primary care 6531
Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?
Antihistamines
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
Apply a topical antibiotic and warm compresses.
Which history is commonly found in a patient with glomerulonephritis?
Ask about recent infections (skin or upper respiratory); recent travel (possible exposure to viruses, bacteria, fungi, or parasites); recent illnesses, surgery, or invasive procedures (possible infection); any systemic diseases (Systemic Lupus Erythematosus -SLE)
Nongonococcal urethritis can be caused by all of the following EXCEPT A) Trichomonas vaginalis. B) Neisseria gonorrhoeae. C) streptococci. D) Mycoplasma homini. E) Candida albicans.
B) Neisseria gonorrhoeae.
Which of the following does not cause nongonococcal urethritis?
B) Neisseria gonorrhoeae.
What is the most common cause of Cushing's syndrome? A. Excessive ACTH production B. Administration of a glucocorticoid or ACTH C. Pituitary adenoma or a nonpituitary ACTH-producing tumor D. Autonomous cortisol production from adrenal tissue
B. Administration of a glucocorticoid or ACTH
A 72 year old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior? A. Dementia B. Delirium C. Parkinson's disease D. Depression
B. Delirium
Reed-Sternberg B lymphocytes are associated with which of the following disorders: A. Aplastic anemia B. Hodgkin's lymphoma C. Non Hodgkin's lymphoma D. Myelodysplastic syndromes
B. Hodgkin's Lymphoma
72 year old female patient reports a 6 month history of progressively more swollen and painful distal interphalangeal (DIP) joints of one hand. There are no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Infection D. Lupus
B. Osteoarthritis
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?
Inferior wall
Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
Inhaled beta-2 agonist bronchodilators
least likely cause of a cough?
acute pharyngitis. common causes: asthma, GERD,allergic rhinitis
intervention for stroke
smoke cessation and tx HTN
The most effective intervention(s) to prevent stroke is (are):
smoking cessation and treatment of hypertension
Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?
stage 2 hypertension (lifestyle change, and medication
non infectious bursistis tx?
rest,NSAID's,intra-articular injecitons
Which of the following statements about malignant melanomas is true?
The prognosis is directly related to the thickness of the lesion
What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement from Medicare?
The physician must be on-site and engaged in patient care
Diagnostic radiological studies are indicated for low back pain:
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection.
Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
-beta 2 agonist -best treatmenat beta 2 agonist + corticosteroids.
The most effective treatment of non-infectious bursitis includes:
Conservative treatment includes rest, cold and heat treatments, elevation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs), bursal aspiration, and intrabursal steroid injections
A 63-year-old man presents to your office with hematuria, hesitancy, and dribbling. Digital rectal examination (DRE) reveals a smooth, moderately enlarged prostate. The client's prostate-specific antigen (PSA) is 1.2. What is the most appropriate management strategy at this time? 1. Prescribing an alpha-adrenergic blocker. 2. Recommending saw palmetto extract. 3. Prescribing an antibiotic .4. Referring the client to urology.
1. Prescribing an alpha-adrenergic blocker.
Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?
A decongestant nasal spray
After thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently considered most effective?
A low fat, tyramine-free, caffeine-free, high fiber diet, along with a daily diary, and attention to psychosocial factors
Harvey has had Meniere's disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?
A vestibular neurectomy
Which of the following medications may predispose the patient to hypoglycemia? A. Beta-adrenergic blockers B. Thiazide diuretics C. Phenytoin (Dilantoin) D. Glucocorticosteroids
A. Beta-adrenergic blockers
Which of the following is the most common causative organism of nongonococcal urethritis? a chlamydia b. mycoplasma c. neisseria d. ureaplasma
A. Chlamydia
Which of the following is the most common causative organism of nongonococcal urethritis? A. Chlamydia trachomatis B. Ureaplasma urealyticum C. Mycoplasma hominis D. Trichonomas vaginalis
A. Chlamydia trachomatis
Which of the following is the most common cause of low back pain? A. Lumbar disc disease B. Spinal stenosis C. Traumatic fracture D. Osteoporosis
A. Lumbar disc disease
Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia? A. Musculosckeletal pain B. Difficulty sleeping C. Depression D. Fatigue
A. Musculosckeletal pain
Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today's visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet's blood pressure?
Add a thiazide diuretic to the Lisinopril 5mg daily
A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? .A Obtain a thorough history and physical, and check serum cortisol and ACTH levels. B. Perform a diet history and check CBC and FBS. C. Provide nutritional guidance and have the patient return in one month. D. Consult home health for intravenous administration
A. Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? . A. Obtain a thorough history and physical, and check serum cortisol and ACTH levels. B. Perform a diet history and check CBC and FBS. C. Provide nutritional guidance and have the patient return in one month. D. Consult home health for intravenous administration
A. Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time? A. Prescribe an alpha adrenergic blocker. B. Recommend saw palmetto. C. Prescribe an antibiotic D. Refer the client to urology.
A. Prescribe an alpha adrenergic blocker.
The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: A. potentiate hypoglycemia. B. interfere with the action of insulin and oral hypoglycemics. C. mask symptoms of hypoglycemia. D. stimulate hepatic glucose secretion.
A. potentiate hypoglycemia
What diabetic complications result from hyperglycemia?
A.Retinopathy B.Hypertension resistant to treatment C. Peripheral neuropathy D. Accelerated atherogenesis
Which of the following is not a risk factor for coronary arterial insufficiency?
Alcohol ingestion
The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy:
An early morning spot urine collection. 24-hour urine test. Your doctor may ask you to collect all of your urine in a special container over 24 hours and submit it for analysis. Timed urine test. Your doctor may ask you to provide a urine sample first thing in the morning or after four hours of not urinating. Random urine test.
Which of the following is the most common complication of the myelodysplastic syndromes
Anemia. Reduced numbers of red blood cells can cause anemia, which can make you feel tired. Recurrent infections. Having too few white blood cells increases your risk of serious infections. Bleeding that won't stop. ... Increased risk of cancer.
A 72-year-old female patient reports a 6-month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Infection D. Lupus
B. Osteoarthritis
A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains: A. Primary hyperparathyroidism is treated with Vitamin D restriction B. Primary hyperparathyroidism is treated with parathyroidectomy C. Primary hyperparathyroidism is treated with daily magnesium D. Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)
B. Primary hyperparathyroidism is treated with parathyroidectomy
You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: he A. lateral meniscus B. cruciate ligament C. medial meniscus D. collateral ligament.
B. cruciate ligament
A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that "there is something in my eye." What is the diagnosis and how should it be treated?
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
A patient who is complaining of a new onset of severe headache is being examined. The patient is instructed to lie down on the examining table while the nurse practitioner flexes his head and neck forward to his chest. The patient reacts by quickly flexing his hip and knee. What is the name of this positive finding?
Brudzinski's sign
An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus, has fasting glucose values 180 to 250 mg/Dl. What is the most appropriate initial treatment to consider? A. A low-calorie diet and exercise B. Sliding-scale NPH insulin every 12 hours C. A sulfonylurea and/or metformin (Glucophage® -XR) D. Sliding-scale regular insulin every 6 hours
C. A sulfonylurea and/or metformin (Glucophage® -XR)
An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects? A. Weight gain B. Fracture risk C. Hypoglycemia D. Weight loss
C. Hypoglycemia
Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)? A. Nocturia B. Urgency incontinence C. Strong urinary stream flow D. Straining to void
C. Strong urinary stream flow
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
Candidiasis
Phalen's test, 90°wrist flexion for 60 seconds, reproduces symptoms of:
Carpal tunnel syndrome
Who is at a higher risk for developing nephrolithiasis?
Caucasian males
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?a. Insulin is not used to control blood glucose in patients with type 2 diabetes.b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?
Chronic bronchitis
A patient has a prolonged PT. Which deficiency can you infer from this result?
Coagulation factors of the extrinsic pathway
The most appropriate treatment for a child with mild croup is:
Croup with corticosteroids is beneficial, even with mild illness. A single dose of an oral corticosteroid is effective in patients with mild croup. Nebulized epinephrine improves outcomes in patients with moderate to severe croup.
Central obesity, "moon" face, and dorsocervical fat pad are associated with:
Cushing's Syndrome
Which of the following is NOT true about Carpal Tunnel Syndrome? A. Symptoms present in the first 3 fingers of the affected hand. B. Symptoms are absent in the 5th finger. C. Median nerve compression can result in decreased strength and impaired fine motor coordination. D. Phalen's and Tinel's signs are negative.
D. Positive Tinel's sign over median nerve. Positive phalen's test Weakness with manual muscle test of abductor pollicis brevis is Carpel Tunnel syndrome.
Diagnostic evaluation for urinary calculi includes: A.Urinalysis and culture B. Non contrast CT C. Serum calcium D. All of the above
D. All of the above
Which of the following is a potential acquired cause of thrombophilia? A. Homocysteinuria B. Protein C deficiency C. Factor V Leiden D. Antiphospholipid antibodies
D. Antiphospholipid antibodies
The most common cause of elevated liver function tests is? a. Hepatitis. b. A drug-induced injury. c. Biliary tract obstruction. d. Chronic alcohol abuse.
D. Chronic alcohol abuse.
The organism most often associated with prostatitis is: A. Klebsiella B. Neiserria gonorrhoaes C. Chlamydia trachomatis D. Escherichia coli
D. Escherichia coli
A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: A. Arthritis B. Ulnar neuritis C. Septic arthritis D. Olecranon bursitis
D. Olecranon bursitis
The primary goals of treatment for patients with alcohol abuse disorder are:
Detoxification, abstinence, and prevention of relapse
Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: 1. Epilepsy. 2. Multiple sclerosis. 3. Diabetes mellitus. 4. Parkinson disease.
Diabetes mellitus
Which of the following is a predisposing condition for furunculosis?
Diabetes mellitus
Common cause of elevated liver function test
ETOH
A patient complains of "an aggravating cough for the past 6 weeks." There is no physiological cause for the cough. Which medication is most likely causing the cough?
Enalapril ; The enalapril-induced cough is insidious, dry, persistent, benign, and reversible on discontinuation of therapy. I
Which of the following best describes hypertrophic cardiomyopathy
Enlarged left ventricle and septum
A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?
Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva)
Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?
PTSD
A 30 year old female patient presents to the clinic with heat intolerance, tremors, nervousness, and weight loss inconsistent with increased appetite. Which test would be most likely to confirm the suspected diagnosis?
Graves hyperthyroid
The most accurate measure of diabetes control is:
HbA1c has evolved to become the gold standard outcome to measure the efficacy of glucose-lowering medications.
The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:
acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs)
Which of the following set of symptoms should raise suspicion of a brain tumor?
Holocranial headaches present in the morning and accompanied by projectile vomiting without nausea Brain tumor size (mass) increases intracranial pressure which manifests as a holocranial headache on morning awakening, often accompanied by projectile vomiting. Personality changes and focal neurological deficits are other frequently associated clinical findings.
A 20 year old male patient complains of "scrotal swelling." He states his scrotum feels heavy, but denies pain. On examination, the nurse practitioner notes transillumination of the scrotum. What is the most likely diagnosis?
Hydrocele
Establishment of a definitive diagnosis of osteomyelitis requires:
If osteomyelitis is suspected, a bone biopsy with bacterial culture should be considered for definitive diagnosis.
patient presents with a deep aching, red eye and there is no discharge, you should suspect:
Iritis
A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:
It can be cured with surgical excision or radiation therapy."
Which of the following heart murmurs warrants the greatest concern?
Murmurs that occur during diastole are NEVER INNOCENT and should always raise concern and indicate further investigation
Your 31-year-old patient, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?
Once all the vesicles are crusted over
The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
Differential diagnosis of proteinuria includes which of the following?
Orthostatic proteinuria, proteinuria in the presence of fever, and effort proteinuria are benign forms. In cases of persistent proteinuria, prerenal or overflow proteinuria are distinguished from renal and post-renal proteinuria. Renal forms can be differentiated into glomerular and tubular as well as mixed forms.
A patient complains of generalized joint pain and stiffness associated with activity and relieved with rest. This patient history is consistent with which of the following disorders?
Osteoarthritis
Which of the following patient characteristics are associated with chronic bronchitis
Overweight, cyanosis, and normal or slightly increased respiratory rate
The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are):
Patient report of pain with the crossed straight leg raise
In order to decrease deaths from lung cancer:
Patients should be counseled to quit smoking
A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial treatment option for this patient?
Prescribe an antifungal powder for application between her toes and in her shoes and a topical prescription strength antifungal cream for other affected areas. Monitor for a secondary bacterial infection.
Discontinue what meds if pt has dx of CHF?
Procardia- activates sympathtic NS and renin-angiotensin. Can cause deterioration.
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:
Quit smoking
Which of the following are classic features of ulcerative colitis?
Remissions and exacerbations of bloody diarrhea, tenesmus, fecal incontinence, abdominal pain and weight loss.
The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is:
Rest the affected part of the body - Once pain free, the person can gradually begin the sporting activity again - Air splinting can reduce pain and decrease the time until return to full participation or intensity of exercise. - NSAIDs to reduce pain and inflammation
Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is "like looking through a veil." He also sees floaters and flashing lights but is not having any pain. What do you suspect?
Retinal detachment
Risk factors for Addison's disease include which of the following?
Risk factors for the autoimmune type of Addison disease include other autoimmune diseases: Swelling (inflammation) of the thyroid gland that often results in reduced thyroid function (chronic thyroiditis) Thyroid gland produces too much thyroid hormone (overactive thyroid, Graves disease)
A 40-year-old White woman with a body mass index (BMI) of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During the physical exam, the nurse practitioner presses deeply on the left lower quadrant of the abdomen and the patient complains of pain on the right side of the lower abdomen. What is the name of this finding?
Rovsing's sign
A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient's TSH?
Six to 8 weeks
Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient's aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?
Serologic markers for hepatitis
type of lung cancer has the poorest prognosis?
Small cell carcinoma
A patient presents to the office with a blood pressure 142/80. This patient is classified as having:
Stage 1 hypertension
Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester? Trimethoprim-sulfamethoxazoleErythromycinCefuroximeLevofloxacin
Sulfonamides are generally avoided during the first trimester of pregnancy and near the time of delivery.
presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:
Systolic heart failure
Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:
The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater.
basketball player complains of itching in the crural folds, buttocks, and upper thighs. The lesions are well demarcated and are half-moon shaped. The area is red, irritated, and there are small breaks in the skin from scratching. What is this patient's diagnosis and how should it be treated?
Tinea cruris; treat with a topical antifungal cream
A thymectomy is usually recommended in the early treatment of which disease?
Thymectomy is an important treatment option for Myasthenia Gravis
Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:
Trauma or inflammation
A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?
Treatment may include counseling and medications, such as antidepressants. Selective Serotonin Reuptake Inhibitor (SSRI), Anxiolytic, and Antidepressant
Potential causes of hypocalcemia include which of the following?
Vitamin D inadequacy or vitamin D resistance. Hypoparathyroidism following surgery. Hypoparathyroidism owing to autoimmune disease or genetic causes. Renal disease or end-stage liver disease causing vitamin D inadequac
Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)?
a. Difficulty initiating a urine stream b. Nocturia c. Urinary retention d. Increased force of urine flow ( flow decreased with BPH)
Which of the following is a contraindication for metformin therapy?
a. Liver disease b. Renal dysfunction c. cardiovascular failure d. serum creatine greater than More than 1.5 mg/dl should not use metformin d. All of the above
acquired cause of thrombophilia?
antiphospholipids antibodies
common cancer on auricle?
basal cell carincoma
Tension h/a, S/SX,
bilateral, occipatal pain w/frontal fullness and waves that ache.
A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
bronchodilator PRN and an inhaled corticosteroid
Tx of asthma
bronchodilators PRN and inhaled corticosteriods.
The National Cholesterol Education Program's Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:
c. 100 mg/dL
Risk factors for acute arterial insufficiency include which of the following?
c. Atherosclerosis d. All of the above
Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to: a. refer her to a hand surgeon b. take a more complete hx c. try neutral position wrist splinting and order an oral NSAID d. order a nerve conduction study such as an electromyography (EMG)
c. try neutral position wrist splinting and order an oral NSAID
Phalen's test, 90°wrist flexion for 60 seconds, reproduces symptoms of
carpal tunnels
characteristic of type 2 diabetes mellitus?
characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss.
A 32-year-old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate intervention is:
collect a urine for culture/sensitivity, order a CBC and an antibiotic.Physician collaboration should be considered in patients with pyelonephritis. Ciprofloxacin is a drug choice for pyelonephritis, but a 14 day course is needed and the urine sensitivity must indicate ciprofloxacin. It is not usually necessary to order blood cultures unless sepsis is suspected. If the patient is not septic appearing and does not have a deterioration in her condition, choice D, with 24-48 hour follow up is prudent.
A 72 year old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior?
delirium
A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?
diabetes
Which of the following can result from chronic inflammation of a meibomian gland?
dry eye syndrome.:the oily part of the tears cannot be released. This causes the watery tears to dry up more quickly which results in the eye becoming dry and can make it feel sore
Pt has pain at medial condyle and lower humerus, and incareased pain with flexion and pronation. What is dx?
epicondylitis
Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)?
frequency, urgency, nocturia TX with alpha adrenergic Terazosin and doxazosin
hypertrophic cardiomyopathy
heart muscle becomes enlarged; left ventricle and septum, and blocks blood flow
brain tumor s/sx
holocranial h/a in am w nausea w/o vomiting.
An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient's pain is:
hydrochlorhiazide
Dx exam/test for Crohns Disease
interstitial obstruction by plain x-ray of abdomen.
The most common symptoms of transient ischemic attack (TIA) include:
lower limb weakness, slur speech, partial vision loss, gait change
Type of asthma; on Beta2 and exacerbation 2x/wk and last days.
moderate persistent asthma
postive drawer sign indicates
posterior crucitate ligament injury
What is the most common cause of Cushing's syndrome?
one is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. ( adrenal adenoma
Epididymititis tx
oral doxy and intramuscle ceftra.
Pt taking levothyroxine over-replaced. What at risk for?
osteoporosis
Serious cause of back pain?
worse with lying down