N675 Practice Quizzes
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis?
Acute Otitis Externa
A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient complains of blurred vision, halos around lights, and vomiting. It began yesterday evening. On exam, the eye is red, tender and inflamed. The cornea is hazy and pupil reacts poorly to light. The most likely diagnosis in this patient is:
Acute angle glaucoma
The most common cause of bloody expectorant in primary care are due to the following:
Acute bronchitis and Pneumonia
A Pt reports a feeling of fullness & pain in both ears & the practitioner elicits pain when manipulating the external ear structures. What is likely diagnosis?
Acute otitis externa.
A 20 year old make of hispanic descent who reports a history of cold that resolved 2 weeks ago except for a dry cough and pain over right cheek that worsens when he bends down. The patient denies fever. The Pt tells you he is very allergic to keflex, and erythromycin. VSS except temp is 99.2 F.
Acute sinusitis.
A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend?
Administering two more doses of albuterol
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient?
Admit to the hospital for evaluation and treatment
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Prescribe a calcium channel blocker Increase the dose of the thiazide medication Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment
Admit to the hospital for evaluation and treatment
A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient?
Admit to the hospital with specialist consultation
A 70 yr old male Pt c/o a bright red spot that has been present on his Lt eye for 2 days. He denies eye pain, or visual changes or HA's. He has new onset of cough from recent UPR & he takes 1 ASA a day.
Advise the Pt that the condition is benign and will resolve spontaneously. This question was on both practice quizzes.
A 70 year old male patient complains of a bright red colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a recent URI. The only medicine he is taking is aspirin 1 tablet daily. Which of the following actions is appropriate follow up for this patient?
Advise the patient that the condition is benign and will resolve spontaneously
When initially treating adults with acute bronchitis, which of the following should the nurse practitioner be least likely to order:
Antibiotics
When initially treating adults with acute bronchitis, which of the following should the nurse practitioner be least likely to order:
Antibiotics/ Acute bronchitis is normally of viral etiology, so antibiotics are not effective
What are factors associated with acute suppurative parotitis? (Select all that apply.)
Anticholinergic medications Diabetes mellitus
During an acute visit for dyspnea, you note a significant medium pitched harsh mid-systolic murmur that is best heard at the right second intercostal space of the chest. It radiates into the neck. Which of the following is the correct diagnosis?
Aortic stenosis
A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which possible signs should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)? Assessment of gasping breaths or not breathing Obtaining a history of previous myocardial infarction Evaluation of peripheral perfusion and level of consciousness Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing Determination of pulselessness or bradycardia
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?
Atrial fibrillation
While doing the cardiac exam on a 45-year-old, you notice any irregular rhythm with a pulse rate of 110 bpm. The patient is alert and not in distress. What is the likely diagnosis?
Atrial fibrillation
A Pt reports severe episodes of vertigo with some lasting up to an hour, the episodes are associated with nausea & vomiting. What is part of the initial diagnostic workup?
Audiogram & MRI.
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?
Audiogram and MRI
A Pt develops acute bronchitis and is dx with having influenza. What medication will help reduce the duration of symptoms in this pt?
Azithromycin
An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient?
Azithromycin daily x 5 days
A patient has shortness of breath. if heart failure is the etiology, which test demonstrates the highest sensitivity in diagnosing this?
BNP
Which are factors can cause a heart murmur? (Select all that apply.) Backward flow into a normal vessel Low rates of flow into a cardiac chamber Backward flow through a septal defect High rates of flow through a normal valve Forward flow into a dilated vessel
Backward flow through a septal defect High rates of flow through a normal valve Forward flow into a dilated vessel
A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms? Candida albicans Bacterial infection Herpes simplex virus Human papilloma virus
Bacterial infection
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?
Beta blocker medication
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?
Beta blocker medications
Some of the hallmark characteristics of hyperosmolar hyperglycemic state are:
Blood glucose over 1000 mg/dL, Negative ketones, Slow onset (over days).
What disease is usually managed with short acting oral long-acting inhaled anticholinergic medications?
COPD
A pt has undergone surgical immobilization for a femur fx and reports dyspnea and chest pain associated with inspiration. The Pt's HT is 120 bpm. What Dx test will confirm a PE?
CT angiography
A 90-year-old is presenting to clinic with isolated systolic hypertension. Which of the following antihypertensive medications are preferred for the treatment of this condition"
Calcium channel blockers and thiazide diuretics [And calcium channel blockers and thiazide diuretics are preferred. There is generally no preference 1 over another unless there is other significant comorbidities. Beta blockers are no longer recommended as first line for hypertension treatment. Alpha blockers is a possible treatment but is not first-line. Loop diuretics are not recommended specifically for hypertension treatment.]
A 56 year old mechanic is brought to your office complaining of heavy pressure in the substernal area of the chest that is radiating to his jaw. The pain began while he was lifting up a tire. He now appears pale and is diaphoretic. His blood pressure is 100/60 mmHg, and his pulse is 50 bpm. His Pulse oxygenation is 99%. What is the most appropriate action? Administer 6 L/min oxygen via nasal cannula Call 911 Observe the patient in the office Preform 12 lead EKG
Call 911 [Heavy chest pressure in the substernal area radiating to the jaw, diaphoresis, low blood pressure, bradycardia or signs of cardiac distress. More specifically, acute coronary syndrome or MI. This patient is exhibiting classic symptoms and needs immediate treatment. Call 911 immediately and transfer patient to the ED. the results of the 12-lead EKG are unlikely to change her management at this point and the more urgent action is to call 911. Patient's oxygenation is good, he does not require oxygen.]
Group A strep pharyngitis:
Can be accompanied by abdominal pain
A 76-year-old obese patient has fatigue, thirst, and frequent urination. She was asked to measure a.m. fasting glucose value for one week. The values range from 142-1 75 mg/dL. She is now back to your clinic due to persistent symptoms, this patient:
Can be diagnosed with type 2 diabetes
A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered?
Cipro HC
A child has recurrent impaction of cerumen in both ears and the parent asks what can be done to help prevent this. What will the provider recommend?
Clean the outer ear and canal with a soft cloth
Which physical examination finding suggests viral rather than bacterial parotitis?
Clear discharge from Stensen's duct
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism?
0.2 uIU/L
A 22 year old tall, thin and athletic man comes into your primary care clinic complaining of pain with breathing and progressively worsening shortness of breath. In order of sequence, what will be your next steps?
2 correct answers: 1.Obtain more history, auscultate the lungs and send pt to the ER for a stat CXR and further evaluation. 2.Obtain more history, and immediately send him to the ER
A Pt has nasal congestion, fever, purulent nasal d/c, HA, fever & pain and begins treatment with Amox-Clav. At f/u 10-days later, Pt still has purulent d/c, congestion & pain but no fever. What is next course of action?
2nd course of Amox-Clav.
Which are causes of pleural effusions? (Select all that apply.)
3 answers: Breast cancer, bronchiectasis, CHF
The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level?
4 weeks Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic.
he patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level?
6 weeks [Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic.]
Which patient might be expected to have the worst FEV1?
65 y/o with emphysema
Acute otitis media can be best diagnosed by identifying which otic characteristic(s)?
Cloudy, bulging TM with impaired mobility
A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially?
Complete Blood Count
A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings?
Congestive heart failure
A patient has two palpable, tender, left preauricular nodes that are about 0.5cm in diameter. What condition might this be associated with?
Conjunctivitis
Mr. Smith, an overweight 48-year-old male with undiagnosed type 2 diabetes mellitus presents to your clinic. Which symptom is least likely associated with type 2 diabetes mellitus?
Constipation
A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do?
Consult with the cardiologist to determine appropriate diagnostic tests
A patient who has diabetes has a blood pressure of 140/90 mm Hg and significant >2mg/dL albuminuria. Which initial action by the primary care provider is indicated for management of this patient?
Consulting with a nephrologist
A NP preforms a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be?
Cotton wool spots
The patient has cough, pharyngitis, nasal discharge, and fever. He has been diagnosed with acute bronchitis. Which symptom is least likely in the first 3 days of this illness? pharyngitis Cough Nasal discharge Fever
Cough Cough is the most common symptom associated with acute bronchitis, but almost always appears after 3 days of illness. in the first few days of acute bronchitis, URI type symptoms are the most common. Acute bronchitis is suggested when cough is lasting longer than 5 days. fever is a relatively uncommon symptom of acute bronchitis. When fever appears along with cough, pneumonia should be considered
The pt has a cough, pharyngitis, nasal d/c & fever, He has been dx w/ acute bronchitis. Which symptom is LEAST likely in first 3 days?
Cough. Cough appears 3 days after. URI common in first 3 days. Acute Bronchitis: cough > 5 days. Fever is uncommon. If fever and cough consider pneumonia.
Which of the following infections can cause a "barky" cough?
Croup
Which patient might be expected to have the worst FEV1?
A 65 her old with emphysema
During a routine physical exam a provider notes a shiny irregular painless lesion on top of one ear auricle & suspects skin cancer. What will the the provider tell the patient about this lesion?
A biopsy should be performed.
Dyspnea, tachypnea and pleuritic CP are classic presentation of a pulmonary emboli. If your pt is complaining of calf or thigh leg pain, you should suspect
DVT
A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of:
Dacryocystitis
A Pt is concerned about frequent nasal stuffiness and congestions that begins shortly after getting out of bed in the morning. Pt denies itching, sneezing. A physical exam reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend?
Daily intranasal steroid.
Excessive thirst and volume of dilute urine may be a symptom of:
Diabetes insipidus
Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media?
Difficulty sleeping, tugging on ears, appetite
An elderly female without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms? Digital subtraction angiography Segmental limb pressure measurement Segmental limb pressure measurement Magnetic resonance angiography
Doppler ankle, arm index
A 65-year-old patient presents to your clinic with evidence of hyperthyroidism. In assessing her cardiovascular status, which should NP assess immediately?
EKG
A 65-year-old patient presents to your clinic with evidence of hyperthyroidism. In assessing her cardiovascular status, which should NP assess immediately?
Electrocardiogram
Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.)
Elevated waist circumference Fasting plasma glucose ≧100 mg/dL HDL cholesterol </= 40 mg/dL
A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient?
Empiric treatment with a macrolide antibiotic
A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain?
Esophageal pain
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What will the provider do next?
Evaluate the patient's orthostatic vital signs
What does peak flow meter measure?
Expiratory flow
Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.)
Fasting plasma glucose ≧100 mg/dL, Elevated waist circumference, Triglycerides ≧150 mg/dL, HDL cholesterol </= 40 mg/dL
Which are factors can cause a heart murmur? (Select all that apply.)
Forward flow into a dilated vessel. Backward flow through a septal defect. High rates of flow through a normal valve
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action? Start statin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication Prescribe a calcium channel blocker mediation Administer a second nitroglycerin tablet
Give the patient a beta blocker medication
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known?
Giving a rapid-acting carbohydrate
A 52-year-old presents with thirst and frequent urination today. His glucose is 352. How should this be managed today?
Have him return tomorrow to recheck his blood glucose
Which are risk factors for developing otitis externa? (Select all that apply.)
Having underlying diabetes mellitus Use of ear plugs and hearing aids Vigorous external canal hygiene
A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinapril, aspirin, metoprolol, and statin daily. What symptom is not indicative of heart failure?
Headache [Headache is a nonspecific symptom and is not typical for heart failure. All the other symptoms are classic for worsening heart failure.]
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
Hemoglobin A1C
A 38-year-old male patient presents for his annual exam. He reports nervousness and weight loss, but denies any changes in his dietary intake or exercise level. Based on these findings and the following lab values, more what is the most likely diagnosis? TSH 0.01 (normal 0.4-3.8) Free T4 6 (normal 0.8-2.8) Free T3 205 (normal 70-205)
Hyperthyroidism
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur?
Hypertrophic cardiomyopathy
Which clinical sign is especially worrisome in a patient with a pulmonary embolism? Hypotension Dyspnea Tachycardia Abnormal lung sounds
Hypotension
A 45-year-old female patient has fatigue for the past 3 months and a 10 pound weight gain. She previously had regular menses occurring about every 30 days, but in the last 3 months her menses have varied. She has high TSH. It was repeated one week later and found to be even higher. Would explain this finding?
Hypothyroidism The patient's TSH is high on 2 occasions, along with symptoms, this was certainly lead to a diagnosis of hypothyroidism.]
Child is hit w/ baseball bat during game & sustains injury to nose along w/ transient loss of consciousness. A healthcare provider at the game notes bleeding from nose & displacement of septum. What is the most important intervention at this time?
Immobilize the child's head and call 911.
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?
Inappropriate secretion of PTH along with hypercalcemia
A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient's symptoms?
Infection
A 40-year-old African-American patient has blood pressure readings of 175/110 and repeat reading of 170/102. He has no significant cardiovascular symptoms. What is a reasonable plan of care for this patient today?
Initiate amlodipine 5 mg daily
A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
Initiate fibrinolytic treatment
Which choice best describes the most common presentation of a patient with type 2 diabetes?
Insidious onset of hyperglycemia with weight gain
Mr. Jones, brings his obese 15 year old son in to see you. You examine the 15-year-old and identify acanthosis nigricans. This probably indicates:
Insulin resistance
A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient?
Intranasal steroids
The major laboratory abnormality noted in patients who have pneumococcal pneumonia is:
Leukocytosis
A 43-year-old Hispanic male presents to clinic for uncomplicated lower leg cellulitis. During her exam, you notice an audible diastolic murmur best heard in the mitral listening point. he does not have any significant cardiovascular symptoms. The murmur is probably: Mitral valve prolapse Chronic mitral regurgitation Acute mitral regurgitation Mitral stenosis
Mitral stenosis Mitral valve prolapse is unlikely as it is a systolic murmur. Acute mitral regurgitation usually develops after rupture of papillary muscles in the heart, patient would be presenting with significant symptoms. Mitral regurgitation is also a systolic murmur.
You're treating your patient for heart failure exacerbation. Which medications could potentially exacerbate heart failure?
Naproxen
A patient who has diabetes has a blood pressure of 140/90 mm Hg and significant >2mg/dL albuminuria. Which initial action by the primary care provider is indicated for management of this patient?
Nephrology consult
The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient?
Obtain an immediate consultation with an otolaryngologist
You see a college student in college health clinic. She complains of abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs show temperature of 99.8°F, otherwise normal physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The NP suspect viral URI. Although the following treatments are appropriate except:
Oral prednisone
An elderly woman has been taking digoxin for 10 years. Her EKG is showing a new onset of atrial fibrillation. Her pulse is 64 bpm. She denies any significant cardiovascular symptoms. Which of the following interventions is most appropriate?
Order a serum TSH, digoxin level, electrolyte panel
A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination reveals slight redness in the ear canal with a clear odorless fluid. This is suggestive of:
Otitis Externa.
A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination reveals slight redness in the ear canal with a clear odorless fluid. This is suggestive of:
Otitis externa
A Pt has recurrent epistaxis without signs of localized irritation. Which lab tests may be performed at this time to evaluate his condition?
PT, PTT, PT/INR, CBC Platelets.
During an eye exam of 50-year-old with HTN, Pt c/o severe HA. The borders of the disc margins on both eyes are blurred. What is the name of this clinical finding?
Papilledema
During an eye exam of a 50 year old hypertensive patient who is complaining of an onset of a sever headache, you find that the borders of the disc margins on both eyes are blurred. What is the name of this clinical finding?
Papilledema
A 40-year-old cashier complains of periods of dizziness and palpitations that have a sudden onset. The EKG shows P waves before each QRS complex and a heart rate of 170 bpm. A carotid massage decreases the heart rate to 80 bpm. These findings best described: Atrial fibrillation Ventricular tachycardia Paroxysmal atrial tachycardia Ventricular fibrillation
Paroxysmal atrial tachycardia Signs and symptoms of paroxysmal atrial tachycardia include rapid, irregular heart rate that begins and ends very quickly. There is a normal conduction with a P-wave before every QRS. A carotid massage his useful to reduce heart rate in regularly conducted rhythms. With ventricular fibrillation patient would not be conscious.
In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers:
Patient's body weight
In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers: Patient's body weight The TSH level The T4 value Patient's gender
Patient's body weight Replacement as based on body weight and is usually calculated in kilograms. Body weight is multiplied by 1.6 to determine replacement needed in one day. This is the amount that should be prescribed in otherwise healthy, less than 50 years old, no evidence of underlying cardiac disease patients
A 65 year old has not had the influenza vaccine is exposed to the flu and comes to the clinic the following day with fever and watery red eyes. What will the provider do?
Perform a nasal swab for RT-PCR assay
A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially?
Perform a nasal swab for RT-PCR assay
A 35-year-old man has a history of an upper respiratory viral infection 4 weeks ago. He reports that he started feeling dyspnea and now complains of sharp pain in the middle of the chest that is worse when he lies down. Physical exam is within normal limits with the exception of pericardial rub on auscultation. The most likely diagnosis would be:
Pericarditis
A patient with cough and fever is found to have infiltrates on chest x-ray. Would this is likely diagnosis
Pneumonia
A patient with cough and fever is found to have infiltrates on chest x-ray. Would this is likely diagnosis?
Pneumonia Infiltrates on x-ray in conjunction with clinical findings of fever and cough should direct the NP to consider pneumonia as diagnosis.
A 32-yr-old is newly dx DM, She has developed a sinus infection. She has had symptoms for 10 days. 6-weeks ago she got amoxicillin for URI. It was cleared up without incident. What's next?
Prescribe Amoxicillin-Clavulanate today.
Previous quiz question about 32 diabetic patient w/ sinus infection.
Prescribe Amoxicillin-Clavulanate today. Rationale: Amoxicillin is not indicated when a beta-lactamase producing organism and suspected, this is the case as patient took antibiotics 6 weeks ago. Amoxicillin-clavulanate is a good choice as it covers a beta-lactamase producers. And bacteria etiology is suspected as symptoms have persisted for 10 days. A decongestant can be added, however this does not substitute antibiotics in this case
Swimmer's ear question on practice test
Prescribe Cipro HC
A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider?
Prescribe amoxicillin and refer to a dentist in 2 to 3 days
A 58 year old farmer presents with a wedge shaped, pinkish, clear growth on the nasal side of his eye. He states that it has been present for a while, but only recently began to feel as if a foreign body was in his eye. This is probably a Pinguecula Stye Xanthelasma Pterygium
Pterygium
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
Pterygium
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
Pterygium.
A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next?
Recommend an NSAID
A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment?
Refer patient to an otolaryngologist for evaluation
A pediatric Pt has otalgia, fever 38.8C & recent h/o of URI. The examiner is unable to visualize the tympanic membrane in the Rt ear b/c of cerumen in the ear canal. The Lt ear tympanic is dull gray w/ fluid present. What is correct course of action?
Remove cerumen & visualize tympanic membrane.
A 50-year-old female presents for her annual exam. She complains of fatigue and weight gain. She has a following lab results. What should the NP order? TSH 7 (normal 0.4-3.8)
Repeat TSH plus free T4
A 50-year-old female presents for her annual exam. She complains of fatigue and weight gain. She has a following lab results. TSH 7 (normal 0.4-3.8) What should the NP order?
Repeat TSH plus free T4 [Patient presents with elevated TSH as well as possible symptoms of hypothyroidism. A repeat of TSH and free T4 should be done to determine presence and degree of hypothyroidism. Replacement therapy is generally not initiated until the TSH is greater than 10 and direct measurement of serum T4 is obtained. there is no nodule or other indications in this scenario for an ultrasound.]
While checking for the red reflex on a 3 year old boy during a well child visit, the NP notes a white reflection on the child's left pupil. Which of the following conditions should be ruled out?
Retinoblastoma of the left eye
What is the most common cause of pneumonia and people of all ages?
S. pneumoniae
Mr. Jones is a type I diabetic that presents to your clinic with nausea/vomiting and weakness. You do random blood sugar test in clinic and his blood sugar is 550. You are not able to obtain a urine sample at this time. What is your next action?
Send to ED. [This patient is a type I diabetic with symptoms and blood glucose that should lead NP to consider DKA. DKA is treated in the inpatient setting as it requires insulin, IV rehydration, and careful monitoring of electrolytes.]
A 75-year-old patient has aortic stenosis is presenting with symptoms of worsening stenosis. You know that to most common symptoms of worsening stenosis include:
Shortness of breath and syncope
The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient:
Should have a hemoglobin A1c performed. [Weight gain is one of the potential symptoms of diabetes, however it is a nonspecific symptom, the patient did not have any of the other classic diabetes symptoms. His nonfasting glucose log has a wide range. Confirmation of prediabetes versus normal finding versus diabetes should be done with repeat testing, preferably with hemoglobin A1c.].
Some of the hallmark characteristics of hyperosmolar hyperglycemic state are:
Slow onset (over days) Blood glucose over 1000 mg/dL Negative ketones
A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient?
Spirometry
An adult develops chronic cough with episodes of wheezing and SOB. The provider performs chest xray & other tests the r/o infection, upper respiratory & GI causes. Which test will provider order initially to evaluate the possibility of asthma as the cause of these symptoms?
Spirometry
An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms?
Spirometry
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
Spontaneous horizontal nystagmus
A 52-year-old presents with thirst and frequent urination today. His glucose is 352. How should this be managed today?
Start insulin
Mr. Smith is a 72-year-old patient takes warfarin for chronic atrial fibrillation. His INR today is 4. The nurse practitioner should:
Stop the warfarin today and repeat INR tomorrow. [INR range for atrial fibrillation is usually 2-3 for chronic atrial fibrillation. Stopping warfarin for 4 days with certainly decrease INR, but his overkill, and would put patient at risk for thromboembolism when INR is subtherapeutic. Vitamin K is not necessary for patients who are not bleeding due to high INR, or whose INR is less than 8.]
A 70 year old male patient complains of a bright red colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a recent URI. The only medicine he is taking is aspirin 1 tablet daily. Which of the following is most likely?
Subconjunctival hemorrhage
A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful?
Surgical drainage
A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient?
Surgical excision
Pt has painful oral lesions and the provider notes several white verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this?
Surgical incision.
Classic symptoms of deep vein thrombosis include: Warmth, edema, relief of pain with walking Calf complaint, pain with walking, history of exercise Swelling, pain, redness Swelling, pain, discoloration in lower extremity
Swelling, pain, discoloration in lower extremity Swelling, pain, redness could describe infection like cellulitis and is not classic for DVT. Redness is an inconsistent sign of DVT as is a positive Homan's sign. pain secondary to DVT is not relieved by walking.
Choose all that apply - The following requires immediate intervention and hospitalization:
Tension pneumothorax, secondary spontaneous pneumothorax*
The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent?
The rest of the family and all close contacts should have the influenza vaccine
The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent?
The rest of the family and all close contacts should have the influenza vaccine.
The parent of a 4-mos-old infant who has an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent?
The rest of the family and all close contacts should have the influenza vaccine.
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She should be referred to an endocrinologist. A thyroidectomy will be necessary. She will need lifelong medication. This condition may be transient.
This condition may be transient.
The NP preforms a fundoscopic exam on a patient who has recently been diagnosed with hypertension. What is the significant of AV nicking?
This is indicative of longstanding hypertension
The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. based on the most likely diagnosis, what should the NP tell the caregivers about this condition?
This usually begins as a viral infection
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Thyroid ultrasound
Acanthosis nigricans is associated with all of the following disorders except: Obesity Tinea versicolor Colon cancer Diabetes
Tinea versicolor [Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It is rarely associated with some types of adenocarcinoma of the GI tract. Tinea versicolor is a superficial infection of the skin that is caused by fungi]
A 17-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely/most common?
Tragal pain
Pleurisy is not a diagnosis but rather a symptom of many localized and systemic disease that needs further evaluation in order to find the cause of the problem.
True
Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media?
Tugging on ears, difficulty sleeping, and appetite.
A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding?
Tympanogram
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? Immediate referral to a thoracic surgeon Ordering computerized tomography angiography Scheduling an MRI to evaluate for aortic disease Ultrasound of the mass to determine size
Ultrasound of the mass to determine size
Current American Heart Association (AHA) recommendations include: (Select all that apply.) Rescue breaths given during 2 seconds to allow full chest rise A compression depth of 1½ inches or more on an adult Using a ratio of 2 rescue breaths to 30 compressions A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths
Using a ratio of 2 rescue breaths to 30 compressions A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths
Current American Heart Association (AHA) recommendations include: (Select all that apply.)
Using a ratio of 2 rescue breaths to 30 compressions Untrained rescuers giving compressions without breaths A rate of 100 compressions per minute at a minimum
The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrythmia?
Ventricular fibrillation
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms?
Viral pharyngitis
Untreated hyperglycemia may lead to all of the following complications except
Vitiligo
Untreated hyperglycemia may lead to all of the following complications except:
Vitiligo
Untreated hyperglycemia may lead to all of the following complications except:
Vitiligo [Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.]
What is the most common complication of influenza?
bacterial pneumonia
An older Pt. w/ COPD is experiencing dyspnea & has O2 at 89% on r/a. The pt has no h/o of pulmonary HTN or CHF. What will the provider order to help manage this pt's dyspnea?
breathing exercises.
Mycoplasma pneumoniae is a disease with
extrapulmonary manifestations; It is difficult to diagnose as Sx can be GI, Myalgia, arthralgia, rash
Hemoptysis can be confuse with other bleeding disorder. To narrow down your differential diagnosis, it is important to evaluate and obtain these pertinent data regarding your patient's history of: (Choose all that apply)
occupational and environmental exposures
A 70 year old male has a yellowish, triangular nodule near the iris this is probably a
pinguecula.
You have an elderly patient with a history of a myocardial infarction with residual paresthesia, and dysphagia. Your patient was brought in by his caretaker in the nursing home. The patient presents with one week of fever, productive cough and malaise. Besides his presentation, you suspect pneumonia due to his risk factors. (Choose all that apply)
possible compromise airway filtration and humidification from his h/o CVA lack of proper housing Diminished gag reflex that can prevent entry of particles, mucus and food debris into the lungs
Classic symptoms of deep vein thrombosis include:
swelling, pain, and discoloration in lower extremity Swelling, pain, and discoloration from impaired blood flow are the classic symptoms. Choice A could describe infection, like cellulitis, and is not classic for DVT. A history of exercise actually decreases the risk of DVT. Pain secondary to DVT is not relieved by walking. The lower extremities are the most likely location of DVT, but symptoms don't always correlate with location of the thrombosis. Patients must be asked about history, family history of DVT, and precipitating conditions.
