Dunphy Primary Care Midterm Review

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1. "Do not donate blood until one year after diagnosis." 2. "Abstain from sex altogether." 3. "There is no possibility of transmission through razors or toothbrushes." 4. "Abstain from sex during your period."

"Abstain from sex during your period."

Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1. "Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel." 2. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." 3. "Antacids contain caffeine, which decreases bowel transit time." 4. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

"Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

Nausea is difficult to discern in a young child. What question might you ask to determine if a child has nausea? 1. "Are you sick to your tummy?" 2. "Are you hungry?" 3. "Are you eating the way you normally eat?" 4. "Are you nauseous?"

"Are you hungry?"

Leslie, age 13, says that her mother has polycystic kidney disease and asks about her chances of developing it. How do you respond? 1. "It is hereditary, but if you develop it, a cure is possible." 2. "It is hereditary and unfortunately incurable, but there are some measures we can use in dealing with it." 3. "It is not hereditary, but you may develop it anyway." 4. "It is hereditary, but it skips generations."

"It is hereditary and unfortunately incurable, but there are some measures we can use in dealing with it."

Dennis, age 62, has benign prostatic hyperplasia (BPH). He tells you that he voids at least 4 times per night and that he has read about a preventive drug called terazosin hydrochloride (Hytrin) that might help him. What do you tell him? 1. "It's not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck." 2. "It changes the pH of the urine and prevents infections caused by urinary stasis." 3. "It relaxes the urethra." 4. "It shrinks the prostate tissue."

"It's not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck."

Mimi, age 52, asks why she should perform a monthly breast self-examination (BSE) when she has her mammograms on schedule. You respond: 1. "If you are faithful about your annual exams and mammograms, that is enough." 2. "More breast abnormalities are picked up by mammograms than by clinical exams or BSE." 3. "More than 90% of all breast abnormalities are first detected by self-examination." 4. "Self-examinations need to be performed only every other month."

"More than 90% of all breast abnormalities are first detected by self-examination."

Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Joseph receive today regarding the care of his feet? 1. "Wash your feet with cold water only." 2. "See a podiatrist every two years, inspect your own feet monthly, and apply lotion to your feet daily." 3. "Go to a spa and have a pedicure monthly." 4. "See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas."

"See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas."

Tina, age 49, is on multiple drug therapy for tuberculosis (TB). She asks you how long she needs to take the drugs. You respond: 1. "Six weeks to two months." 2. "Four to six months." 3. "Six to nine months." 4. "One year."

"Six to nine months."

A patient asks how to avoid contracting pharyngitis and tonsillitis. Which piece of advice is not appropriate for this patient? 1. "Replace your toothbrush as soon as you develop a sore throat." 2. "Use condoms or dental dams when performing oral sex." 3. "Take antibiotics when well to avoid future infections." 4. "Avoid low-humidity environments."

"Take antibiotics when well to avoid future infections."

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1. "Occasionally he accumulates blood in the gut." 2. "There is an interruption of the normal clotting mechanism." 3. "Long-term alcohol abuse has made his vessels very friable." 4. "His bone marrow has been affected."

"There is an interruption of the normal clotting mechanism."

Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1. "You should have two to three stools per day." 2. "You should defecate once a day." 3. "You should have at least three stools per week." 4. "There is no such thing as a 'normal' pattern of defecation."

"There is no such thing as a 'normal' pattern of defecation."

A 35-year-old nurse presents to your employee health clinic for her annual purified protein derivative (PPD) skin test. Two days later she comes in for the recheck. She has a raised, erythematous lesion at the injection site. What diameter measurement would you consider a positive test? 1. 5 mm. 2. 8 mm. 3. 9 mm. 4. 12 mm.

12 mm.

Mary, age 69, has chronic obstructive pulmonary disease (COPD). Her oxygen saturation is less than 85%. She is to start on oxygen therapy to relieve her symptoms. How often must she be on oxygen therapy to actually improve her oxygen saturation? 1. On an as needed basis. 2. 6 to 12 hours per day. 3. 15 hours per day. 4. 24 hours per day.

15 hours per day

Julia, age 18, asks you how many calories of fat she is eating when 1 serving has 3 g of fat. You tell her: 1. 12 cal. 2. 18 cal. 3. 27 cal. 4. 30 cal.

27 cal.

If a screening test used on 100 individuals known to be free of breast cancer identified 80 individuals who did not have breast cancer while missing 20 of the individuals, the specificity would be: 1. 80%. 2. 60%. 3. 40%. 4. 20%.

80%.

Which of the following patients is health literate? 1. A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive. 2. A 70-year-old patient with dementia. 3. A 22-year-old migrant worker who only speaks Spanish. 4. A 45-year-old college graduate with no health insurance.

A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive.

Which of the following patients would you recommend get a low-dose computed tomography (CT) scan for lung cancer screening? 1. A 25-year-old with a 10-pack-year history and asthma. 2. A 75-year-old with a history of pneumonia. 3. A 65-year-old smoker who started smoking at age 12. 4. A 65-year-old smoker who quit 20 years ago but has a previous 50-pack-year history.

A 65-year-old smoker who started smoking at age 12.

Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1. A throat culture. 2. A Monospot test. 3. A rapid antigen test. 4. A Thayer-Martin plate test.

A Monospot test.

Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: 1. Eye discomfort. 2. Slow progression. 3. A ciliary flush. 4. No change in or slightly blurred vision.

A ciliary flush.

Sarah, age 25, has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following medications ordered for allergic rhinitis would be most appropriate? 1. A decongestant nasal spray. 2. An antihistamine nasal spray. 3. Ipratropium bromide (Atrovent). 4. Omalizumab (Xolair).

A decongestant nasal spray.

Macrocytic normochromic anemias are caused by: 1. Acute blood loss. 2. An infection or tumor. 3. A nutritional deficiency of iron. 4. A deficiency of folic acid.

A deficiency of folic acid.

The gold standard for definitive diagnosis of sickle cell anemia is: 1. A reticulocyte count. 2. The sickle cell test. 3. A hemoglobin electrophoresis. 4. A peripheral blood smear.

A hemoglobin electrophoresis.

Which diagnostic procedure can visualize the renal outline and identify lower rib fractures? 1. Intravenous pyelography. 2. Renal angiography. 3. Computed tomography. 4. A kidney, ureter, and bladder (KUB) film.

A kidney, ureter, and bladder (KUB) film.

Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: 1. Bell palsy. 2. A lesion affecting the trigeminal nerve. 3. A stroke—brain attack, cerebrovascular accident (CVA). 4. Shingles.

A lesion affecting the trigeminal nerve.

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3. Amoxicillin (Amoxil) and omeprazole (Prilosec). 4. Clarithromycin (Biaxin) and metronidazole (Flagyl).

A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl).

In which of the following circumstances is the reticulocyte count elevated? 1. Aplastic anemia. 2. Iron deficiency anemia. 3. Poisoning. 4. Acute blood loss.

Acute blood loss.

Stridor can be heard on auscultation when a client has: 1. Atelectasis. 2. Asthma. 3. Diaphragmatic hernia. 4. Acute epiglottitis.

Acute epiglottitis.

Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1. Dental abscess. 2. Acute rhinosinusitis. 3. Chronic rhinosinusitis. 4. Nasal tumor.

Acute rhinosinusitis.

What is the most common histologic type of lung cancer? 1. Adenocarcinoma. 2. Squamous cell carcinoma. 3. Small cell carcinoma. 4. Large cell carcinoma.

Adenocarcinoma.

Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1. Allergic rhinitis. 2. Viral rhinitis. 3. Nasal polyps. 4. Nasal vestibulitis from folliculitis.

Allergic rhinitis.

The well-established risk factor(s) for nosocomial pneumonia caused by a multidrug-resistant organism is (are): 1. Antibiotic exposure and a hospital stay of more than 1 week. 2. Age greater than 65 and a history of chronic obstructive pulmonary disease (COPD). 3. Outpatient surgery. 4. Allergies to multiple antibiotics.

Antibiotic exposure and a hospital stay of more than 1 week.

A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1. Appendicitis. 2. Cholecystitis. 3. Constipation. 4. Gastroenteritis.

Appendicitis.

Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1. Appendicitis. 2. Gastroenteritis. 3. Acute pancreatitis. 4. Rocky Mountain spotted fever.

Appendicitis.

Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction.

As having metabolic syndrome.

Jim, age 35, has had several episodes of kidney stones. The last stone he passed was examined and found to be an oxalate stone. You tell him to avoid foods high in oxalate, such as: 1. Beans and lentils, chocolate and cocoa, dried fruits, canned or smoked fish (except tuna), flour, milk, and milk products. 2. Cheese, cranberries, eggs, grapes, meat and poultry, plums and prunes, tomatoes, and whole grains. 3. Asparagus, beer, beets, cabbage, celery, chocolate and cocoa, fruits, green beans, nuts, tea, cola, and tomatoes. 4. Goose, organ meats, sardines, herring, and venison, with only a moderate intake of beef, chicken, crab, pork, salmon, and veal.

Asparagus, beer, beets, cabbage, celery, chocolate and cocoa, fruits, green beans, nuts, tea, cola, and tomatoes.

Which of the following conditions is characterized by intermittent episodes of airway obstruction caused by bronchospasm, excessive bronchial secretions, or edema of bronchial mucosa? 1. Asthma. 2. Atelectasis. 3. Acute bronchitis. 4. Emphysema.

Asthma.

A cough caused by postnasal drip related to sinusitis is more prevalent at what time of day? 1. Continuously throughout the day. 2. In the early morning. 3. In the afternoon and/or evening. 4. At night.

At night.

Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1. Ciprofloxacin (Cipro). 2. Azithromycin (Zithromax). 3. Amoxicillin (Amoxil). 4. Cephalexin (Keflex).

Azithromycin (Zithromax).

Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1. Left-sided pleural effusion. 2. Bluish discoloration over the flanks. 3. Bluish discoloration around the umbilicus. 4. Jaundice.

Bluish discoloration over the flanks.

Which type of bloody urine is characteristic of bleeding from the upper urinary tract? 1. Grossly bloody urine. 2. Urine with blood clots. 3. Brown, smoky, or tea-colored urine. 4. Blood noted at the beginning or end of the stream.

Brown, smoky, or tea-colored urine.

The increased presence in a urinalysis of which of the following indicates the presence of bacteria or protein, which is seen in severe renal disease and could also indicate urinary calculi? 1. Crystals. 2. Casts. 3. Nitrites. 4. Ketones.

Casts.

Which of the following statements regarding sleep apnea is not true? 1. Thirty percent of the male population in the United States has sleep apnea. 2. Unmanaged sleep apnea is associated with worse control of atrial fibrillation. 3. Central sleep apnea is the most common type of sleep apnea. 4. Unmanaged sleep apnea increases a patient's coronary risk.

Central sleep apnea is the most common type of sleep apnea.

When teaching smokers about starting nicotine gum to aid in smoking cessation, tell them to: 1. Chew the gum like regular gum. 2. Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. 3. Drink a cup of coffee before chewing the gum because it assists the nicotine absorption. 4. Chew 1 piece every 4 hours for the first 6 weeks,

Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa.

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1. Appendicitis. 2. Crohn's disease. 3. Cholecystitis. 4. Irritable bowel syndrome.

Cholecystitis.

Which of the following is the most common type of leukemia in the United States? 1. Acute lymphocytic leukemia. 2. Chronic myelogenous leukemia. 3. Acute myelogenous leukemia. 4. Chronic lymphocytic leukemia (CLL).

Chronic lymphocytic leukemia (CLL).

What is the greatest risk factor for the development of chronic obstructive pulmonary disease (COPD)? 1. Cigarette smoking. 2. Air pollution. 3. Work exposure. 4. Asthma.

Cigarette smoking.

Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1. Campylobacter jejuni. 2. Clostridium botulinum. 3. Clostridium perfringens. 4. Staphylococcus.

Clostridium botulinum.

You are examining the respiratory system of a 65-year-old female client in whom you suspect "impaired gas exchange." This finding may be demonstrated by: 1. Clubbing of the fingers. 2. Nasal flaring. 3. The use of accessory muscles. 4. A cough.

Clubbing of the fingers.

Which of the following workers are at risk for developing "black lung disease?" 1. Farmers. 2. Coal miners. 3. Construction workers. 4. Potters.

Coal miners.

James, age 12, just moved from Texas. He presents with a headache, cough, fever, rash on the legs and arms, myalgias, and dysuria. His white blood cell count is 12.9 with 8% bands and 7% to 10% eosinophils. Electrolyte levels are normal. Blood cultures are negative. Sputum is not available. A Mantoux skin test so far is negative. What do you suspect? 1. Pulmonary tuberculosis. 2. Lymphoma. 3. Asthma. 4. Coccidioidomycosis.

Coccidioidomycosis.

The screening guidelines for colon cancer recommend which of the following for the general population? 1. Colonoscopy starting at age 50. 2. Colonoscopy starting at age 45. 3. Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4. Fecal occult blood test (FOBT) and rectal exam starting at age 45.

Colonoscopy starting at age 50.

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1. Constipation. 2. Colorectal cancer. 3. Irritable bowel syndrome. 4. Acute appendicitis.

Colorectal cancer.

Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli.

Cryptosporidiosis

In children aged 1 to 5 years with a chronic cough, which of the following should be considered part of the differential diagnosis after the more common causes have been ruled out? 1. Allergic rhinitis. 2. Chronic sinusitis. 3. Enlarged adenoids. 4. Cystic fibrosis.

Cystic fibrosis.

Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1. Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2. Drink at least 2000 mL of fluids per day. 3. Decrease her dietary fiber for 1 month. 4. Take stool softeners as prescribed.

Decrease her dietary fiber for 1 month.

Which of the following initiatives does not fall under the National Prevention Strategy? 1. Diabetes management. 2. Tobacco-free living. 3. Healthy eating. 4. Mental and emotional well-being.

Diabetes management.

What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A.

Digital trauma.

You have a new client, Robert, age 67, who presents with generalized lymphadenopathy. You know that this is indicative of: 1. Disseminated malignancy, particularly of the hematologic system. 2. Cancer of the liver. 3. Sjögren syndrome. 4. Pancreatic cancer.

Disseminated malignancy, particularly of the hematologic system.

What is the percussion tone heard over a distended bladder? 1. Dullness. 2. Resonance. 3. Hyperresonance. 4. Tympany.

Dullness.

What is the first step in the treatment of uric acid kidney stones? 1. Encouraging hydration. 2. Alkalinizing the urine. 3. Prescribing allopurinol (Zyloprim). 4. Reducing protein intake.

Encouraging hydration.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1. Inguinal hernia. 2. Epigastric hernia. 3. Umbilical hernia. 4. Incisional hernia.

Epigastric hernia.

Which of the following parapharyngeal upper respiratory tract infections occurs most often in children aged 2 to 5 years? 1. Peritonsillar abscess. 2. Epiglottitis. 3. Laryngotracheobronchitis (croup). 4. Bacterial tracheitis.

Epiglottitis.

What is the most common bacterial cause of traveler's diarrhea? 1. Escherichia coli. 2. Campylobacter jejuni. 3. Salmonella. 4. Shigella.

Escherichia coli.

Postmenopausal women tend to have more recurrent urinary tract infections because of: 1. Frequent urination. 2. Estrogen depletion-related changes. 3. An increase in lactobacilli. 4. A decrease in Escherichia coli.

Estrogen depletion-related changes.

Mary Lou, age 55, has stress urinary incontinence. She is desperate for some relief and asks for your help. She already takes several pills a day and does not really want to take any more, but she wants to do something about her problem. What do you suggest? 1. Propantheline bromide (Pro-Banthine). 2. Dicyclomine hydrochloride (Bentyl). 3. Estrogen vaginal cream. 4. Imipramine hydrochloride (Tofranil).

Estrogen vaginal cream.

You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? 1. Maxillary. 2. Ethmoid. 3. Frontal. 4. Sphenoid.

Ethmoid.

How do you respond when Jill, age 42, asks you how long she should work out each week? 1. Exercise for at least 30 minutes every day. 2. Exercise a total of 2 hours per week. 3. Exercise for at least 20 minutes 3 or more days per week. 4. Exercise for at least 30 minutes 5 days per week.

Exercise for at least 30 minutes 5 days per week.

Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1. Acute otitis media. 2. Chronic otitis media. 3. External otitis. 4. Temporomandibular joint (TMJ) syndrome.

External otitis.

Which is the best serum test for spotting an iron deficiency early, before it progresses to full-blown anemia? 1. Hemoglobin. 2. Hematocrit. 3. Ferritin. 4. Reticulocytes.

Ferritin.

As a primary care provider, which of the following topics is not typically important for adults aged 20 to 40? 1. Focusing on increasing lifespan. 2. Career development. 3. Self-image. 4. Family relationships.

Focusing on increasing lifespan.

Of the following groups, which is at the highest risk of tuberculosis in the United States? 1. People born in the United States. 2. Foreign-born individuals. 3. People in rural populations. 4. Residents of Oklahoma.

Foreign-born individuals.

Which of the following is the most common cause of acute pancreatitis? 1. Gallstone obstruction of the pancreatic duct. 2. Alcoholism. 3. Hypertriglyceridemia. 4. Gallstone obstruction of the pancreatic duct and alcoholism.

Gallstone obstruction of the pancreatic duct and alcoholism.

Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1. Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2. Eat smaller meals. 3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4. Stop smoking.

Have a snack before retiring so that the esophagus and stomach are not empty at bedtime.

Which of the following statements about health promotion is false? 1. Health promotion is a benefit to add to your practice if you have time. 2. Health promotion helps to prevent diseases. 3. Health promotion includes early screening to detect diseases. 4. Health promotion includes helping to restore health after a patient has had an illness.

Health promotion is a benefit to add to your practice if you have time.

Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1. Glomerulonephritis. 2. Rheumatic heart disease. 3. Scarlet fever. 4. Hemolytic anemia.

Hemolytic anemia.

Coughing up blood or sputum that is streaked or tinged with blood is known as: 1. Hemoptysis. 2. Regurgitation. 3. Bloody sputum. 4. Rhinorrhea.

Hemoptysis.

Your client George, age 60, presents with pruritus and complains of lymphadenopathy in his neck. He also complains of night sweats and has noticed a low-grade fever. He has not lost any weight and otherwise feels well. He is widowed and has been dating a new woman recently. On physical exam, you find enlarged supraclavicular nodes. You suspect: 1. Lung cancer. 2. Hodgkin lymphoma. 3. A lingering viral infection from a bout of flu he had 6 weeks ago. 4. Non-Hodgkin lymphoma.

Hodgkin lymphoma.

The most common metabolic condition that predisposes individuals to the formation of kidney stones is: 1. Idiopathic hypercalciuria. 2. Hyperuricosuria. 3. Hyperoxaluria. 4. Low urinary citrate excretion.

Idiopathic hypercalciuria.

Which of the following medications prescribed for asthma acts to prevent binding of IgE receptors on basophils and mast cells? 1. Anti-inflammatory agents. 2. Bronchodilators. 3. Mast cell stabilizers. 4. Immunomodulators.

Immunomodulators.

Martin, age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that he should be hospitalized? 1. Inability to take oral medications and multilobar involvement on chest x-ray. 2. Alert and oriented status, slightly high but stable vital signs, and no one to take care of him at home. 3. Sputum with gram-positive organisms. 4. A complete blood count (CBC) showing leukocytosis.

Inability to take oral medications and multilobar involvement on chest x-ray.

Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1. Age. 2. Infection. 3. Pain. 4. Length of time between exacerbations.

Infection.

You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1. Cirrhosis. 2. Inflammation of the kidney. 3. Inflammation of the spleen. 4. Peritonitis.

Inflammation of the kidney.

Which of the following doesn't fall under the umbrella of health promotion as a nurse practitioner? 1. Information about online dating. 2. Exercise programs. 3. Immunizations. 4. Nutrition support.

Information about online dating.

A 66-year-old female with a history of diabetes presents to your primary care office complaining of a cough and fever for 6 days. Her vitals are as follows: temperature 101.5°F, oxygen saturation 94 % on room air, respiratory rate (RR) 32 per minute, pulse (P) 110, and blood pressure 145/96. What is the best way to treat this patient for pneumonia? 1. Inpatient admission to the intensive care unit (ICU). 2. Inpatient admission. 3. Outpatient treatment with oral antibiotics. 4. Outpatient treatment with close follow-up until a sputum culture returns.

Inpatient admission.

Mr. Tanner, age 67, presents to the clinic with fever, chills, a productive cough with sputum that has changed color from clear to yellow, chest discomfort, fatigue, and myalgias. His wife is concerned because he is confused at times. His blood pressure is 100/54, his pulse rate is 92, and his respirations are 22 per minute. When percussing the chest, you detect dullness over the right lower lobe and suspect that Mr. Tanner has pneumonia. Your plan for Mr. Tanner includes: 1. Outpatient treatment. 2. Inpatient treatment. 3. Macrolide antibiotic therapy. 4. A respiratory fluoroquinolone.

Inpatient treatment.

Which of the following is not one of the generalized patterns of nursing care included in the Circle of Caring model? 1. Intelligence. 2. Patience. 3. Advocacy. 4. Courage.

Intelligence.

A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1. Internal hemorrhoid. 2. External hemorrhoid. 3. Bleeding peptic ulcer. 4. Rectal fissure.

Internal hemorrhoid.

Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis.

Iritis.

Lorie, age 29, appears with the following signs: pale conjunctivae and nail beds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? 1. Vitamin B12 deficiency. 2. Folate deficiency. 3. Iron deficiency anemia. 4. Chronic fatigue syndrome.

Iron deficiency anemia.

Michael, age 52, has had a gradual onset of dry cough, dyspnea, chills, fever, general malaise, headache, confusion, anorexia, diarrhea, myalgias, and arthralgias. Which diagnosis do you suspect? 1. Bronchopneumonia. 2. Legionnaires' disease. 3. Primary atypical pneumonia. 4. Pneumocystis jiroveci pneumonia.

Legionnaires' disease.

Dietary management for a client in acute renal failure includes: 1. Decreasing carbohydrate intake. 2. Increasing dietary sodium intake. 3. Limiting protein intake. 4. Increasing potassium intake.

Limiting protein intake.

A 55-year-old male presents to your primary care clinic complaining of a cough for 3 months. He is a diabetic and is currently taking lisinopril, atorvastatin, and metformin. He denies dyspnea, chest pain, and productive cough. He was recently diagnosed with diabetes and has started all 3 of these medications within the last 4 months. The patient's vital signs are within normal limits, and his chest x-ray is negative. What is the etiology of the patient's cough? 1. Upper respiratory infection (URI). 2. Walking pneumonia. 3. Lisinopril. 4. Sinus infection.

Lisinopril.

Your client Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in terms of diagnosis? 1. Iron deficiency anemias. 2. Hemolytic anemias. 3. Lead poisoning. 4. Liver disease.

Liver disease.

Keaton, age 6, comes to the clinic with his mother for a 3-month follow-up visit for his asthma. His mother reports he has symptoms 2 days a week but not more than once each day, he has had only 1 episode of nighttime awakening because of his asthma, he is able to play soccer without provoking an attack, and his peak flow personal best is 80% or higher. His current treatment includes a short-acting beta agonist and a leukotriene receptor antagonist. Based on the level of control, your plan for adjusting therapy includes: 1. Considering a short course of oral systemic corticosteroids. 2. Stepping up 1 step. 3. Stepping up 2 steps. 4. Maintaining the current step.

Maintaining the current step.

Mark, age 72, has been living in a shelter for 4 months. Today he appears at the clinic complaining of productive cough, weight loss, weakness, anorexia, night sweats, and generalized malaise. These have been bothering him for 8 weeks. What would be one of the first tests you order? 1. Mantoux test. 2. Chest x-ray. 3. Complete blood work. 4. Sputum culture.

Mantoux test.

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1. Maxillary sinus. 2. Ethmoid sinus. 3. Sphenoid sinus. 4. Frontal sinus.

Maxillary sinus.

Jill, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities, and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Jill in? 1. Intermittent. 2. Mild persistent. 3. Moderate persistent. 4. Severe persistent.

Moderate persistent.

Which of the following statements regarding pulmonary tuberculosis is true? 1. Manifestations are usually confined to the respiratory system. 2. Dyspnea is usually present in the early stages. 3. Crackles and bronchial breath sounds are usually present in all phases of the disease. 4. Night sweats are often noted as a manifestation of fever.

Night sweats are often noted as a manifestation of fever.

Marci, age 15, has been given a diagnosis of step 1 (intermittent) asthma. What long-term control therapy is indicated? 1. None. 2. A single agent with anti-inflammatory activity. 3. An inhaled corticosteroid with the addition of a long-acting bronchodilator if needed. 4. Multiple long-term control medications with oral corticosteroids if needed.

None.

Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1. Antibiotics. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Oral contraceptives. 4. Antifungals.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

Which of the following is considered a nephrotoxic agent and should be avoided in clients with chronic renal failure (CRF)? 1. Nonsteroidal anti-inflammatory drugs (NSAIDs). 2. Kayexalate. 3. Calcium carbonate. 4. Erythropoietin.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

Which of the following is not a risk factor for the development of asthma? 1. Younger age. 2. African American race. 3. Female gender. 4. Obesity.

Obesity.

You have been counseling your client about her asthma. You realize she does not understand your suggestions when she tells you she will do which of the following? 1. Cover the mattress and pillows in airtight, dustproof covers. 2. Wash the bedding weekly and dry it on a hot setting for 20 minutes. 3. Avoid sleeping on natural fibers such as wool or down. 4. Open the windows and air out the room daily.

Open the windows and air out the room daily.

An 83-year-old female presents to the urgent care clinic for diarrhea. The patient was just discharged from the hospital 1 week ago following treatment for pneumonia. The patient states she has diarrhea, described as diffuse and watery, with mucus in it at times. She has approximately 10 episodes per day. What is the recommended treatment for this patient? 1. Fecal transplant. 2. Intravenous (IV) metronidazole. 3. Oral vancomycin. 4. Gastrointestinal rest.

Oral vancomycin.

Which of the following demonstrates a subjective finding? 1. Pain level. 2. Pulse rate. 3. Eye color. 4. Extremity edema.

Pain level.

Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1. A gastric ulcer. 2. Gastritis. 3. Pelvic inflammatory disease. 4. Pancreatitis.

Pelvic inflammatory disease.

The antibiotic of choice for the treatment of Streptococcus pneumoniae infection is: 1. Dicloxacillin. 2. Erythromycin. 3. Penicillin. 4. Amoxicillin-clavulanate.

Penicillin.

Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? 1. Repeat the laboratory tests. 2. Perform a fecal occult blood test. 3. Start him on an iron preparation. 4. Start him on folic acid.

Perform a fecal occult blood test.

Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily? 1. Drink all the soda you like—it has no effect on your bone density. 2. It has not been proved that smoking affects bone loss. 3. Replace estrogen when you reach menopause. 4. Perform aerobic exercise at least 3 times a week.

Perform aerobic exercise at least 3 times a week.

When teaching a mother who has a child with cystic fibrosis (CF), you emphasize that the most important therapeutic approach for promoting the child's pulmonary function is: 1. Continuously administering low-flow oxygen. 2. Administering bronchodilators on a regular basis. 3. Performing chest physiotherapy with postural drainage, percussion, and vibration. 4. Using maintenance antibiotic prophylactic therapy.

Performing chest physiotherapy with postural drainage, percussion, and vibration.

Which of the following is the most common cause of megaloblastic anemia? 1. Vitamin B12 deficiency. 2. Pernicious anemia. 3. Iatrogenesis. 4. Folate deficiency.

Pernicious anemia.

As a nurse practitioner, which of the following would not be an example of primary health promotion? 1. Posting health articles on your social media account. 2. Speaking to patients at each visit about strategies for maintaining/attaining a healthy life. 3. Lecturing at local community centers about diabetes. 4. Organizing a 5K running event for the patients in your practice.

Posting health articles on your social media account.

Which category of diuretics has the following side effects: hyperkalemia, headache, hyponatremia, nausea, diarrhea, urticaria, and menstrual disturbances? 1. Osmotic diuretics. 2. Loop diuretics. 3. Potassium-sparing diuretics. 4. Thiazide diuretics.

Potassium-sparing diuretics.

Jamie, age 16, has had her asthma well controlled by using only a beta-2 adrenergic metered-dose inhaler. Lately, however, she has had difficulty breathing during the night, and her sleep has been interrupted about 3 times a week. What do you do? 1. Prescribe a short course of steroid therapy. 2. Prescribe an inhaled steroid. 3. Prescribe a longer acting bronchodilator. 4. Prescribe oral theophylline.

Prescribe an inhaled steroid.

In trying to differentiate between chronic bronchitis and emphysema, you know that chronic bronchitis: 1. Usually occurs after age 50 and has insidious progressive dyspnea. 2. Usually presents with a cough that is mild and with scant, clear sputum, if any. 3. Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. 4. Results in an increased total lung capacity with a markedly increased residual volume.

Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note.

Laura, age 36, has an acute onset of dyspnea. Associated symptoms include chest pain, faintness, tachypnea, peripheral cyanosis, low blood pressure, crackles, and some wheezes. Her history reveals that she is taking birth control pills and that she smokes. What do you suspect? 1. Asthma. 2. Bronchitis. 3. Pulmonary embolism. 4. Pneumothorax.

Pulmonary embolism.

Which of the following is not a modifiable risk factor? 1. Weight. 2. Stress level. 3. Race. 4. Physical activity level.

Race.

General recommendations for the prevention of kidney stones, regardless of the type of stone the client has, include: 1. Drinking 3 to 4 L of mineral water per day. 2. Reducing protein in the diet. 3. Increasing vitamin C in the diet. 4. Decreasing fiber in the diet.

Reducing protein in the diet.

Which of the following indicate that Jim, a 32-year-old client with AIDS, has oropharyngeal candidiasis? 1. Small vesicles. 2. White, fissured, thickened patches. 3. Removable white plaques. 4. Flat-topped papules with thin, bluish-white spiderweb lines.

Removable white plaques.

Dennis, age 54, has chronic obstructive pulmonary disease (COPD). He has recently been experiencing difficulty in breathing. His arterial blood gas screening reveals pH 7.3, Pao2 57 mm Hg, Paco2 54 mm Hg, and oxygen saturation 84%. Dennis has: 1. Respiratory acidosis. 2. Respiratory alkalosis. 3. Metabolic acidosis. 4. Metabolic alkalosis.

Respiratory acidosis.

The kidneys excrete increased amounts of Hco3 to lower the pH as a mode of compensation for which acid-base disturbance? 1. Respiratory acidosis. 2. Respiratory alkalosis. 3. Metabolic acidosis. 4. Metabolic alkalosis.

Respiratory alkalosis.

Which of the following is not a subjective finding? 1. Headache. 2. Respiratory rate. 3. Shortness of breath. 4. Ankle pain.

Respiratory rate.

A 23-year-old college student presents to your primary care clinic complaining of the following symptoms: fever for 4 days that is controlled with Tylenol, nonproductive cough, general malaise and fatigue, and minimal rhinorrhea. The patient did not get a flu shot this year and states his girlfriend was diagnosed with the flu 3 days ago. His rapid influenza test is positive. What is the best treatment? 1. Rest and hydration. 2. Oseltamivir. 3. Inpatient hospitalization for supportive care. 4. Azithromycin.

Rest and hydration.

When you teach clients about using steroid inhalers for asthma or chronic obstructive pulmonary disease (COPD), what information is essential? 1. Keep the inhaler in the refrigerator. 2. Do not use another inhaler for 10 minutes after the steroid inhaler. 3. Rinse your mouth after using the inhaler. 4. Be careful not to shake the container before using.

Rinse your mouth after using the inhaler.

Which of the following changes in laboratory values is associated with kidney disease? 1. Serum creatinine greater than 4 mg/dL. 2. Serum albumin 0.5 to 1.0 g/dL. 3. Serum sodium greater than 150 mEq/L. 4. Serum calcium greater than 6.0 mEq/L.

Serum creatinine greater than 4 mg/dL.

Which of the following diagnostic studies for the evaluation of renal function assesses for the lack of erythropoietin? 1. Urine creatinine clearance. 2. Serum urea nitrogen. 3. Serum albumin. 4. Serum hemoglobin and hematocrit.

Serum hemoglobin and hematocrit.

Joyce, age 48, is being treated conservatively for her low back pain with a nonsteroidal anti-inflammatory drug (NSAID), a muscle relaxant, and physical therapy. She has recently been diagnosed with chronic kidney disease. Which of the following statements is true? 1. She should switch to a different NSAID. 2. She should not be taking anything for pain other than narcotics. 3. You should just increase her physical therapy and hope for the best. 4. She could try acetaminophen 650 mg 3 times daily.

She could try acetaminophen 650 mg 3 times daily.

Which of the following types of lung cancer is most associated with paraneoplastic syndromes? 1. Small cell carcinoma. 2. Adenocarcinoma. 3. Squamous cell carcinoma. 4. Large cell carcinoma.

Small cell carcinoma.

Caroline, 65, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has a stomach ulcer. Which of the following is not one of her risk factors for iron deficiency anemia? 1. Smoking. 2. Poverty. 3. Ulcer. 4. Age greater than 60.

Smoking.

You have completed a physical exam on Sandra, age 32, who presented to the clinic for a cough that is particularly worse at night. She has been experiencing episodes of recurrent tightness in the chest with wheezing. She tells you that exercise and changes in the weather make her symptoms occur or worsen. Which test is performed to diagnose asthma? 1. Bronchoprovocation with methacholine, histamine, cold air, or exercise challenge. 2. Peak expiratory flow meter monitoring. 3. Spirometry testing. 4. Chest x-ray.

Spirometry testing.

What is the gold standard for the diagnosis of asthma? 1. Validated quality-of-life questionnaire. 2. Client's perception of "clogged" airways. 3. Spirometry. 4. Bronchoscopy.

Spirometry.

When you suspect a diagnosis of asthma, which test is the most appropriate to order to confirm the diagnosis? 1. Chest x-ray. 2. Spirometry. 3. Bronchoprovocation. 4. Bronchoscopy.

Spirometry.

Ms. Jones, your client, has an elevated platelet count. You suspect: 1. Systemic lupus erythematosus (SLE). 2. Infectious mononucleosis. 3. Disseminated intravascular coagulation (DIC). 4. Splenectomy.

Splenectomy.

You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome.

Stevens-Johnson syndrome.

Janet has stress urinary incontinence and has been doing Kegel exercises with some success. What other simple action might help relieve some of the problem? 1. Stopping smoking. 2. Limiting fluids. 3. Taking a daily multivitamin. 4. Beginning lifting 2-lb weights.

Stopping smoking.

A 50-year-old male presents to your primary care clinic complaining of fever and cough. The patient's symptoms have been present for 5 days. He complains of mild shortness of breath. Past medical history is positive for hypertension. He takes metoprolol and has no allergies. Vitals show a temperature of 101.5°F, pulse oximetry of 95% on room air, pulse of 101, and blood pressure of 138/90. His chest x-ray shows pulmonary infiltrates in the lower lobes of both lungs. What is the most likely pathogen causing his symptoms? 1. Streptococcus pneumoniae. 2. Legionella pneumophila. 3. Staphylococcus aureus. 4. Mycoplasma pneumoniae.

Streptococcus pneumoniae.

What is the most common bacterial pathogen associated with acute otitis media? 1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Streptococcus pyogenes. 4. Moraxella (Branhamella) catarrhalis.

Streptococcus pneumoniae.

You explain to Yolanda that pelvic floor (Kegel) exercises help to restore and maintain continence by improving pelvic muscle strength, increasing urethral pressure, and decreasing abnormal detrusor muscle contractions. These exercises are used for her diagnosis of: 1. Stool incontinence. 2. Full-bladder incontinence. 3. Cystitis-related incontinence. 4. Stress incontinence.

Stress incontinence.

In relation to writing a patient encounter note, the acronym SOAP stands for which of the following words? 1. Subjective, objective, assessment, plan. 2. Symptoms, objective, assessment, pills. 3. Subjective, outward findings, assessment, plan. 4. Symptoms, objective, assessment, plan.

Subjective, objective, assessment, plan.

An infant who has periodic breathing with persistent or prolonged apnea (greater than 20 seconds) may have an increased risk of: 1. Pneumonia. 2. Left-sided congestive heart failure. 3. Sudden infant death syndrome (SIDS). 4. Anemia.

Sudden infant death syndrome (SIDS).

Cough and congestion result when breathing: 1. Carbon monoxide. 2. Sulfur dioxide. 3. Tear gas. 4. Carbon dioxide.

Sulfur dioxide.

Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? 1. Metronidazole (Flagyl). 2. Supportive care. 3. Quinolone antibiotics. 4. Gastric lavage.

Supportive care.

You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days.

Supportive measures and lubricating drops (artificial tears).

The diagnosis of tuberculosis does not need to be reported when: 1. The client's Mantoux test shows an induration of 15 mm. 2. A case of tuberculosis is only suspected. 3. An asymptomatic client has a positive chest x-ray for pulmonary tuberculosis. 4. The Mantoux test shows a raised, injected, or red area without induration.

The Mantoux test shows a raised, injected, or red area without induration.

You have a patient who presents with ankle pain. Which of the following facts or observations does not belong in the physical exam portion of your note? 1. The patient's pain started after a fall off his skateboard. 2. The patient has a normal pulse and normal sensation of the foot. 3. The patient has edema in his ankle. 4. The patient has limited motion of his ankle.

The patient's pain started after a fall off his skateboard.

A definitive test for cystic fibrosis (CF) is: 1. The sweat test. 2. A sputum culture. 3. A fecal fat test. 4. A Chymex test for pancreatic insufficiency.

The sweat test.

Which of the following statements regarding the respiratory status of a pregnant woman is true? 1. The thoracic cage may appear wider. 2. The costal angle may feel narrower. 3. Respirations may be shallow. 4. Oxygenation is decreased.

The thoracic cage may appear wider.

Which of the following is considered a therapeutic indication for a bronchoscopy? 1. To evaluate indeterminate lung lesions. 2. To stage cancer preoperatively. 3. To determine the extent of injury secondary to burns, inhalation, or other trauma. 4. To remove a foreign body lodged in the trachea.

To remove a foreign body lodged in the trachea.

In tumor classification, TNM stands for which of the following? 1. Tumor, node, metastasis. 2. Tumor, nodules, metastasis. 3. Tumor, node, medicine. 4. Treat, nodules, metastasis.

Tumor, node, metastasis.

Decreased bladder capacity; bladder irritation from a urinary tract infection, tumor, stones, or irritants such as caffeine and alcohol; central nervous system disorders; and spinal cord lesions are all contributing factors to: 1. Stress urinary incontinence. 2. Urge urinary incontinence. 3. Overflow urinary incontinence. 4. Reflex urinary incontinence.

Urge urinary incontinence.

Cloudy urine is usually indicative of which of the following conditions? 1. Diabetes insipidus. 2. Proteinuria. 3. Malignancy. 4. Urinary tract infection (UTI).

Urinary tract infection (UTI).

Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer's ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming.

Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming.

What do you include in your teaching about tiotropium (Spiriva) when you initially prescribe it for your client with chronic obstructive pulmonary disease (COPD)? 1. Use it every time you use your beta-2 agonist. 2. Stop taking all your other COPD medications. 3. Use it once per day. 4. Stop taking Spiriva if you develop the adverse effect of dry mouth.

Use it once per day.

A 28-year-old teacher presents to your primary care office in the winter complaining of severe hoarseness for 3 days. It is progressive, and the patient can no longer teach her classes because she can't talk for long periods of time. The patient's vital signs show a temperature of 97.9°F, pulse of 70 beats per minute (BPM), pulse oximetry of 97% on room air, and blood pressure (BP) of 135/82. The patient has erythematous nasal and pharyngeal membranes, no nasal drainage, erythematous tympanic membranes, and a very sore throat. Rapid streptococcal (strep) test is negative, and there is no cervical lymphadenopathy. What is the treatment of choice? 1. Azithromycin. 2. Vocal rest. 3. Oral methylprednisolone. 4. Codeine cough syrup.

Vocal rest.

Which finding in urinary sediment is indicative of pyelonephritis and interstitial nephritis? 1. Hyaline casts. 2. Granular casts. 3. Red blood cell casts. 4. White blood cell casts.

White blood cell casts.

Doug, age 6, appears with abdominal distention and pain, an abdominal mass on the right side, fever, and slight hematuria. There is no precipitating event. What do you suspect? 1. A urinary tract infection (UTI). 2. Appendicitis. 3. Wilms tumor. 4. An intestinal obstruction.

Wilms tumor.

You are teaching Holly, age 14, who has asthma, to use a home peak expiratory flow meter daily to measure gross changes in peak expiratory flow. Which "zone" would rate her expiratory compliance as 50% to 80% of her personal best? 1. White zone. 2. Green zone. 3. Yellow zone. 4. Red zone.

Yellow zone.

Sherri, age 49, has had asthma for several years but has never used a peak expiratory flow (PEF) meter. Should you now recommend it? 1. No, she has been managing fine without it. 2. Yes, she might recognize early signs of a potential respiratory problem. 3. Present the options and let Sherri decide. 4. No, at her age it is not recommended.

Yes, she might recognize early signs of a potential respiratory problem.

Which of the following is not a risk factor for cholecystitis? 1. Female gender. 2. Obesity. 3. Sickle cell anemia. 4. Younger age.

Younger age.

Which of the following statements does not belong in the past medical history portion of your chart note? 1. Your patient had lab work at their last appointment that was negative. 2. Your patient had a cholecystectomy 3 years prior. 3. Your patient's father passed away from lung cancer. 4. Your patient has an allergy to penicillin.

Your patient had lab work at their last appointment that was negative.