BOARD PRACTICE QUESTIONS - TEST 4

Rank the following cancers according to mortality rate (highest to lowest) in adults (all ages/genders). 1. 2. 3. 4. A. Colorectal cancer B. Pancreatic cancer C. Lung cancer D. Breast cancer

C1, A2, B3, D4. According to the American Cancer Society, the cancer with the highest mortality in adults (all ages/genders) is lung and bronchus cancer, followed by colorectal, pancreatic, and breast cancers. CancersRank Mortality Rate in Adults (All Ages/Genders) from Highest (1) to Lowest (4)A. Colorectal cancer1. C) Lung cancerB. Pancreatic cancer2. A) Colorectal cancerC. Lung cancer3. B) Pancreatic cancerD. Breast cancer4. D) Breast cancer

The nurse practitioner is reviewing evidence regarding the use of a drug used to treat Parkinson's disease. Rank the strength of evidence from strongest (1) to weakest (3). 1. 2. 3. A. An editorial that discusses how the drug may impact the advancement of Parkinson's treatment, published in the official journal of the American Academy of Neurology B. An experimental study of 300 patients with Parkinson's disease who were randomly assigned to receive either a placebo or the drug daily for 12 months C. A meta-analysis that evaluates the effectiveness of the drug, using 25 randomized controlled trials found on MEDLINE and the Cochrane database

Solution: C1, B2, A3. A meta-analysis study has the highest level of evidence and is considered the gold standard for gathering research evidence for evidence-based practice. Experimental studies are the second level of evidence, and expert opinions and editorials are the lowest level of evidence.

The nurse practitioner is going to prescribe levothyroxine (Synthroid) to an elderly patient with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease. What is the appropriate initial dose for this patient? A. 12.5 mcg/day B. 50 mcg/day C. 25 mcg/day delayed until after thyroid surgery D. 100 mcg initiated before thyroid surgery

Solution: A 12.5 mcg/day. Older patients and patients with cardiac disease should begin with an initial dose of 12.5 mcg/day. The dosage is increased at 2- to 4-week intervals until 100 mcg/day is reached. This slow titration prevents further cardiac stress. Younger patients would be started on the usual maintenance dose of 25 to 50 mcg/day. Patients with Hashimoto's thyroiditis do not require surgical intervention.

What dietary guidance will the nurse practitioner provide to a patient newly diagnosed with celiac disease? A. Avoid all gluten-containing foods indefinitely B. Eat wheat breads sparingly C. Avoid all milk and dairy products D. Consume pasta in moderation

Solution: A Avoid all gluten-containing foods indefi nitely. Persons with celiac disease must avoid gluten and gluten-containing cereals and foods throughout their lifetime. Wheat and pasta contain gluten and must be avoided. Milk and dairy products are gluten-free.

A chest radiograph shows an area of consolidation on the lower lobe of the lung. Which of the following conditions is most likely? A. Bacterial pneumonia B. Acute bronchitis C. Chronic obstructive pulmonary disease (COPD) D. Atypical pneumonia

Solution: A Bacterial pneumonia. Pneumonia is an inflammatory condition of the lung especially affecting the alveoli. It is associated with fever, chest symptoms, and consolidation on a chest x-ray. Infectious agents include bacteria, viruses, fungi, and parasites. Consolidation is not present in the lungs with bronchitis, COPD, or atypical pneumonia.

The nurse practitioner is examining a child with Down syndrome brought to the clinic with flu-like symptoms. The caregiver offers conflicting information about the source of bruises on the child's buttocks. The child is quiet and reserved. Which criterion is most important for the nurse practitioner to consider when evaluating this patient? A. Explanation of the injury is inconsistent with the presentation B. The behavior of the child during the assessment C. The hygiene of the caregiver D. Unexplained bruises are common in children with Down syndrome children

Solution: A Explanation of the injury is inconsistent with the presentation. Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. Children who are developmentally or physically disabled are at a higher risk for abuse. The behavior of the child may also suggest child abuse but is a less reliable indicator, since the child has a disability. The hygiene of the caregiver and the fact that the child has Down syndrome (and may have a predisposition for bruising) are less reliable indicators of abuse.

When teaching an overweight prehypertensive 16-year-old patient about the importance of potassium, magnesium, and calcium in the diet, which dietary guidelines will the nurse practitioner recommend? A. Four or five servings of fruits and vegetables a day B. Lean red meats twice a day C. Three servings of beans and legumes a day D. Omega-3 oils daily

Solution: A Four or five servings of fruits and vegetables a day. Calcium is found in low-fat dairy products, and potassium is found in most fruits and vegetables. Several servings of beans are recommended each week, not several times daily. Reduction of red meat consumption is advised. Omega oils (fatty acids) are nutrients that are shown to assist in the prevention of heart disease; they are not minerals.

Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is contraindicated in which of the following conditions? A. Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia B. Lead poisoning C. Beta thalassemia minor D. B12 deficiency anemia

Solution: A Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia. G6PD deficiency is a hereditary condition that occurs when the red blood cells break down, causing hemolysis, because of absence or lack of sufficient G6PD, an enzyme that is needed to help the red blood cells work efficiently. Certain foods and medications may trigger this reaction. Some of the medications include antimalarial drugs, aspirin, nitrofurantoin, nonsteroidal anti-inflammatory drugs (NSAIDs), quinidine, quinine, and sulfa medications.

A 45-year-old female presents with complaints of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) of 0.02 mU/L, T3 of 253 ng/dL, T4 of 20 g/dL, and 6-hour radioactive iodine uptake (RAIU) of 85%. Which diagnosis is most likely? A. Graves' disease B. Hashimoto's thyroiditis C. Primary hypothyroidism D. Multinodular goiter

Solution: A Graves' disease. Graves' disease, an autoimmune disease that causes hyperthyroidism, is most prevalent in middle-aged females. Symptoms include rapid weight loss, anxiety, and insomnia. The patient may experience cardiac symptoms (e.g., palpitations, hypertension) and ophthalmopathy. Labs show low TSH (<0.5 mU/L) and elevated serum-free T4 and T3. A 6-hour RAIU shows diffuse uptake (goiter). In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, RAIU is low (≤2%). A multinodular goiter will show an uptake in the high-normal range (3%-10%).

Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia? A. Hemoglobin electrophoresis B. Bone morrow biopsy C. Peripheral smear D. Reticulocyte count

Solution: A Hemoglobin electrophoresis. Patients with the diagnosis of beta thalassemia and/or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.

A patient complains of nausea, vomiting, abdominal pain, and cramping 2 days after returning from an international vacation. Upon assessment, the nurse practitioner finds an elevated temperature but otherwise normal vital signs. Which diagnosis is most likely? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

Solution: A Hepatitis A. Hepatitis A is transmitted by the fecal-oral route. It is associated with international travel and high fever. Hepatitis B, C, and D are transmitted via blood products and body secretions.

A 42-year-old obese male presents to the clinic with a history of recurrent heartburn. He is diagnosed by the nurse practitioner with gastroesophageal reflux disease (GERD). Which of the following drug classes is preferred initially to treat symptoms of GERD? A. Histamine-2 receptor antagonist B. Proton pump inhibitor C. Antibiotic D. Antiviral

Solution: A Histamine-2 receptor antagonist. A histamine-2 receptor antagonist (H2 receptor antagonist ) is the initial drug considered in treating a patient with GERD whose symptoms are not responding to lifestyle changes. If a patient's symptoms do not respond to the H2 antagonist, the next step is a trial of a proton pump inhibitor.

The nurse practitioner is educating a new patient with Raynaud's phenomenon about lifestyle recommendations to decrease exacerbations of the disorder. Which of the following lifestyle changes would not be useful for this patient? A. Increasing consumption of caffeine-containing drinks and foods, such as chocolate B. Wearing gloves or mittens during cold weather and being careful when handling frozen foods C. Quitting smoking and exercising at least three times a week D. Decreasing emotional stress and lifestyle stressors

Solution: A Increasing consumption of caffeine-containing drinks and foods, such as chocolate. Lifestyle changes associated with decreasing exacerbations are wearing gloves or mittens during cold weather, taking care when handling frozen foods (wear gloves), avoiding vasoconstricting agents (caffeine, smoking, cocaine, amphetamines), and reducing emotional stress. Exercise and reducing lifestyle stress are recommended. Raynaud's disease usually involves the fingers and/or toes because of severe arteriolar vasospasm causing ischemia. During an exacerbation, the fingers change color, becoming white, blue, and red (think of the American flag as a reminder). Raynaud's is classified either as primary (Raynaud's disease) or secondary (Raynaud's phenomenon). Individuals with secondary Raynaud's have a higher risk of autoimmune disorders, such as scleroderma, Sjögren's syndrome, and systemic lupus erythematosus. The disorder affects mostly young women (ages 15-30 years).

The nurse practitioner is examining an 82-year-old male patient and notes that his penile gland and foreskin are inflamed. A reddened, moist macular lesion is present on the prepuce. The patient is being treated for a urinary tract infection with amoxicillin. The nurse practitioner will: A. Obtain a swab of the lesion for a potassium hydroxide (KOH) prep B. Prepare the patient for a needle biopsy of the lesion C. Obtain a serum sample for a rapid plasma reagin test (RPR) D. Prescribe 0.05% betamethasone cream BID × 4 weeks

Solution: A Obtain a swab of the lesion for a potassium hydroxide (KOH) prep. The patient has symptoms associated with balanoposthitis. Fungal infections, specifically candida infections, are commonly associated with the use of antibiotics and are the most common identifiable infectious etiology associated with balanoposthitis. Therefore, the nurse practitioner will obtain a swab of the lesion for a KOH preparation to confirm the diagnosis of a fungal infection. There is no indication the client requires a biopsy to determine the cause of the eruption. An RPR test is used to screen for syphilis; the patient does not present with a chancre-type lesion or other findings consistent with syphilis. Prior to prescribing a 0.05% betamethasone cream, the nurse practitioner will confirm the causative agent associated with the diagnosis, as it can promote the exacerbation of a fungal infection.

A second triple screen on a 35-year-old primigravida reveals abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient? A.Order an ultrasound B.Order a CT scan of the abdomen C.Order a 24-hour urine for protein clearance D.Assess for a history of illicit drug or alcohol use

Solution: A Order an ultrasound. Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be ordered to further evaluate the fetus for characteristics of Down syndrome and/or fetal demise.

A middle-aged male was the sole survivor of a fatal car crash that occurred 3 years ago. After a long recovery, he returned to his job but reports nightmares and visions of the crash. He reports excessive drinking to deal with these recurrent flashbacks, and his lack of sleep and drinking have caused him to miss a significant amount of work. Which drug class is first-line treatment for this patient? A. Selective serotonin reuptake inhibitors (SSRIs) B. Antimanic mood stabilizers C. Monoamine oxidase inhibitors (MAOIs) D. Tricyclic antidepressants (TCAs)

Solution: A Selective serotonin reuptake inhibitors (SSRIs). The patient is experiencing posttraumatic stress disorder (PTSD). PTSD occurs after an exposure to a traumatic event and often causes nightmares, recollection of the event, and feelings of helplessness and hopelessness. The first-line prescriptive treatment for PTSD is an SSRI. Antimanic mood stabilizers (e.g., lithium) are used to treatmanic episodes such as those experienced with bipolar disorder. MAOIs are used to treat depression and anxiety disorders that are not responsive to other medications. TCAs are used to treat depression and chronic pain disorders.

What is an abnormal assessment finding in a male newborn at 39 4/7 weeks' gestation? A. Smooth scrotum B. Pendulous scrotum C. Increased scrotal pigmentation D. Smegma beneath the prepuce

Solution: A Smooth scrotum. An infant at 39 4/7 weeks' gestation is considered term newborn. The presence of a smooth scrotum is associated with prematurity. Scrotal rugae and a pendulous scrotum are anticipated newborn assessment findings for a male infant's genitalia. Increased scrotal pigmentation is an incidental finding associated with ethnicity and can also be familial. The presence of smegma beneath the prepuce is normal assessment finding.

When evaluating the blood pressure on both the arms and legs of an infant who has a diagnosis of coarctation of the aorta, which of the following is the correct finding? A. The blood pressure is higher in the arms than in the legs B. Only the diastolic blood pressure is higher in the legs than in the arms C. The blood pressure is higher in the legs than in the arms D. The blood pressure is lower in the arms than in the legs

Solution: A The blood pressure is higher in the arms than in the legs. In coarctation of the aorta, blood pressure is higher in the arms than in the legs because of the narrowing in the aorta. Blood pressure must rise to get adequate blood flow to the lower extremities; therefore, the blood pressure above the coarctation rises to compensate for this.

A positive Coombs test on an Rh-negative pregnant woman means: A. The mother has autoantibodies against Rh-positive red blood cells (RBCs) B. The fetus has autoantibodies against Rh-negative RBCs C. The mother does not have Rh factor antibodies D. The fetus does not have Rh factor antibodies

Solution: A The mother has autoantibodies against Rh-positive red blood cells (RBCs). The mother's autoantibodies can attack the fetus's Rh-positive RBCs and cause destruction of these cells, which can cause severe anemia and complications in the fetus. Today this is preventable with the administration of anti-RhD immunoglobulin (Rho[D] immune globulin) to an Rh-negative mother at 28 weeks' gestation and after birth if the newborn is Rh positive.

Upon assessment of a patient, the nurse practitioner notes several small, smooth, and round papules on the abdominal area. These papules are bright red and blanchable with pressure. Which of the following is a true statement regarding the findings? A. The lesions are cherry angiomas, which are benign and require no treatment B. The lesions are lipomas, which require surgical excision C. The lesions are acrochordons, which can be treated with steroids D. The lesions are actinic keratosis, which must be biopsied

Solution: A These lesions are cherry angiomas, which are benign and require no treatment. These small lesions are cherry angiomas. A cherry angioma is a smooth, cherry-red bump on the skin. Although cherry angiomas usually appear on the trunk of the body, they can occur nearly anywhere. The cause of cherry angiomas is malformed arterioles in the skin, and the growths usually appear on people over the age of 40. Lipomas are soft, fatty cystic tumors usually located in the subcutaneous layer of the skin. They can be located on the trunk and are round or oval in shape. They measure 1 to 10 cm. Acrochordons, or skin tags, are painless outgrowths of the patient's skin and therefore are the same color as the patient's skin. Actinic keratosis presents as a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck.

When an infant is found to have tufts of fine dark hair on the sacrum, which of the following tests is recommended? A. Ultrasound of the sacrum B. Plain radiograph of the lumbar sacral spine C. No imaging test is necessary D. Genetic testing

Solution: A Ultrasound of the sacrum. An infant with tufts of fine dark hair on the sacrum should be evaluated for occult spina bifida. The first imaging test to order is an ultrasound of the lower spine.

A 4-year-old child presents with a red, swollen, painful blister-type lesion on his lower back, fever of 101°F, and vomiting for 24 hours. His mother reports that the child was playing with a box of toys that were brought down from the attic the day before. The nurse practitioner will: A. Wash the lesion and apply antibiotic cream B. Prescribe tazarotene 0.1% cream C. Apply hydrocolloid and silver-impregnated dressings D. Prescribe doxycycline 100 mg BID × 10 days

Solution: A Wash the lesion and apply antibiotic cream. The history indicates the probability that the child was bitten by a brown recluse spider living in the box from the attic, as spiders prefer dark places to hide. The bite should be washed with soap and water and then treated with an antibiotic cream. A poisonous spider bite generally will form a blister (eschar) and then ulcerate. It can take several weeks to heal. Tazarotene cream is a retinoid prescribed for psoriasis. Hydrocolloid and silver-impregnated dressings are used to treat burns. Doxycycline is first-line treatment for the tick-borne diseases Rocky Mountain spotted fever and Lyme disease, which are generally contracted outside the house.

A 13-year-old male patient complains of chronic low-back pain persisting for more than 3 months and hip joint pain that keeps him up at night. He has a temperature of 99.4°F. Which of the following would help confirm a diagnosis? (Select all that apply.) A. MRI B. X-ray C. HLA-B27 D. C-reactive protein E. Erythrocyte sedimentation rate (ESR)

Solution: A, B, C, D, E MRI; x-ray; HLA-B27; C-reactive protein; erythrocyte sedimentation rate (ESR). These symptoms are consistent with ankylosing spondylitis (AS), which is believed to be a genetically inherited autoimmune disorder that occurs most often in young men. It is an inflammatory disease that, over time, can cause some of the small bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. There is no single conclusive diagnostic test for AS. Diagnostics includes MRI and x-ray to assess for changes in joints and bones. HLA-B27 is a genetic marker present in 95% of those with the disorder. C-reactive protein and ESR are indicators of inflammation; however, they are not present in all AS patients.

Peak expiratory flow is calculated using which factors? (Select all that apply.) A. Height B. Age C. Weight D. Gender E. Body mass index (BMI)

Solution: A, B, D Height, age, gender. Peak expiratory flow is calculated using the mnemonic HAG: Height, Age, and Gender.

A 37-year-old male presents for a follow-up visit after a recent positive HIV diagnosis. Another staff member at the clinic asks the nurse practitioner if she can read the patient's chart, as the patient is the cousin of a friend. What is the responsibility of the nurse practitioner? (Select all that apply.) A. The nurse practitioner should inform the staff member of the patient's right to privacy B. The nurse practitioner should not provide the chart to the staff member C. The nurse practitioner should remind the staff member not to share the HIV status with anyone D. The nurse practitioner should ask the staff member to sign a waiver to maintain confidentiality after reviewing the chart E. The nurse practitioner should report the incident to the supervisor

Solution: A, B, E The nurse practitioner should inform the staff member of the patient's right to privacy; the nurse practitioner should not provide the chart to the staff member; the nurse practitioner should report the incident to the supervisor. Under the Health Insurance Portability and Accountability Act (HIPAA), personal health information may not be used for purposes that are not related to healthcare. The staff member is not providing healthcare to the patient and should not have access to the chart. A supervisor should be informed, who will then report the infraction to the proper authorities. The obligation of the nurse practitioner is to protect the patient and all patient information.

The cytology (Pap smear) results for a 35-year-old woman reveal a high-grade squamous intraepithelial lesion (HSIL) of the cervix. The human papillomavirus (HPV) test is positive for the type 16 strain. Place each action in chronological order by dragging it to the correct location. 1. 2. 3. A. Colposcopy B. Loop electrosurgical excision procedure (LEEP) C. Cervical biopsy

Solution: A1, C2, B3. HPV strains 16 and 18 are highly oncogenic. This patient has cervical cancer and requires immediate biopsy, excisional treatment, and staging for cervical cancer. The correct order of these actions is as follows: (1) Refer the patient for a colposcopy, (2) obtain cervical biopsy specimens for pathologic evaluation, and (3) perform LEEP for removal of cancerous cervical tissue.

A 49-year-old male sustains burns to both the legs, abdomen, and chest that have manifested as painful blisters. What is the total percentage of body surface area for this superficial partial-thickness burn? A. 46% B. 54% C. 72% D. 36%

Solution: B 54%. The calculation is based on the rule of nines for the body surface of an adult: 9% for each arm and the head, and 18% for each leg, anterior trunk, or posterior trunk. For children, it is 9% for each arm, 14% for each leg, and 18% for anterior trunk or posterior trunk.

A middle-aged adult reports rhinitis and an ice-pick headache behind the left eye. The patient has a body mass index (BMI) of 20.1, FEV1% of 63%, and a C-reactive protein (CRP) level of 3.7 mg/L. The nurse practitioner will: A. Administer 100% oxygen at 12 L/minute by mask B. Administer a dose of sumatriptan (Imitrex) by injection C. Administer a dose of verapamil (Calan) orally D. Advise patient to engage in stress-relieving activities

Solution: B Administer a dose of sumatriptan (Imitrex) by injection. The patient likely has a cluster headache. The best intervention to treat this patient's cluster headache is to administer sumatriptan (Imitrex) by injection or nasally. According to the BODE (body mass index, oximetry, dyspnea, exercise) index score, the patient has chronic obstructive pulmonary disease (COPD) and should not receive oxygen at high doses (e.g., 12 L/minute via mask) because it will shut down the breathing center in the brain. The patient's CRP level is slightly elevated at 3.7 mg/L (normal is <3 mg/L), indicating an inflammatory process. Verapamil (Calan) PO daily is prescribed for maintenance therapy. Stress-relieving activities are important for the treatment of muscle tension headaches.

A 7-year-old child presents at the clinic with pain in the wrist after falling at recess. Upon examination, the nurse practitioner identifies pain to be more prominent on the side of the thumb area. X-ray of the wrist appears normal. The nurse will do all of the following, except: A. Apply a thumb spica splint B. Administer a steroid injection C. Refer patient to a hand surgeon D. Repeat wrist x-ray in 2 weeks

Solution: B Administer a steroid injection. Symptoms represent a navicular fracture, which is notable for pain on axial loading of the thumb. This can be caused by falling with an outstretched hand to break the fall. The best treatment plan is to apply a thumb spica splint and refer to a hand surgeon for further examination. Initially the x-ray may appear normal, but in 2 weeks it probably will show a scaphoid fracture. Administering a steroid injection is not recommended for this injury, as movement can exacerbate the injury. Immobilization is the proper treatment.

The nurse practitioner is assessing a new 55-year-old male patient who has smoked cigarettes for 30 years. He is now occasionally coughing up blood-tinged sputum and experiencing increased dyspnea and dull, achy chest pain that does not resolve. The nurse practitioner will order a: A. Lung/tumor biopsy B. Chest radiograph C. CT scan D. Bronchoscopy

Solution: B Chest radiograph. Chest radiograph to detect nodules, lesions, or irregular borders would be ordered first. If lesions are noted, a CT scan is ordered, and the patient is referred to a pulmonologist for additional assessment to include a bronchoscopy and lung biopsy.

Which type of fracture is referred to as the dinner fork fracture? A. Navicular fracture B. Colles' fracture C. Axial fracture D. Scaphoid bone fracture

Solution: B Colles' fracture. The Colles' fracture is the most common type of wrist fracture and is referred to as the dinner fork fracture because of the appearance of arm and wrist fracture. The navicular fracture is located on the anterior portion of the thumb as a scaphoid fracture. The axial fracture is not a type of fracture. Axial refers to the bones of the central axis of the body.

When assessing an infant during a well-baby visit, the nurse practitioner notes pale and damp skin, fussiness, and shortness of breath. There is a delay of the femoral pulse when compared with the brachial pulse. To confirm diagnosis, all of the following should be ordered, except: A. Echocardiogram B. Complete blood count C. EKG D. Chest x-ray

Solution: B Complete blood count. Based on exam findings, the nurse practitioner suspects coarctation of the aorta. An absence or delay of the femoral pulse compared with the brachial pulse is considered diagnostic. To further confirm diagnosis, an echocardiogram, EKG, and chest x-ray should be ordered. A complete blood count is not diagnostic for coarctation of the aorta.

There is a higher risk of balanitis in which of the following conditions? A. Renal insufficiency B. Diabetes mellitus C. Graves' disease D. Asthma

Solution: B Diabetes mellitus. Balanitis is a yeast infection of the glans of the penis. Men who are not circumcised and who have diabetes mellitus are at higher risk for developing balanitis.

The nurse practitioner is examining a 4-year-old child who is experiencing nausea, lethargy, fever, and loss of appetite. The child attends day care, and several other children in the facility have experienced similar symptoms. Blood tests reveal the child is positive for IgM antibodies and negative for IgG antibodies. Which diagnosis is most likely? A. Hand-foot-mouth disease B. Hepatitis A C. Kawasaki disease D. Influenza

Solution: B Hepatitis A. The hepatitis A virus is transmitted primarily via the fecal-oral route—i.e., when an uninfected person ingests food or water that has been contaminated with the feces of an infected person. Transmission can occur when an infected person, or someone caring for an infected person, does not use proper hand hygiene while preparing food. Children who attend day care are at risk of hepatitis A infection because of poor hand hygiene and sanitation practices. Labs that are positive for IgM antibodies and negative for IgG antibodies confirm hepatitis A. Hand-foot-mouth disease is a common, acute viral illness caused by the coxsackievirus. Kawasaki disease presents with high fever, enlarged neck lymph nodes, conjunctivitis, peeling skin on hands and feet, and a swollen, red tongue. Influenza, also called "the flu," is a highly contagious viral infection of the respiratory system. It causes a high fever, body aches, cough, and other symptoms. Most children are ill with the flu for less than a week.

The mother of a 16-year-old boy is concerned that her son is not developing normally. On physical exam, the patient is noted to have small testes with no pubic or facial hair. What is the most appropriate statement to the mother? A. Her son is developing normally B. Her son's physical development is delayed and should be evaluated by a pediatric endocrinologist C. Her son should be rechecked in 3 months; if he still does not have secondary sexual characteristics, a thorough hormonal workup should be initiated D. Her son's physiologic development is slower than normal but is within the lower limit of normal for his age group

Solution: B Her son's physical development is delayed and should be evaluated by a pediatric endocrinologist. Puberty may be delayed for several years and still occur normally, in which case it is considered constitutional delay, a variation of healthy physical development. Delay of puberty may also occur due to malnutrition, many forms of systemic disease, or defects of the reproductive system (hypogonadism) or the body's responsiveness to sex hormones. Hypogonadism occurs when the sex glands produce little or no hormones. In men, these glands (gonads) are the testes. A 16-year-old male without secondary sexual characteristics should be referred to an endocrinologist. If there is no testicular development by 14 years of age, an endocrinology consult is warranted.

What does a positive posterior drawer sign signify? A. Normal knee B. Instability of the knee C. Swelling on the knee D. Injury to the meniscus

Solution: B Instability of the knee. The drawer test is used to identify mediolateral or anteroposterior plane instability of the knee. The test is performed on the unaffected and affected knee for comparison. The anterior drawer test evaluates the anterior cruciate ligament (ACL). To perform the test, the patient lies supine, and the knee is placed at 90-degree flexion. Grasp the posterior aspect of the tibia over the upper calf muscle; then, with a steady force, try to push the lower leg forward and backward. Anterior or posterior movement of the knee is positive. With the leg extended, stabilize the femur with one hand and the ankle with the other. Try to abduct and adduct the knee. There should be no medial or lateral movement.

The nurse practitioner diagnoses a child with measles after observing which signs? A. Hairy leukoplakia B. Koplik's spots C. Boggy turbinates D. Enlarged parotid gland

Solution: B Koplik's spots. One of the classic symptoms of measles is Koplik's spots, groups of small-sized red papules with white centers in the cheeks. The other signs include fever, rash, red eyes, and sneezing. Oral hairy leukoplakia is related to secondary infections from HIV and is caused by the Epstein-Barr virus (EBV). Boggy turbinates would be found in allergic rhinitis, in addition to an itchy nose and congestion. An enlarged parotid gland is more indicative of mumps.

A computer programmer reports tingling and numbness of the thumb, index finger, and middle finger bilaterally. The patient is diagnosed with carpal tunnel syndrome. All of the following interventions will be included in the initial treatment plan, except: A. Wrist splinting at night B. Physical therapy C. Glucosteroid injections D. Occupational therapy

Solution: B Physical therapy. Initial therapy for a patient with carpal tunnel syndrome includes wrist splinting at night, glucosteroid injections, and occupational therapy. The next level of interventions before surgery is physical and ultrasound therapies to reduce pressure around the median nerve.

A 68-year-old male presents with a sudden onset of headache with right-sided eye pain and blurred vision. He states he is seeing halos around lights. On examination, the nurse practitioner notes the right eye is fixed with a mid-dilated, cloudy pupil that reacts slowly to light. Which diagnosis is most likely? A. Subconjunctival hemorrhage B. Primary angle-closure glaucoma C. Pterygium D. Pinguecula

Solution: B Primary angle-closure glaucoma. The symptoms are consistent with those of primary angle-closure glaucoma, which is a sudden blockage of the aqueous humor. Primary angle-closure glaucoma causes marked increase of intraocular pressure and can cause permanent damage to the optic nerve. A subconjunctival hemorrhage occurs when blood is trapped under the conjunctiva and sclera. It is painless. A pterygium is a painless, yellow, triangular thickening of the conjunctiva that extends across the cornea on the nasal side. A pinguecula is a painless, yellowish, raised growth on the conjunctiva next to the cornea.

High-grade squamous interepithelial lesions (HSILs) were found in a Pap specimen for a 26-year-old patient. The nurse practitioner will: A. Test the specimen with a potassium hydroxide slide B. Refer the patient for loop electrosurgical excision procedure C. Refer the patient for colposcopy with cervical biopsy D. Administer vaccination for human papillomavirus (HPV)

Solution: B Refer the patient for loop electrosurgical excision procedure. HSILs are likely to be associated with precancer and cancer. If they are found in patients aged 25 years or older, the patient should be referred for immediate excisional treatment by LEEP or cervical conization surgery. A potassium hydroxide slide is useful in the diagnosis of fungal infections. Colposcopy is appropriate for HSIL found in younger women (aged 21-24). Quadrivalent recombinant vaccination can prevent HPV, which is associated with cervical cancer, but once the patient has HSIL, administration of the vaccination would not be useful.

Which type of exercise would you recommend to a 65-year-old arthritic patient who complains of a new onset of a painful, swollen left knee caused by overworking in the garden for 2 days? A. Quadriceps-strengthening exercises of the left knee followed by the application of cold packs for 20 minutes QID B. Rest the joint and apply cold packs intermittently for the next 48 hours C. Passive range of motion and cold packs D. A cool tub bath with warm packs on the knee to avoid stiffening of the joint

Solution: B Rest the joint and apply cold packs intermittently for the next 48 hours. New onset of a painful, swollen left knee (inflammation) should be treated using RICE: Rest the knee/joint, use alternating Ice packs for the first 24 to 48 hours, use Compression if knee feels unstable, and Elevate the limb to decrease swelling.

Puberty begins during which Tanner stage? A. Tanner stage I B. Tanner stage II C. Tanner stage III D. Tanner stage IV

Solution: B Tanner stage II. Puberty is defined as the period in life when secondary sexual characteristics begin to develop, identified as Tanner stage II for boys and girls.

What effect does finasteride (Proscar) have on prostate-specific antigen (PSA) levels in patients with prostate cancer? A. Finasteride does not have an acute effect on the PSA B. The chronic effect of finasteride is the stabilization of the PSA C. When using finasteride for long-term management, the PSA will be doubled D. An increase in PSA within the normal range may occur with the use of finasteride

Solution: B The chronic effect of finasteride is the stabilization of the PSA. The chronic effect of using finasteride to treat prostate cancer is the stabilization or gradual decline of the patient's PSA. An acute effect of the finasteride on PSA is a reduction, rather than an increase, of approximately 50%. Any increase in PSA is a concern, even if the value is within a normal range.

Which of the following is not an absolute contraindication for use of oral contraceptive pills? A. Active hepatitis A infection B. Thrombosis related to an intravenous (IV) needle C. Undiagnosed vaginal bleeding D. Transient ischemic attack (TIA)

Solution: B Thrombosis related to an intravenous (IV) needle. Thrombosis related to either a known trauma or an IV needle does not represent a contraindication for use of oral contraceptives.

What type of breath sounds are best heard over the base of the lungs? A. Fine breath sounds B. Vesicular breath sounds C. Bronchial sounds D. Tracheal breath sounds

Solution: B Vesicular breath sounds. Vesicular breath sounds are heard best over the base of the lungs. Vesicular sounds are soft and/or blowing and heard throughout inspiration and fade away with expiration. Bronchial sounds are heard over the bronchi, the largest tubes in the anterior chest. Sounds are loud and high pitched. Tracheal breath sounds are heard over the trachea. They sound harsh and similar to air being blown through a pipe.

A nurse practitioner working in a community health clinic sees a male patient who expresses concern about starting a homosexual relationship with a new partner. Which of the following is the best plan to follow during this visit? (Select all that apply.) A. Contact the patient's partner to schedule HIV testing B. Educate the patient about using barrier devices during sex C. Prescribe daily oral PrEP D. Draw a blood sample for a combination HIV antigen/antibody test E. Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP

Solution: B, D, E Educate the patient about using barrier devices during sex; draw a blood sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested.

A patient has a past medical history of chickenpox (childhood), which provided what type of immunity? A. Herd immunity B. Passive immunity C. Active immunity D. No immunity

Solution: C Active immunity. Active immunity is acquired by vaccination administration or by infection. Passive immunity is when the antibodies are obtained from another host. Herd immunity occurs when large numbers of the population are resistant to a disease.

A 62-year-old woman complains of chronic severe low-back pain. She also reports mild episodes of fecal incontinence and numbness to her lower legs over the past week. The nurse practitioner suspects which of the following conditions? A. Fracture of the lower spine B. A herniated disk C. Cauda equina syndrome D. Ankylosing spondylitis

Solution: C Cauda equina syndrome. Cauda equina is a serious condition caused by compression of the lumbar, sacral, or coccygeal nerve roots in the lower portion of the spinal cord. It is considered a emergency. If left untreated, acute pressure causes ischemia and can lead to permanent nerve damage, including loss of bowel and bladder control and paralysis of the legs. Signs and symptoms include a change in bowel and bladder control (incontinence), saddle-pattern anesthesia (perineum), sciatica, low-back pain, and loss of sensation or movement below the level of the lesion. Causes include disk herniation, abscess, tumor, inflammation, and others.

The nurse practitioner assesses a 5-year-old for growth and development milestones. Which finding concerns the nurse practitioner? A. Child cannot tie shoes B. Child cannot copy a square C. Child is unable to draw a person with two parts D. Child is unable to copy a triangle

Solution: C Child is unable to draw a person with two parts. A 5-year-old child should be able to draw a person with up to four parts. Tying shoes and copying a triangle are advanced fine motor skills typical of a 6-year-old. Inability to copy a square would not be concerning at this point, as it is a 5-year-old milestone and the child may not have developed this skill yet.

The spouse of an elderly patient with Alzheimer's disease tells the nurse practitioner that she is exhausted and cannot continue to be the sole caregiver. The couple have no children. They both have healthcare coverage with Medicare, but no supplemental insurance. The nurse practitioner will initially do which of the following to support the caregiver? A. Refer to home health services B. Provide a list of qualified in-home caregivers C. Contact an agency that provides skilled respite care D. Provide a brochure for "meals on wheels"

Solution: C Contact an agency that provides skilled respite care. Contacting an agency that provides skilled respite care is the best intervention because respite care is reimbursed by Medicare and will provide the caregiver some "break" time. Nurse practitioners should be knowledgeable regarding resources for patients with needs. Home health services are not the appropriate level of intervention, as the patient does not need skilled nursing services. Providing a list of qualified in-home caregivers would be helpful if the family has the financial ability to incur the steep costs of private caregivers, but this would not be the best action initially in helping with the problem. Providing a brochure for "meals on wheels" could be useful, but the service would not provide the caregiver with needed rest.

An older adult male presents with complaints of sharp flank and back pain. The patient has difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which diagnosis is most likely? A. Congestive heart failure B. Infective endocarditis C. Dissecting abdominal aortic aneurysm D. Acute myocardial infarction

Solution: C Dissecting abdominal aortic aneurysm. Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain located in the abdomen, back, or flank area, accompanied by a distended abdomen and hypotension. Older male adults with a smoking history and hypertension are at higher risk. Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with the presence of a new murmur. Acute myocardial infarction generally presents with a gradual onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy pressure in the chest.

A 67-year-old retired clerk presents with complaints of fatigue, shortness of breath, and weight gain over a 2-week period. A nonproductive cough accompanies her symptoms. She reports that climbing up the stairs worsens her dyspnea. The lung exam is positive for fine crackles in the lower lobes with no wheezing. An S3 heart gallop is noted. Which of the following drugs is most likely to relieve the patient's symptoms? A. Atenolol (Tenormin) B. Trimethoprim-sulfamethoxazole (Bactrim DS) C. Furosemide (Lasix) D. Hydrocodone/guaifenesin syrup (Hycotuss)

Solution: C Furosemide (Lasix).. The patient likely has left-sided heart failure. Loop diuretics, such as furosemide (Lasix), are used to help remove the extra fluid load in hemodynamically stable patients (contraindicated if systolic blood pressure <90 mmHg, severe hyponatremia, acidosis).

The nurse practitioner is assessing an 84-year-old patient suffering from an acute onset of confusion. The patient is brought to the office by their adult child caregiver who states the patient has become combative and threatening. Which medication will the nurse practitioner prescribe? A. Disulfiram (Antabuse) B. Varenicline (Chantix) C. Haloperidol (Haldol) D. Temazepam (Restoril)

Solution: C Haloperidol (Haldol). The patient is experiencing delirium. Delirium is a short-term condition; the removal of the illness and/or circumstances will typically resolve the delirium. When a patient becomes combative, healthcare providers must seriously consider a medication option to alleviate the risk of violence to self or others. Haloperidol (Haldol), a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium. Disulfiram (Antabuse) is used to treat alcoholism. Varenicline (Chantix) is used to decrease smoking. Temazepam (Restoril) is used to treat insomnia.

A 18-year-old college freshman presents at the campus clinic with reports of severe night sweats, lymphadenopathy, and severe pain over gland areas after drinking alcohol. Further assessment indicates that the patient has a positive Pel-Ebstein sign. Blood work reveals several Reed-Sternberg cells. Which diagnosis is most likely? A. Leukemia B. Acute lymphocytic leukemia (ALL) C. Hodgkin's lymphoma D. Acute myelogenous leukemia (AML)

Solution: C Hodgkin's lymphoma. Hodgkin's lymphoma is typically diagnosed between the ages of 15 and 19 years. Patients present with enlarged cervical, axillary, and supraclavicular lymphadenopathy with fluctuating days of fever and no fever. Leukemia causes extreme fatigue, weakness, pale skin, and easy bruising. Some patients will experience petechiae. ALL is a fast-growing cancer of lymphoblasts that causes very high white blood cell (WBC) counts (>50,000 cells). AML is also a fast-growing cancer of the bone marrow; it affects immature WBCs, macrophages/monocytes, red blood cells (RBCs), and platelets.

Which statement made by a 24-year-old patient with diabetes mellitus indicates that education about disease management was effective? A. I will check my blood sugars at the same time I do now B. Eating small meals every 2 hours will keep my blood sugars stable C. If I feel really tired or cannot concentrate, I will call you D. I will stop taking my oral medications and just take insulin

Solution: C If I feel really tired or cannot concentrate, I will call you. A patient with diabetes should eat small meals every 3 to 4 hours to keep blood sugars as normal as possible. Patients who have a blood sugar >300 mg/dL, level of consciousness changes, or dehydration should contact the provider for advice. Blood sugars should be checked more frequently when a patient is sick, and they should not stop taking oral medications or insulin unless their fasting blood glucose (FBG) is lower than expected and as per their provider's orders.

All of the following are correct statements regarding the S3 component of the heart sound, except: A. It occurs very early in diastole and is sometimes called an opening snap B. It is a normal finding in some children, healthy young adults, and athletes C. It can be a normal variant if heard in a person aged 40 years or older D. It signifies congestive heart failure (CHF)

Solution: C It can be a normal variant if heard in a person aged 40 years or older. The S3 heart sound occurs early in diastole and is sometimes referred to as an opening snap. It is a normal variant in children, healthy young adults, and athletes. Bibasilar crackles in lung bases and the presence of S3 heart sounds are classic findings of CHF.

A score of 23 on the Folstein Mini-Mental State Exam (MMSE) indicates: A. Severe dementia B. Moderate dementia C. Mild dementia D. Parkinson's disease

Solution: C Mild dementia. The MMSE measures cognitive decline. A score of 18 to 23 is considered mild dementia, a score of <17 is considered moderate-to-advanced dementia, and a score of <12 is considered severe dementia. Parkinson's disease is a progressive neurodegenerative disease caused by decreased dopamine receptors. Depression, resting tremor, and muscular rigidity are common. The disease is not measured by the MMSE.

Which initial treatment will the nurse practitioner prescribe to a 23-year-old female allergic to sulfa drugs who is diagnosed with acute cystitis? A. Cephalexin (Keflex) 500 mg BID × 5 days B. Ciprofloxacin (Cipro) 250 mg BID × 3 days C. Nitrofurantoin (Macrobid) 100 mg BID × 5 days D. Amoxicillin 500 mg BID × 5 days

Solution: C Nitrofurantoin (Macrobid) 100 mg BID × 5 days. Nitrofurantoin (Macrobid) can be safely administered to a patient with a sulfa allergy to treat acute cystitis and is the first line of treatment. Cephalexin (Keflex) and amoxicillin are beta-lactam antibiotics that can be prescribed to a patient who has an allergy to sulfa and nitrofurantoin and who does not have a known allergy or resistance to beta-lactam antibiotics. A fluoroquinolone such as ciprofloxacin (Cipro) is recommended for a patient who is allergic to sulfa and beta-lactam drugs or has a sulfa allergy and a known resistance to beta-lactam antibiotics.

Kyphosis is a late sign of: A. Rheumatoid arthritis B. Osteopenia C. Osteoporosis D. Osteoarthritis

Solution: C Osteoporosis. Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain.

A 35-year-old man has a history of an upper respiratory viral infection 4 weeks ago. He reports that he started feeling short of breath and now complains of sharp pain in the middle of his chest that seems to worsen when he lies down. The patient's physical exam is within normal limits with the exception of a precordial rub on auscultation. Which diagnosis is most likely? A. Pulmonary embolism B. Dissecting aneurysm C. Pericarditis D. Esophageal reflux

Solution: C Pericarditis. Pericarditis is inflammation of the sac around the heart. Common signs and symptoms include chest pain over the center/left side of the chest; shortness of breath, especially with lying down; low-grade fever; weakness; fatigue; dry cough; and abdominal or leg swelling. Pericardial rub may be auscultated.

All of the following are risk factors that could lead to hearing loss in an infant who was premature at birth, except: A. Hyperbilirubinemia B. Low Apgar scores C. Rubeola D. Seizures

Solution: C Rubeola. Use the HEARS mnemonic for risk factors that may lead to hearing loss: Hyperbilirubinemia; Ear infections that are frequent; low Apgar scores; Rubella/cytomegalovirus (CMV), not rubeola; and Seizures. Sickle cell disease is not a risk factor for hearing loss.

A 13-year-old boy is brought in by his mother for a physical exam. During the genital exam, the nurse practitioner notices that the patient is at Tanner stage II. Which of the following is the best description of this Tanner stage? A. The penis is growing more in length than in width, the testicles become larger with darker scrotal skin, and the pubic hair is starting to curl B. The penis is growing more in width than in length with darker scrotal skin and more numerous pubic hairs that are darker, curly, and more coarse. C. The testicles become larger, and the skin of the scrotum starts to become darker with straight, fine, countable hairs on the genitals and the axilla D. The testicles and penile width and length are developing quickly

Solution: C The testicles become larger, and the skin of the scrotum starts to become darker with straight, fine, countable hairs on the genitals and the axilla. Tanner stage II is when the testicles start to grow. The scrotal skin becomes thicker and starts to get darker (hyperpigmentation). The pubic hair is of a fine texture and straight, and there are few countable hairs on the genitals and the axilla.

The primary function of all of the following pharmacologic agents is to treat inflammation in the lungs, except: A. Nedocromil sodium inhaler (Tilade) B. Cromolyn sodium inhaler (Intal) C. Theophylline oral (Theo-24) D. Fluticasone inhaler (Flovent)

Solution: C Theophylline oral (Theo-24). The primary function of nedocromil sodium inhaler (Tilade), cromolyn sodium inhaler (Intal), and fluticasone inhaler (Flovent) is to treat inflammation in the lungs. Nedocromil sodium and cromolyn sodium are mast cell stabilizers, which inhibit the degranulation of mast cells, preventing the release of inflammatory mediators. Fluticasone is a corticosteroid. Theophylline oral (Theo-24), a methylxanthine, primarily functions as a bronchodilator, widening the airways and relaxing the bronchial muscles.

An 80-year-old patient arrives at the primary care clinic with new changes in mental status, anorexia, and oliguria. The patient has a temperature of 99.0°F, pulse of 126, and diffuse lower abdominal pain on palpation. Which diagnosis is most likely? A. Pyelonephritis B. Cystitis C. Urosepsis D. Kidney stone

Solution: C Urosepsis. An elderly patient with a serious urogenital infection will exhibit mental status changes, temperature within normal range, tachycardia, tachypnea, and decreased urinary output. Elderly patients are at high risk for sepsis and must be treated emergently before organ system failure occurs. Cystitis (urinary tract infection [UTI]) presents with increased urinary frequency, dysuria, and white blood cells (WBCs) and bacteria in urine, and there may be mental status changes. Pyelonephritis is a kidney infection, and the patient will present with severe flank pain, fever, malaise, and other symptoms similar to cystitis. A patient who has a kidney stone will experience colicky, intermittent pain as the stone is trying to move down the ureters and may have nausea and vomiting.

All of the following deficiencies are common in pediatric patients with celiac disease, except: A. Folate B. Ferritin C. Vitamin D D. Vitamin B12

Solution: C Vitamin D. Pathophysiologic hematologic manifestations of celiac disease frequently reflect nutritional deficiencies, including folate, ferritin, and vitamin B12. Vitamin D deficiency is not specifically associated with celiac disease.

A mother brings her 2-year-old to the clinic with nausea and vomiting, fever, and abdominal pain. The mother noticed blood in the child's diaper this morning. Upon physical examination, the nurse practitioner palpates a nontender abdominal mass extending from the flank toward the midline. Swelling is noted on the side of the mass, and the child has an elevated blood pressure. Which diagnosis is most likely? A. Hodgkin's lymphoma B. Lipoma C. Wilms' tumor D. Kawasaki disease

Solution: C Wilms' tumor. A young child with a nontender abdominal mass with swelling, constitutional symptoms, and pain is likely to have a Wilms' tumor. Wilms' tumor is the most common renal tumor in pediatric patients. It presents as an abdominal mass that extends from the flank toward the midline. Symptoms can include abdominal pain, hematuria, nausea, vomiting, and, in a quarter of reported cases, hypertension. Peak onset is 2 to 3 years of age. Hodgkin's lymphoma is a malignancy of the white blood cells. A lipoma is a growth of fatty tissue that slowly develops under the skin. People of any age can develop a lipoma, but they are rare in children. Kawasaki disease presents with high fever and enlarged lymph nodes in the neck. It is characterized by peeling skin and swelling in the hands and feet. Kawasaki disease is also characterized by "strawberry" tongue appearance.

A 27-year-old male patient reports a strong desire to dress and be treated as a woman, telling the nurse practitioner that they have never been comfortable with their assigned sex. The nurse practitioner will: (Select all that apply.) A. Refer the patient to a psychiatric-mental health professional B. Tell the patient that they may be experiencing a hormonal imbalance C. Maintain respect for the patient's process of disclosure D. Ask for the patient's preferred gender pronouns and use gender-neutral language in communications and on patient forms E. Inform the patient that they are experiencing gender dysphoria, which can be treated

Solution: C, D Maintain respect for the patient's process of disclosure; ask for the patient's preferred gender pronouns and use gender-neutral language in communications and on patient forms. The patient's gender preferences should be acknowledged and respected by the nurse practitioner. Suggesting that the patient has medical or psychological disorders is not an appropriate action.

Which skin condition is caused by elevated androgen levels? A. Tinea corporis B. Onychomycosis C. Acne rosacea D. Acne vulgaris

Solution: D Acne vulgaris. Acne vulgaris is most prevalent in the adolescence stage because of elevated androgen levels, bacteria (Propionibacterium acnes), and genetic factors. Severe cystic acne causes painful, indurated cysts and abscesses on the face, back, shoulders, and chest. Tinea corporis is ringworm of the body and creates ringlike pruritic scales that slowly enlarge over the body. Onychomycosis is a fungal infection of the nail, which becomes yellowed and thickened, with scaling under the nail; it is also known as tinea unguium. Acne rosacea is a chronic inflammatory skin disorder that occurs mostly in fair-skinned people and causes small acne-like papules and pustules on the cheeks, mouth, and chin.

In a Rinne test, what is considered a normal finding? A. Vibration is louder in the "good" ear B. Sound is heard equally in both ears C. Frequency is heard higher in the "bad" ear D. Air conduction (AC) is heard longer than bone conduction (BC)

Solution: D Air conduction (AC) is longer than bone conduction (BC). A normal finding for a Rinne test is AC heard longer than BC. In the Weber test, a normal finding is when there is no lateralization, where sound is heard equally in both ears when a tuning fork is placed on the midline of the forehead. If vibrations are louder in the "good" ear with a Weber test, that is a normal finding.

Systemic lupus erythematosus (SLE) is more common among female patients from all of the following ethnic and racial backgrounds, except: A. African American B. Asian C. Hispanic D. Caucasian

Solution: D Caucasian. Lupus is two to three times more prevalent among women of African American, Asian, Hispanic, and Native American backgrounds than in Caucasian women.

An elderly patient presents with right-sided hearing loss. On physical examination, there is lateralization to the right ear. The Rinne test shows BC>AC. Which diagnosis is most likely? A. Ménière's disease B. Labyrinthitis C. Acoustic neuroma D. Cerumen impaction

Solution: D Cerumen impaction. Cerumen (ear wax) is obstructive to the middle and/or outer ear. Any type of obstruction to sound waves will cause conductive hearing loss. Sensorineural hearing loss occurs when there is damage to vital ear structures such as the cochlea/vestibule and/or to the auditory nerve pathways. Ménière's disease, labyrinthitis, and acoustic neuroma are associated with sensorineural hearing loss.

The nurse practitioner diagnoses an adult patient with heart failure. Which of the following will be included in the treatment plan to relieve symptoms of volume overload? A. Sodium restricted to 4 g/d B. Fluids restricted to 3 L/d C. Atenolol (Tenormin) D. Furosemide (Lasix)

Solution: D Furosemide (Lasix). An adult patient with heart failure should be prescribed furosemide (Lasix) to relieve symptoms of volume overload (e.g., dyspnea, peripheral edema). The patient should be advised to restrict sodium to 2 to 3 g/day and fluids to 1.5 to 2 L/day. Atenolol would also be prescribed if the patient had heart failure with reduced ejection fraction (<40%).

An 18-year-old male patient is found to have a 47,XXY karyotype and is diagnosed with Klinefelter's syndrome. The patient is likely to have all of the following physical characteristics, except: A. Gynecomastia B. Long limbs C. Lack of secondary sexual characteristics D. Large testes

Solution: D Large testes. Signs and symptoms of Klinefelter's syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/reproductive system in the future.

The nurse practitioner is evaluating an 80-year-old woman who is a resident of a long-term care facility. She instructs the patient to remember the words orange, house, and world. A few minutes later, the patient is asked to recall these three words. Which of the following tests is being described? A. Lachman test B. Katz Index C. Romberg test D. Mini-Mental State Exam (MMSE)

Solution: D Mini-Mental State Exam. The MMSE, also known as Folstein Mini-Mental State Exam, is performed to assess for cognitive impairment and dementia. It is also used to estimate the severity of cognitive impairment at a specific time and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual's response to treatment. Requiring about 10 minutes to complete, the MMSE samples several cognitive functions, including arithmetic, memory, and orientation. The Lachman test is performed on the knee; a positive result is indicative of anterior cruciate ligament damage or rupture. The Katz Index measures independence in activities of daily living. The Romberg test is for assessment of the cerebellum.

Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? A. Chancroid B. Chlamydia trachomatis C. Herpes genitalis D. None of the above

Solution: D None of the above. The CDC no longer recommends that patients with gonorrhea always be cotreated for chlamydia. They now recommend cotreatment only when chlamydial infection has not been excluded. Do not cotreat if test is negative.

A patient taking phenytoin (Dilantin) has a current level of 22 mcg/mL. Which assessment finding would the nurse practitioner expect to see in this patient? A. Ataxia B. Confusion C. Seizures D. Nystagmus

Solution: D Nystagmus. The therapeutic level of phenytoin (Dilantin) is 10 to 20 mcg/mL. Levels greater than this may cause adverse effects: 20 to 30 mcg/mL, nystagmus; 30 to 40 mcg/mL, ataxia; 40 to 50 mcg/mL, mental status changes; >50 mcg/mL, breakthrough seizures; and levels near 100 mcg/ mL may cause death.

A female patient with a body mass index (BMI) of 29 has a 20-year history of primary hypertension. She has been taking hydrochlorothiazide 25 mg PO daily with excellent results. On this visit, she complains of feeling thirsty all the time, even though she drinks more than 10 glasses of water per day. She reports to the nurse practitioner that she has been having this problem for about 6 months. Upon reading the chart, the nurse practitioner notes that the last two fasting blood glucose levels have been 140 mg/dL and 168 mg/dL. The result of a random blood glucose test is 210 mg/dL. The nurse practitioner will: A. Order another random blood glucose test in 2 weeks B. Initiate a prescription of metformin (Glucophage) 500 mg PO BID C. Order a 3-hour glucose tolerance test D. Order an A1C level

Solution: D Order an A1C level. The next step is to check the A1C level. The treatment goal is an A1C less than 7%. But if the patient is frail or has frequent hypoglycemic episodes, the American Diabetes Association allows a goal of up to 8%. If the A1C level is 6.5 or higher, the patient has type 2 diabetes. With a history of primary hypertension and the use of hydrochlorothiazide, which can have some diuretic-induced renal impairment, this patient is also at moderately increased risk for a rare, but serious and potentially life-threatening, condition—lactic acidosis—when using metformin. Thiazide diuretics have been associated with hyperglycemia, so checking the A1C would help to better understand the role that these medications may be playing in the glucose levels seen in recent lab testing.

All of the following are covered under Medicare Part B, except: A. Persons aged 65 years or older B. Durable medical equipment C. Mammograms annually starting at age 50 D. Outpatient anesthesiologist's services

Solution: D Outpatient anesthesiologist's services. Medicare Part A covers anesthesia that is received while in an inpatient hospital. Medicare Part B covers outpatient care, durable medical equipment, home health services, and other medical services, including some preventive services such as annual physical exams, and mammograms (baseline age 50 years).

All of the following medications have drug interactions with levothyroxine (Synthroid), except: A. Antacids B. Tricyclic antidepressants C. Anticoagulants D. Penicillins

Solution: D Penicillins. Levothyroxine (Synthroid) does not interact with penicillins, but there are numerous drugs with which it interacts, including anticoagulants, tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton pump inhibitors, estrogens, statins, metformin. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together and should space these foods and drugs several hours apart. Levothyroxine is a synthetic form of T4.

A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse practitioner that he has been bloated and is experiencing difficulty with bowel movements. Which of the following will the nurse practitioner incorporate into the treatment plan? A. Senna B. Methylnaltrexone (Relistor) C. Magnesium citrate D. Polyethylene glycol

Solution: D Polyethylene glycol. Caridopa-levodopa (Sinemet), an antiparkinsonian drug, can cause constipation in older adults. The first-line treatment for the patient's constipation is osmotic laxatives such as polyethylene glycol. Senna is a stimulant laxative that is a second-line treatment for constipation in an older adult. Methylnaltrexone (Relistor) is a peripherally acting mu-opioid antagonist that acts on the gastrointestinal tract to decrease opioid-induced constipation. Magnesium-based laxatives (e.g., magnesium citrate) taken over the long term should be avoided due to the potential for toxicity.

Which of the following conditions is associated with a positive Auspitz sign? A. Contact dermatitis B. Seborrheic dermatitis C. Systemic lupus erythematosus D. Psoriasis

Solution: D Psoriasis. The Auspitz sign is simply bleeding that occurs after psoriasis scales have been removed. It occurs because the capillaries run very close to the surface of the skin under a psoriasis lesion, and removing the scale essentially pulls the tops off the capillaries, causing bleeding. Auspitz sign is also found in other scaling disorders such as actinic keratoses.

A nurse practitioner's right to practice is regulated under: A. Medicare regulations B. The board of medicine C. The federal government D. The board of nursing

Solution: D The board of nursing. APRN practice is typically defined by the state nurse practice act and governed by the state board of nursing, but other laws and regulations may affect practice, and other boards may play a role. For instance, in some states nurse-midwives are regulated by a board of midwifery or public health. In other states, both the board of medicine and the board of nursing regulate nursing practice.

Which assessment finding may be present in children with a migraine headache? A. Abdominal pain B. Sharp pain in cheek C. Band-like pain D. Ice-pick pain

Solution: A Abdominal pain. Children with a migraine headache may present with abdominal pain and may also have anorexia, nausea, vomiting, or pallor. Photophobia and phonophobia are not common in children with abdominal migraines. Sharp, stabbing pain in one cheek is trigeminal (CNV) neuralgia, which is more common in older adults and the elderly. A cluster headache is more common in middle-aged males and presents as severe ice-pick, piercing pain behind one eye and temple. Band-like pain is caused by muscle tension headaches, and it is common in adults with high levels of stress.

Abrupt loss of consciousness accompanied by generalized tonic-clonic seizures followed by a postictal period characterizes what type of seizure disorder? A. Absence seizure B. Grand mal seizure C. Atonic seizure D. Myoclonic seizure

Solution: B Grand mal seizure. Grand mal seizure is the older term for generalized tonic-clonic seizure. It starts with abrupt loss of consciousness and stiffening of the muscles (tonic phase). After about a minute, the muscles start to jerk for 1 to 2 minutes (clonic phase). Cessation of muscle twitching signals the start of the postictal period. During this period, the person may be asleep (and gradually wake up) or may become agitated or confused. Do not insert anything in the mouth such as tongue blades. Help the person lie on the floor on his or her side.

A 70-year-old male patient complains of a bright-red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new-onset cough from a recent viral upper respiratory infection. The only medicine he is taking is Bayer aspirin one tablet daily. Which of the following actions is appropriate follow-up for this 70-year-old patient? A. Refer the patient to an optometrist B. Refer the patient to an ophthalmologist C. Advise the patient that the condition is benign and will resolve spontaneously D. Prescribe an ophthalmic antibiotic solution

Solution: C Advise the patient that the condition is benign and will resolve spontaneously. Subconjunctival hemorrhages do not require any treatment. The blood in the eye will be absorbed within 10 to 14 days.

A 76-year-old patient is seen for follow-up after 2 months of taking atorvastatin (Lipitor) 40 mg daily. The patient complains of muscle pain and weakness. The nurse practitioner: A. Maintains current drug therapy B. Instructs patient to increase daily activity C. Discontinues atorvastatin and prescribes a moderate-intensity statin D. Adds niacin once daily

Solution: C Discontinues atorvastatin and prescribes a moderate-intensity statin. After 2 months of a high-intensity statin such as atorvastatin, patients may complain of muscle pain and weakness. The patient should discontinue atorvastatin and begin taking moderate-intensity statin such as pravastatin (Pravachol).

All of the following physiologic changes are present in the lungs of the elderly, except: A. Decreased forced expiratory volume (FEV1) B. Slightly increased residual volume (RV) C. Increased lung compliance D. Earlier airway collapse with shallow breathing

Solution: C Increased lung compliance. Lung compliance decreases as we get older; therefore, the FEV1 also decreases. There is minimal change in the total lung volume. Airways tend to collapse earlier (than in young patients) with shallow breathing, which increases the risk of pneumonia.

Which condition is associated with the findings in this image? A. Milia B. Erythema toxicum neonatorum C. Infantile seborrheic dermatitis D. Head lice

Solution: C Infantile seborrheic dermatitis. The infant has a common disorder known as seborrheic dermatitis (cradle cap), which presents as excessive scaling of the scalp of a young infant. It is a self limiting condition that will resolve spontaneously over a period of months. It is treated with mild shampooing and removing scales with a soft brush. Milia are small, bump-like cysts found under the skin. They are usually 1 to 2 mm in size. They form when skin flakes or keratin, a protein, become trapped under the skin. Milia most often appear on the face, commonly around the eyelids and cheeks, though they can occur anywhere. Erythema toxicum neonatorum appears as small pustules that develop on the face, back, and chest 3 days after birth. Head lice lay nits (eggs) in the hair, which appear as white "clumps" that can be mistaken for dandruff.

A 6-year-old patient who was recently started on methylxanthine for asthma treatment returns to the clinic for a medication follow-up. Which of the following findings is abnormal? A. Heart rate = 102 beats/minute B. Respiratory rate = 18 beats/minute C. Theophylline level = 16 mcg/mL D. Temperature = 99.9°F

Solution: C Theophylline level = 16 mcg/mL. A therapeutic level of theophylline for a child is 5 to 15 mcg/ mL. A level of 16 mcg/mL would be concerning because the level could reach toxicity. A heart rate of 102 beats/minute and respiratory rate of 18 beats/minute are considered normal findings for a 6-year-old. A 99.9°F temperature is also normal.

How would the nurse practitioner ensure explanations of treatment and medications are correctly translated to a patient who does not speak English? A. Ask a family member to interpret the medications and treatment plan to the patient B. Ask the patient to repeat information back C. Ask a family member to write down the directions for the patient to follow at home D. Contact language access services for additional assistance

Solution: D Contact language access services for additional assistance. Language barriers can pose a real challenge to the clinician and may result in miscommunication of a patient's care. It is best to contact language access services for additional assistance. This can be done virtually, over the telephone, or in person. Untrained staff or family should not provide this service, because medical information can be interpreted incorrectly.

A woman at 32 weeks' gestation has a positive throat culture for Streptococcus pyogenes (strep throat). She denies allergies but becomes very nauseated with erythromycin. Which of the following is the best choice for this pregnant patient? A. Clarithromycin (Biaxin) B. Trimethoprim-sulfamethoxazole (Bactrim DS) C. Ofloxacin (Floxin) D. Penicillin (Pen VK)

Solution: D Penicillin (Pen VK). Pen VK is safe to use for strep throat during pregnancy and is the best choice for a pregnant patient with the presented symptoms.

Which pain medication will the nurse practitioner prescribe for an 11-year-old patient with a fractured ulna? A. Capsaicin topical cream B. Hydrocodone-acetaminophen C. Aspirin D. Regular-strength acetaminophen

Solution: D Regular-strength acetaminophen. Regular-strength acetaminophen is the safest pain medication for a child <12 years. Capsaicin topical cream provides temporary relief of muscle, joint, and neuropathic pain. Aspirin contains salicylates and should not be prescribed for children <12 years due to the risk of Reye's syndrome. Hydrocodone-acetaminophen is not recommended because of abuse potential.

Acanthosis nigricans is associated with all of the following disorders, except: A. Obesity B. Diabetes C. Colon cancer D. Tinea versicolor

Solution: D Tinea versicolor. Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It appears as hyperpigmented velvety areas that are usually located on the neck and the axillae. It is rarely associated with some types of adenocarcinoma of the gastrointestinal tract. Tinea versicolor is a superficial infection of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the tinea family. Another name for it is sunspots.

What is the most common site for the development of diverticula? Click on the correct anatomical location.

Sigmoid colon. The correct anatomical location is the sigmoid colon, which is the most common site for the development of diverticula. Patients with diverticulitis most commonly present with left lower quadrant pain.

All of the following are considered selective serotonin reuptake inhibitors (SSRIs), except: A. Imipramine (Tofranil) B. Fluoxetine (Prozac) C. Sertraline (Zoloft) D. Paroxetine (Paxil CR)

Solution: A Imipramine (Tofranil). Imipramine (Tofranil) is a tricyclic antidepressant (TCA). Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil CR) are SSRIs.

A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. Which of the following medications is indicated for the treatment of obsessive-compulsive disorder? A. Paroxetine (Paxil CR) B. Haloperidol (Haldol) C. Alprazolam (Xanax) D. Imipramine (Elavil)

Solution: A Paroxetine (Paxil CR). The first-line medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). Paroxetine (Paxil CR) is in the SSRI drug class. Haloperidol (Haldol) is an antipsychotic, alprazolam (Xanax) is a benzodiazepine, and imipramine (Elavil) is a tricyclic antidepressant.

A nurse practitioner is conducting a study on a group of subjects over 5 years, looking at the variables of blood pressure, body mass index (BMI), and presence of cardiovascular disease. This is a: A. Retrospective study B. Longitudinal study C. Case study study D. Cross-sectional study

Solution: B Longitudinal study. A longitudinal study examines a group of subjects with the same variables over a long period of time. A retrospective study examines that have already occurred. A case study examines a single person, event, or phenomena. A cross-sectional study compares the similarities and differences between two or more groups of people at one given point in time.

The nurse practitioner has diagnosed a 30-year-old male patient with contact dermatitis on the left side of his face secondary to poison ivy. The nurse practitioner recommends: A. Washing with antibacterial soap BID to reduce risk of secondary bacterial infection until it is healed B. Zanfel poison ivy wash C. Clotrimazole (Lotrimin) cream BID × 2 weeks D. Halcinonide (Halog) 1% ointment × 2 weeks

Solution: B Zanfel poison ivy wash. Zanfel is a soap-like product (over the counter [OTC]) that removes urushiol oil from poison ivy, poison sumac, and poison oak. It will relieve the itch and pain quickly. A topical steroid can be used to speed up healing. For rashes, hydrocortisone cream 1% BID (OTC) is helpful.

The nurse practitioner is conducting a health history on a 39-year-old male patient with necrotic ulcers on his arms, face, and neck. The patient reveals that he is a livestock farmer. The nurse practitioner will: A. Isolate the patient in an examination room B. Administer the anthrax vaccine adsorbed (AVA) C. Prescribe ciprofloxacin (Cipro) D. Send a blood sample to the state lab and Centers for Disease Control and Prevention (CDC)

Solution: D Send a blood sample to the state lab and Centers for Disease Control and Prevention (CDC). A patient with suspected cutaneous anthrax requires a blood test to confi rm Bacillus anthracis (grampositive rods). The blood sample should be sent to the state lab and the CDC for confirmation. Because anthrax is not contagious, there is no need to isolate the patient in an examination room. The anthrax vaccine is administered to specific populations (18 to 65 years), such as military personnel, veterinarians, and people who work with specific animals or in slaughterhouses. Once the diagnosis is confirmed and course of antibiotics completed, the vaccine can be administered.

The nurse practitioner is assessing a patient who presents with abdominal pain with nausea and vomiting for the past 24 hours. He reports feeling a sharp pain after he hit a pothole in the road while riding his bicycle. His blood pressure is 140/84 mmHg, temperature is 102°F, pulse is 98 beats/minute, and respirations are 26 breaths/minute. Where on the abdomen is the nurse practitioner most likely to elicit definitive data for diagnosis? Click on the correct anatomical location.

Right lower quadrant. The correct anatomical location is the right lower quadrant. All of the data provided (abdominal pain, nausea with vomiting, elevated temperature, and rebound tenderness when hitting a pothole) indicate a potential appendicitis. If the appendix has ruptured, acute pain and guarding will occur. Rebound tenderness would also be present.

The lipid panel results of an otherwise healthy 17-year-old female show total cholesterol of 192 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, low-density lipoprotein (LDL) of 120 mg/dL, and triglycerides of 170 mg/dL. The nurse practitioner asks the patient: A. Did you fast for 12 hours before the blood work was drawn? B. Did you eat a high-fat meal the evening before the blood work was drawn? C. Have you been exercising at least three times a week? D. Have you been eating more than usual?

Solution: A "Did you fast for 12 hours before the blood work was drawn?" A complete lipid panel requires 12 hours of fasting to ensure accurate results and interpretation. If the patient does not fast, it may impact the triglyceride level. Triglycerides of 170 mg/dL in an otherwise healthy 17-year-old female patient may indicate that the patient did not fast. The nurse practitioner should schedule a followup lipid panel in 3 months to confirm whether the result was accurate.

A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. The patient's symptoms are highly suggestive of which condition? A. Angina pectoris B. Acute myocardial infarction (MI) C. Gastroesophageal reflux disease D. Acute costochondritis

Solution: A Angina pectoris. The classic pain of angina is described as discomfort, pressure, tightness, or heaviness on the center or left side of the chest that is precipitated by exertion and relieved by rest. The pain can be referred to the back, shoulders, neck, or jaw. The pain is not sharp, knife like, or stabbing in nature. Angina is caused by transient myocardial ischemia. The most common cause of angina is coronary artery disease. If the angina worsens, is not relieved by rest, or lasts more than 20 minutes, it may be due to acute MI. If acute MI is suspected, call 911.

A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes: A. Budesonide with formoterol B. Budesonide with montelukast C. Cromolyn or nedocromil D. Fluticasone with salmeterol

Solution: A Budesonide with formoterol. The patient has moved from step 2 to step 3 on the asthma classification scale; therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States.

A 70-year-old male patient presents with reports of rectal bleeding and a recent change in bowel habits with alternating bouts of constipation and diarrhea. Upon physical assessment, the nurse practitioner notes that the patient has lost 17 pounds since his last visit 6 months ago. Blood work reveals that the patient is anemic. Which diagnosis is most likely? A. Colorectal cancer B. Pancreatic cancer C. Multiple myeloma D. Urinary tract infection

Solution: A Colorectal cancer. An older patient with symptoms such as a change in bowel habits or the shape of stools, abdominal pain, bloody stools or rectal bleeding, and weight loss should be screened for colorectal cancer. Family history, polyps, and/or a previous diagnosis of a bowel disease are also risk factors that would warrant further evaluation for colorectal cancer. Pancreatic cancer presents with weight loss, anorexia, weakness, and abdominal pain, but changes in bowel habits are not typically a key symptom. Multiple myeloma is a cancer of the bone marrow. Urinary tract infections are common and can be asymptomatic, though older patients are often confused and agitated and present with incontinence.

A 30-year-old male patient with bipolar disorder refuses to take his afternoon dose of pills. The nurse practitioner tells him of the possible consequences of his action, but the patient still refuses to cooperate. Which of the following is the best course of action? A. Document the patient's behavior in his record and the action taken by the nurse B. Reassure the patient that he will be fine after taking the medicine C. Document only the patient's behavior D. Document only the nurse's action

Solution: A Document the patient's behavior in his record and the action taken by the nurse. Patients have the right to refuse their medications. Bipolar disorder tends to worsen if it is not treated. Explain that there is a good chance that manic and depressive episodes will become more frequent and severe over time. If a patient is non compliant, the patient's behavior and the actions taken by the nurse both must be documented.

The nurse practitioner is reviewing the laboratory results for a 27-year-old patient with decreased energy, paresthesia, and oral ulceration. The patient's vitamin B12 is 215 ng/mL, methylmalonic acid (MMA) is 175 mM/L, and homocysteine (HC) is 18 µM/L. Which diagnosis is most likely? A. Folate deficiency B. Pernicious anemia C. Normocytic anemia D. Vitamin B12 deficiency

Solution: A Folate deficiency. Diagnostic laboratory findings of folate deficiency include a borderline vitamin B12 level, an MMA level within the reference range, and an elevated HC. The standard reference range for vitamin B12 is 200 to 900 ng/mL; values between 200 and 300 ng/mL are considered to be borderline. The normal reference range for MMA is 70 to 350 mM/L. The normal reference range for HC is 5 to 15 μM/L. Mean corpuscular volume is used to evaluate for normocytic anemia. Elevated levels of MMA and HC, paired with an increase in antiparietal antibodies, are findings associated with pernicious anemia. Vitamin B12 deficiency is associated with elevated levels of MMA and HC

The nurse practitioner recently increased a patient's antipsychotic medication and is assessing the patient in a follow-up appointment. All of the following symptoms suggest the patient is experiencing malignant neuroleptic syndrome, except: A. Headache B. Tremors C. Muscular rigidity D. Fever

Solution: A Headache. Malignant neuroleptic syndrome is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, mental status changes, and diaphoresis. Headache is not a manifestation of malignant neuroleptic syndrome and would not contribute to confirmation of this diagnosis.

The Lachman maneuver is used to detect: A. Instability of the knee B. Nerve damage of the knee due to past knee injuries C. Integrity of the patellar tendon D. Tears on the meniscus of the knee

Solution: A Instability of the knee. The Lachman maneuver is a test performed to assess for knee instability (i.e., damage to the motion of anterior translation [laxity] of the anterior cruciate ligament [ACL]) or tear of the ACL. The maneuver should be tested on both knees, comparing the injured and the opposite knee; the uninjured knee is used as the "control." The test is positive if the injured knee slips back further (laxity). Perform the test by bending the knee 30 degrees. Stabilize the femur with one hand. Place the other hand under the proximal tibia at the level of the joint line and then pull forward. The laxity is graded on a 0 (normal)-to-3 scale (1.0-1.5 cm of translation).

The nurse practitioner is examining a child diagnosed with impetigo. Which symptom will the nurse practitioner identify as the primary manifestation? A. Lesions filled with pus B. Superficial area of local edema C. White plaques in the throat D. Pinpoint areas of bleeding (purple or red) in the skin

Solution: A Lesions filled with pus. Pustules, the primary lesions with impetigo, are pus-filled lesions. Impetigo is a superficial skin infection caused by gram-positive bacteria. A wheal is a superficial area of localized edema. White plaques in the throat are associated with candidiasis or thrush. Pinpoint areas of bleeding (purple or red) in the skin are petechiae, which are not associated with impetigo.

Patient confidentiality is breached when: A. Medical information is given to a spouse B. Records are subpoenaed C. Reports are sent to the public health department D. Records are released to insurance companies

Solution: A Medical information is given to a spouse. Patient confidentiality is breached when medical information is given to a spouse or any other individual without consent of the patient.

Which of the following murmurs are best heard at the apex of the heart? A. Mitral stenosis and mitral regurgitation B. Aortic regurgitation and aortic stenosis C. Mitral stenosis and aortic stenosis D. Aortic regurgitation and mitral stenosis

Solution: A Mitral stenosis and mitral regurgitation. Mitral stenosis and mitral regurgitation murmurs are best heard at the apex of the heart. Aortic regurgitation and aortic stenosis are heard at the second intercostal space (ICS) at the right side of the sternum.

An 84-year-old female presented to the clinic 2 weeks ago with vague reports of fatigue, red maculopapular rash, and low-grade fever. Upon examination, there was no lymphadenopathy, sore throat, atypical white blood cells (WBC), or splenomegaly. During a follow-up exam 2 weeks later, the patient is diagnosed with Guillain-Barré syndrome. What was the original diagnosis? A. Mononucleosis B. Influenza C. Meningitis D. Measles

Solution: A Mononucleosis. In older adults, reactive infectious mononucleosis presents atypically, without the classic triad of fever, pharyngitis, and lymphadenopathy. Influenza (virus) presents with a sore throat, fever, chills, and runny nose. Meningitis presents with high fever, severe headache, photophobia, and neck stiffness. Measles presents with a fever, reddish-brown rash, lethargy, cough, and photophobia. Measles may occur in unvaccinated infants, but it may also affect older adults.

The nurse practitioner is assessing a patient who presents with syncope, dyspnea, and angina. Which additional assessment data would confirm a diagnosis of aortic valve stenosis? A. Murmur that radiates to neck B. Murmur that is heard on left side of the sternum C. Murmur that radiates to axillae D. Loud blowing, high-pitched murmur

Solution: A Murmur that radiates to neck. A patient with aortic valve stenosis will present with SAD: syncope, angina, and dyspnea. Additional assessment findings include a harsh and noisy murmur that is heard on the right side of the sternum and radiates to the neck region. A patient with mitral regurgitation will have a loud blowing, high-pitched murmur at the apical area that radiates to the axillae.

A 25-year-old woman complains of dysuria, severe vaginal pruritus, and malodorous vaginal discharge. Pelvic examination reveals a strawberry-colored cervix and frothy yellow discharge. Microscopic examination of the discharge reveals mobile organisms that have flagella. The correct pharmacologic therapy for the condition is: A. Oral metronidazole (Flagyl) B. Ceftriaxone sodium (Rocephin) injection C. Doxycycline hyclate (Vibramycin) D. Clotrimazole (Gyne-Lotrimin) cream or suppositories

Solution: A Oral metronidazole (Flagyl). Trichomoniasis symptoms include dysuria, severe vaginal pruritus, and malodorous vaginal discharge. Wet prep microscopic examination should show trichomonads that are pear shaped and have several flagella (whiplike tails) at one end. The Centers for Disease Control and Prevention (CDC) recommendation for treatment is metronidazole. A single dose is effective treatment in most cases of trichomoniasis infections.

A patient presents with fever, severe throat pain, difficulty swallowing, a "hot potato" voice, and trismus. On examination, there is unilateral swelling of the peritonsillar and soft palate area. The uvula is deviated to the left. Which diagnosis is most likely? A. Peritonsillar abscess B. Infectious mononucleosis C. Pharyngitis D. Aphthous stomatitis

Solution: A Peritonsillar abscess. The most likely diagnosis is peritonsillar abscess. Peritonsillar abscess is classically associated with severe sore throat, difficulty swallowing, trismus, and a muffled "hot potato" voice. The abscess displaces the uvula. Infectious mononucleosis refers to a group of symptoms usually caused by the Epstein-Barr virus. Symptoms include fatigue, fever, rash, and swollen glands. Pharyngitis is the inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and a hoarse voice. Aphthous stomatitis is a common condition characterized by the repeated formation of benign and noncontagious mouth ulcers.

A 38-year-old patient who is 3 weeks postpartum presents for follow-up and reports frequent headaches and intermittent blurred vision when arising in the morning. Her blood pressure is 128/86 mmHg in the left arm and 122/78 mmHg in the right arm. The next day, the patient returns with worsening headaches and a 2-pound weight gain in 3 days. Her blood pressure is now 156/92 mmHg in the left arm and 148/94 mmHg in the right arm. Which diagnosis is most likely? A. Pregnancy-induced hypertension B. Preexisting chronic hypertension C. Eclampsia D. Migraine headaches

Solution: A Pregnancy-induced hypertension. Pregnancy-induced hypertension (preeclampsia) can occur in the late 3rd trimester or up to 4 weeks postpartum. Classic triad: Hypertension, proteinuria, and edema that occur after 20 weeks' gestation and up to 4 weeks postpartum. Rapid weight gain of 2 to 5 pounds per week and edema is most obvious in the face around the eyes and on the hands. Preexisting/chronic hypertension is defined as elevated BP (>140/90 mmHg) before the 20th week of gestation. Eclampsia is similar to preeclampsia, but the patient typically experiences a seizure. Migraine headaches can occur on one or both sides of the head. This usually causes nausea, vision disturbances, and photophobia.

A charitable foundation plans to build a community youth center in a large urban area with a history of gang violence. What type of health prevention activity is being done in this area? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Quaternary prevention

Solution: A Primary prevention. A community youth center with good staffing can be an effective method of drawing youth out of the streets into a safer environment. It can reduce the risk of youth becoming victims of gang violence. In addition, staff members can serve as role models or mentors for adolescents.

An elderly patient with chronic obstructive pulmonary disease (COPD) is diagnosed with an essential tremor of the left hand. Which medication is contraindicated? A. Propranolol (Inderal) B. Primidone (Mysoline) C. Nimodipine (Nymalize) D. Gabapentin (Neurontin)

Solution: A Propranolol (Inderal). Because this patient has COPD, beta-blockers such as propranolol (Inderal) are contraindicated. Primidone (Mysoline) is an antiepileptic medication that is effective for the management of an essential tremor. Nimodipine (Nymalize; third-line treatment) is a calcium channel blocker that has been successful in managing limb tremors associated with essential tremors. Gabapentin (Neurontin) is a safe alternative to essential tremors, especially in the elderly. It is an anticonvulsant that is also prescribed for neuropathic pain.

An 87-year-old man is being seen at the health clinic. He tells the nurse practitioner that his grandson locks him in the bedroom when he leaves the house and sometimes withholds food from him if he does not give him spending money. The patient appears frail, with poor grooming, and has a strong odor of urine on his clothing. Which of the following is the best action for the nurse practitioner to take? A. Report the patient's grandson for elder abuse to the state protective health services B. Speak to the grandson and educate him about the importance of proper grooming for his grandfather C. Advise the grandson that if the patient has the same complaints the next time he is seen, the grandson will be reported for elder abuse to the state authorities D. Advise the patient that he should call his son as soon as possible to tell him about the grandson's actions

Solution: A Report the patient's grandson for elder abuse to the state protective health services. Speaking with the grandson and warning him about elder abuse and being reported to authorities may result in harm to the patient and/or refusal to return to the clinic in the future for follow-up of the patient. Advising the patient to call his son as soon as possible is vague (for what?) and may benefit the patient, but it is not the best option in this case.

The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant? A. Rule out any physiologic cause for the crying spells B. Make sure that the infant is well clothed C. Evaluate the environment D. Order laboratory and diagnostic testing

Solution: A Rule out any physiologic cause for the crying spells. For infants who cry for several hours during the day, ruling out a physiologic problem that may be causing the distress is recommended.

Thiazide diuretics have been shown to have a beneficial effect on the bones, making them a desirable treatment option in hypertensive women with osteopenia or osteoporosis. What is the mechanism of action for their effect on the bones? A. Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoblast production B. Thiazide diuretics increase both calcium and magnesium retention by the kidneys C. Thiazide diuretics increase bone mineral density (BMD) D. Thiazide diuretics influence electrolyte excretion by the kidneys

Solution: A Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoblast production. This positive side effect of thiazides results in a decrease in calcium bone loss and an increase in BMD

A 75-year-old patient with a 25-year history of diabetes is at the primary care clinic for an annual exam. Which finding would prompt the nurse practitioner to refer the patient to the ED? A. Tonometer reading of 28 mmHg B. Retinal hemorrhages C. Cotton-wool spots on the retina D. Reports of difficulty driving at night

Solution: A Tonometer reading of 28 mmHg. A tonometer is used to measure intraocular pressure (IOP). A normal range for IOP is 8 to 21 mmHg. A reading of 28 mmHg could be indicative of primary open-angle glaucoma. Retinal hemorrhages in a 75-year-old patient with a 25-year history of diabetes would likely be the result of systemic vascular conditions such as hypertension and carotid artery stenosis. They represent a long-standing disease and are not a medical emergency; however, if the patient presented with sudden black spots or floaters in the vision, the retinal hemorrhage could represent a more emergent issue such as retinal tear/retinal detachment. Cotton-wool spots on the retina indicate diabetic retinopathy, which is not a medical emergency. Cataract symptoms include difficulty driving at night due to glare, halos around lights, and blurred vision.

The nurse practitioner discovers that a patient received an inappropriate medication due to a lab error. The nurse practitioner immediately informs the patient of the error. Which ethical principle is reflected in the nurse practitioner's behavior? A. Veracity B. Autonomy C. Confidentiality D. Fidelity

Solution: A Veracity. By presenting the information honestly and truthfully, the nurse practitioner is following the ethical principle of veracity. Autonomy is the obligation to ensure that patients have the right to make their own healthcare choices. Confidentiality is the obligation of the nurse practitioner to protect all medical and personal information of the patient. Fidelity is the process of following through with promises and maintaining trust within relationships.

The nurse practitioner is examining a 3-year-old with fainting spells and a "racing heart." The child's heart rate is 182 beats/minute. Which diagnosis is most likely? A. Wolff-Parkinson-White syndrome B. Marfan syndrome C. Ehlers-Danlos syndrome D. Rheumatic fever

Solution: A Wolff-Parkinson-White syndrome. Wolff-Parkinson-White syndrome is caused by extra electrical charges in the heart, resulting in extreme tachycardia, syncope, and dyspnea. A normal heart rate for a 3-year-old child is 70 to 110 beats/minute. Marfan syndrome is usually diagnosed in early adulthood; patients present with joint hypermobility and are at risk for an aortic aneurysm. Ehlers-Danlos syndrome is similar to Marfan syndrome with joint hypermobility, but there is a risk for a cerebral or cervical artery aneurysm. Rheumatic fever presents with fatigue, nosebleeds, painful joints, and a lattice-like rash on chest and back.

A 14-year-old female is brought by her stepfather to the clinic with complaints of nausea and vomiting. Upon initial assessment, the patient states that she does not recall her last menstrual period and denies sexual activity. Blood work confirms a positive pregnancy test. The patient appears nervous when the stepfather is present and refuses to answer the nurse practitioner's questions. What guidelines will the nurse practitioner follow during the physical exam? (Select all that apply.) A. Interview the adolescent without the stepfather present B. Report the suspected abuse to the state/local authority C. Ask another healthcare professional to be present during the physical exam D. Address the findings and concern with the stepfather and mother in order to get an explanation E. Test the patient for sexually transmitted infections

Solution: A, B, C, E Interview the adolescent without the stepfather present; report the suspected abuse to the state/local authority; ask another healthcare professional to be present during the physical exam; test the patient for sexually transmitted infections. In cases of suspected abuse, the nurse practitioner should follow very specific guidelines to obtain information and assess the patient. The patient should be interviewed without the stepfather present to make the patient feel safer. If the patient feels safer, she may provide more information. Information and suspicions should be reported to the proper authorities. While assessing the patient, there should be another healthcare professional present for safety and ethical reasons. The patient should be tested not only for trauma but also for sexually transmitted infections.

Your patient is a 65-year-old man who has been taking a new prescription of rosuvastatin (Crestor) 40 mg daily for 6 weeks. During a follow-up visit, he reports feeling extremely fatigued and having dark-colored urine. He denies any generalized muscle soreness." Which of the following diagnoses is most likely for this patient? A. Rhabdomyolysis B. Acute drug-induced hepatitis C. Acute mononucleosis D. A major depressive episode

Solution: B Acute drug-induced hepatitis. Liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK), can be elevated with the use of medications such as statins. High liver enzymes can cause an acute drug-induced hepatitis.

When initially treating an adult for acute bronchitis, which of the following is the nurse practitioner least likely to prescribe? A. Expectorants B. Antibiotics C. Bronchodilators D. Antitussives

Solution: B Antibiotics. Acute bronchitis is normally a viral infection, so expectorants, bronchodilators, and antitussives would be prescribed for the cough. Antibiotics are not effective against viral infections.

A 53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitioner diagnoses a grade II sprain. The initial treatment plan includes which of the following? A. Intermittent application of cold packs the first 24 hours followed by applications of low heat at bedtime B. Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours C. Rechecking the knee in 24 hours and encouraging isometric exercises D. Application of an elastic bandage wrap to the affected knee

Solution: B Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours. Elevation of the injured knee above the heart will reduce the amount of swelling that can occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 to 20 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30 to 45 minutes between icing of the limb is recommended.

Which of the following is a true statement regarding genu valgum? A. Genu valgum is a term for hyperextension of the knees B. Genu valgum is a term for misalignment of the knees and is often called "knock-knees" C. Genu valgum is a term for a bow-legged stance D. Genu valgum is caused by a misalignment of the knees and resulting asymmetry of the hips

Solution: B Genu valgum refers to a misalignment of the knees and is often called "knock-knees." Genu valgum is the term for knock-knees, a misalignment of the knees that causes the knees to turn inward. If you think of gum stuck between the knees, it helps you remember "valgum." Bow-leggedness is termed genu varum. Hyperextension or backward curvature of the knees is genu recurvatum.

Podagra is associated with: A. Rheumatoid arthritis B. Gout C. Osteoarthritis D. Septic arthritis

Solution: B Gout. Gout (also known as podagra when it involves the big toe) is characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is most commonly affected (approximately 50% of cases). Pain occurs due to the accumulation of uric acid and salts in the joint.

Which diagnosis describes a chronic disease of the apocrine follicles and glands, characterized by clusters of abscesses and pustules in the axilla, groin, and perianal area? A. Mulloscum contagiosum B. Hidradenitis suppurativa C. Folliculitis D. Furuncle

Solution: B Hidradenitis suppurativa. Hidradenitis suppurativa is a chronic disease and recurrent inflammatory disorder of the apocrine glands that results in painful pustules, nodules, and abscesses in areas such as the axilla, groin, perianal, and mammary areas. It is more common in women; risk factors include obesity and a history of smoking. Mulloscum contagiosum is a relatively common viral infection of the skin that results in round, firm, painless bumps ranging in size from a pinhead to a pencil eraser. Folliculitis is a common skin condition in which hair follicles become inflamed. It is usually caused by a bacterial or fungal infection. At first, it may look like small red bumps or white headed pimples around hair follicles. It is not a chronic condition. A furuncle, also known as a boil, is a painful infection that forms around a hair follicle and contains pus. It is not a chronic condition.

A 3-year-old child with a respiratory virus was given aspirin for an elevated temperature. The child subsequently became lethargic and developed severe vomiting and diarrhea. The nurse practitioner assesses for all of the following findings, except: A. Elevated alanine aminotransferase (ALT) B. Hyporeflexia C. Confusion D. Cerebral edema

Solution: B Hyporeflexia. The patient likely has Reye's syndrome, which is a rare condition that can develop in children and young adults recuperating from febrile viral infections who ingest aspirin or salicylate medications. The condition can progress very quickly. Stage 1 symptoms are severe vomiting, diarrhea, lethargy, stupor, and elevated ALT and AST. Stage 2 includes personality changes, irritability, aggression, and hyperactive (not hypoactive) reflexes. Stages 3 to 5 present with confusion, delirium, cerebral edema, coma, seizures, and death.

The nurse practitioner is performing an assessment on an elderly patient who lives in a long-term care facility that has recently been investigated for elder abuse. All of the following physical findings are suggestive of potential abuse, except: A. Faded bruises on the arms and legs B. Incontinence C. Signs of malnutrition D. Stage II pressure injury

Solution: B Incontinence. Bruises are a result of ruptured vessels under the skin. Unless the patient is receiving antiplatelet medication, they may be a sign of physical abuse. Signs of malnutrition that are not due to a physical illness may indicate that the patient is not receiving adequate nutrition or being fed. A pressure injury is indicative of inadequate positioning or movement and may indicate the patient is being isolated in a chair or bed. These observations must be evaluated by the nurse practitioner. A combination of these signs is suggestive of elder abuse. Incontinence is common in older adult clients and is not a direct indicator of abuse.

A 10-year-old boy has type 1 diabetes. His late-afternoon blood sugar levels over the past 2 weeks have ranged from 210 mg/dL to 230 mg/dL. He currently injects 10 units of regular insulin and 25 units of neutral protamine Hagedorn (NPH) insulin in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient? A. Increase both types of insulin in the morning dose B. Increase only the NPH insulin in the morning dose C. Decrease the afternoon dose of NPH insulin D. Decrease both NPH and regular insulin doses in the morning

Solution: B Increase only the NPH insulin in the morning. Regular insulin is rapid/short-acting insulin. Depending on the type of regular insulin, the onset is 10 to 15 minutes, and the insulin peaks within an average of 1.5 hours, with a duration of 3 to 5 hours. NPH insulin is an intermediate-acting insulin. Depending on the type of NPH insulin, the onset is 1.5 to 3 hours. NPH peaks in 4 to 12 hours, and the duration is from 18 to 24 hours. By increasing the morning NPH, the peak will occur in the afternoon, bringing down the blood glucose.

A 75-year-old male patient with bone pain has the following lab values: calcium = 2.76 mmol/L, creatinine = 175 mmol/L, hemoglobin = 9.9 g/dL, and blood serum monoclonal protein = 8 g/dL. What are the treatment steps for this patient? A. Induction therapy, consolidation therapy, salvage therapy, stem cell transplant B. Induction therapy, stem cell transplant, consolidation therapy, salvage therapy C. Consolidation therapy, stem cell transplant, induction therapy, salvage therapy D. Consolidation therapy, induction therapy, salvage therapy, stem cell transplant

Solution: B Induction therapy, stem cell transplant, consolidation therapy, salvage therapy. This patient has signs and symptoms consistent with multiple myeloma (MM), evaluated by the CRAB mnemonic (hyper Calcemia, Renal dysfunction, Anemia, and Bone lesions). Monoclonal protein is part of an antibody produced by cancerous cells, the presence of which in the blood can indicate MM. With symptomatic MM the first step is induction therapy along with bisphosphonates, adjunctive treatment, and evaluation for autologous stem cell transplant (SCT). If a ≥partial response is seen and the patient is a SCT candidate, then an autologous SCT is done. Consolidation therapy follows an SCT. Depending on the response of the patient, salvage therapy may be indicated for aggressive forms of the disease.

The nurse practitioner is performing a vision assessment on a 10-week-old infant. All of the following assessment findings require a referral to a pediatric ophthalmologist, except: A. Pseudostrabismus B. Intermittent esotropia C. White reflex D. Positive Hirschberg test

Solution: B Intermittent esotropia. Abnormal vision screenings that require a referral to a pediatric ophthalmologist include pseudostrabismus (epicanthal folds appear "crossed-eyed"); white reflex, which could indicate cataracts, leukocoria, or retinoblastoma; and a positive Hirschberg test. Intermittent esotropia is common in infants younger than 20 weeks and usually resolves spontaneously. Refer if esotropia is still present after age 20 weeks.

A 75-year-old woman has been on a diuretic for many years to control her stage II hypertension. Her blood pressure at this visit is 165/80 mmHg. She is currently complaining of pain at her right hip and in both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg three times daily (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following is a true statement regarding the effects of ibuprofen (Motrin) on her disease? A. It increases the chances of adverse effects to her health B. It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic C. It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics D. None of the statements are true

Solution: B It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA) inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs can cause acute kidney injury by decreasing renal blood flow. Nonselective NSAIDs can adversely affect the kidneys, gastrointestinal tract, liver, cardiovascular system, and lungs (bronchospasm).

An otherwise healthy 4-year-old child presents with painful, itchy clusters of pustules around the nose and mouth. On assessment, the nurse practitioner notes honey-colored crusted lesions over an erythematous base. How will the nurse practitioner treat this condition initially? A. Hydrocortisone cream B. Mupirocin ointment C. Topical azole antifungal D. Sulfadiazine cream

Solution: B Mupirocin ointment. The child likely has impetigo, an acute superficial skin infection caused by gram-positive bacteria, which is common in young children. As the lesions associated with impetigo rupture, the serous fluid dries and appears as honey-colored crusts. Mupirocin, a topical antibiotic ointment, is used to treat impetigo. Hydrocortisone cream is used to treat a variety of skin conditions featuring inflammation and pruritus by reducing swelling, itching, and redness. It is not used to treat infection and is contraindicated in the treatment of impetigo. Azole antifungals are used in the treatment of tinea infections. Sulfadiazine cream is a sulfa-type antibiotic used to prevent and treat infections in patients with serious burns.

Which cervical cancer screening guideline would the nurse practitioner follow when designing a health promotion program for women over 65 years of age? A. Human papillomavirus (HPV) testing every 3 years B. No screening for women with low risk C. Pap smear with cytology every 5 years D. Screen throughout the life span for women with a cervix

Solution: B No screening for women with low risk. Women >65 years who have had adequate prior screening with no history of high-grade precancerous lesions, or those who have had a hysterectomy with removal of cervix, do not require screening for cervical cancer. These women are considered low risk. The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 21 to 29 years be screened every 3 years with cervical cytology alone, and that women aged 30 to 65 years be screened every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology.

Your patient is a 65-year-old man who has been taking a new prescription of rosuvastatin (Crestor) 40 mg daily for 6 weeks. During a follow-up visit, he reports feeling extremely fatigued and having dark-colored urine. He denies any generalized muscle soreness." Which of the following is the most appropriate treatment plan? A. Order a complete blood count (CBC) with differential B. Order a liver function profile and creatine kinase (CK) level C. Recommend an increase in fluid intake and rest D. Order a urine culture and sensitivity test

Solution: B Order a liver function profile and creatine kinase (CK) level. Statin medications such as rosuvastatin (Crestor) can affect liver function and increase liver enzymes, as well as cause the patient to feel weak and fatigued and have muscle aches. Therefore, checking the liver function profile is recommended.

A 17-year-old female patient tells the nurse practitioner that she is sexually active with her long-term boyfriend and asks for contraception information and a prescription. What is the responsibility of the nurse practitioner? A. Call the parent and obtain consent B. Prescribe the contraceptive after educating the patient about the medication C. Counsel the patient on the dangers of early sexual activity D. Ask the patient to include the boyfriend in the contraceptive decision

Solution: B Prescribe the contraceptive after educating the patient about the medication. A 17-year-old patient has the right to consent for the use of contraceptives. She may give full consent without the involvement of her parents or boyfriend. The nurse practitioner should provide all necessary education regarding safe sexual practices and choice of contraception. The patient is due all confidentiality in this matter.

The nurse practitioner completes a physical assessment for a 45-year-old Hispanic female and prescribes an antihypertensive medication. The patient refuses the prescription and tells the nurse practitioner that she would prefer to take a family-prepared herbal medication to lower her blood pressure. What is the appropriate response by the nurse practitioner? A. Inform the patient that herbal substances are not always effective B. Respect the patient's choice and ask her to return weekly for blood-pressure monitoring C. Implore the patient try the conventional medication for 3 months D. Place the patient on a restricted low-sodium, low-fat diet and monitor blood pressure monthly

Solution: B Respect the patient's choice and ask her to return weekly for blood-pressure monitoring. The nurse practitioner should respect the patient's right to refuse and support her cultural beliefs. Cultural practices influence a person's interpretation of illness. Asking the patient to return for frequent assessment of her blood pressure can help determine the effectiveness of the patient's regimen, as well as allow adaptations to be made. Some herbal medications and treatments may have beneficial effects, but any other medications taken by the patient must be assessed to avoid an adverse combination.

An elderly male patient is complaining of shortness of breath on minimal exertion. He has a long history of chronic obstructive pulmonary disease (COPD) and hypertension. Respirations are 28 breaths/minute. Upon auscultation, lung and heart sounds are diminished. Which of the following will the nurse practitioner avoid when treating this patient? A. Anticholinergics B. Short-acting beta agonists C. Influenza vaccination D. Pneumococcal vaccination

Solution: B Short-acting beta2-agonists. Short-acting beta2-agonists (SABAs) should be avoided in patients who have a history of hypertension and/or hyperthyroidism, as they may cause adverse cardiac side effects such as tachycardia and palpitations. Anticholinergics should be avoided in patients with a history of narrow angle glaucoma, benign prostatic hyperplasia, or bladder neck obstruction. The influenza and pneumococcal vaccinations are recommended in patients with chronic obstructive pulmonary disease (COPD).

The result of a postmenopausal woman's dual-energy x-ray absorption (DEXA) scan shows osteopenia. Which of the following T-scores is indicative of osteopenia? A. T-score of −1.0 or higher B. T-score of −1.0 to −2.5 C. T-score of less than −2.5 D. Normal results

Solution: B T-score between −1.0 and −2.5. Osteopenia is defined as a T-score of −1.0 to −2.5. Osteoporosis is defined as a T-score of −2.5 or below. The T-score is sometimes called the Z score.

The nurse practitioner is evaluating a 72-year-old male patient newly diagnosed with benign prostatic hyperplasia (BPH). The patient has difficulty starting a urine stream, and urinary retention is noted upon exam. The patient takes sublingual nitroglycerin as needed for angina. Which medication will the nurse practitioner prescribe? A. Tadalafil (Cialis) 5 mg PO once daily B. Tamsulosin (Flomax) 0.4 mg PO once daily C. Oxybutynin (Ditropan) 5 mg PO once daily D. Vardenafil (Levitra) 10 mg PO once daily

Solution: B Tamsulosin (Flomax) 0.4 mg PO once daily. Tamsulosin (Flomax), an alpha-adrenergic antagonist, is the first-line agent for the treatment of BPH. Tadalafil (Cialis) and Vardenafil (Levitra) are phosphodiesterase-5 (PDE5) inhibitors used to treat erectile dysfunction (ED). Tadalafil can be prescribed for combined BPH and erectile dysfunction; however, it is contraindicated in patients who take nitrates due to risk of adverse cardiac effects. Oxybutynin (Ditropan) is an anticholinergic agent that is used to treat urinary incontinence.

The S4 heart sound mimics the sound of which state? A. Kentucky B. Tennessee C. Texas D. Montana

Solution: B Tennessee. The S4 heart sound, also called an atrial gallop or atrial kick, mimics the sound of "Tennessee." It is best heard at the apical area using the bell of the stethoscope. The S3 heart sound, also called a ventricular gallop or S3 gallop, mimics the sound of "Kentucky." Texas and Montana are not used to describe heart sounds.

Which of the following is a true statement regarding pes planus in an infant? A. It should be evaluated by a pediatric orthopedist if spontaneous correction does not occur by age 12 months B. The fat pads on an infant's feet can mimic pes planus C. It is always corrected by wearing special orthotic shoes D. It is also called talipes equinovarus

Solution: B The fat pads on an infant's feet can mimic pes planus. The fat pads on an infant's feet can resemble pes planus, or flat feet.

When should a patient diagnosed with a carbuncle return for a follow-up visit? A. Within 12 hours B. Within 48 hours C. Within 3 days D. Within 7 days

Solution: B Within 48 hours. A carbuncle is a group of abscesses that form a large boil with several heads. The patient should be treated with doxycycline or minocycline PO BID × 10 days or clindamycin TID to QID for 10 days if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. The patient should return within 48 hours, as there is usually improvement within 48 to 72 hours after starting antibiotics.

A 24-year-old patient with a history of epilepsy presents to the clinic with complaints of fatigue and unexplained bruising. The patient is taking valproic acid and has a diagnostic level of 75 mcg/mL. Which additional laboratory assessment will the nurse practitioner use to determine the patient's diagnosis? (Select all that apply.) A. Folate level B. Blood smear C. Reticulocyte count D. Antiparietal antibodies E. Complete blood count with differential

Solution: B, C, E Blood smear; reticulocyte count; complete blood count with differential. Valproic acid places patients at an increased risk for aplastic anemia. Based on the patient's current treatment with valproic acid and clinical presentation, the nurse practitioner will evaluate for aplastic anemia. The standard laboratory assessment for aplastic anemia includes a blood smear, a reticulocyte count, and a complete blood count. Other laboratory tests include a complete metabolic panel, lactic acid dehydrogenase, haptoglobin, and coagulation parameters. The clinical presentation of unexplained bruising is not associated with a folate deficiency. Evaluation of the antiparietal antibodies is used to assess a patient for pernicious anemia caused by vitamin B12 deficiency. Clinical findings of vitamin B12 deficiency do not include unexplained bruising.

Which hematologic findings on a peripheral smear support a diagnosis of sickle cell anemia? (Select all that apply.) A. Burr cells B. Target cells C. Schistocytes D. Howell-Jolly bodies E. Anisopoikilocytosis

Solution: B, D Target cells; Howell-Jolly bodies. Target cells and Howell-Jolly bodies are found on a peripheral smear in patients with sickle cell anemia. Burr cells and schistocytes are cell shapes categorized as poikilocytosis. Anisopoikilocytosis is associated with beta thalassemia major, not sickle cell anemia.

A nurse practitioner assesses a child who is experiencing severe otalgia and has a temperature of 100.7°F. The Rinne test result shows BC > AC, and the Weber exam shows lateralization in the affected ear. The nurse practitioner notes blisters on an erythematic tympanic membrane (TM). Which of the following conditions is most likely? A. Acute otitis media (AOM) B. Otitis media with effusion C. Bullous myringitis D. Otitis externa

Solution: C Bullous myringitis. Bullous myringitis is a severe type of AOM with painful blisters (bullae) on a reddened TM. The patient may exhibit conductive hearing loss, otalgia, muffled hearing, and a low-grade fever. With otitis media with effusion, the TM may bulge or retract, but it is not red. It may follow AOM and be caused by chronic allergic rhinitis. Otitis externa (swimmer's ear) is more common in the warm and humid seasons. There is external otalgia, swelling, discharge, pruritus, and hearing loss if the canal is blocked with pus.

A 62-year-old man with chronic obstructive pulmonary disease (COPD) complains to the nurse practitioner that his prescription for ipratropium bromide (Atrovent) is not working. He reports that he still feels short of breath even after using it four times a day for 3 months. Which of the following actions is the next step for the nurse practitioner? A. Increase the patient's dose of ipratropium bromide (Atrovent) to three inhalations QID B. Continue the ipratropium bromide and start the patient on oxygen by nasal cannula C. Continue ipratropium bromide (Atrovent) and add two inhalations of an albuterol (Ventolin) inhaler QID D. Start the patient on oxygen by nasal cannula at bedtime and PRN during the daytime

Solution: C Continue ipratropium bromide (Atrovent) and add two inhalations of an albuterol (Ventolin) inhaler QID. Treatment of COPD starts with an anticholinergic (ipratropium bromide [Atrovent]). The next step is to add a short-acting beta-2 agonist (albuterol [Ventolin]).

A 4-year-old child of Chinese parents presents to the clinic with fever, chills, and coughing. Upon examination, the nurse practitioner discovers round, reddened marks on the child's back. How will the nurse practitioner interpret the marks on the child's back? A. Allergic skin reaction B. Chicken pox lesions C. Cupping marks D. Signs of abuse

Solution: C Cupping marks. Families who practice traditional Chinese medical beliefs may use the practice of cupping. Cupping creates large, round, reddened marks or bruises on the back. These lesions can be interpreted as signs of abuse. Interviewing the family and assessing its cultural background helps distinguish between abuse and cultural practices and beliefs. The nurse practitioner should question the parents about how the child received such lesions before concluding abuse. Allergic reactions generally appear as itchy welts. Chicken pox is a communicable disease and produces pustules.

A patient visits the primary care office with complaints of nausea, vomiting, confusion, and yellowish-green halos in their vision. The patient's lab values are potassium of 3.2 mg/dL and calcium of 11.8 mg/dL. Which medication is most likely causing toxicity? A. Lithium (carbonate) B. Phenytoin (Dilantin) C. Digoxin (Lanoxin) D. Carbamazepine (Tegretol)

Solution: C Digoxin (Lanoxin). The classic symptoms of digoxin toxicity are nausea, vomiting, confusion, and yellowish-green halos in the patient's vision. Digoxin toxicity can cause hypokalemia and hypercalcemia. Lithium toxicity symptoms are seizures, slurred speech, increased urination, and increased thirst. Phenytoin (Dilantin) toxicity symptoms include nystagmus, ataxia, and confusion. Carbamazepine (Tegretol) toxicity will present as a skin rash and jaundice.

Some nurse practitioners bill directly for their services. Regarding reimbursement, who is considered a third-party payer? A. Patient B. Healthcare provider C. Health insurance companies, health plans, Medicare, and Medicaid D. Federal government

Solution: C Health insurance companies, health plans, Medicare, and Medicaid. Third-party payers are health insurance companies, health plans (HMOs or PPOs), Medicare, and Medicaid. The "first party" is the patient. The "second party" is the healthcare provider.

A 7-year-old is brought to the clinic by his mother, who is concerned about "bumps" on his trunk and armpits lasting for several weeks. There are no complaints of pain or itching, and the child is afebrile. Upon examination, the nurse practitioner notes a cluster of 2-mm papules that are flesh-colored, dome-shaped, and smooth with a central umbilication. Which diagnosis is most likely? A. Secondary milia B. Verruca vulgaris C. Molluscum contagiosum D. Folliculitis

Solution: C Molluscum contagiosum. Molluscum contagiosum is a viral condition common in children spread by direct contact. The condition is self-limiting, does not produce pain or itching, and resolves over several months. Milia are keratin-filled cysts that usually occur around the nose and eyes. Verruca vulgaris (warts) are viral and appear as irregular, raised, flesh-colored growths that feel rough to the touch. Folliculitis is an inflammation of the hair follicles, which can become pus-filled sores.

The nurse practitioner should avoid prescribing all of the following drug classes to patients with sulfa allergies, except: A. Thiazides B. Loop diuretics C. Potassium-sparing diuretics D. Protease inhibitors

Solution: C Potassium-sparing diuretics. Patients with sulfa allergies may be sensitive to thiazides, loop diuretics, and some protease inhibitors (e.g., darunavair, fosamprenavir), which are used in the treatment of HIV. Potassium-sparing diuretics are a safe alternative for patients with severe sulfa allergy

Which of the following pathogenic bacteria are commonly found in the lungs of older children and adults with cystic fibrosis? A. Streptococcus pneumoniae B. Chlamydia pneumoniae C. Pseudomonas aeruginosa D. Staphylococcus aureus

Solution: C Pseudomonas aeruginosa. P. aeruginosa is a common chronic lung infection seen in older children and adults with cystic fibrosis. This infection is difficult to eliminate and sometimes is the cause of death.

The nurse practitioner is conducting a health assessment on a 21-year-old patient with pheochromocytoma. During the assessment, the nurse practitioner is likely to detect all of the following signs and symptoms, except: A. Headaches B. Tachycardia C. Weight gain D. Sweaty palms

Solution: C Weight gain. Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamine. It causes hypertension, diaphoresis (including sweaty palms), headaches, tachycardia, hyperglycemia, hypermetabolism, and weight loss (not weight gain).

All of the following patients are at higher risk of suicide, except: A. A 66-year-old White man whose wife of 40 years recently died B. A high school student with a history of bipolar disorder C. A depressed 45-year-old woman with a family history of suicide D. A 17-year-old teen who has only one close friend in school

Solution: D A 17-year-old teen who has only one close friend in school. Risk factors for suicide include (a) elderly White men (especially after the death of a spouse); (b) past history of suicide; (c) family history of suicide; (d) plans for use of a lethal weapon such as a gun or knife; (e) gender (higher attempt rate in females, but higher success rate in males); and (f) personal history of bipolar disorder or depression.

A 50-year-old female presents with complaints of fatigue, new onset of shortness of breath, nausea and vomiting, and pain radiating to the back. Her skin is cool and clammy. The nurse practitioner suspects: A. Congestive heart failure B. Infective endocarditis C. Dissecting abdominal aortic aneurysm D. Acute myocardial infarction

Solution: D Acute myocardial infarction. While men may complain of a gradual onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy pressure in the chest, women and elderly patients may have more nonspecific symptoms. They are more likely to present with dyspnea, weakness, nausea, vomiting, syncope, and fatigue. Pain may radiate to the back instead of chest. Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and ankles. Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain located in the abdomen, back, or flank area. Infective endocarditis (bacterial endocarditis) is a potentially fatal infection of the heart lining that can cause damage to the heart and its valves. The patient presents with chills, fever, and malaise with an onset of new heart murmur. Associated skin findings include subungual hemorrhages on the toes/feet, fingers, and hands (Osler nodes, Janeway lesions). Fundal exam will reveal retinal hemorrhages (Roth spots).

A 15-year-old boy has just moved into the community and is staying in a foster home temporarily. There is no record of his immunizations. His foster mother wants him to be checked before he enters the local high school. Which of the following immunizations does this patient need? A. Meningococcal vaccine B. Measles-mumps-rubella (MMR) vaccine C. Tdap vaccine D. All of the above

Solution: D All of the above. This 15-year-old teenage patient will follow the Centers for Disease Control and Prevention (CDC) "catch-up" schedule and needs the meningococcal vaccine, MMR vaccine, and Tdap vaccine. In addition to these three vaccines, this patient needs the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and varicella vaccine (if no history of chickenpox).

A middle-aged male patient being treated for benign prostatic hypertrophy (BPH) presents to the clinic for a follow-up appointment. He reports that over the past few days, he has experienced painful ejaculation and pain during urination. The patient's prostate is enlarged and boggy, and the patient experiences discomfort during the examination. Which treatment will the nurse practitioner prescribe? A. Cefixime (Suprax) 400 mg single dose PO B. Ceftriaxone (Rocephin) 250 mg single dose IM C. Doxycycline 100 mg PO BID × 10 days D. Ciprofloxacin (Cipro) 500 mg PO BID × 10 days

Solution: D Ciprofloxacin (Cipro) 500 mg PO BID × 10 days. The patient's symptoms and clinical findings are consistent with a diagnosis of acute bacterial prostatitis. The patient can be treated with ciprofloxacin (Cipro) 500 mg PO BID × 10 days. There is no indication that the patient's acute bacterial prostatitis is related to a sexually transmitted infection; therefore, treatment with cefixime (Suprax), ceftriaxone (Rocephin), and doxycycline would not be indicated. Cefixime 400 mg single dose PO and ceftriaxone 250 mg single dose IM are prescribed for patients with acute bacterial prostatitis who are at risk for sexually transmitted infections. If neither cefixime nor ceftriaxone resolves the infection for these patients, doxycycline 100 mg PO BID × 10 days can be prescribed.

A patient recently returned from a trip to Africa and is experiencing 10 to 12 loose stools/day. The patient takes metformin every morning and otherwise is in good health. Which medication will the nurse practitioner prescribe to treat the diarrhea? A. Levofloxacin (Levaquin) daily B. Ofloxacin (Floxin) BID C. Trimethoprim-sulfamethoxazole (Bactrim DS) BID D. Ciprofloxacin (Cipro) in a single dose

Solution: D Ciprofloxacin (Cipro) in a single dose. The patient most likely has traveler's diarrhea, given the history of a recent return from another country. The patient's treatment should be based on functional impact of symptoms and not frequency of symptoms, which is not indicated in the question. The patient likely has moderate acute traveler's diarrhea, which can be treated with loperamide as monotherapy or with adjunctive antibiotic therapy. The patient is taking metformin daily for diabetes, so risk of precipitating hypoglycemia is lower than with other oral antidiabetic agents. Because it can be given in a single dose, ciprofloxacin would be the appropriate choice for reducing exposure and microbiome colonization disruption. Levofloxacin and ofloxacin require one to three doses. Trimethoprim-sulfamethoxazole is a sulfonamide and would be appropriate treatment for cyclosporiasis but not giardiasis, which is the most common parasitic cause of traveler's diarrhea.

The nurse practitioner sees a patient for a skin assessment and finds a small number of rough, scaly patches on the patient's face, lips, ears, and neck. What is the most appropriate treatment for this condition? A. Cryopexy B. Radiation C. 5-fluorouracil cream D. Cryotherapy

Solution: D Cryotherapy. The patient has a small number of actinic keratosis lesions on their head, so cryotherapy is the best plan. If the patient had larger numbers of lesions all over their body, 5-fluorouracil cream would be the most appropriate intervention. Cryopexy is the treatment for a retinal detachment. Although actinic keratosis is a precursor to squamous cell carcinoma, it is not cancerous and does not require radiation.

Which lifestyle modification will the nurse practitioner recommend to a 23-year-old female patient with a body mass index (BMI) of 27? A. Daily strength training B. A diet high in fat and low in sodium C. A diet high in protein and low in carbohydrates D. Daily aerobic exercise (30 minutes)

Solution: D Daily aerobic exercise (30 minutes). A BMI of 27 for a 23-year-old female is considered "overweight" (normal: 18.5-24.9). The nurse practitioner should recommend 30 minutes of daily aerobic exercise and a healthy balanced diet (e.g., vegetables/fruits, lean proteins, complex carbohydrates) that is low in sodium and fat. The patient should be encouraged to limit red meat consumption and control portions. Strength training is recommended three or four days per week, not daily.

A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. Which of the following symptoms does not characterize this disorder? A. Ritualistic behaviors that the patient feels compelled to repeat B. Increased anxiety when attempting to ignore or suppress the repetitive behaviors C. Frequent intrusive and repetitive thoughts and impulses D. Disorganized speech or behavior

Solution: D Disorganized speech or behavior. Obsessive-compulsive disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. Signs and symptoms of obsessive compulsive disorder include ritualistic behaviors that are repeated, increased anxiety when the patient attempts to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses. Disorganized speech or behavior is a symptom of schizophrenia.

A 74-year-old male presents to the clinic with a 3-day history of redness to the face, fever, and chills. Upon examination, the nurse practitioner notes a large, hot, indurated, and demarcated red skin lesion on his cheek. The patient states he has tenderness to the face but denies ocular pain. Which diagnosis is most likely? A. Rosacea B. Chagas disease C. Intertrigo D. Erysipelas

Solution: D Erysipelas. Erysipelas is a subtype of cellulitis involving the upper dermis and superficial lymphatics. It is distinguished by well-demarcated borders, marked erythema, and warmth. It occurs commonly in the face. Rosacea is a common skin condition that causes redness and visible blood vessels on the face. It may also produce small, red, pus-filled bumps. It is not associated with fever and chills. Chagas disease (American trypanosomiasis) presents with circumorbital edema. Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.

The nurse practitioner is completing a health assessment on a 15-year-old female patient who is in the office for her annual physical. The patient reports feelings of hopelessness and sadness for several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores an 11 on Beck's Depression Inventory. The nurse practitioner will prescribe: A. Sertraline (Zoloft) B. Lithium carbonate (Eskalith) C. Bupropion (Wellbutrin) D. Escitalopram (Lexapro)

Solution: D Escitalopram (Lexapro). Escitalopram (Lexapro) is a safe antidepressant for an adolescent who has severe depression and no history of suicidal ideations. Sertraline (Zoloft) is not a safe option for patients <24 years of age due to increased risk of suicidal ideation. Bupropion (Wellbutrin) is an atypical antidepressant and is not a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium carbonate (Eskalith) is indicated for patients with bipolar disorder.

A sexually active young adult is diagnosed with Chlamydia trachomatis and treated with doxycycline 100 mg BID 7 days. During a follow-up visit, the patient reports a new onset of right upper quadrant pain and tenderness on palpation. Alanine aminotransferase (ALT) is 43 U/L, and aspartate aminotransferase (AST) is 24 U/L. The nurse practitioner suspects: A. Jarisch-Herxheimer reaction B. Reiter's syndrome C. Stevens-Johnson syndrome D. Fitz-Hugh-Curtis syndrome

Solution: D Fitz-Hugh-Curtis syndrome. The patient is most likely presenting with Fitz-Hugh-Curtis syndrome, a pelvic inflammatory disease. Signs and symptoms include right upper quadrant pain and pain on palpation, normal liver function, and "violin string" adhesions revealed on laparoscopy exam. Reiter's syndrome is more common in men and is a secondary reaction to bacteria such as chlamydia. Treatment is supportive, and the syndrome spontaneously resolves. Stevens-Johnson syndrome is an adverse reaction to an antibiotic that produces a severe rash and flu-like symptoms. A Jarisch-Herxheimer reaction is an acute response from syphilis or other spirochete treatment in the first 24 hours and produces acute fever, chills, headache, and myalgia.

A 74-year-old patient diagnosed with streptococcal pharyngitis was treated with oral penicillin V 500 mg BID × 10 days. During a follow-up visit, the patient presents with tonsillar exudate and a low-grade fever. The nurse practitioner will: A. Prescribe a 5-day course of azithromycin B. Refer patient to an ENT specialist C. Prescribe another course of penicillin V D. Repeat culture and sensitivity (C&S)

Solution: D Repeat culture and sensitivity (C&S). If a patient returns post strep-pharyngitis and has completed a course of treatment, a throat C&S should be repeated. It is not necessary to refer the patient to an ENT specialist. Another round of penicillin V may not be clinically appropriate without a repeat C&S first. Once the C&S report is back, it may or may not be appropriate to begin a new antibiotic such as azithromycin.

A 70-year-old male patient complains of a bright-red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new-onset cough from a recent viral upper respiratory infection. The only medicine he is taking is Bayer aspirin one tablet daily. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage

Solution: D Subconjunctival hemorrhage. Bright-red blood in a sharply defi ned area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. The blood stays red because of direct diffusion of oxygen through the conjunctiva. Risk factors include diabetes, hypertension, illnesses that cause severe coughing or sneezing, blood-thinning medications and aspirin, and herbal supplements such as ginkgo.

An adult patient is being evaluated for tuberculosis (TB) infection with a Mantoux test. The purified protein derivative (PPD) result is 10.5 mm. The patient denies weight loss, cough, and night sweats, and the results of a chest x-ray are negative. The patient reports that he is in the United States illegally and is fearful about discovery. What is the most appropriate action for the nurse practitioner? A. The nurse practitioner has a legal duty to report the patient to the local federal agency responsible for illegal migrants B. The nurse practitioner is legally mandated to report illegal migrants to state authorities C. The nurse practitioner should call the state health department to report that the patient has a TB infection D. The nurse practitioner has an ethical duty to provide quality healthcare to patients

Solution: D The nurse practitioner has an ethical duty to provide quality healthcare to patients. Currently, health caregivers are not legally required to report illegal migrants to the state or local authorities. This patient does not have the signs and symptoms of active TB disease (cough, weight loss, night sweats) and has a negative chest x-ray. Therefore, he has latent TB infection and is not contagious. Only patients with active TB disease (has signs/symptoms) must be reported to the state public health department.

An elderly female patient is brought to the primary clinic clutching a spoon. Her caregiver states, "I'm worried about her. She uses that spoon to eat, then combs her hair with it, and she even tries to write with it." Which of the following is true statement regarding this possible dementia diagnosis? A. A CT scan is the best imaging test for dementia B. The most common cause of dementia is Lewy bodies C. A high score on the Mini-Cog indicates severe dementia D. This is one of the few types of dementia that has a possible genetic component

Solution: D This is one of the few types of dementia that has a possible genetic component. The patient is demonstrating utilization behavior commonly seen in frontotemporal dementia (FTD). Most dementias do not have a known genetic component; however, 10% to 15% of people with FTD, formally called Pick's disease, have a family history. The best brain imaging test to use for screening dementia and cognitive impairment is an MRI scan of the brain. The most common cause of dementia is Alzheimer's disease (60%-80%). Lewy bodies are the second most common cause of dementia. The lower the score on the Mini-Cog or Folstein's Mini-Mental State Examination (MMSE), the greater the level of dementia.

Which area of the lung is the most common location of a Mycobacterium tuberculosis infection? A. Lower lobes B. Left lower lobe C. Right middle lobe D. Upper lobes

Solution: D Upper lobes. The upper lobes are the most common location of a tuberculosis infection of the lungs. The typical findings are cavitation (round black holes due to local loss of lung tissue), fibrosis, lymphadenopathy, and calcifications.