going to sleep. She lives with her partner Jeremy and their 5-year-old son Ron who they adopted three years ago. She has no past medical history; had gender reassignment surgery four years ago. What is the next action for the FNP to take? a. Ask follow-up questions on the name, dosage, and frequency of the medications the patient has taken. b. Prescribe a Proton Pump Inhibitor, such as pantoprazole. c. Ask if she wants to have tests for STIs since LGBT adults have higher rates of STIs. d. Empathize with the patient that she must feel worried that she will have to tell her son once he is older that she is a transgender woman.

Mumford, from Mumford and Sons, is in the ED due to aspiration pneumonia. The Sons, who are twittering anxiously in the waiting room, tell you that Mumford has probably aspirated some vomit when he was passed out from drinking all that artisanal whiskey. On which side are you likely to see the infiltrate on the X-ray? A. The right B. The left

Patient J.L. is a 49-year-old male who is being seen in the emergency department for a chief complaint of chest pain. He states that the pain started while he repotting his plants in the backyard. He said he has been seen for chest pain before, but the pain seems to be occurring more frequently, especially when doing work. What pertinent negatives are appropriate for this patient? The patient denies any shortness of breath. He denies cigarette smoking. He denies any family history of coronary artery disease or ACS. The patient denies headaches or loss of consciousness. The patient states he feels intermittent chest pain when he exercises. The patient denies recent exposure to an environment or with an individual with TB.

Patient LW, a 63 year old male came into the clinic with complaints of pain in his foot at rest. He noticed that his skin appeared thin, and shiny, and he was having loss of hair over his foot and toes. When pulling the sock off, you also note that there is atrophic skin, and his nails are thickened and ridged. His dorsal is pedis pulse is decreased to palpating. What is the diagnosis of this patient? Chronic arterial insufficiency Chronic venous insufficiency Neuropathic ulcer Compartment syndrome

Richard came to the ER complaining of his left eye pain and blurred vision; the nurse practitioner performed the physical examination on the patient and found the following: sudden onset of left eye pain, with headache localized to the left eye, nausea, and blurred vision, the reaction of light in the left pupil is sluggish compared to the right eye, and unable to examine the left eye. Cornea and sclera injection and ciliary flush are present, edematous, and cloudy cornea. Intraocular pressure is 35 mmHg. The absence of photophobia and other physiological symptoms rules out cardiovascular accidents. What should the nurse suspect? a. Acute angle-closure glaucoma. b. Acute iritis. c. Subconjunctival hemorrhage. d. Chronic open-angle glaucoma.

Rose is 67-year-old women who came to urgent care for chest pain and a strong cough. She has no history and is worried that she will die of a heart attack just like her father did when he had chest pain. What education can be given to the patient regarding women and S/S of acute coronary syndrome? A) Women usually have atypical S/S such as nausea, vomiting and fatigue. B) Women and men have the same S/S, only worry if you have chest pain. C) Women complain about pain all the time, so they can't be trusted. D) Women only get chest pain during menopause.

Sam Inna, a 58-year-old, was stricken with cataracts about a year ago. Which assessment data would the NP expect when collecting the nursing history from the client? Blurred vision Eye pain Floaters Eye redness

Select the incorrect description related to gastrointestinal contrast studies. For an upper GI series, the patient swallows liquid barium sulfate, often combined with water-producing crystals, to visualize the esophagus, stomach, and small intestine under fluoroscopy. When both barium and air are used, the process is referred to as a double-contrast study. When perforation of the upper GI tract is suspected, water-soluble contrast is used. To evaluate post-op anatomy is a common indication for this study.

Selena, 45 years old, comes to the clinic for her annual check-up; the nurse practitioner noticed enlarged thyroid during the physical examination. To best examine the thyroid, which type of lighting can the nurse open for clear visualization? a. Tangential lighting. b. Perpendicular lighting. c. Window lighting. d. Usual room lighting.

Simon, 50 years old, came to the urgent unit complaining of shortness of breath, cough with sputum, and fever. After conducting the focused respiratory assessment, the nurse noticed the following: a bronchovesicular sound over the right middle lobe. A transmitted voice sounds of egophony, bronchophony, and whispered pectoriloquy. And an increased tactile fremitus. A dull sound while percussion and late inspiratory crackles. The nurse suspect which of the following diagnosis? a. Lobar pneumonia. b. Pleural effusion. c. Chronic bronchitis. d. Chronic obstructive pulmonary disease.

Since the 1980s, what medical imaging contributes to the largest amount of radiation exposure to an individual? CT PET MRI Ultrasound

Stewie is a 3-year-old that presents to the emergency department (ED) with his mother. The mother reports Stewie has had difficulty breathing since last night. You assess Stewie and can hear an audible, high-pitched musical sound during inspiration over his neck. What is your assessment of this breath sound? a. Stridor b. Rhonchi c. Course crackles d. Wheezes

Suzy is a 34-year-old female with a history of alcoholism who presents to the ED complaining of persistent nausea and indigestion over the past week. She also informs you that she has been unable to keep anything down. During the examination, she asks you for an emesis bag and says she needs to vomit. You then note a large amount of coffee-ground, dark brown liquid in the emesis bag. Which of the following information do you record as objective data in her chart? a. Coffee ground emesis b. Inability to tolerate food/liquid c. Nausea d. Indigestion

Test A has a high sensitivity for disease B. A negative result for Test A will most likely mean what? A Rules OUT disease B. B Rules IN disease B. C Test A is not sensitive to disease B. D Test A is specific to disease B.

The 26-year-old male arrived to ED after a MVA. The patient appears to be having difficulty breathing on his own. If the APRN is going to insert an endotracheal tube, what is a risk factor related to intubation? If the tube is advanced too far, it can enter the right mainstem bronchus If the tube is advanced too far, it can enter the left bronchus There is no risk factor The patient does not need intubation

The APRN is assessing the abdomen of a patient with a student nurse. The APRN palpates the right upper quadrant of the patient, and asks the student to state what abdominal structures reside in this quadrant. What would the student nurse respond? Liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, and head of pancreas Spleen, splenic flexure of colon, stomach, body and tail of pancreas Sigmoid colon, descending colon, and left ovary Cecum, appendix, ascending colon, terminal ileum, and right ovary

The Acute Care Nurse Practitioner is assessing a 26 year-old male admitted to the cardiac unit for further workup of shortness of breath, increased work of breathing and a history of dilated cardiomyopathy. What would be an appropriate action to take to ensure you are building good rapport with the patient and creating a comfortable environment? a. Move physical barriers out of the way and sit at eye level. b. Have a confidential conversation in the ICU hallway. c. Keep arms crossed. d. Get right to the point without introducing yourself, the patient has been waiting to see you!

The Advanced Practice Nurse (APN) is conducting a physical examination in the cardiology office. Upon auscultation, the APN notes a positive holosystolic grade 3/6 murmur to the left 2nd interspace along the sternal border. Based on the location of this finding, where does the APN suspect cardiac valvular disease? a) Pulmonic valve b) Aortic valve c) Tricuspid valve d) Mitral valve

The FNP is examining a 32-year-old Hispanic female who is complaining of frequent anxiety attacks and palpitations. BP=144/50, HR=105, RR=22, Temp=98.7F, O2sat=98% on room air. Which of the statements made by the patient warrants suspicion and further assessment for hyperthyroidism? "Is it possible to make the room a lot cooler? It feels as hot as hell here. My heart can't tolerate it, and I am sweating like I just ran 50 miles." "My cousin has thyroid cancer." "Acetaminophen does not work for my headaches." "Road traffic gives me a ton of anxiety."

The FNP is seeing patients in the primary care clinic. Which one of the following patients should the FNP send to the emergency room right away? A. 26-year-old female with asthma, who came for physicals for college and to get a refill prescription for a long-acting asthma inhaler. Absent wheezing on lung auscultation. B. 43-year-old female who came to know the results of a recent mammogram, whose mother died of ovarian cancer at age 51, is very anxious, hyperventilating, RR=28/min, restless, reporting lightheadedness. C. 55-year-old female with chronic meth and tobacco use, came to get an early refill for her COPD medication because she lost the medication. O2 sat = 90% on room air, a barrel chest, coughing. D. 69-year-old male with aortic valve stenosis and heart failure with an EF of 38%, came to be evaluated for a new heart failure medication. Coarse crackles bilaterally, diaphoresis, anxiety, coughing.

The NP has 4 patients who have been diagnosed with latent tuberculosis and have started treatment with Isoniazid. Which patient must return to the clinic for more frequent check-ups? A. A 22-year-old female with a history of hepatitis C. B. A 45-year-old male with a history of asthma. C. A 20-year-old female with a history of DM, HTN, and HLD. D. A 50-year-old make with a history of COPD

The NP has difficulty finding the popliteal pulse when palpating the peripheral arterial pulses. What is another approach the NP can take. Patient prone, knee flexed at 90 degrees, and press two thumbs on the popliteal fossa Apply some pressure on the flexor surface of the lateral wrist Press deeply below the inguinal ligament Apply pressure on the radial and ulnar arteries

The NP is conducting an H&P for patient Cathleen prior to gender reassignment surgery male to female. How should the NP address the patient to establish rapport? Good morning! My name is Charlotte Nguyen; I am a nurse practitioner and I work with the surgery team. How would you like me to address you? What pronouns do you prefer? Good morning sweetie! How are you doing today? My name is Charlotte and I work with the surgery team. Good morning, Cathleen or is it Conor? Which name do you go by? Good morning Mrs. Saperstein! My name is Charlotte, and I am a nurse practitioner working for the surgery team. Let's start with the questionnaires.

The NP is gathering social history on a patient with COPD. What information should the NP focus on gathering for someone who has COPD? Tobacco and recreational drug use, occupational and environmental exposures, and travel history. OLDCARTs PQRST Medication and allergies

The NP performs a physical assessment on a patient with a history of smoking. When assessing tactile fremitus, the Nurse Practitioner (NP) recalls that it is normal to feel tactile fremitus most intensely over which location? Between the scapulae Fourth intercostal space Fifth intercostal space, midaxillary line (MAL) Over the lower posterior lobe

The NP student provides discharge teaching for a patient with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the patient indicates a need for further instruction? a. "I should increase the fiber in my diet." b. "I will need to avoid caffeinated drinks." c. "I'm going to learn some stress reduction techniques." d. "I may have exacerbations and remissions with Crohn's disease."

The NP you are shadowing is assessing a patient that came in with abdominal pain. With the patient supine, the NP places her hand just above the patient's right knee and asked the patient to raise the thigh against her hand. Then, the patient was asked to turn onto the left side and extend the right thigh at the hip. What is the NP assessing? Psoas Sign Rovsing Sign Obturator sign Murphy sign

The Np would like to order Hepatitis antigen test and titer for a patient for further investigation. How would you the lab results? HBsAg Positive Anti-HBc Positive IgM anti-HBc Negative Anti-HBs Negative Chronically infected Acutely infected Immune due to Hepatitis B vaccination Immune due to natural infection

The Nurse Practitioner (NP) is conducting a cardiac assessment on the patient and notes a cardiac murmur. The Nurse Practitioner notes that the cardiac murmur is a grade 4. Which of the following describes a grade 4 murmur? Loud, with a palpable thrill Quiet, but heard immediately after placing the stethoscope on the chest Moderately Loud Very loud, with thrill. May be heard when the stethoscope is partly off the chest

The Nurse Practitioner is attempting to conduct an interview with the patient in a busy Emergency Department. The patient is staying in a hallway bed due to overpopulation in the ED. Which action by the NP encourages the patient to be more receptive during the interview? Bringing the patient to an empty examination room to conduct the initial assessment Apologizing to the patient about being in a hallway due to the ED being very busy prior to conducting the initial assessment Obtaining a privacy screen during the assessment to ensure that the patient is not within view of other patients Lowers the volume of their voice and instructs the patient to lower theirs so that other patients in the area will not hear the interview.

The Nurse Practitioner working at a primary care clinic has been assessing patients all day. The Nurse Practitioner recognizes which one of these patients is experiencing significant weight loss? The 23 year-old female who weighed in at 150 pounds 6-months ago and is now 140 pounds without any special efforts. The 34 year-old male who weighed in at 188 pounds a year ago and is now 170 pounds without any special efforts. The 20 year-old male who weighed in at 160 pounds 6-months ago and is now 155 pounds without any special efforts. The 44 year-old female who weighed in at 240 pounds 6-months ago and is now 230 pounds without any special efforts.

The Nurse Practitioner working at a primary care clinic is assessing a 54 year-old patient's heart sounds. The Nurse Practitioner knows the best place to listen to the patient's aortic valve is? Right second intercostal space or cardiac apex Left second and third intercostal spaces close to the sternum Near the lower left sternal border At and around the cardiac apex

The clinician understands that a flat, soft intensity, high pitch, and short sound during percussion is indicative of which of the following? Large pleural effusion. COPD. Pneumothorax. Chronic bronchitis.

The main benefit of performing the Allen test is to: Compare the patency of the ulnar and radial arteries. Diagnose a patient with poikilothermia. To detect lower extremity peripheral artery disease. To measure the ratio of blood pressure measurements in the foot and arm.

The nurse is assessing a patient in the clinic. While auscultating the patient's lungs, the nurse hears a relatively high-pitched, very loud breath sounds that are heard over the manubrium, with a short silence between inspiratory and expiratory sounds. The nurse knows that these sounds are: A. Bronchial breath sounds that are normally found in that location B. Vesicular breath sounds that are normally found in that location C. Wheezes that are usually found in that location D. Broncho-vesicular breath sounds that are not usually found in that location

The nurse is doing a focused assessment on the respiratory system. While percussing over the lungs of a patient with pneumonia, the nurse knows that percussion over an area of atelectasis in the lung will reveal which of the following: a. dullness. b. tympany. c. resonance. d. hyperresonance.

The nurse practitioner is assessing a 50-year-old male complaining of pain and muffled hearing in the right ear. How will the nurse practitioner correctly assess the patient's ear using the otoscope? A. Straighten the right ear canal using your left hand to grasp the auricle firmly but gently, pull it upward, backward, and slightly away from the head. B. Just insert the otoscope gently in the ear canal as is C. Straighten the right ear canal using your right hand to grasp the auricle firmly, pull it upward and towards the head. D. Straighten the right ear canal using your left hand to grasp the auricle firmly but gently, pull it downward and backward.

The nurse practitioner is gathering a history and physical from a 69-year-old male. The patient reports that he can't sleep at night without experiencing shortness of breath. The patient states "I have to sleep with 4-5 pillows at night or even sleep sitting up in my rocking chair". Which is the patient's diagnosis? A) Heart failure B) Anxiety C) Pulmonary embolus D) Spontaneous pneumothorax

The nurse practitioner is interviewing a patient who has a hearing impairment. What techniques would be most beneficial in communicating with this patient? Find out The patient's preferred method of communication. Hand gestures and facial expressions may be degrading to the hearing impaired so avoid using them For the patient With unilateral hearing loss sit opposite of the hearing side. Speak loudly and with exaggerated facial movement when talking with him because this helps with lip reading

The nurse practitioner is percussing the lung of a 35 year old male and notes dull percussion, this most likely results from Increased density of lung tissue Normal lung tissue Shallow breathing Decreased adipose tissue

The nurse practitioner knows the pulses of the inferior mesenteric artery can be found in all EXCEPT: Transverse colon Descending colon Sigmoid colon Proximal rectum (hindgut)

The nurse practitioner performs auscultation of the patient's posterior chest. The technique involved includes asking the patient to say "ninety-nine." Normal results reveal muffled and indistinct transmission of sounds. Based on the description of the method, the nurse practitioner student describes the test as: A. Bronchophony B. Egophony C. Pectoriloquy D. Ronchi

The nurse practitioner receives the following ABG results on a patient who is beginning to show worsening respiratory compromise and is currently on a non-rebreather. PH: 7.2 PCO2: 46 HCO3: 29 PO2: 89 Oxygen saturation: 92% What is a differential diagnosis the nurse practitioner can make based off of the ABG results? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d.Metabolic alkalosis

The nurse practitioner student knows that rapid, shallow breaths can be identified as which breathing sound? A. Tachypnea B. Hyperpnea C. Bradypnea D. Obstructive

The optic disc identifies the start of the optic nerve where transfers all the visual information to the brain. So, a 20-year-old female student with myopic eyes wants a physical examination. The FNP inspects the student's optic disc and retina with an ophthalmoscope. She notes normal findings in her eye check. Except. Retinal structures look smaller than normal. The disc outlines are sharp, but the nasal portion of the disc margin may be blurred. The color of the disc is yellow-orange to creamy pink, but white crescents may ring the disc. The horizontal diameter of the central physiologic cup is usually less than half the diameter of the disc.

The patient presents to the ED with a nonproductive cough, shortness of breath with activity, and fever. They tested positive for COVID-19 2 days prior. You order a chest x-ray. What does the film show? Right pleural effusion Right pneumothorax Left pleural effusion Pulmonary edema

The patient presents to your clinic with abdominal pain. During your assessment, you palpate the left lower quadrant abdomen, and they report right-sided pain. What is this sign called? Rovsing sign Obturator sign Psoas sign Murphy sign

The practitioner is auscultating the chest in an adult. Which of the following techniques is correct? Firmly holding the diaphragm of the stethoscope against the chest Lightly holding the bell of the stethoscope against the chest to avoid friction Instructing the patient to take deep , rapid breaths Instructing the patient to breathe in and out through his nose

The primary muscles of respiration include the: Diaphragm and intercostals. Sternomastoids and scaleni. Trapezii and rectus abdominis. External obliques and pectoralis major.

The six cardinal gazes help test the cranial nerve innervation of which cranial nerves? CN VI, CN III, CN IV CN IV, CN VI, CNII CN VI, CN III, CN VII CN IV, CN II, CN VIII

The stroke volume is dependent on all except: Ejection Fraction Myocardial contractility Afterload Preload

The student Nurse Practitioner (NP) working at a community clinic was tasked to perform clinical history taking on a fifteen (15) year old adolescent accompanied by her mother. Upon introducing herself as the student NP of California State University, LA, the student asked the patient's mother to step out of the room so that the student may begin the encounter; however, the mother stated she would like to stay in the room. What would be the best response of the student NP? a. Let the mother know that they will have the opportunity to speak with you; however, you would like to hear from the patient first. b. Tell her that she is not the patient and does not need to be present in the room. c. Allow the mother to stay in the room. d. Reassure the mother will be part of the treatment plan.

The urgent care is full of patients. Which patient should the nurse practitioner assess first? A 74-year-old patient who has COPD and seems sleeping in a tripod position with silent chest A 50-year-old patient with 8/10 painful ulcers on feet bilaterally on wheelchair A 21-year-old patient with gritty sensation and painful red eye A 42-year-old patient who complains that the government spies on her

To examine the preauricular lymph nodes where would you palpate? In front of the ear Superficial to the mastoid process At the angle of the mandible Superficial to the sternocleidomastoid

Troy, a 59-year-old male with a history of smoking and cancer, comes in the Emergency department complaining of shortness of breath and fatigue. Other notable assessments include increased heart rate and tracheal deviation to the left. Patient states "I was just doing the usual home chores." Chest x-ray shows a right-sided pneumothorax. As you prepare for the thoracostomy, which side and intercostal space is your target? 2nd intercostal space on the right 3rd intercostal space of the left 3rd intercostal space of the right 1st posterior intercostal space on the left

Upon percussion of the chest of your 56 year old female patient, HR, you notice that all of her lobes posteriorly sound resonant except for the right middle lobe where you hear dullness. Knowing that dullness could indicate fluid or a solid mass, what should you order next? CXR CT chest US CBC

What are you looking for when inspecting the conjunctiva and sclera? Color and vascular pattern Reaction to light Lid lag Proptosis

What food choice below has the highest amount of potassium and the best selection for a patient with high blood pressure? Bananas Pickles Olives Pretzels

What information would you use to support a diagnosis of squamous cell carcinoma on the right lateral tongue? a. 55-year-old male, smoker, tobacco chewer for 30 years, ingests Vodka every night b. 45-year-old female, marathon runner, vegetarian c. 63-year-old male, smoker, moderate tooth decay and gingivitis d. 32-year-old female, ingests a gallon of wine daily

What is a useful technique to assess the patient's understanding to your teachings during a visit? "Teach back", where you invite the patient to tell you in his or her own words Have the patient demonstrate it Have the patient read off the handouts Tell the patient to use Google if they have any questions

What is normal expected finding for a patient with COPD coming into the office for a cardiovascular exam? PMI may be in the xiphoid or epigastric area PMI apex of the heart Right ventricle Left aorta

What is the most effective way in communicating with older adults? Face the patient and speak in low tones; and choose a quiet place. Speak louder than you normally would because older adults are hard of hearing Provide printouts for older patients to read at home None of the above

What lobes of the lungs are more commonly seen in patients with aspiration pneumonia? Right middle and lower lobes Left upper and lower lobes Right upper and middle lobes None of the above

What patient position is best to hear aortic regurgitation? A) Patient sitting up and leaning forward B) Supine C) Prone D) Supine slightly turned to their left

What would the NP suspect is the cause of the following symptoms: pulmonary edema, orthopnea, SOB, syncope? Right ventricular pathology Left ventricular pathology Right atrial pathology Lt atrial pathology

When asking about the past medical history, the FNP is informed that the patient is allergic to penicillin because "it makes me very nauseous". What would be the FNP's best response? A "What you're experiencing is not an allergic reaction, but a common side effect of penicillin." B "What do you do to treat the nausea?" C "Let's make sure that goes under your list of allergies." D "Make sure you eat before you take penicillin."

When auscultating a patient's heart, the NP hears an opening snap (OS) after S2. What could this mean? Mitral stenosis It's normal Acute Aortic dissection Aortic Stenosis

When auscultating the heart, the NP knows that that a "gallop" sound is associated with which heart sound. S3 S4 S2 S1

When disclosing serious news, it is important to use SPIKES protocol. What is an appropriate action when executing the "K- Giving knowledge and information to the patient" portion of the pneumonic? A. Start with a warning message such as: "I'm sorry to tell you that..." B. Use medical jargon to accurately describe the medical situation C. Find out how much the patient wants to know before disclosing any information D. After sharing the primary information, immediately proceed into further necessary information

When inspecting the patient's chest, the FNP notes that the sternum is displaced anteriorly, increasing the AP diameter. The coastal cartilages adjacent to the protruding sternum are depressed. Classify the thorax deformity according to this assessment. Pigeon chest Flail chest Funnel chest Thoracic kyphoscoliosis

When palpating the thyroid gland, the nurse notices that the thyroid gland is enlarged. The nurse places a stethoscope to listen over the lateral lobes and detects a bruit. A bruit heard over the thyroid is typically heard in what: A. Graves Disease B. Heart Failure C. Pemberton Sign D. Hashimoto's Disease

When studying for the exam, the nurse practitioner student understands one of the causes that does not decrease right ventricular preload is: a. Inhalation b. Exhalation c. Dehydration d. Pooling of blood in the venous system

When testing extraocular movements of eyes on an ophthalmic examination and noted visible rim of sclera on downward gaze on both eyes. You suspect the patient may have, Hyperthyroidism Cataract Glaucoma Homer syndrome

When testing for lateralization (Weber test) the nurse practitioner understands this test is restricted to patients with unilateral hearing loss because: a. patients with bilateral conductive or sensorineural deficits will not lateralize b. lateralization will occur regardless c. lateralization cannot occur in normal hearing d. this test will give a false positive reading

When the new APRN student is auscultating S3 and S4 heart sounds, the preceptor will correct her if she says the following statements? a) We use the diaphragm to listen to S3 and S4 sounds. b) We use the bell to listen to S3 and S4. c) Low pitch sounds are heard better if the bell is used. d) The bell is more sensitive to low pitch sounds.

When you do a physical assessment of a patient's face, which two parts of the salivary glands can you examine? A) Submandibular and parotid B) Sublingual and parotid C) Parotid and occipital D) Parotid and submental

When you examine a patient's cranial nerve (CN) function, muscles of the CN XI, which is in the neck, are: A) Trapezius and sternomastoid B) Omohyoid and sternomastoid C) Omohyoid and spinal accessory D) Clavicle and sternal notch

Where is the typical origin for heart murmurs of the mitral valve? At and around the cardiac apex At or near the lower left sternal border Right 2nd interspace to the apex Left 4th intercostal space

Which of the following are forms of nonverbal communication? Select all that apply a. Head nodding with facial animation b. Tone and use of voice c. Posture d. Signing informed consent.

Which of the following is Objective data? "patient displays significant guarding upon palpation" "patient states they become dizzy when they stand up" "patient describes having pain in left arm when they run" "patient states they are in 10/10 pain"

Which of the following is Subjective information? ( comprehension) A. "Chest pain." B. " tenderness on palpation of the anterior chest." C. WBC 14.1 D. Gastritis on EGD

Which of the following items of patient information would be documented as subjective data? A) Patient complaints of abdominal pain 5/10 B) The patient has jugular venous distention C) A positive D dimer test D) Nonpalpable pedal pulses

Which of the following statement about abdominal pain is correct? Visceral pain is typically non-specific and difficult to localize. Somatic pain is usually less severe than visceral pain. Visceral pain in the LLQ suggests liver distention. Palpation at the site of referred pain often results in tenderness.

Which of the following statement is TRUE regarding respiratory patterns? Cheyne-stokes breathing is normal in children and older adults during sleep The normal respiratory rate for infants is up to 60 per min Sighing respiration is always abnormal Ataxic breathing is a normal respiratory pattern

Which of the following types of dyspnea do not have exertion as an aggravating factor? a. Spontaneous pneumothorax b. Chronic bronchitis c. COPD d. pneumonia

Which sequence does the electrical stimulus of the cardiac cycle follow? A) AV node, SA node, the bundle of HIS, and bundle branches B) SA node, AV node, the bundle of HIS, and bundle branches C) AV node, SA node, and bundle branches D) AV node, SA node, bundle branches, and the bundle of HIS

Which sound is typically heard in the first and second interspaces anteriorly and between the scapulae? Bronchovesicular Vesicular Bronchial Tracheal

While assessing the thyroid gland, you noticed it enlarged and no palpable nodules. What are some causes of an enlarged gland? Diffuse enlargement Single nodule Trachea deviation Multinodular goiter

While auscultating heart sounds, you heard a murmur on the right second intercostal space. You suspect which valve dysfunctions on this patient. A. Aortic valve B. Mitral valve C. Tricuspid valve D.Pulmonic valve

While doing an oral exam, you asked the patient to say "ah" or yawn. You noticed that patient's soft pallet fails to rise, and the uvula deviates to the opposite side. Do you suspect which cranial nerve paralysis on this patient? Cranial Nerve X Cranial Nerve IX Cranial Nerve V Cranial Nerve XII

While preparing to collect an arterial blood gas specimen, the RN performs the Allen test to ensure adequate perfusion to the patient's right hand. The RN knows that the Allen test is negative and may draw the blood specimen when: Release of pressure from the right ulnar artery while compressing the right radial artery causes flushing of the right palm Release of pressure from the right ulnar artery while compressing the right radial artery causes pallor to persist on the right palm Compression of the right brachial artery does not cause pallor of the right palm Compression of the right ulnar artery causes pallor of the right palm

While the nurse is making her rounds, she hears Mr. Stark in the next room coughing repeatedly. When inspecting the cup that Mr. Stark coughed into, she assessed yellowish-green colored sputum. The nurse is aware this may be indicative of: a. Bacterial pneumonia b. Viral pneumonia c. Left ventricular failure d. Cystic fibrosis

Why do reviewing systems questions play a significant role in adult health history taking? Select the best answer and apply. a. It may help to uncover the problems that the patient has overlooked. b. This may help the provider know more about the patient's physical condition. c. Often patients may forget to tell all their medical problems and complaints. d. Knowing all systems helps the provider to prescribe the proper medications.

Willaim is a 50 years old patient who comes to the hospital for an annual routine check-up; the nurse practitioner performs a head-toe assessment for him; when reaching the cardiovascular system, the nurse knows that the best position to assess cardiac murmurs is to Instruct the patient to a. Set and lean forward. b. Standing position. c. Supine position. d. Prone position.

You are assessing a 42 year old male patient and auscultating their heart. You hear a murmur at the right second intercostal space right after S1, which valve is displaying this murmur? Aortic Valve Mitral Valve Pulmonic Valve Tricuspid Valve

You are assessing the patient in the emergency room. The patient is tachycardic, tachypneic, pale skin, diaphoretic and basilar crackles are heard on auscultation. The patient stated that he fractured his right foot a week ago from a snowboarding accident. On exam, you noticed that his right leg was swollen and has a positive human sign. What labs and diagnostic test are pertinent for this patient? D-Dimer, CT pulmonary angiography CBC, BNP, chest x ray VVG, BMP, MRI ABG, echocardiogram

You are assessing your 67 year old male patient's for hearing loss because he is talking in an especially loud voice. On assessment you notice that acuity is diminished to both whispered and spoken voice tests. Bilateral external auditory canals and TMs are intact and clear with good cone of light. There is no sinus tenderness. You conduct the Rinne test but the patient hears no sound. During the Rinne test, the patient is not able to localize the sound in either ear. These findings suggest sensorineural hearing loss. a. True b. False

You are doing an eye examination on your 72-year-old male patient. Using an ophthalmoscope, you notice the patient has cotton-wool spots that are white/grayish with ovoid lesions with irregular "soft" borders. Based on this finding, you suspect that your patient has which condition? Diabetes Corneal Arcus Cataracts Acute Closed Angle Glaucoma

You are examining your patient, and based on the patient's symptoms, you begin developing your diagnosis and differential diagnoses. As a practitioner, you know that you must include which of the following in your differential diagnoses. a. "The worst-case scenario" b. Genetic diagnoses based on family history c. Most likely diagnosis d. Least likely diagnosis

You are listening to heart sounds in your 55-year-old female patient, and you notice a systolic heart murmur. You grade the heart murmur as a 3/6. Which of the following accurately describes a grade 3/6 systolic heart murmur? a. Louder in volume than S1 and S2, moderately loud b. Louder in volume than S1 and S2 with thrill, may be heard when the stethoscope is partly off the chest c. Softer in volume than S1 and S2, very faint d. Equal in volume to S1 and S2, quiet, but heard immediately

You are percussing a patient's lungs. While listening, you notice that the sound is tympanic with a loud intensity, high pitch, longer duration, and unilateral. Based on this assessment finding, which could be the most likely cause? a. Large pneumothorax b. Pneumonia c. Normal Finding d. Pleural Effusion

You are reading a note input by another provider, which says the following: "egophony and broncophony heard bilaterally." From your reading, you remember that these transmitted voice sounds reveal: A. lung consolidation B. wheezy-breezy fremitus C. flail chest D. normal air-filled lung

You are seen a 63-year-old patient for his annual physical exam. He explains to you that he has recently gained 8 lbs., he noticed that it happened in about a week. Based on your interview what can be the most likely cause of his weight gain? A) The patient is likely retaining fluid due to CHF or liver failure. B) The pats diet consist of pizza and In n Out. C) The pts weightlifting regimen is showing results. D) The patient forgot to take his Dr. Martins off when being weighted.

You continue to assess Mr. H.G., examining both ears. Based on the image below, you note the following: Screen Shot 2022-02-03 at 10.08.19 PM.png The cone of light is at the 5 o'clock position indicating the right ear The cone of light is at the 5 o'clock position indicating the left ear The cone of light is at the 7 o'clock position indicating the right ear The cone of light is not visible due to cerumen

You examine a patient with a feeding tube, complaining of lower back pain and difficulty breathing during feeding. Which of the following statements by the caregiver demonstrates a need for further teaching? I always put him in High Fowler's position, sitting straight up when I feed him or give him meds because I want to make sure the food and meds go straight down. I always put him in Low Fowler's position, with the head raised between 15 and 30 degrees, when I feed him or give him his medications. I was told that Low Fowler's position is best to help relieve his back pain and help with breathing. I was told that High Fowler's position is best for helping him defecate, but I have to be careful not to leave him in that position too long because pressure sores may develop.

Your 89-year-old female patient has been coughing while eating for the last two days. When you auscultate the lungs, you hear crackles. You suspect aspiration pneumonia. Based on what you know about the anatomy of the lungs, where do you expect the patient to have pneumonia? a. Right lower lobe b. Left lower lobe c. Bilateral lower lobes d. Left upper lobe

Your patient is undergoing a weaning trial from the ventilator. Fifteen minutes into that the patient heart rate increases to 140bpm and they start to grab their oxygen and IV tubing. What should you do next? Stop weaning and rest the patient Set the head of bed to high-fowlers Perform a complete set of vital signs Administer PRN pain medication

Your patient presents with hearing loss. One of the tests you conduct is the Rinne test. What would the test results be if sensorineural hearing loss was present? Sound is heard longer through air than bone Sound is heard the same amount of time in air and bone Sound is heard longer in bone than air None of the above are correct

Your patient with a BMI of 32 is looking to improve their diet. They request your recommendation of foods that contain healthy fats. Which of the following foods is not an example of a food high in omega-3 fatty acids? Corn Salmon Walnuts Flaxseed

y/o male comes into the ER complaining of left-sided chest pain that radiates to his left arm, Pt has a history of stent placement 2 years ago, upon approach he stated "I feel exactly the same way I felt when I had my last Heart attack" as an NP what would be your next approach? Select all that apply a. Order a STAT 12 leads EKG b. Explore his perspective of his illness c. Go further by asking him to describe the pain. d. Ask if he has tried any medication to help with the chest pain before getting here.

. During the assessment, you note that your patient has a left-sided facial droop, has trouble closing their eyelid, and has eye dryness from the incomplete eye closure. What would be a possible etiology of this patient's symptoms? Stroke Bite from a tick TIA Extraocular muscle palsy

A patient has recently travelled overseas and is now experiencing restlessness, vomiting, and profuse diarrhea. The patient describes the stool as thin and white, like "rice-water." Which diagnosis do you think the patient has? C. diff infection Giardiasis Cholera Salmonella

An elderly woman who is hard of hearing is accompanied by her son. What interventions can a nurse practitioner utilize? Select all that apply. Determine the patient's preferred method of communication. Provide a quiet environment. Instruct patient to wear her hearing aid and/or glasses. Dim the light to the lowest setting.

ABC

Which risk factors are associated with metabolic syndrome (select all that apply)? 160/100 Triglyceride level of 350 Fasting plasma glucose of 250 HDL cholesterol of 60

ABC

A patient suffers from obstructive sleep apnea. What symptoms are considered as hallmarks of this condition (select all that apply)? Excessive daytime sleepiness Snoring Morning headache Awakening with a choking sensation

ABCD

A nurse practitioner is interviewing a patient. A nurse practitioner: "What brings you in today?" Patient: "I have chest discomfort." A nurse practitioner: " How does it feel when you have chest discomfort? Please describe it." Patient: "I feel pressure and tightness. It comes and goes and gets worse when I run." A nurse practitioner: "The discomfort gets worse when you are doing physical activity?" Patient: "Yes, it is like the pain my father told me when he had a heart attack. A nurse practitioner: "Your father had a heart attack?" Among the following options, select all techniques the nurse practitioner is using. Using echoing Moving from open-ended to focused questions Offering multiple choices for answers Questioning that elicits a graded response

How do you distinguish a pleural rub from bronchial sounds, select all that apply: a. Listen to all specified points so you can get a complete picture b. Listen for a discontinuous, low-frequency grating sound c. Listen for snap, crackle, and pop type sounds d. Listen for a sound that sounds like an extra frenzied Sinead O'Connor

An 18-year-old male who sustained a fall at school after hitting his head on the bench is requiring stitches on a laceration over his right eyebrow. He is alert and oriented. His head CT is negative for any bleeds or contusions. As an NP you need to obtain informed consent to proceed with the suturing. Which of the following is required to include when obtaining informed consent? Select all that apply. Nature of the procedure or treatment Risks and benefits of the procedure or treatment Reasonable alternatives Risks and benefits of alternatives Assessment of the patient's understanding of the first four elements

ABCDE

A patient came into your clinic with hard of hearing. What can the NP do to better communicate with the patient? Select all that apply. Minimize background noise and glare Look directly at the patient when speaking Turn your back as you talk to the patient Do not shout

ABD

Select all that apply. What are causes of Primary (essential) hypertension? Age Genetics Renal artery stenosis Physical inactivity

ABD

To decrease preanalytic effects of laboratory tests, patients should be given the following instructions (select all that apply): Avoid any strenuous activity the night before getting tested. Urinate before checking in for the appointment. Do not exert themselves with any kinds of exercise, such as walking long distances, running, or climbing the stairs, prior to giving a blood sample Stop taking non-prescribed medications and alcohol the day before the allotted time

Which of the following conditions produce foul-smelling purulent sputum? Select all that apply a. Bronchiectasis b. Tuberculosis c. Lung abscess d. Gastroesophageal reflux e. Gnarly bong rips

You're interviewing a 19-year-old male college student for a physical exam. You have reached the social part of your interview more specifically about alcohol consumption. The patient discloses, "I drink when I go out with my friends". You later find out your patient attends fraternity parties every weekend. He later discloses, "I have blacked out a couple of times". You want to further evaluate his risk for unhealthy alcohol use. Which tool would assist you in making this decision? Single Alcohol Screening Question (SASQ) Clinical Institute Withdrawal Assessment for Alcohol (CIWA) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)

. Jonathan is a 67-year-old patient that comes to your clinic newly diagnosed with heart failure. Jonathan has a lot of questions regarding his new diagnosis and how the heart works as a pump. Which of the following is best refers to the degree of vascular resistance to ventricular contraction? a. Preload b. Afterload c. Myocardial contractility d. Stroke volume

5. The nurse is performing an ear exam on a patient to evaluate for conductive hearing loss. The nurse knows the patient is experiencing conductive hearing loss when she confirms that: A. The patient can hear sounds, but cannot comprehend speech B. The patient's hearing improves in a noisy environment C. The patient's hearing worsens in a noisy environment D. The patient is constantly yelling because she can't hear voices in her immediate vicinity

) During a comprehensive physical assessment, a nurse practitioner is assessing a 45-year-olds patients neck. Which finding would suggest to the NP to think that the patient may have a malignancy issue? A)A recent diagnosis of pharyngitis. B) A persistent fixed neck mass. C) Enlarged lymph nodes. D) Tender lymph nodes.

. A 20 yr old college student named Sally comes into the clinic complaining of fatigue, sore throat, body aches, and headache. On physical exam, swollen lymph nodes in the neck were noted and a red throat with thick white exudates on the tonsil was noted. What is your diagnosis? mono.jpg Thrush, Candidiasis Infectious mononucleosis Diphtheria Leukoplakia

. A 60-year-old Hispanic male comes into the office for his yearly physical. He is complaining of a sore throat with white bumps that can be visibly seen when he opens his mouth. The patient mentions to the ANP that he occasionally drinks about three beers a night that work has been stressful lately and has also had trouble sleeping. Given the information what would the ANP do next? A. Ask the patient to describe the stressors he is having at work B. Do a focused assessment and examine the patient's throat C.Perform a head-to-toe comprehensive assessment D. Tell the patient that it's probably a simple cold and that it should go away on its own

. A 60-year-old male presents to the clinic with a non-productive cough and dyspnea. The patient has a past medical history of hypertension, obesity, and chronic obstructive pulmonary disease (COPD). The patient also reports he was a former smoker of 30 years. The patient states "I used to smoke a half pack of cigarettes per day". The nurse practitioner documents in his medical record that the patient has a pack history of which of the following? A) 30 pack-year history B) 15 pack-year history C) 45 pack-year history D) 18 pack-year history

. A 63-year-old male patient comes into the clinic complaining of chronic bilateral leg pain and shortness of breath with exertion. He states that he's had the pain "for some time now," however he has been avoiding seeking medical treatment because he fears doing so means he'll have to stop smoking. "Besides, the pain goes away if I stop and rest a few minutes." Pertinent medical history includes active smoker (1 pack a day x 40 years), arthritis, diabetes mellitus II, hypertension, and hyperlipidemia. Which assessment finding would cause the most concern and therefore warrant further medical evaluation? A. Positive Homan sign B. Intermittent claudication C. Bilateral knee pain lasting more than 10 minutes D. Shortness of breath with exertion

. A 7 year-old boy arrives to the emergency room with sudden, acute, severe lower right sided abdominal pain, nausea, vomiting, loss of appetite, and a fever of 100.5 F. The nurse practitioner suspects these symptoms as possible presentation of acute appendicitis. What imaging will the Nurse practitioner preferred first order? a. CT scan b. Ultrasound c. MRI d. X- Ray

. A 77-year-old female presented to your office reporting worsening hearing loss. What medication would you be concerned about her taking? A. Vitamin C B. Gentamicin C. Coreg D. Plavix

. A nurse practitioner examines a patient who she asks to squat and then stand while auscultating the patient's heart in both positions. The nurse practitioner knows that an increase in intensity during squatting-to-standing action and decrease in intensity during standing-to squatting movement is most likely correlated to: A. Heart failure B. Hypertrophic obstructive cardiomyopathy C. Hypertension D. Straining

. A young female patient enters your clinic with a chief complaint about heavy, painful periods and feeling depressed. She is 13 years old and is accompanied by her mother, who brought her in. Her mother talks over her daughter and describes the patient's symptoms, and when you address her daughter, she continues to answer for her. What is the best option for the NP to assess this patient appropriately? a. Continue to address the mother with questions regarding the patient since the patient is a minor b. Ask the mother to leave to assess and question the patient privately and indicate to the mother that she will have an opportunity afterward to ask questions. c. Ask the patient if she wants her mother to continue to speak for her d. Call social services on the mother for being overbearing

. Mr. Valerio is a 45 years-old male, who presents to the clinic with three days of abdominal pain, nausea, and vomiting. As soon as the FNP enters the exam room, Mr. Valerio starts yelling at the NP, saying "I have been waiting to be seen for two days. I missed two days of work just to have a 20-minute appointment with you. I am having a 100 pain level out of 10, but no one cares about it! Who is going to pay the bills? Who is going to take care of my family?" Which statement by the NP is appropriate? a. "Mr. Valerio, please relax, I can't take care of you if you keep yelling at me like that." b. "I can see that you are upset and frustrated. You seem to have suffered enough. It must be hard to miss work because you are in a lot of pain, and on top of it you can't see a doctor soon enough." c. "If your symptoms were severe, you could have gone to the Emergency Room and received care sooner than later." d. "I can see that you are angry, but you are not the only one who could not get an appointment on time. The pandemic has been tough on everyone, and we are short-staffed."

. You are taking a patient's blood pressure; you notice that the patient's cuff is too small. How will this affect the patient's blood pressure reading? Cuff size does not affect the blood pressure reading. The blood pressure reading will be skewed higher than what it really is The reading will be lower than what it should be Reading would not result as the cuff would not work

. You assess a patient with chronic venous insufficiency to their lower extremities. All of the following are characteristic of chronic venous insufficiency except? a. Often painful b. Decreased or absent pulses c. Brown pigmentation d. Normal body temperature

1. A female patient arrived at the emergency department with an unwitnessed fall. Per EMS, the patient was found passed out in a bush. The patient has abrasion bilateral forearms and face. The patient states she blackout and remembers waking up in a bush. While the Nurse Practitioner (NP) is assessing the patient, the NP suspects the patient has a drinking problem and would like to screen for alcohol abuse or dependency. The emergency department is busy, and the acuity is high, so the NP has limited time to screen the patient. Which alcohol assessment tool would the NP use: CAGE AUDIT-C HARK SOGI

1. Greg is a 56-year-old male with a history of chronic heart failure who presents to the emergency department (ED) complaining of worsening shortness of breath over the last week. During your assessment, you begin to palpate for pitting edema in his feet by pressing firmly over the dorsum of each foot with your thumb for at least two seconds. You note there is a slight indentation, and it takes fifteen seconds for his skin to rebound. On a four-point scale, what would you grade the severity of his pitting edema? a. 1+ b. 2+ c. 3+ d. 4+

1. What description is correct regarding the S1 heart sound? a. It is the opening of the mitral and tricuspid valves b. It is the closure of the mitral and tricuspid valves c. It is the opening of the aortic and pulmonic valves d. It is the closure of the aortic and pulmonic valves

2) For which patient is it appropriate for the NP to obtain a comprehensive adult health history? A. Mr. Flores, a 26-year-old male presenting to the urgent care clinic with throat pain. B. Mrs. Palmer, a 50-year-old female presenting to a new clinic for her yearly physical. C. Mr. Rivas, an 18-year-old presenting to the ER with leg pain after falling off his bike. D. Mrs. Cheng, a 45-year-old patient returning for a follow-up appointment after knee surgery.

2. A 21-year-old male client comes into the clinic for TB tests. He moved into the community and found a new job last week. The client is healthy and denies specific complaints. What kind of assessment would the student Nurse Practitioner conduct properly? Lung sounds auscultation Comprehensive assessment Focused or problem-oriented assessment Take past history

2. Mr. Stewart is an 80-year-old patient with no known medical history who presents to the emergency department (ED) complaining of syncope. A troponin T level comes back as 2.1 ng/ml. Based on your knowledge about older adults, you suspect that: a. Stewart lied about having chest pain b. Myocardial infarction may present differently in older adults c. The troponin level is invalid and should be repeated d. Mr. Stewart did not experience shortness of breath

29-year-old female presents with palpitations. She states these episodes are intermittent and are not associated with chest pain, shortness of breath, or chest discomfort. She explains that she gave birth to her baby a few weeks ago. Her vitals were normal aside from a heart rate of 115 (sinus). Which of the following tests would you order for your patient? Echocardiogram Labs including a thyroid panel Order a CT chest Psych evaluation

3. A 60-year-old patient has come to the clinic for the first time complaining of ear pain. The nurse knows that pertinent positives and negatives go under which section of the adult health history? A. Chief complaint B. Past medical history C. History of present illness D. Review of systems

3. The Nurse Practitioner is conducting a comprehensive health history and interviewing a 40 year-old male patient. The patient comes in today with complaints of chest pain. Which of the following statements by the NP is an empathetic response? "Can you tell me what brings you to the clinic today?" "It sounds like your father passing at a young age from a heart attack must have been a difficult time for you." "So, you've been experiencing chest pains recently. Do you have any family history of heart disease?" "It sounds like you've been having increased stress at work and at home lately. Is that correct?

3. The student nurse practitioner is interviewing a patient with a hearing disability, all the actions she is performing are correct except? A. Sitting on the side of the ear that can hear better or has a hearing aid. B. Exaggerate your mouth while speaking and speak loudly. C. Eliminate background noise. D. Face the patient, especially if they can read lips.

45-year male with history of COPD, HTN, and GERG comes to the clinic for a colonoscopy. The APRN understands that when she documents this procedure it will fall under which section of the electronic health system (EHR) ? a) The Review of Systems b) Health Maintenance c) Past Medical History d) Social History

A 10-year-old kid came home from the beach complaining of scratchy discomfort and eye pain. He says that they were playing at the beach when one of his friends threw sand at him and a good amount of sand hit his eyes. Upon assessment, you noticed a black dot like a rock in his cornea. What is a possible differential diagnosis for this scenario? Conjunctivitis Corneal abrasion Glaucoma Allergies

A 12-year-old female is brought in for the first time by her parent for examination. The parent's chief complaint is that the patient "is sleepy and moody all the time. She isolates and only wants to spend time with her friends." Upon examination, the patient presents with bradycardia, hypotension, tremors and avoids eye contact. The patient denies the parent's report stating, "I am fine. I just hate my parents, and I want to be with my friends." What should the provider do next? Ask the patient direct questions about possible substance use, sexual abuse, or suicidal ideation in the presence of the parent? Ask the parent to step out of the room and, with another female staff present, proceed to ask the patient direct questions about possible substance use, sexual abuse, or suicidal ideation. Ask the parent direct questions about possible substance use, sexual abuse, or suicidal ideation in the presence of the patient? It's the first time you meet this patient, so you must avoid asking questions about possible substance use, sexual abuse, or suicidal ideation to avoid making them feel uncomfortable.

A 15-old- girl arrived at your clinic complaining of stuffy nose as well as constant nasal drip for the last few months, that started when the family moved to Hawaii. Her mother asked you what do you think the diagnosis is? As a clinician, which of the following is the best explanation? It is viral, nothing to worry about It is allergic rhinitis It is sinusitis Otitis media

A 16-year-old Female was brought in to the emergency department after a car accident with shortness of breath, pleuritic pain, and cough. The nurse practitioner orders a chest X-ray and interprets the imaging to be a tension pneumothorax. The patient needs immediate needle decompression, the nurse practitioner knows to insert the needle: a. In between the 4th and 5th intercostal space b. 2nd intercostal space c. In between the 7th and 8th intercostal space d. 3rd Intercostal space

A 17-year-old student athlete arrives to the clinic complaining of 7/10 non-radiating right shoulder pain after sustaining an injury while lifting weights. He is visibly anxious about his injury in light of the upcoming playoff tournament. Which of the following responses is appropriate for therapeutic communication? A You don't need to worry, the team will do fine without you. B You seem upset, how do you feel about this? C I will fix you up in no time, so you can play in the tournament. D Let's take a look at your shoulder.

A 20-year-old female patient admits to the ED. The patient is guarding her abdomen. Her hands are over the RLQ. The patient states she's been having some nausea. The NP received her pregnancy results, and they are negative. What should the NP suspect the patient has Ectopic pregnancy Appendicitis Diverticulitis IBS

A 20-year-old student came into the clinic with abdominal pain for food intolerance. The NP student asks the patient to point to her stomach with her finger. Which of the following quadrant is the stomach supposed to localize? a. Right upper quadrant b. Left upper quadrant c. Left lower quadrant d. Right lower quadrant

A 24-year-old male patient presented to a clinic for his annual checkup. An NP is assessing the lungs. The NP recalls the right lung: A) Consists of all lobes B) Consists of three lobes C) is longer than the left lungs because of underlying the diaphragm D) Consists of two lobes

A 25-year-old male comes into the clinic with a chief complaint of pain upon urination. The Family Nurse Practitioner asks the patient how long his symptoms have lasted and when his symptoms began. The Family Nurse Practitioner is asking the patient which part of the adult health history? A. Past Medical History B. History of Present Illness C. Chief Complaint D. Review of Systems

A 26-year-old female came in for annual physical. No chief complaints about physical health but briefly mentioned feeling sad most of the days especially during the middle of quarantine. As a NP, what is the best way to approach this finding? "It's normal to feel sad especially it was hard not to see your loved ones during the pandemic." "Tell me how the pandemic has affected your life, especially when it comes with your relationship with family and friends." "Why do you feel sad? You should be happy because you are as healthy as you can be" "I will recommend you to a psychiatrist because they can help you better."

A 26-year-old pregnant presented to a clinic since she complained of shortness of breath, cough, and chest pain. The pain level is 4/10. The pain has been on and off since two days ago. You are suspecting pulmonary embolism and will order one of the following orders. Which one do you select? A) Chest x-ray B) Limited V/Q scan C) MRI D) CT with angiogram

A 30 year old female patient with severe asthma comes into your clinic. Which of these adventitious sounds would be a finding when listening to her breath sounds? Bronchophony Wheezes Bronchial sounds Whispered pectoriloquy

A 30-year-old female comes into the clinic complaining of a large lump on her neck. Upon further physical assessment, the NP concludes that the patient has a goiter. The provider proceeds to ask questions pertaining to the patient's weight, skin, and temperature intolerances. Explain the significance of these questions. These are standard questions when interviewing a patient The NP is evaluating the patient's thyroid function There is concern for malignancy Goiters commonly accompany pharyngitis

A 30-year-old female patient is being assessed in the trauma bay for a hemothorax after being the victim of a stab attack. As the APRN student, you anticipate the attending trauma physician to place a chest tube in the: Second intercostal space Fourth intercostal space Along the lower margin of T4 Below the eight rib

A 30-year-old male visited the urgent unit; after focused physical examination, the nurse suspects that patient has a subconjunctival hemorrhage; which of these findings would the nurse most likely find on examination? a. Mild discomfort in the eye with mucopurulent discharge. b. Leakage of blood outside the vessels with the absence of pain. c. Corneal opacity with affected vision. d. An acute increase in intraocular pressure.

A 51-year-old female comes into the primary care clinic with request for colon cancer screening due to recently learning that her sister was diagnosed with it. As the patient's primary care provider, you understand that the following recommendation options are true for colorectal cancer screening for adults ages 50 to 75 EXCEPT: Annual highly sensitive fecal occult blood testing Annual digital rectal exam Sigmoidoscopy every 5 years with high-sensitivity fecal occult blood testing every 3 years Screening colonoscopy every 10 years

A 30-year-old male who had an appendectomy seven days ago after ruptured appendicitis, presents to the clinic for a post-op follow-up care. He brings incentive spirometry, saying he does not remember how to use it and why he should be using it. The patient works at a dry cleaning service. During percussion to identify the extent of diaphragmatic excursion, the FNP notes absent descent of diaphragm on the left side of the chest, with diminished breath sounds on the left lower lung fields on auscultation. All other exam results are unremarkable. What is the best explanation for the exam findings? The patient developed left lower lobar pneumonia after the surgery. The patient developed left-sided atelectasis perioperatively. The patient has been exposed to toxic inhalants at his job and possibly is developing left lung cancer. The patient developed phrenic nerve paralysis of the left hemidiaphragm as a complication of the surgery.

A 35-year-old Female admitted to a post-operative ortho floor after surgery to fix her fractured femur. The patient acutely develops dsypnea, pleuritic chest pain, tachypnea and fever. The nurse practitioner is concerned that patient developed a pulmonary embolism and will order which gold standard diagnostic test? a. Chest X-ray b. CT Angiography c. Ultrasound d. ABG

A 35-year-old male patient presents with RLQ pain, elevated lipase, anorexia, N/V, and fever. The patient is lying on their left side with increased pain on the extension of the right hip. This is a positive ______ sign. A) Rovsing B) Psoas C) Obturator D) McBurney

A 37-year-old male with a history of HTN and allergy to contrast dye, patient presents with sudden onset chest pain and shortness of breath. Labs were collected and the patient was found to have an elevated D-Dimer. What would be your next diagnostic step? CTA chest V/Q scan ABG CXR

A 40-year-old Hispanic male is visiting you in clinic for the first time. Patient denies any past medical history, surgical history and any allergies. You're examining your patient's thyroid. As you palpate over the thyroid gland it feels firm and no nodules are felt. Patient denies any tenderness as you palpate. What diagnosis are you to consider? Thyroiditis Graves' Disease Hashimoto Thyroiditis Normal finding

A 42-year-old male comes to the clinic stating that he feels his heart is racing and pounding really fast he states he has no medical history. One possible differential diagnosis could be anxiety, another differential diagnosis could be? a) Hypothyroidism b) Hyperthyroidism c) Hypomagnesia d) Hyperglycemia

A 44-year male comes to the clinic stating that he has hoarseness for more than 3 months. He states that he feels pain and lost weight. Denies any alcohol, smoking or drug use. What is the possible differential diagnosis? a) Environmental Allergies b) Vocal cord nodules c) Viral infection d) Bacterial infection

A 44-year-old male comes into your office for a general physical. Upon examination, the patient discloses that their father, for whom the patient was the primary caregiver, died a couple of weeks ago. What is the appropriate empathic response? Death of a parent is always difficult. Assume the patient is grieving and offer condolences stating, "I'm sure that must be hard for you. Is there anything you need?" Say to the patient, "You have lost your father. What has that been like for you?" Share your own experience with your father dying, telling the patient, "I know exactly how you feel." Don't probe any further and change the subject. The patient is obviously bothered by it and may start crying in the exam room, which may upset other patients.

A 45-year male presents to the ED with c/o severe anxiety and panic attacks that bring about SOB and chest pain. The patient does not speak English and requires an Armenian translator. What should the provider's first step be in initiating care for this patient? A. Walk into the room and introduce themselves and begin the patient interview B. Find an appropriate translator via the hospital approved translation system C. Ignore the patient interview d/t the language barrier and order an EKG to be safe D. Determine the patient diagnosis simply by evaluating body language and other data, there is no need to interview the patient

A 45-year-old male comes to the clinic complaining of a dry cough. This patient is a nonsmoker, has no sick contacts, has a past medical history of diabetes mellitus, recently diagnosed hypertension and started treatment with lisinopril. What is likely the cause of this cough? a. Post nasal drip b. Lisinopril c. GERD d. Sinusitis

A 45yrs old came to the emergency room complaining of intermittent claudication pain while walking and doing activities. He also stated that pain gets better at rest. You ordered a doppler study to rule out what peripheral vascular diseases? A. DVT B. PAD C. Compartment Syndrome D. Acute Cellulitis

A 50-year-old female comes to your clinic for the first time. You are going to examine the patient in the room. The patient complains of difficulty swallowing, shortness of breath, and headache for three days. The pain level is 4 out of 10. BP 135/78, HR 92, RR 18, O2sat 98% on RA, Temp 97.8F. How do you prepare to collect the pertinent information from this patient? a) Greet the patient and negotiate plans of action. b) Start the interview with initiation the session, gathering information, physical examination, explanation, and planning, and closing the session c) Start having the interview by calling the patient "sweetie" or "dear" to get more detailed information. d) Start a conversation with the conclusion so that patients can get their clear treatment plans.

A 50-year-old male patient who is a heavy smoker comes to the clinic with chest pain. He said he has lost 15 pounds in the last 1 month even though he does not have a particular diet. He also said he has a cough that doesn't go away in the last 8 weeks with rust-colored sputum with blood. What would be the best diagnosis of this patient? asthma lung cancer acute respiratory failure latent tuberculosis

A 50-year-old man with a BMI of 32, smoker of one pack a day of cigarettes, hypertension, hyperlipidemia, diabetes, and previous placement of cardiac stents x2 presents to the clinic today for a one month follow up after starting on new blood pressure medication. The clinician wants to use motivational interviewing to encourage the patient to quit smoking and change lifestyle habits. Select which statement by the clinician demonstrates the "listen" aspect of this guiding style? "How would you feel if you were able to quit smoking?" "I understand that quitting smoking feels beyond your reach at the moment." "If you continue smoking, it will only continue to be harder to treat your elevated blood pressures and keep you healthy." "Don't you want to be around for a long time to see your children grow old?"

A 55-year-old male comes to the ED complaining of shortness of breath and difficulty breathing with exertion. On the monitor, patient's HR is 110, BP 155/90, O2 saturation 90% on room air, respiration rate 38, temperature 98-degree F. What is considered subjective data? Patient's BP is 155/90 Patient complains of chest pain 6/10 with exertion on the pain scale Patient is alert and oriented Patient's O2 saturation is 90% on room air and 100% on 2L nasal cannula

A 55-year-old male presents with a chief concern of feeling tired all day and states his wife complains that he snores a lot. His vitals are BP 124/73 P 81 R 18 O2Sat 98%RA T 98.9 BMI 31. What is the most likely diagnosis? a. Insomnia b. Obstructive sleep apnea c. Pneumonia d. Bronchitis

A 56 year-old male presents to the ED with complaints of shortness of breath. On assessment, the Nurse Practitioner notes the patient is tachypneic, tachycardic, with a right tracheal deviation. CXR shows a left-sided pneumothorax. The Nurse Practitioner prepares for needle thoracostomy and prepares to insert the needle at which location? Right 2nd intercostal space Left 2nd intercostal space Left 4th intercostal space Right 3rd intercostal space

A 56-year-old Hispanic woman comes into the clinic with a chief complaint of abdominal pain. She has her 10-year-old son at her side. She doesn't speak any English, but her son does and he is willing to translate. As a Nurse Practitioner you a.) Have her son translate hoping she understands what you are telling him b.) Use the translation line phone that is available to the staff c.) Have the c.n.a translate because you know she speaks good Spanish d.) Insist you carry on getting by with the little words you know

A 60 y/o patient complains of feeling dizzy. The nurse practitioner (NP) wants to clarify what the patient means by dizzy and will ask: "Do you feel dizzy or lightheaded?" "Do your symptoms get worse when you move your head?" "Do you have any ear drainage?" "Do you have any bruising."

A 60-year-old patient with GERD has failed empiric therapy and started to develop "alarm symptoms" such as GI bleed and dysphagia. You are concerned that the patient is at risk for developing Barrett esophagus. What will you order for the patient for your primary concern? Video fluoroscopic swallowing exam Endoscopy Chest x-ray CBC

A 65-year-old female African American patient with diabetes complains of abdominal pain. She said she has bad heartburn. The nurse practitioner knows that is it important for her to order what next? UA ECG MRI colonoscopy

A 65-year-old male with a history of smoking and drinking is getting a routine check-up at a clinic. The nurse practitioner notices the patient has a mass on the periumbilical area and pulsating. The NP ordered an ultrasound. What does the NP suspect the patient has? Appendicitis AAA Acute Cholecystitis Ascites

A 67-year-old Asian male presented to your clinic complaining of vague abdominal pain. He was accompanied by his daughter as the patient speaks only minimal English. The daughter tells you he had been having abdominal pain for the past month and it took much effort to bring the patient to the clinic. As the student NP, what is the best course of action to ensure an effective encounter with the patient and family member? a. Speak only to the daughter and allow the daughter to tell you about the patient's chief complaint. b. With eye contact, address the patient and ask, "How can I help you" or "tell me more about this abdominal pain"? c. Conduct the interview and ask questions with minimal interaction with the patient. d. Have the medical assistant perform the interview as she speaks the same language as the patient.

A 68-year male comes in the ER complaining of shortness of breath and sharp stabbing chest pain. After the chest x-ray, the results show a tension pneumothorax. As the ACNP you know that when inserting the chest tube, the correct anatomical location is between which number ribs? The third and fourth ribs Fourth and fifth ribs Fifth and sixth ribs Seven and eighth ribs

A 70-year-old female presents to your ER complaining of increased shortness of breath. Her past medical history includes smoking one pack a day for 30 years. You suspect lower airway respiratory failure. Which of the following best described lower airway respiratory failure? A)Drug overdose B) COPD C) Hemothorax D) Brain trauma

A 72-year-old male patient with a history of heart failure comes to your clinic complaining of being awakened due to shortness of breath while sleeping. Which assessment by the NP is most important? A) Assessing other signs and symptoms of paroxysmal nocturnal dyspnea B) Assessing past medical history, especially asthma attack and sleep apnea C) Assessing other signs and symptoms of paroxysmal nocturnal dyspnea and notifying the patient it is a self-limit to be gone in a week. D) Assessing pharyngitis

A 75-year male presents to the clinic stating that he is having visual problems in both eyes, and he started to lose vision slowly, especially when he looks straight ahead. As a health care provider what will you tell him? a) This is common with aging, don't worry. b) I will refer you to an ophthalmologist to rule out macular degeneration. c) This is cataracts. d) This is hyperopia (farsightedness).

A 76-year-old lady with right upper quadrant discomfort came to the clinic. The FNP is assessing this patient experiencing an acute episode of cholecystitis. Which of the following clinical manifestation does NOT support this diagnosis? a. Fever b. Positive Cullen's sign c. Complaints of indigestion d. Severe pain usually occurs after a fatty meal

A 80-year-old female with CAD, CHF, and HTN comes into the primary care office for a check-up. She explains to you that her cardiologist heard a murmur at her last visit and he suspects she has mitral valve regurgitation. She asks "if you can listen to see if it's still there". Where would the FNP auscultate to hear a medium/high pitch murmur? A. Left third, fourth, and fifth intercostal space Apex Left second to fourth intercostal space Left sternal boarder

A Cal State LA student was taken to the ED by her counselor because she has difficulty taking a deep breath and feels like she cannot get enough air. She also says she feels "pins and needles" on her hands. What do these symptoms indicate? Asthma Anxiety Abdominal Aortic Aneurysm Aortic Stenosis

Ms. King is a 55-year-old female who has a long history of smoking. She was diagnoses with COPD and is non-complaint. When percussing her lungs, what would the nurse practitioner most likely find? A) Resonant B) Generalized Hyperresonant C) Unilateral Hyperresonant D) Dullness

A Nurse Practitioner is assessing a 67 year-old male patient who is hard of hearing. When communicating with this patient, which of the following is NOT an approach the Nurse Practitioner should use? The Nurse Practitioner should ask the patient how to best communicate with him. The Nurse Practitioner should raise their voice to ensure the patient hears them well. The Nurse Practitioner minimizes background noise. The Nurse Practitioner looks directly at the patient when speaking to him.

A follow-up appointment with your 19 year old patient revealed that she had prematurely stopped taking her Bactrim for her UTI. When asked why she had ended her antibiotics allergy, she responds "I stopped the medication early because I think I might be allergic since I had nausea and diarrhea right after taking the medication." What is the best response by the Nurse Practitioner? A. "You're right, you may be allergic. Let me switch the medication to something else" B. "You may be experiencing an expected side effect of the medication. How long were you taking the antibiotic?" C. "It isn't an allergy to the medication since you didn't have trouble breathing, hives, or rashes" D. "You were correct in stopping the antibiotic prematurely

A middle-aged woman is observed leaning forward on a park bench, pursed lip breathing with arms placed on her knees. The NP student jogging in the park looks at the patient is this position and objectively judges this woman most likely has: a. Asthma b. COPD c. Tactile fremitus d. Pleural friction rub

A mother brought her 6 yrs old daughter to the clinic complaining of sore throat and fever. Upon examination, you noted tonsillar exudates with beefy red uvula, and you suspect streptococcal pharyngitis. What test do you order to confirm the diagnosis? Chest X-ray Rapid antigen- detection test Complete blood count Blood culture.

A new couple came into the clinic with infertility for one year. According to your inspection, you noted the wife was active, had big eyes with poor convergence, and model shape with fine, soft, black, and shiny hair. Which of the following is a possible differential diagnosis? Hypothyroidism Hyperthyroidism Hyperparathyroidism Hypoparathyroidism

A normal optic disc will have which of the following appearance? The base of enlarged cup is pale, with a loss of tiny disc vessels. Color yellowish orange to creamy pink, disc vessels tiny. Color pink, hyperemic, disc vessels are more visible and numerous. Color white, tiny disc vessels absent.

A nurse practitioner (NP) finished a visit with a new patient admission in the hospital. As she is writing her SOAP note, she lists four differential diagnoses relating to the patient's main reason for admission. What type of diagnosis must the NP include in the assessment portion of her note? A rare type of disease A potentially life-threatening condition A possible genetic disorder A potential autoimmune disorder

A nurse practitioner listens to a patient's heart sounds. Where should the NP assess to obtain the sound of the valve closures? A) Tricuspid and mitral valves B) Aortic and pulmonic valves C) Tricuspid and aortic valves D) Pulmonic and mitral valves

A patient presents to the clinic and states "I was told I have thyroid problems but I don't remember which one." Which of the following statements by the patient alerts the Nurse Practitioner that the patient likely has hypothyroidism? "Sometimes I have a hard time swallowing because it feels like I have a lump in my throat." "I have to keep layering up my clothes because I get cold really easily." "There are times where I feel like my heart is beating really fast like it's going to jump out of my chest." "I don't really gain much weight no matter how much food I eat."

A patient presents to the clinic for an annual check up. During her vital sign measurements she seems anxious, tapping her foot and starting to sweat. The patient's BP reads 150/94. The patient sees the number and responds "that can't be right, I just checked my blood pressure at home before I got here and it was 138/90". What does the APRN suspect is happening? Masked hypertension White Coat hypertension Orthostatic hypotension Hypotension

A patient says that he has recently noticed a lump in the front of his neck below his Adam's apple that seems to be getting bigger. During the assessment, the finding that leads the nurse to suspect that this may not be a cancerous thyroid nodule is that the lump (nodule)? a. Is tender. b. It is mobile and not hard. c. It disappears when the patient smiles. d. It is hard and fixed to the surrounding structures.

A patient with no known past medical history comes into the clinic complaining of 7/10 abdominal pain for the past three days. The patient states the pain is sharp on the right upper quadrant of her abdomen. The pain starts after she eats a heavy meal and continues until she takes acetaminophen which then provides her moderate relief bringing her pain down to a 3/10. The APRN recognizes that the patient describing the pain as "sharp" is attributing to which pain descriptor? Location Quality Quantity Timing

A.G., a 72-year-old female, with a family past medical history of coronary artery disease is in today for an annual physical exam. She asks you about the signs and symptoms of a heart attack. You respond: "You will know when you are having a heart attack." "Watch for upper back pain, or jaw pain; shortness of breath; and fatigue." "You only need to worry about the classic symptoms." "It will feel like the worst headache of your life."

After determining the patient's height and weight and calculating the BMI. Which BMI is considered normal? A. >18.5 B. 18.5-24.9 C. 25.0-29.9 D. 30-34.9

Alexie came to the clinic, weary of having a cough for the past 9 weeks. She was diagnosed with chronic bronchitis. According to the duration, what kind of cough does she have? Acute cough Chronic cough Subacute cough Postinfectious cough

All of the following are risk factors for primary (essential) hypertension, EXCEPT for: A. Genetics B. Obstructive sleep apnea C. Obesity and weight gain D. Age

An 18-year-old male presents to the emergency department with severe abdominal pain, confusion, weakness, rapid breathing, and a fruity breath odor. The patient has a history of type 1 diabetes and has been non-compliant with his insulin. The glucometer reads HI. What is the patient's compensatory breathing called? Ataxic breathing Kussmaul breathing Cheyne-stokes breathing Obstructive breathing

An 87-year-old male patient with heart disease came to a clinic. A nurse practitioner tries to take risk factors of heart disease. Which should the NP include while taking a history from the patient? A) Alcohol intake, smoking, hypertension, and diabetes B) Hypertension, diabetes, hyperlipidemia, obesity, and smoking C) Family history, social history, psychosocial history, and stress D) Age, sex, hypertension, atherosclerosis, and cardiovascular diseases

An 89-year-old male is brought in by ambulance into the emergency department for a syncopal episode at home. The patient's wife contacted 911 after she found him, "down in the hallway and not responding." Upon your assessment, the patient tells you, "I felt lightheaded and dizzy before I passed out." As the Advanced Practice Nurse, you understand that this type of data is considered to be: The patient's chief complaint Subjective data Objective data Part of the patient's past medical history

An ambulance arrives with a 2-year-old child and a very frantic parent. EMS tells you that the parents report the child may have accidentally swallowed a Lego. Upon inspection the child is tearful, mild respiratory distress noted, and you hear audible stridor. Where is the Lego possibly at? Stomach Trachea Mouth Right Lower Lobe

An experienced nurse practitioner is speaking to a student nurse about assessing for conductive hearing loss, which statement by the student nurse indicates effective learning? A) Disorders of the inner ear cause conductive hearing loss. B) In conductive loss, noisy environment may help C) Older adults always get conductive hearing loss. D) Disease such as Ménière disease and congenital conditions cause conductive hearing loss.

As a clinician evaluating your patient's history of chest pain and always considering life-threatening situations, which of the following must be considered? Ask the patient to rate their pain from 0-10, and point to the location of the pain Ask open-ended questions, elicit specific details, point to the pain, quantify the patient's baseline activity Ask the patient to describe the pain and when the pain occurs Ask about their past medical history

As a healthcare provider, there are Core Values of Medical Ethics, which of the following would not be considered a core value? Truth Telling Being compassionate and respectful Respect for autonomy Justice

As a student nurse you are evaluating a patient's ankle-brachial index (ABI) score. The ABI is the ratio of blood pressure measurements in the foot and arm. After collecting the data your score is 0.42, how would you interpret this ABI? A) Mild B) Moderate C) Severe D) Normal

As an ACNP who works in an acute hospital, it is essential to understand the special landmarks in the chest and ribs. Which of the following is correct? The needle insertion for decompression of a tension pneumothorax is the 5th intercostal space. Intercostal space between the 4th and 5th ribs is for chest tube insertion. A well-placed endotracheal tube is located at the level of the 2nd rib for the lower margin on a chest x-ray. The intercostal space between the 6th and 7th ribs is a landmark for thoracentesis with needle insertion immediately superior to the 7th rib.

As the ACNP you are rounding on your patient in the hospital. You walk into the room to greet them and find them sitting on the bedside commode trying to have a bowel movement. As you greet them you witness them lose consciousness and pass out. The nurse gets the patient back in bed and raises the feet above the head, at which the patient starts to wake back up. Which of the following do you expect might have happened? A. They are faking it and don't want to speak to you B. The patient vasovagal while trying to have a bowel movement C. The patient is just tired D. Massive pulmonary embolism

As the NP auscultates the patient's heart sounds, she identifies the mitral regurgitation and upon palpation, notes a thrill. When recording her assessment, she would fully describe the murmur as: Medium-pitched, grade 2/4, blowing decrescendo diastolic murmur, best heard in the 4th ICS Medium-pitched, grade 4/6, blowing systolic murmur, best heard at the apex Medium-pitched, grade 4/6, blowing decrescendo diastolic murmur, best heard in the 4th ICS Medium-pitched, grade 2/4, blowing systolic murmur, best heard at the apex

As you are auscultating a patient's chest, you hear a murmur between S2 and S1 sounds. How would you chart this? A) Systolic murmur B) Diastolic murmur C) Pansystolic murmur D) Midsystolic murmur

As you assess the patient's lymph nodes, you note that the nodes are hard and immovable. What are you concerned for? Incorrect technique Malignancy HIV Mononucleosis

As you palpate the patient's thyroid gland, you noticed that it is soft and may be nodular. What do you suspect the patient might have? Hashimoto thyroiditis Graves disease Hyperthyroidism Hypothyroidism

Bean is a 65- year- old male who has smoked 1 pack of cigarettes every day since he was a young adult. He presents to the clinic with complaints of 7/10 sharp abdominal and back pain unrelieved with pain medication. When performing the abdominal exam, the NP can feel a pulsating mass about 5cm wide. The NP orders an abdominal ultrasound to assess for: a. Gastrointestinal bleed b. Abdominal aortic aneurysm c. Nephrolithiasis d. Small bowel obstruction

Before discharging Ms. Smith to home, you provide health education to promote cardiovascular health and decrease the risks of CVD. You adopt the American Heart Association guideline of 'ideal cardiovascular health'. Which of the following statement from Ms. Smith during the teach-back session indicates further teaching or clarification is needed? I should keep the body mass index below 25kg/m2 I should maintain my blood pressure below 140/90mmHg I need to be physically active My target untreated total cholesterol is less than 200mg/dL

Blood flowing through the heart travels from the right atrium to the right ventricle through the semilunar valve into the ____ on its way to the lungs. Pulmonary veins Pulmonary arteries Aorta Inferior vena cava

Brian, 45 years old, is in the urgent unit complaining of shortness of breath, chest pain, pain radiating to the shoulder, nausea. He elaborated that his chest pain is sudden and very sharp, and he has had insomnia for the last two weeks. These types of data are a. objective. b. subjective. c. interrelated. d. reflective.

Carmen is an obese 28-year-old female on oral contraceptives and smokes cigarettes daily. After returning from a trip to New York and a five-hour flight, she noticed swelling, tenderness, and pain in her right calf. The NP orders an ultrasound to assess for: A. Phlebitis B. Deep venous thrombosis C. Compartment syndrome D. Peripheral arterial disease

Diane is a 21-year-old female who comes to the clinic for evaluation of blurry vision when looking at things at a distance. During your assessment, Diane denies any recent trauma, double vision, or headaches. You find that she has PERLA and normal extraocular movements. Given her presentation, you decide to test her visual acuity and find that: a. Patient most likely has presbyopia because her visual acuity is 20/50 on both eyes b. Patient most likely has myopia because her visual acuity is 20/50 on both eyes c. Patient most likely has hyperopia because her visual acuity is 20/50 on both eyes d. Her vision is normal because her visual acuity is 20/50 on both eyes

Donald is a 46-year-old patient with a history of anxiety that presents to the ED with a sudden onset of 8/10 constant, non-radiating chest pain. You inquire about his allergies to medications, and he tells you that he is allergic to morphine. You ask him what reaction he experiences to morphine, and he tells you it makes him nauseous. What would be your best response to Donald? a. Okay, I will document morphine as an allergy in your chart. b. Nausea is a common side effect of morphine. It is not a true allergy. c. Okay, I will make sure you do not receive morphine for your pain today. d. What other medications are you allergic to?

During an abdominal assessment, the nurse deeply palpates the LLQ of the patient's abdomen, which causes pain in the patient's right lower abdomen. This is most commonly indicative of what? A. Hepatitis B. Appendicitis C. Diverticulitis D. Splenomegaly

During an assessment of a middle-aged female, the clinician palpates the patient's foot for pitting edema. After the clinician releases their finger from the foot, they notice a slight indentation and about 15 seconds until the skin rebounds. Which number on the pitting edema scale does this represent? 1+ 2+ 3+ 4+

During your physical assessment of a 70-year-old female, you notice enlargement of a left supraclavicular lymph node (Virchow's node). The patient you are examining has a history of abdominal malignancy. Based on this finding, you suspect which of the following: Normal finding since the patient has abdominal malignancy Possible metastasis from the abdominal malignancy The patient probably has a cold Nothing and move on

Hailey a 40 year old female with two children comes into your clinic. She lives a sedentary lifestyle and has recent stressors affecting her sleep. She is 64.8 inches tall and weighs 183 lbs with a BMI of 31.4 (kg/m). Her waist circumference is 36 inches. To promote optimal patient weight and nutrition counseling for Hailey all of the following are correct, except? Encourage Hailey to walk 30 to 60 minutes 5 or more days a week Inform Hailey that her diet is more important than total kilocalories a day Encourage proven behavioral habits such as portion-controlled meals, meal planning, food diaries and activity records Inform Hailey that the most effective diets combine realistic weight loss goals with exercise and behavioral reinforcements

In sensorineural hearing loss compared to conductive hearing loss, what assessment can the nurse practitioner expect to find? A) Patient has an appropriate voice volume because inner ear and cochlear nerve are intact B) During the Rinne Test air conduction (AC) is longer than bone conduction (BC). C) Hearing seems to improve in a noisy environment D) Usual onset of age is childhood and young adulthood, up to age 40 years old

Itzy is increasingly concerned about swelling in her lower legs and catching her breath when doing yard work. Which response shows the most appropriate response by the FNP? a. Assure Itzy not to worry about it. She'll be fine. b. Encourage Itzy to measure and record her weight every morning. c. Inform Itzy it is okay to stay in bed all day. d. Tell Itzy she can drink endless amount of Coca-Cola and Hot Cheetos.

Janice is a 26-year-old female who comes to your clinic for an annual exam. You are training a new nurse to perform auscultation of her abdomen. Which statement by the nurse demonstrates a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen? a. Auscultation allows the patient to be more comfortable with the examination b. Auscultation prevents distortion of bowel sounds after percussion and palpation c. Auscultation does not precede percussion and palpation d. Auscultation allows us to move from the least to most invasive approach

Jessica Jones is a 55-year-old female patient with a vague history of heart disease who presents to the emergency room (ER) with shortness of breath (SOB) that gradually worsened over one week. Dyspnea is present at rest but worsens with exertion. She uses three pillows to sleep at night because she "can't breathe lying down." She denies fevers or chills. What should the NP include as a differential diagnosis? Right ventricular heart failure Left ventricular heart failure Pneumonia Asthma exacerbation

Jordan 57 years old male who has severe COPD, what is considered a normal finding of the chest during his physical assessment? Funnel Chest Pigeon breast Barrel Chest None of the above

Julie is a 76-year-old female who is bed-bound coming from an assisted-living facility, who presents to the ED with hypoxia. Her oxygen saturation on room air is 87%. A chest x-ray reveals a new fluid accumulation in the pleural space, and you confirm this read with the radiologist. What do you infer is her diagnosis based on the reading and your interpretation of the x-ray results? a. Pneumothorax b. Pleural effusion c. Atelectasis d. Pneumonia

M.J. is a 56-year-old obese male who comes into the clinic today complaining of increasing daytime sleepiness and fatigue despite sleeping an average of 8 hours. Based on the information provided, formulate the next question you would ask the patient. A. "What is your nighttime routine?" B. "Do you snore loudly or gasp for air during sleep?" C. "What did you have for dinner? D. "Who is your favorite basketball team?

Mr. Calderon, a 67-year-old male, came in complaining of abdominal pain. Which of the following is correct. ( comprehension) A. While he is sitting, untie the gown from the back to examine him. B. Adjust the gown to cover the chest and place a sheet to drape at the inguinal area. C. Have Mr. Calderon lay prone on the exam table. D. Have Mr. Calderon undress only from the waist up.

Mr. Holmes comes to see you and explains that he is feeling more fatigues then usual. When asked to provide more information he states that he has excessive daytime sleepiness, and he thinks it is from being woken up at night feeling like he is choking. Mr. Holmes is 55 years-old and has a history of being obese. What is the most likely diagnosis? A) Narcolepsy B) Obstructive sleep apnea C) Asthma D) Leukemia

Mr. Jones is a 62-year-old male with history of hyperlipidemia and diabetes. He is here for his yearly physical. When you check his vitals the blood pressure is 138/102. Per the American Society of Hypertension what blood pressure classification would you assign to this patient? Prehypertension Stage 2 hypertension Stage 1 hypertension Normal blood pressure

Mr. Keen a 74 year old patient comes into the clinic complaining of a cough that is unresolved. "I have had a really bad cough for about 4-5 weeks now, I figured once I recovered from Covid it would go away but it didn't". The APRN documents Mr. Keen's cough as which of the following? A. Acute B. Subacute C. Chronic D. None of the above

Mr. Kim is a 75-year-old construction worker and presents to the clinic with mild dyspnea and persistent cough. He has a fever of 100.8℉. While assessing his respiratory system, you hear abnormally located the broncho-vesicular sound. You decide to assess transmitted voice sounds using Egophony. When Mr. Kim says "ee", you hear nasal bleating "A" sound. Which diagnosis below would be considered? Asthma Pneumonia COPD Rib fracture

Mr. Smith, a 65-year-old male, comes into the clinic complaining of generalized fatigue and shortness of breath with exertion over the past several months. He says he's not sure when the issue first started - "I just can't seem to keep up with the grandkids like I used to." Upon assessment, the nurse notices right jugular venous distension (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows that this finding indicates: A. Hypovolemia B. Increased right atrial pressure C. Decreased preload D. Superior vena cava obstruction

Mrs. Garcia, an 85-year-old Hispanic female, presents to the emergency department from home via ambulance complaining of altered mental status. Per the paramedics, the patient has a history of dementia and is noted by her daughter with increased lethargy and confusion for the last 3 days. Upon arrival, the patient is awake and oriented to self only. She refuses treatment, attempts to get out of bed, and shouts "I need to go home now". Family is not present at the bedside, what should the nurse practitioner do? Allow the patient to sign Against Medical Advice form and leave the facility Consider patient lacks capacity to make a health care decision, identify and contact patient's family or power of attorney for health care Explain to the patient the rationale of the proposed treatment and assume the patient understand the information Respect for autonomy and allow the patient to refuse all the treatment

Mrs. Jones is a 55-year-old woman with a past medical history of diabetes mellitus, dyslipidemia, hypertension, and endometriosis. Her mother and father both passed away from myocardial infarcts at age 60. As the Nurse Practitioner, you want to start Mrs. Jones on statin therapy as she is not currently on any. What is not a pertinent risk factor experienced by Mrs. Jones for CVD? a. Hypertension b. Endometriosis c. Dyslipidemia d. Diabetes Mellitus

Mrs. Pargas is a 76 years old female, a retired bank associate, who presents to the clinic complaining of heartburn and epigastric pain. The patient reports she has never had this symptom before. She was a smoker, quit 5 years ago. Has HTN and HLD, for which she takes medicine. What is the next action for the FNP to take? Refer to Gastroenterologist Order STAT EKG Ask when was the last time HTN and HLD medicine taken Refer to a Cardiologist for atypical symptoms of a heart attack in women

Ms. Gomez, a 66-year-old female presents to the ER complaining of generalized weakness, nausea, and shortness of breath. She is also experiencing 4/10 dull back pain that radiates to her neck. What should the NP do next? A. Order Tylenol 325 mg PO and discharge Ms. Gomez home B. Order a STAT EKG, troponin, BNP, and echocardiogram C. Order a CT chest D. Order a CT of the brain

Ms. Good is a 70-years-old female patient who has been diagnosed with ESBL urinary infection recently. She returns to your office today to follow up. Before beginning the physical examination on her, which action is not appropriate? Adjust the lighting and temperature of the examining room Put on a surgical mask and gloves only as of the personal protection equipment Check the stethoscope to make sure it works Perform hand hygiene

Ms. Gordon, a 40-year-old female, presents to the Emergency Department reporting abrupt onset of "ripping" substernal chest pain radiating to the back. She denies any other symptoms as well as any exacerbating or alleviating factors. The Advanced Practice Nurse (APN) evaluating Ms. Gordon orders stat labs including cardiac enzymes, as well as an EKG, chest X-ray, and echocardiogram. What other imaging test should be considered to be done immediately? a) MRI of chest wall to evaluate for rib cartilage tear b) CT angiogram of chest and abdomen to evaluate for aortic aneurysm dissection and/or PE c) Doppler venous ultrasound of bilateral lower extremities to evaluate for DVT d) Transvaginal ultrasound to evaluate for ectopic pregnancy

Ms. Jones comes into the office complaining of a cough. As the nurse practitioner, you ask how long she has been having the cough. Ms. Jones states about 2 weeks now. Given this information how would you describe the duration of the cough? A common cold Acute Chronic Subacute

Ms. Jones is a 45-year-old female who presents to the hospital primarily for a GI bleed but during your interview, she has a "positive review of systems" and is going off on a tangent with her story. What is the best approach for this type of patient? Allow the patient to speak freely for the first 20 minutes to get a full story Interrupt after 18 seconds to ask your follow up questions and ask focused questions to get a more coherent story Explain to the patient that she is not making sense and to be more specific Consider speaking to a family member who can provide a better history

Ms. Jones is a 50-year-old female who comes to your clinic for the first time while guarding her left flank. You are an Advanced Practice Registered Nurse (APRN) and need to establish an agenda for the patient encounter. You greet her and introduce yourself as she sits down. Which of the following is the best example of an open-ended question you would ask her next? a. Are you having flank pain? b. What brings you into the clinic today? c. Can I get you something for your back? d. What is your weight?

Ms. Swift presents to the clinic with a productive cough, fever, and malaise. After imaging tests and lab tests, the FNP suspects right middle lobe pneumonia. Which exam finding does the FNP expect to find? A. Hyperresonant percussion note on the affected field. B. The trachea is midline. C. Trachea shifts toward the involved area. D. Absent breath sounds on the involved area.

Patient AG, 9 year old male is brought in by mother for concerns of poor depth perception. Upon examination, you notice that his right eye wanders and does not work cohesively with the left eye movement. What test can be performed to screen for lazy eye? (A) Swinging flashlight test (B) Cover-uncover test (C) Visual acuity test (D) Retinal Tomography

Patient AG, an 80year old male, came in with complaints of SOBX1week, thick/green sputum, and a strong cough. After completing a CXR and a WBC w/differentials, you see that there are infiltrates to bilateral lower lobes of the lungs, and there is presence of leukocytosis. Based on these findings, you can assume that the diagnosis of this would be: Chronic Bronchitis Pneumonia Emphysema Pneumothorax

Patient RL, a 72 year old female, is diagnosed with aspiration pneumonia. Knowing correct anatomy, where did the aspiration pneumonia most likely occur? In the left lung In the right lung In both lungs In the stomach

Patient arrives to the urgent care complaining of diffuse abdominal pain 7/10, nausea and no bowel movement for 3 days. On exam, the patient's abdomen is distended. Patient stated that he just had his back surgery 1 week ago and he has been consistently taking oxycodone 10mg every 6 hrs for pain. What will be the mostly likely diagnosis? Acute Diverticulitis Acute Bowel Obstruction Acute appendicitis Acute Cholecystitis

Patient came in for nausea and vomiting, placed on tele monitoring. At the beginning of the shift, patient was Normal Sinus Rhythm. Now, the monitor is showing Sinus Bradycardia to low 40s. Upon assessing patient, you notice that she is sleeping but easily arousable. BP 128/64, HR 45, SpO2 100% on RA, RR 16. Pt does not complain of any SOB or dizziness. What will you do next? Call Rapid Response Team and get a 12 lead EKG Continue to monitor patient Give atropine 0.5mg IV Q3-5mins Ask patient to perform vagal maneuver to increase heart rate

Patient is complaining of eye pain, photophobia, headache and blurry/hazy vision. On examination, the patient's left pupil is dilated and fixed, steamy, couldy cornea and absent ocular discharge. Right eye IOP is 20 mm Hg, Left eye IOP is 50 mm Hg. What will most likely be the diagnosis? Open-angle glaucoma Acute angle-closure glaucoma Acute Iritis Subconjunctival hemorrhage

Pt C.L has been going to his NP for swollen feet and says he wakes up with puffy eyes. What would the NP recommend the patient to do? Take his furosemide (Lasix) at night before going to sleep. Weigh himself every morning and record it Drink more water Check his blood pressure every day

Pulses of the abdomen. Which is palpable? A) celiac trunk B) Aorta C) superior mesenteric artery D) inferior mesenteric artery

Regina is a 25-year-old female who visited your clinic today complaining of fatigue, weakness, and recent weight loss. She states she has not been feeling well, lacking energy, and lacks motivation to do anything. Ms. Regina also been missing many days of work because of her current state. As the Nurse Practitioner that day, what pertinent information would you assess to formulate your diagnosis? Ask open-ended question, obtain vital signs, and weight Ask open-ended questions, sleep patterns, obtain a thorough psychosocial history and review of systems, recreational drug and alcohol use, assess food intake, medication history, and depression screening Ask your medical assistant to perform depression screening Ask if she has any financial and social challenges.

Sally is a 43-year-old obese female who presents to your clinic with complaining of a headache that often occurs in the morning. She denies any light sensitivity or changes in vision. She is often fatigued and reports she is very tired during the day. Which one of the following tests is most appropriate to order for this patient? CT of the head Sleep Study Thyroid study MRI of the head

Smith is an 85-year-old male with a history of dementia and CAD, who presents to your office with chest pain. Upon arrival to the ED, it is made apparent that the patient requires an angiogram with a possible balloon or stent placement. Patient lacks the capacity to make health care decisions. Who will be your point of contact to obtain consent? Patient's spouse Patient's power of attorney Patient's eldest child The provider

The APRN is performing a respiratory assessment on her 35 year old patient at the clinic. The APRN is training a student and wants him to perform the assessment first. The student is getting ready to auscultate the patient's lungs, which of the following actions did the student not do correctly. A. The student asked the patient to cough a few times to clear any airway mucus. B. The student places the stethoscope on top of the patient's blouse. C. The student uses the ladder pattern to auscultate. D. The student listens to at least one full breath at each location.

The APRN student is completing a comprehensive assessment on a 60-year-old male patient who has a history of controlled hypertension, episodic depression due to his wife's death 5 years ago, and ongoing back pain. During the physical assessment and interview, the patient discloses that he has been experiencing mild chest discomfort during strenuous physical activity. What is the best order of priority the student should list the patient's problems? a. Hypertension, chest pain, back pain, depression b. Chest pain, back pain, hypertension, depression c. Depression, chest pain, back pain, hypertension d. Back pain, chest pain, depression, hypertension

The Advanced Practice Nurse (APN) is conducting rounds in a nursing home and is concerned that a patient may have an aspiration pneumonia because breath sounds are diminished in the right lower lung field after patient reportedly had a "choking" episode during breakfast. The APN knows the right middle and right lower lung locations are most common regions to have an aspiration pneumonia because: a) The right lung ventilates more air than the left b) The right main bronchus is wider, shorter, and more vertical than the left c) It is further away from the stomach d) It is opposite of the left ventricle of the heart

The Advanced Practice Nurse (APN) is formulating a problems list for a patient. The APN knows that a problems list: a) Allows for maximum billing capability b) Helps individualize care and provides a quick summary of the patient's clinical history c) Only needs to be done if provider is an NP or PA d) Is necessary only when the patient has more than 3 clinical issues

The FNP is seeing a patient with a history of COPD. Upon inspection, he notes a barrel chest with decreased tactile fremitus and diminished breath sounds bilaterally. Upon percussion, the FNP expects to find the following Dullness Generalized hyperresonance Resonance Unilateral hyperresonance

The FNP student nurse practitioner is about to perform a physical examination on a 86 year-old patient with a history of colorectal cancer and chronic heart failure in the clinic. What would indicate the patient would need a comprehensive exam versus a focused exam? Patient is complaining of abdominal pain Patient is here for a wellness visit Patient complains of SOB Patient is having visual changes

The LDL of a 40-year-old man without history of heart failure or renal disease is 210 mg/dl. Based on the 2013 American College of Cardiology/American Heart Association cholesterol guideline, what would you recommend to the patient as the best treatment regarding statins? Calculate 10-year risk of atherosclerotic CVD and start moderate to high intensity statin therapy Start high intensity statin therapy Initiate low intensity statin therapy Schedule a follow up in 3 months without any starting any medication.

The NP distinguishes which of the following chief complaint as a priority? 25-year-old female complaining of dysuria 80-year-old male status post fall who takes warfarin at home 18-year-old male who is on keto-diet with a blood sugar of 500 40-year-old female with history of DVT complaining of shortness of breath during activities

The NP in the Emergency Department is examining a female brought in by ambulance after a car accident. Upon inspection, the NP finds the patient's chest caves inward when the patient inhales. What should the NP order first? Full chem panel Chest X-ray Ultrasound Echocardiogram

The NP is assessing a patient with a productive cough and would like to know how much phlegm the patient is coughing up. How can the NP make it easier for the patient to describe the amount of sputum coughed up? "Do you have a fever?" "How much do you think you cough up in 24 hours: a teaspoon, tablespoon, quarter cup, half cup, cupful?" "What color is your sputum?" "Do you spit out about 50cc a day?

The NP is assessing the patient who was admitted for abdominal pain (right upper quadrant pain) and vomiting x 1 day. The NP suspicious of acute cholecystitis, but the patient denied tenderness on palpation in the RUQ. What is the next test the NP expect to perform: Homan sign Murphy sign Psoas sign Rovsing sign

The Nurse Practitioner is performing a head-to-toe assessment for a comprehensive examination of a 55-year-old female patient. As the Nurse Practitioner performs the physical exam of the neck, what would indicate a cause for concern for malignancy and further testing? The Nurse Practitioner palpates the thyroid gland inferior to the cricoid cartilage and feels the isthmus of the thyroid gland but is unable to palpate the lobes. The Nurse Practitioner palpates the neck for the cervical nodes and notes an enlarged supraclavicular node on the left side, fixed and painless. The Nurse Practitioner palpates the neck for the cervical nodes and notes small, mobile, discrete, and nontender nodes bilaterally. The Nurse Practitioner observes jugular venous distention while the patient is in the sitting position, leaning slightly backward.

The Nurse Practitioner is providing blood pressure monitoring training to a medical assistant in the clinic. Which statement by the medical assistant indicates that further teaching is needed? "Normal blood pressure is a systolic less than 120 and diastolic less than 80 in adults." "If the blood pressure cuff is too small for the patient's arm, the blood pressure will read lower." "I should wait 3 minutes between measuring sitting and standing blood pressure when checking for orthostatic hypotension." "White coat hypertension can happen because a patient is anxious."

The advanced nurse practitioner understands to document CN 111 intact they would see what reaction when a person shifts gaze from a far object to a near object? a. the pupils dilate b. the pupils constrict c. no reaction d. the eyes get teary

The ankle-brachial index (ABI) is a quick noninvasive to test for peripheral artery disease. You conduct the test by measuring the systolic pressures in the arms and ankles. After you complete the calculation, you find that the ABI is 0.89. What does this interpretation mean? Normal finding Mild PAD Moderate PAD Severe PAD

The family nurse practitioner is seeing a 10-year-old boy for the first time in the clinic. She asks the patient to stick his tongue out. Which finding would be concerning to the FNP? Tongue tip at midline Tongue protruding to the left Appearance of papillae on the tongue Moist, pink mucosa

The following information is recorded in the patient's chart, "The patient has had a pulsating headache for one week. The headache lasts for one hour at a time; it comes and goes. The severity is 8 on a scale of 1 to 10. It is accompanied by aura, nausea, and vomiting. Which of these categories does it belong to? A) chief complaint B) history of present illness C) review of the system D) family history

The leading cause of death in women is? A) Stroke B) Cardiovascular disease C) Diabetes D) Lupus

The nurse Practitioner is completing a physical examination on a patient. During the examination of the neck, the nurse practitioner recognizes a stridor. The next step is: a. continue the examination b. alert the respiratory rapid response team c. ask how long this has been occurring d. give 2L O2 via NC

The nurse is assessing a patient in the clinic. The patient appears jaundice, with a history of alcoholism. The nurse finds positive shifting dullness on percussion of the abdomen. This is indicative of which of the following? A. Hepatitis B. Ascites C. Appendicitis D. Cholecystitis

You have received a patient who's labs came back with elevated T4, excessive sweating and fatigue, suggesting hyperthyroidism. You remember that risk factors for hyperthyroidism include a. Down Syndrome b. Older age c. Type 1 diabetes d. Goiter

The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true? Percussion is a useful tool for outlining the hearts borders. Studies show that percussed cardiac borders do not correlate well with the true cardiac border. Only expert health care providers should attempt percussion of the heart. Percussion is easier in patients who are obese.

The nurse is percussing a patient with an active pneumonia diagnosis. The nurse knows that when she percusses over atelectasis, she will hear what type of sound? A. Resonant B. Dull C. A loud, low-pitched long breath sound D. Tympanic

The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? a. Slope of the earpieces should point posteriorly (toward the occiput). b. Although the stethoscope does not magnify sound, it does block out extraneous. room noise. c. Fit and quality of the stethoscope are not as important as their ability to magnify sound. d. Ideal tubing length should be 22 inches to dampen the distortion of sound.

The nurse noticed that her patient has a diastolic murmur that is faint but immediately audible. She should document the diastolic murmur as a grade: 1/4 2/4 3/4 4/4

The nurse practitioner can distinguish peripheral arterial disease based on which exam finding? A. Warm, even hair distribution in lower extremities B. Cramping in legs on exertion with relief with rest C. No edema D. + 2 bilateral dorsalis pedis pulse

The nurse practitioner is able to distinguish myopia based on which patient narrative? a. "I have noticed more and more white streaks of light passing in front of me." b. "Everything looks blurry far away if I don't wear my glasses." c. "I always keep my reading glasses nearby to read the medicine container." d. "Back in 2004, the vision in my right eye started to get really blurry but only in the middle. I noticed the same is starting to happen with my left eye last year."

The nurse practitioner is auscultating the heart sounds on an elderly male. Upon auscultation, the nurse practitioner notes a systolic murmur that is louder in volume than S1 and S2 with a palpable thrill. Using the six-point scale, the nurse practitioner documents in the patient's chart that the patient has a systolic murmur of which of the following? A) Grade 3/6 B) Grade 4/6 C) Grade 5/6 D) Grade 6/6

The nurse practitioner is following up on a patient in the hospital admitted for community acquired pneumonia. The portable chest XRAY continues to show infiltrates. The nurse practitioner auscultates the lungs and hears coarse, grating phasic sounds primarily heard upon expiration. The nurse practitioner is hearing which of the following lung sounds? a. Crackles b. Pleural friction rub c. Rhonchi d. Fine crackles

The nurse practitioner is performing a focused physical assessment for the cardiac system on 50 years old female known case of heart failure. While assessing the carotid artery. What does the nurse know to be true regarding carotid artery palpation? a. Immediately palpate the carotid pulse. b. Auscultate first to listen for bruit, then palpate. c. Inspection is enough for carotid artery assessment. d. Inspect, then palpate immediately.

The nurse practitioner knows that metabolic syndrome consists of risk factors that increase an individual's risk for cardiovascular disease and diabetes. Which of the is not a risk factor: A. Elevated blood pressure B. Elevated HDL cholesterol C. Elevated Triglycerides D. Reduced HDL cholesterol

The nurse practitioner performs a battery of cognitive function tests on Don because Don has been exhibiting mood swings, grandiosity, and confabulation. Which exam result below proves Don needs to be referred to a neurologist for further testing. A. During the Serial 7s exam, Don is able to subtract 7 from 100 getting, most of them right but making 3 errors. B. When asked about possible cognitive deficits, Don answers, "Person. Woman. Man. Camera. Tv." without prompting. C. During the Abstract Thinking test, Don is able to consider concepts, make generalizations, and think philosophically. D. After being shown a picture of a clock, the picture removed from sight, Don is able to draw the picture of the clock and the time on the clock accurately from memory.

The nurse practitioner will observe a student nurse do an abdominal examination. Before the student starts, the NP asks the nursing student to state what he will do before percussing the abdomen. What will be the correct answer? Nothing Auscultate Palpate Deep palpation

The nursing assistant noticed well-demarcated vividly purple patches so she reports them to the family nurse practitioner. How should the nurse practitioner respond? A) Get ready to report for elder abuse as it is evidenced by the skin discoloration B) Tell the nursing assistant not to worry since it is normal and will fade after several weeks C) Prescribe some topical medication as it can get itchy and infected D) Move the patient to the isolation room since the patient might have infectious skin disease

The patient is brought in after a motor vehicle accident. The patient complains of difficulty breathing. The physical assessment shows the trachea displaced towards the right, and reduced breath sounds on the left. Percussion is heperresonant. What finding do you suspect? A) Pleural effusion B) Tension Pneumothorax C) Lung Cancer D) Asthma

The patient presents to the clinic for an annual assessment. This patient has a history of alcohol abuse and IV drug abuse. During your abdominal assessment, you feel the liver is enlarged with a firm, non-tender edge. What could this assessment be indicative of? Carcinoma Cirrhosis Riedel lob Normal finding

The period of ventricular contraction when the left ventricle ejects blood into the aorta is called what? a. Diastole b. Systole c. ventricular pressure d. Aortic contraction

The spleen, splenic flexure of colon, stomach, and body and tail of pancreas are all anatomic structures located in which abdominal quadrant? A. RUQ B. LUQ C. RLQ D. LLQ

The student nurse practitioner is assessing a 52-year-old patient. The patient has a systolic murmur, and you grade it a 2/6. Which of the following describes a 2/6 systolic murmur? A) Louder in volume than S1 and S2, with palpable thrill. B) Equal in volume to S1 and S2, quiet but heard immediately. C) Louder in volume than S1 and S2, with thrill, maybe heard when the stethoscope is partly off the chest. D) Softer in volume than S1 and S2, very faint.

The student nurse practitioner is ready to perform an assessment for an 85-year-old female who came into the clinic for her annual physical. Her vital signs are as follows: BP: 140/85 HR: 85 RR: 16 T: 36.5 O2: 95%. What are some expected changes the student nurse practitioner should assess as normal evolution of aging and not a sign of a new health issue? a. Strong skin tugor b. Auscultating a fourth heart sound c. Double vision d. Delirium

Tina is a 34-year-old woman with a history of smoking who presents to your clinic for an annual exam. You have a nursing student, and you are about to demonstrate the correct technique for assessing chest expansion. How do you demonstrate the correct technique for testing chest expansion on the posterior chest wall? a. Begin by using the ulnar surface of your hand and ask the patient to repeat the words "ninety-nine". b. Place your thumbs at the level of the 10th ribs and ask the patient to inhale deeply. Watch the distance between your thumbs as they move apart and feel for the range and symmetry of the rib cage. c. Holding the pleximeter finger above and parallel to the expected level of dullness, percuss downward in progressive steps until dullness replaces resonance. d. Place your stethoscope on the skin to listen with the diaphragm of your stethoscope after instructing the patient to breathe deeply through an open mouth.

Tom a 64 year-old patient, comes into the clinic complaining of intermittent fevers, shortness of breath, and pain when taking a deep breath. Per Tom "My symptoms started last week right after I thought I had recovered from getting the flu." Tom denies any history of smoking or tobacco use. The medical assistant reported Tom's respiratory rate at 18 breaths per minute. Before the APRN assesses the patient, what disorder is the APRN suspicious that Tom might have? A. Asthma B. Pneumonia C. Chronic Obstructive Pulmonary Disease (COPD) D. Anxiety with Hyperventilation

Upon assessment what special landmark would you expect for needle insertion for decompression of a tension pneumothorax? 1st ICS 2nd ICS 3rd ICS 4th ICS

Upon evaluation of patient A.G., the Nurse Practitioner is for gastrointestinal or some other malignancy as she inspects the mouth. Which finding might indicate likelihood of gastrointestinal malignancy? Localized subcutaneous or submucosal swelling of the bottom lip after ingestion of a new medication. Prominent small brown pigmented spots are seen on the dermis of the lips, buccal mucosa, and perioral region. A single, painless ulcerated papule is noted on the lower lip Multiple, painful vesicular lesions can be seen in clusters on the lip and perioral region, with yellow crusting.

When a nurse is assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would consider doing the following: instruct the patient to slowly exhale during auscultation listen to the bell of the stethoscope to assess for bruits. simultaneously palpate the arteries to make sure they have the same amplitude locate the deep cervical lymph node area and auscultate the area with the diaphragm

When a person shifts gaze from a far object to a near object, the pupils constrict. What CN response is meditated by this? CN II CN III CN VI CN X

When assessing for Pulsus Alternan, which of the following symptoms would the NP determine to be reason for concern? Pulse rhythm is irregular and the force of the pulse is bounding and regular Pulse rhythm is regular and the force of the pulse alternates between strong and weak Pulse rhythm and pulse are both irregular and weak Pulse rhythm are bounding

When auscultating the heart sounds in a healthy patient, the APRN understands that the S2 sound: Is generated by the opening of the aortic and pulmonary valves Is generated by the closing of the aortic and pulmonary valves Is generated by the closing of the mitral and tricuspid valves Is generated by the opening of the mitral and tricuspid valves

When describing the duration of bronchial sounds, the NP knows the nursing student demonstrates understanding when they respond. Inspiratory and expiratory sounds are almost equal Expiratory sounds last longer than inspiratory ones Inspiratory sounds cannot be heard in bronchioles Inspiratory sounds last longer than expiratory sounds

When examining 35-year-old Fred's left ear with the otoscope, the NP views a reddened tympanic membrane with vesicles on the surface and inability to view the cone of light. Fred's signs and symptoms include 10/10 ear pain, bloody discharge, and conductive hearing loss. The recommended next best step for the NP to take is: a. Give Fred a lollipop b. Refer to otolaryngologist c. Clean the ear with NS d. Prescribe antibiotics

When examining the ears with the otoscope, the provider should? A. straighten the right ear canal using the fingers of your right hand to grasp the auricle and then gently pull it upward, backward, and slightly away from the head. straighten the right ear canal using the fingers of your left hand to grasp the auricle and then gently pull it upward, backward, and slightly away from the head. straighten the right ear canal using the fingers of your left hand to grasp the auricle and then gently pull it downward, backward, and slightly away from the head. straighten the right ear canal using the fingers of your right hand to grasp the auricle and then gently pull it downward, backward, and slightly away from the head.

When performing a physical assessment of the ear, what is the first technique you will always use is as an NP: a. Palpation. b. Inspection. c. Percussion. d. Auscultation

Which is not a reason for higher quality error rates in point-of-care testing than central lab testing? Lack of training of clinical non-lab staff Delayed results needed for critical decision making Test limitations Misuse of POCT

Which of the following data is correctly documented by the nurse practitioner student as subjective in the electronic health record? a. WBC 14.2 b. Pain 6/10 c. Hgb 10.2 d. Pulse 68

Which of the following example is the most well-developed and contains important semantic qualifiers? 20-year-old Chinese female patient with no PMH complains of occasional abdominal cramps with nausea and vomiting 50-year-old African American male patient with hypertension complains of sudden onset of intermittent, left-sided, non-radiating, chest pressure pain 6/10 for 2 days 70-year-old Hispanic patient with diabetes and ESRD complains of dizziness and "a big" headache for 1 week 55-year-old patient complains of severe chronic back pain and worsens with activity such as walking and bending

Which of the following is an appropriately written chief complaint by the nurse practitioner student? a. 28- year-old female positive for strep two years ago b. 37-year-old female complaining of shortness of breath and fever over the past two days c. A 16-year-old male with a family history of diabetes d. 67-year-old with a history of CVA in 2019

Which of the following is incorrect regarding the characteristics of breath sounds? a. Bronchovesicular sounds, inspiratory and expiratory sounds are almost equal b. Vesicular sounds, expiratory sounds last longer than inspiratory c. Bronchial sounds, expiratory sounds last longer than inspiratory d. Tracheal sounds, inspiratory and expiratory sounds are almost equal

Which of the following is not an intervention you would do if you were unable to find the apical impulse? Ask the patient to exhale fully and stop breathing for a few seconds. Have the patient sit and lean forward. If the patient is a woman, displace the left breast upward or laterally as necessary. When supine, ask the patient to roll partly onto the left side into the left lateral decubitus position.

Which of the following is not considered a warning sign for peripheral arterial disease? Poorly healing wound on the leg Erectile dysfunction Fatigue and numbness in the right calf that limits walking Chest pain

Which of the following is not identified by utilizing the Valsalva maneuver? Pulmonary hypertension Hypertension Hypertrophic cardiomyopathy Heart failure

Which of the following is the correct description of a "unstageable pressure ulcer? A. Partial-thickness loss of skin with exposed dermis B. Full-thickness skin and tissue loss. Slough or eschar is present. C. Persistent nonblanchable deep red, maroon, or purple discoloration. D. Full-thickness skin loss, in which adipose is visible in the ulcer, with granulation tissue and rolled wound edges present.

Which of the following is the correct pathway for the propagation of the cardiac impulse. Purkinje fibers-AV node-SA node-Bundle of His SA node-AV node-Bundle of His-Purkinje fibers SA node-Purkinje fibers-AV node-Bundle of His AV node-Bundle of His-SA node-Purkinje Fibers

Which of the following patient information would be considered objective data? A. A patient is complaining of a headache 6/10 B. Upon assessment, you observe tenderness upon palpating the upper right quadrant of the abdomen C.A patient states "I feel weak" D. A patient complains that they are feeling nauseous

Which of the following patients is suffering from an upper airway obstruction? Bill who has impaired respiratory movement on both sides. Thomas who has abnormal muscle retraction of the intercostal spaces during inspiration. Sussy who has asymmetric chest expansion. Carly who has a unilateral delay in chest expansion.

Which of the following patients' symptoms suggest chronic venous insufficiency? Patient A with brawny, thick skin. Patient B with brownish discoloration just above the malleolus. Patient C with atrophic and hairless skin. Patient D with an exaggerated widened popliteal pulse.

Which of the following physical assessment findings would the NP expect to find in a client with advanced COPD? Underdeveloped neck muscles. Increased anteroposterior chest diameter. Collapsed neck veins. Increased chest excursions with respiration.

Which of the following signs or symptoms indicates a patient might not be tolerating extubation? The respiratory therapist is administering a breathing treatment The patient is coughing and has tachycardia 150s The patient is suctioning their mouth with a yankeur The patient is able to carry on a conversation

Which of the following statements made by the patient would lead the NP to suspect the patient is experiencing PND, paroxysmal nocturnal dyspnea? Snoring, ptyalism, and edema after 1 to 2 hours after falling asleep. Sudden dyspnea, coughing, 1 to 2 hours after falling asleep. There is no need for concern. PND is a medical term for a good night sleep Vivid dreams that interrupt sleep and lave you feeling tired in the morning.

Which statement below is incorrect about deep vein thrombosis (DVT)? A DVT is a type of venous thromboembolism (VTE) which is a blood clot that starts in the vein A DVT is a chronic venous disease with chronic venous engorgement from venous occlusion or incompetent venous valves Signs and symptoms of DVT include painful or painless extremity swelling and positive Homan's sign DVT risk factors include immobilization or recent surgery, lower extremity trauma, pregnancy or postpartum state

While collecting health history, the patient complained of productive cough for three days. You asked the patient how much the patient coughed up in 24 hours and the characteristics/color of the phlegm. Based on the patient's explanation, you assumed that the patient had a bacterial infection and ordered a sputum culture. Which of these characteristics of phlegm best explains a bacterial infection a. White or gray-colored sputum b. Yellow or green colored sputum c. Foul-smelling sputum d. A large volume of purulent sputum

You are about to examine a 40-year-old male presenting with abdominal pain. Pt reports his last bowel was "a couple of days ago" and states, "I normally have a bowel movement every day." Select the proper order you will follow to inspect the abdomen. Palpate, Inspect, Percuss, Auscultate beginning in the right lower quadrant. Inspect, Auscultate beginning in the right lower quadrant, Percuss, Palpate Auscultate beginning in the left lower quadrant, Palpate, Percuss, Inspect Inspect, Auscultate beginning in the right lower quadrant, Palpate, Percuss

You are doing an ophthalmologic examination on your patient; you asked the patient to cover his one eye with a card and read the Snellen eye chart. By doing this, what are you examining on the patient? Testing visual fields Testing visual acuity Testing color vision Testing ocular motility.

You are going to meet a new patient today. Mr. Smith is a 35-year-old male who wants an annual checkup. You realize that all health providers should avoid implicit and explicit biases. Which of the following statement is an example of explicit bias? You are audibly sighing in frustration about Mr. Smith's alcohol use disorder Mr. Smith is at risk of HIV because he is homosexual Mr. Smith tells you that he is married, and you assume his partner is a female You think Mr. Smith is less likely to adhere to medical advice because he is low-income

You noticed a nursing student conducting a physical cardiac assessment on an adult patient. You noticed that the nursing student is using their stethoscope to auscultate the seventh intercostal space left midclavicular space. How should the Nurse Practitioner respond? "This is where the point of maximal impulse is located" "This is not where the point of maximal impulse is located" "This is where the right ventricle is located" "This is the quietest part of the heart to hear a murmur"

Your 64 year old patient presents to the clinic with complaints of shortness of breath with exertion, fatigue, and a chronic cough. You decide to conduct a forced expiratory time examination as part of your evaluation. Which of the following is a proper explanation for you would conduct this test? Ask the patient to take a deep breath and while auscultating over their trachea ask the patient to hold their breath and time it. Repeat three times. Ask the patient to take a deep breath and exhale as rapidly and completely as possible with their mouth open. Auscultate over their trachea for audible expiration. Time it and repeat for three consistent readings. Ask the patient to take a deep breath and exhale as slowly as possible with their mouth open. Auscultate over their chest for audible expiration. Time it and repeat for three consistent readings. Ask the patient to take a shallow breath and while auscultating over their trachea ask the patient to hold their breath and time it. Repeat three times.

Your paitent presents to the primary care clinic with fever and runny nose. During physical examination you want to palpate for sinus tenderness. Which of the following is the appropriate way to test for this? Palpate around the jaw to examine maxillary sinuses and palpate the frontal sinuses by pressing on the tempels Palpate the frontal sinuses by pressing under the bony brows and palpate the maxillary sinuses by pressing on the mid-face Palpate the frontal sinuses by pressing on the top of the forehead and palpate the maxillary sinuses by pressing on the mid-face Palpate the maxillary sinuses by pressing on the chin and palpate the frontal sinuses by palpating under the bony brows

Your patient presents with englarged cervical nodes and fever. On throat examination you note white exudate on their tonsils. What is the most likely cause of their infection. Influenza B Group A Streptococcal Fusobacterium necrophorum Coronavirus

a nurse practitioner student, you understand that hypertension is a serious public health problem in the United States. More than one-third of adults age 20 years and older have hypertension. Which of the following statement is incorrect? a. SBP increases in more distal arteries, whereas DBP falls. b. For the patient with chronic atrial fibrillation, home blood pressure monitoring one time a day should be recommended. c. The white coat effect is usually considered clinically significant when office SBP/DBPs are >20/10mmHg higher than home BP monitoring. d. Masked hypertension means office BP<140/90, but elevated daytime BP>135/85 at home.

he Nurse Practitioner is examining a 56-year-old patient who comes into the clinic complaining of a wound on the anterior lower leg, superficial to the distal tibia, after tripping on a planter at home four weeks ago. The wound does not seem to be healing completely after the past four weeks. What else would the Nurse Practitioner want to ask or examine? Palpate for the location, size, tenderness, and mobility of the lymph nodes. Ask the patient if he/she has been having any leg pain with exertion that is relieved by rest. Auscultate for the heart sounds in the appropriate anatomic locations and check for murmurs. Perform the Allen's test, to check for proper circulation the area.

hich patient warrants an order for an imaging test? A 43-year-old female with a complaint of unrelieved headache that lasts for hours A 7-year-old child who had an ultrasound and suspected to have appendicitis An 82-year-old female with small, seemingly benign, fluid-filled cysts in her ovaries and uterus A 35-year-old male with no known medical history and has normal findings in his physical examination

An 80-year-old male came into the clinic complaining of dizziness, loss of balance, ringing in both ears, and progressive hearing loss. Which interventions should you take (select all that apply)? Drink plenty of fluids. Recommend follow-up with an eyes, ear, nose, and throat specialist. Educate patient to change positions slowly. Perform both Rinne and Weber tests.

BCD

You are looking for the pulse of maximal impact on your client's chest but just can't seem to find the darn thing where it's supposed to be (7-9cm lateral to the midsternal line and to the left). What should you do? A. Inform the patient's family that sadly, their loved one no longer among the living. B. Check the patient's position and body habitus (build and size) C. Check for displacement of the PMI D. If you can't find it after feeling/looking around, that's okay too

BCD

) Luke, a 32-year-old male, presents to the urgent care for evaluation of right-sided inner ear pain. He denies any discharge or swelling of the ear canal. The patient denies hearing loss and notes he has not recently gone swimming. He notes having prior ear infections in the past which resolved with Amoxicillin. During assessment of the ear, the Advanced Practice Nurse (APN) attributes which finding as the likely source of Luke's pain? a) Cerumen noted on external auditory canal b) The tympanic membrane (TM) is pearly grey and translucent c) The TM is erythematous d) There is a presence of a cone of light at the 4' oclock position

) Ms. Rodriguez, a 30-year-old female presents to the clinic complaining of debilitating headaches, that are reoccurring every few weeks. She describes the pain as 7/10, unilateral, and associated with photophobia, nausea, and vomiting. After examination, you diagnose Ms. Rodriguez with migraine headaches, and educate the patient to avoid which triggers? Sleeping too much Avocados and aged cheese White wine Citrus fruits

. A 26-year-old female is at her PCP office with chief complaints of burning sensation around the vagina, yellow discharge, and increased need to pee. She begins to cry and states, "I am afraid of having an infection." Your initial response will be "Don't worry; I'm sure it's nothing." "Better an infection than being pregnant, right?" "To help me take better care of you, I need to ask you some personal questions about your sexual health and practices." "Are you a person who uses condoms?"

. A 60-year old male patient came in to the ED with a chief complaint of shortness of breath during exertion and diaphoresis. Patient also complains of difficulty sleeping at night due to cough with blood-tinged sputum and needing to sleep upright. No signs of peripheral edema and negative JVD. With these symptoms, what is a possible diagnosis for this patient? Right-sided heart failure Tuberculosis Left-sided heart failure Cor Pulmonale

. A nurse practitioner is doing a physical examination on a newly admitted trauma patient; the student noticed a jugular vein distention and trachea deviation during the examination and a sudden drop in blood pressure. What is the priority intervention? a. Ask for two litters of ringer lactate and pack RBC to restore circulation. b. Press the jugular vein hardly to relieve pressure. c. The patient developed tension pneumothorax injects a needle in the second intercostal space to release pressure and safe airway and breathing. d. Change patient position and elevate the head of the bed to 90 degrees.

. A patient walks into the clinic for his routine check-up. Upon arrival you notice him walking in and appearing short of breath. As soon as he sits downs and slows his breathing you notice he appears fine. You assess him and breath sounds are decreased with delayed expiration. As the ACNP you note this as: a. Asthma b. Pneumothorax c. COPD d. MI

. An established patient at the clinic presents with shortness of breath and increased swelling in her legs for the past two days. The nurse practitioner is examining the patient and becomes concerned when the patient makes one of the following statements: A. "I have been limiting the amount of water I drink." B. "I elevated by legs with two pillows." C. "I'm unable to lay flat in bed without becoming short of breath and need two pillows when I sleep." D. "I have been limiting my salt intake."

. Chief Complaints are generally recorded in the patient's chart as: "patient exhibits rebound tenderness at 4th lower quadrant" "patient reports family history of colon cancer" "patient brought self into the ED stating 'I've been noticing more and more blood when I poop." "Guaiac test demonstrates the presence of blood"

. Mary brings her 2-year daughter Alexa to see her pediatrician with concerns about her daughter's unusual irritability, difficulty staying asleep, frequent tugging of her ears and fever. APRN uses her otoscope and sees this. Screen Shot 2022-02-06 at 3.20.56 PM.png Normal left ear tympanic membrane Normal right ear tympanic membrane Acute otitis media left ear Acute otitis media right ear

. Mr. Smith is a 50-year-old male who is an active tobacco user and presents to the ED with a complaint of shortness of breath when he walks up the stairs. He informs you that he first noticed feeling out of breath when he was climbing up the stairs to his apartment. You inquire about his tobacco use. He informs you that he has been smoking for the past 5 years, about one 1-pack day. You then ask him if he has considered smoking cessation. Mr. Smith responds, "I am concerned about the effects of smoking on my health, but I am not ready to make any changes right now". According to the Transtheoretical Model for Behavioral Change, which stage is Mr. Smith currently in? a. Precontemplation b. Preparation c. Contemplation d. Action

. When assessing for a DVT, the provider understands the following: A. Pacemakers and defibrillators are rarely associated with DVT's B. Roughly 75% of those with a DVT have a pulmonary embolism C. Most patients present with unilateral or asymmetric swelling of the extremities D. DVT in the upper extremity is 50 % of cases

. Which of the following descriptions represents a mid-diastolic murmur? It starts late in diastole and typically continues up to S1. It starts immediately after S2, without a discernible gap, then usually fades into silence before the next S1. It starts a short time after S2. It begins in systole and extends into all or part of diastole.

1. A 60-year-old man comes to the clinic for an annual checkup. The patient appears normal but has flaky dermatitis and ankle swelling. The APN recognizes those signs of malnutrition. Which of the following factors increase the likelihood of malnutrition? Except. A. Social isolation B. Physical disability C. Fit dentures D. Drug abuse

1. A 67-year-old Hispanic male is brought into the Emergency room after being found passed out on the front of his lawn. As the Advanced Practice Nurse (APN) you go to assess the patient and note the patient is lethargic and unable to stay awake during your assessment and his answers aren't making much sense. What would be the next appropriate steps to obtain some medical history on this patient? Keep trying to force the patient awake so you can obtain a full health assessment on the patient Come back a different time when the patient is more awake and alert Check the chart for any family contact information or if there is a current family member present obtain a history from them being more reliable Assume the past medical history based on visualizing the patient's current condition

1. A 78-year-old patient comes into the clinic for an annual wellness exam under a new insurance plan. She does not take any prescribed medications. She states that her previous doctor, "was really on her about eating sugar." Which assessment finding is consistent with the normal aging process and not a sign of an underlying disease? A. Increased oral temperature B. Elevated heart rate C. Widened pulse pressure D. Narrowed pulse pressure

1. Mrs. Edwards is a 43-year-old adult female with a history of type 2 diabetes who comes to your clinic for the first time. You begin the physical examination by measuring her blood pressure, and it reads 135/85. According to the Eighth Joint National Committee (JNC 8) Blood Pressure Categories for Adults, what would you categorize her blood pressure? a. Normal b. Elevated c. Stage 1 hypertension d. State 2 hypertension

1. The nurse practitioner student reviews the patient's identification data, problem list, checks appearance before entering the patient's room, greets the patient appropriately and arranges the room at a proximity most appropriate and comforting to the patient. Identify which stage of the clinical encounter is described. a. Gathering information b. Performing the physical examination c. Initiating the encounter d. Closing the encounter

1. The student nurse practitioner knows that the write-up of the physical examination starts with a general description of the patient's appearance based on the general survey. The student knows which of the following is the most correctly written general survey? A. M.C., a 21-year-old male in no acute distress B. K.G., a well-developed ten-month-old female C. R.B. a young, healthy-appearing 46-year-old woman, well-groomed, pleasant D. H.D. is an adolescent male, neglected and malnourished

1. Ultrasonography (US) is a useful diagnostic imaging tool that is non-invasive and does not use x-rays or radiation. US has significantly improved the diagnosis, treatment, and management of many diseases. Which of the following options is NOT US advantage? Real-time and Fast. Inexpensive. Technical skill Safe and Painless.

5. A 45-year-old male comes into clinic for further workup a palpable, non-pulsatile mass on the left side of his neck. He is a current smoker. The nurse practitioner will order what type of imaging before a percutaneous biopsy? a. Xray b. Ultrasound c. MRI d. CT Angiogram

Your patient had an unplanned self-extubation. They are now alert and sitting up. Their pulse oximetry is 98% on 4L face mask. What action should you prioritize? Performing an ordered STAT ABG Inspecting oral cavity Administering an albuterol nebulizer Checking blood pressure and the heart rate

2. A 26-year-old healthy female presents to the outpatient office with a chief concern of redness in the right eye. On exam, the nurse practitioner notes a clearly demarcated area of redness. Visual acuity is 20/30 bilaterally. Lids and adnexa are normal. Pupils are 4mm constricting to 3mm, equally round, and reactive to light. No neuro deficits noted, all CN nerves intact. The patient denies pain, vision changes, and discharge. The patient also denies any trauma but states she is recently recovering from bronchitis. Which option is most accurate? a. This is an emergency that needs prompt attention b. Refer the patient to ophthalmology c. Reassure the patient that this is a normal finding, particularly after forceful coughing d. Order a CT scan to rule out brain lesion

2. A 35-years-old female came to the clinic for an annual physical exam. When listening to heart sounds, the NP knows the valve closures that can be heard best at the base of the heart are: A. Mitral and tricuspid B. Tricuspid and aortic C. Aortic and pulmonic D. Mitral and pulmonic

2. Jones is a 75 years old patient who presents today for an annual physical examination. Which condition is an unexcepted finding related to aging? a. Presbyopia b. Presbycusis c. Auscultated a third heart sound (S3) d. The testicles drop lower in the scrotum

2. Mrs. Keppra presented to the clinic with complaints of palpitations, excessive sweating, and frequent bowel movements throughout the day. She is also complaining of weight loss over the past several months despite an increase in appetite. Mrs. Keppra is sitting in the chair resting with a heart rate of 150, blood pressure of 160/50. Which of the following conditions is most likely causing Mrs. Keppra's symptoms? A. Cushing's Disease B. Hypothyroidism C. Hyperthyroidism D. Addison's Disease

2. Patient presents to the ED for assessment after a motor vehicle accident. She reports head strike and left eye blurriness. During your assessment, you notice a horizontal sliver of darkness on the iris. What would be part of your differential diagnosis? Detached retina Glaucoma Hyphema Corneal ulcer

2. The NP is performing an admission assessment on a client diagnosed with a detached retina. Which of the following is associated with the patient's complaint associated with this eye disorder? Pain in the affected eye. Total loss of vision. Flashes of light Yellow discoloration of the sclera

3. A 40-year-old man comes to the clinic for an annual physical exam. He has had a dry cough once in a while and social smoking history since age 20. He told the Nurse Practitioner that he smokes about a half pack of cigarettes per day. Which of the following tobacco use documents is correct? Social smoking ½ pack of cigarettes a day 10 pack-years history Less than one pack daily for 20 yea

3. A 65-year-old male with a history of DM and HTN presents with a chief concern of blurred vision, cobwebs, and flashing lights. Which of the following statements made by the patient is incorrect regarding the condition described? a. I need to see an ophthalmologist. b. This condition is the most common cause of blindness in the United States. c. This is a rare condition with no long-term consequences. d. I need to be sure to manage my blood sugars and blood pressure.

3. The nurse performs and eye exam on a patient that is new to the clinic. When inspecting the patient's right eye under oblique lighting, she notices a crescentic shadow cast across the iris of the eye. The nurse knows that this finding could be indicative of which optical disorder that would warrant further medical examination? A. Conjunctivitis B. Subconjunctival hemorrhage C. Narrow-angle glaucoma D. Chemosis

3. While gathering information during a patient encounter, a 15-year-old male begins to cry when asked about school. The patient explains having challenging encounters with a classmate who frequently makes fun of the patient's clothing. Which statement best reflects the use of the pneumonic NURSE when the patient exhibits emotional distress. a. "Can you ask your mother to buy you new clothes?" b. "You should not let your classmate see you cry; it will only make it worse." c. "That sounds like an upsetting encounter." d. "You should immediately tell a teacher."

3. what part of the ear does otitis media affect ? a. External ear b. Inner ear c. Middle ear d. Outer ear

4. A 61-year-old male patient comes to your clinic. The patient complains of shortness of breath, dry cough, chest pain, and orthopnea for two days. The pain is not radiating to the jaw or shoulders, but the pain level is 5 out of 10. The patient takes a CXR. Which one do you select the diagnosis following these options? p effusion.jpg a) Cardiomegaly b) Pneumonia due to coronavirus diseae 2019 c) Pleural effusion d) Hydropneumothorax-

4. A patient comes into your office for a check-up. He has a history of congestive heart failure and coronary artery disease. When you greet him and ask him how he's been feeling he states, "I feel like I can't catch my breath especially when I try to lay down in bed, it is so bad that I have been sleeping in my chair at night." As the ACNP, you might consider which of the following the patient is describing: A. Sleep apnea B. The patient is out of shape and needs to make better lifestyle changes C. left-sided heart failure D. TIA

4. Identify which of the following visual acuity is expressed correctly A. 200/20 B. 200-20 C. 20/30 corrected D. 10

4. Mr. Keen, a 77 year-old male, comes in complaining of falling off a ladder last week and getting a small cut on his right leg that has yet to heal. Upon further questioning by the APRN Mr. Keen states, "you know actually my leg has been swollen for a time now, I didn't think much of it before, do you think there is something wrong with me?" The APRN starts her assessment and can feel a diminished weak pulse on his right leg. What do you expect the APRN to document this pulse as? 3+ 2+ 1+ 0

4. Mr. Robertson who is a first time patient at the local clinic comes in complaining of decreased hearing in his left ear. The APRN has a APRN-student shadowing that day. The APRN turns to the student and asks "What test would you initially perform on Mr. Robertson?" Weber test Rinne test Whisper test "You cannot perform any tests, you need to refer Mr. Robertson to an audiologist."

5) When interviewing a patient who is hard of hearing, the nurse practitioner should: A. Speak loud and clear so that the patient can hear. B. Ask family members to answer questions on behalf of the patient. C. Eliminate background noise and face the patient while speaking. D. Use exaggerated mouth movements so that the patient can easily read your lips.

5. A 67 year-old patient comes into the clinic for an annual check up. The APRN is assessing the patient's eyes. The APRN holds a pencil far from the patient's gaze and then notices pupil constriction when moving the pencil closer to the patient's eyes. The APRN knows that what cranial nerve is intact while doing this? CN I CN II CN III CN VI

5. Patient TL, a 32 year old male comes into your clinic with throat soreness, difficulty swallowing, and noisy breath sounds. Upon X-ray, you notice a thumbprint appearance. This appearance can hint to the diagnosis of: (A) Mononucleosis (B) Gingivitis (C) Epiglottitis (D) Pharyngitis

54-year-old female comes into the clinic with complaints of pain in the ear. She also states that she has had a yellow-greenish discharge for 4 days. You are going to examine her ear. Which of the following description is NOT correct? Acute otitis externa and acute or chronic otitis media with perforation usually present with yellow-greenish discharge. Pain in the ear may also be referred from other structures in the mouth, throat, or neck. To see the ear canal and drum, a nurse practitioner should use an otoscope with the smallest ear speculum that inserts easily into the canal. The movement of the auricle might be painful.

A 10-year-old female is brought in by ambulance with complaints of "difficulty breathing". This patient has a past medical history of asthma. You suspect the patient is having an asthma attack. During your assessment, you percuss the thorax and lungs. Percussion findings that will confirm asthma are: Dull to flat Hyperresonant or tympanitic Resonant to diffusely hyperresonant Diffusely hyperresonant

A 16-year-old female patient is nearing death due to a motor vehicle accident. The family is suffering from this tragedy. List Kubler-Ross's five-stage model in the correct order, which this family will demonstrate their psychological transition. a) Anger, denial and isolation, bargaining, depression or sadness, and acceptance b) Denial and isolation, bargaining, anger, acceptance, and depression or sadness c) Denial and isolation, anger, bargaining, depression or sadness, and acceptance d) Depression or sadness, denial and isolation, anger, bargaining, and acceptance

A 17 y/o female came into the ER for abdominal pain, during the interview she stated that her primary concern is her itchy vaginal and that she's embarrassed to talk about it as an Np which method would you use to get information from her? a. Ask her what she's embarrassed about? b. Focus your questions on the abdominal pain c. Take her to a more private area, maintain open-ended questions d. Call her parents to get more information about her past medical history.

A 17-year-old male comes into the medical office for an annual physical exam. The adolescent appears to be well-appearing and in no acute distress. How should the nurse practitioner establish rapport with this adolescent? A) Have the family members step out of the room B) Gather the information from only the family members C) Speak with the adolescent first and then speak with the family members D) Only speak with the adolescent to allow for more autonomy

A 20-year-old male patient presents to the emergency department with complaints of abdominal pain and fever. After interviewing the patient, the APRN should anticipate a diagnosis of appendicitis if all the following signs are positive, EXCEPT: Rovsing sign Psoas sign Cullen sign Obturator sign

A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handlebars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding the assessment of the spleen in this situation? a. The spleen can be enlarged because of trauma. b. The spleen is normally felt on routine palpation. c. An enlarged spleen should not be palpated because it can easily rupture. d. If an enlarged spleen is noted, the nurse should thoroughly palpate to determine its size.

A 24 year-old female presents to the clinic with complaints of weight loss despite eating more than usual, heart palpitations, and states "I literally cannot stop sweating". The APRN orders lab work for her TSH, T3, and T4, what does she suspect the patient has? Hypothyrodism Polycystic Ovarian Syndrome (PCOS) Hyperthyroidism Parkinson Disease

A 24-year old African-American female comes into the clinic complaining of shortness of breath for the past three days. She states "I have asthma and my inhaler usually helps but this time I feel like it's not doing the job". Upon assessment of breath sounds the APRN notices relatively high-pitched with a hissing quality sounds on the patient's posterior lower lobes. The APRN knows the best way to describe this sound is? A. Fine crackles B. Coarse crackles C. Wheezes D. Rhonchi

A 24-year-old male patient presented to a clinic for his annual check-up. A nurse practitioner is palpating the apical impulse. Where should the NP palpate? A) Third left intercostal space at the midclavicular line B) Forth left intercostal space at the sternal border C) Forth or fifth left intercostal space at the midclavicular line D) Fifth left intercostal space at the sternal border

A 26-year-old homeless comes to the clinic for checkup. He stated that there is a nonhealing wound on his arm that has smelly drainage. The APRN assess the site and notices the wound is an abscess 4cm x 3 cm, inflamed, warm to touch and foul smell. The APRN prescribes antibiotics for 7 days only without further interventions or teaching. Based on common types of clinical errors which error has the APRN committed? a) Confirmation Bias b) Anchoring Bias c) Visceral Bias d) Availability Heuristic

A 26-year-old second-trimester pregnant presented to a clinic. The patient took vital signs: BP 101/68 and HR 82. A nurse practitioner(NP) reviewed the patient's previous data and found out her BP last month was 128/79 and HR 81. The NP should know one of the following is true. Which one do you select? A) Ask the patient if she takes enough fluids. B) This finding should be treated. C) The declined BP due to peripheral vasodilation is an expected change. D) Due to the pregnancy, the cardiac output should be higher at this time.

A 30 year old patient came to the hospital with complaints of left calf pain and left lower extremity pain that increases with walking. The patient states she has been in her normal state of health and had just returned home from a 15 hour flight. Which one of the following is the patient possibly experiencing? A. Cellulitis B. Fracture C. Venous Thrombosis D. Sprain

A 30- year-old athletic male with no past medical history presents to the medical office for an annual physical exam. Upon auscultation of the patient's heart sounds, the nurse practitioner hears S3 and S4 sounds in diastole. What does this physical finding indicate in this patient? A) Ventricular hypertrophy B) Pulmonary hypertension C) It's a normal finding D) Heart-failure

A 30-year-old male present to the ED with a sudden onset of dizziness when he got out of bed today at 9:00 am. The patient denies vision changes, headache, weakness and N/V. The patient states "It feels like the room is spinning". The patients CT head w/o contrast showed no acute intracranial abnormality. Labs are unremarkable. The EKG shows a normal sinus rhythm with a heart rate of 67. Blood pressure: 130/78 standing up, 128/74 sitting down, 125/70 lying down. The patient was given 1 liter bolus of 0.9% Normal saline intravenously & 25 mg Meclizine by mouth. The patient expresses relief of symptoms with medication and fluids. The nurse practitioner discharges the patient with a diagnosis of which of the following? A) Meniere's disease B) Orthostatic hypotension C) Vertigo D) Presyncope

A 32 year-old female patient presents to the clinic with complaints of shortness of breath after a bee sting. She reports a history of asthma. The patient states that her inhaler did not relieve her symptoms. Upon auscultation, which breath sound should the nurse practitioner be most concerned about? High-pitched sound with hissing or shrilling quality Low-frequency popping sound that disappears after coughing Continuous, high-frequency, high-pitched musical sound during inspiration Discontinuous, low-frequency grating sound during inspiration

A 35 year-old Female who recently started a new career, comes into the emergency room with a chief complaint of "feeling palpitations, hyperventilating, sweating, nervousness, and trouble concentrating". Once the primary symptoms have calmed and the patient is able to answer question, what would be an example of an open-ended questions a nurse practitioner can ask to learn more about the symptoms this patient is experiencing? a. Have you experienced these symptoms before? b. When did you start your new job? c. Can you tell me about any recent changes or stressors you've experienced? d. Are you taking any medications?

A 35-year-old female who is currently receiving radiation for her triple negative breast cancer diagnosis has developed soft and pitting edema that has progress to indurated, hard, and non-pitting. There is no pigmentation noted, but it is unilateral to her right arm. As the nurse practitioner, you would know that this type of edema is most likely: a. Pitting edema b. Chronic venous insufficiency c. Lymphedema d. DVT in R upper arm

A 35-year-old man with a history of dyslipidemia and hypertension arrives to the emergency room with crushing chest pain, nausea, and vomiting. As a nurse practitioner, you order a STAT EKG. On the EKG, you see there are ST elevation on leads I, II, and aVF. Which of the following choices best describe the EKG? Anterior STEMI Inferior NSTEMI Inferior STEMI Lateral STEMI

A 37-year-old patient weighs 175 lbs and is 5'3" tall. Which BMI classification does he fit in? Overweight Normal weight Obesity I Extreme obesity

A 40-year-old male patient presents to the clinic for a light headache. A nurse practitioner is doing the cardiovascular assessment. Which of the following assessment is not included in signs of hypertension? Loud S2, S4 Retinal arteriolar changes Anemic conjuntiva Abdominal bruit

A 40-year-old male patient, recently admitted to the hospital for pancreatitis, asks a novice hospitalist APRN if his pancreas is located under his right scapula as he reports pain originating from there. The best response by the APRN would be: Yes, your pancreas is a highly vascular organ requiring protection from a bony structure like your right scapula. No, your pancreas is in your abdominal left upper quadrant. You are having referred pain, which is pain felt at different location of the affected organ. No, your pancreas is in your abdominal right upper quadrant. You are having referred pain, which is pain felt at different location of the affected organ. No, your pancreas is under your left scapula. You are having referred pain, which is pain felt at different location of the affected organ.

A 40-year-old male with a history of smoking one pack a day of cigarettes since the age of 18 comes to the clinic with complaints of "coughing up small amounts of red blood" in his sputum. Before documenting "hemoptysis" in the patient's medical record, the APRN should carefully assess and consider which of the following? Intestinal bleeding Viral pneumonia Epistaxis Community acquired pneumonia

A 40-year-old patient came to the healthcare facility with bronchitis and dyspnea. The FNP cares for the patient and recommends bronchoscopy and biopsy. Which finding if noted in the patient should be reported immediately to the health care provider? Dry cough Hematuria Bronchospasm Blood-streaked sputum

A 42-year-old female presents to the clinic with sudden onset of left eye pain and blurry vision in the left eye. The nurse practitioner is using an ophthalmoscope to assess the patient's left eye and notes an enlarged physiologic cup. This is indicative of which diagnosis? A) A normal physiologic cup B) Papilledema C) Chronic open-angle glaucoma D) Chalazion

A 42-year-old-female presents to the emergency department with a sudden onset of severe burning in the chest that radiates to the back. She reports she was sitting down eating dinner when the pain started. The patient denies any past medical history. The patient reports the pain subsided after taking tums at home. This patient's diagnosis is most likely indicative of which diagnosis? Diffuse Esophageal Spasm Costochondritis Gastrointestinal Reflux Disease Myocardial Infarction

A 43 year old patient has been admitted to the hospital to r/o cirrhosis. The patient is being seen by the medical team and you this morning to evaluate him at bedside. Upon physical examination the patient is seen with scleral jaundice and yellowish skin. Upon palpation of right and upper quadrant you notice the patients jugular vein distention becoming more pronounced. You anticipate to order what exam to follow up on cardiac function? a. CT of the chest with no contrast b. EKG c. Echocardiogram d. MRI

A 45-year-old healthy male presents to the gastroenterologist's office to inquire about his first colonoscopy screening. To obtain informed consent from the patient, the doctor must explain and document the following EXCEPT: The nature of the procedure The risk and benefits of the colonoscopy The location of the procedure The alternatives to a colonoscopy

A 45-year-old patient comes to the clinic complaining of fever, dyspnea, chills, and a productive cough for the past 3 days. During her assessment, the nurse finds dull percussion note elicited over his lungs. What type of sputum does the nurse expect this patient to report producing? A. Translucent white sputum B. Gray sputum C. Purulent sputum D. Foul-smelling sputum

A 46yrs old at the clinic complaining of chest pain. You asked the patient to point to the location of the pain in the chest. The patient pointed his finger to a point on the chest wall, knowing that this type of pain was mainly related? a. Angina Pectoris b. Heartburn c. Musculoskeletal pain d. Pneumothorax

A 48-year-old female patient in a DOU unit. A nurse practitioner (NP) assesses a patient and finds the patient has Cheyne-stroke breathing. The NP knows what factors cause the abnormal breathing: A) Pneumonia, asthma, and obstructive sleep apnea B) Pneumothorax, hypoxia, and hypoglycemia C) Heart failure, uremia, drug-induced respiratory depression, and brain injury (typically bi-hemispheric). D) Salicylate intoxication, restrictive lung disease, pleuritic chest pain, and an elevated diaphragm.

A 50 y/o female patient with a history of depression is complaining of fatigue, weight gain, and cold intolerance. The provider assumes the patient is experiencing worsening depression. The provider is avoiding alternative explanations such as hypothyroidism. Which type of clinical cognitive error is the provider committing? Confirmation bias Framing effect Diagnostic momentum Representation error

A 50-year-old male comes into the emergency room complaining of nausea and vomiting for 2 days, associated with abdominal pain. Upon speaking with the patient, the patient reveals he had a total-knee replacement surgery done 7 days ago. Since then, he has not had a bowel movement and it is noted the patient has severe abdominal distention. What is the probably or most likely diagnosis for this patient? Acute diverticulitis Pancreatic cancer Acute Bowel Obstruction Gastroesophageal Reflux Disease (GERD)

A 50-year-old man with a history of hyperlipidemia, hypertension, and diabetes visits the clinic for annual physical. Upon assessing his eyes, he tells you that recently he has blurred vision and sees black spots every so often. He states that it doesn't last long but he is worried that he will lose his vision one of these days. Based on his medical history, you suspect that patien might have diabetic retinopathy. What findings do you expect to see with diabetic retinopathy? Pale, opaque, wrinkled retina Red conjunctiva with watery yellow discharge Hard, bright-yellow markings from lipid transudation via leaky capillaries Persistent rise in intraocular pressure

A 52-year-old woman who has a constant, dull left knee pain (rated 7/10) for 3 days came into the ER. She had an unwitnessed fall a few days prior and believes that her knee pain started then after she hit her left knee on the floor. She mentioned that it was swollen the next day. She tried applying a cold pack and later a heat pack. She has been taking Tylenol for the pain. Which component does the gathered information pertain to? Review of systems Personal history History of present illness Chief complaint

A 55-year-old male has been experiencing gastroesophageal reflux disease (GERD) for a year without resolution of symptoms on empiric therapy. The patient is now experiencing "alarm symptoms" warranting the nurse practitioner to order an endoscopy. What complaint would not be considered an alarm symptom? a. Weight loss b. Evidence of GI bleeding c. Reddish non-bloody stool d. Difficulty swallowing

A 55-year-old patient came to the clinic for a follow-up checkup after increasing blood pressure medication dosage. You are a new NP in the clinic and this is the first time meeting the patient. You notice that the patient is taking multiple medication but based on his chart, he has no past medical history. As his new care provider, what is the best way to correct his chart? Ignore, it's not your job to update patient's chart because it should have been done beforehand. Call patient's family to ask about his past medical history because you don't think he remembers most of it Ask the patient, "Tell me about your past medical health events" then update medical chart. List down all his medications and clarify why the patient is taking those medications when they don't have any past medical problems.

A 55yr old brought in by ambulance to the emergency room, complaining of acute onset of anterior chest pain, feels like his chest is tearing/ripping apart, pain also radiating to the back. This type of pain is present in what cardiac emergency? A. Pulmonary Embolism B. Angina Pectoris C. Acute aortic dissection D. Pneumothorax

A 56-year-old female has an 1100 appointment scheduled in your office today. Her chief complaint is, "discomfort when urinating." The medical assistant walks the patient back into the exam room and collects the following vital signs: Oral temperature of 97.9 F, heart rate of 67 BPM, blood pressure 118/78 mmHg, and O2Sat of 98% on room air. In the general structure and sequence of the clinical encounter, you have set the stage and greeted the patient. What is the next action to take? Negotiate a plan of action Establish initial rapport Review the patient's clinical record Perform the physical exam

A 57-year old male patient with a history of right ventricular dysfunction presents to the clinic for a regular checkup. He states he has not been on medication for the past 2 months, and gained 10 pounds for a month. He complains of shortness of breath and shows pitting edema grade 2 to 3. Which of the following is the most appropriate education that a nurse practitioner should provide to the patient? Eating less salty food is helpful to lose weight. Aerobic exercise at least 3 times a week for 30 minutes is the best way to keep you fit. Record your morning weights daily. You should not drink more than 4 cups of water a day.

A 60-year-old male patient with a history of emphysema presents to the clinic for his routine follow-up appointment. The nurse practitioner (NP) assesses his forced expiratory time (FET). His FET is consistently 10 seconds for three expirations. With this finding, the NP expects which of the following? The patient is twice more likely to have chronic obstructive pulmonary disease (COPD). The patient is three times more likely to have COPD. The patient is four times more likely to have COPD. The patient is five times more likely to have COPD.

A patient has just been intubated and the nurse practitioner identifies correct placement of the endotracheal tube upon the assessment of the chest x-ray based on which landmarks? A. 2nd intercostal space B. 3rd intercostal space C. 4th intercostal space D. 5th intercoastal space

A 61-year-old female presents with a chief concern of sharp, knifelike, retrosternal pain that radiates to her left shoulder. She describes it as a 9/10. The pain is worse with breathing and lying down and relieved by leaning forward. She is recovering from a recent "bug" with which she had a mild cough, runny nose, and sore throat. What is the most likely diagnosis? a. Angina b. Costochondritis c. Pericarditis d. Pleuritis

A 62-year-old male presents to the clinic to be evaluated for extreme fatigue and sleepiness during the day. The patient has a past medical history of hypertension and a BMI of 36.2 kg/m2 and a neck circumference of 41 cm. The nurse practitioner is screening the patient for obstructive sleep apnea (OSA) using the STOP-Bang Questionnaire. Utilizing the information given, what is the patient's score that is highly suggestive of OSA? 3 5 6 4

A 64 year-old male presents to the emergency department complaining of chest pain for the past three hours. He states "I experience occasional shortness of breath but only when I am using energy". What is an appropriate follow up question for the APRN to ask? Do you have pain anywhere else? Are you experiencing any arm pain? Please tell me more about your symptoms Does anyone in your family have a history of heart attacks?

A 65-year-old male arrives to the emergency department with chief complaint chest pain. As the evaluating nurse practitioner, you should consider all the following in your differential diagnosis EXCEPT: Myocardial infarction Pulmonary embolism Stroke Dissecting aortic aneurysm

A 65-year-old male patient complains of leg cramping pain that is alleviated by resting within 10 minutes. As the nurse practitioner, what do you suspect is the most appropriate diagnosis? A) Venous thromboembolism B) Cellulitis C) Peripheral arterial disease D) Peripheral venous disease

A 65-year-old male patient just had an Anterior Cervical Decompression and Fusion 3 hours ago. You enter the room, and the patient is sitting forward in bed, drooling and complaining of difficulty breathing and swallowing. You listen to his lung sounds, and you hear a high-pitched inspiratory whistling and realize this is an emergency. What type of sound most likely did you hear? a. Wheezing b. Ronchi c. Stridor d. Crackles

A 65-year-old male with no medical history complains of a syncopal episode last night after he got out of bed at night to void. The patient states "I don't know what happened but I passed out while urinating." The patient mostly likely had: Orthostatic hypotension Cough syncope Micturition syncope Aortic stenosis

A 65-year-old man with a history of mitral valve regurgitation is admitted to your unit. You are the nurse practitioner admitting the patient and you are anticipating to auscultate a medium to high pitch murmur on your assessment. Where will you auscultate the murmur? a. Left second intercostal space b. Right second intercostal space c. Apex d. Left third, fourth, and fifth intercostal space

A 65-year-old man with history of chronic heart failure is admitted to the step down unit for exacerbation of his heart failure. Patient is experiencing shortness of breath and increased edema. The nurse practitioner should anticipate to hear what type of breath sounds on auscultation? a. Wheezes b. Fine crackles c. Coarse crackles d. Rhonchi

A 67 year-old female pt. presents to the Endocrinologist clinic for follow-up after a recent diagnosis of Diabetes Mellitus Type 2. The patient states: "I don't know how I'll be able to follow a low sugar diet. I live with my daughter's family, and they usually order take-out for all of our meals." Under which category of the patient's history will this concern be entered? Family History Chief Complaint Personal and Social History Review of Systems

A 67-year-old male in good health reports having trouble focusing on his computer screen and watching his television. He describes his focus improving if he sits a bit farther away. You realize that this condition is normal with older adults and is called a. Myopia b. Astigmatism c. Presbyopia d. Hyperopia

A 68 year-old male patient with a history of hypertension and hyperlipidemia presents to the ED with complaints of abdominal pain. The patient reports that he is a 1PPD smoker for 30 years but stopped 10 years ago. The Nurse Practitioner recognizes that all of the following are the patient's strongest risk factors for abdominal aortic aneurysm EXCEPT: Patient age: 68 years old Medical History: Hypertension and Hyperlipidemia Gender: Male Social History: 1PPD smoker for 30 years, but stopped 10 years ago

A 70 year old female comes into the Emergency Department complaining of worsening shortness of breath, worsening upper back pain for 3 days, jaw pain, fatigue, and states that she suddenly wakes up at night feeling as if she cannot breathe. Which of the following could this patient be experiencing? A. Dissecting aortic aneurysm B. Pulmonary Embolism C. Acute Coronary Syndrome D. Anxiety

A 70-year-old female with a history of atherosclerosis and hypertension presents for her routine follow-up appointment. The medical assistant (MA) notes an initial blood pressure (BP) of 160/80 in the right arm. The MA repeats the measurement on the left arm with a BP of 140/80. Which of the following statements is true? A difference of up to 20 mmHg in systolic blood pressure (SBP) is considered normal. The difference is likely due to "white coat syndrome". This finding requires immediate evaluation. The patient should be prescribed an antihypertensive medication and sent home to return in 1 month.

A 70-year-old male patient with a history of heart disease comes to see you. You decide to examine jugular vein pressure (JVP). What level should you place the patient's head to begin the exam? a. 15 degrees b. 20 degrees c. 30 degrees d. 45 degrees

A 75 year old male patient came into the clinic for a check up of his existing Congestive Heart Failure. Based on your assessment, which symptom is most indicative of right sided heart failure? lightheadedness shortness of breath fluid buildup in the extremities a productive cough

A 76-year-old man is being seen for an annual physical examination. When the family nurse practitioner (FNP) moves on to the portion of the thorax and lung exam she knows the correct order of exam for the posterior and anterior chest are: Inspect, percuss, palpate, auscultate Inspect, auscultate, palpate, percuss Inspect, palpate, percuss, auscultate Inspect, auscultate, percuss, palpate

A 76-year-old man is referred to a cardiology clinic by his primary care physician for concerns of possible mitral valve regurgitation. The nurse practitioner (NP) seeing the patient knows that the best location to auscultate for this heart murmur is at the: Lower left sternal border Right 4th intercostal space (ICS) Cardiac apex Left second and third ICS close to the sternum

A Family Nurse Practitioner is seeking ways of mitigating biases in their clinical encounters. Which of the following is NOT an effective skill and practice in mitigating bias? A. Reflecting on patterns of emotion and behavior B. Pausing before the start of an encounter and prepare for the potential triggers of the bias C. Making assumptions of the patient based on their body language and appearance D. Exploring the patient's experiences of bias

A Patient who is deaf enters your examination room with a family member. When building rapport with this patient, it is important to: A. Ask their family member about the patient's medical history B. Use family members for communication interpretation if needed C. Address the patient directly regarding medical care D. Utilize and address the interpreter regarding medical care

A clenched fist over the sternum suggests what? a. Myocardia Impaction b. Costochondral inflammation c. Angina Pectoris d. Pericarditis

A faculty member is educating NP students on the events of the cardiac cycle. The students are reviewing their answers, which statement is incorrect and will need clarification from the professor? A) During systole the aortic valve is open B) During systole the mitral valve is closed. C) During diastole the aortic valve is open. D) During diastole the mitral valve is open.

A family nurse practitioner (FNP) is seeing a patient at the clinic and during the session, the patient mentions that she is experiencing financial hardship after being laid off from her job. The FNP replies "This seems to be a difficult time for you." Identify the skilled interview technique being used. A Summarization B Partnering C Empathic Response D Transition

A healthy 50-year-old female with a history of diabetes presents to the office for her routine eye exam. The practitioner performs a fundoscopic assessment with an ophthalmoscope. Which finding would be concerning to the practitioner? Irregular white patches with feathered margins Yellowish tiny round spots Swelling of the optic disc with the appearance of an anterior bulge Tiny, round, red spots in the macular area

A month ago, a 40-year-old female presented to a clinic for newly diagnosed esophageal cancer was brought by her sister. The patient still cannot accept her diagnosis and lost 15 lbs in a month. The patient is a single mom and expresses concerns about her only son, who is five years old. How do you apply to conduct the assessment? a) Talk to the patient about your experience and tell her to follow your strategies. b) Suggest the patient have a second opinion. c) Utilize therapeutic communication, such as active listening, to encourage the patient to express her feelings. d) Explain her treatment plans, side effects, and prognosis.

A mother brought her 8-year-old kid with a right earache. The child has this problem after she started joining a swimming team at her school. When you assess the patient, you notice a foul odor ear drainage coming out from the child's right ear, swelling in the preauricular area, and decrease auditory acuity on the affected ear. The external ear canal is also erythematous and swollen. What would be the most potential diagnosis for this child A) Otitis media B) Ear canal myringitis C) Otitis externa D) Tinnitus

A new grad nurse practitioner is conducting a comprehensive assessment for a new patient in her office. The following information is recorded in the patient's chart, "01/31/21 11:00 AM. Mr.N is a pleasant, 56-years-old construction worker residing in Orange county, reliable. The patient has had chest palpitations for a month. He tested negative for the COVID-19 self-test. The symptom comes and goes with no known reasons. He had chickenpox when he was 6 years old. He does not have any other health condition, as far as he knows. He is not taking any medicine. No known allergies. He has 2 daughters and goes hiking with his daughters 2 times a month." Which of the following items is NOT collected yet? Chief complaint Past history Family history Present illness

A nurse practitioner student is planning out her first interview with a patient at a primary care clinic, which answer is the correct order of the general structure and sequence of the clinical encounter? A. Closing the encounter, explaining and planning, performing physical examination, gathering information, initiating the encounter. B.Initiating the encounter, gathering information, performing the physical examination, closing the encounter, explaining and planning. C. Initiating the encounter, gathering information, performing the physical examination, explaining and planning, closing the encounter. D. Gathering information, explaining and planning, performing the physical examination, initiating the encounter, closing the encounter.

A patient comes to the ER with c/o wheezing, cough, tightness in the chest. The patient is without a productive cough, fever, or viral infection. The patient reports severe seasonal allergies. The provider believes the patient is likely experiencing what based on their symptoms: A. Pneumonia B. Chronic bronchitis C. Asthma D. COPD

A patient complains of chest pain that worsens with inspiration and coughing. Which of the following diagnoses will give you the lowest level of suspicion? Pulmonary emboli Pericarditis Myocardial infarction Viral pleurisy

A patient diagnosed with heart failure comes into the clinic complaining of swollen feet. The nurse asks the patient if he has been recording his daily weights like they discussed in his last visit. The patient replies, "Why do I need to weigh myself? I've been following my diet and I haven't skipped any workouts. I thought we were here to talk about feet?" It is important that the nurse include which of the following teaching points in her answer? A. "Try propping yourself up with extra pillows before you go to bed at night." B. "You know what they say - Fat feet? God you'll soon meet!" C. "Call your doctor if you experience a weight gain of 1-2 lbs. overnight or 3-5 lbs. in 1 week." D. "You should try to drink room-temperature water instead of cold water to assist with perfusion in your extremities."

A patient has a BMI of 40 what classification of weight by body mass index does this patient belong to? Overweight Obesity class 2 Obesity class 3 Obesity class 1

A patient is brought to the ED on a 5150 hold after becoming aggressive with family at the residence; she had been off her medications for schizophrenia for about 1 month and decompensated as a result. She continues to be irritable, loud, and agitated in the ED. What is one way to communicate effectively with this challenging patient? A. Stand over the patient as you talk to them B. Take private phone calls while in their room during the interview C. Remain calm, avoid being confrontational, and keep your posture nonthreatening D. Speak over the patient by giving her an ultimatum regarding her behavior

A patient presented to your clinic today for a well check-up. She tells you she would like to stay healthy and ask what is considered high blood pressure. Which of the following is true? Blood pressure of 120/80 Blood pressure of 130/80 Blood pressure reading >140/90 on more than one occasion Blood pressure reading <130/80.

A patient was brought into the Emergency Department after falling and hitting his head rollerblading, when you go in to assess the patient you noticed the patient has his eyes closed. As you try to greet him, he still does not open his eyes, you lightly tap his shoulder, and still nothing. You then rub his sternum painfully and only then does he open his eyes. As the nurse practitioner, how would you document his level of consciousness? A. Coma B. Obtundation C. Stupor D. Lethargy

A patient who has a history of breast cancer came in for a follow-up after having lab work done. Her results show that the cancer is back and has metastasized to her bones. As the ANP how would you disclose this serious news? A. The results show the cancer is back and we need to discuss end of life care B. Start by saying I have bad news C. In a private space, start by saying, I am sorry to tell you that your cancer is back... D.Lie and pretend like the news is good, bad news can wait until the next visit.

A patient with a history of obesity, hypertension, and gout complains of a lump on the helix of his ear. The lump is currently painless and palpable with yellowish deposits. Which of the following diagnoses will you consider first? Cutaneous cyst Keloid Tophus Chondrodermatitis Helicis

A systolic murmur heard louder in volume than s1 and s2 with a palpable thrill only with the stethoscope placed on the patients chest is graded as: A. Grade 5/6 B. Grade 2/6 C. Grade 4/6 D. Grade 1/6

A young male patient comes in for chief complaint of SOB. During your initial assessment, you hear relatively high-pitched with hissing shrill quality adventitious breath sounds. Which differential diagnoses is least priority based on the above findings? Bronchitis. Asthma. Heart Failure. COPD.

According to the 2009 Diagnostic Criteria for metabolic syndrome, which of the following patients can be diagnosed with metabolic syndrome? A 22-year-old man with a waist circumference of 100cm, fasting plasma glucose 110 mg/dL, HDL cholesterol of 38mg/dL, and blood pressure of 140/80 mmHg A 50-year-old man with a waist circumference of 110cm, fasting plasma glucose 98 mg/dL, HDL cholesterol of 45mg/dL, and triglycerides of 140 mg/dL A 48-year-old woman with a waist circumference of 95cm, fasting plasma glucose 12 mg/dL, HDL cholesterol of 48mg/dL, and being treated with drugs for hypertension A 64-year-old woman with a waist circumference of 68cm, fasting plasma glucose 120 mg/dL, HDL cholesterol of 48mg/dL, and blood pressure of 120/80 mmHg

After auscultating the abdomen, the nursing student knows he needs to percuss all four quadrants of the abdomen. What is the student looking for? Bruits Masses and pulses Dullness and tympany Rebound tenderness

After greeting a new patient, the patient states, "I've switched doctors because I feel like I'm not getting any better. There's just so much going on. I feel like it's harder to breathe sometimes." Which is the most appropriate response from the provider that will strengthen the client-patient relationship? "I see you're here for shortness of breath and that you have a history of asthma. We will check your medication and have you feeling better soon." "Let's begin by discussing your reason for coming in today. We will discuss why you haven't gotten better after obtaining more information later on. Can I listen to your lungs?" "It must be tough to make that change. Can you tell me more about how you've been doing lately?" "Don't worry about that. We will find a way to help your shortness of breath."

After listening for S1 and S2 heart sounds on Mrs. Jones, you begin to auscultate for S3 and S4. Auscultation for S3 and S4, is best demonstrated by: a. Pressing the diaphragm of your stethoscope firmly against the chest b. Pressing the bell of your stethoscope firmly against the chest c. Applying the bell lightly, with just enough pressure to produce an air seal with its rim d. You don't require a stethoscope to listen for S3 and S4

Allen presents to the emergency department with sudden shortness of breath while playing basketball. He is 6ft 2inches tall, weighs 160 lb's, his SpO2 is 91%, HR 100, BP 138/69, RR 26, and he is afebrile. Upon osculation you notice absent breath sounds to his right side. What is the most likely diagnosis? Acute Pulmonary Embolism Hyperventilation with Anxiety Spontaneous Pneumothorax Asthma

An 18-year-old female visited the clinic one week ago after experiencing painful urination. She reported that she had a new partner and did not use a condom for sexual intercourse. The provider ordered a STD panel and a combination of ceftriaxone and azithromycin. She returns to the clinic complaining of continued dysuria, eye pain, and recently discovered fluid filled vesicles near her groin. You will complete all the following interventions except for what? Order a herpes viral culture Order a fluorescein staining Give another dose of ceftriaxone and azithromycin Order acyclovir 400 mg PO TID x 7 days

An 18-year-old thin tall Caucasian male patient come with a suspected spontaneous pneumothorax. What would be the expected percussion note flat dull hyper resonant resonant

An 40 year-old patient had hip surgery two days ago and suddenly develops shortness of breath and chest pain. Upon assessment, all breath sounds are equal and chest rise is symmetrical. The nurse practitioner wants to rule out the patient for: a. Anxiety b. Spontaneous Pneumothorax c. Acute Pulmonary Embolism d. Pneumonia

Joe a 21-year-old male comes in the Emergency department complaining of dyspnea and fevers. He reports being unable to sleep because of increased work of breathing and cough. Upon assessment you hear a high-pitched musical sound during inspiration. You identify this breath sound as? Rhonchi Stable pneumothorax Stridor Crackles

An 80 yr old patient is recovering in the PACU post dual-chamber pacemaker placement. The patient was under general Anesthesia intra-op. The patent is lethargic but arousable, complains of sore throat, respiratory rate 9, BP 100/56, HR 60, O2 6L simple mask, O2 saturation 96%. You obtain an ABG, PH 7.29, PaO2 85, PaCO2 68, HCO3 26. What should be your priority intervention? Get a stat chest Xray Prepare for intubation Place the patient on Bipap Increase the O2 to 10L

An 87-year-old male patient is bedbound. The patient has multiple pressure injuries, and he is not in a hospice. How do you examine this patient's skin? A) Ask the patient's family where the patient has pressure injuries. B) Deferred C) Roll the patient onto one side and assess bony prominences, such as the back, sacrum/coccyx, gluteal area, and heels. D) Since your office is short-staffed, perform only the Braden scale.

An 89-year-old male patient comes to a clinic complaining of right foot pain. The NP knows about a normal finding when assessing the lungs of older adults is: A) The same with younger generations B) Increased chest expansion. C) Decreased mobility of the chest. D) Increased lung sounds

An 89-year-old male patient was admitted into the intensive care unit (ICU) for a hemorrhagic stroke. Upon assessment, the acute care nurse practitioner (ACNP) notes that the patient is confused. and therefore, is unable to obtain a health history. What would be the ACNP's next appropriate action? A Obtain a health history another time B Ask the patient, "Do you have dementia?" C Check if a family or caregiver is present D Ask the primary nurse for the patient's health history

An APRN working in a busy clinic sees a patient an hour after their scheduled appointment time. The patient had complained to the receptionist multiple times regarding the wait time. Which of the following is an empathetic response from the APRN? "I know you waited past your appointment time, but we had more urgent cases". "I am here now, what can I do for you?" "I understand the wait was longer than you expected, I am sorry about that, you have my undivided attention now, what can I do for you?" "If you don't want to wait next time you can go to a different clinic that is not as busy".

An expert FNP is reviewing the documentation of two novice FNPs. As she is reading the History of Present Illness (HPI) documentation, she has decided to make corrections on some HPIs where unintentional stigmatizing language is used. Which HPI below needs correction? a. "A 26-year-old male with left leg disability after a gunshot wound to the left tibia and ankle presenting with redness, swelling, and purulent drainage of the wound." b. "A 49-year-old female who worked as a sex worker in the past, and was formerly incarcerated, presenting with increased thirst and urination, weakness, and dry mouth." c. "A 29-year-old who is a drug addict and tattoos all over his body, presenting with oral thrush that has not gone away for one week." d. "A 30-year-old female who is a sexual assault survivor, presenting with pelvic pain and inability to enjoy intercourse."

Anita is a 50 years old patient who has recently experienced episodes of urinary leakage. She asked you some questions about urinary incontinence. Which of the following descriptions related to urinary incontinence is incorrect? Stress incontinence is a condition in which the urethral sphincter is weakened. Overflow incontinence is a condition in which detrusor contractions are insufficient to overcome urethral resistance. It can be seen in patients with benign prostatic hyperplasia. The bladder is typically large in urge incontinence. Functional incontinence means that the patient is functionally unable to reach the toilet in time because of impaired health conditions.

As the nurse practitioner (NP) puts on the blood pressure cuff around his patient's arm, he notices that the cuff appears to be small. What should be the nurse practitioner's next step? Apply the blood pressure cuff on the patient's other arm Tell the patient, "It's going to be a tight one." Select a larger blood pressure cuff Take the blood pressure another time

As the nurse practitioner in the ICU, you begin your assessment of the patient. However, upon entering the room, the patient does not open their eyes spontaneously or to your greeting. After touching the patient firmly on their trapezius do they open their eyes. Their response to you is slow and somewhat confused. How would you document their level of consciousness? A) Stupor B) Lethargy C) Obtunded D) Coma

As the nurse practitioner, you are percussing a patient that presents with a chief concern of difficulty breathing. You hear dullness over the posterior bilateral bases. What is the most likely diagnosis? a. COPD b. Bronchitis c. Pneumonia d. Pneumothorax

At the Telemetry unit, the NP student is watching the cardiac monitor and notices that the rhythm suddenly changes to no P waves and the QRS complexes become wide. The ventricular rate is more than 140 bpm with a regular rhythm. Which following dysrhythmia does the patient have? a. Sinus tachycardia b. Ventricular fibrillation c. Ventricular tachycardia d. PVC

Code Stroke is alerted in the hospital for patient with new left sided weakness and facial droop. Which of the following diagnostic test should be ordered first for the patient? A MRI of the head B Echocardiogram C CT scan of the head D Carotid artery doppler ultrasound

Cynthia is a 29 year old elementary teacher that comes into the urgent care for evaluation of a recurrent headache usually monthly. She has noted nausea, vomiting and sensitivity to light. She describes the pain as moderate and throbbing. She usually takes an analgesic and sleeps and the headache subsides. Based on this description, what is the most likely diagnosis of the type of headache? Cluster Tension Migraine Benign positional vertigo

Denice is a 56-year-old woman who comes into your clinic complaining of increased weight gain over the past few months. She tells you that she is stressed out and has been eating at McDonalds almost every day. You inspect her abdomen and note the contour to be bulging and stretched in appearance. What do you describe this finding as? a. Hernia b. Obesity c. Protuberant d. Scaphoid

During HPI interview, the NP asked the patient if she had any allergy to medications, foods or environment factors. The patient responded, "I'm allergic to Norco, the last time I took it, it made me dizzy and nauseous." How should the NP respond to the patient? I will put Norco on your allergy list in the chart It is too strong for you, you should take only half next time You do not have an allergy to Norco. Some side effects of Norco can include dizziness and nausea. You shouldn't take Norco anymore since you can't tolerate it

During a routine office visit, the provider orders lab tests for a 28-year pregnant female patient to get a baseline workup d/t c/o fatigue, mood changes, hair loss. The provider orders a CBC, CMP, vitamin D, and TSH levels. When ordering these tests, the provider understands that there is the potential for preanalytic errors. Which of the following is true? A. Seasonal changes affect vitamin D levels causing them to be lower in the summer B. Hct and Hgb are always the same regardless of altitude C. Thyroid hormones can be higher during the winter D. There is no dilutional effect noted during pregnancy

During an interview of an overweight young adult male, he verbalizes concern that he will "die just like the rest of his family because they all have heart problems." This information is important and should be documented in the a.) Chief Complaint b.) Review of Systems c.) Family History d.) Personal and Social History

During health history taking, the nurse asked her 25-year-old female patient about her medication and herbal supplement list. After reviewing it, the nurse realize that her patient might have an increased risk of cardiovascular disease because she is taking one of the following: Ginkgo Biloba St John Wort Oral contraceptive Spicy food

During hospital rounds, the NP visits a 37-year-old male patient with a peripherally inserted central catheter (PICC) in the left arm. The patient verbalized that his left arm looks bigger than his right arm. His left arm is red, tender, and hot. All the following are possible differential diagnoses EXCEPT: Venous thromboembolism Cellulitis Intravenous extravasation Phlebitis

During your assessment with Mr. H.G., he expresses that over the last several years his vision has been affecting him. He further explains that his ability to see "things" up close appears "blurry", but becomes "clearer" when moved further away. With this information, you suspect the following: Cataracts Myopia Presbyopia Macular degeneration

During your cardiac assessment with Ms. J.G., you also note a systolic murmur. The murmur is louder in volume than S1 and S2, moderately loud. Using the Levine grading system, you grade this murmur as: Grade 1/6 Grade 2/6 Grade 3/6 Grade 4/6

Generalized lymphadenopathy can be defined as enlargement of more than two non-contiguous lymph node groups. Lymphadenopathy can be seen in the following conditions, except? HIV/AIDS Infectious Mononucleosis Myopia Sarcoidosis

Identify in which quadrant the following structures lie: Sigmoid Colon and Descending colon A. Right upper quadrant B. Left upper quadrant C. Left lower quadrant D. Right lower quadrant

In a family health clinic, an expert Family Nurse Practitioner (FNP) is reviewing the documentation of the eye examination of four patients by a novice FNP. Which of the following findings necessitates the expert FNP to instruct the novice FNP to send the patient to the Emergency Room (ER) right away? "22 years old male with visual acuity 20/100 bilaterally corrected, last eye exam 5 years ago" "46 years old female with noticeable leakage of blood outside the vessels in the sclera, reportedly it developed after a strong cough after choking on food" "69 years old female with severe photophobia, dilated and fixed pupil, steamy and cloudy cornea on the left eye, no abnormal eye discharges" "71 years old male with the lower lid margin turning outward, exposing the palpebral conjunctiva, clear drainage present"

In lymphedema, skin is initially soft and pitting then becomes all EXCEPT: Hard Indurated Pigmented nonpitting

In older adults an S3 sound sometimes called an "S3 gallop" usually Indicates an infarct Is known as the point of maximal impulse (PMI) Indicates pathology Is a heart murmur

In patients experiencing hyperthyroidism, what signs or symptoms could you expect to see? A) Periorbital myxedema B) Swelling of face, hands and legs C) Exophthalmos D) Prolonged relaxation phase during ankle reflex

In the urgent unit, a patient came with a deviated trachea, distended jugular vein, and tachycardia with absent breath sounds. According to the nurse practitioner assessment, the patient developed tension pneumothorax. To solve this life-threatening problem, the nurse should insert the needle in which following landmarks? a. Between the fourth and fifth intercostal space. b. In the suprasternal notch. c. Second intercostal space. d. 8th intercostal space.

In which scenario is it appropriate for the provider to order radiological imaging? A 7 y/o patient complaining of lower right quadrant pain that is now intense and consistent, nausea and vomiting, a low-grade fever, and loss of appetite. A 30 y/o patient complaining of a headache for the past four days. The patient states Tylenol and ibuprofen do not relieve the pain. A 32 y/o female patient who had knee surgery three weeks ago is complaining of shortness of breath, a dry cough, and lightheadedness. The patient has a heart rate of 120 bpm. A psychiatric patient who requires tuberculosis to be ruled out to be admitted to the behavioral health hospital.

Jacob a 26 year old male is seen today because he says usually after 1 or 2 hours of going to bed he wakes up with shortness of breath and coughing. His Vitals are B/P 125/83, HR 87, T: 38.7 and R: 17. His EKG shows normal sinus rhythm and chest X-ray is normal. He also says his symptoms are relieved when he stands up and goes to his window for some air. Based on this description Jacob is experiencing Hypertension Pulmonary Embolus Paroxysmal nocturnal dyspnea Edema

Jessica Jones brings her healthy 78-year-old mother into the office to inquire if she needs to continue her regular cancer screening schedules. The appropriate response by the clinician would be: "It is mandatory to continue mammography every two years for early diagnosis of breast cancer." "Although your mother is at low risk of cervical cancer with a history of normal pap smears, it is still necessary to perform them regularly." "Because she is healthy with no risk factors for cancer, it is not necessary to undergo cancer screening tests or procedures." "Because older adults are prone to many skin changes, it is still recommended to perform whole-body examinations to look for signs of skin cancer."

Jessica is a 38 year female patient comes into your clinic with complaints of leakage of small amounts of urine with coughing, laughing and sneezing when she is in the upright position. She also states she does not have an urge to urinate after these episodes. She states it is very embarrassing especially when she is out with her kids. What type of urinary incontinence is Jessica experiencing? Urge incontinence Polyuria Stress Incontinence Nocturia

Joe is a 25 year old male who presents to the emergency department after a physical altercation a local bar. Upon physical examination you note a large bruise to his posterior thorax on the right side. You note during palpation it is tender and there is a grinding sound over the region. Which of the following is the appropriate description for this finding? Fremitus Edema Crepitus Fibrous Tissue

Joffrey a 66-year-old male who loves to watch Sunday night football and snack in his favorite chair that reclines comes in with a fever, shortness of breath, and dark mucus. His kids stated he has not traveled nor has he encountered anyone with an illness. You suspect aspiration pneumonia and understanding the anatomy of the lungs, where would it occur? The patient's symptoms are signs of ARDS. Intubate immediately for airway patency Left upper lung Right bronchus Proximal convoluted bronchus

Jolie is 16-year-old-female, who presents herself to the primary care office with complaints of diarrhea and constipation, especially in social settings and during moments of stress. After further information is gathered regarding Jolie's symptoms, the Family Nurse Practitioner (FNP) is able to diagnose the patient with irritable bowel syndrome (IBS). Distinguish which open-ended statement/question by the clinician establishes the clinician's desire to understand the patient's perception of the illness. How often do you find yourself taking trips to the bathroom during a flare up of diarrhea? Have you been diagnosed with any gastrointestinal disorders in the past? Describe to me how these symptoms are affecting your daily living, social events and overall sense of well-being. Do you experience appetite changes when you are experiences constipation?

Jones, 65-year-old male, with a PMH of HTN presents to the clinic today complaining of a cough x1 week. He explains that he thought he was just getting a cold, until he developed a fever and coughed up green sputum. He denies nausea, vomiting, night sweats, and chills. He states that he has felt very fatigued the last week, and notes that his cough is more frequent and he often feels short of breath. What is the likely cause of Mr. Jones respiratory issues? COPD Pulmonary Embolism Pneumonia Tuberculosis

Julia is a 36-year-old female with a history of alcohol abuse who presents to the emergency department with abdominal pain. You want to perform an assessment of her liver. Which of the following assessment techniques is used to estimate the size of the liver? a. Inspection b. Palpation c. Percussion d. Auscultation

Justin, a 54 year old male walks into the clinic complaining of always feeling tired and sleepy. "My wife is a nurse and suggested I may have obstructive sleep apnea so I wanted to get that checked out". Justin has a BMI of 35 and a neck circumference of 37 cm. Which of the following is NOT a risk factor of sleep apnea that Justin meets? A. Body mass index of 35 B. Neck circumference of 37cm C. Male D. Age of 54

K.M., a 28-year-old female with a history of asthma, comes into the clinic with complaints of shortness of breath and chest tightness. Upon auscultation of a patient's posterior chest, the nursing student describes the lung sound as continuous musical sounds, as if the airways are narrowed. Based on the description, the nurse practitioner classifies the lung sounds as... A. Fine crackles B. Coarse crackles C. Wheezing D. Rhonchi

Leah is a 35-year-old anxious appearing female who presents to the Emergency Department with sudden onset, intermittent, burning, non-radiating, substernal chest pain which is worse after eating and lying flat. When performing a physical exam on Leah, the APN utilizes a draping technique with a bedsheet when assessing her trunk and abdomen. What is the primary benefit of draping? a) It hides odorous scents from certain areas of the patient's body. b) The patient may feel warmer c) It allows the provider to visualize one area of the body at a time while preserving the patient's modesty d) It is considered another form of personal protective equipment

Leah is a 52-year-old female presenting to the Emergency Department reporting progressively worsening 3-day history of dizziness described as the room spinning. Which finding upon assessment of the eyes would support a diagnosis of acute vestibular neuritis? a) Uneven pupils b) Photophobia c) Saccadic nystagmus upon head thrust test d) Scleral icterus

Looking at the x-ray below, what is the most likely differential diagnosis? A) Pneumothorax B) Pleural effusion C) Pneumonia D) Tuberculosis

Many patients who are older than 70 years old have difficulty swallowing food. The nurse practitioner should know that the normal changes in older adults that cause dysphagia are which of the following? schatckia dystrotomia xerostomia obstipamia

Mary is a 44yrs old female with no medical history other than complaining about heavy bleeding and cramping abdominal pain with her periods for the past two months. This is Mary's first-time visit to the clinic. What type of assessment should the Nurse Practitioner provide? a. A focused assessment because Mary is healthy otherwise with no other medical problems. b. A routine assessment c. A comprehensive assessment d. An urgent assessment

Melany is a new NP student on her clinical rotation. She is about to do a patient's physical examination; before beginning the assessment, her instructor told her to examine the patient from the patient's right side. Melany asked her instructor why it was important? The instructor's best response was, a. Most patients are right-handed, and they feel more comfortable when you assess from the right side. b. have been practicing physical examination that way and found it very easy and convenient. c. This is the standard position for the physical examination and has several advantages compared to the left side. d. Most places examination rooms are designed to examine patients from their right side.

Mikaela, a 56-year-old female, comes in complaining of abdominal pain, eye tearing, and always being "hot." She mentions that she has been eating more lately. What is your initial diagnosis? Menopause Exophthalmos Graves' disease Cushing syndrome

Mr. A, a 48 year old male comes into your clinic for worsening shortness of breath. You decide to obtain a chest XRAY and an EKG. You notice his vital signs are as follows: 155/71, RR of 20. SPO2 of 91% and some left sided chest discomfort. What is the patient's chief complaint? a. Left sided chest discomfort b. SPO2 of 91% c.Shortness of breath d. His worsening hypertension

Your patient has been newly diagnosed with Hepatitis B. As the nurse practitioner, what other infection should you rule out? A) HIV B) Hepatocellular carcinoma C) Hepatitis D D) Ascites

Mr. B comes into the clinic complaining of feeling more fatigued and tired. He reports feeling more sleepy throughout the day and pale skin or lack of color is observed. Mr. B also states he sometimes starts wheezing with activity. Which one of the following symptoms are hallmarks of obstructive sleep apnea? a. JVD b. Wheezing c. Daytime sleepiness/fatigue and snoring d. Pale skin

Mr. Fallon is a 59 years-old male, who presents to the clinic with complaints of worsening fatigue and shortness of breath after only a few hours of working. He works as a sous chef at a busy local restaurant. PMH includes aortic stenosis, DM2, and GERD. The FNP is preparing the patient for cardiovascular examination. Which of the following is NOT an expected finding of aortic stenosis? The carotid upstroke is delayed. Thrills are transmitted to the carotid arteries from the suprasternal notch or second right intercostal space. S1 is diminished. S2 is diminished.

Mr. Guillen, a 67-year-old male presents to your clinic for the first time for his yearly physical. Which immunization is not routinely recommended for older adults in the United States? Influenza vaccination Zoster vaccination HPV vaccination Pneumococcal vaccination

Mr. Jin is an obese 50 years old patient who comes to your clinic today. He complained of coughing with white inodorousness sputum for three days. This type of sputum is commonly seen in which condition? Cystic fibrosis Bacterial pneumonia Viral respiratory infection Anaerobic lung abscess

Mr. Jones, an 86-year-old male who is independent and lives by himself, has a medical history of CHD, Atrial fibrillation, and prostate cancer in admission is coming into clinic with complaints of chronic, but worsening back pain. Prior to assessing Mr. Jones, what are considerations you can take as the nurse practitioner to ensure communication is effective and efficient? a. Perform the assessment in a room next to a loud procedure b. Speak fast, Mr. Jones probably wants to get home soon. c. Face Mr. Jones and speak in low tones, enunciating, and ensure the patient has his glasses, hearing devices or dentures if needed. d. If Mr. Jones is accompanied by a family member, be sure to only speak directly to the family member as Mr. Jones is too old to be a participant of his care.

Mr. Kent is a 53-year-old male who presents to the Emergency Department reporting a 3-day history of progressively worsening shortness of breath, associated with orthopnea and bilateral leg swelling. The dyspnea is worse on exertion and better at rest. Upon auscultation of the heart during physical exam, the Advanced Practice Nurse (APN) notes the point of maximal impulse (PMI) is laterally displaced. The APN understands this particular finding may indicate the patient has: a) A normal anatomical variant b) Pulmonary artery hypertension (PAH) c) Left ventricular hypertrophy (LVH) d) Dilated loops of bowel

Mr. Kinder comes in complaining of Shortness of breath. Chest x-ray shows a large pleural effusion on his right side. A Thoracentesis is indicated; which landmark is used to drain the fluid?. A) 2nd intercostal space B) 11th and 12th intercostal space C) between the 7th and 8th intercostal space D) Between 4 and 5th intercostal space.

Mr. Kyle calls the clinic to get a piece of advice from his primary provider. His 80-year-old mother has shown increased incidents of falls and minor injuries for the past 2 months. She mostly stays at home. He states that his mother denies any pain and complains of blurred vision. She was diagnosed with cataracts 5 years ago but refused to get surgery for that. Which of the following advice or explanation is NOT appropriate for the primary provider to provide? The prevalence of visual impairment increases dramatically with age. In older adults, visual impairment is associated with an increased risk of falls and injuries. This is an emergency. Please bring her to the clinic. The visual impairment can be gradual and those affected may not recognize their visual decline.

Mr. Manzo is a 54 years old male, presenting to the clinic complaining of progressive shortness of breath with daily activities. Blood pressure = 151/81, Temp = 37.1C, RR = 19/min, O2 sat = 91% on room air. The patient reports a 30 pack-year smoking. He also says "A doctor told me a few years ago that I had some kind of chronic breathing problem, but I don't remember the name of it." The FNP suspects COPD and performs percussion on the chest wall. What percussion note does the FNP expect? A. Tympanitic B. Resonant C. Hyperresonant D. Dull

Mr. Rivas, a 46-year-old male patient presents to the clinic for his yearly physical exam. The NP asks about changes in vision. Mr. Rivas states that he has never worn glasses or contacts or had problems with his vision. However, within the last year Mr. Rivas has noticed an increased difficulty with his vision while reading. The neurological assessment is within normal limits. The NP knows that because of his age, these are most likely attributed to: Myopia Retinal detachment Presbyopia Diplopia

Mr. Smith comes into the hospital complaining of shortness of breath that occurs mainly in his sleep that started one month ago. Mr. Smith denies any history of asthma and does not smoke. He states he has had to sleep with about three pillows at night but still finds himself waking up suddenly to feeling short of breath. Which of the following could be the cause of Mr. Smith's shortness of breath? a. Asthma b. Anxiety c. Left-Sided Heart Failure d. Chronic Obstructive Pulmonary Disease

Mr.Jones is getting a physical exam. He is sitting while leaning forward and holding his breath after exhalations; the NP can easily hear a diastolic murmur. What level would she grade it? A) Grade 1/4 B) Grade 2/4 C) Grade 3/4 D) Grade 4/4

Mrs. Alexander is 80-year-old female with mild symptoms of Alzheimer's and is getting discharged from the hospital home under the new care of her oldest daughter. The Nurse Practitioner recognizes the importance of educating the daughter about how acute illnesses often present differently in older adults. What is an example of how acute illnesses present differently? a. Older patients with infections are more likely to get a fever. b. Older patients experiencing myocardial infarctions are more likely to report chest pain c. 1/3 of older adults present with new onset Atrial Fibrillation with hyperthyroidism. d. New onset altered mental status is normal and shouldn't be investigated.

Mrs. Jones, a 35-year-old woman, is admitted to the surgical ICU following a liver transplant. The nurse practitioner is assessing the patient and notices the patient's abdomen is protuberant and is tympanitic throughout. The nurse practitioner knows this finding is typically consistent with: a. Normal finding b. Ascites c. Intestinal obstruction d. Intrauterine pregnancy

Mrs. Seager came in to get her annual physical assessment done. Her blood pressure was a little higher than usual. The student nurse practitioner decides to take it herself. While reviewing her steps, the student nurse knows all the actions she is taking are correct except? A) There should be a 2 to 3 cm space for the stethoscope between the lower end of the cuff and the antecubital fossa. B) Inflate the cuff rapidly to the target level and deflate slowly at a rate no faster than 2 to 3 mm Hg per second. C) Have repetitive and slow inflation of the cuff. D) If a patient is sitting rest their arm on a table a little higher than the heart.

Mrs. Watson is in your ER and has been diagnoses with PNA, she is receiving antibiotic therapy for the first time. What symptom might point towards anaphylaxis and warrant immediate care? A) Fever B) Cough C) Stridor heard with breathing D) Rash to arms.

Ms. Ellen, a 55-year-old woman, presents to the clinic with a headache. She states that it started a year ago, and the unilateral pain tends to peak over several hours. She also states that she experiences a visual aura like flashes of light. Which of the following could be the differential diagnosis? Subarachnoid hemorrhage Tension headache Migraine headache Tension headache

Ms. Jones is a 35-year-old female that comes to your office today for routine checkup after 3 years of not visiting the doctor's office. After assessing and running diagnostics, what findings concerns you for the presence of metabolic syndrome in Ms. Jones? A. Waist Circumference 60 cm, Triglycerides 100, HDL 65, Blood Pressure 130/70, Fasting plasma glucose 80 B.Waist Circumference 60, Triglycerides 170, HDL 60, Blood Pressure 109/65, Fasting plasma glucose 90 C. Waist Circumference 85 cm, Triglycerides 200, HDL 57, Blood Pressure 140/80, Fasting plasma glucose 120 D. Waist Circumference 70, Triglycerides 145, HDL 70, Blood Pressure 120/60, Fasting plasma glucose 105

Ms. Meyers is a 51 years old female, who works as a school teacher, visits the clinic for an annual check-up. PMH includes HTN, CKD 3, HLD, and BMI of 28. The FNP is performing palpation of the chest wall. Which of the following statements is true regarding palpation of the chest wall? If the apical impulse cannot be identified when a patient is in the supine position, placing her onto partly right lateral decubitus position is helpful. A diffuse point of maximum impulse (PMI) (more than 3 cm) is a normal finding and not clinically significant in a person with a BMI of 28. The apical impulse may be shifted upward and to the left during pregnancy or a high left diaphragm. The apical impulse represents the brief pulsation of the right ventricle when it moves anteriorly and comes in contact with the chest wall, can be palpated in the epigastrium or subxiphoid process.

Ms. Rodriguez is a 40-year-old female with a history of HTN, HLD, and smoking. She is complaining of right leg swelling, redness, and pain that started 2 days ago after she came home from vacation. Based on this clinical presentation, the NP initially suspects which diagnosis? A. Nephrotic Syndrome B. Heart failure C. Venous thromboembolism D. Nephrotic syndrome

Ms. Samuels is an 86-year-old woman admitted to the hospital after a diagnosis of acute heart failure. During your morning rounds her night shift nurse tells you that Ms. Samuels had episodes of bradypnea throughout the night, demonstrated by her breathing deeply for some periods followed by periods of not breathing. You explain to the nurse that this is an example of Cheyne-stokes breathing. The nurse asks you how to differentiate it from bradypnea (slow breathing). a. "In Cheyne-Stokes breathing, there are periods of rapid, deep breathing" b. "In Cheyne-Stokes breathing, expiration is prolonged as demonstrated by pursed-lip breathing" c. "In Cheyne-Stokes breathing, there are periods of deep breathing alternating with periods of apnea" d. "Cheyne-Stokes breathing is the same thing as bradypnea"

Ms. Smith is a 50-years-old woman who visits the emergency room today with complaints of sudden onset dyspnea. Which of the following condition is the least likely? Pulmonary embolus Anxiety Chronic left-side heart failure Pneumothorax

Ms. Smith presents to your clinic with complaints of fatigue and a chronic cough. She states she sleeps on her recliner most nights or on multiple pillows as she feels it is easier to breath in this position. Based on this scenario what is this patients most likely diagnosis? Coronary Vascular Disease Hypertension Left Ventricular Heart Failure Atrial Fibrillation

One morning, a 50-year-old lady with type 2 diabetes visited the clinic for follow-up. This patient's fingerstick blood sugar was 510 mg/dL, and she denied eating. However, she had normal vitals and denied any discomfort. Which of the following action or skills by the Advanced Practice Nurse (APN) would need to intervene due to her low health literacy, "Only sweets can elevate blood sugar"? Empathic responses Call 911 to be not in jeopardy. Lower her BS with guided questioning to get the point Nonverbal communication

One nursing student panicked to see that his patient has a black stool. He checks that the patient has a negative fecal blood test but he is confused why his patient has a black stool. He calms down after he checks the patient's medication and supplement list and finds that the patient take which of the following item black cohosh blackberry iron supplement mimosa with ginger ale

Patient AR is a 62 year old male with a chief complaint of increased fatigue and shortness of breath upon exertion. Upon obtaining a complete health history, it is brought to your attention that the patient smokes 1.5PPD, and has been doing so for the past 10 years. When educating the patient about the health risks of smoking, the patient interrupts and says, "I get this lecture daily from my wife and kids, but I don't want to quit." What stage of change does this patient currently present at? A. Preparation B. Contemplation C. Precontemplation D. Maintenance

Patient EW, a 56 year old male, comes into the clinic for a routine checkup.During your patient interview, the patient reports that he experiences chest pain after exercising, and shortness of breath. After assessment, you become suspicious of left ventricular hypertrophy because the PMI is displaced >10cm laterally to its normal anatomical location. Where would you palpate to determine this? At the midclavicular line at the 3rd intercostal space Over the upper left border of the chest At the 5th intercostal space at or medial to the left midclavicular line Over the upper right border of the chest at the 2nd intercostal space

Patient LT, a 43 year old female develops sepsis s/p appendectomy. Her associated symptoms include dyspnea at rest, severe subcostal retractions, crackles in her bilateral lower lobes, and hypoxia. She starts to become lethargic and diaphoretic. You decide to intubate this patient because you know that she is presenting signs of: Traumatic pneumothorax Pneumonia ARDS COPD Exacerbation

Patient ML, a 16 year old female comes into the ER with shortness of breath, chest tighntess, tachycardia, and wheezing. Patient states in broken up sentences that she as a history of asthma, and upon auscultation, you do not hear any air movement. After giving X1 dose of nebulized albuterol and an IV corticosteroid, you now hear wheezing bilaterally in all lung fields. Is this patient improving or declining? What should be your next step? Improving, sent patient home Declining, admit patient Improving, give a repeat albuterol treatment and corticosteroid Declining, refer to a pulmonologist

Patient is taking digoxin for CHF, which value/assessment is most concerning? HR 65 Potassium 3.0 Confusion and vision problems Digoxin level 1.2

Robert Lee is an 85-year-old patient in the medical intensive care unit who is post cholecystectomy, patient is confused, thrashing around in bed and trying pull the foley catheter. Bob is positive on CAM assessment. All of the interventions to treat ICU delirium in elderly patients are correct except. Repeated reorientation of the patient Grouping all nursing tasks and medication administration before 10 pm Giving the patient a sleep medication Restoril so that the patient can have a good night sleep Ambulating the patient with a walker during the day

Taylor presents to the primary care clinic with sudden onset of severe left eye pain with blurry vision and redness. Patient denies trauma, itchiness, or ocular discharge. A crescentic shadow is seen when inspecting the left iris with light. The left pupil is fixed and dilated, the left cornea appears steamy and cloudy. What should the provider do immediately? Explain to the patient that subconjunctival hemorrhage can happen without a cause and will be resolved over 2 weeks Educate the patient to practice good hand hygiene as her condition is highly contagious Prompt patient to go to the emergency department or be seen by an ophthalmologist immediately since acute angle-closure glaucoma is a medical emergency Prescribe antibiotic eye drops and pain medication, arrange to follow up with the patient in one month

The 75-year-old male is diagnosed with pneumonia. The NP is percussing over the lungs field. The NP knows that percussion over an area of atelectasis in the lungs will reveal: Tympany Resonance Dullness Hyperresonance

The APRN arranges a family meeting to discuss the goals of care of a 30-year-old AJ who has stomach cancer. Chemotherapy was no longer effective, and the cancer spread everywhere. When communicating with the patient and the family how will the APRN deliver the news? a) AJ cancer spread and she has little time to live. b) Since AJ's cancer spread and there is nothing, we can do is best to put her in hospice. c) I 'm sorry I have to tell you this. I was hoping AJ's cancer did not spread. d) AJ's cancer spread and is best for her to be home.

The APRN is assessing a patient in the clinic who has a normal palpable femoral pulse and diminished dorsalis pedis pulse. After performing an ankle-brachial index (ABI) calculation, the ABI= 0.75. The APRN understand that these findings are most likely indicative of: Chronic venous insufficiency Deep vein thrombosis Peripheral artery disease Heart failure

The APRN is interviewing a 50-year-old male patient in the emergency department whose father recently passed away due to Coronavirus 19 complications. The patient is emotionally distraught and expressing suicidal ideation as he states: "I miss my father". In order to convey empathy to the patient and establish rapport, the APRN should: a. Respond by saying "At least you still have your mother" b. Leave the interview room so the patient can cry privately c. Respond by saying "I cannot imagine how hard this must be for you" d. Respond by saying "Don't be sad, you will feel better soon"

The APRN is meeting with Martha, a 23 year-old female in the clinic for the first time. After initial blood work, the APRN notifies the patient that she is pregnant. Martha asks the APRN not to mention the pregnancy test results to her mother that may call the clinic for information. The APRN notifies Martha that it is the clinic's duty to prevent the disclosure of patients' personal information to parties who are not authorized. What core value is the APRN practicing? Informed consent Respect for autonomy Confidentiality Truth telling

The APRN is performing a full physical assessment on a new patient. While listening to the patient's heart sounds, where would the NP place her stethoscope to listen to the tricuspid valve? A. Right second intercostal space B. Left second and third intercostal spaces C. At or near the lower left sternal border D. At and around the cardiac apex

The Emergency Nurse Practitioner is assessing a 61 year-old patient complaining of a severe headache and nausea. The patient states "This started about 30 minutes ago. I've never had headaches this bad before." The diagnostic test the Nurse Practitioner should order is: CBC, BMP, PT, PTT, INR CT of the Brain with Contrast CT of the Brain without Contrast MRI of the Brain

The NP is conducting a comprehensive adult health history on an 81year old patient named Gale. What of the following information should be placed under personal and social history? Gale is allergic to shrimp and copper Gale's mother passed away of breast cancer Gale has decreased strength of her legs and she uses a walker to get around the house Gale has hypertension, GERD, hypothyroidism, and CKD

The NP is performing a physical assessment on a patient who complains of chronic abdominal pain. During an abdominal assessment, deep palpation is used to determine: Bowel motility Superficial tenderness Enlarged organs Overall impression of the skin surface and superficial musculature

The Nurse Practitioner (NP) is caring for a 37 year-old patient with complaints of impaired hearing on the left ear. The NP notes the following assessment findings: "Weber Test - Positive lateralizing to left side. Rinne Test - Left Ear BC > AC." These assessment findings are associated with: Right Conductive Hearing Loss Left Sensorineural Hearing Loss Left Conductive Hearing Loss Normal Findings

The Nurse Practitioner is assessing a patient's Jugular Venous Pressure (JVP). All of the following regarding JVP assessment is correct EXCEPT? The usual starting point for the head of the bed should be placed at 30 degrees. Elevated JVP is highly correlated with heart failure, tricuspid stenosis, cardiac tamponade, superior vena cava obstruction, and constrictive pericarditis. When assessing hypovolemic patients, the head of the bed must be placed at a higher angle (60 to 90 degrees) to locate the oscillation point. An elevated JVP is specific for increased left end-diastolic pressure and low left ventricular EF.

The Nurse Practitioner is conducting health promotion education to an overweight patient during a routine office visit. The NP knows that the following are part of the steps to promote optimal weight and nutrition EXCEPT: Assess dietary intake Assess the patient's motivation to change Determine if the patient has a support system that can help with change Measure the patient's BMI and waist circumference

The Valsalva maneuver is used to identify the following except A) Heart failure B) Pulmonary Hypertension C)Jugular Venus Pressure D) Hypertrophic cardiomyopathy

The clinician is with a student NP preceptee, interviewing a patient in an exam room. While the student preceptor is performing the interview, which actions would require the preceptor to give constructive criticism and for the student NP to make corrections on next time? The student NP leans forward as the patient talks, using head-nodding and phrases such as, "go on." The student NP starts with open-ended questioning, then asks more specific questions, then asks yes-no questions to the patient. The student NP makes sure to type the patient's responses in detail during the entire interview, ensuring that no answers are left out of the documentation. The student NP validates the patient's emotional experience to show understanding and gain rapport.

The following descriptions are about techniques of the thorax and lung examination. Which description is incorrect? Examine the posterior thorax and lungs while the patient is sitting, and the anterior thorax and lungs with the patient supine. For women, cover the anterior chest when you examine the back. For the patients who cannot sit up, you should roll the patient to one side and then to the other. Ventilation is relatively greater in the dependent lung, so you are more likely to hear abnormal breathing sounds on the dependent side.

The following information is best placed in which area in the patient's past medical history? "The patient has asthma." A) Surgical B) Obstetric/ Gynecologic C) Medical D) Psychiatric

The nurse assesses a postoperative adult patient. Which of the following is an example of subjective data: A. Hemoglobin 7.0 B. Alert and oriented C. Shortness of breath D. The blood pressure reading 100/60

The nurse is auscultating the chest in an adult. Which technique is correct? Instructing the patient to take deep, rapid breaths. Instructing the patient to breathe in and out through his or her nose. Firmly holding the diaphragm of the stethoscope against the chest. Lightly holding the bell of the stethoscope against the chest to avoid friction.

The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear? Tympany Resonance Dullness Hyperresonance

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test will confirm this diagnosis? Check x-ray Bronchoscopy Sputum culture Tuberculin skin test

The nurse practitioner distinguishes chronic arterial insufficiency based on which exam finding? a. Normal pulses b. 2+ pitting edema c. Thin, shiny skin with loss of hair over the foot and toes d. Brown pigmented, thickened skin at the ankle

The nurse practitioner is educating a 40-year-old female on risk factors and prevention of cardiovascular disease (CVD). The nurse practitioner determined that the patient may need more teaching and educational resources on CVD if the patient makes which of the following statements? A) "I need to keep my BMI < 25." B) "I'm going to eat less fast-food and incorporate more green-leafy vegetables into my diet." C) "My fasting blood glucose should be less than <110 mg/dL." D) "I'm going to incorporate at least an hour of exercise into my daily routine 3-4 times a week."

The nurse practitioner is examining a 53-year-old male that presented to the clinic with shortness of breath and pleuritic chest pain for 3 days. Upon assessment, the nurse practitioner notes a dullness sound upon percussion of the lower posterior chest. This is indicative of which of the following diagnosis? Emphysema Pneumothorax Pneumonia Asthma

The nurse practitioner performs a pupils' examination in the patient`s eyes. She inspects both eyes' size, shape, and symmetry. Which following findings would the nurse consider as a normal finding? a. Anisocoria > 1mm, unilateral small pupil reacts briskly to light, with ipsilateral ptosis of the eyelid. b. Unilateral dilated pupil, reaction to light is severely reduced or absent. c. Anisocoria with a diameter of > o.4 mm, and equal in dim and bright light. d. The pupil is large and fixed to light, ptosis of the upper eyelid, and lateral deviation of the eye.

The nurse reads the following note in a patient's chart: "Abdomen is flat - bowel sounds absent. It is firm and boardlike, with increased tenderness, guarding, and rebound in the RLQ. Liver percusses to 7 cm in the midclavicular line, edge not felt. Kidneys and spleen not felt. No palpable masses. No CVA tenderness. Psoas sign positive." What diagnosis does this assessment suggest? A. Diverticulitis B. Hepatitis A C. Peritonitis D. Hepatitis B

The patient says to the nurse, "I am going to die. Cancer already spread and there is no hope for me." The nurse responds to the patient: "Don't worry. Everything will be all right." what is the example of the Nurse Practitioner communicating with the patient? A. The therapeutic technique of giving advice B. The therapeutic technique of reassurance the patient C. The nontherapeutic technique of reassurance the patient D. The therapeutic technique of comforting the patient

The practitioner wants to assess the patients PMI and for extra heart sounds. The practitioner knows that the best position to place the patient in to assess these sounds is: A. Supine B. 45 Degrees C. Left lateral decubitus position D. Right lateral decubitus position

The preceptor instructed the NP student to measure a patient's jugular venous pressure (JVP). Which of the following actions by the NP student would warrant intervention and further instruction from the preceptor? The NP student raises the patient's head of the bed to at least 30 degrees. The NP student uses tangential lighting to locate the internal jugular (IJ) venous pulsations. The NP student palpates the IJ vein. The NP measures the vertical distance of the highest point of oscillation in the IJ vein to the sternal angle.

This statement is an example of what core values of medical ethics, the provider stopping a medication known to be harmful or refusing to give a medication to a patient if it has not been proven to be effective? Justice Beneficence Nonmaleficence Confidentiality

Timmy is a 35 years old male patient who presents to the urgent care with a complaint of RUQ pain 7/10. The pain started 2 hours ago and radiated to the right shoulder. He also feels nauseous. He had dinner with friends in the Cheesecake Factory tonight. During the physical examination, you do not feel any tenderness on palpation in the RUQ. You ask Timmy to take a deep breath while deeply palpating his RUQ again. He experiences serve pain and a halt in inspiration. What diagnosis is most likely? Acute appendicitis Chronic Liver cirrhosis Acute Cholecystitis Acute Pancreatitis

Upon percussion, the APRN assesses the following findings: Bilateral posterior lung lobes sound resonant and the right lower sounds dull. Based on this information, the APRN would order which diagnostic test? Ultrasound CT chest CXR CBC

Vanessa is 46 years old at the clinic complained of the "worst headache of her life," with nausea and vomiting. While interviewing her, she mentioned 'trouble seeing' and episodes of confusion. She is a single parent of two teenagers and working two full-time jobs. Because of her headache lately, she is calling sick often and afraid to lose her job. She asked you to give her some 'strong' meds for her headache because over-the-counter medications are not helping her. What is your best response to this situation? a. You understand how important it is for Vanessa to keep her job and prescribe her some strong medications for headaches; ask her to follow up if her headache persists. b. After interviewing Vanessa, you found that she is very stressed out may need some time off from her work and offered her a note for some medical leave of absence. c. Based on her symptoms, you think it may be related to increased ICP, suspecting a 'brain tumor, and immediately ordered her CT scan of the brain. d. You medicated her for nausea and vomiting and referred her to a pain specialist.

What inference can the NP make of Lucy, an 86-year-old female nursing home resident with incontinence, multiple falls in the last month, frequent UTI's and increasingly forgetful? a. Lucy is independent because she has the ability to make her own decisions b. Lucy's mortality rate is low c. Lucy has a poor health outcome because she is disabled and dependent d. Lucy's risk of hospital admission is low

What valve would you expect to hear while auscultating at or near the lower left sternal border? Aortic valve Pulmonic valve Tricuspid valve Mitral valve

When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true? The left ventricle is larger and weighs more than the right ventricle. The circulation of a newborn is identical to that of an adult. Blood can flow into the left side of the heart through an opening in the atrial septum The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after.

When assessing a patient, an experienced provider believes that odors can be important diagnosis clues because breath odors can indicate the presence of some diseases? Which of the following is not correct? A. Diabetes B. Uremia C. Pulmonary embolism D. Liver failure

When assessing a patients lungs, the NP recalls that the left lung: Is shorter than the right lung because of the underlying stomach Is divided by the horizontal fissure Consists of two lobes Primarily consists of an upper lobe on the posterior chest

When assessing lymph nodes, the nurse knows she might not be able to palpate which of the following? A. Submental B. Supraclavicular C. Deep cervical chain D. Occipital

When conducting an ophthalmoscopic examination, the practitioner is aware that all of the following are contraindications for mydriatic drops except: a. Head injury and coma b. Narrow-angle glaucoma c. Open-angle glaucoma d. Pregnancy and breast feeding

When examining the mouth and pharynx the NP should do the following A. Dim the lights and use a flashlight to visualize and insect the mouth. B.Have the patient maintain dentures in the mouth to visualize and inspect the inside. C. Test the hypoglossal nerve (XII) and Vagus nerve (X) D. Inspect the mouth without using any tools such as a tongue depressor.

When formulating a plan and documenting it in the health history progress note within the patient's medical record, the Advanced Practice Registered Nurse (APRN) should incorporate all the following EXCEPT: a. Changes in medications and needed diagnostic tests b. Patient's response to the problems identified and to the diagnostic and therapeutic interventions the APRN has recommended c. Patient's subjective complaint and reason for seeking care d. Education provided to the patient

When identifying characteristics of breath sounds, expiratory sounds last longer than inspiratory ones, loud intensity, and the pitch is relatively high, you would note this as: a. Vesicular b. Tracheal c. Bronchial d. Broncho-vesicular

You have a 68-year-old female that has arrived at your office. During your assessment, you ask how many pillows she uses when she sleeps at night. By asking this question, you are assessing for what disorder? a. Neck pain b. Economic status, can the patient afford a pillow c. Heart Failure d. None of the above

Your 65-year-old female patient has arrived at the clinic for a general physical. Your patient reports that she recently gained 10 pounds. You asked the patient when she noticed the weight gain, and she said it occurred over the last few days. What is the likely cause of the weight gain in this patient? The patient has been eating too many cheeseburgers The patient has been doing weightlifting and is now seeing the results The patient is likely retaining body fluid because of possible heart failure, nephrotic syndrome, liver failure, or venous stasis The patient probably has heavy objects in her pockets.

Which of the following is a correct HPI for a patient with pain? Mr. Johnson is an 83-year-old male with a history of CHF and degenerative disc disease, who presents to the ED with left leg pain. Patient explains his left leg pain is sudden onset, rated 7/10, and radiates down his leg. Mr. Johnson is an 83-year-old male with a history of CHF and degenerative disc disease, who presents to the ED with left lower extremity pain. Patient explains his left leg pain is sudden onset this morning, presenting intermittently throughout the day, radiating from his left hip down his leg, rated 7/10. Mr. Johnson is an 83-year-old male with a history of CHF and degenerative disc disease, who presents to the ED with left lower extremity pain. Patient explains his sharp left leg pain is sudden onset, presenting intermittently, radiating from his left hip down his leg, rated 7/10, exacerbated with ambulation, relief at rest. Mr. Johnson is an 83-year-old male with a history of CHF and degenerative disc disease, who presents to the ED with left lower extremity pain. Patient explains his sharp leg pain is rated 7/10, exacerbated with ambulation, and has relief at rest.

Which of the following is a priority and a medical emergency? 80-year-old female with history of COPD complaining of SOB with exertion 26-year old male without any past medical history complaining with new onset wheezing 50-yearold female post-snowboarding accident with tracheal deviation 35-year-old male with past medical history of bronchitis coughing with moderate green sputum

Which of the following is not an example of the preanalytic error of laboratory tests? Wrong patient's identity on the urine simple Contaminated blood culture sample Wrong hemoglobin result is informed during telephone reporting Illegible handwriting on the requisition of wound culture

Which of the following is the incorrect skill for the thorax and lung examination? With the patient sitting, examine the posterior thorax and lungs. Always place the stethoscope directly on the skin. To detect fremitus, use the index fingers to feel the vibratory sensitivity. During percussion, the same force of each percussion strike is applied.

Which of the following patients meet the 2009 Diagnostic Criteria for metabolic syndrome? A man with a waist circumference of 38 inches, a fasting glucose 104 mg/dL, triglyceride levels of 156 mg/dL, and HDL cholesterol of 56 mg/dL A woman with a waist circumference of 37 inches, on metformin, blood pressure of 121/80 mm Hg, and triglyceride levels of 131 mg/dL A woman with a waist circumference of 32 inches, fasting glucose of 113 mg/dL, HDL cholesterol of 41 mg/dL, and triglyceride levels of 155 mg/dL A man with a waist circumference of 33 inches, a fasting glucose of 98 mg/dL, on fenofibrate for high triglyceride levels, and blood pressure of 125/74 mm Hg

Which of these statements describes the closure of the valves in a normal cardiac cycle? The pulmonic valve closes slightly before the aortic valve. The aortic valve closes slightly before the tricuspid valve. The tricuspid valve closes slightly later than the mitral valve. The aortic valve closes slightly before the tricuspid valve.

Which patient is more likely to benefit from low-dose computed tomography (LDCT) screening for lung cancer? A. Ben, a 45-year-old male who quit smoking 20 years ago. B. Jamie, a 30-year-old female current smoker who has smoked 1 PPD for 12 years. C. Ana, a 56-year-old female who smoked 1 PPD for 30 years but quit smoking 12 year ago. D. Alex, an 88-year-old male who currently smokes and has smoked 1 PPD since he was 20 years old.

Which patient with signs and symptoms of sinusitis would you NOT treat with antibiotics? The patient c/o symptoms for 13 days. The patient c/o severe symptoms and has a temperature of 101.2F The patient c/o mild symptoms for six days. The patient c/o worsening symptoms on day 12 after having an initial improvement of symptoms.

Which type of hepatitis is transmitted by fecal-oral route via contaminated food, water or direct contact with an infected person? Hepatitis B Hepatitis C Hepatitis A Hepatitis D

While assessing a 75-year-old with ascites, the NP also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The NP knows this finding indicates A. Decreased fluid volume B. Jugular vein atherosclerosis C. Increased right atrial pressure D. Incompetent jugular vein valves

While reading the H&P of a patient, this was the thorax and lung examination findings, thorax symmetric with increased AP diameter, breath sounds distant with delayed expiratory phase, and scattered expiratory wheezes. Lungs are hyper resonant. Fremitus decreased. Diaphragms descend 2 cm bilaterally. These are some typical findings of what disease condition a. Asthma b. Pneumonia c. COPD d. Pneumothorax

Williams is 27 -year-old construction worker shows up in your clinic complaining of pain to his eyes. His eyes are very red and appear irritated. He states, "He feels like there is something in his eyes." Which of the following is the most appropriate intervention by the Nurse Practitioner? Perform a physical examination including and eye exam. Apply a warm compress, prescribe an antibiotic eye drops and send him home Perform a focus examination of the eye, history of present illness, and attempt to remove the foreign body following the fluorescein staining procedure Refer him to an ophthalmologist

You are a new-grad nurse practitioner working in the ER. One day, you encounter a patient sitting leaning forward, with lips pursed during exhalation and arms supported on their knees or table. What other findings of assessment would you NOT expect to find? Abnormal retraction of the anterior chest Hyperresonance during percussion An increase in the local pain in the chest area A forced expiratory time of 9 seconds

You are auscultating a patient's chest cavity for the presence of heart murmurs. You hear a murmur in both systole and diastole, with a silent interval later in diastole. The murmur is loudest in late systole, harsh-sounding and machine-like, and fades in diastole. Which condition could the patient possibly have? Venous hum Pericardial friction rub Patent Ductus Arteriosus Right sided congestive heart failure

You assess a patient who appears very quiet and has difficulty expressing their concerns. After reviewing the patient's cart and chief complaint, you still have more questions you wish to ask the patient. You decide to use open-ended questions in an attempt to get more information out of your patient. Which of the following would be the best form of a question to ask for this patient? a. Does your chest hurt? b. Have you had this problem before? c. You are quiet, what are you thinking about? d. What types of medications do you take?

Your patient is a 43-year-old, morbidly obese male nursing student who mentions that he is experiencing excessive daytime sleepiness, especially during physical assessment lectures. He consumes one 'snickers' bar every ten minutes just to stay awake! You suspect obstructive sleep apnea (OSA). Which of the following would be a clue that it's paroxysmal nocturnal dyspnea (PND)? a. Older age, smoking hx b. Loud snoring c. Choking or gasping during sleep relieved by sitting up d. Hx of craniofacial and upper airway abnormalities

Your patient is a 70-year-old male who complains that his swallowing is "dry" and he has to try several times before getting the bolus down. What condition more accurately describes his chief complaint? A. Dysphagia B. Odynophagia C. Xerostomia D. Indigestion

Your patient reports bulging in her abdomen. She explains she delivered her baby two months ago and noticed it after delivery. To diagnose this patient with diastasis recti, how large of a gap would the rectus muscle need to have? 5 cm 3 inches 2-3 cm 5 cm

Your patient reports feeling fatigued in the daytime and loud snoring that is embarrassing when she falls asleep around others. You decide to do an Epworth Sleepiness scale. What score would be considered excessive daytime sleepiness? 0-3 4-7 >10 8-9

he NP is conducting a pre-evaluation for a Transcatheter Aortic valve Replacement procedure. The NP is auscultating the chest wall to assess for the aortic murmur. Where will she hear the murmur best? Left 2nd and 3rd intercostal spaces close to the sternum Near the lower left sternal border Right 2nd intercostal space or cardiac apex Right 4th intercostal space close to the sternum

patient who has chronic heart failure tells the NP, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The NP will document this assessment finding as A. Orthopnea B. Pulsus alternans C. Paroxysmal nocturnal dyspnea D. Acute bilateral pleural effusion

patient with obesity, hypertension, hyperlipidemia, diabetes, and asthma is educated by the family nurse practitioner about the importance of changing lifestyle such as diet and exercise to reduce poor health outcomes. The patient states repeated attempts at eating healthy but doesn't understand how to read food labels. The FNP classifies the patient as: a. Confused b. Talkative c. Having low health literacy d. Discriminatory

the nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include: a. Flatness, resonance, and dullness. b. Resonance, dullness, and tympany. c. Tympany, hyperresonance, and dullness. d. Resonance, hyperresonance and flatness.

which of the following is the best way to examine the chest? a. Inspect, palpate, auscultate, percuss b. Inspect, auscultate, percuss, palpate c. Inspect, palpate, percuss, auscultate d. Inspect, percuss, auscultate, palpate

James Smith is a 53 y/o male with no pertinent medical history. He states that he has been an athlete since he was in middle school. Today he comes in complaining of lingering knee pain at 6/10. He states that the pain has happened in the past but would eventually subside. However, he states that it has been hurting more often after he turned 50 years old. He mentions participating in Ragnar relays and marathons. Temp: 98.6F BP: 129/75 HR: 52 O2 sat: 98% RR: 16 1) What type of assessment should be done for this particular patient? Physical assessment Focused assessment Comprehensive assessment All of the above 2) Given the patient data, what are some examples of subjective data? Knee pain at 6/10 A & C Blood pressure 123/65 None of the above 2) Given the patient data, what are some examples of subjective data? Knee pain at 6/10 A & C Blood pressure 123/65 None of the above 4) What are some examples of objective data for this particular patient? Patient stating "I have no serious medical history" Patient admitting "I participate in multiple relays across the country" Respiratory rate of sixteen The patient explaining his family history 4) What are some examples of objective data for this particular patient? Patient stating "I have no serious medical history" Patient admitting "I participate in multiple relays across the country" Respiratory rate of sixteen The patient explaining his family history

CAACD

. A 21-year-old homeless male presents to the clinic with complaints of fatigue, weakness, fever, chills, weight loss and generalized pain. As the nurse practitioner student, name the category to which the generalized symptoms pertain to. a. General survey b. General appearance c. Appearance d. Constitutional symptoms

. A 22-year-old female patient with no medical history presents to urgent care with sudden onset of dizziness and nausea, described as "the room is tilting." The patient has no hearing changes. What is the most likely condition? a. Vestibular Neuronitis b. Acoustic Neuroma c. Central Vertigo d. Benign Positional Vertigo

. A 35 years-old woman visits the clinic to follow up on her colonoscopy result. the patient states,"I have a hard time sleeping, and I am not able to sleep in the last three nights." Which response by the nurse shows a therapeutic communication response to this patient? A. I see B. Really? C. People your age should not have a problem sleeping D. You are having difficulty sleeping? it must be hard for you

. A 38 yr old male patient comes to the emergency room with complaints of coughing for 1 week, blood-streaked sputum, fatigue and shortness of breath with exertion. The patient has a medical history of hypertension and social history of smoking 1 pack a week. You will arrive to all of the following differential diagnoses except: Pulmonary Tuberculosis Bacterial Pneumonia Neoplasm Laryngitis

. A 45-year-old male presents to the clinic with a productive cough, runny nose, with burning retrosternal discomfort. The FNP suspects viral acute bronchitis. As she auscultates breath sounds, the FNP notes continuous low-pitched adventitious sound with snoring quality that clears with coughing. What breath sound does the FNP note? A. Wheeze B. Fine crackles C. Coarse crackles D. Rhonchi

. A 45-year-old patient comes into the emergency room with difficulty breathing, and per the Chest X-ray, you diagnose a tension pneumothorax. You need to do a needle insertion for decompression. Where would you insert the needle for aspiration? a. 5th Intercostal space b. 4th Intercostal space c. 3rd Intercostal space d. 2nd intercostal space

. A 85-years-old male patient who has had chest pain for several hours is admitted with a diagnosis of ruling out acute myocardial infarction (AMI). Which laboratory test should the NP monitor to help determine whether the patient has had an AMI? A. Myoglobin B. Homocysteine C. C-reactive protein D. Cardiac-specific troponin

. A patient with a history of anxiety presents to the clinic for an annual checkup. During the checkup, the patient denies specific complaints and mentions that she last experienced anxiety symptoms two years ago. When documenting the Chief Complaint (CC), the nurse practitioner would write: A KC is a 21-year-old female with a history of anxiety who states "I have been managing my anxiety pretty well." B "I am anxious" C KC is a 21-year-old female with a history of anxiety who states "I am here for my regular checkup." D "I am here for my regular checkup."

. During the cardiac auscultation, the nurse hears a sound immediately occurring after the S2 at the second left intercostal space. To further assess this sound, what should the nurse do next? a. Have the patient turn to the left side while the nurse listens with the stethoscope bell. b. Ask the patient to hold their breath while the nurse listens again. c. No further assessment is needed because the nurse knows that this sound is S3. d. Watch the patient's respiration while listening for the effect on the sound.

. Kimberly is a 24-year-old patient with no known medical history that comes to your clinic for the first time complaining of right-sided ear pain. You have a new nursing student who is watching you perform the examination. You begin palpating Kimberly's head bilaterally at the preauricular areas. The nursing student asks why you are not palpating one area at a time. What is your correct response? a. "You are right. I will palpate one area at a time." b. "Okay, I will palpate only one side, and you can palpate the other" c. "This way, I can finish the exam faster." d. "Bilateral palpation allows you to note for the presence of asymmetry and lymph nodes."

. Mr. Navarro, a 40-year-old male, comes into the clinic complaining of intermittent chest pain on the left side of his sternum. On assessment, the nurse hears a high-pitched click in late systole, followed by a murmur that increases in density up until S2. When Mr. Navarro stands, the click and the murmur move closer to S1. Based on these findings, which of the following diagnoses is most likely? A. Mitral valve regurgitation B. Mitral valve stenosis C. Mitral valve insufficiency D. Mitral valve prolapse

. The "triangle of safety" is an anatomical region formed by all EXCEPT: a. The lateral border of the pectoralis major muscle anteriorly b. The lateral border of the latissimus dorsi posteriorly c. The nipple line (4th or 5th intercostal space) d. Anterior axillary line

. The nurse practitioner obtains information from Robert, a 45 year old male who reports a family history of hypertension. His BP is 129/89 and his BMI is 24. Which dietary recommendation below would be best for Robert? A. No restrictions or dietary options are needed. Both his BP and BMI are within normal limits. B. Drink 1 glass of wine every night. Research shows wine is a vasodilator and can decrease BP. C. Eat plenty of canned fish. Fish is very good for the heart and has plenty of Omega-3 fatty acids. D. Incorporate soybeans, spinach, and sweet potatoes into his diet.

. Which of the following is Subjective data? "patient displays significant guarding upon palpation" "patient's urine tox screen demonstrates the presence of THC" "patient reports history of Bipolar Disorder type 2" "patient states they are in 10/10 pain"

1) Tom, a 4-year-old, comes in the Emergency department with his grandmother after falling from a 5-foot table. He continues to cry and repeats "booboo." While assessing for pain, what is the best pain scale to use? Numeric rating scale CPOT Verbal rating scale FACES rating scale

1. A patient comes to the clinic for a routine check-up and during the provider assessment, the provider must auscultate heart sounds. The provider understands that this valve sound can be found at or near the lower left sternal border. A. Pulmonic valve B. Aortic valve C. Mitral valve D. Tricuspid valve

2. Mydriatic eye drops are necessary for an eye examination. A 50-year-old lady arrived in the clinic with normal vision but floaters. She was afraid and refused to instill eye drops. The FNP would explain all of the contraindications Except. A. Suspicion of narrow-angle glaucoma. B. Head injury. C. Hypertension. D. Dry eye syndrome

2. Which sequence does the electrical stimulus of the cardiac cycle follow? A. AV node, SA node, bundle branches, and then to the bundle of HIS B. Bundle of HIS, bundle branches, AV node, and SA node C. AV node, SA node, the bundle of HIS, and bundle branches D. SA node, AV node, the bundle of HIS, and bundle branches

3. A patient in the hospital has been experiencing excessive dizziness when standing up and unsteadiness when climbing out of bed. The provider orders staff to assess for orthostatic hypotension. Which of the following BP measurements would indicate orthostatic hypotension? A. Lay 135/90 Sit 120/75 Stand 118/73 B. Lay 135/90 Sit 125/85 Stand 125/75 C. Lay 135/90 Sit 130/88 Stand 125/85 D. Lay 135/90 Sit 110/85 Stand 100/70

3. Metabolic syndrome is a group of risk factors that increase the risk for diabetes and cardiovascular disease. Which of the following is not considered a risk factor? a. Reduced HDL cholesterol b. Elevated blood pressure c. Elevated fasting glucose d. BMI ≥ 25

3. You are about to have an interview with a male patient who is 30-year-old come to your clinic for an annual check-up. The patient started talking about his concerns. BP 148/82, HR 87, RR 19, temp 98.6, and pain 3/10. Which one do you select as the objective information? a) feelings b) chest pain c) itching d) tenderness on palpation of the right lower quadrant of the abdomen

4) A 65-year-old female has recently been diagnosed with a severe bacterial infection. She traveled to Florida 6 months ago with her family. She has been diagnosed with glaucoma since she was in her early 40. Which of the following medications is considered highly toxic to this patient? Metronidazole Digoxin Penicillin Gentamycin

4. A 19 y/o presents to the Ed for medication refill Past medical history of schizophrenia, Pt stated he's been out of medication for 1 week, however, does not know the name of his medication which of the following approach is not a teach-back method upon discharge? a. Clarify and check again b. Chunk and check c. Start slowly and use consistently d. Use handouts only

4. A 37-year-old transgender woman presents to urgent care stating, "I don't feel like myself; I feel really sick." Which of the following guided questioning techniques will best clarify what the patient means? a. Asking the patient, "Do you have a fever?" b. Stating to the patient, "Tell me about your pain." c. The nurse practitioner leans forward and nods their head in agreement. d. Asking the patient, "You said you feel really sick. What do you mean by that?"

4. Ms. Jones is a 60 years old patient. She comes to the urgent care today and complaints of vision change. You are the nurse partitioner who takes care of Ms. Jones. Which of the following finding on her is less concerned? a. The presence of blood within the aqueous fluid of the anterior chamber. b. Sudden, severe pain on the left eye, with blurred vision and haloes c. A curtain-like shadow over her visual field, with reduced peripheral vision d. The presence of blood in the white of the eye

4. Which of the following is not an Ototoxic drug? a. Aminoglycosides b. Antimalarials c. erythromycin d. Ceftriaxone

40 year old male comes into the clinic with complaints of a bloody cough for 3 weeks. He states he has unintentionally lost weight over the past few months, has had night sweats, and a fever the past few days. The patient denies wheezing, tobacco use, and shortness of breath. Which of the following diagnosis would the practitioner like to rule out the patient for: a. Pneumonia b. Bronchiectasis c. Chronic Bronchitis d. Pulmonary Tubercul

5. The nurse practitioner is assessing a 70-year-old female with a chief complaint of decreased appetite and tongue soreness. The patient states "I also had some white plaque on my tongue, but I was able to scrape some off". The patient is currently taking steroids and antibiotics for pneumonia. At the end of the visit, the nurse practitioner prescribes the patient Fluconazole (Diflucan). The nurse practitioner determines learning has occurred if the patient states which of the following? A) "The white stuff on my tongue is called leukoplakia" B) "I'll stop using my antibiotics" C) "This fluconazole is used for my pneumonia" D) "I'm going to take fluconazole for my candida infection"

5. What is the best approach when communicating effectively with older adults? a. Speak loudly, being sure to slowly annunciate each word b. Adjust the pace of the interview to try and get everything done in one appointment c. Provide a well-lit cooler setting d. Allow time for open-ended questions and reminiscing

5. Which of the following is not a risk factor for the abdominal aortic aneurysm? age above 65 years history of smoking male gender Umbilical hernia

5. While interviewing a 41-year-old female she states, "I want to quit taking Norco, but I am not ready yet." Understanding the transtheoretical model for behavior change, what action is best to take next? A. Discharge the patient to a rehab center. B. Tell her you don't think she is taking her substance abuse issue seriously. C. Advise her of all the horrible side effects of withdrawal. D. Support her behavior changes with motivational interview.

75-year-old female presents to the ED for progressively worsening shortness of breath. She has digital clubbing, evidence of accessory muscle use, and states she's had a cough for the last 3 months. She reports smoking a pack a day for the last 15 years and noticed some BLE swelling. What would not be part of your differential diagnosis? Chronic bronchitis Emphysema COPD Pneumonia

A 10-year-old male patient is brought in by his mother to the clinic due to throat pain with intermittent fever for 2 days. During the clinical interview, the provider notices the patient's mother speaks limited English and often asks the patient to translate for her. What is the most appropriate action for the provider? Ask the patient's 17-year-old sibling in the room to translate instead Continue to interview in English and provide the mother printed information in her preferred language Use a Spanish-speaking registration clerk as the translator Set up a telephonic interpreter in the preferred language and assess understanding at the end of the session

A 14-year-old male comes to the ER with his friend. His chief complaint is chest pain only located on the right side. His buddy states they were at a cannabis convention down the street when his buddy took a "mad bong rip and starting coughing really bad". You're ruling out pneumothorax upon percussion over the right lung you feel _____. Flat Dull Resonant Hyperresonant

A 16-year-old female presents to the urgent care after spraining her ankle. Her mother informs the nurse practitioner (NP) that her daughter never liked seeing doctors because she had bad experiences with them during her childhood. Knowing this, the NP can establish rapport with the patient by all the following EXCEPT: Introducing self & role in patient's care Identifying the patient by her preferred name Speaking with the patient as an adult Asking the mother questions about her daughter

A 16-year-old male is being interviewed by the nurse practitioner student about intentionally ingesting 30 acetaminophen tablets two hours prior to his arrival in the ER. Which following option demonstrates the most appropriate open-ended question to ask for the NP student to gather additional information about what led to the adolescent's action? a. "Have you done this before?" b. "Do you have any pain?" c. "Do you have a support system at home?" d. "There are times people feel they are not worthy of living. Tell me how you feel about living?"

A 16-year-old male patient presents to you after playing soccer in the cold. As you are auscultating all lung fields, you hear continuous musically, high-pitched sounds with a shrill quality on expiration and inhalation. How would you document your findings? A) Crackles B) Rhonchi C) Stridor D) Wheezes

A 21-year-old male patient with no significant medical history comes to the emergency department with complaint of shortness after being involved in a motor vehicle crash. Upon assessment, he does not appear to have any visible signs of external injuries. After auscultating, you percuss his lung fields and find hyper-resonance over the left lung and resonance over the right lung. As the evaluating APRN, you order a chest anticipating the patient may have: Left lower lobe pneumonia Right hemothorax Left hemothorax Left pneumothorax

A 21-year-old woman felt embarrassed and scared with her first pap smear exam. She said she never had to have an exam down there before. What should the NP do to minimize her fear? A) Provide statistics on how effective a pap smear is in the early detection of STDs and cancer. B) Assure the patient that everything will be alright and that you have pap smear experience. C) Provide the patient with her laboratory findings. D) Explain how the examination will proceed, what is about to happen, and ask if she has any questions before you proceed.

A 23-year-old female patient comes to the clinic for an annual physical exam. Upon auscultation you hear a systolic murmur louder in volume than s1 and s2 with a palpable thrill. What grade would you give this systolic murmur according to your physical findings? Grade 6/6 Grade 5/6 Grade 3/6 Grade 4/6

A 23-year-old female patient complains of intermittent fingertip paleness, numbness, and tingling that has been present for the past two years. She denies any pain associated with the episodes. What might you ask her as the advanced practitioner to get a better idea of the history of the present illness? Do you take your blood pressure regularly in both arms? Do you have any chest pain associated with these episodes? Do you have any tight, bursting pain in your forearms or calves? Does the pale discoloration occur when you are in cold temperatures?

A 24-year-old male with no medical history came into the ER complaining of an itchy throat and a productive cough for 20 days. He states that cough medication does not help much. He smokes occasionally and drinks socially. He denies any allergies, current medications, and drug use for the past month. Patient presents with a hoarse voice, thick yellow phlegm, and swollen, red tonsils. As an advanced practice nurse (APN), what should you do next? Instruct patient to drink plenty of fluids. Refer him to a specialist. Ask the psychiatrist for instructions. Create a list of different diagnoses.

A 27-year-old female comes into the clinic for an annual physical exam. The FNP proceeds to check her vital signs including her respiratory rate. Based on the FNP's knowledge, what is the normal respiratory rate in adults? 20-30 per min 18-28 per min 8-14 per min 14 -20 per min

A 28-year-old was brought to the emergency room after an automobile accident. The patient was experiencing shortness of breath, with shallow breathing, heart rate >140, trachea shifted to the right, upon percussion the APRN heard a unilateral hyperresonance sound this would indicate? a) pneumonia b) pleural effusion c) hemothorax d) pneumothorax

A 32-year-old female comes to the clinic stating that she lost weight, has poor appetite, has fever, night sweats and has a dry cough for a few weeks. The APRN suspects? a) Chronic Bronchitis b) Bronchiectasis c) Lung Abscess d) Pulmonary tuberculosis

A 32-year-old male admitted to the Intensive Care Unit after being found unresponsive after a cocaine overdose has recently been extubated after one week of mechanical ventilation for airway protection. You order a psychosocial consult for the patient to begin the plan for drug cessation. During the consult, the patient states, "I'm concerned about my behavior, but not ready to make any changes now." Under the Transtheoretical Model for Behavioral Change, this patient is in the stage of: Relapse Precontemplation Action Contemplation

A 35 year old female patient comes to see you about "an itchy runny nose for the last two weeks." She is breathing from her mouth, clutching a package of kleenex, her voice is nasally and her eyes are moist. She appears fatigued. VSS: BP 112/78, P86, RR20, T 99.6F, O2 sat 96%. She reports no pain at the moment. On examination you find that bilateral erythema and edema of turbinates with clear discharge. There is no lymphadenopathy, tenderness, posterior pharynx is mildly injected, there's no exudate but there's some post-nasal drainage. Bilateral external auditory canals and TMs are intact and clear with good cone of light. There is no sinus tenderness. You suspect allergic rhinitis. To rule out a more serious or less-evident cause, you can ask all of the following questions EXCEPT one: a. Has there been any change in your vision? b. Do you feel short of breath? c. Is your neck stiff? d. Does your face hurt if you lean over? e. How about those Bengals?

A 35 year old male patient with a hx of continuing tobacco use complains of dry mouth and has evident tooth decay and gum recession and inflammation. Oral mucosa is dry and pink, dental caries in the upper molars, tongue midline, pharynx erythematous, no tonsil enlargement, no exudates. No lymphadenopathy palpated. His medications include Abilify and Cogentin. Your patient teaching should include all of the following EXCEPT a. Drink more water b. Chew sugarless gum c. Make sure to brush teeth with fluoride-containing toothpaste at least twice a day and to floss daily d. Stop all your medications immediately

A 35-year-old female comes to the emergency room due to difficulty breathing, upon assessment the APRN notices that she is using her accessory muscles and seems like she will get tired out, based on the assessment the APRN knows? a) the patient ventilatory requirement is not affected. b) the patients ventilatory requirement is decreased. c) the patient ventilatory requirement is compensating. d) the patient ventilatory requirement is increased.

A 35-year-old female presents to the ED for RLQ abdominal pain with nausea and vomiting. She is tender to palpation in the RLQ. What would not be part of your differential diagnosis? Appendicitis Pelvic inflammatory disease Ectopic pregnancy Pancreatitis

A 35-year-old male patient is brought into the emergency department with complaint of severe abdominal pain. Due to the discomfort, the patient is not able to clearly describe the exact location of the pain. To understand the origin of the pain, the APRN should: Order abdominal radiologic studies right away Ask the patient if he is having "parietal pain" to narrow down the origin Ask the patient if he is having "visceral pain" to narrow down the origin Ask the patient to point where it hurts

A 40-year-old male patient who came to the urgent care with appendicitis suddenly developed shortness of breath. After the patient is given O2 immediately, what is the next thing that the nurse practitioner should take when further assessing the patient? Check pt FEV volume Transfer him to ER since he would need CT or MRI study Inspect the thorax for any new discoloration associated with hemothorax Bilaterally percuss the thorax areas and check if there are any tone differences noted

A 40-year-old male patient with a family HTN history presents in the clinic for an annual check. When reviewing his EKG strip, the APN finds the p waves and QRS complexes are regular with the PR interval is 0.16 seconds. His overall heart rate is 62 bpm. Which following action should the APN take? a. Notice the healthcare provider b. Check the patient's vital signs c. Check his lab results d. Continue to follow up on the patient's rhythm.

A 41-year old male patient comes into the clinic complaining of chest pain. His medical history includes hypertension, and diabetes. His mother has coronary heart disease and his father had an MI at 50-years old. When questioning his symptoms, the NP asks, "Does it radiate into the neck, shoulder, back, or down your arm"? Why is this question significant? It's a standard question to ask patients who come in with chest pain It would confirm whether or not the patient is having a heart attack It's important to have the patient describe his symptom in detail Symptoms of myocardial infarction include chest pain that radiates to the shoulder, neck, back, or arm

A 60 year old female comes to the clinic on a check up for her coronary heart disease. Teaching has been effective when the patient makes which statement? "Lack of sleep has no effect on worsening hypertension or coronary heart disease" "As long as I exercise regularly, I can eat whatever I want" "I just need to give up sugar completely to improve my diabetes" "I can reduce my risk for coronary heart disease if I stop or reduce my smoking"

A 41-year-old male patient with Down syndrome presents to urgent care with a chief complaint of head pain. Which of the following scenarios best describes the clinical cognitive error, visceral bias? a. The nurse practitioner diagnoses anxiety exacerbated by a stressful work environment and does not consider other more acute options despite an atypical presentation compared to the patient's usual headache symptoms. b. The patient is considered noncompliant with preventative medication, and the patient's recent job and health insurance loss are not considered. c. The nurse practitioner has recently seen multiple patients with sinus headaches and assumes this diagnosis and does not consider migraine headaches. d. The nurse practitioner prescribes a simple, less effective treatment plan, assuming the patient can not handle a more complex plan due to a history of Down syndrome.

A 42-year-old male runner with a history of type II diabetes comes in the emergency department with a broken ankle. As the provider you prescribe him pain medications and corticosteroids. Which of the following statements by the patient demonstrates that the teaching has been effective? "I will consider herbal remedies if the pain persists even with the pain medications" "I will not check my blood sugar since the steroids will help control it" "I will just double my usual dose of insulin since my blood sugar will be high" "I will check my blood sugar before taking any insulin"

A 45-year-old female complains of dyspnea x 1 month, states "it is getting worse, especially at night and I can't sleep lying down anymore." The patient also complains of nonproductive cough with an occasional small amount of pink frothy sputum. No fever, chills, or chest pain are reported. The patient most likely has: Chronic bronchitis Bacterial pneumonia Gastroesophageal reflux Left ventricular failure or mitral stenosis

A 48-year-old female who was diagnosed with hypothyroidism and hypertension early in her 30s comes in complaining of cramping leg pain. The patient admits to walking every single day, however since it is starting to snow, she had to stop. What is your next course of action? Order CT venogram Stop the assessment, admit the patient, and start heparin immediately Send her home on Eliquis Ask the patient more questions about her symptoms

A 49-year-old woman is at her wellness check up. The patient shares her concern for colon cancer with the nurse practitioner and asks what the screening recommendations are once she turns 50 years old. The nurse practitioner will recommend what test every five years: a. Ultrasound of abdomen and pelvis b. Guaiac-based fecal occult c. Fecal immunochemical test (FIT) d. Sigmoidoscopy

A 50-year-old man comes to the clinic complaining of a steady aching, rated 7/10, that is localized to the left upper quadrant of the abdomen. The pain is aggravated by movement. The FNP knows this pain is: Visceral Neuropathic Referred Somatic/Parietal

A 52-year-old female presents to the emergency department with dyspnea, palpitations, and dizziness. The nurse practitioner orders an EKG. The EKG shows an irregularly irregular heart rhythm with a saw-tooth pattern and a heart rate of 175. The nurse practitioner determines the following rhythm is which of the following? A) Supraventricular tachycardia B) Atrial fibrillation C) Sinus tachycardia D) Atrial flutter

A 54 year old female comes into the office with a chief complaint of a "fluttering feeling" in her chest. When performing a physical examination, it is time to assess her cardiovascular system, including assessing for S1, S2, murmurs or extra sounds. What position should this patient be in for this examination? A. Sitting up leaning forward B. Supine with HOB at 30 degrees, then standing C. Standing, sitting up, and supine D. Supine with HOB at 30degrees, then turned partly to left side, the sitting up leaning forward

A 54-year-old patient presents to the emergency room with chest pain for 2 days. The patient later explains she has been coughing after falling ill with COVID-19, stating her chest pain is exacerbated after coughing. Which of the following is an example of anchoring bias by the clinician? Assuming pulmonary embolus (PE) because the last 2 patients she saw with chest pain and COVID had a PE The clinician assumes the patient is homeless from her appearance and probably abused drugs prior to arrival, causing her to have chest pain. Will order simple blood panel and less optimal plan due to inability to comply. The patient is a frequent flyer for anxiety attacks presented by chest pain. MD locks onto the first impression of chest pain and the idea of myocardial infarction too early in the diagnostic process and fails to pick up on red flags

A 55-year is female who is blind, comes to the clinic for an annual physical. She is accompanied by her caregiver. The APRN enters the room and verbally introduces herself to the patient and caregiver. The following methods are used to establish rapport with the blind patient EXCEPT? a) Do not leave the room without letting the patient know. b) Ask the patient if she needs help or assistance prior to assisting. c) Be ready to provide information regarding care and treatment such as (Braille, large print, or audio file). d) Direct all the questions to the caregiver instead of the patient.

A 55-year-old male patient presents to the clinic post-op day 5 c/o obstipation, N/V, and abdominal distention. What is your number one differential diagnosis? A) Diverticulitis B) Cholecystitis C) Peritonitis D) Bowel obstruction

A 55-year-old male patient with a 30-pack year smoking history presents to the clinic for his physical exam after 10 years from his last visit. All the following objective findings support a diagnosis of COPD EXCEPT: Increased anteroposterior (AP) diameter Decreased chest expansion Hyperresonant lungs Increased fremitus

A 55yr old, morbidly obese patient at the clinic for his physical examination. During the conversation with the patient, you noticed that he seemed depressed. You asked him if there was anything that bothered him. He started telling you that he frequently falls asleep when watching television or in the middle of a meeting at work, and he is afraid to drive because of his recent car accident. Based on the subjective data, what might be his diagnosis? a. Congestive heart failure b. Obstructive sleep apnea c. Depression d. COPD

A 56-year-old male is status post-emergent intubation at the bedside due to hypoxia. You notice unequal chest rise and cannot auscultate bilateral breath sounds. A STAT chest x-ray shows the following image: Upon review, you identify the following: Right tension pneumothorax Left pneumothorax Optimal location of the endotracheal tube (ETT) ETT inadvertently placed in the right bronchus

A 63-year-old African American male walked into the ER complaining of chest pain that started 2 hours ago associated with difficulty to breath, while listening to his heart sound you noticed murmurs, what would be your next line of action a. Give baby aspirin b. Order labs for BNP and Troponin level c. Do a bedside Ultrasound of the heart d. Order an EKG STAT

A 65-year-old male with a history of benign prostatic hyperplasia (BPH) presents to the outpatient clinic for routine screening for prostate cancer. After consulting with the clinician, the patient completes a PSA test in the outpatient lab. The resulting PSA value is 6 ng/mL (normal = <4 ng/mL). The clinician reviews the patient's PMH and recent events and lifestyle. What leads the clinician to believe that this is a falsely elevated PSA value and that a repeat test should be performed? The patient had a prostate needle biopsy one year ago. The patient is currently taking 5mg of finasteride daily for his BPH and prevention of prostate cancer. The patient used to be a marathon biker in his 50's. The patient had a recent ejaculation 24 hours prior to his PSA test.

A 65-year-old man with a history of hypertension comes into the emergency room complaining of 10/10 chest pain that radiates to the neck and abdomen that started about 20 minutes ago. The patient describes the chest pain as "ripping" sensation and he states "I have never experienced anything like this before". He appears diaphoretic and is grimacing in pain. The nurse practitioner performs an assessment on the patient. Given the patient's past medical history, what is the likely cause of this pain? Angina Pectoris Myocardial Infarction Pericarditis Aortic Dissection

A 65-year-old patient is brought into the ER by his daughter for altered mental status. The daughter states his illness starts with a cough and fever, it then escalated to shortness of breath, chest pain and now he is coughing up yellowish-green sputum. What would your likely diagnosis be? A) Viral infection B) CHF C) PE D) Bacterial PNA

A 65-year-old patient is diagnosed with chronic venous insufficiency. The following features are expected in chronic venous insufficiency except: Skin thickening near the ankle Ulceration Brownish pigmentation Nonpitting edema

A 65-year-old patient presents to the clinic complaining of a cough over the past 2 days. The patient's oral temp is 100.1. While assessing the patient, the nurse hears loud, relatively high-pitched breath sounds over the manubrium during percussion. She also notes a short silence between inspiratory and expiratory sounds. She asks the patient to say "ee,' but all she hears is "aaa" with a nasal bleating quality. Based on this assessment, the nurse knows the most likely diagnosis is what? A. Asthma B. Emphysema C. Bronchitis D. Pneumonia

A 66-year-old white woman comes into the clinic complaining of a sudden increase of nocturnal dyspnea, nausea, and pain in the neck and jaw. She denies any abdominal pain or changes in her lifestyle. There is no sign of domestic violence. She has been diagnosed with hypertension, but never took medicine. She does not smoke and drink. Her mother died of a heart attack at the age of 59. Which of the following assessment and lab results would cause the most concern and therefore warrant further medical evaluation? Race Diet rich in fruits and low-fat dairy products BP 145/85 Fasting glucose 210mg/dL

A 67-year-old Asian woman arrived in the clinic with sudden vision changes. She claims to have low pain tolerance, and she is currently suffering from extreme 9/10 eye pain, photophobia, nausea/ vomiting, and red eyes. After examination, you noted that her IOP is 52. What is the best course of action to do next? A) Give her anesthetic eye drops and reassess her in 30 minutes B) Provide therapeutic communication and urge her not to worry C) Perform a more comprehensive visual and neurologic evaluation D) Immediately refer her to the emergency department

A 67-year-old retired female banker visits your clinic for advice regarding vaccinations for older adults. As her primary care provider, you understand that all the following are recommended for her age group EXCEPT: a. Influenza vaccine b. Pneumococcal vaccine c. Zoster vaccine d. Human papillomavirus vaccine

A 70-year-old female is brought into the primary care clinic by her daughter due to fatigue, nausea, vomiting, and jaw pain. The patient's daughter reports that her mother probably has indigestion after having eaten sea food the evening before. As the evaluating nurse practitioner, you should: Advise the patient to hydrate, rest, and take Pepto-Bismol for symptom relief Add "sea food" to the patient's list of food sensitivities and advise her to avoid it in the future Refer the patient to the dentist, as the jaw pain may be related to a tooth infection Perform a 12 lead ECG and investigate the possibility of acute coronary syndrome

A 72-year-old male presents to the medical clinic with his caregiver for urinary retention. The patient has a past medical history of benign prostatic hyperplasia (BPH), diabetes mellitus (DM) type 2, hyperlipidemia (HLD), and diabetic retinopathy which has progressed to complete loss of his vision in both eyes. The nurse practitioner should establish rapport with this patient by doing all the following except. A) Provide written materials in auditory, tactile or electronic format of patient's preference. B) Ask the patient how he would like to be assisted C) Announce when you enter and leave the room D) Speak directly to the caregiver so they can give the patient the information

A 75-year-old male patient with a history of dementia was brought in by an ambulance was found that at home on the floor laying on his urine. Upon assessment, NP noticed that the patient has a deep tissue injury in the sacral area and weighs 90.5kg. Patient's son came in 1 hour later stating that he is the caretaker but would have to leave his dad for the day to go to work. He also states that there is a caregiver that would come in during the day to check up on his dad. As a healthcare provider, what is the priority in handling this situation? Interview both the patient and son at the same time to have a better understanding about the situation. Continue to monitor patient because no serious injury/harm was done. Inform son that he should not be leaving his father unattended due to high risk for injury with people with dementia and older patients. Report suspected abuse/neglect to protective services to start investigation.

A 75-year-old patient was admitted to placing a PEG tube. After the procedure, the patient complained of pain in the sacrum/coccyx area. You found a significant nonblanchable, maroon skin discoloration and blood-filled blisters. How do you grade this finding? A) Dark discoloration B) Pressure injury stage 1 C) Pressure injury stage 3 D) Deep tissue pressure injury

A 87-year-old man with a history of hypertension and smoking presents to the ER with complaints of severe abdominal pain. The pain is radiating to his back. While performing the physical examination, The NP noticed pulsatile abdominal mass. The NP is suspected of Abdominal Aortic Aneurysm (AAA). What test the NP expect to order: A. CT of the abdomen with contrastB. Measure serum amylase and lipase levelsC. Measure serum lactate level D. Abdominal ultrasound

A Nurse Practitioner working at a cardiac clinic is auscultating chest sounds on a 35-year-old female. The Nurse Practitioner knows the best place to hear the mitral valve is? A. Right second intercostal space or cardiac apex B. Left second and third intercostal spaces close to the sternum C. Near the lower left sternal border D. At and around the cardiac apex

A family nurse practitioner (FNP) is performing a physical examination on a patient in the primary clinic. When palpating the patient's radial pulses, he notes a brisk pulse. When recording his findings, how should the FNP grade the pulses based on the AHA guidelines? 3+ 1+ 4+ 2+

A highly anxious patient has a respiratory rate of 25 bpm. When taking vital signs the patient's temperature is noted to be lower than expected. which of the following methods would glean the most accurate temperature reading? Oral Temperature reading Temporal Artery Temperature reading Axillary Temperature reading Rectal Temperature reading

A middle-aged patient complains of sudden onset of dizziness, describes as "the room is spinning" for 2 days. The patient denies decreased hearing or tinnitus. Slurred speech and weakness to extremities are noted while assessing the patient. What is the most likely cause for these symptoms? Drug toxicity Meniere Disease Vestibular Neuronitis Central Vertigo

A patient comes into the clinic for a regular checkup. During the interview, the NP learns that the patient's last physical exam was 7 years ago. Upon inspecting the right retina, the NP visualizes soft exudates and microaneurysms in the fundus. Based on the assessment, the NP will include in the patient's care plan: Ensure patient comes into the clinic annually for a physical exam Education on risks and benefits of noncompliance of medication Management of high blood pressure with blood pressure medication Referral to an ophthalmologist and endocrinologist

A patient comes to the clinic complaining of right ear pain and yellow-green discharge. The nurse is unsure yet whether the patient developed otitis media or externa; the nurse's next action on examination to get the correct findings is to? a. Inspect if there is any nodular swelling surrounding the outside of the right ear. b. Test hearing deficit to ensure the cerumen impaction doesn't block the canal. c. Immediately take a swap of the right ear and send it to the lab. d. Move the auricle up and down, press the tragus, and press firmly behind the ear.

A patient in the intensive care unit (ICU) was extubated an hour ago. As the ICU team is rounding on the patient, they notice an audible high-pitched inspiratory whistling coming from the patient. What is the significance of this scenario? The patient's throat is sore from the endotracheal tube and requires attention. The patient is experiencing airway edema and the team should check back in an hour. The audible breathing sounds are normal post-intubation. The patient is having stridor and requires urgent airway evaluation.

A patient is being assessed by the provider who is auscultating the patient's lungs, the provider hears sounds with a longer duration and low frequency that appears early in inspiration and lasts through expiration with a popping sound and can be heard over any lung region. The provider understands they are listening to: A. Wheezes B. Stridor C. Fine crackles D. Coarse crackles

A patient present to the emergency room with a chief complaint of eye redness. On exam you note diffuse conjunctival injection on the right eye with redness primarily in the peripherals and mucopurulent discharge. Patient denies any trauma to the eye or visual disturbances. Denies pain but states its uncomfortable. What is one of your differentials related to this finding. Abrasion Herpes Zoster Acute Angle closure glaucoma Bacterial conjunctivitis

A patient presents to the urgent care complaining of an ankle ulcer. Pulses and skin color are normal but +1/+2 edema present. Skin around ankle ulcer appears thickened with brown pigmentation. What is the most appropriate diagnosis? A) Chronic arterial insufficiency B) DVT C) Neuropathic ulcer D) Chronic venous insufficiency

A patient visits the clinic with c/o excessive daytime sleepiness, loud snoring, choking, and gasping during sleep. The provider understands that the following is not true regarding obstructive sleep apnea: A. It is associated with higher risk for cardiovascular morbidity B. Risk factors include obesity, male sex, and older age C. It is characterized by repeated episodes of upper airway collapse D. Sleep is uninterrupted despite hypoxemic episodes

A septic ICU patient requires multiple pressors and as result will need an arterial line to closely monitor the blood pressure. You assess the patency of both the radial and ulnar arteries. You compress both arteries and then release pressure off the ulnar arteries to see the palm flush within 3 to 5 seconds. You also test the radial artery. This is called what? Phalen's test Tinel's Sign Bae test Allen test

A student nurse is auscultating the lungs of a patient on the telemetry floor admitted for CHF. The student nurse reports back to you, "I hear a popping sound upon inspiration over the bilateral lower lobes". What adventitious lung sound is this? Fine Crackles Wheezes Rhonchi Coarse Crackles

According to CDC recommendations for hand hygiene, which of the following situation does NOT require additional hand hygiene? After contact with body fluids Prior to preparing an injection After glove removal After recording patient information in an office

Adventitious sounds: Rhonchus is described as A) Discontinuous, loud, low in pitch B) Discontinuous, loud, higher pitch C) continuous, high-pitched, hissing D) continuous, low-pitched, snoring quality

After assessing the patient, the NP diagnoses him with neuropathic pain. What symptoms did he likely describe? A. Dull, pressing pulling B. Throbbing, boring, C. Spasmodic or colicky D. Electric shock-like, " pins and needles"

After attending a training class for comprehensive and focused history taking and knowing the differences between these two types, the nurse practitioner can apply focused history taking in which situation? a.The patient is coming for the first time to the clinic. b. The patient is admitted to a long-term care facility. c. The patient is coming for a daycare surgery the next day. d. The patient is having signs and symptoms of covid19.

After patient intubation, the nurse practitioner wants to confirm the endotracheal tube placement by checking the bilateral chest expansion and auscultation. She noticed a unilateral chest rise in the right lung, and a chest X-ray confirms that the tube is inserted into the right mainstem bronchus. The nurse knows that the endotracheal tube usually shifted to the right mainstem bronchus because of: a. The right mainstem bronchus is longer and vertical. b. The right lung is larger than the left lung. c. This is a normal finding, and the tube should enter just the right bronchus. d. The right mainstem bronchus is shorter and wider and more vertical.

After the student NP completed the clinical interviewing and comprehensive physical assessment, all of the following are critical components of the clinical reasoning process except: a. Gathering initial patient information b. Organizing and interpreting information to synthesize the problem c. Generating and testing hypotheses and planning the diagnostic and treatment strategy. d. Educate the patient regarding the disease process.

All of the following organs can be found in the right upper quadrant of the abdomen except? Liver Gallbladder Duodenum Appendix

An 83-year-old man is admitted to the hospital after losing his wife a week ago. He states that he has been coughing for the last three nights and it has been making him feel short of breath. After doing a sputum sample, you note the sputum color is yellowish-green in color. This is most common in what type of diagnosis? Viral infections Common cold Bronchitis Bacterial pneumonia

An 89-year-old female was brought to the emergency department by her daughter, the daughter stated that her mother felt dizzy, lightheaded and was more confused. The APRN notice that the patient had a dry mouth and urine sample was dark and concentrated, based on this finding the APRN will know that the patient has? a) Increased preload b) Decreased myocardial contractility c) Increased myocardial contractility d) Decreased preload

An Indonesian woman came to the ER with her husband and 10-year-old daughter, complaining of abdominal pain and a heavy period. The spouse refused to utilize a medical interpreter and continued to answer everything. Only Indonesian is spoken and understood by the patient. Which of the following people should the NP use to obtain a history from this patient? A) The patient's 10-year-old daughter B) The patient's husband, who speak both English and Indonesian C) A male IR technician working in ED D) Female interpreter who speaks Indonesian and is available by phone

An eye examination of a 68-year-old female is performed. Small, rounded, irregular red spots, otherwise called dot or blot hemorrhages are found. What medical condition do you suspect the patient has? Vascular dysplasia Macular degeneration Hypertension Diabetes

As a healthcare provider, you will encounter situations that call for ethical principles. Which of the following is not the core values of medical ethics? Justice Confidentiality Decisional capacity Social status

As a nurse practitioner, you suspect your patient has pneumonia. Which of the following findings would you not expect? a. Whispered pectoriloquy b. Bronchophony c. Egophony d. Decreased tactile fremitus

As a part of your physical examination, you are going to do a cardiac assessment. You had the patient on the examination table with the upper body raised at 30 degrees. To assess the PMI better, you asked the patient to turn to the left side because, A. The heart is located on the left side of the chest B. You are standing on the right side of the patient C. You can assess JVP at the same time D. This will bring the ventricular apex close to the chest wall

Assess which of the following findings during the routine physical examination of a 46-year-old male would prompt concern for further work-up. A. The upward movement of the thyroid gland when the patient is asked to swallow B. Tender tonsillar lymph nodes during a recent infection C. Trachea midline D. Persistent, fixed cervical lymph node and not movable on palpation.

Assessing the elderly patient's functional status begins as soon as the patient walks into the room. The 10-minute Geriatric Screener is one of several validated and time-efficient performance-based tools. All of the following are part of the three important areas except: a. cognitive b. psychosocial c. physical functions d. vital signs

At the clinic, the NP student instructs a COPD patient to use the pursed-lip method of breathing and evaluates the teaching by asking the patient about the purpose of this type of breathing. The nurse determines if the patient understands when the patient states that the primary purpose of pursed-lip breathing is to promote which outcome? Promote oxygen intake Strengthen the diaphragm Strengthen the intercostal muscles Promote carbon dioxide elimination

Bilateral vision loss can occur in all of the following except: a. macular degeneration b. cataracts c. glaucoma d. retinal detachment

Clarissa Darling is a 29-year-old female with a history of anxiety, asthma, and pollen allergy. She presents to the urgent care with shortness of breath (SOB), wheezing, and tachypnea while walking through a park and a gust of wind blew through it. Which of the following is an appropriate differential diagnosis for the patient? Allergic rhinitis Chronic bronchitis Pneumonia Asthma exacerbation

Josh, 45 years, came to the urgent unit complaining of right lower abdominal pain that migrates to the navel, combined with nausea, vomiting, and loss of appetite. During an abdominal assessment, the nurse elicits tenderness on light palpation in the right lower quadrant. The nurse interprets that this finding could indicate a disorder of which of these structures? a. Spleen. b. Diverticulitis. c. Appendix. d. Gallbladder.

Dave is a 50-year-old man, admitted for chest-pain and shortness of breath for one week, with elevated troponin levels. The cardiologist decides he would like to take to perform a cardiac catherization and would like to get and informed consent from the patient. Prior to gaining consent, the cardiologist must determine if the patient has decisional capacity. Which of the following is an element of decisional capacity? The clinician's intent to avoid causing harm to the patient. The clinician's commitment to preventing or treating disease in an act to do good. The clinician's duty to prevent the disclosure of patients' personal information to unauthorized parties. The clinician's assessment of whether or not the patient has the ability to communicate a choice, understand relevant information, and reason about treatment options.

During an assessment of a healthy adult, where would the Nurse Practitioner (NP) expect to palpate the apical impulse? A. Third left intercostal space at the midclavicular line B. Fourth left intercostal space at the sternal border C. Fourth left intercostal space at the anterior axillary line D. Fifth left intercostal space at the midclavicular line

During an interview, a patient said she has a functional change in frequency of bowel movement with change in stool form and appearance. She also said she has diarrhea and constipation pattern with abdominal pain that last for more than 6 months. The nurse practitioner knows that the patient most likely has which of the following diagnosis? mechanical obstruction inflammatory bowel disease colon cancer irritable bowel syndrome

During morning rounds, the NP walks into the patient's room to find the patient inconsolably crying and states she just found out her mother died from cancer that morning. Which of the following describes an empathic response from the NP? a. "Now I would like to examine you." b. "Don't worry. This too shall pass." c. "I will see you tomorrow." d. "I cannot imagine how hard this must be for you."

During the cardiovascular assessment, the point of maximal impulse (PMI) is clinically important to produce the apical impulse for checking some heart issues. An elder adult came to the clinic with COPD for a checkup. The APN starts to auscultate this patient and can possibly find where is the PMI palpable impulse located? Except. a. xiphoid b. epigastric c. not palatable d. right the 5th interspace

Gathering information from a patient during an interview can be overwhelming. As a novice, it's difficult to take note of everything the patient tells you verbatim. All the following are important except a.) Maintaining good eye contact during the interview b.) Jotting down specific details including dates, symptoms, or words the patient uses c.) Explaining to the patient that it is important that you take notes during the interview so they understand you might look down at times to write d.) Use your memory to collect all the information that can be later documented in the patient's chart

Gina a 34 year-old female patient comes into the clinic for her annual check up. The APRN is asking Gina questions regarding her heart health and general well being. The APRN recognizes which of the following as a risk health behavior or factor about Gina? Body mass index of 22 Non smoker Blood pressure 112/77 mm Hg Untreated total cholesterol 310

HEENT: normocephalic, atraumatic, PERRLA, extraocular muscles intact, anicteric sclera, no conjunctival pallor, mucus membrane moist, no oropharyngeal redness or tongue exudate. You will find this piece of information in which category? A Family History B Social History C Subjective Data D Objective Data

How should a nurse assess the radial pulse of a patient if the rhythm is irregular? 15 seconds and then multiplied by 4 20 seconds and then multiplied by 3 30 seconds and then multiplied by 2 count for full 60 seconds

J.D. is a 54-year-old male who comes into your clinic with a chief complaint of fatigue and shortness of breath when walking long distances or climbing stairs in the past few months. What part of the physical examination would be of importance to pay attention to? Checking the cranial nerves are intact and that the patient has all spinal reflexes. Auscultating the lungs bilaterally, listening for any adventitious lung sounds. Placing the patient in a dorsal recumbent position to inspect for jugular venous pulsations, palpating the carotid arteries, and listening for carotid bruits. Then palpating the apical impulse in high-fowler's position, auscultating each auscultatory area with the diaphragm and bell of the stethoscope. Placing the head of the exam table at 30 degrees to inspect for jugular venous pulsations, palpating the carotid arteries, and listening for carotid bruits. Then palpating the apical impulse and auscultating each auscultatory area with the diaphragm and bell of the stethoscope.

Jane is a 29 year old presenting to the ED with worsening chest pain. An EKG is ordered showing sinus tachycardia with PAC's and PVC's. She does not have much of a history and her co morbidities include pre diabetes, HTN and hypothyroidism. She mentions she had a tooth extraction about 2 weeks ago at her local dentist office. A TEE is performed and she's vegetation on the aortic valve leaflets.What part of her history or co-morbidity is the likely cause of the valvular disease? a. Pneumonia b. Pre-diabetes c. HTN d.Having a tooth extraction

Jeremy is a 42-year-old obese man who comes into the urgent care for sudden dyspnea. Jeremy states that he just came back from a long flight. He has a history of hypertension and smoking. What would be your best differential diagnosis? A) Anxiety B) URI C) CHF D) PE

Johnny is a healthy 40-year-old male with no known medical history who presents to your clinic for an annual exam. You are auscultating his breath sounds across his lung fields. What do you correctly identify as soft and low-pitched sounds heard through inspiration? a. Bronchovesicular b. Bronchial c. Tracheal d. Vesicular

Jon a 50 year old male, presents with pain in his epigatrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered? Myocardial ischemia Pancreatitis Peptic ulcer All of the above

Jon weighs 210 lbs and is 6ft tall. His BMI is 28.48. He would like to change his eating habits to promote healthy weight loss goals. Which of the following food sources should Jon avoid Nuts Salmon Sardines Hot Dogs

Jones is instructed to say "ee" but it sounds like "A". This voice transmission is identified as: a. Whispered pectoriloquy b. Pleural friction rub c. Bronchophony d. Egophony

June is a 45-year-old woman with a history of gallstones that presents with RUQ pain. You ask her to take a deep breath as you deeply palpate her RUQ. You ask her to take in a deep breath as you deeply palpate her gallbladder, and she holds her breath and grimaces. What do you interpret this finding as positive of? a. Psoas sign b. McBurney's sign c. Rovsing's sign d. Murphy's sign

Kate is a 6-year-old girl who was brought to the clinic by her mother because of exacerbated asthma. Which of the following from lung auscultation requires your emergent intervention? Fine crackles Wheezing Rhonchi The silent chest

Larissa is a 30 year old paralegal who has had intermittent lower abdominal pain approximately one week a month for the past year. Not related to her menses. She finds relief with defecation, and change in form and frequency of her bowel movements. Which of the following is most likely? Cholecystitis Inflammatory bowel disease Colon cancer Irritable bowel syndrome

Luke is a 25-year-old male with no significant past medical history. He presents to the Emergency Department reporting a gradual onset, right upper quadrant abdominal pain associated with nausea and vomiting. On physical exam, the Advance Practice Nurse (APN) noted a positive Murphy's Sign. Which cardinal technique of examination was utilized to obtain this finding? a) Inspection b) Auscultation c) Percussion d) Palpation

Mark is a 45-year-old male with no significant medical history and goes to his primary care office with a complaint of fatigue. Upon assessment, Mark states, "I don't have any energy; I can hardly get through the day." The APRN student interviewing Mark knows that all the following are true about fatigue, EXCEPT: a. Fatigue is a nonspecific symptom with many causes b. Fatigue is a normal response to hard work, sustained stress, and grief c. Fatigue is a common symptom of depression and anxiety d. Fatigue is the same thing as weakness or loss of muscle strength and power

Maya, a 20-year-old female, is preparing to go on a road trip to the Grand Canyon with her grandmother, Burma. At her most recent doctor's visit, Burma's visual acuity was 20/200. Based on this information, Maya should: A. Let Burma drive them to the Grand Canyon B. Let Burma borrow Maya's glasses for their drive to the Grand Canyon C. Perform a Cover/Uncover test on Burma D. Drive her and her grandmother to the Grand Canyon

Mr. A, a 75-year-old male with PMH of DM, CAD and hyperlipidemia presents to the clinic today with an unhealing wound on his left anterior lateral shin. You note there is discoloration to the legs bilaterally started at the shin, down to the ankles. You believe Mr. A may have peripheral vascular disease. What test do you expect the APRN to provide next? Order doppler study Perform the Rinne test Order an abdominal ultrasound Perform the ankle-brachial index

Mr. Alvarez is a 40 yr old male who came to you because he was feeling lethargic, excessively thirsty and urinating very often. Upon interviewing him, you discover he stopped taking his diabetic medication. How do you address this? A. Give him a new prescription to fill at the pharmacy and follow up in a month B. You hand him written education on the health risk of uncontrolled diabetes C. You call his wife to ask if she is aware that he stopped taking the medication D. Take the time to assess the Barriers that might be causing the non-adherence.

Mr. Bob presents to the clinic complaining of worsening wheezing upon expiration. He states taking a longer amount of time to recover from any form of activity now. The nurse practitioner observes purse lipped breathing and the corners of his lips look slightly pale/dusky. During the interview process Mr.Bob continues to complain more about a cough that has been present for a year now. The nurse practitioner discovers that Mr. Bob used to work in construction and had a side job of being an exterminator. The nurse suspects which of the following as a differential diagnosis: A. Asthma B. Emphysema c. Metastatic lung cancer d. COPD

Mr. Cruise is a 32 years-old male, who presents to Urgent Care for one day of a productive cough, fever, runny nose, and lethargy. The Family Nurse Practitioner (FNP) orders some tests including chest X-Ray. While analyzing the X-Ray, the FNP notices a bone mass on the left humerus. The patient denies any pain or discomfort, numbness, or tingling on the left arm. A neurovascular check of the arm reveals no abnormalities. What is the best action for the FNP to take? a. Refer the patient to Musculoskeletal Oncologist ASAP. b. No further action is needed; the incidental finding is not related to the present illness. c. Ask the patient if he has a family history of bone cancer. d. Inform the patient of what was incidentally discovered, and that it is too early to rule in or rule out any possible diagnosis with one simple chest X-Ray, and he needs to follow up with his Primary Care Provider for further work-up and referral if needed.

Mr. Evans is a 55-year-old truck driver, who presents with diffuse, progressive pain of bilateral lower legs. The FNP notes erythematous skin at the affected site, with some areas of brownish discoloration. Patient reports elevating the legs and walking somewhat alleviate the pain. What peripheral vascular disease should the FNP suspect? Raynaud Phenomenon Peripheral arterial disease (PAD) Deep vein thrombosis. (DVT) Chronic venous insufficiency

Mr. Gonzalez, a 50-year-old patient presents to the ER with chest pain. Mr. Gonzalez only speaks Spanish, and the NP speaks conversational Spanish. How should the NP proceed? A. Ask the patient's 15-year-old son to interpret. B. Ask the patient simple "yes or no" questions in English. C. Ask a Spanish-speaking phlebotomist in the room next door to interpret. D. Use the hospital medical interpreter service.

Mr. McCane is a 60 years-old male who presents to the GI clinic for constipation. He denies any bloody stools. He is also preparing for his colonoscopy for colorectal cancer screening that is scheduled in two weeks. He reports feeling anxious, fears that the biopsy result will be positive for cancer because his second uncle died of rectal cancer at the age of 53. How can the NP help Mr. McCane reduce his anxiety? a. Provide reassurance by telling him everything will hopefully be fine. b. Provide more information and statistics on colon cancer risks, incidence, and prevalence. c. Ask him about the previous biopsy results. d. Acknowledge his fears, use therapeutic listening to allow him to vent his feelings.

Mr. Rivas, a 55-year-old male with a history of DM, HTN, asthma, HLD, and obesity presents to the clinic complaining of excessive daytime sleepiness and daily headaches in the morning, despite sleeping for 8 hours each night. The NP knows that which of the following is NOT a risk factor for obstructive sleep apnea: A. Obesity B. Age C. Gender D. History of asthma

Mr. Smith is being screened for Tuberculosis at the clinic using the Tuberculosis Skin Test (TST). Which statement demonstrates an understanding by Mr. Smith. a. "This will screening will require that you draw blood from my vein" b. "If I develop an induration on my skin this means that I am negative for Tuberculosis" c. "I must return to the clinic in 24 to 72 hours to have my TB test read" d. "I must return 48 to 72 hours later to have my TB test read"

Mrs. D.G. a 48-year-old female is in your clinic for a physical exam today. She reports having COVID-19 three weeks ago. Mrs. D.G. further reports that her symptoms were "mild" comparable to allergy-like symptoms. Her chief complaint today is a residual cough. During her physical examination of the thorax and lungs, you perform the four classic techniques: Interview, palpation , and auscultation Interview, palpation, percussion, and auscultation Identify, palpation, percussion, and auscultation Inspection, palpation, percussion, and auscultation

Mrs. Good is a 70 years old woman with a history of COPD. She complained of coughing for five days. Her chest x-ray shows infiltration on the right lower lobe. Which of the following findings in your physical examination is not expected? Localized bronchophony in the right lower lobe from auscultation The right lower lobe is dull from percussion Fine crackles on the right lower lobe from auscultation The right lower lobe is tympanitic from percussion

Ms. Lane, a 42-year-old female who has a history of peripheral vascular disease (PVD), presents to the urgent care clinic reporting bilateral lower leg cramping pain which only occurs with exertion and resolves with rest. She denies any trauma, leg swelling, prolonged immobility, or history of thromboembolic disease. Based on this presentation, the Advanced Practice Nurse suspects this pain is due to: a) Bilateral leg strains b) Genetics c) Deep vein thrombosis d) Intermittent claudication

Niko is a 28-year-old bodybuilder with no significant medical history. He is very muscular, but his weight has increased by 3 pounds since his last visit one year ago. Niko expressed concern as he recently learned that his BMI of 30kg/m^2 is considered obese. As his primary care provider, you: a. Teach Niko that his obesity increases his risk for diabetes, hypertension, and cardiovascular disease b. Explain to Niko that he is considered obese only if his waist circumference is 35 inches or more c. Refer Niko to a cardiologist as his increase in weight may be due to heart failure d. Explain to Niko that he is unlikely obese given his exercise routine, muscle mass, and waist circumference less than 40 inches

Parker is a 32-year-old male s/p intubation for acute respiratory failure. After endotracheal tube insertion, a stat CXR was ordered to assess for placement. Meanwhile, the NP listened to the lung sounds bilaterally, where she heard diminished left lung sounds and clear right lung sounds. CXR results demonstrate ETT is positioned within the right bronchus. What generalization can the NP deduce about ETT placement? a. ETT tube placement is expected. b. The ETT should be pushed down even further. c. Remove the ETT and put the patient on a non-rebreather. d. The ETT is advanced distal to its optimal position.

Patient A.G. is a 48-year-old male, presenting to the clinic for a physical. He has history of cardiovascular disease and endocarditis. The Nurse Practitioner auscultates the heart sounds and hears a late crescendo systolic murmur with an associated systolic click. What might this indicate? A normal finding in athletes The turbulent flow in aortic stenosis The turbulent flow across incompetent semilunar valves The turbulent flow of mitral valve prolapse

Patient ER, a 24 year old female comes into the clinic with unexplained weight loss. This patient reports losing weight despite the fact that she's been consuming a relatively high food intake. According to a general survey and initial differential diagnosis prior to further testing, what diseases would these symptoms suggest? (A) Hypothyroidism, malnutrition (B) Anorexia, hyoptension (C) Cardiac failure, pulmonary failure, liver failure (D) Diabetes mellitus, hyperthyroidism, malabsorption

Patient HW, a 56 year old female came into the clinic for gradually increased blurry vision. Patient has a BMI of 30.2 and has a history of hypertension, hypercholesteremia, diabetes mellitus type 2, and restless leg syndrome. Upon examination of the fundus, you notice cotton wool spots. You know that cotton wool spots are indicative of: (A) Conjunctivitis (B) Acute angle closure glaucoma (C) Subconjunctival hemorrhage (D) Diabetic retinopathy

Patient LR, a 22 year old male, presents to the ER after getting hit in the chest with a baseball. You notice that the patient is short of breath, is speaking in broken up sentences, he is tachycardic, and hypotensive. Upon CXR, you notice that his right lung is completely white out. Given the patient history and presentation, what would you diagnose him with? Spontaneous pneumothorax Tension pneumothorax Pneumonia Hemothorax

Patient TL, a 44 year old male comes into the clinic with a cough and palpitations. Upon a 12-Lead EKG examination, you notice a convex rhythm with ST elevation in both leads II and III. What diagnosis could this be indicative of? Myocarditis Gastritis Myocardial infarction Pericarditis

Patient is on a Heparin drip for DVT. The previous two PTT levels are 88 and 90 which has been in the therapeutic range. When it was time for the next PTT level, the RN notifies the NP of critical level PTT 200. How should the NP respond? Stop the heparin drip immediately Stop the heparin drip for 2 hours and restart it at the same rate Continue the heparin drip but decrease the heparin rate by half Draw a PTT level stat, make sure the nurse draws the blood sample from the opposite arm of the heparin infusion

Primary hypertension is the most common cause of hypertension. All of the following are risk factors except Age Black race Weight gain Cushing Syndrome

Q3. Which example below is an example of abnormal thought process "derailment" (loose association)? A. Speech that is incomprehensible and illogical, lack meaningful connection. B. Repetition of words and phrases of others. C. Sudden interruption of speech in mid-sentence or before the idea is completed. D. Tangential speech with shifting topics that are loosely connected or unrelated.

Select the correct order of the abdominal examination: A. Palpation, auscultation, percussion, inspection B. Inspection, palpation, percussion, exclamation C. Percussion, palpation, auscultation, inspection D. Inspection, auscultation, percussion, palpation

Several patients come into the clinic with various weight concerns. Weight change can be indicative of an underlying problem. Which of the following patients requires further investigation and follow up? A 28-year-old male with a baseline weight of 200 lb. loses about 5% of his body weight within 6 months due to changes in diet & exercise regimens A 65-year-old menopausal woman with a baseline weight of 145 lb. gains about 5% in about 6 months A 36-year-old female with a baseline weight of 160 lb. unintentionally lost about 10 lb. in one year A 44-year-old male with a baseline weight of 250 lb. lost about 15% of his total body weight in 3 months with light modification to his diet

Smith is a 67-year-old gentleman who has a history of 10 year plus of poorly controlled type 2 diabetes. He has a history of missing his appointments. Today, he came to your clinic with a complaint of blurry vision and black spots. All of the following interventions are appropriate to the patient except: Perform a comprehensive history and physical examinations Order laboratory including chemistry and hemoglobin A1C Refer him to a dietician, endocrinologist, and ophthalmologist Prescribed an eye drop and instruct him to follow up in 2 weeks.

Sustained nystagmus within the binocular field of gaze is often seen in all of the following EXCEPT? A patient with a phenytoin drug overdose. A patient with ocular albinism. A patient with a cerebellar injury. A patient medicated with baclofen 5mg PO three times a day.

The APN has conducted discharge teaching with a patient diagnosed with tuberculosis who has been receiving medication for 2 weeks. The APN determines that the patient has understood the information if the patient makes which statement? "I need to continue medication therapy for 1 month." "I cannot shop at the mall for the next 6 months." "I can return to work if a sputum culture comes back negative." "I should not be contagious after 2 to 3 weeks of medication therapy."

The APRN is auscultating the lung fields of a 50-year-old patient who came into the clinic with complain of crackle sounds while he breaths. While auscultating the patient's lungs, the APRN can auscultate crackle sounds. After asking the patient to cough and clear the crackles, the APRN no longer can auscultate the crackles. Which of the following if the most likely etiology? Heart failure Pneumonia Cystic fibrosis Bronchitis

The APRN needs to be aware that certain medications could cause permanent hearing loss. While precepting a new APRN she will further educate the new APRN if she makes the following statement? a) Gentamicin could cause permanent hearing loss. b) Cisplatin could cause permanent hearing loss. c) Carboplatin could cause permanent hearing loss. d) Lasix, NSAIDS, and quinines could cause permanent hearing loss.

The Advanced Practice Nurse (APN) conducted a comprehensive physical exam on a patient and is now formulating an assessment and plan. The APN knows all of the following are tips to ensure quality patient data EXCEPT: a) Ask open ended questions and listen carefully to the patient story b) Keep an open mind toward patient and clinical data c) Analyze any mistakes between data collection or interpretation d) Assume the patient is lying about social history if the patient is part of a lower socioeconomic population

The Advanced Practice Nurse (APN) is conducting an eye exam of the fundus. When inspecting the optic disc, what finding may indicate an increased intracranial pressure? a) The arteries and veins are visualized b) The physiologic cup is visualized c) The optic disc is unable to be evaluated unless the ophthalmoscope lens is adjusted until the image is sharp d) There are no evidence of spontaneous venous pulsations (SVPs)

The Advanced Practice Nursing student is reviewing lung anatomy and physiology in preparation for board exams. The student recognizes that pleuritic pain is secondary to: a) Anxiety from prolonged stress related to board exams b) Ischemia from Myocardial Infarction (MI) c) Irritation of the lower esophageal sphincter (LES) due to acid reflux d) Irritation of the parietal pleura which is richly innervated with phrenic and intercostal nerves

The FNP is assessing a patient with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of ulcer? a. Bradycardia b. Numbness in the extremities c. Nausea and vomiting d.A rigid, board-like abdomen

The FNP is examining a 73-year-old Asian male who is being seen for nutritional deficiency. With throat and oral cavity assessment, the FNP notes the right soft palate failing to rise and the uvula deviating to the left. What does this finding suggest? Fusobacterium necrophorum pharyngitis. Exudative tonsillitis Cranial Nerve XII (Hypoglossal nerve) lesion Cranial Nerve X (Vagus nerve) paralysis

The Family Nurse Practitioner student is performing an interview on 80-year-old woman in the primary care providers office. The FNP gathers that the patient's preferred pronouns are he/him/his. Later in the interview, the FNP refers to the patient with the pronouns her/hers/she and the patient politely corrects the FNP. Recommend which response is the BEST response to this mistake? Ignore it, and continue to conduct the interview. The FNP should overstate how terrible he/she feels about making the mistake. The FNP should state, "This is too confusing for me, I think you should go with she/her/hers to make it easier on everyone else." The FNP should state, "I apologize for using the wrong pronoun. I did not mean to disrespect you" and continue to conduct interview.

The NP distinguishes which of the following as a chief complaint? a. 18-year-old female positive for gonorrhea in 2018 b. 52-year-old female whose mother died of ovarian cancer c. 45-year-old male who occasionally smokes tobacco and marijuana d. 29-year-old complaining of left lower quadrant pain for the past six hours

The Nurse Practitioner (NP) has documented a diagnosis of legal blindness in the client's chart. The Snellen's chart test results expecting to note which of the following? 20/20 vision 20/40 vision 20/60 vision 20/200 vision

The Nurse Practitioner (NP) is establishing a plan of care for a 54 year-old patient during a routine office visit for follow-up for management of his Congestive Heart Failure. The NP knows that a critical aspect of formulating a plan to ensure patient adherence is: Planning care and time around the NP's availability and convenience Ensuring that the treatment options are affordable for the patient Involving the family in the plan of care Clearly discussing each assessment item, including the patient's preferences, and encouraging active patient participation during the decision-making process.

The Nurse Practitioner is palpating the chest wall during a regional cardiac physical examination. Using the ball of his right hand, he firmly presses on the chest wall across the precordium. He feels a vibratory sensation in the left sternal border, right intercostal space. What does this possibly indicate? An extra S3 beat, from rapid deceleration of blood against the ventricular wall. An extra S4 beat, due to ventricular stiffness A normal finding A thrill, which is also associated with an auscultated murmur due to turbulent flow

The Nurse Practitioner is providing education regarding auscultation of heart sounds to a student. Further education is needed when the student states which of the following? "Closure of the mitral valve produces the heart sound S1" "Closure of the aortic valve produces the heart sound S2" "To listen to the aortic valve, I should auscultate the right 2nd interspace to the apex" "To listen to the Mitral valve, I should auscultate at or near the lower left sternal border"

The clinician is performing a physical assessment on a 50-year-old man with poorly controlled diabetes and hypertension. He states he has noticed gradual vision changes in his right eye, leading to mild blurriness. The clinician documents the following objective data: Left fundoscopic exam reveals sharp disc margins, no hemorrhages. Right fundoscopic exam reveals mild retinopathic changes. Left eye vision: 20/20. Right eye vision: 20/40. Describe what the clinician saw upon examination of the right eye fundus with an ophthalmoscope: Healed Chorioretinitis Drusen Preretinal Hemorrhage Soft Exudates: Cotton-Wool spots

The clinician understands that an abdominal aortic aneurysm chances for rupture drastically increase when the diameter exceeds which measurement? 4.5mm 2mm 3.5mm 5.5mm

The correct anatomical location for chest tube insertion to drain a right-side pleural empyema is: a. 2nd ICS b. 4th ICS c. Between the 7th and 8th ICS d. Between the 4th and 5th ICS

The diagnosis of tuberculosis does not need to be reported when The patients Mantoux test shows an induration of 10mm An outbreak of tuberculosis is suspected A patient shows a positive chest x-ray for pulmonary tuberculosis The patient has a Mantoux test with redness and no induration.

The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that finding indicates? a. Decrease fluid volume. b. Increase cardiac output. c. Narrowing of the jugular vein. d. Elevated pressure related to heart failure.

The following descriptions are about the sounds during events in the cardiac cycle. Which of the following is NOT true? S1 is the first heart sound that indicates the closure of the mitral valve. S2 indicates the sound of aortic valve closure. Maximal left ventricular pressure corresponds to systolic blood pressure. S3 indicates a pathologic change in ventricular compliance in children and young adults.

The following information is recorded in the health history progress note: "No known heart disease or high blood pressure. Patient denies dyspnea, orthopnea, chest pain, and palpitations". The student APRN understands that this information should be recorded in which category of the health history? a. Physical examination b. Assessment and plan c. Past history d. Review of systems

The following information is recorded in the health history: "The patient completed 8th grade. She currently lives with her husband and three children. She works as a receptionist during the week. She does yoga on her spare time." Which category does it belong to? A. Present illness B. Chief complaint C. Review of Systems D. Personal and social history

The nurse asks I would like to ask you some questions about your health and your usual daily activities so that we can better plan your stay here. This question is found at the phase of the interview process. a. Summary b. Closing c. Body d. Opening or introduction

The nurse is aware that ptosis is a condition that caused because of damage in which CN? A) CN IX B) CN II C) CN VII D) CN III

The nurse practitioner (NP) is visiting with a 68-year-old male patient on the telemetry unit. While obtaining the health history, the patient informs the NP that he has a history of heart murmurs. Upon physical examination, the NP hears the murmur at the cardiac apex. Where does the murmur most likely originate from? Aortic valve Pulmonic valve Tricuspid valve Mitral valve

The nurse practitioner is assessing a 25-year-old male with right ear pain and tenderness. No drainage noted on exam. How does the nurse practitioner correctly assess the patient's right ear using the otoscope? A) Straighten the right ear canal, grasping the auricle firmly but gently, pulling it upward, forward, and slightly toward the head. B) Straighten the right ear canal, grasping the auricle firmly but gently, pulling it downward and forward. C) Straighten the right ear canal, grasping the auricle firmly but gently, pulling it downward and backward. D) Straighten the right ear canal, grasping the auricle firmly but gently, pulling it upward, backward and slightly away from the head.

The nurse practitioner is examining a 52-year-old female with a history of deep vein thrombosis (DVT). The patient is currently being treated with Warfarin. The nurse practitioner knows that certain herbs, medications, drinks, and food can decrease the effectiveness of Warfarin. The nurse practitioner determined learning has occurred if the patient states which of the following? A) "I can take St. Johns Wart occasionally to help me sleep". B) "I can continue to drink green tea in the mornings to start my day". C) "I can incorporate green leafy vegetables such as kale into my juices to help me lose weight and live a healthier lifestyle". D) "I'll cut down on my alcohol intake".

The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition? a. Percuss and palpate in the lumbar region. b. Inspect and palpate in the epigastric region. c. Auscultate and percuss in the inguinal region. d. Percuss and palpate the midline area above the suprapubic bone.

The patient presented to the clinic with the complaint of epigastric pain after a meal, difficulty swallowing, and experience regurgitation of food or sour liquid. Upon the collection history, the NP learns that the patient works the evening shift and she eats dinner at 11 pm right before she is going to bed. What problem the NP suspect on the patient: A. Gastric cancer B. Acute appendicitis C. Acute diverticulitis D. Gastroesophageal Reflux Disease (GERD)

The patients comes in to the sleep lab for a polysomnography. Which of the following will determine the severity of Obstructive Sleep Apnea? a. Breathing cessation for > 15 seconds and breathing flow reduction for > 15 seconds accompanied by oxygen desaturation or sleep arousal. b. Breathing cessation for > 10 seconds. c. Breathing flow reduction for > 15 seconds accompanied by oxygen desaturation or sleep arousal. d. Breathing cessation for > 10 seconds and breathing flow reduction for > 10 seconds accompanied by oxygen desaturation or sleep arousal.

The student nurse practitioner is assessing an 18-year-old who came into clinic for a chief complaint of purulent nasal discharge, nasal obstruction, and facial pain. What would be a positive finding in your assessment to prove patient is experiencing an acute sinus infection? a. Hearing loss b. Epistaxis c. Nasal polyps d. Frontal/maxillary sinus tenderness on palpation

The use of appropriate language in clinical can improve the effectiveness of the encounter and enhance patient rapport. Which of the following is the best demonstration? Refer a patient who uses methamphetamine regularly as a "drug abuser" Ask a patient "Does your chest pain radiate?" Call a quadriplegic patient "the disabled" Use the term "person with short stature" on Turner syndrome patient

Tina is a 56-year-old woman with a history of aortic regurgitation who presents to the ED with palpitations over the last two days. You are performing an assessment of her pulses and note her radial pulses are 3+ bilaterally. What would you grade her pulses as? a. Absent, unable to palpate b. Diminished, weaker than expected c. Brisk, expected (normal) d. Bounding

Tito is a 45-year-old male who has had 3 rounds of radiation treatment therapy for small cell lung carcinoma. He states he has been increasingly sad and depressed because both his feet and toes are swollen, feel stiff when he touches them, but no ulcers. He is also very fatigued and has no appetite. Based on these signs and symptoms, the NP classifies which of the following as what he is experiencing? a. High blood pressure b. Chronic venous insufficiency c. Peripheral arterial disease d. Lymphadenopathy

Tywin is a 66-year-old male who loves to watch America's Got Talent and eat tasty snacks, moreover, he has been diagnosed with diabetes 28 years ago. His wife and children admit that he is not the most compliant with his medications. Today he comes in the ER disoriented and breathing rapidly, what is your diagnosis and identify his breathing pattern? ARDS due to sepsis Shortness of breath due to pneumonia DKA - Cheyne-Stokes DKA - Kussmaul breathing

Under a SOAP note, you write the following for a patient with atrial fibrillation: Monitor on telemetry, continue home medication, follow up EKG, ICD interrogation. You will find this information under which category? A Subjective B Objective C Assessment D Plan

Up to March 19, 2022, COVID-19 has caused 421,716,638 cases and 5,874,048 deaths worldwide; 78,423,525 cases and 934,321deaths in the USA. People who have severe underlying medical conditions seem to be at higher risk for developing more serious complications. Which of the following conditions may be associated with this high risk for severe disease, Except? Hypertension Cystic fibrosis Cerebrovascular disease Allergic rhinitis

Upon assessing Mr. Smith's eyelids, the practitioner notices drooping of the upper lid in one eye. What is the term used to describe drooping of the upper lid. A. Entropion B. Ectropion C. Exophthalmos D. Ptosis

Upon reviewing a HPI of a patient you are about to see, it currently says: "ST is a 48 year old male with stabbing intermittent upper right quadrant abdominal pain with a severity rating of 7/10 that started this morning. Patient states, 'It gets worse with activity,' and denies any relief from Tylenol intake." With the attention to chronology, what elaboration of the chief complaint is this current HPI missing? A. Location B. Quantity or Severity C. Timing D. Associated Manifestations

What are the steps and proper sequence of the clinical encounter between NP and patient? A. Explaining/planning, initiating the encounter, gathering information, performing the physical examination, and closing the encounter B. Initiating the encounter, performing the physical examination, gathering information, explaining/planning, and closing the encounter C. Gathering information, initiating the encounter, performing the physical examination, explaining/planning, and closing the encounter D. Initiating the encounter, gathering information, performing the physical examination, explaining/planning, and closing the encounter

What finding is a concerning red flag in need of immediate, emergent evaluation? A patient reads a Snellen chart, but can only read greater than half of the third line Upon pressing on the patient's lacrimal sac, mucopurulent fluid is discharged from the puncta. Upon bringing a pencil close to a patient's nose, the eyes converge and the pupils constrict. The patient reports seeing flashes of bright light and fixed floaters in the field of vision, but denies any pain.

What information is most accurate regarding a nurse's understanding of pain experienced by non-verbal or comatose patients? Comatose patients will come out of a coma and tell you if they are in real pain. Non-verbal or comatose patients must be medicated round the clock, so they don't experience pain. There is no way to tell when a non-verbal or comatose patient experiences pain, so the nurse shouldn't concern themselves. Facial expressions, vital signs, signs of agitation, and withdrawing quickly are all signs a nurse can use to assess and manage a patient's pain.

What is the quality of the abdominal pain that is most suggestive of acute bowel obstruction? A. Steady, deep, nonspecific and intractable B. Intermittent pain that resolves by itself C. Longstanding persistent and unrelieved pain D. Cramping, colicky pain relieved by hydration

What should you say to a person who was just recently released from prison during a physical assessment using nonstigmatizing language? Thug Criminal Ex-Felon Formerly incarcerated

When conducting a comprehensive patient assessment, the provider will include all of the following information EXCEPT: History of present illness Family history Review of Systems Differential diagnosis

When considering ordering an imaging test, the Advanced Practice Nurse (APN) considers appropriateness criteria (AC). The APN knows AC was developed primarily to: a) Prioritize patients who have insurance b) Increase patient satisfaction scores c) Increase billable services to patients d) Grade the risk/benefit ratio of an imaging test to determine if it is in the patient's best interest

When inspecting a patient's tongue, the family nurse practitioner (FNP) asks the patient to stick out her tongue. What findings should the FNP be concerned about? Appearance of fissures on the tongue Appearance of papillae on the tongue Tongue tip at midline Tongue protruding to the right side

When percussing the lungs, how would you document the following sounds: Loud intensity, high-pitch, long duration, similar to percussing puffed-out cheeks? Flat Resonant Dull Tympanic

When performing a physical examination, the nurse practice starts to palpate the lymph nodes. Which lymph nodes might not be palpable? A.Tonsillar B. Occipital C.Submental D. Deep cervical chain

Which answer choice describes a grade 6/6 systolic murmur? Equal in volume to S1 and S2, quiet, but heard immediately Louder in volume than S1 and S2 with a thrill, may be heard with the stethoscope partly off of the chest Louder in volume that S1 and S2, moderately loud Louder in volume than S1 and S2 with thrill, may be heard without a stethoscope

Which breath sound is defined by soft and low pitched, heard throughout inspiration, and heard over most of both lungs? Bronchovesicular. Bronchial. Tracheal. Vesicular.

Which deformity of the thorax is accompanied by long term COPD? Pigeon chest. Funnel chest. Traumatic flail chest. Barrel chest.

Which description of crackles typically suggests abnormal lung tissue? Crackles that are cleared after coughing. Crackles are best heard in the posterior inferior lung fields. Crackles that appear in early inspiration and last throughout expiration have a popping sound and do not vary with body position. Crackles that are fine late inspiratory that persist from breath to breath.

Which finding is most concerning upon the Nurse Practitioner's assessment of a 25-year-old female patient coming in for a comprehensive physical examination? The Nurse Practitioner performs a Rinne test with a tuning fork. The patient hears the sound of the tuning fork held next to her ear for a longer period than when the tuning fork's base is placed on the mastoid bone behind her ear. Upon inspection of the ear canal with an otoscope, the Nurse Practitioner finds a nontender nodular swelling covered with normal skin, deep in the ear canal. Upon inspection of the tympanic to the malleus. A raised nodule is found on the dermis of the auricle; telangiectatic vessels are seen on the lesion.

Which is an example of an appropriate and sufficient summary statement in the NP's documentation? J.D. is a 35-year-old female with a history of uterine fibroids. The patient presents to with a chief complaint of vaginal bleeding. J.D. is a 35-year-old female with a history of uterine fibroids, found in incidental CT scan 5 years ago. The patient believes she might be pregnant and presents with vaginal bleeding. J.D. is a 35-year-old female who present to the emergency department for vaginal bleeding. J.D. is a 35-year-old female with a history of uterine fibroids who presents to the emergency department for vaginal bleeding. She denies knowledge of pregnancy at this time and is G2P2 with 2 living children. She states her menstrual cycle is regular, with this bleeding starting 15 days after her last menstrual cycle and seems to be "a lot of bleeding". On examination, she is tachycardic and normotensive, with no discoloration of her skin or general appearance.

Which of the following describes Carotid pulsations? A) Rarely palpable B) Pulsations eliminated by light pressure on the vein just above the sternal end of the clavicle C) height of pulsation usually falls with inspiration D) Palpable

Which of the following diagnoses best represents pleuritic chest pain, cough, sputum, fever? Chronic bronchitis. Left sided heart failure. Asthma. Pneumonia.

Which of the following is Chronic Pain? Pain not associated with cancer or other medical conditions that persists for more than 3 to 6 months Pain lasting more than 1 month beyond the course of an acute illness or injury Pain recurring at intervals of months or years All of the Above

Which of the following is NOT a good way to interview challenging patients? Always remember the importance of listening to the patient even when interviewing silent patients. Determine whether a patient has "decision-making capacity." Make every effort to find a trained interpreter when a patient has a language barrier. Make questions as long as possible.

Which of the following is NOT a major cardiovascular risk factor? A. Cigarette smoking B. Atrial fibrillation C. Diabetes D. High HDL levels

Which of the following is NOT the most relevant health history question when suspecting a patient with peripheral artery disease? Do you have leg pain on exertion and rest? Do you notice hair loss over your lower legs? Do you have any poorly healing or nonhealing wounds of the legs? Do you feel short of breath when you are lying down in bed?

Which of the following is an emergency finding on a 6-month-old baby? Wheezing Diffuse rash on the body Inward curve of the fontanelle Stridor

Which of the following is not a cause of mononucleosis? CMV HIV Toxoplasma gondii Influenza virus

Which of the following is not a reason for ordering diagnostic tests? Ordering a thyroid-stimulating hormone test and T4 to reach a diagnosis. Ordering lactic acid, BMP, and CBC frequently for the septic patient. Ordering an A1C in 50 y/o symptomatic patient on first patient visit. Ordering antibody testing after recent vaccination to determine immunity.

Which of the following patients have a risk factor for iron deficient and pernicious anemia? a) A patient who is taking a daily multivitamin b) A patient who is on a carnivore diet c) A patient who is emotionally stressed during graduate school d) A patient who is a vegetarian and also on a proton pump inhibitor (PPI)

Which of the following patients most likely has peripheral arterial disease (PAD)? Bill, who is a snowboarding instructor who is c/o numbness and tingling in his fingertips. Jill, who is pregnant and is c/o diffuse aching of the legs and swelling. Pain is relieved by walking. Thomas who has had a recent MI and is c/o sudden onset pain and numbness in the leg and foot. Peter who has a history of smoking and is c/o brief calf muscle pain and numbness that is relieved by rest.

Which of the following source of history is NOT considered a reliable source? A husband of a 68-year-old woman who was diagnosed with mild Alzheimer's last year A psychiatric consultant who has had regular sessions with the patient for the past 2 years A patient who presents to the emergency room suffering from a broken ankle A man who was waiting for his turn in the clinic

While assessing your patient's iris, you shine light directly from the temporal side. You notice a crescentic shadow on the medial side of the iris. Based on this observation, which of the following diagnoses are you considering? Esotropia Exotropia Open angle glaucoma Narrow angle glaucoma

While auscultating heart sounds on a 7-year-old child for a routine physical examination, the nurse hears an S3, a soft murmur at the left midsternal border, and a venous hum when the child is standing. What would be a correct interpretation of these findings? S3 is indicative of heart disease in children. These findings are indicative of congenital problems. The venous hum most likely indicates an aneurysm. These findings can all be normal in a child.

While doing chest percussion on a patient, you noticed dullness over the bases of both lungs. Knowing that a healthy lung is resonant, what condition can cause this type of abnormal percussion? a. Large pleural effusion b. COPD c. Large pneumothorax d. Lobar pneumonia

While evaluating what pain scale is best for each patient, the student nurse understands that the Wong-Baker Faces Pain Rating Scale is best for all these patients except? A) Cognitive impaired B) Children C) Patients with a language barrier D) Blind patients.

While examining a patient with a long history of COPD, the nurse practitioner should be alarmed if: The AP ratio is 1.0 The forced expiratory time is 10 seconds The patient states "I get short of breath if I walk for more than 10 mins" An audible stridor sound during inspiration is heard over the neck

While examining a patient with the otoscope, the tympanic membrane appears to be scarred with no visible landmarks, a reddened ring of granulation tissue is seen. All of the following might be associated with this condition EXCEPT: Earache and hearing loss Vertigo Yellow-green drainage from the ear Air bubbles seen within the amber fluid

William, a new FNP student, is doing a health assessment on an elderly patient at a clinic. While doing cardiac auscultation, he heard some cardiac murmurs. Being a student, what would be the best practice of William? a. Stop his assessment and ask his instructor to confirm that what he listened was right in front of the patient. b. William tells his patient that he heard some murmurs and will request a cardiac consultation. c. Tell the patient that murmurs are common for elderly patients and nothing to worry about unless he has any symptoms. d.William should continue his assessment and, in the end, request his instructor to confirm what he heard was right in private before making any conclusions.

Write a recommendation for your 55-year-old, female, obese patient (BMI 35) on steps to promote weight loss. Establish a realistic weight loss goal, walk 30-60 minutes 5 days of the week, gradually decrease calorie intake until you reach a total calorie deficit of 500-1000 kilocalories Have the patient pick a weight loss goal and stick to a strict low-calorie diet to avoid exercise Exercise 2 hours a day in addition to portion-control and fasting for 14 hours Have the patient start a ketogenic diet due to fast results and follow up in 3 weeks to ensure the patient is complying to diet

You are able to hear a systolic murmur during a patient assessment. Which grade would you categorize a palpable thrill? 1/6 2/6 3/6 4/6

You are assessing a 15-year-old asthmatic patient who presents in distress and difficulty breathing. Upon evaluation and auscultation of his lungs, you note that wheezing and breath sounds are absent. You: a. Continue with assessment b. Assume he used his Albuterol inhaler, which opened up his airways c. Provide education about inhaler use d. Understand the patient is experiencing "silent chest"

You are assessing a 54-year-old man that complains of a chronic cough. Out of all of his comorbidities, which comorbidity is most likely NOT contributory comorbidity to the patient's cough? Post-nasal drip Asthma GERD Allergic rhinitis

You are conducting an exam on your patient with Wilson disease. Which of the following eye exam abnormalities would you expect to see related to this disease process? A thin grayish white arc or circle close to the edge of the cornea An opacity of the lens visible through the pupil A superficial grayish white opacity in the cornea A golden to red brown ring in the periphery of the cornea

You are doing a physical examination on your patient. While palpating the lymph nodes of the neck, you noticed an enlargement of the supraclavicular lymph node on the left side; what does it suggest? Tonsilitis Thyroiditis Parotiditis Metastasis from a thoracic or abdominal cancer

You are examining an obese female patient with a BMI of 45. On examination, you pay particular attention to her distribution of fatty tissue, and you notice most of her adipose tissue is concentrated around her abdomen and torso. Based on this assessment finding, you know the patient is most at risk for which of the following? a. Constipation b. Inguinal Hernia c. Obstructive Sleep Apnea d. Metabolic Syndrome

You are observing your patient who has heart failure who is sleeping when you notice he has periods of deep breathing that alternate with periods of apnea. How would you document this finding? A) Ataxic breathing B) Sighing respirations C) Obstructive breathing D) Cheyne-Stokes breathing

You are performing the peak expiratory flow rate (PEFR) test for assessment of the severity of airflow obstruction on your asthmatic patient in the clinic. Which of the following peak flow would indicate that the patient has severe airway obstruction? Peak flow 500 Peak flow 300 Peak flow 150 Peak flow 99

You are the nurse practitioner seeing a 60-year-old male who has a history of smoking, atherosclerosis, hypertension, hyperlipidemia, CAD, and history of other aneurysms at a yearly check up. You recognize he is at risk for abdominal aortic aneurysm rupture (AAA), what would be the best imaging to order for this patient to screen for AAA? a. CXR b. CT Scan c. MRA d. Abdominal ultrasound

You missed an assignment deadline and failed a physical assessment quiz because your boss asked you to come in on a day that you are off due to "extremely short" staffing. She told you she'd pay you an extra hour and buy you some Panda Express and also "your review is this week and you've been doing great!" In all of the following cases, you are likely to hear dullness on percussion, except a. Consolidation b. Atelectasis c. Pleural effusion d. pneumothorax

Your 45-year-old female patient arrives in the office complaining of a persistent dry cough that started a month ago and that has been increasingly productive over the last five days. Last month, she was prescribed Zestril to help control her high blood pressure. She' an international journalist who just returned from an assignment in Afghanistan, she reports kicking off her blankets at night despite a/c, and sometimes sees a little blood when she's brushing her teeth. She is not short of breath and does not have chest pain. Her current vitals are 141/80; HR 84; RR20, T: 101.3; O2 SAT 96%. What would be a key pertinent negative when making a diagnosis in this case? A. Recent travel to Afghanistan B. Night sweats C. Hemoptysis D. Dyspnea

Your 65-year-old female patient with a recent trip to India to visit family has a positive tuberculin skin test (TST). She is asymptomatic, denying night sweats, chills, cough, or fever. What is the most appropriate thing to say to this patient? a. "Immediately isolate yourself and come see me in 1 month." b. "You need to go to the hospital immediately." c. "Since you're feeling well, just go home and take it easy." d. "You are not contagious, but we do need to start treatment to prevent you from getting active tuberculosis."

Your nursing instructor witnessed your patient interview in which you almost never looked up from the computer and kept typing as the patient was speaking. Afterward, she commented that you need to practice more active listening. Active listening means the following A. Jogging in place while looking at your watch B. Attempting to feel the patient's pain as your own and responding in a supportive manner C. Asking your patient more yes/no type questions D. Closely attending to what the patient is communicating

Your patient is a 43 year old artist who's chief complaint is chest pain. He's now telling you a story about how a new York hipster couple was just arrested for trying to launder billions in stolen bitcoin. Your mind drifts... you feel a tinge of regret not jumping at the opportunity to buy bitcoin when you first heard about it in 2014. You are now mentally shopping with the billions you do not have, but then, the patient says, "...and my pain increases when I take a deep breath during yoga." You remember that this pain is associated with pleural inflammation and consider all of the following differential diagnoses, except A. Pneumonia B. Pulmonary embolism C. Autoimmune disease D. Acid reflux

Your patient is intubated and begins to cough up clear mucous inside their ETT. What should you do next? Inspect their oral cavity and suction mouth Instill normal saline to lavage ETT Sit the patient up to 30 degrees in bed Provide 100% oxygenation and prepare to suction

ext, you palpate Ms. Smith's chest wall and identify the apical impulse and the point of maximal impulse. Which of the following component may not obscure detection of the apical impulse? a. BMI b. AP diameter of the chest c. Muscular chest wall d. Age

During a routine wellness visit, you notice the patient is saying confusing and bizarre things such as, "my bellybutton feels like a walnut reindeer... does the Virgin Mary discombobulate dream daylights?" What's best to consider when further interviewing this patient? A. The possibility of a psychiatric or neurologic disorder B. The patient may not be a reliable historian and it's best to move on to the physical part of the assessment and to ask their caregiver or another informed source about pertinent history. C. Ask the patient to rephrase their response and tell them that they are not making any sense D. It's a sprain, definitely a sprain... E. A and B

Ms. Jones is a 17-year-old who presents to the clinic complaining of severe cough. You have known the patient since she was born, and her last visit was 6 months ago. What question is NOT appropriate for a nurse practitioner to ask while assessing her? "Is the cough lasting less than 3 weeks, or lasting 3 to 8 weeks, or more than 8 weeks?" "Is the chough dry?" "How much do you think you cough up in 24 hours: a teaspoon, tablespoon, or half cup?" "Please cough into this tissue, if possible." "Do you exercise regularly?"

During expiration the diaphragm contracts true or False a. True b. false

FALSE

A 73-year-old female patient s/p mitral valve replacement (mechanical valve) has had a difficult time maintaining a therapeutic INR. She has had supratherapeutic results that has required admittance to the hospital. If the patient stated that her diet comprised greatly of which foods, would require patient education? A) Garlic and ginkgo B) Ginseng and St. John's wort C) Red wine and carrots D) Chicken and yogurt

When assessing a patients lungs, the nurse recalls that the left lung: Consists of two lobes. Is divided by the horizontal fissure. Primarily consists of an upper lobe on the posterior chest. Is shorter than the right lung because of the underlying stomach.

Michaela 43-year-old woman came into your urgent care for annual health exam. Upon admission you asked questions regarding Michaela's daily lifestyle behaviors. She informs you that her family has a history of heart diseases. You the Nurse Practitioner recognizes which of the following health behavior requires further education? Not smoking Body mass index over 30.0 Eating around 2,000 calories a day Drinking 1L of water daily

One method a nurse practitioner can use to establish patient rapport would be A) Avoid first names, instead, use overly familiar names such as "dear" and "sweetie" B) Establish preferred names and gender pronouns C) Provide an environment with soft classical music D) Ask caregivers for clarification instead of the patient

Which statement about the apices of the lungs is true? The apices of the lungs: Are at the level of the second rib anteriorly. Extend 3 to 4 cm above the inner third of the clavicles. Are located at the sixth rib anteriorly and the eighth rib laterally. Rest on the diaphragm at the fifth intercostal space in the midclavicular line (MCL).

You are about to begin palpating the Thyroid Gland using the posterior approach. Which of the following is the first step that outlines the posterior approach to palpation of the Thyroid glad? Dim the light to the room and make sure the patient is lying in prone position Ask the patient to flex the neck slightly forward Place the fingers of your right hand on the patients neck so that your ring finger are just above the cricoid cartilage Ask the patient to sip and spit water in a cup

A 13-year-old female and her mom arrive for a clinic visit where you as the nurse practitioner notice that the mom is answering all of your questions instead of the patient. At this time, what would be the best actions? A) Continue with your assessment B) Ask open-ended questions and make eye contact with the patient C) Acknowledge mom's concerns but ask that she step out while you speak with the patient alone. D) Call security and have mom removed

A 65-year-old male patient with peripheral vascular disease presents to preop with results from POCT (point-of-care testing) that revealed unusual CBC results. As the reviewing clinician, what are your next steps?A) Assume the results are correct and treat accordingly B) Call a rapid response C) Have the bedside RN redraw the CBC and send to lab stat D) Chart review the patient's most recent vital signs

A patient that is wheelchair bound comes to see you. What can the NP do to make them feel comfortable? A) Propel the wheelchair from the waiting area to the examination room B) Speak loudly and clearly so that they can hear you C) Make sure there is a clear path of access to the room D) Separate the patient from their personal wheelchair into the hospital's wheelchair

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of: Adventitious sounds and limited chest expansion. Increased tactile fremitus and dull percussion tones. Muffled voice sounds and symmetric tactile fremitus. Absent voice sounds and hyperresonant percussion tones.

Jones is a 50year-old male, who visits you in the office today complaining of pain in his lower back that feels like "pins and needles", and the pain is constant. He stated the onset of this pain occurred 4 months ago when he felt a sudden and sharp stabbing pain in his back while lifting a heavy box at work. Mr. Jones works as a contractor and states the pain is very "bothersome" and affects his work. Select the correct name of the pain the patient is describing. Somatic Pain Phantom Pain Neuropathic Pain Visceral Pain

Michelle a 28-year-old woman with a history of murmurs, present at the ED with shortness of breath for the past 24hours. You are performing an assessment of her cardiac system and noted on auscultation that her murmur is loud, with palpable thrill. What would you grade her murmur as? Grade 6 Grade 5 Grade 4 Grade 3

Jon calls the clinic regarding his mother who is 60 years old and is now living in an apartment independently. He does have a nurse visit his mother everyday for a few hours, however, he would like to get some tips for home safety for older adults. You would advise Jon all of the following, except? Remove items that cause tripping like papers, books, clothes and shoes from and walkways Store medications safely Install hand rails and lights on all staircases. Keep a step stool nearby common items in cabinets that are hard to reach

Mr. Bavarsad, a 35-year-old male patient presents to the clinic complaining of cough for 1 month. A cough lasting for 1 month is classified as: A. Acute B. Temporary C. Chronic D. Subacute

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