MIDTERM 609 Part III

20. When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as a: A. Gibbus B. Scoliosis C. Kyphosis D. Lordosis

A. Gibbus

What is a common outcome of fibrosis, calcification, and fusion of the spine in ankylosing spondylitis? a. Damage to the spinal nerves and loss of function b. Frequent fractures of long bones c. Impaired heart function d. Rigidity, postural changes, and osteoporosis

ANS: D

In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be diagnostic, the specimen should reveal how many white blood cells per high-power field? A. Five B. Ten C. Fifteen D. Twenty

B. Ten

What should the nurse include in the teaching plan for a patient who is taking alendronate (Fosamax)? a.Take drug with any meal b.Take drug first thing in the morning c.Drink at least 5 oz of milk before taking drug d.Takedrug with an antacid to avoid heartburn

ANS: B Alendronate (Fosamax) should be taken on an empty stomach first thing in the morning with 6 oz of water, accompanied by no other medication.

Which patient statement indicates the need for additional teaching for a patient with rheumatoid arthritis who is taking meloxicam (Mobic)? a.I am keeping a daily record of my blood pressure. b.I take aspirin before I go to bed. c.I know I can take meloxicam with or without regard to meals. d.I weigh every day so I will be aware of any weight gain.

ANS: B Aspirin or products containing aspirin should be avoided while taking meloxicam.

The nurse is assessing a patients ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient: a.Standing .b.Flexing the hip. c.Flexing the knee. d.Lying in the supine position.

ANS: B The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. The other options are not correct.

Which of the following statements about osteoarthritis is true? A. It affects primarily weight-bearing joints B. It is a systemic inflammatory illness C. The metacarpal phalangeal joints are commonly involved D. Prolonged morning stiffness is common

A. It affects primarily weight-bearing joints

Joint effusions typically occur later in the course of OA, especially in the: A. Knee B. Elbow C. DIP joints D. Hips

A. Knee

Asymptomatic 1+ bacteruria is found in a nursing home resident with an indwelling catheter. The nurse practitioner's initial intervention includes: A. Assessing resident's cognitive status and last change of the catheter/bag B. Prescribing prophylactic Bactrim 1 tablet at bedtime C. Ordering a urine culture and sensitivity and prescribing empiric treatment until results obtained D. Ordering an x-ray of the kidney, urine, and bladder

A. Assessing resident's cognitive status and last change of the catheter/bag

10. In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results you would expect to see include: A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour B. Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and ACPA) C. Decreased C-reactive protein level (CR-P) D. Elevated thyroid stimulating hormone (TSH

A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour

16. The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as: A. Haygarth's nodes B. Heberden's nodes C. Bouchard's nodes D. Benediction hand

A. Haygarth's nodes

Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: A. Increased estrogen production's influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle

A. Increased estrogen production's influence on the bladder and ureter

Which of the following is not a contributing factor to the development of esophagitis in older adults? A. Increased gastric emptying time B. Regular ingestion of NSAIDs C. Decreased salivation D. Fungal infections such as Candida

A. Increased gastric emptying time

The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days B. Doxycycline 100 mg BID for 5 days C. Prednisolone 35 mg QD for 5 days D. Ice therapy

A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days

13. Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years of age. The patient's most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior to initiating hormone replacement therapy? A. Mammogram B. Endometrial biopsy C. Bone mineral density measurement D. Papanicolaou smear

A. Mammogram

Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? A. Misoprostol (Cytotec) B. Cimetidine (Tagamet) C. Metronidazole (Flagyl) D. Bismuth subsalicylate (Pepto bismol)

A. Misoprostol (Cytotec)

Joints affected by osteoarthritis can sometimes affect healthy joints by: a. causing enzymes to be released that travel to other joints .b. bacteria traveling from the affected join to a healthy one through the bloodstream. c. inflammation and edema affecting the entire limb. d. the affected individuals exerting stress on the normal joint to protect the damaged one.

ANS D

A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called :a.Flexion. b.Abduction. c.Adduction. d.Extension.

ANS: C Moving a limb toward the midline of the body is called adduction; moving a limb away from the midline of the body is called abduction. Flexion is bending a limb at a joint; and extension is straightening a limb at a joint.

23. The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? a.Taking calcium and vitamin D supplements b.Taking medications to prevent osteoporosis c.Performing physical activity such as fast walking d.Assessing bone density annually

ANS: C Physical activity, such as fast walking, delays or prevents bone loss in perimenopausal women. The faster the pace of walking, the higher the preventive effect is on the risk of hip fracture. The other options are not correct.

A sprain is a tear in a: a. ligament. b. tendon. c. skeletal muscle. d. meniscus.

ANS: A

Systemic effects of rheumatoid arthritis are manifested as:a. nodules in various tissues, severe fatigue, and anorexia. b. headache, leukopenia, and high fever. c. swelling and dysfunction in many organs. d. progressive damage to a joint.

ANS: A

Which of the following may precipitate an attack of gout? a. A sudden increase in serum uric acid levels b. Severe hypercalcemia c. Mild trauma to the toes d. Development of a tophus

ANS: A

What is a common effect of long-term use of glucocorticoids to treat rheumatoid arthritis? a. Leukocytosis b. Osteoporosis c. Severe anemia d. Orthostatic hypotension

ANS: B

A 16-year-old male patient presents in the emergency room with a pathologic fracture of the left femur and complains of pain on weight bearing. These are cardinal indicators of: a.osteogenic sarcoma. b.osteoporosis .c.rheumatoid arthritis .d.osteochondroma.

ANS: A Osteogenic sarcoma occurs in young men aged 10 to 25. They are malignant bone tumors that can cause a pathologic fracture and they are accompanied by pain on weight bearing. Osteochondromas are benign and usually do not cause fractures.

How is rheumatoid arthritis distinguished from osteoarthritis? a.Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints. b.Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease. c.People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis. d.Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis

ANS: A RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis.

The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include? a.Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. b.Estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c.With a family history of osteoporosis, there is no way to prevent or slow bone reabsorption. d.Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

ANS: A To prevent osteoporosis, women are advised to have an adequate daily intake of calcium and vitamin D; exercise regularly; avoid smoking; decrease coffee intake; decrease excess protein in the diet; and engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week. A contributing factor may be use of steroids.

Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease? a.Leafy green vegetables b.Foods high in sodium c.Tea and coffee d.Vitamin A

ANS: A To slow the bone loss, a patient with osteoporosis should eat green leafy vegetables, foods low in sodium, and also avoid caffeine. Vitamin A does not help with the absorption of calcium.

A patient states, I can hear a crunching or grating sound when I kneel. She also states that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints. The nurse should assess for signs of what problem? a.Crepitation b.Bone spur c.Loose tendon d.Fluid in the knee joint

ANS: A Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. The other optionsare not correct

A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement? a.Flexion b.Abduction c.Adduction d.Extension

ANS: A Flexion, or bending a limb at a joint, is required to move the hand to the mouth. Extension is straightening a limb at a joint. Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body.

3. The functional units of the musculoskeletal system are the: a.Joints. b.Bones. c.Muscles. d.Tendons.

ANS: A Joints are the functional units of the musculoskeletal system because they permit the mobility neededto perform the activities of daily living. The skeleton (bones) is

The ankle joint is the articulation of the tibia, fibula, and: a.Talus. b.Cuboid. c.Calcaneus. d.Cuneiformbones.

ANS: A The ankle or tibiotalar joint is the articulation of the tibia, fibula, and talus. The other bones listed are foot bones and not part of the ankle joint.

The nurse is checking the range of motion in a patients knee and knows that the knee is capable of which movement(s)? a.Flexion and extension b.Supination and pronation c.Circumduction d.Inversion and eversion

ANS: A The knee is a hinge joint, permitting flexion and extension of the lower leg on a single plane. The knee is not capable of the other movements listed.

Of the 33 vertebrae in the spinal column, there are: a.5lumbar. b.5thoracic. c.7sacral. d.12cervical.

ANS: A There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 4 coccygeal vertebrae in the spinal column

A woman who is 8 months pregnant comments that she has noticed a change in her posture and is having lower back pain. The nurse tells her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: a.Lordosis. b.Scoliosis .c.Ankylosis. d.Kyphosis.

ANS: A Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance, in turn, creates a strain on the low back muscles, felt as low back pain during late pregnancy by some women. Scoliosis is lateral curvature of portions of the spine; ankylosis is extreme flexion of the wrist, as observed with severe rheumatoid arthritis; and kyphosis is anenhanced thoracic curvature of the spine.

Juvenile rheumatoid arthritis (JRA) differs from the adult form in that: a. only small joints are affected. b. rheumatoid factor is not present in JRA, but systemic effects are more severe. c. onset is more insidious in JRA. d. deformity and loss of function occur in most children with JRA.

ANS: B

When a patient recovering from a fractured tibia asks what callus formation is, the nurse tells her it is: a.when blood vessels of the bone are compressed .b.a part of the bone healing process after a fracture when new bone is being formed over the fracture site. c.the formation of a clot over the fracture site. d.when the hematoma becomes organized and a fibrin meshwork is formed.

ANS: B Callus formation occurs when the osteoblasts continue to lay the network for bone buildup and osteoclasts destroy dead bone.

What should the nurse do when a patient with osteomyelitis is admitted with an open wound that is draining? a.Enforce a low calorie diet b.Initiate drainage and secretion precautions c.Frequently do passive ROM on the elbow d.Ambulate several times daily

ANS: B The patient with osteomyelitis should be at least in drainage and secretion precaution. The limb should be positioned for maximum comfort and left at rest. These patients are usually on bed rest and require a high-calorie, high-protein diet.

Which patient is most likely to develop osteoporosis? a.43-year-old African American woman b.57-year-old white woman c.48-year-old African American man d.62-year-old Latino woman

ANS: B White and Asian women have a higher incidence of osteoporosis than African American women or Hispanic women because of the greater bone density in the African American.

A patient has been diagnosed with osteoporosis and asks the nurse, What is osteoporosis? The nurse explains that osteoporosis is defined as: a.Increased bone matrix. b.Loss of bone density. c.New weaker bone growth. d.Increased phagocytic activity.

ANS: B After age 40 years, a loss of bone matrix (resorption) occurs more rapidly than new bone formation. The net effect is a gradual loss of bone density, or osteoporosis. The other options are not correct.

An imaginary line connecting the highest point on each iliac crest would cross the __________ vertebra. a.First sacral b.Fourth lumbar c.Seventh cervical d.Twelfth thoracic

ANS: B An imaginary line connecting the highest point on each iliac crest crosses the fourth lumbar vertebra. The other options are not correct.

An 80-year-old woman is visiting the clinic for a checkup. She states, I cant walk as much as I used to. The nurse is observing for motor dysfunction in her hip and should ask her to: a.Internally rotate her hip while she is sitting. b.Abduct her hip while she is lying on her back. c.Adduct her hip while she is lying on her back. d.Externally rotate her hip while she is standing.

ANS: B Limited abduction of the hip while supine is the most common motion dysfunction found in hip disease. The other options are not correct.

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms. The nurse should suspect: a.Crepitation b.Rotator cuff lesions. c.Dislocated shoulder. d.Rheumatoidarthritis.

ANS: B Rotator cuff lesions may limit range of motion and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal. The other options are not correct.

An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: a.Long bones tend to shorten with age. b.The vertebral column shortens. c.A significant loss of subcutaneous fat occurs. d.A thickening of the intervertebral disks develops

ANS: B Postural changes are evident with aging; decreased height is most noticeable and is due to shortening of the vertebral column. Long bones do not shorten with age. Intervertebral disks actually get thinner with age. Subcutaneous fat is not lost but is redistributed to the abdomen and hips.

During an interview the patient states, I can feel this bump on the top of both of my shoulders. It doesn't hurt but I am curious about what it might be. The nurse should tell the patient that it is his: a.Subacromial bursa. b.Acromion process. c.Glenohumeral joint. d.Greater tubercle of the humerus.

ANS: B The bump of the scapulas acromion process is felt at the very top of the shoulder. The other options are not correct.

The nurse is examining the hip area of a patient and palpates a flat depression on the upper, lateral side of the thigh when the patient is standing. The nurse interprets this finding as the: a.Ischial tuberosity. b.Greater trochanter .c.Iliac crest. d.Gluteus maximus muscle.

ANS: B \The greater trochanter of the femur is palpated when the person is standing, and it appears as a flat depression on the upper lateral side of the thigh. The iliac crest is the upper part of the hip bone; the ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed; and the gluteus muscle is part of the buttocks.

What is the likely immediate result of fat emboli from a broken femur? a. Additional ischemia in the broken bone b. Nonunion or malunion of the fracture c. Pulmonary inflammation and obstruction d. Abscess and infection at a distant site

ANS: C

Where does inflammation usually begin in an individual with ankylosing spondylitis? a. Costovertebral joints with progression down the spine b. Cervical and thoracic vertebrae, causing kyphosis c. Sacroiliac joints with progression up the spine d. Peripheral joints and then proceeds to the vertebrae

ANS: C

Which of the following distinguishes septic arthritis? a. Multiple joints that are swollen, red, and painful at one time b. Presence of mild fever, fatigue, and leukocytosis c. Purulent synovial fluid present in a single, swollen joint d. Presence of many antibodies in the blood

ANS: C

Which statement applies to menisci? a. They are found in the hip joints. b. They are secretory membranes in joints. c. They prevent excessive movement of joints. d. They are found in the shoulder joint.

ANS: C

The articulation of the mandible and the temporal bone is known as the: a.Intervertebral foramen. b.Condyle of themandible. c.Temporomandibular joint. d.Zygomatic arch of the temporalbone.

ANS: C The articulation of the mandible and the temporal bone is the temporomandibular joint. The other responses are not correct.

A 56-year-old female patient is being seen for osteoarthritis of the knee in the clinic. What should the nurse recommend when discussing strengthening exercises? a.Jogging b.Walking rapidly on a treadmill c.Bicycling d.Aerobic exercises

ANS: C Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations.

During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient complains of a pain going down his buttock into his leg. The nurse suspects: a.Scoliosis. b.Meniscustear .c.Herniated nucleus pulposus. d.Spasm of paravertebral muscles.

ANS: C Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus. The other options are not correct

Calcium is a mineral found in many foods that can slow bone loss during the aging process. Which food is high in calcium? a.Oranges b.Bananas c.Spinach d.Eggs

ANS: C Spinach and green vegetables, as well as yogurt, are considered calcium-rich foods. Fresh oranges, bananas, and eggs are not good calcium choices.

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The nurse examines her hand and would expect a fracture if the girl complains of a :a.Dull ache. b.Deep pain in her wrist. c.Sharp pain that increases with movement. d.Dull throbbing pain that increases with rest.

ANS: C A fracture causes sharp pain that increases with movement. The other types of pain do not occur with a fracture

The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. Where does lengthening of the bones occur? a.Bursa b.Calcaneus c.Epiphyses d.Tuberosities

ANS: C Lengthening occurs at the epiphyses, or growth plates. The other options are not correct.MSC: Client Needs: Health Promotion and Maintenance

A patient is complaining of pain in his joints that is worse in the morning, better after he moves around for a while, and then gets worse again if he sits for long periods. The nurse should assess for other signs of what problem? a.Tendinitis b.Osteoarthritis c.Rheumatoid arthritis d.Intermittent claudication

ANS: C Rheumatoid arthritis is worse in the morning when a person arises. Movement increases most joint pain, except the pain with rheumatoid arthritis, which decreases with movement. The other options are not correct

A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and that he is unable to remove his wedding ring. This joint is called the _________ joint. a.Interphalangeal b.Tarsometatarsal c.Metacarpophalangeal d.Tibiotalar

ANS: C The joint located just above the ring on the finger is the metacarpophalangeal joint. Theinterphalangeal joint is located distal to the metacarpophalangeal joint. The tarsometatarsal and tibiotalar joints are found in the foot and ankle. (See Figure 22-10 for a diagram of the bones and joints of the hand and fingers.)

To palpate the temporomandibular joint, the nurses fingers should be placed in the depression__________ of the ear. a.Distal to the helix b.Proximal to the helix c.Anterior to the tragus d.Posterior to the tragus

ANS: C The temporomandibular joint can be felt in the depression anterior to the tragus of the ear. The other locations are not correct

The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test. To perform this test, the nurse should instruct the patient to: a.Dorsiflex the foot. b.Plantar flex the foot. c.Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. d.Hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds

ANS: C For the Phalen test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome. The other actions are not correct when testing for carpal tunnel syndrome.

A professional tennis player comes into the clinic complaining of a sore elbow. The nurse will assess for tenderness at the: a. Olecranon bursa. b.Annular ligament. c.Base of the radius. d.Medial and lateral epicondyle.

ANS: D The epicondyles, the head of the radius, and the tendons are common sites of inflammation and local tenderness, commonly referred to as tennis elbow. The other locations are not affected.

When reviewing the musculoskeletal system, the nurse recalls that hematopoiesis takes place inthe: a.Liver. b.Spleen. c.Kidneys. d.Bone marrow.

ANS: D The musculoskeletal system functions to encase and protect the inner vital organs, to support the body, to produce red blood cells in the bone marrow (hematopoiesis), and to store minerals. The other options are not correct.

The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves the: a.Nucleus pulposus. b.Articula processes. c.Medial epicondyle. d.Glenohumeral joint.

ANS: D A rotator cuff injury involves the glenohumeral joint, which is enclosed by a group of four powerful muscles and tendons that support and stabilize it. The nucleus pulposus is located in the center of each intervertebral disk. The articular processes are projections in each vertebral disk that lock on to the next vertebra, thereby stabilizing the spinal column. The medial epicondyle is located at the elbow.

The nurse notices that a woman in an exercise class is unable to jump rope. The nurse is aware that to jump rope, ones shoulder has to be capable of: a.Inversion. b.Supination. c.Protraction. d.Circumduction.

ANS: D Circumduction is defined as moving the arm in a circle around the shoulder. The other options arenot correct.

Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: a.Bursa. b.Tendons. c.Cartilage. d.Ligaments

ANS: D Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called ligaments. The other options are not correct.

The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. The nurse is referring to his: a.Vertebral column. b.Nucleus pulposus. c.Vertebral foramen. d.Intervertebral disks.

ANS: D Intervertebral disks are elastic fibrocartilaginous plates that cushion the spine similar to shock absorbers and help it move. The vertebral column is the spinal column itself. The nucleus pulposus is located in the center of each disk. The vertebral foramen is the channel, or opening, for the spinal cord in the vertebrae.

The nurse is examining a 3-month-old infant. While the nurse holds his or her thumbs on the infants inner mid thighs and the fingers on the outside of the infants hips, touching the greatertrochanter, the nurse adducts the legs until the his or her thumbs touch and then abducts the legs until the infants knees touch the table. The nurse does not notice any clunking sounds and is confident to record a: a.Positive Allis test. b.Negative Allis test. c.Positive Ortolani sign. d.Negative Ortolani sign.

ANS: D Normally, this maneuver feels smooth and has no sound. With a positive Ortolani sign, however, the nurse will feel and hear a clunk, as the head of the femur pops back into place. A positive Ortolani sign also reflects hip instability. The Allis test also tests for hip dislocation but is performed by comparing leg lengths.

The nurse has completed the musculoskeletal examination of a patients knee and has found a positive bulge sign. The nurse interprets this finding to indicate:a.Irregularbonymargins.b.Soft-tissueswellinginthejoint.c.Swellingfromfluidintheepicondyle.d.Swellingfromfluidinthesuprapatellarpouch.

ANS: D A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch. The other options are not correct.

Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica (PMR) can be ruled out with a muscle biopsy? A. Parkinson's disease B. Polymyositis C. Late onset rheumatoid arthritis D. Giant Cell Arteritis

B. Polymyositis

12. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: A. Green leafy vegetables B. Beer, sausage, fried seafood C. Sugar D. Gluten and bread items

B. Beer, sausage, fried seafood

The nurse practitioner is examining a 62-year-old female who has been complaining of lower abdominal pain. Upon auscultation, bowel sounds are high pitched and tinkling. Which of the following terms describes this finding? A. Succession splash B. Borborygmi C. Tenesmus . Puddle sign

B. Borborygmi

A clinical clue for suspected renal artery stenosis would be: A. Decreased urine output B. Development of resistant hypertension in a previously well-controlled patient C. Retroperitoneal pain on the affected side D. Rising BUN level with normal creatinine level

B. Development of resistant hypertension in a previously well-controlled patient

In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient's history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age

B. Diffuse epigastric pain

When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to: A. Use all the medication B. Do not use for possible infectious diarrhea C. Use should exceed one week for effectiveness D. These drugs provide exactly the same pharmaceutical effects

B. Do not use for possible infectious diarrhea

The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? A. Weight reduction and rest 30 minutes after each meal in the supine position B. Elevation of head of the bed 4-6 inches on blocks and weight reduction C. Encouraged to wear restrictive clothing to add support for diaphragmatic breathing D. Using oral mints to relieve gastric distress

B. Elevation of head of the bed 4-6 inches on blocks and weight reduction

Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle modifications and antacids, the patient continues to have occasional mild heartburn after occasional meals and at night. The most appropriate next action is: A. Prokinetic agents B. H2 antagonists C. Proton pump inhibitors D. Surcralfate

B. H2 antagonists

A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner's appropriate intervention is: A. Digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results

B. Immediate referral to gastroenterologist and colonoscopy

A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition? A. Inflammatory bowel disease B. Irritable bowel syndrome C. Giardiasis D. Lactose intolerance

B. Irritable bowel syndrome

You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which two clinical findings are common in patients with PMR? A. Neutropenia and hypochromic, normocytic anemia B. Normochromic, normocytic anemia and thrombocytosis C. Microcytic, hypochromic anemia and reticulocytopenia D. Macrocytic, hyperchromic anemia and leukocytopenia

B. Normochromic, normocytic anemia and thrombocytosis

A 78-year-old female comes to the office because she has pain when she urinates. She has been seen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last UA: WBCs: 2-3/high-power field RBCs: 0-2/high-power field Epithelial cells: Few Nitrite: Negative Leuckocyte esterase: Negative Which of the following should be done next? A. Obtain a clean catch urine for UA and urine for C&S B. Perform a pelvic examination C. Reassure the patient that she has asymptomatic bacteriuria and does not need antibiotics D. Order a pelvic ultrasound

B. Perform a pelvic examination

. A 62-year-old woman presents with a recurrent urinary tract infection. She now has a fever of 104°F and severe costovertebral tenderness with pyuria. What is the appropriate diagnosis and intervention for this patient? A. Septic arthritis and oral prednisolone is indicated B. Pyelonephritis and hospitalization is required C. Recurrent cystitis and 10 days of antibiotics are needed D. Pelvic inflammatory disease and 7 days of antibiotics are indicated

B. Pyelonephritis and hospitalization is required

15. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosions

B. Soft tissue swelling

.Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? A. Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy C. All clients with dyspepsia who smoke and drink alcohol D. When a therapeutic response to empiric treatment is obtained

B. Symptoms persisting after 6-8 weeks of therapy

2. In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be: A. Erythrocyte sedimentation rate (ESR) B. Synovial fluid analysis C. C-reactive protein analysis D. Complete blood cell count

B. Synovial fluid analysis

The nurse practitioner is evaluating a patient's pelvic muscle strength by digital examination. This is performed when: A. A male patient complains of nocturia and dribbling B. The nurse practitioner needs to confirm a cystocele or stress incontinence C. The patient reports sudden loss of large amounts of urine or urge incontinence D. The nurse practitioner suspects overflow incontinence

B. The nurse practitioner needs to confirm a cystocele or stress incontinence

All of the following may be reasons associated with an elevated PSA besides prostate cancer except: A. Prostatitis B. Urinary tract infection C. Perineal trauma D. Digital rectal exam

B. Urinary tract infection

Which ethnic group has the highest incidence of prostate cancer? A. Asians B. Hispanics C. African Americans D. American Indian

C. African Americans

3. Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as: A. Ataxic B. Festinating C. Antalgic D. Steppage

C. Antalgic

4. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight bearing and/or use of the joint D. Begins in the morning but decreases with activity

C. Begins upon arising and after prolonged weight bearing and/or use of the joint

. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals? A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years

C. Every 2 years

An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? A. Atypical pneumonia B. Peptic ulcer disease C. Gastroesophageal reflux D. Mononucleosis (Epstein-Barr)

C. Gastroesophageal reflux

11. Which of the following is the most appropriate laboratory test for monitoring gout therapy over the long-term? A. Erythrocyte sedimentation rate (ESR) B. Completer blood count (CBC) C. Serum urate level D. Serum albumin

C. Serum urate level

In acute prostatitis, an exam of the prostate may find the gland to be: A. Nodular B. Cool and pliable C. Swollen and tender D. Asymmetrical

C. Swollen and tender

In teaching an older adult female client with end-stage renal disease her medication regimen, the nurse practitioner must include which of the following pieces of information in the treatment plan? A. Report any changes in the color of her stool B. Take iron supplement and elemental calcium with each meal C. Take iron supplement before meals and the calcium after meals D. Take calcium with a high phosphorus mea

C. Take iron supplement before meals and the calcium after meals

14. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination? A. Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigued. B. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis. C. Thorough abdominal and gynecological exam to rule out masses and identify any tenderness. D. A rectal examination to rule out colon cancer as a secondary site for breast cancer.

C. Thorough abdominal and gynecological exam to rule out masses and identify any tenderness.

Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? A. It is highly contagious and a mask should be worn at home. B. Treatment regimen is multiple lifetime medications. C. Treatment regimen is multiple medications taken daily for a few weeks. D. Treatment regimen is complicated and is not indicated unless the patient is symptomatic.

C. Treatment regimen is multiple medications taken daily for a few weeks.

11. A pelvic mass in a postmenopausal woman: A. is most commonly due to uterine fibroids. B. is always symptomatic. C. is highly suspicious for ovarian cancer. D. should be monitored over a period of time.

C. is highly suspicious for ovarian cancer.

When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? A. Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins B. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime C. Sit up for an hour after taking any medication and restrict fluid intake D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal

D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal

All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: A. Ciprofloxacin B. Levofloxacin C. Trimethoprim D. Azithromycin

D. Azithromycin

A 62-year-old client presents with a complaint of fever, pain, and burning on urination. Difficulty urinating with dribbling has been increasing in the past few days. He has a feeling of pressure in his groin. On examination, his prostate is tender, boggy, and warm. A stat urinalysis reveals the presence of leukocytes and bacteria. He is allergic to sulfa drugs. His weight is 70 kg and his last serum creatinine was 1.0. While awaiting the culture and sensitivity, the nurse practitioner begins empiric treatment with which of the following? A. Trimethoprim/sulfamethroxazole DS bid x 2 weeks B. Ampicillin 250 mg PO q day for 10 days C. Nitrofurantoin 100 mg Q 12 hours for 7 days D. Ciprofloxacin 500 mg Q 12 hours for 14 days

D. Ciprofloxacin 500 mg Q 12 hours for 14 days

1. Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following except: A. Bone spur formation B. Pressure of the ligaments C. Reactive muscle spasm . Crystal deposition

D. Crystal deposition

Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: A. Recommending she increase her dietary intake of Calcium and Vitamin D B. Ordering once a year bisphosphonate and a proton pump inhibitor C. Participate in a fall prevention program D. Dual-energy x-ray (DEXA) scan and updating immunizations

D. Dual-energy x-ray (DEXA) scan and updating immunizations

In chronic bacterial prostatitis, what is the organism most commonly associated with the disease? A. Klebsiella B. Proteus C. Pseudomonas D. Escherichia coli

D. Escherichia coli

. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age-associated change? A. PSA level of 3.3 ng/mL B. Decreased bladder capacity C. Involuntary detrusor contradictions D. Increased postvoid residual urine volume

D. Increased postvoid residual urine volume

The best method of verifying a diagnosis of gout in a joint is which of the following: A. Radiographic examination of the joint with two views B. Ultrasound C. Palpation D. Joint aspiration and polarized-light microscope

D. Joint aspiration and polarized-light microscope

An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy's sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation

D. Midepigastric pain that is not reproducible with palpation

7. You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative of GCA and PMR? A. Jaw pain and heart murmur B. Joint swelling and sudden loss of central vision bilaterally C. Hoarseness and the total inability to grasp small objects D. Scalp tenderness and aching in shoulder and pelvic girdle

D. Scalp tenderness and aching in shoulder and pelvic girdle

Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure? A. Urinary incontinence B. Impotence C. Dribbling urine D. Selected low back pain

D. Selected low back pain

A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? A. C-reactive protein level of 3 mg B. White blood cell count of 11,000 C. Direct serum bilirubin level of 0.3 mg/dL D. Serum amylase level of 145 U/L

D. Serum amylase level of 145 U/L

19. In considering the specificity of laboratory data, the most reliable diagnostic test listed below would be: A. Elevated erythrocyte sedimentation rate (ESR) to rule out inflammation B. CBC to rule out infection C. Antinuclear Antibody (ANA) test to rule out a collagen disease D. Synovial fluid analysis to differentiate between an infectious versus an inflammatory infusion

D. Synovial fluid analysis to differentiate between an infectious versus an inflammatory infusion

A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is: A. Lead intoxication B. Illegal whiskey C. Binge-eating D. Thiazide diuretics

D. Thiazide diuretics