Test 1 bank

3.A client asks the nurse if there is an antihistamine that does not cause drowsiness. Which of the following medications would this client most likely prefer to treat allergic rhinitis? 1.Diphenhydramine 2.Chlorpheniramine maleate 3.Clemastine 4.Fexofenadine

4

6.The nurse is caring for a client diagnosed with acute sinusitis. Which of the following symptoms is the client most likely experiencing? 1.Anosmia 2.Fever 3.Halitosis 4.Metallic taste

1

7.The nurse is planning care for the client diagnosed with viral rhinitis. Which of the following would be the best goal of care for this client? 1.Prevent secondary bacterial infection. 2.Prevent rhinitis medicamentosa. 3. Refrain from use of analgesics. 4. Encourage complete participation in activities.

1

The nurse is planning to administer the pneumococcus vaccination to a client. Which of the following would indicate that a client is a candidate for this vaccination? (Select all that apply.) 1. Age 70 2. Age 55 3. Diagnosis of heart failure 4. Recovering from knee replacement surgery 5.Diagnosis of asthma 6.Recovering from an appendectomy

1 3 5

13.A client diagnosed with viral rhinitis tells the nurse that she has been using a decongestant nasal spray for several weeks and the symptoms are getting worse. Which of the following does the nurse suspect is occurring with this client? 1.Developing pneumonia 2.Subacute rhinitis 3.Rhinitis medicamentosa 4.Chronic otitis media

3

A client has been smoking for the last 40 years and has a history of emphysema. Which of the following findings would the nurse not expect to find? 1. Decreased forced vital capacity (FVC) 2. Increased anterior-posterior chest diameter 3. Increased forced expiratory volume (FEV1) 4. Pursed lip breathing

3

Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? 1. Ordering physical therapy 2.Ordering a lumbosacral x-ray 3. Ordering extensive lab work 4.Referring to a neurosurgeon

4

23. lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be? a. The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment. b. Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen. c. A throat culture should be performed to confirm the results of the rapid strep test. d. The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive.

A

11.A client is experiencing redness, burning, itching, and pain of the eyes. The nurse suspects the client is experiencing: 1.blepharitis. 2.conjunctivitis. 3.keratitis. 4.iritis.

ANS: 2 Clinical manifestations of conjunctivitis (pink eye) include watery eyes, redness, itching, and burning pain. Blepharitis is associated with a sticky exudate. Keratitis is associated with photophobia. Iritis is associated with blurred vision and photophobia.

5.A client is complaining of dizziness, unilateral ringing in the ear, feeling of pressure or fullness in the ear, and unilateral hearing loss. The nurse would suspect the client is experiencing: 1. Meniere's disease. 2. osteosclerosis. 3. otitis media. 4. mastoiditis.

ANS: 1 All of the clients complaints are signs and symptoms of Meniere's disease. Although hearing disorders may have similar signs and symptoms, they do not include all of them.

The nurse is caring for a client diagnosed with pneumonia. Which of the following signs and symptoms would the nurse most likely assess in this client? (Select all that apply.) 1.Abdominal pain 2.Anorexia 3.Cough 4.Dyspnea 5.Fever 6.Frequent wiping of the nose

ANS: 1, 2, 3, 4, 5 Specific symptoms suggestive of pneumonia include fever, chills or rigor, sweats, new cough (with or without sputum), pleuritic chest pain, and dyspnea. Nonspecific symptoms include malaise, fatigue, abdominal pain, headaches, anorexia, and worsening of an underlying illness. Frequent wiping of the nose is a sign of allergic rhinitis.

5.The nurse is planning instruction for a client experiencing dry eyes. Which of the following should be included in these instructions? (Select all that apply.) 1.Drink 8 to 10 glasses of water each day. 2.Apply petroleum jelly to the eyelids. 3. Blink more frequently. 4. Avoid sun exposure. 5. Avoid rubbing the eyes. 6. Avoid dry air.

ANS: 1, 3, 5, 6 Interventions to improve dry eyes include drink 8 to 10 glasses of water each day; blink more frequently; avoid rubbing the eyes; and know that dry air makes the condition worse. Petroleum jelly is not a treatment for dry eyes. Avoiding the sun is good advice; however, it is not proven to help with dry eyes.

4.A client is diagnosed with a conductive hearing loss. The nurse realizes type of hearing loss is not associated with: 1. cerumen. 2. brain damage. 3. otitis media. 4. otosclerosis.

ANS: 2 Conductive hearing loss results in a blockage of sound waves in the external or middle portions of the ear. Wax (cerumen) buildup and infections are a large part of conductive hearing loss. Otosclerosis is associated with conductive hearing loss. Brain damage is not a cause of conductive hearing loss.

4.The nurse realizes that a client, diagnosed with chronic dry eyes, may have a disorder of the lacrimal gland because it: 1.covers the eye for protection. 2.produces tears to lubricate the eye. 3.helps the eye keep its shape. 4. provides blood to the eye.

ANS: 2 The lacrimal gland moistens the eye by producing and distributing tears to lubricate the eye. The lacrimal gland does not cover the eye for protection, help the eye keep its shape, or provide blood to the eye.

The nurse is reviewing clients for risk factors in the development of pneumonia. Which of the following clients would be at the highest risk for developing this disorder? 1.A 48-year-old client experiencing menopause 2.An 18-year-old client with abdominal pain 3.A 23-year-old client diagnosed with sickle-cell anemia and a cough 4.A 3-year-old client with fever

ANS: 3 High-risk groups for acquiring pneumonia are people with diabetes, infants 6- to 23-months old, and those with a chronic illness such as sickle-cell anemia. Menopause and abdominal pain are not symptoms associated with pneumonia. Fever in a 3-year-old client could be caused by many disorders and not necessarily pneumonia.

. The nurse is testing a patients visual accommodation, which refers to which action? a. Pupillary constriction when looking at a near object b. Pupillary dilation when looking at a far object c. Changes in peripheral vision in response to light d. Involuntary blinking in the presence of bright light

ANS: A The muscle fibers of the iris contract the pupil in bright light and accommodate for near vision, which also results in pupil constriction. The other responses are not correct.

7. The nurse is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction? a. Air conduction is the normal pathway for hearing. b. Vibrations of the bones in the skull cause air conduction. c. Amplitude of sound determines the pitch that is heard. d. Loss of air conduction is called a conductive hearing loss.

ANS: A The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction.

25. The nurse is examining a patients retina with an ophthalmoscope. Which finding is considered normal? a. Optic disc that is a yellow-orange color b. Optic disc margins that are blurred around the edges c. Presence of pigmented crescents in the macular area d. Presence of the macula located on the nasal side of the retina

ANS: A The optic disc is located on the nasal side of the retina. Its color is a creamy yellow-orange to a pink, and the edges are distinct and sharply demarcated, not blurred. A pigmented crescent is black and is due to the accumulation of pigment in the choroid.

1. When examining the eye, the nurse notices that the patients eyelid margins approximate completely. The nurse recognizes that this assessment finding: a. Is expected. b. May indicate a problem with extraocular muscles. c. May result in problems with tearing. d. Indicates increased intraocular pressure.

ANS: A The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid margins approximate completely, which is a normal finding.

31. The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane? a. Red and bulging b. Hypomobility c. Retraction with landmarks clearly visible d. Flat, slightly pulled in at the center, and moves with insufflation

ANS: B An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge.

34. A patient comes into the clinic complaining of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is a: a. Chalazion. b. Hordeolum (stye). c. Dacryocystitis. d. Blepharitis.

ANS: B A hordeolum, or stye, is a painful, red, and swollen pustule at the lid margin. A chalazion is a nodule protruding on the lid, toward the inside, and is nontender, firm, with discrete swelling. Dacryocystitis is an inflammation of the lacrimal sac. Blepharitis is inflammation of the eye

How do leukotriene modifiers reduce the symptoms of asthma? a. By drying up mucus b. By causing bronchodilation and anti-inflammation effects c. By suppressing cough d. By liquefying mucus

ANS: B Leukotriene modifiers reduce the symptoms of asthma by causing bronchodilation and antiinflammatory processes.

2.A client diagnosed with chronic obstructive pulmonary disease is experiencing pneumonia. The nurse applies oxygen at 2 L/min via nasal cannula. When the nurse leaves the room, a family member increases the oxygen to 5 L. Which complication may occur? a. Angina b. Apnea c. Metabolic acidosis d. Respiratory alkalosis

ANS: B The COPD clients drive to breathe is hypoxia. Increasing the oxygen removes this drive and leads to apnea. Angina occurs because of decreased oxygen to the myocardial tissues. Neither respiratory alkalosis nor metabolic acidosis would occur with the increased oxygen level.

3. When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear: a. Light pink with a slight bulge. b. Pearly gray and slightly concave. c. Pulled in at the base of the cone of light. d. Whitish with a small fleck of light in the superior portion.

ANS: B The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles

36. A 17-year-old student is a swimmer on her high schools swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. The nurse instructs her to: a. Use a cotton-tipped swab to dry the ear canals thoroughly after each swim. b. Use rubbing alcohol or 2% acetic acid eardrops after every swim. c. Irrigate the ears with warm water and a bulb syringe after each swim. d. Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.

ANS: B With otitis externa (swimmers ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim.

32. The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 oclock and landmarks visible. The nurse should: a. Refer the patient for the possibility of a fungal infection. b. Know that these are scars caused from frequent ear infections. c. Consider that these findings may represent the presence of blood in the middle ear. Be concerned about the ability to hear because of this abnormality on the tympanic

ANS: B membrane. Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing

What are age-related changes in the older adult that make them at risk for respiratory diseases? (Select all that apply.) a. Moist mucous membranes b. Kyphosis c. Decrease in pulmonary blood flow d. Stasis pooling of secretions e. Reduced number of cilia

ANS: B, C, D, E Age-related changes that affect the respiratory system are dryer mucous membranes, which reduce ability to humidify inspired air, kyphosis, which restricts the expansion of the lung, stasis pooling of respiratory secretions, and reduced number of cilia, which make infection of the upper and lower airway more likely.

8. A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the nurse to: a. Speak loudly so the patient can hear the questions. b. Assess for middle ear infection as a possible cause. c. Ask the patient what medications he is currently taking. d. Look for the source of the obstruction in the external ear.

ANS: C A simple increase in amplitude may not enable the person to understand spoken words. Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea.

5. A patient with a middle ear infection asks the nurse, What does the middle ear do? The nurse responds by telling the patient that the middle ear functions to: a. Maintain balance. b. Interpret sounds as they enter the ear. c. Conduct vibrations of sounds to the inner ear. d. Increase amplitude of sound for the inner ear to function.

ANS: C Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. The other responses are not functions of the middle ear.

18. The nurse is performing an otoscopic examination on an adult. Which of these actions is correct? a. Tilting the persons head forward during the examination b. Once the speculum is in the ear, releasing the traction c. Pulling the pinna up and back before inserting the speculum d. Using the smallest speculum to decrease the amount of discomfort

ANS: C The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed.

. How does pursed lip breathing assist patients with asthma during an attack? a. It distracts the patient with breathing technique to reduce anxiety. b. It gets rid of CO2 faster. c. It opens bronchioles by backflow air pressure. d. It increases PACO2..

ANS: C The resistance or the expiration through the pursed lips causes a backflow of air and helps to open the bronchioles

35. During an otoscopic examination, the nurse notices an area of black and white dots on the tympanic membrane and the ear canal wall. What does this finding suggest? a. Malignancy b. Viral infection c. Blood in the middle ear d. Yeast or fungal infection

ANS: D A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis).

9. During an interview, the patient states he has the sensation that everything around him is spinning. The nurse recognizes that the portion of the ear responsible for this sensation is the: a. Cochlea. b. CN VIII. c. Organ of Corti. d. Labyrinth.

ANS: D If the labyrinth ever becomes inflamed, then it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo

21. During an examination of the eye, the nurse would expect what normal finding when assessing the lacrimal apparatus? a. Presence of tears along the inner canthus b. Blocked nasolacrimal duct in a newborn infant c. Slight swelling over the upper lid and along the bony orbit if the individual has a cold d. Absence of drainage from the puncta when pressing against the inner orbital rim

ANS: D No swelling, redness, or drainage from the puncta should be observed when it is pressed. Regurgitation of fluid from the puncta, when pressed, indicates duct blockage. The lacrimal glands are not functional at birth

4. The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true? a. The eustachian tube is responsible for the production of cerumen. b. It remains open except when swallowing or yawning. c. The eustachian tube allows passage of air between the middle and outer ear. d. It helps equalize air pressure on both sides of the tympanic membrane.

ANS: D The eustachian tube allows an equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture during, for example, altitude changes in an airplane. The tube is normally closed, but it opens with swallowing or yawning.

28. In an individual with otitis externa, which of these signs would the nurse expect to find on assessment? a. Rhinorrhea b. Periorbital edema c. Pain over the maxillary sinuses d. Enlarged superficial cervical nodes

ANS: D The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa.

8. A patient has a normal pupillary light reflex. The nurse recognizes that this reflex indicates that: a. The eyes converge to focus on the light. b. Light is reflected at the same spot in both eyes. c. The eye focuses the image in the center of the pupil. d. Constriction of both pupils occurs in response to bright light.

ANS: D The pupillary light reflex is the normal constriction of the pupils when bright light shines on the retina. The other responses are not correct.

15. The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation? a. Do you ever notice ringing or crackling in your ears? b. When was the last time you had your hearing checked? c. Have you ever been told that you have any type of hearing loss? d. Is there any relationship between the ear pain and the discharge you mentioned?

ANS: D Typically with perforation, ear pain occurs first, stopping with a popping sensation, and then drainage occurs.

5. African American patients seem to have a negative reaction to which of the following asthma medications? a. Inhaled corticosteroids b. Long-term beta-agonist bronchodilators c. Leukotriene receptor agonists d. Oral corticosteroids

B

2. The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis? a. Viral conjunctivitis b. Keratoconjunctivitis c. Bacterial conjunctivitis d. Allergic conjunctivitis

Bacterial conjunctivitis

6. Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? a. Asthma b. Emphysema c. Chronic bronchitis d. Influenza

C

14. Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead? a. Fever b. Headache c. Exudative pharyngitis d. Rhinorrhea

D

7. You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Her score is 3. What should you do? a. Consider home treatment. b. Plan for a short inpatient hospitalization. c. Closely supervise her outpatient treatment. d. Hospitalize and consider admitting her to the intensive care unit.

D

Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD? a. 3 to 5 hours b. 6 to 10 hours c. 11 to 14 hours d. 15 to 18 hours

D

Which of the following statements regarding pulmonary function is true? a. Cigarette smoking accelerates the decline in pulmonary function tenfold. b. Smoking cessation can reverse most pathological changes. c. Cigarette smoking decreases mucus production. d. There is a normal age-related decline in pulmonary function

D

10. A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition? a. Otitis media b. Meniere's disease c. Tinnitus d. Otitis externa

a. Otitis media

Severe dyspnea on exertion, weight loss, barrel chest, low cardiac output, tissue hypoxia and pulmonary cachexia are often symptoms associated with: A.) Emphysema B.) Asthma C.) Chronic Bronchitis D.) Pneumonia

a

Which of the following indicates a stretch/tear of the tendons? A.) Strain B.) Sprain C.) Fracture D.) Spasm

a

A chronic cough lasts longer than: a. 3 weeks b. 1 month c. 6 months d. 1 year

a

A patient is diagnosed with Acute Otitis Media. They have never had this diagnosis before, and have no drug allergies. Which medication is the preferred treatment? A.) Amoxicillin B.) Azithromycin C.) Bactrim D.) Macrobid

a

A patient presents with an ankle injury after rolling their ankle during a soccer match. They report they were unable to bear weight immediately after the injury, and they are having difficulty with weight-bearing at the urgent care clinic. On physical examination tenderness is noted over the navicular bone. What is an appropriate next action by the APRN? A.) Obtain foot and ankle radiographs as fracture cannot be ruled out based on history and physical exam. B.) Do not obtain imaging as fracture can be ruled out based on history and physical exam. C.) Treat with analgesics and ACE-wrap for stability, refer the patient to orthopedics. D.) Refer the patient to the emergency department, urgent care clinics cannot manage acute fractures.

a

17. Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking? a. Inhaled corticosteroid b. Leukotriene receptor antagonist c. Systemic corticosteroid d. Methyl xanthenes

a. Inhaled corticosteroid

15. What is the first line tx-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis? a. Penicillin b. Quinolone c. Cephalosporin d. Macrolide

a. Penicillin

19. George has chronic obstructive pulmonary disease (COPD) and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD? a. Stage 1 mild COPD b. Stage 2 moderate COPD c. Stage 3 severe COPD d. Stage 5 very severe COPD

a. Stage 1 mild COPD

The most common cause of CAP is? a. Streptococcus pneumoniae b. Klebsiella pneumoniae c. Legionella pneumoniae d. Pseudomonas aeruginosa

a. Streptococcus pneumoniae answers one

15. Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? a. Vasomotor rhinitis b. Rhinitis medicamentosum c. Atrophic rhinitis d. Viral rhinitis

a. Vasomotor rhinitis

19. Which type of stomatitis results in necrotic ulceration of the oral mucous membranes? a. Vincent's stomatitis b. Allergic stomatitis c. Apthous stomatitis d. Herpetic stomatitis

a. Vincent's stomatitis

Mary is 85 years old and has osteoarthritis. On physical exam, you might expect to see: (select all that apply) A.) bunions. B.) Bouchard's node C.) Boutonniere deformity D.) swan neck deformity.

ab

Established risks for COPD include: (Select all that apply) A.) age B.) male gender C.) cigarette smoking D.) reduced lung function E.) occupational exposure F.) alpha-1 antitrypsin deficiency phenotype

abcdef

Criteria for diagnostic testing for strep pharyngitis include (select all that apply): A.) fever over 100.5 B.) Cough C.) tonsillar exudate D.) Under 15 years of age

acd

Treatment for viral conjunctivitis could include the following: Select all that apply: A.) Lubrication for comfort B.) Ciprofloxacin 1 gtt Q2H for 2 days then one drop Q4h while awake for 5 days C.) Mast cell stabilizer topical D.) Antivirals: pyrimidine ophthalmic or acyclovir oral

ad

A 24 year old male presents with left inner ear pain, cough, sore throat. He c/o discharge from his left ear as well. The most likely diagnosis is... A.) otitis externa B.) otitis media C.) tinnitus D.) cholesteatoma

b

Objective findings for a patient presenting with otitis externa include all of the following except: A.) Tenderness when moving pinna B.) Opaque or dull TM C.) Edema or redness of canal D.) Purulent discharge

b

Sandy, a 30 year old female presents to urgent care with a sore throat (states 5/10 pain), low grade temperature, and cough. On exam, you note reddened tonsils and a fever of 100.5 F. No tonsillar exudate or lymphadenopathy noted. What are next steps for the APRN? A.) Send culture for GABHS, follow up with patient based on results. B.) Offer supportive care (including hydration) to Sandy, as this is likely viral. C.) Empirically treat Sandy with Penicillin VK 500 mg BID x 10 days and D.) Send culture for GABHS. check rapid GABHS and treat regardless of results.

b

The refined ABCD assessment tool for COPD includes what two categories of information when classifying COPD? A.) Degree of airflow obstruction, response to bronchodilators. B.) Airflow limitation severity, symptoms and risk of exacerbation. C.) Patient symptoms, airflow limitation severity. D.) Patient symptoms, response to bronchodilator therapy.

b

Which of the following indicates a stretch/tear of the ligaments? A.) Strain B.) Sprain C.) Fracture D.) Spasm

b

Which of the following scenarios is appropriate to allow outpatient treatment of CAP? A) 58-year-old female with CAP, BP 100/50, and confusion B) 68-year-old male with CAP, blood pressure of 130/80mmHg, and respiratory rate of 18/min C) 32-year-old female with CAP, blood pressure of 90/50mmHg, altered mental status, and respiratory rate 34/min D) 69-year-old female with CAP, blood pressure of 125/82mmHg, and creatinine of 2.1mg/dL

b

20. The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection? a. HSV type 2 b. HIV c. Pneumonia d. Syphilis

b. HIV

1. An acutely presenting, erythematous, tender lump within the eyelid is called: a. Blepharitis b. Hordeolum c. Chalazion d. Iritis

b. Hordeolum

14. Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis? a. IgA b. IgE c. IgG d. IgM

b. IgE

22. A patient presents with the following signs and symptoms: gradual onset of low grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause? a. Gonorrhea b. Mononucleosis c. Influenza d. Herpes zoster

b. Mononucleosis

. You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her? a. ―Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow. b. ―Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow. c. ―Drive to the emergency room now. d. ―Call 911.

b. ―Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.

3. Julie has a postnasal drip along with her cough. You assess her for: a. Asthma b. Sinusitis c. Allergic or vasomotor rhinitis d. Influenza

c

37. During an examination, the patient states he is hearing a buzzing sound and says that it is driving me crazy! The nurse recognizes that this symptom indicates: a. Vertigo. b. Pruritus. c. Tinnitus. d. Cholesteatoma.

c

A 40-year-old patient presents for the evaluation of symmetric polyarthritis, which they report has been worsening gradually over the past two years. When obtaining your history, the patient reveals that they have significant morning stiffness, which lasts for greater than one hour, and on physical examination, you note boutonniere deformities to bilateral thumbs and Swan neck deformities to the fingers. What is the most likely diagnosis for this patient? A.) Fibromyalgia syndrome B.) Osteoarthritis C.) Rheumatoid arthritis D.) Infectious/septic arthritis

c

A patient comes into the office with complaints of itchiness and a tender lump on her left eye lid. What would you diagnose the patient with? A.) Conjunctivitis B.) Chalazion C.) Hordeolum D.) Blepharitis

c

A patient receiving Hemodialysis after being diagnosed with CKD stage 5 is an example of what type of prevention? A.) Primary Prevention B.) Secondary Prevention C.) Tertiary Prevention D.) Quaternary Prevention

c

Appropriate treatment of acute viral bronchitis includes: A.) antihistamines B.) antibiotics C.) humidification D.) all of the above

c

Tommy presents to the office with c/o 3 days of nasal stuffiness, maxillary tenderness, low grade fever, and post-nasal drip. He reports some relief with use of OTC decongestant. On exam you note maxillary and frontal sinus tenderness with pressure as well as redness in bilateral nares. What is your plan of care? A.) Prescribe Augmentin x 7 days and encourage him to continue decongestant B.) Refer him to ENT C.) Offer supportive care with hydration and reassurance D.) Obtain cultures of any nasal secretions to determine treatment

c

Topical treatment for a chalazion is: A.) Topical fluoroquinolone B.) Topical corticosteroid C.) Warm compress to the affected area D.) Surgical excision

c

What is the first line empiric treatment for acute sinusitis? A.) Levofloxacin B.) Keflex C.) Augmentin D.) Bactrim

c

16. Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than: a. 4 weeks b. 8 weeks c. 12 weeks d. 16 weeks

c. 12 weeks

20. Most nosocomial pneumonias are caused by: a. Fungi b. Viruses c. Gram-negative bacteria d. Pneumococcal pneumonia

c. Gram-negative bacteria

12. Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking? a. He should stop smoking today. b. He should stop smoking tomorrow. c. His quit date should be in 1 week. d. He will be ready to quit after the first 30 days.

c. His quit date should be in 1 week.

. Which of the following is a possible consequence of sleep apnea? a. Asthma b. Increased white blood cells c. Insulin resistance d. Hyperactivity

c. Insulin resistance

17. Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected? a. Penicillin V b. Amoxicillin c. Levofloxacin d. Clindamycin

c. Levofloxacin

16. Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity? a. Mild intermittent b. Mild persistent c. Moderate persistent d. Severe persistent

c. Moderate persistent

9. The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient's mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? a. Weber test b. Schwabach test c. Rinne test d. Auditory brainstem response (ABR) test

c. Rinne test

12. The most significant precipitating event leading to otitis media with effusion is: a. Pharyngitis b. Allergies c. Viral upper respiratory infection d. Perforation of the eardrum

c. Viral upper respiratory infection

The use of a continuous positive airway pump in the treatment of sleep apnea will: a. reduce bronchospasm. b. force expansion of pleural membranes. c. maintain an open airway. d. awaken the person and increase respirations.

c. maintain an open airway. answers one

A patient has been newly diagnosed with moderate persistent asthma after having mild persistent asthma that has worsened over past six months. She currently has a low dose ICS and rescue inhaler. What should the provider consider prescribing? Select all that apply. A.) Increase rescue albuterol dose B.) Add a systemic corticosteroid C.) Increase ICS dose D.) Add LABA

cd

A 32-year-old male presents with an acute onset of pain and swelling in his left ankle. On exam, the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. What is the most likely diagnosis? A.) Gout B.) Pseudogout C.) Acute rheumatic fever D.) Septic arthritis

d

What is the primary treatment for allergic rhinitis? Select one: A.) Topical nasal sprays and antibiotics B.) Humidified air and cough suppressants C.) Systemic steroids and decongestants D.) Allergy avoidance and antihistamines

d

24. In using the ophthalmoscope to assess a patients eyes, the nurse notices a red glow in the patients pupils. On the basis of this finding, the nurse would: a. Suspect that an opacity is present in the lens or cornea. b. Check the light source of the ophthalmoscope to verify that it is functioning. c. Consider the red glow a normal reflection of the ophthalmoscope light off the inner retina. Continue with the ophthalmoscopic examination, and refer the patient for further

d. ANS: C evaluation. The red glow filling the persons pupil is the red reflex and is a normal finding caused by the reflection of the ophthalmoscope light off the inner retina. The other responses are not correct. MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. Patients with acute otitis media should be referred to a specialist in which of the following situations? a. Concurrent vertigo or ataxia b. Failed closure of a ruptured tympanic membrane c. If symptoms worsen after 3 or 4 days of treatment d. All of the above

d. All of the above

18. In which of the following situations would referral to a specialist be needed for sinusitis? a. Recurrent sinusitis b. Allergic sinusitis c. Sinusitis that is refractory to antibiotic therapy d. All of the above

d. All of the above

21. Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting from infection with which of the following pathogens? a. Coxsackievirus b. Cytomegalovirus c. Francisella tularensis d. Group A streptococcus

d. Group A streptococcus

8. Which of the following is an example of sensorineural hearing loss? a. Perforation of the tympanic membrane b. Otosclerosis c. Cholesteatoma d. Presbycusis

d. Presbycusis

. The forced vital capacity is decreased in: a. Asthma b. Chronic bronchitis c. Emphysema d. Restrictive disease

d. Restrictive disease

25. You have a patient who is a positive for Strep on rapid antigen testing (rapid strep test). You order amoxicillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5 F in office). You also note significant adenopathy, most notably in the posterior and anterior cervical chains, some hepatomegaly, and a diffuse rash. You decide: a. to refer the patient. b. that he is having an allergic response and needs to be changed to a macrolide antibiotic. c. that his antibiotic dosage is not sufficient and should be changed. d. that he possibly has mononucleosis concurrent with his strep infection.

d. that he possibly has mononucleosis concurrent with his strep infection.