Exam 3 questions weeded through 101-200

Which of the following individuals is most likely to be at higher risk for 538 osteoporosis? A) 70-year-old woman of African ancestry who walks daily for exercise B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma C) 55-year-old Caucasian woman who is an aerobics instructor D) 45-year-old Asian woman who has been on high-dose steroids for 1 week

42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma Risk factors for osteoporosis include postmenopause, early menopause, use of chronic steroids, smoking, excessive use of alcohol, sedentary lifestyle, insufficient intake of calcium and vitamin D in the diet, and being an Asian or Caucasian female.

The nurse practitioner is evaluating patients who are at high risk for complications due to urinary tract infections (UTIs). Which of the following patients does not belong in this category? A) A 38-year-old diabetic patient with an A1C of 7.5% B) A woman with rheumatoid arthritis who is being treated with methotrexate and low-dose steroids C) A 21-year-old woman who has a history of irritable bowel syndrome D) A pregnant woman

A 21-year-old woman who has a history of irritable bowel syndrome Irritable bowel syndrome is not associated with higher risk for urinary tract infection (UTI). Risk factors for UTI are gender (female), pregnancy, spermicide use during the past year, having a mother with history of UTIs, having a new sex partner during the past year, urinary incontinence, and cystocele.

The Phalen test is used to evaluate: A) Inflammation of the median nerve B) Rheumatoid arthritis C) Degenerative joint changes D) Chronic tenosynovitis

A) Inflammation of the median nerve The Phalen test is used to identify inflammation of the median nerve seen with carpal tunnel syndrome. Phalen's test is performed by examining the wrist with full flexion of the wrist for 60 seconds. Positive findings are reproduction of the symptoms such as numbness and tin- gling of the thumb, index finger, and middle finger areas.

The following skin findings are considered macules except: A) A freckle B) Petechiae C) Acne D) A flat, 0.5-cm brown birthmark

Acne A macule is a flat, nonraised lesion on the skin. Acne lesions are papules because they consist of raised, erythemic lesions on the skin. A freckle, petechiae, and a flat birthmark are all considered macules.

A 44-year-old man with Down syndrome starts to develop impaired memory and difficulty with his usual daily routines. He is having problems functioning at the job where he has been employed for the past 10 years. The physical exam and routine labs are all negative. The vital signs are normal. His appetite is normal. The most likely diagnosis is: A) Tic douloureux B) Stroke C) Alzheimer's disease D) Delirium

Alzheimer's disease Delirium is an acute decline in mental status and is temporary. Common causes are fever, shock, drugs, alcohol, and dehydration. Alzheimer's disease involves a permanent change to the brain that causes short-term memory loss, agnosia, apraxia, and aphasia. In this case, the patient's physical exam is normal; however, he is having memory loss and difficulty working and carrying out his normal tasks.

Physiological anemia of pregnancy is due to: A) An increase in the cardiac output at the end of the second trimester B) A physiological decrease in the production of red blood cells in pregnant women C) An increase of up to 50% of the plasma volume in pregnant women D) An increase in the need for dietary iron in pregnancy

An increase of up to 50% of the plasma volume in pregnant women Physiological anemia of pregnancy is caused by the increased volume of plasma during pregnancy when compared to the production of red blood cells.

Which of the following laboratory tests is positive in a large number of patients with systemic lupus erythematosus? A) Antinuclear antibody (ANA) B) Rheumatoid factor C) Antiparietal antibody D) Immunoglobulin

Antinuclear antibody (ANA) Screening tests for systemic lupus erythematosus include ANA. The rheumatoid factor test is performed to diagnose rheumatoid arthritis. Antiparietal antibody testing is done to evaluate for antibodies against the parietal cells. The parietal cells make a substance that the body needs to absorb vitamin BImmunoglobulin testing is done to assess for the amount of antibodies in the blood for a specific disease.

Which cranial nerve (CN) is being evaluated when patients are instructed to shrug their shoulders? A) CNIX B) CNX C) CNXI D) CN XII

CN XI Cranial nerves (CNs) IX through XII are the glossopharyngeal, vagal, spinal accessory, and hypoglossal, respectively. CN XI tests for spinal accessory. The procedure to test trapezius muscle strength is to have the patient shrug the shoulders against resistance. To test sternocleidomastoid muscle strength, have the patient turn the head to each side with resistance.

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

Cauda equina syndrome Cauda equina is a serious condition caused by 646 compression of the lumbar, sacral, or coccygeal nerve roots in the lower portion of the spinal cord. It is considered a surgical emergency. If left untreated, acute pressure causes ischemia and can lead to permanent nerve damage, including loss of bowel and bladder control and paralysis of the legs. Signs and symptoms include a change in bowel and bladder control (incontinence), saddle-pattern anesthesia (perineum), sciatica, low-back pain, and loss of sensation or movement below level of the lesion. Causes include disk herniation, abscess, tumor, inflammation, and others.

40-year-old man complains to the nurse practitioner of severe stabbing pains behind his left eye for the past 2 days. They are accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely? A) Migraine headache with aura B) Cluster headache C) Tic douloureux D) Cranial neuralgia

Cluster headache Cluster headaches' cardinal symptoms are an excruciating, unilateral, orbital, supraorbital, and/or temporal pain. The attack ranges from 15 minutes to 3 hours or more. Autonomic symptoms include ptosis (drooping eyelid), miosis (pupil constriction), lacrimation (tearing), and rhinorrhea in the nostril on the affected side of the face. Migraine headaches with aura include visual changes, such as blind spots or flashing lights, that appear before the onset of the headache. Trigeminal neuralgia (tic douloureux) is a unilateral headache from compression or inflammation of the trigeminal nerve (cranial nerve V).

Heberden's nodes are commonly found in which of the following diseases? A) Rheumatoid arthritis B) Degenerative joint disease C) Psoriatic arthritis D) Septic arthritis

Degenerative joint disease Heberden's nodes are bony nodules on the distal interphalangeal joints, commonly seen in degenerative joint disease.

A common side effect of metformin (Glucophage) therapy is: A) Weight gain B) Lactic acidosis C) Hypoglycemic episodes D) Diarrhea

Diarrhea Common side effects of metformin (Glucophage) include diarrhea, stomach pain, nausea, and flatulence.

Which of the following would you recommend on an annual basis for an elderly patient with type 2 diabetes? A) Eye exam with an ophthalmologist B) Follow-up visit with a urologist C) Periodic visits to an optometrist D) Colonoscopy

Eye exam with an ophthalmologist Elderly patients with type 2 diabetes should have a dilated eye exam done annually by an ophthalmologist. They should also see a podiatrist once or twice a year. Preventive care also includes receiving a flu shot annually, receiving a Pneumovax vaccine if older than 60 years of age, and taking a 81-mg baby aspirin each day.

What does a potassium hydroxide (KOH) prep help the nurse practitioner 531 diagnose? A) Herpes zoster infections B) Fungal infections C) Herpes simplex infections D) Viral infections

Fungal infections The potassium hydroxide (KOH) prep test is performed 650 to evaluate for tinea or candida (yeast) infection of the skin. In vaginal discharge, the yeast organism is outside the skin cells, so KOH is not needed to visualize it. But for skin cells, yeast is not visible unless the skin cell walls are destroyed by KOH. The test involves placing a sample of skin on a glass slide, with one to two drops of KOH (causes lysis of skin cells) and a coverslip on top. If done correctly, you can visualize the budding spores and pseudohyphae.

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

Imipramine (Tofranil) Imipramine (Tofranil) is a tricyclic antidepressant (TCA). Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil CR) are selective serotonin reuptake inhibitors (SSRIs).

A positive straight leg raising test is indicative of which of the following? A) Myasthenia gravis B) Inflammation of the sciatic nerve/herniated disk C) Multiple sclerosis D) Parkinson's disease 535

Inflammation of the sciatic nerve/herniated disk To perform the straight leg test, have the patient lie supine on an exam table. Lift the patient's leg toward his or her head while the knee is straight. If the patient experiences sciatic pain when the straight leg is at an angle between 30 and 70 degrees, then the test is positive and a herniated disk is likely to be the cause of the pain. The straight leg test should be done on the pain-free side first to find out which range of movement is normal and to enable the patient to distinguish between "normal" stretching of muscles and a different sort of pain.

Koilonychia is associated with which of the following conditions? A) Lead poisoning B) Beta thalassemia trait C) B12 deficiency anemia D) Iron-deficiency anemia

Iron-deficiency anemia Koilonychia is also known as spoon-shaped nails. The finger nails are thin and have a concave shape. Koilonychia is associated with severe iron- deficiency anemia

The red blood cells in pernicious anemia will show: A) Microcytic and hypochromic cells B) Microcytic and normochromic cells C) Macrocytic and normochromic cells D) Macrocytic and hypochromic cells

Macrocytic and normochromic cells Anemias resulting from vitamin B12 or folate deficiency are sometimes referred to as macrocytic or megaloblastic anemia because red blood cells are larger than normal. A diagnosis of pernicious anemia first requires demonstration of megaloblastic anemia with a complete blood count (CBC) with differential that evaluates the mean corpuscular volume (MCV), as well the mean corpuscular hemoglobin concentration (MCHC). Pernicious anemia is identified with a high MCV (macrocytic) and a normal MCHC (normochromic).

Beta thalassemia minor is considered a: A) Macrocytic anemia B) Normocytic anemia C) Microcytic anemia D) Hemolytic anemia

Microcytic anemia Beta thalassemia minor is a genetic disorder in which the bone marrow produces small, pale, red blood cells in which mild hypochromic, microcytic anemia occurs.

Which of the following is indicated for the prophylactic treatment of migraine headache? A) Ibuprofen (Motrin) B) Naproxen sodium (Anaprox) C) Propranolol (Inderal) D) Sumatriptan (Imitrex)

Propranolol (Inderal) Propranolol (Inderal) is a beta-blocker. Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. The goal of preventive therapy is to improve patients' quality of life by reducing migraine frequency, severity, and duration, and by increasing the responsiveness of acute migraines to treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen (Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex) are all medications used to treat symptoms of migraine headache.

An elderly woman with a history of rheumatoid arthritis reports to the nurse practitioner that she had been taking ibuprofen twice daily for many years. All of the following organ systems are at risk of damage from chronic nonsteroidal anti- inflammatory drug (NSAID) use except: A) Cardiovascular system B) Pulmonary system C) Gastrointestinal system D) Renal system

Pulmonary system Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of ulcers, perforation, and bleeding of the gastrointestinal tract, heart attacks, cardiovascular damage, strokes, acute interstitial nephritis and kidney injury, and liver damage. It does not affect the lungs or the pulmonary system.

A new patient is complaining of severe pruritus that is worse at night. Several 540 family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with: A) Contact dermatitis B) Impetigo C) Larva migrans D) Scabies

Scabies Scabies is a parasitic disease (infestation) of the skin caused by the human itch mite Sarcoptes scabiei. The rash is generally characterized as red, raised excoriated papules. The scabies mite is generally transmitted from one person to another by direct contact with the skin of the infested person and can also be acquired by wearing an infested person's clothing (fomites), such as sweaters, coats, or scarves. Following the incubation period, the infested person will complain of pruritus (itching), which intensifies at bedtime under the warmth of the blankets. Common sites of infection are the webs of fingers, wrists, flexors of the arms, the axillae, lower abdomen, genitalia, buttocks, and feet.

A 30-year-old woman with type 2 diabetes uses regular and NPH (neutral protein Hagedorn) insulin in the morning and in the evening. She denies changes in her diet or any illness, but recently started attending aerobic classes in the afternoon. Her fasting blood glucose level before breakfast is now elevated. Which of the following is best described? A) Somogyi phenomenon B) Dawn phenomenon C) Raynaud's phenomenon D) Insulin resistance 533

Somogyi phenomenon This is caused by too much insulin (or missing a meal or snack) in the evening, which results in hypoglycemia in the early morning (2 a.m. to 3 a.m.). The body compensates by secreting glucagon (from the liver) and epinephrine, which results in high blood glucose levels in the morning. The Somogyi phenomenon (or Somogyi effect) is also known as the rebound effect.

A male patient has type 2 diabetes mellitus and a "sensitive stomach." Which medication is least likely to cause him gastrointestinal distress? A) Naproxen sodium (Anaprox) B) Aspirin (Bayer's aspirin) C) Erythromycin (E-mycin) D) Sucralfate (Carafate)

Sucralfate (Carafate) Naproxen sodium, aspirin, and erythromycin all have gastrointestinal side effects. Sucralfate is used to protect the stomach lining by building a protective layer over the stomach lining; it allows healing to occur.

A 72-year-old woman complains of a crusty and nonhealing small ulcer on her upper lip that she has had for several years. Which of the following would you recommend? A) Triamcinolone acetonide (Kenalog) cream BID for 2 weeks B) Triple antibiotic ointment BID × 2 weeks C) Hydrocortisone 1% cream BID for 2 weeks D) The patient needs to be evaluated by a dermatologist

The patient needs to be evaluated by a dermatologist Nonhealing ulcers of the skin are a risk for skin cancer and should be evaluated by a dermatologist for treatment.

A menopausal woman with osteopenia is attending a dietary education class. Which of the following foods are recommended? A) Yogurt and sardines B) Spinach and red meat C) Cheese and red meat D) Low-fat cheese and whole grain

Yogurt and sardines Postmenopausal women are advised to increase their dietary intake of calcium and vitamin D to help protect their bones from osteopenia and osteoporosis. Good sources of calcium include low-fat dairy products (yogurt), dark leafy vegetables, canned salmon or sardines with bones, soy products, and calcium-fortified cereals and orange juice. Just 3 ounces of canned sardines, including bones, drained of oil, provides 324 mg of calcium.

Which of the following patients is least likely to become an alcoholic? A) A patient whose father has a history of alcoholism B) A patient whose wife complains that he drinks too much C) A patient who drinks one glass of wine nightly with dinner D) A patient who feels he drinks all the time

patient who drinks one glass of wine nightly with dinner Excessive use or exposure to alcohol increases the risk of becoming an alcoholic. A patient who drinks one glass of wine at dinner has a lower risk of becoming an alcoholic than someone who has been exposed to alcohol while growing up, one who drinks all the time, or one whose family believes he is drinking excessively.

When assessing a patient suspected of having vertigo, which description provided by the patient is most consistent with the diagnosis? A) A sensation of imbalance while walking B) A sensation of spinning or rotating C) A sensation of "passing out" D) A sensation of lightheadedness when changing positions from reclining to standing

sensation of spinning or rotating Vertigo is defined as having a sensation of spinning or rotating