Nur 825

Adults at high risk for POAG should undergo a complete eye examination every Select one: a. 1 to 2 years b. 3 to 4 years c. 5 to 6 years d. 3 to 6 months

1 to 2 years

Which of the following clinical findings constitutes a possible emergency situation? Select one: a. A fiery red epiglottis b. Sudden onset of hoarseness c. Purulent drainage from the external canal d. Tragal tenderness

A fiery red epiglottis- A finding of a fiery red epiglottis signals epiglottitis. Since airway obstruction can be rapid with epiglottitis, immediate referral to an emergency department is warranted. Sudden onset of hoarseness does not signal a specific emergency situation. Purulent drainage from the external canal may signify a ruptured tympanic membrane or otitis externa. Tragal pain is significant of otitis externa.

When using a TNM Classification of Malignant Tumors staging system to classify the spread to regional lymph nodes, all of the following grades would be appropriate EXCEPT: Select one: a. A grade of 4 b. A grade of 0 c. A grade of X d. A grade of 3

A grade of 4- The TNM Classification of Malignant Tumors staging system uses 0-3 or "X" when classifying the spread of tumor to regional lymph nodes, therefore, a rating of 4 is not valid for measuring spread. The range of the size or extent of the primary tumor can be classified by "a" , "is" or 1-4. Presence of distant metastasis can be designated by 0 or 1. In all of the above parameters, an "X" can be used instead of a number or letter to denote that the parameter was not assessed in the patient.

All of the following pharmacologic agents are used to treat inflammation in the lungs of asthmatics except: Select one: a. Nedrocromil sodium (Tilade) two sprays QID b. Cromolyn sodium inhaler (Intal) two puffs QID c. A long-acting oral Theophylline (Theo-Dur) 200 mg every 12 hours d. Fluticasone inhaler (Flovent) two puffs BID

A long-acting oral Theophylline (Theo-Dur) 200 mg every 12 hours

A patient who has been using inhaled corticosteroids to manage his asthma has started to experience symptom breakthrough. Which of these steps should you take next? Select one: a. Add a short-acting beta-2 adrenergic agonis b. Increase the dose of the inhaled corticosteroid c. Add an inhaled anticholinergic d. Start an antileukotriene

Add a short-acting beta-2 adrenergic agonist- A short-acting beta-2 adrenergic agonist, such as albuterol, may be added to an asthma patient's regimen for control of breakthrough symptoms. Although the dosage of inhaled corticosteroids may be increased to aid in management, this is meant to assist in daily maintenance not in controlling breakthrough symptoms. Inhaled antcholinergics and antileuktrienes may likewise aid in daily management but you are looking for a "rescue" inhaler for breakthrough symptoms.

For a patient diagnosed with bacterial acute otitis media, which of the these medications is usually recommended for first line-treatment? Select one: a. Amoxicillin b. Miconazole c. Ceftriaxione d. Clotrimazole

Amoxicillin- A patient diagnosed with a bacterial case of acute otitis media would most likely be treated with amoxicillin. Ceftriaxone may be used to treat OM but is not typically recommended as first line. Clotrimazole and miconazole are antifungals.

Your patient was seen by a pulmonologist 2 months ago and diagnosed with asthma. The pulmonologist ordered a short acting-beta-2 agonist for initial symptom relief. However, on today's visit to your office, the patient states: " I don't think this stuff is really working because I'm still short of breath." You refer the patient back to the pulmonologist. Which of the following would you anticipate to be the next step in the patient's management following the latest national guidelines? Select one: a. An antileukotriene b. A long-acting beta-2 adrenergic agonist c. A metered anticholinergic d. An inhaled corticosteroid

An inhaled corticosteroid- Ny national guidelines for asthma management, a low dose inhaled corticosteroid (ICS) is usually the first step for increased management after a short acting beta-2 agonist shows insufficient results in controlling symptoms. While an antileukotriene, such as montelukast may serve as alternate treatment at this step, a low-dose corticosteroid is considered to be the standard medication. Long-acting beta-2 agonists typically see use if treatment with a low-dose ICS fails to manage symptoms, whereas metered anticholinergics are usually paired with a SABA for short-term symptom relief, not long-term symptom control

A thin patient with a slight build presents with constant difficulty breathing and clear mucous. A physical exam also indicates an increased chest anteroposterior diameter and hyperresonance on percussion. Given the most likely diagnosis, which class of medications is best suited for long-term treatment? Select one: a. Antibiotics b. Anticholinergics c. Antileukotrienes d. Short-acting beta-2 adrenergic agonist.

Anticholinergics- Progressive and constant dyspnea, mild sputum, and increased chest anteroposterior diameter are most indicative f emphysema; such as, core symptoms of the condition are best managed in the long term through inhaled anticholinergics, such as ipratropium bromide. Antibiotic treatment is usually aimed at preventing complications resulting from emphysema and does not treat the condition itself. Short-acting beta-2 adrenergic agonists may also be used to treat emphysema, but ipratropium bromide is often preferred due to greater efficacy and minimal cardiac stimulation effects. Atiileukotrienes are not typically considered in management of emphysem

Of the following, which condition is most likely to develop as a result of pressure on the cornea in cases of chalazia? Select one: a. Glaucoma b. Astigmatism c. Arcus senilis d. Presbyopia

Astigmatism- In cases of chalazia, pressure on the cornea may lead to astigmatism. In contrast, glaucoma usually develops as a consequence of increased intraocular pressure as opposed to corneal pressure.

An elderly male presents with symptoms that include a burning sensation in the eye and red, scaly flakes around the eyelids, which are covered with thick crusts. Based on the patient's presentation, which of the following medications should be prescribed to treat the patients condition? Select one: a. Levofloxacin or ofloxacin b. Ofloxacin or erythromycin c. Bacitracin or erythromycin d. Ciprofloxacin or bacitracin

Bacitracin or erythromycin- Based on the patients presentation, the most likely condition is blepharitis. The most likely treatment is bacitracin or erythromycin.

A chest radiograph shows an area of consolidation on the lower lobe. Which of the following conditions is most likely? Select one: a. Bacterial pneumonia b. Acute bronchitis c. COPD d. Atypical pneumonia

Bacterial pneumonia

Chlamydial conjunctivitis would most likely be treated with all of the following except: Select one: a. Erythromycin b. Doxycycline c. Ceftriaxone d. Clarithromycin

Ceftriaxone- Gonococcal, rather than Chlamydial conjunctivitis would typically be treated with an intramuscular dosing of Ceftriaxone. Chlamydial conjunctivitis is usually treated with erythromycin, doxycycline or clarithromycin. Other oral medications that often see use in cases of chlamydial conjunctivitis include azithromycin and tetracycline.

A patient presents with this condition. Of the following, which condition is the patient experiencing? Select one: a. Conjunctivitis b. Hordeolum c. Chalazion d. Blepharitis

Blepharitis

The American Academy of Ophthalmology recommends that all patients receive a complete screening for glaucoma by at least what age? Select one: a. By age 25 b. By age 30 c. By age 35 d. By age 40

By age 40- The AAO recommends adults receive complete screening for glaucoma every 4 years after age 40.

A 67-year-old female with a 50 pack/year history of smoking presents for a routine annual physical examination. She complains of being easily short of breath and is frequently fatigued. Physical examination reveals diminished breath sounds, hyperresonance, and hypertrophied respiratory accessory muscles. Her CBC results reveal that her hematocrit level is slightly elevated. Her pulmonary function test (PFT) results show increased total lung capacity. What is the most likely diagnosis for this patient? Select one: a. Bronchogenic carcinoma b. COPD (chronic obstructive pulmonary disease) c. Chronic bronchitis d. Congestive heart failure

COPD (chronic obstructive pulmonary disease)

A 62-year-old male patient presents with cloudy vision in a single eye. In addition, he complains of glare coming off of bright lights and difficulty with night vision. Which of the following is the most likely diagnosis? Select one: a. Chalazion b. Cataracts c. Conjunctivitis d. Glaucoma

Cataracts- A patient experiencing cloudy vision in a single eye, glare from bright lights, and difficulty with vision at night is most likely to be diagnosed with cataracts. Although chalazia may present with changes to vision, it usually presents with other distinctive symptoms such as swelling on the eyelid, eyelid tenderness, and increased tearing.

Which of the following medications would be the best first-line treatment for a patient with gonococcal pharyngitis? Select one: a. Levofloxacin b. Penicillin V c. Prednisone taper d. Ceftiaxone

Ceftiaxone- Gonococcal pharyngitis should be typically treated with Ceftriaxone, as it treats the infection itself instead of just maintaining the symptoms produced by the infection. Levofloxacin does not typically see use in the treatment of bacterial pharyngitis and is more often used to treat pneumonia and sinusitis. Although penicillin V is also used to treat pharyngitis, it is typically only prescribed for streptococcal infections. Prednisone tapers may be used to reduce inflammation but would not serve much use in treating the underlying infection

A patient presents with the following condition. What are they most likely experiencing? Select one: a. Conjunctivitis b. Hordeolum c. Chalazion d. Blepharitis

Chalazion

Cataracts are most commonly associated with which condition? Select one: a. Diabetes b. Hypertension c. Hypercholesterolemia d. Retinal artery occlusion

Diabetes- Cataracts may derive from a variety of causes including aging, diabetes, heredity, tobacco use, and alcohol consumption, among others. This phenomenon does not typically occur as a direct result of hypertension, hypercholesterolemia, or retinal artery occlusion

When evaluating a patient with Meniere's disease, the procedure of observing for nystagmus while moving the patient from sitting to supine with the head angled 45 degrees to one side and then the other is called: Select one: a. the Romberg test b. Dix-Hallpike test c. the Rinne test d. the Fukuda test

Dix-Hallpike test

Which of the following does not accurately describe the usual mucosal findings of a patient with a typical case of sinusitis? Select one: a. Dry b. Reddened c. Foul-smelling d. Discolored

Dry- Dry is the least common finding in a patient with sinusitis, the other choices are much more likely.

Which of the following would be LEAST indicative of chronic obstructive pulmonary disease? Select one: a. Hyperinflated lungs b. Elevated diaphragm c. Reduced FEV1 d. Increased residual volume

Elevated diaphragm- A chest x-ray for a patient with COPD commonly shows a flattened not elevated diaphragm. Hyperinflation can also be detected on a chest x-ray and is a common finding for both chronic bronchitis and emphysema.In addition, increased residual volume and reduced FEV1 are diagnostic findings indicative of COPD.

A 52-year-old female patient comes to your practice with complaints of breathlessness and a cough accompanied by excessive phlegm. She produces a sputum sample, which appears clear upon inspection. You order a pulmonary function test; in reviewing the results, you find evidence indicating both an increased functional residual capacity and an increased total lung capacity. Which of the following respiratory diseases would be the most likely diagnosis? Select one: a. Acute bronchitis b. Emphysema c. Tuberculosis d. Pneumonia

Emphysema- Emphysema is the most likely diagnosis, as it typically presents past the age of 50, and is characterized by a productive cough, clear sputum, and breathlessness, as well as an increase in both functional residual capacity and total lung capacity. Acute bronchitis may present with bronchospasm and bronchial hyperreactivity but does not present with changes to FRC or TLC. Furthermore, tuberculosis does not result in an increased FRV or TLN, rather a decreases respiratory capacity often presents in patients with advanced TB. Pneumonia may produce a decrease, rather than an increase in FRV and TLC.

If a patient with a sore throat has been advised to avoid contact sports, his condition most likely stems from which of the following viruses? Select one: a. Respiratory syncytial virus b. Adenovirus c. Epstein-Barr Virus d. Rhinovirus

Epstein-Barr Virus

A patient with tuberculosis is being treated with a regimen of isoniazid, rifampin, pyrazinamide and ethambutol. The patient's condition is improving significantly and there is evidence indicating that the isolate being treated is fully susceptible to the current regimen. At this time, which change would be recommended to incorporate into the patient's regimen? Select one: a. Rifampin may be dropped b. Isoniazid may be dropped c. Pyrazinamide may be dropped d. Ethambutol may be dropped

Ethambutol may be dropped- If a patient with TB shows susceptibility of the isolate while on a treatment regimen of isoniazid, rifampin, pyrazinamide and ethambutol, then ethambutol may be dropped. Pyrazinamide should be continued for at least 2 more months, and isoniazid and rifampin should be continued as daily or intermittent therapy for 4 or more months.

A patient is diagnosed with allergic rhinitis. Which symptom below is NOT associated with allergic rhinitis? Select one: a. Paroxysmal sneezing b. Rhinorrhea c. Nasal congestion d. Facial pain

Facial pain

What are hyperopia and myopia also known as, respectively? Select one: a. Astigmatism and farsightedness b. Farsightedness and nearsightedness c. Astigmatism and near sightedness d. Nearsightedness and farsightedness

Farsightedness and nearsightedness- Hyperopia is known as farsightedness or difficulty seeing close objects. Myopia is nearsightedness, or difficulty seeing distant objects. Astigmatism refers to shaping of the cornea or lens that alters the orientation of the light rays.

Jackie; a 25- year-old female comes to the clinic experiencing respiratory distress and difficulty speaking. Her lungs are hyperresonant and show hyperinflation on the x-ray. which result would most strongly indicate that Jackie should be admitted to the hospital? Select one: a. Forced expiratory volume is below 30% b. Respiratory rate is 25 breaths per minute c. Pulsus paradoxus of 8 mmHg d. Pulse of 112 bpm

Forced expiratory volume is below 30%- Hospitalization for asthma is typically recommended when the forced expiratory volume is one second (FEV1) is 30% below predicted value. A respiratory rate of 25 breaths per minute is higher than the average breaths peer minute for an adult, but does not indicate a need for hospitalization. Pulsus paradoxus of 8 mmhg and pulse of 112 bpm are not necessarily indicative of severe manifestation of asthma and would not indicate the need for hospitalization

Of the following causes of conductive hearing loss, which is the most common? Select one: a. Perforated tympanic membrane b. Hematoma c. Foreign body d. Otosclerosis

Foreign body- Foreign bodies in the ear canal, along with cerumen build-up are the most common and most treatable causes of conductive hearing loss. Hematoma, tympanic membrane perforation, and otosclerosis are also likely causes of conductive hearing loss, but are not as common as foreign bodies.

Which of the following choices is least likely to cause costochondritis? Select one: a. Injury to the chest b. Physical strain c. Giant cell arteritis d. Fibromyalgia

Giant cell arteritis- Giant cell arteritis is not likely to cause costochondritis, but may be associated with polymyalgia rheumatic. Additionally, giant cell arteritis affects the blood vessels that supply blood to the head. Typical causes for costochondritis include physical strain injury to the chest, and fibromyalgia.

During an eye exam, a patient's optic cup-to-disc ratio indicates that the size of the optic cup is larger than one half of the diameter of the optic disc. Which optic disease does this finding most strongly indicate? Select one: a. Cataract b. Retinal detachment c. Glaucoma d. Conjunctivitis

Glaucoma- If the size of a patients optic cup is larger than one half of the optic disc during an eye exam, glaucoma should be considered. The pathology of cataracts typically consists of clouding and opacification of the eye lens, which is normally clear. Retinal detachment is more commonly detected through pupil reaction and an external examination for signs of trauma, particularly in the vitreous. Last, conjunctivitis typically manifests as inflammation with possible infection of the conjunctiva

A patient describes a sensation that something is in his throat. He denies throat pain. His exam is normal. What diagnosis should the NP make? Select one: a. Factitious sore throat b. Pseudo pharyngitis c. Globus d. GERD

Globus- The diagnosis will describe the patient's symptoms, globus. This is a sensation that there is a lump or a foreign body in the throat. It is not associated with sore throat or pain. If pain is present, this is not globus. The most common cause of globus is GERD, but this diagnosis cannot be made based on the information from the question.

Of the following choices, the practitioner recognizes which two as the most common pathogens responsible for sinusitis in the adult? Select one: a. Haemophilus influenzae and Streptococcus pneumoniae b. Escherichia coli and Haemophilus influenzae c. Klebsiella pneumoniae and Moraxella catarrhalis d. Streptococcus pneumoniae and Staphylococcus aureus

Haemophilus influenzae and Streptococcus pneumoniae- Haemophilus influenzae and Streptococcus pneumoniae are the two pathogens most commonly responsible for bacterial sinusitis in adults. Klebsiella pneumoniae and Moraxella catarrhalis are common pathogens in Community-aquired and nosocomial bacterial sinusitis, respectively, but not as common as H. influenzae and S. pneumoniae. Staphylococcus aureus may likewise produce sinusitis, but is not a common pathogen. Finally Esherichia coli is more likely to cause pneumonia than sinusitis.

Shawn, a 23-year-old male, has been experiencing nasal mucosal discharge, headache, cough and malaise for approximately 5 days. You suspect he has a cold. Which of the following findings would best suggest an alternative diagnosis? Select one: a. He has a sore throat b. His nasal passages are occasionally blocked c. He continuously sneezes d. He has occasional muscle aches

He has occasional muscle aches- The common cold and influenza share similar signs and symptoms that include mucosal discharge, headache, cough, and malaise, however, patients with influenza are more likely to experience muscle soreness and body aches, which typically present lightly is at all, in patients with the common cold. sore throat, blocked nasal passages, and sneezing would all help confirm the initial diagnosis of the common c

A 45-year-old patient describes a spinning sensation that lasts for several hours before abating. During this time, he complains of nausea and vomiting, and headache. Which symptom is not characterized of benign positional vertigo? Select one: a. The length of duration of symptoms b. Nausea and vomiting c. Headache d. Sensation of spinning

Headache- A spinning sensation is a typical description of a patient with benign positional vertigo (BPV). It can last from seconds to days. A common description by a patient is the sensation of moving, having objects around them move, or a tilting sensation. During acute attacks of vertigo, regardless of the etiology, nausea and vomiting are typical. A headache during an episode of vertigo likely represents a different etiology than BPV.

A patient presents with a white pimple like small lesion protruding on his eyelid. It is tender, firm, and discrete. Which of the following should you most likely chart? Select one: a. Dacryocystitis b. Hordeolum c. Blepharitis d. Ectropion

Hordeolum

A patient presents with the following abscess and reports that it appeared suddenly presenting with pain in the surrounding area. Of the following, which condition is the patient most likely experiencing? Select one: a. Conjunctivitis b. Hordeolum c. Chalazion d. Blepharitis

Hordeolum

Which of the following is not an expected type of pleural effusion? Select one: a. Hyperemic b. Transudate c. Empyema d. Exudate

Hyperemic- Of the choices, hyperemic is not a type of pleural effusion. Hyperemia is an increase of blood flow to tissues in the body. Types of pleural effusions include transudates, exudates, empyema, and hemorrhagic pleural effusions.

Victor, a stocky 40-year-old male, presents to the clinic complaining of difficulty breathing and 'endless amounts of gunk whenever he coughs'. During the visit, he coughs up a substantial amount of yellow phlegm. A blood test reveals an increased hematocrit level, and a physical examination detects lungs that are normal upon percussion. You order a pulmonary lab for this patient. Given the most likely condition, which of the following findings would you LEAST expect? Select one: a. Increased forced expiratory volume in 1 second b. Increased total lung capacity c. Increased functional residual capacity d. Increased residual volume

Increased forced expiratory volume in 1 second- The patient most likely has chronic bronchitis, which is indicated by excessive purulent sputum, mild to moderate dyspnea, a stocky body habitus, lungs that are normal on percussion, and an increased hematocrit level; chronic bronchitis commonly results in a decreased forced expiratory volume in 1 second. Patients with chronic bronchitis also typically exhibit increases in TLC, FRC, and RV alike.

Which of the following medications is considered to be the mainstay of treatment of chronic obstructive pulmonary disease? Select one: a. Budesonide b. Ipratropium bromide c. Salmeterol d. Triamcinolone

Ipratropium bromide- Chronic obstructive pulmonary disease (COPD) is best treated with anticholinergic agents such as ipratropium , Beta-agonists, such as salmeterol, and inhaled corticosteroids, such as budesonide and triacinolone, may also see use in . treatment of COPD, but antcholinergics often show better results in producing bronchodilation

You are treating a 52-year-old female diagnosed with chronic glaucoma. The patient is most likely to state which of the following? Select one: a. My eye hurts really bad b. My vision has become blurry c. Its harder to see objects that are on the side of me d. I've started seeing spots.

Its harder to see objects that are on the side of me- Although chronic glaucoma is usually asymptomatic, patients may complain of a reduction in peripheral vision due to angle closure. Extreme pain, blurred vision, and dilated pupils are all symptoms more commonly found in acute glaucoma than chronic glaucoma

A kindergarten teacher is diagnosed with acute pharyngitis. On exam, the throat is a bright red color with no tonsillar exudate, and clear mucous is seen on the lower nasal turbinates. The result of her urinalysis shows a large amount of white blood cells and is positive for nitrates. The patient has a sulfa allergy and thinks she may also be allergic to penicillins. Which of the following is the best treatment choice? Select one: a. Amoxicillin/clavulanic acid ( Augmentin) 500 mg po bid b. Levoquinolone 250 mg po daily c. Bactrim DS 1 tablet daily d. Clarithromycin (Biaxin) 500 mg po bid

Levoquinolone 250 mg po daily

When performing an eye exam, if you have difficulty visualizing the macula, what instruction should you give the patient? Select one: a. Look into the light b. Look slightly upward c. Look at an object on the distant wall d. Look downward

Look into the light- A patient should look directly into the light of the ophthalmoscope if the NP has difficulty visualizing the macula. Asking a patient to look downward, slightly upward or at an object on the distant wall will not typically help to visualize the macula.

What is the first-line class of antibiotics recommended by the American Thoracic Society (ATS) for patients younger than 60 years of age who are diagnosed with community-acquired pneumonia with no comorbidity? Select one: a. First generation cephalosporins b. Second-generation cephalosporins c. Macrolides d. Beta-lactam antibiotics

Macrolides

A 70-year-old male with open glaucoma is prescribed Betimol (timolol) ophthalmic drops. All of the following are contraindications to Betimol ophthalmic drops except: Select one: a. Overt heart failure or sinus bradycardia b. Asthmatic patients c. Second or third degree AV block d. Migraine headaches

Migraine headaches-Contraindications with Betimol include heart failure, sinus bradycardia, asthmatic patients, and second or third degree AV block

An adult patient is being evaluated for tuberculosis with a Mantoux test. The PPD result is 10.5 mm. The patient denies weight loss, cough, and night sweats and has a negative chest x-ray. He tells you he is in the United States illegally and is fearful about discovery. What is the most appropriate action for the nurse . practitioner? Select one: a. The patient is an illegal alein and the NP has the legal duty to report the patient to the local State Department responsible for illegal immigrants b. Health care workers are legally mandated to report illegal migrants to state authorities c. The NP should call the state health department and report the patient has a TB infection d. NP's have the ethical duty to provide quality health care to patients

NP's have the ethical duty to provide quality health care to patients- Currently, healthcare givers are not legally required to report illegal aliens to the state or local authorities. This patient does not have 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 must be reported to the public health department.

Lauren, a 29-year-old female, presents to the clinic with a sudden onset of productive cough that is accompanied by wheezing and a high-grade-fever. During the physical exam, you find no evidence of lung consolidation, as the lungs are clear to auscultation and resonant to percussion. Given the most probable condition, which of the following pathogens would be the least likely cause? Select one: a. Streptococcus pneumoniae b. Neisseria gonorrhoeae c. Mycoplasma pneumoniae d. Haemophilus influenzae

Neisseria gonorrhoeae- A high-grade fever that is accompanied by a productive cough and wheezing usually indicates acute bronchitis with a bacterial etiology; Neisseria gonorrhoeae is more often a cause of pharyngtis than a cause of acute bronchitis. Common bacterial causes of acute bronchitis include Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

You are treating Peter, a 47-year-old male who exhibits symptoms of senorineural hearing loss. In order to determine the cause of his condition, you obtain the patient's history. You know that the following factors may usually contribute to this type of hearing loss except: Select one: a. Close range to an explosion b. Acoustic neuroma c. Perforated tympanic membrane d. Long-term exposure to loud music

Perforated tympanic membrane- A perforated tympani membrane is considered a conductive cause of hearing gloss, not a sensorineural

Of the following, which treatment is best employed to treat severely enlarged tonsils in cases of mononucleosis? Select one: a. Antibiotics b. Hydration c. Referral for surgery d. Prednisone taper

Prednisone taper- Severely enlarged tonsils resulting from mononucleosis would typically be treated with a prednisone taper. Antibiotics see use in cases of bacterial infections that produce enlarged tonsils such as tonsillitis; however, mononucleosis is a viral infection and would not usually require antibiotics. Although hydration may form a part of supportive care in cases of mono, it does not usually provide effective treatment for severely enlarged tonsils.

All of the following treatment options are commonly used to manage vertigo except: Select one: a. Meclizine b. Diazepam c. Prednisone d. Scopolamine transdermal patch

Prednisone- Prednisone a corticosteroid is not regularly used in treating vertigo and is more commonly prescribed to treat inflammatory diseases.

A male patient in his early 20's who was diagnosed with a stye in his left eye has been applying a warm compress to the affected area for more than a week as part of a home remedy. Despite this treatment, the aptient's stye is still present. What further treatment would be best to recommend at this time? Select one: a. Refer the patient for surgical removal b. Prescribe erythromycin topical ointment c. Recommend the patient scrub and rinse his lashes and lid margins d. Begin a course of systemic antibiotics.

Prescribe erythromycin topical ointment- Since the warm compress has proven ineffective in treating the patient's hordeolum, the best course of treatment would be an antibiotic ointment such as erythromycin. Systemic antibiotics are usually reserved for cases where the patient's hordeolum displays signs of preseptal cellulitis. A referral for surgical removal would not be advised at this time, as the patient should continue conventional treatment first. Scrubbing and rinsing the lashes and lid margins is not typically recommended for treatment of hordeolum, but is often recommended in cases of blepharitis.

A patient comes to your practice with symptoms of fever, rhinorrhea, and pain in the throat. Suspecting strep pharyngitis, you assess the patient under the guidelines of the Centor criteria. Under these standards, which of these findings would NOT be confirmatory for strep pharyngitis? Select one: a. Pharyngo-tonsilar exudate b. Presence of persistent cough c. Fever of 100.6 F d. Anterior cervical adenopathy

Presence of persistent cough- The lack of cough rather than the presence of a persistent cough is considered an indicator for strep pharyngitis under the Centor criteria.

What is the least common pathogen found in community-acquired atypical pneumonia? Select one: a. Moraxella catarrhalis b. Streptococcus pneumoniae c. Pseudomonas aeruginosa d. Mycoplasma pneumonia

Pseudomonas aeruginosa

Which of the following pathogenic bacteria are commonly found in the lungs of older children and adults with cystic fibrosis? Select one: a. Streptococcus pneumoniae b. Chlamydia pneumoniae c. Pseudomonas aeruginosa d. Staphylococcus aureus

Pseudomonas aeruginosa

A patient with COPD is referred for pulmonary testing. Which of the following pulmonary function tests are abnormal in patients with COPD? Select one: a. Reduction of the TLC (total lung capacity) and the RV (residual volume) b. Complaints of mild to severe dyspnea with hypoxemia c. Normal forced vital capacity (FVC) with no changes in the FEV 1 (Forced expiratory volume in one second) d. Reduction of the FEV1 with increase in the TLC and RV

Reduction of the FEV1 with increase in the TLC and RV- COPD findings during pulmonary function testing are the reduction of the FEV1 and the reduction of the FVC. There is an increase in the TLC and RV. The lungs of patients with emphysema has lost their recoil (decreased FEV1). The lungs are always full of air that is hard to 'squeeze out" of the lungs (Increases residual volume and total lung capacity). To summarize, COPD=reduction in FEV1 and FVC with increased RV and TLC

In cases of asthma, the trachea and bronchi typically become more: Select one: a. Thickened b. Narrowed c. Responsive d. Hyperemic

Responsive- Asthma commonly results in the increased responsiveness of the trachea and bronchi to stimuli. Thickening of the epithelial basement membrane and mucosal edema and hyperemia typically result in narrowing of the respiratory airways.

The bacterium responsible for the highest mortality in patients with community acquire pneumonia is: Select one: a. Mycoplasma pneumoniae b. Moraxella catarrhalis c. Haemophilus influenzae d. Streptococcus pneumoniae

Streptococcus pneumoniae

Which of the following is most typical of a patient with allergic rhinitis? Select one: a. Normal nasal turbinates b. Cough c. Post nasal drip d. Symptoms are associated with exposure to cats

Symptoms are associated with exposure to cats

Which of these is NOT a common indoor trigger for asthma? Select one: a. Cockroaches b. Dust mites c. Exercise d. Termites

Termites- Although termites may trigger asthma, they are not commonly considered to be an indoor trigger for the condition. Dust mites, pets, cockroaches, indoor molds, exercise and cigarette smoke are all common indoor causes of asthma.

A patient's vision is recorded as 20/40 using the Snellen eye chart. What does this mean? Select one: a. The patient can read at 40 feet what a person with normal vision can read at 20 feet. b. The patient can read the chart from 20 feet in the left eye and 40 feet in the right eye c. The patient can read at 20 feet what a person with normal vision can read at 40 feet. d. The patient can read the entire chart at 40 feet, indicating what a person with normal vision can do.

The patient can read at 20 feet what a person with normal vision can read at 40 feet.- The term 20/40 means that the patient can see at 20 feet what a normal person with perfect vision can see at 40 feet. The term does not pertain to the difference in vision between the left and right eye.

A patient states that she is unable to hear well with her left ear. The Weber test shows lateralization to the right ear. The Rinne test shows AC>BC with a ratio of 2:1 in both ears, left AC 4 sec., and BC 2 sec, right AC 20 sec., and BC 10 sec. What would be the best interpretation of these results? Select one: a. The test results are reflective of normal hearing b. Conduction of sound through bones is impaired c. The patient may have sensorineural hearing loss d. Further testing should be done

The patient may have sensorineural hearing loss- When a patient has sensorineural hearing loss, the Weber test usually causes the sound to lateralize to the unaffected ear, whereas the Rinne Test would typically show air conduction (AC) as greater than bone conduction (BC). Normal hearing usually results in equal sound lateralization with the Weber test and AC that is twice as long as BC with the Rinne test. Using the Weber test on a patient with conduction loss would typically result in sound lateralization to the poorer ear, whereas, the BC for such a patient would typically be equal to or greater than AC with the Rinne test.

The TNM classification for a patient reads as follows: T2 N1 M0. All of the following inferences are supported by the patient's TNM classification EXCEPT: Select one: a. The patient's bladder tumor has spread to the muscle of the bladder wall b. The patient's breast tumor has spread to axillary lymph nodes c. The patients colon tumor has spread to nearby lymph nodes d. The patient's brain tumor has not spread to distant tissue

The patient's brain tumor has not spread to distant tissue- Brain tumors do not have TNM classifications for several reasons: the size of the tumor in the brain is not relevant as the histology and location, there are no lymphatics within the brain, and metastatic spead is not as observable because patients may not live long enough for the tumor to spread. The "T" parameter of the NM classification refers to the size or direct extent of the primary tumor. A 'T" parameter of T2 indicaates that there has been some growth, such as a bladder tumor that has spread to the muscle of the bladder wall. The "N" parameter of the TNM classification refers to the spread of regional lymph nodes. A classification of N1 indicates that there has been minimal spreading to regional lymph nodes. The "M" parameter refers to the distant metastasis, the spread of cancer to other parts of the body.

Which of these manifestations is least likely to present with the onset of asthma? Select one: a. Plugging of airways by thick mucus b. Hypertrophy of the mucus glands c. Thinning of the epithelial basement membrane d. Hypertrophy of smooth muscle

Thinning of the epithelial basement membrane- Asthma produces as a result of increased responsiveness of the trachea and bronchi to stimuli, often leading to the thickening, not thinning, of the epithelial basement membrane. Other physical changes likely to produce from asthma include plugging of the airways by thick mucus and hypertrophy of both the mucus gland and smooth muscle.

Which of the following is true concerning Meniere's disease? Select one: a. Neuroimaging helps locate the offending cochlear lesion b. Associated high-frequency hearing loss is common c. This is largely a diagnosis of exclusion d. Tinnitus is rarely reported

This is largely a diagnosis of exclusion

The Union for International Cancer Control uses all of the following parameters to classify tumor development except: Select one: a. Size or extent of the primary tumor b. Type of tissue in which the cancer originates c. Amount of spread to regional lymph nodes d. Presence of metastasis

Type of tissue in which the cancer originates- The type of tissue in which the cancer originates is not one of the three categories within the TNM classification of malignant tumors. The Union for International Cancer Control TNM classification system classifies tumors by the size or extent of the primary tumor, amount of spread to regional lymph nodes and presence of metastasis.

What type of breath sounds are best heard over the base of the lungs? Select one: a. Fine breath sounds b. Vesicular breath sounds c. Bronchial sounds d. Tracheal breath sounds

Vesicular breath sounds

A patient presents with complaints of a burning sensation in the left eye. A physical examination reveals redness and watery, nonpurulent discharge. The patient presents with no other physical symptoms or sensations. Based on the patients sign's and symptoms, which type of conjunctivitis is the most likely diagnosis? Select one: a. Bacterial conjunctivitis b. Gonococcal conjunctivitis c. Allergic conjunctivitis d. Viral conjunctivitis

Viral conjunctivitis- The patient experiencing a burning sensation in the eye as well as redness and watery discharge, is most likely experiencing viral conjunctivitis. Although other forms of conjunctivitis also involve redness and a burning sensation in the eye, these forms typically present with a different quality and quantity of discharge. Bacterial and gonococcal forms of conjunctivitis often exhibit a particularly copious discharge. Allergic conjunctivitis more commonly presents with string-like discharge and an itching sensation, viral conjunctivitis often presents with a watery discharge and no itch.

A patient has been diagnosed with acute rhinosinusitis. What is the most likely etiology? Select one: a. Strep organisms b. Staph organisms c. Viral pathogens d. Mycoplasma

Viral pathogens- The vast majority of patients who have acute rhinosinusitis have a viral infection. In fact, 2% or fewer cases of acute rhinosinusitis are due to bacteria. When bacteria are the causative agents, Strep and Staph are common pathogens. Mycoplasma generally affects the lower respiratory tract.

A patient reports a penicillin allergy. What question regarding the allergy should the NP ask to determine whether a cephalosporin should be prescribed? Select one: a. Have you ever taken a cephalosporin? b. How long ago was the reaction? c. What kind of reaction did you have? d. What form of penicillin did you take?

What kind of reaction did you have?- About 2-10% of patients who are penicillin allergic are also cephalosporin allergic. This class of medications should not be excluded in penicillin allergic patients unless they report an anaphylactic reaction. If this is the case, cephalosporins should NEVER be considered. The most important question to ask the patient is "what kind of reaction did you have?" If it was a rash, then it is considered safe to prescribe a cephalosporin with the warning that there might also be a reaction to this. If there is, it should be stopped immediately and reported. If a more severe reactions occurs, an emergency department visit is appropriate.

A medication which should avoided in patients with mononucleosis is: Select one: a. azithromycin b. ampicillin c. acetaminophen d. topical lidocaine

ampicillin- A generalized rash may be seen in patients with mononucleosis who are given amoxicillin or ampicillin at the time of the acute phase of the illness. The rash does not represent an allergic reaction, but, instead probably represents a reaction between the Epstein Barr virus and the penicillin molecule. The rash is usually describe as maculopapular and may be pruritic. The rash has also been described with other lactam antibiotics.

A 19-year-old woman presents with a complaint of bilateral itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope like eye discharge and clear nasal discharge. this is most consistent with conjunctival inflammation caused by Select one: a. a bacterium b. a virus c. an allergen d. an injury

an allergen

You inspect the oral cavity of a 69-year-old man who has a 100 pack year cigarette smoking history. You find a lesion suspicious for malignancy and describe it as: Select one: a. raised, red and painful b. a denuded patch with a removable white coating c. an ulcerated lesion with indurated margins d. a vesicular form lesion with macerated margin

an ulcerated lesion with indurated margins

Mrs. Olsen, is a 58-year-old woman presenting with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyball is firm. Vision screen with the Snellen chart is 20/30 OD, and 20/90 OS. The most likely diagnosis is: Select one: a. unilateral herpetic conjunctivitis b. open angle glaucoma c. angle-closure glauscoma d. anterior uveitis

angle-closure glauscoma

A 48-year-old man presents with a new onset right eye vision change accompanied by dull pain, tearing, and photophobia. The right pupil is small, irregular, and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20?80 OD. The most likely diagnosis is: Select one: a. unilateral herpetic ocnjunctivitis b. open angle glaucoma c. angle closure glaucoma d. anterior uveitis

anterior uveitis

Most cases of epistaxis occur Select one: a. in women b. at Kiesselbach's plexus c. in the posterior septum d. in patients on anticoagulants

at Kiesselbach's plexus

Screening for oral cancer is recommended Select one: a. for high risk patients only b. at regularly scheduled dental visits c. every 2 years d. to be conducted by qualified healthcare providers only

at regularly scheduled dental visits

The most common complication of influenza is: Select one: a. cough b. bacterial pneumonia c. viral pneumonia d. bronchitis

bacterial pneumonia- Pneumonia is the most common complication of influenza; bacterial pneumonia is the most common form. Streptococcus pneumoniae is the most common bacterial pathogen. 25% of deaths associated with influenza are related to pneumonia. Clinical presentation of pneumonia is characterized by worsening of symptoms after an initial period of improvement for 1 to 3 days. Fever, cough, purulent sputum predominate. Cough is a symptoms of influenza not a complication. Bronchitis might be part of the differential of influenza, however, fever is uncommon in bronchitis.

Risk factors for POAG include all of the following except: Select one: a. African ancestry b. type 2 diabetes mellitus c. advanced age d. blue eye color

blue eye color

Alterations in the ear involved Meniere's disease include all of the following except: Select one: a. change in endolymphatic pressure b. breakage in the membrane separating the endolymph and perilymph fluids c. distension of the tympanic membrane causing low tone roaring tinnitus d. sudden change in the vestibular nerve firing rate

distension of the tympanic membrane causing low tone roaring tinnitus

A patient who is otherwise healthy comes in for evaluation. He states that he woke up this morning and cannot hear out of his left ear. He feels well otherwise. His ENT and neurological evaluations are normal. How should the nurse practitioner proceed. Select one: a. Prescribe an antihistamine and nasal decongestant b. Send the patient to an audiologist for hearing evaluation c. Refer the patient to ENT for evaluation d. Initiate steroids and consider referral in a week

efer the patient to ENT for evaluation- Sudden hearing loss has a number of etiologists of central origin. The differential diagnosis should include acoustic neuroma, vascular insufficiency, carotid artery occlusion, and other intracranial tumors. This patient is going to need MRI initially unless a deficit is found in the examination that would indicate a different imaging study. This patient should be deferred for a specialty workup.

POAG is primarily caused by Select one: a. hardening of the lens b. elevated intraocular pressure c. degeneration of the optic nerve d. hypotension in the anterior maxillary artery.

elevated intraocular pressure

Which of the following is most likely to be found on the fundoscopic examination in a patient with untreated POAG? Select one: a. excessive cupping of the optic disk b. arteriovenous nicking c. papilledema d. flame-shaped hemorrhages

excessive cupping of the optic disk

The symptom triad most commonly associated with infectious mononucleosis is: Select one: a. fever, pharyngitis, lymphadenopathy b. fatigue, pharyngitis, fever c. splenomegaly, fever, body aches d. tonsillar exudates, lymphadenopathy, headache

fever, pharyngitis, lymphadenopathy- The triad includes fever, pharyngitis and lymphadenopathy. Fatigue commonly accompanies mononucleosis, but this is not part of the triad. Approximately 50% of patients with mono have splenomegaly. Body aches are probably the effect of fever, but, do not characterize the disease. The etiologic agent of mono is the Epstein-Barr viruse. It is usually spread by intimate contact between susceptible contacts. It is spread via saliva and has been called "the kissing disease".

A patient with fever and pharyngitis has a negative rapid strep test. A preliminary throat culture sent to the laboratory reveals "normal flora after 24 hours". The patient: Select one: a. probably has strep and should be treated b. probably has some bacterial pathogen c. has a pharyngitis of undetermined etiology d. should be treated with penicillin based on symptoms

has a pharyngitis of undetermined etiology- has a pharyngitis of undetermined etiology

An independent risk factor of oral cancer is infection with: Select one: a. human herpes virus I b. human papillomavirus type 16 c. adenovirus type 16 d. Epstein Barr virus

human papillomavirus type 16

A 70-year-old patient states that her father and mother had hearing loss that began in their sixth decades. She has begun having hearing loss. Which complaint below is typical of presbycusis? Select one: a. inability to hear consonants b. Asymmetrical loss of hearing c. Inability to hear low pitched sounds d. Pulsatile noise in the ear

inability to hear consonants- The significance of this patient's parental hearing loss is important for history. Presbycusis is influenced by genetics as well as noise exposure, medications, and infections. Hearing loss associated with aging is termed presbycusis. Loss of ability to hear speech in crowded rooms or noisy areas, inability to understand consonants, and loss of high-pitched sounds is typical. Hearing loss is symmetrical. Asymmetrical hearing loss is a red flag regardless of the age at which it occurs. Tinnitus is common and is an annoying sensation associated with presbycusis. A pulsatile noise in the ear raises suspicion of a tumor or arteriovenous malformation.

A 22-year-old man with recurrent epistaxis episodes fails to respond to simple pressure. Alternative approaches include all of the following except: Select one: a. initiating systemic prothrombotic therapy b. nasal packing c. chemical cautery d. topical antifibrinolytic agents

initiating systemic prothrombotic therapy

Key diagnostic findings in POAG include which of the following? Select one: a. intraocular pressure greater than 25 mm Hg. b. papilledema c. cup-to-disc ratio greater than 0.4 d. sluggish pupillary response

intraocular pressure greater than 25 mm Hg.

Anterior epistaxis is usually caused by Select one: a. hypertension b. bleeding disorders c. localized nasal mucosa trauma d. a foreign body

localized nasal mucosa trauma

Which of the following is most likely to be found in the laboratory data of a person with infectious mononucleosis? Select one: a. neutrophils with reactive forms b. lymphocytes with atypical lymphocytes c. thrombocytosis d. macrocytosis

lymphocytes with atypical lymphocytes

Treatment options for POAG include all of the following topical ocular agents except: Select one: a. beta-adrenergic antagonists b. alpha 2 agonists c. prostaglandin analogues d. mast cell stabilizers

mast cell stabilizers

A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of: Select one: a. herpes simplex b. acute otitis media (AOM) c. bacterial pharyngitis d. oral cancer

oral cancer

The Epstein Barr virus is primarily transmitted via: Select one: a. skin to skin contact b. contact with blood c. oropharyngeal secretions d. genital contact

oropharyngeal secretions

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except: Select one: a. polymyxin B plus trimethoprim b. levofloxacin c. polymyxin d. azithromycin

polymyxin

All of the following are components of the classic ophthalmological emergency except: Select one: a. eye pain b. purulent eye discharge c. red eye d. new-onset change in visual acuity

purulent eye discharge

Prevention and prophylaxis in Meniere's disease include all of the following except: Select one: a. avoiding ototoxic drugs b. protecting the ears from loud noise c. limiting sodium intake d. restricting fluid intake

restricting fluid intake

Mrs. Allen is a 67-year-old woman with type 2 diabetes who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her left eye. The most likely diagnosis is: Select one: a. open angle glaucoma b. central retinal artery occlusion c. anterior uveitis d. retinal detachment

retinal detachment

A patient's tympanic membrane reveals a chalky white mark. The patient has no complaints of ear pain or decreased hearing. This is probably: Select one: a. a normal tympanic membrane b. scarring of the tympanic membrane c. chronic inflammation d. pus in the middle ear

scarring of the tympanic membrane- A white chalky mark very likely reflects scarring of the tympanic membrane. This commonly results from prior episodes of TM rupture or tube placement. The normal color of the TM is pink or pearly gray. Inflammation associated with the TM is usually erythematous or hyperemic appearing. Pus in the middle ear is usually yellow or white. Fluid in the middle ear appears clear, white gray or blue.

A 19-year-old man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were "stuck together" this morning when he awoke. Examination reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU) and purulent eye discharge on the right. This presentation is most consistent with Select one: a. suppurative conjunctivitis b. viral conjunctivits c. allergic conjunctivitis d. mechanical injury

suppurative conjunctivitis

Neuraminidase inhibitors can shorten the duration of symptoms of influenza by approximately how many days? Select one: a. two b. Four c. Six d. Eight

two- Your instructor hates this question and will likely throw it out as Tamiflu only shortens the illness by 4-16 hours.