504 Exam 5: Leik Practice Questions
Which chronic illness disproportionately affects the Hispanic population? A) Diabetes mellitus B) Hypertension C) Alcohol abuse D) Skin cancer
A) Diabetes mellitus The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.
The most current Eighth Joint National Committee (JNC 8) recommendation for the blood pressure goal in diabetics is: A) <140/90 mmHg B) <130/85 mmHg C) <130/80 mmHg D) <125/75 mmHg
A) <140/90 mmHg The Eighth Joint National Committee (JNC 8) blood pressure goal for adults and older adults 60 years of age or older who have diabetes (with or without chronic kidney disease) is blood pressure less than 140/90. In addition, all patients with hypertension should have lifestyle intervention (i.e., weight loss, smoking cessation, healthy diet), which should be continued throughout treatment.
A 20-year-old college student reports to the student health clinic with a laceration of her left hand. She tells the nurse practitioner that she cut her hand while working in her garden. Her last Td booster was 5½ years ago. Which of the following is correct? A) Administer a booster dose of the Tdap vaccine B) Administer the Td vaccine and the Td immunoglobulin (HyperTET) C) Administer Td immunoglobulin (HyperTET) only D) She does not need any Td immunoglobulin (HyperTET) or a Td booster
A) Administer a booster dose of the Tdap vaccine The Centers for Disease Control and Prevention (CDC) recommends the Tdap for teens or adults who need a Td booster (once in a lifetime). A tetanus vaccine booster is recommended for recent injuries if it has been more than 5 years since the last dose.
A 35-year-old woman is complaining of gradual weight gain, lack of energy, and amenorrhea. The urine pregnancy test is negative. A complete blood count (CBC) shows hemoglobin of 13.5 g/dL and mean corpuscular volume (MCV) of 84 fL. The nurse practitioner suspects that the patient may have hypothyroidism. The thyroid-stimulating hormone (TSH) level is 10 mU/L. Which of the following is the next step in the evaluation? A) Check the thyroid profile B) Check the total T3 level C) Check the FSH level D) Recheck the TSH in 4 to 6 months
A) Check the thyroid profile The upper limit of the serum thyroid-stimulating hormone (TSH) level is about 4.0 mU/L. With an elevated TSH of 10, it is important to rule out hypothyroidism. The next step in this patient's evaluation is to order a thyroid profile or thyroid panel test. Serum assays measure bound and unbound (free) forms of thyroxine (T4) and triiodothyronine (T3). Classic findings of hypothyroidism are a low free T4, low T3-resin uptake (THBI), and low free T4 index.
A 35-year-old smoker is being evaluated for birth control choices. The patient has a history of pelvic inflammatory disease (PID) along with an embolic episode after her last pregnancy. Which of the following methods of birth control would you recommend? A) Condoms and the vaginal sponge (Today Sponge) B) Estrogen patches C) Intrauterine device D) Depo-Provera (depot medroxyprogesterone)
A) Condoms and the vaginal sponge (Today Sponge) Contraindications for hormonal contraception include migraine headaches; cigarette smoking or obesity in women older than 35 years; history of thromboembolic disease; hypertension or vascular disease if older than 35 years of age; systemic lupus erythematosus with vascular disease, nephritis, or antiphospholipid antibodies; breastfeeding (may use progestin-only pills); hypertriglyceridemia; coronary artery disease; congestive heart failure; and strokes.
All of the following measures have been found to help lower the risk of osteoporosis except: A) Drinking organic orange juice B) Eating low-fat dairy foods C) Performing weight-bearing exercises D) Vitamin D supplementation
A) Drinking organic orange juice Commercial orange juice is fortified with calcium and vitamin D. But organic products usually do not have any additives such as calcium. Vitamin D levels must be sufficient for the body to absorb calcium. Eating foods high in vitamin D and calcium along with calcium and vitamin D supplements is advised to protect the bones and prevent bone loss. Performing weight-bearing exercises daily also increases bone strength.
Which of the following would you recommend on an annual basis for an elderly patient with type 2 diabetes? A) Eye exam with an ophthalmologist B) Follow-up visit with a urologist C) Periodic visits to an optometrist D) Colonoscopy
A) Eye exam with an ophthalmologist Elderly patients with type 2 diabetes should have a dilated eye exam done annually by an ophthalmologist. They should also see a podiatrist once or twice a year. Preventive care also includes receiving a flu shot annually, receiving a Pneumovax vaccine if older than 60 years of age, and taking a 81-mg baby aspirin each day.
The majority of serum alpha fetoprotein is produced by the: A) Fetal liver B) Maternal liver C) Placenta D) Fetal neural tube
A) Fetal liver Alpha fetoprotein (AFP) is produced mainly by the growing fetal liver. A small amount comes from the mother's liver, but by the end of the first trimester, most of the AFP is produced by the fetal liver.
All of the following statements are correct regarding the Td vaccine except: A) Fever occurs in up to 80% of the patients B) A possible side effect is induration on the injection site C) The Td is given every 10 years D) The DPT and DT should not be given beyond the seventh birthday
A) Fever occurs in up to 80% of the patients Side effects of the Td vaccine include induration at the injection site. Td is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever.
Women with polycystic ovary syndrome (PCOS) are at higher risk for the following: A) Heart disease and endometrial cancer B) Uterine fibroids and ovarian cancer C) Premature menopause D) Pelvic inflammatory disease (PID)
A) Heart disease and endometrial cancer Chronic anovulation results in high levels of estrogen and androgens in the body. The risk of heart attack is four to seven times higher in women with polycystic ovary syndrome (PCOS) than women of the same age without PCOS. Women with PCOS are at greater risk of having high blood pressure and have high levels of low-density lipoprotein (LDL) and low levels of highdensity lipoprotein (HDL) cholesterol. Lack of ovulation is usually the reason for fertility problems in women with PCOS. More than 50% of women with PCOS have diabetes or prediabetes (impaired glucose tolerance) before the age of 40. Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not progesterone. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia and cancer.
A middle-aged Black man complains of a history of outbreaks of painful large nodules and pustules on both his axillae that resolve after treatment with antibiotics. On physical examination, the nurse practitioner notices large red nodules that are tender to palpation. In addition, several pustules are present along with multiple scars on the skin. The nurse practitioner advises the patient that the condition is caused by a bacterial infection of the sweat glands in the axillae. Which of the following conditions is being described? A) Hidradenitis suppurativa B) Severe nodular acne C) Granuloma inguinale D) Cat scratch fever
A) Hidradenitis suppurativa Hidradenitis suppurativa is a chronic skin condition, commonly found in the apocrine glands in the axilla and/or groin, that causes painful nodules under the skin. These abscesses tend to open and drain fluid and pus. Significant scarring of the skin may result from these outbreaks.
A 44-year-old woman who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure (BP) is 160/80 mmHg, pulse is 110 beats/min, and she is afebrile. Her labs reveal mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? A) Inevitable abortion B) Threatened abortion C) Incomplete abortion D) Acute pelvic inflammatory disease
A) Inevitable abortion Inevitable abortion is defined as vaginal bleeding with pain, cervical dilation, and/or cervical effacement. Threatened abortion is defined as vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion involves moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping or contractions. Acute pelvic inflammatory disease is a sudden onset of inflammation and pain that affects the pelvic area, cervix, uterus, and ovaries, and is caused by infection.
All of the following vaccines are contraindicated in pregnant women except: A) Influenza B) Mumps C) Varicella D) Rubella
A) Influenza Not all vaccinations are safe to get during pregnancy. However, the flu vaccine can be given before, during, and after pregnancy. The other vaccines are live viruses and are contraindicated during pregnancy.
Epidemiological studies show that Hashimoto's disease occurs most commonly in: A) Middle-aged to older women B) Smokers C) Obese individuals D) Older men
A) Middle-aged to older women Hashimoto's disease (Hashimoto's thyroiditis, or chronic lymphocytic thyroiditis) is an autoimmune disease. An enlarged thyroid is most often the first sign of the disease. Hashimoto's disease is about seven times more common in women than in men. It can occur in teens and young women, but is more common in middle age.
Human chorionic gonadotropin (hCG) is produced by the: A) Placenta B) Hypothalamus C) Anterior pituitary D) Ovaries
A) Placenta Human chorionic gonadotropin (hCG) is a hormone produced by the placenta after implantation. It can also be produced in gestational trophoblastic disease or hydatidiform mole (molar pregnancy).
A 55-year-old woman who has had type 2 diabetes for 20 years is concerned about her kidneys. She has a history of three urinary tract infections (UTIs) within the past 8 months, but is currently asymptomatic. Which of the following is the best course to follow? A) Recheck urine during the visit, send a urine specimen for culture and sensitivity, and refer to a nephrologist B) Order a urinalysis dipstick test to be repeated monthly C) Order a CT scan of the kidneys D) Provide empiric treatment for a UTI
A) Recheck urine during the visit, send a urine specimen for culture and sensitivity, and refer to a nephrologist Although the patient is currently asymptomatic, her history of three urinary tract infections (UTIs) in 8 months warrants testing while she is in the office. A UTI is defined as the presence of 100,000 organisms per milliliter of urine in asymptomatic patients or greater than 100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic patient. Diabetic patients are at higher risk for UTIs and over time may develop bladder damage (cystopathy) and nephropathy. A nephrology consult is prudent.
A 30-year-old woman with type 2 diabetes uses regular and NPH (neutral protein Hagedorn) insulin in the morning and in the evening. She denies changes in her diet or any illness, but recently started attending aerobic classes in the afternoon. Her fasting blood glucose level before breakfast is now elevated. Which of the following is best described? A) Somogyi phenomenon B) Dawn phenomenon C) Raynaud's phenomenon D) Insulin resistance
A) Somogyi phenomenon This is caused by too much insulin (or missing a meal or snack) in the evening, which results in hypoglycemia in the early morning (2 a.m. to 3 a.m.). The body compensates by secreting glucagon (from the liver) and epinephrine, which results in high blood glucose levels in the morning. The Somogyi phenomenon (or Somogyi effect) is also known as the rebound effect.
A 14-year-old girl who is sexually active is brought to the health clinic by her mother for an immunization update. According to the mother, her daughter has had one dose of hepatitis B vaccine. Which of the following vaccines would you administer at this visit? A) Tdap, hepatitis B, and HPV vaccine B) DTaP (diphtheria, tetanus, acellular pertussis) and hepatitis B C) Hepatitis B only D) MMR (measles, mumps, rubella), Td, and HPV vaccine
A) Tdap, hepatitis B, and HPV vaccine There are two types of HPV vaccine. Gardasil can be used for both girls and boys, but Cervarix can only be used for females. HPV vaccine is recommended for preteen boys and girls at age 11 or 12 years. Young women can get HPV vaccine until age 27 years and men can get the HPV vaccine until age 22 years.
A 20-year-old White man is being seen for a physical exam by the nurse practitioner. He complains of pruritic macerated areas in his groin that have been present for the past 2 weeks. Which of the following is the most likely? A) Tinea cruris B) Tinea corporis C) Tinea capitis D) Tinea pedis
A) Tinea cruris Tinea cruris (jock itch) is a common skin infection that is caused by a type of fungus called tinea. The fungus thrives in warm, moist areas of the body and, as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or in warm, wet climates. Tinea cruris appears as a red, itchy rash that is often ring shaped. Tinea corporis involves the body, tinea capitis involves the head, and tinea pedis involves the feet.
An 8-year-old boy with type 1 diabetes is being seen for a 3-day history of urinary frequency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially? A) Urine for culture and sensitivity B) 24-hour urine for protein and creatinine clearance C) 24-hour urine for microalbumin D) Intravenous pyelogram
A) Urine for culture and sensitivity An 8-year-old male patient with the diagnosis of diabetes has a high risk of urinary tract infections (UTIs). A large amount of leukocytes in the urinalysis is abnormal, and he has been having symptoms of frequency and nocturia for the past 3 days. The urine culture would be ordered because he has a high risk of infection. The urine culture and sensitivity (C&S) is the best evaluation for diagnosing a UTI.
Which of the following is the best method for diagnosing a Candida albicans infection of the vagina in the primary care setting? A) Wet smear B) Tzanck smear C) KOH (potassium hydroxide) smear D) Clinical findings only
A) Wet smear The wet smear or wet prep is best used to diagnose Candida albicans infection of the vagina (candidiasis) in the primary care setting. To perform the wet smear or wet prep, a small amount of vaginal discharge is obtained and smeared on a slide, then one to two drops of normal saline solution is applied. Candida albicans is a type of yeast organism (fungi). Candida viewed under the microscope will have pseudohyphae and spores. The specimen may also include white blood cells because Candida causes an inflammatory reaction in the vagina.
Which of the following groups has been recommended to be screened for thyroid disease? A) Women aged 50 years or older B) Adolescent girls C) Elderly men D) School-aged children
A) Women aged 50 years or older Women have a greater risk of developing thyroid disease than men. Being age 50 or older increases the risk of thyroid disease for both men and women. Screening for thyroid disease is therefore recommended for women 50 years of age and older.
A menopausal woman with osteopenia is attending a dietary education class. Which of the following foods are recommended? A) Yogurt and sardines B) Spinach and red meat C) Cheese and red meat D) Low-fat cheese and whole grain
A) Yogurt and sardines Postmenopausal women are advised to increase their dietary intake of calcium and vitamin D to help protect their bones from osteopenia and osteoporosis. Good sources of calcium include low-fat dairy products (yogurt), dark leafy vegetables, canned salmon or sardines with bones, soy products, and calcium-fortified cereals and orange juice. Just 3 ounces of canned sardines, including bones, drained of oil, provides 324 mg of calcium.
Which of the following individuals is most likely to be at higher risk for osteoporosis? A) 70-year-old woman of African ancestry who walks daily for exercise B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma C) 55-year-old Caucasian woman who is an aerobics instructor D) 4-year-old Asian girl who has been on high-dose steroids for 1 week
B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma Risk factors for osteoporosis include postmenopause, early menopause, use of chronic steroids, smoking, excessive use of alcohol, sedentary lifestyle, insufficient intake of calcium and vitamin D in the diet, and being an Asian or Caucasian female.
Which of the following laboratory test results meet the diagnostic criteria for prediabetes? A) Fasting plasma glucose of 79 mg/dL B) A1C of 5.9% C) Random blood glucose of 200 mg/dL with polyuria, polydipsia, and polyphagia D) Random blood glucose of 200 mg/dL
B) A1C of 5.9% Do not confuse the criteria for diabetes with those for prediabetes. For prediabetes, look for an A1C between 5.7% to 6.4%, fasting plasma glucose (FPG) of 100 to 125 mg/dL, and/or 75-g oral glucose tolerance test (OGTT) 2-hour postprandial glucose of 140 to 199 mg/dL. To diagnose diabetes, look for random blood glucose ≥200 mg/dL with polyuria, polydipsia, and polyphagia, or A1C ≥6.5%, FPG of ≥126 mg/dL, or 2-hour OGTT ≥200 mg/dL (American Diabetes Association, 2016).
A mother brings in her 6-year-old daughter to see the nurse practitioner (NP). She complains that the school nurse found a few nits in her daughter's hair. The mother states that the school has a "no nits" policy regarding head lice and her daughter cannot go back to school until all the nits have been removed. The child was treated with permethrin shampoo (Nix) twice about 3 months ago. During the physical exam, the NP sees a few nits that are about 2 inches away from the scalp. The child denies itchiness on her scalp. Which of the following is the best action for the NP to follow? A) Prescribe lindane (Kwell) for the child because she may have head lice that are resistant to permethrin B) Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair C) Advise the mother to retreat the child with permethrin cream instead of shampoo D) Reassure the mother that the nits will probably drop off after a few weeks
B) Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair According to the Centers for Disease Control and Prevention (CDC), nits that are more than ¼ inch from the scalp are usually not viable. The child also does not have an itchy scalp. One method of removal is to soak the patient's head with distilled vinegar (and then rinse after), which will break down the protein of the nit casings, making it easy to comb them out of the hair
During a breast exam of a 30-year-old nulliparous woman, the nurse practitioner palpates several rubbery mobile areas of breast tissue. They are slightly tender to palpation. Both breasts have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in 5 days. Which of the following would you recommend? A) Referral to a gynecologist for further evaluation B) Advise the patient to return 1 week after her period so her breasts can be rechecked C) Advise the patient to return in 6 months to have her breasts rechecked D) Schedule the patient for a mammogram
B) Advise the patient to return 1 week after her period so her breasts can be rechecked Symptoms of fibrocystic breast disease include cyclic tenderness with prominent breast tissue that is present in both breasts. The symptoms are worse about 1 week before menses. A few days after menses starts, the bloating and breast tenderness resolve. Symptoms are caused by elevated hormone levels (progesterone). Fibrocystic disease is differentiated from breast cancer by the lack of a dominant mass or other symptoms such as peau d'orange, dimpling, retraction, or eczema-like rash on the nipples and areola.
Which of the following effects are seen in every woman using Depo-Provera (medroxyprogesterone injection) for more than 5 years? A) Melasma B) Amenorrhea C) Weight loss D) Headache
B) Amenorrhea Depo-Provera (contraceptive injection) is a progesterone hormone that causes cessation of periods. One common side effect seen in women who have been taking Depo-Provera for more than 5 years is amenorrhea. As women continue using Depo-Provera, fewer experience irregular bleeding and more experience amenorrhea. By month 12, amenorrhea was reported by 55% of women, and by month 24, amenorrhea was reported by 68% of women.
Which of the following factors is associated with increased risk of osteopenia in teenage girls? A) Drinking one glass of low-fat milk daily B) Anorexia nervosa C) Participation in sports D) A normal BMI (body mass index)
B) Anorexia nervosa Anorexia nervosa increases the risk for osteopenia in teenage girls as a result of the poor intake of foods high in calcium and vitamin D.
A 78-year-old woman's dual-energy X-ray absorptiometry (DEXA) scan yields a T-score of −2.8. Which of the following pharmacological options is preferred for treating this condition? A) Selective estrogen receptor modulators (SERMs) B) Bisphosphonates C) Hormone replacement therapy D) Calcium with vitamin D
B) Bisphosphonates A T-score of -2.8 means that the patient has osteoporosis. Bisphosphonates are considered the first-line treatment for osteoporosis. They include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and others with chemical names that end in "-dronate." Dual-energy x-ray absorptiometry (DEXA) scores are reported as either T-scores or Z-scores, but T-scores are more commonly used. A T-score of −1 or higher is normal. A T-score between −1 and −2.5 indicates osteopenia. A T-score of −2.5 or lower indicates osteoporosis.
When starting an elderly patient on a new prescription of levothyroxine (Synthroid), the nurse practitioner should keep in mind that the rationale for beginning with a lower dose in such patients relates to the drug's: A) Central nervous system effects B) Cardiac effects C) Renal effects D) Hepatic effects
B) Cardiac effects Levothyroxine (Synthroid) should be started on the lowest dose in elderly patients due to the severe side effects that can occur. These include palpitations, tachycardia, anxiety, irritability, elevated blood pressure, flushing, and insomnia.
A nurse practitioner is writing a referral for a middle-aged diabetic who has an A1C of 8.5% despite being on three antidiabetic medications. She is referring the patient to an endocrinologist. What type of relationship exists between the nurse practitioner and the endocrinologist? A) Consultative relationship B) Collaborative relationship C) Referral relationship D) Formal relationship
B) Collaborative relationship A collaborative relationship is a formal process of sharing responsibility for treating a patient together (sharing progress reports); for example, referring a patient to a specialist or for rehabilitation.
There is a higher risk of balanitis in which of the following conditions? A) Renal insufficiency B) Diabetes mellitus C) Graves' disease D) Asthma
B) Diabetes mellitus Balanitis is a yeast infection of the glans of the penis. Men who are not circumcised and who have diabetes mellitus are at higher risk for developing balanitis.
A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? A) Give the infant hepatitis B immunoglobulin B) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin C) Give the infant hepatitis B vaccine only D) Send the infant home because he is not infected
B) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.
Thiazolidinediones are contraindicated in which of the following patient populations? A) Alcoholic patients B) Heart failure patients C) Obese patients D) Elderly patients
B) Heart failure patients Thiazolidinediones (TZD) cause fluid retention and can cause or exacerbate heart failure in some patients. They are contraindicated in patients with New York Heart Association Class III or VI heart failure. After initiating a TZD, watch patients for signs and symptoms of heart failure (rapid weight gain, dyspnea, and/or edema).
A 10-year-old boy has type 1 diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210 mg/dL and 230 mg/dL. He currently injects 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient? A) Increase both types of the morning dose B) Increase only the NPH insulin in the morning C) Decrease the afternoon dose of NPH insulin D) Decrease both NPH and regular insulin doses in the morning
B) Increase only the NPH insulin in the morning Regular insulin is rapid/short-acting insulin. Depending on the type of regular insulin, the onset is 10 to 15 minutes and peaks within an average of 1.5 hours, with a duration of 3 to 5 hours. NPH insulin is an intermediate-acting insulin. Depending on the type of NPH insulin, the onset is 1.5 to 3 hours. NPH peaks in 4 to 12 hours, and the duration is from 18 to 24 hours. By increasing the morning NPH, the peak will occur in the afternoon, bringing down the blood glucose.
About one third of children in the United States are considered obese. Which of the following methods is an appropriate intervention for obese school-aged children? A) Severe restriction of dietary carbohydrates B) Increase physical activity and outdoor play C) Prescribe appetite suppressants D) Over-the-counter herbal weight-loss pills
B) Increase physical activity and outdoor play Lifestyle changes, such as increasing physical activity and spending more time outdoors, are appropriate recommendations for children. Consider referral to a registered dietician for dietary recommendations and counseling. Participation in an exercise program designed for children (if available) is also appropriate. Severe caloric and/or carbohydrate restriction is not recommended for this age group.
Which of the following would be appropriate initial management of a second-degree burn? A) Irrigate with hydrogen peroxide and apply Silvadene cream BID B) Irrigate with normal saline and apply Silvadene cream BID C) Irrigate with tap water and apply Neosporin ointment BID D) Unroof all intact blisters and apply antibiotic ointment BID
B) Irrigate with normal saline and apply Silvadene cream BID Burns should be cleansed with saline solution and Silvadene (silver sulfadiazine) cream applied BID to the site. Hydrogen peroxide is no longer recommended. Intact blisters should not be unroofed.
All of the following are false statements about atopic dermatitis except: A) Contact with cold objects may exacerbate the condition B) It does not have a linear distribution C) It is associated with bullae D) The lesions have vesicles that are full of serous exudate
B) It does not have a linear distribution Atopic dermatitis, also known as eczema, is a skin condition in which the lesions occur in a linear fashion. They may have many different stages, including erythematous papules and vesicles, with weeping, drainage, and/or crusting. Lesions are commonly pruritic and are found on the scalp, face, forearms, wrists, elbows, and backs of the knees.
You are checking a 75-year-old woman's breast during an annual gynecological exam. The left nipple and areola are scaly and reddened. The patient denies pain or pruritus. She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist gave her a potent topical steroid, which she used twice a day for 1 month. The patient never went back for the follow-up. She still has the rash and wants an evaluation. Which of the following is the best intervention for this patient? A) Prescribe another potent topical steroid and tell the patient to use it twice a day for 4 weeks B) Order a mammogram and refer the patient to a breast surgeon C) Advise the patient to stop using soap on her breasts when she bathes to avoid drying up the skin on her areolae and nipples D) Order a sonogram of the breast and fine-needle biopsy of the breast
B) Order a mammogram and refer the patient to a breast surgeon A scaly, reddened rash on the breast that does not resolve after a few weeks of medical treatment may indicate breast cancer. She should have a mammogram performed and see a breast surgeon for evaluation and treatment. Paget's disease of the breast is a rare type of cancer involving the skin of the nipple and, usually, the areola. It may be misdiagnosed at first because its early symptoms are similar to those caused by some benign skin conditions. Most patients with Paget's disease of the breast also have one or more tumors inside the same breast, either ductal carcinoma in situ or invasive breast cancer.
You would advise an 18-year-old female student who has been given a booster dose of MMR at the college health clinic that: A) She might have a low-grade fever during the first 24 to 48 hours B) She should not get pregnant within the next 4 weeks C) Her arm will be very sore at the injection site for 24 to 48 hours D) Her arm will have some induration at the injection site in 24 to 48 hours
B) She should not get pregnant within the next 4 weeks MMR should not be administered to women known to be pregnant. In addition, women should be counseled to avoid becoming pregnant for 28 days following vaccination.
A 65-year-old Hispanic woman has a history of type 2 diabetes. A routine urinalysis reveals a few epithelial cells and is negative for leukocytes, nitrites, and protein. The serum creatinine is 1.5 mg/dL. Which of the following actions would you recommend next? A) Order a urine test for culture and sensitivity (C&S) B) Order a spot urine for microalbumin-to-creatinine ratio C) Because the urinalysis is negative, no further tests are necessary D) Recommend a screening intravenous pyelogram (IVP)
B) Order a spot urine for microalbumin-to-creatinine ratio The American Diabetes Association (ADA) now prefers a spot urine for the microalbumin-to-creatinine ratio (ACR) test instead of a urine albumin test. Use the first morning void sample. The ACR has high predictive value for albuminuria and early kidney disease in patients with prediabetes, diabetes, and hypertension (McCulloch & Bakris, 2016). Because the patient has type 2 diabetes, both an annual urinalysis and an annual ACR test are recommended. Regarding the urinalysis result, a few epithelial cells is within normal limits.
What is the most common cause of infertility among women in the United States? A) Fallopian tube scarring due to pelvic inflammatory disease (PID) B) Ovulation disorders C) Age older than 35 years D) Endometriosis
B) Ovulation disorders Ovulation disorders are the top cause of female infertility (25%). Affected women may have no ovulation (anovulation) or infrequent ovulation that results in oligomenorrhea (i.e., polycystic ovarian syndrome [PCOS]). The second cause is endometriosis (15%). About 10% of women in the United States (ages 15-44 years) have difficulty getting pregnant (Centers for Disease Control and Prevention, 2009). PCOS is one of the most common causes of female infertility. Infertility in men is often caused by a varicocele (heats up the testes) and abnormal and/or low sperm count.
A 16-year-old girl presents in the school clinic and tells the nurse that she would like birth control pills for contraception because she is sexually active. How should the nurse practitioner proceed? A) Refuse to see the patient until consent can be obtained from her parent or legal guardian B) Perform a history and physical exam and, if the patient does not have health contraindications, prescribe birth control pills C) Speak with the patient about safe sex and have her obtain parental consent for the physical exam D) Perform a gynecological exam and obtain a Pap smear
B) Perform a history and physical exam and, if the patient does not have health contraindications, prescribe birth control pills In the United States, the majority of states grant minors the right to privacy to obtain contraceptives (such as birth control pills), pregnancy testing, and testing for sexually transmitted infection (Guttmacher Institute, n.d.). To safely prescribe birth control pills, it is necessary to obtain a history and perform a physical exam to rule out health contraindications, rule out pregnancy, and evaluate the patient's decision-making skills and ability to follow instructions. Contraceptive options and safe sex education are also part of the first visit. It is not necessary to obtain a Pap smear to prescribe birth control pills. The U.S. Preventive Services Task Force does not recommend a Pap smear for woman younger than age 21 years.
A postmenopausal woman who has been on low-dose estrogen and progesterone replacement hormone therapy for her severe vasomotor symptoms complains to the nurse practitioner that over the past 4 months she has had a few episodes of small amounts of vaginal bleeding that seem to occur at random. She denies uterine cramping and dyspareunia. Which of the following is the best treatment plan for this patient? A) Recommend a dilation and curettage (D&C) procedure, which is very helpful in cases of postmenopausal bleeding B) Schedule the patient for uterine ultrasound and endometrial biopsy C) Prescribe a 13-day course of progesterone pills to induce uterine shedding of the thickened endometrial lining at the end of the month D) Refer the patient to a gynecologist for further evaluation
B) Schedule the patient for uterine ultrasound and endometrial biopsy Postmenopausal bleeding should always be investigated because it could be a sign of endometrial carcinoma. Although endometrial carcinoma is the most serious cause of postmenopausal bleeding, an atrophic endometrium with dyssynchronous shedding is the most common cause. A less common cause is cervical or endometrial polyps. A uterine ultrasound is ordered to evaluate the lining of the endometrium and rule out polyps. A uterine biopsy is ordered to sample for pathology.
Metronidazole (Flagyl) produces the disulfiram (Antabuse) effect when combined with alcoholic drinks or medicine. You would educate the patient that: A) She should avoid alcoholic drinks during the time she takes the medicine B) She should avoid alcoholic drinks 1 day before, during therapy, and a few days after therapy C) She should avoid alcoholic drinks after she takes the medicine D) There is no need to avoid any food or drink
B) She should avoid alcoholic drinks 1 day before, during therapy, and a few days after therapy The patient should avoid alcoholic drinks during and for at least 3 days after therapy with metronidazole (Flagyl). Flagyl and alcohol together cause severe nausea and vomiting, flushing, fast heartbeat (tachycardia), and shortness of breath. The reaction has been described as being similar to the effects of Antabuse.
The nurse practitioner is evaluating a middle-aged woman who has experienced gradual weight gain, lack of energy, dry hair, and an irregular period for the past 8 months. Routine annual laboratory testing showed a thyroid-stimulating hormone (TSH) level of 10 mU/L. The nurse practitioner decides to order a thyroid profile. Results show that TSH is 8.50 mU/L and serum free T4 is decreased. During the physical exam, the patient's body mass index (BMI) is 28. The heart and lung exams are both normal. Which of the following is the best treatment plan for this patient? A) Advise the patient that the decreased thyroid-stimulating hormone (TSH) level means her thyroid problem has resolved B) Start the patient on levothyroxine (Synthroid) 0.25 mcg PO daily C) Start the patient on Armour thyroid D) Refer the patient to an endocrinologist
B) Start the patient on levothyroxine (Synthroid) 0.25 mcg PO daily The patient is symptomatic (weight gain, lack of energy, and irregular periods) with low free T4. Even though the thyroid-stimulating hormone (TSH) level decreased slightly, the free T4 remains low. An elevated TSH and low free T4 are indicative of hypothyroidism. The next step is to start the patient on levothyroxine (Synthroid) 0.25 mcg daily and recheck the TSH in 6 weeks. The goal is to normalize the TSH (between 1.0 and 3.5) and to ameliorate the patient's symptoms (increased energy, feels better, etc.). Armour thyroid (desiccated thyroid) is a natural supplement composed of dried (desiccated) pork thyroid glands. It is used in alternative medicine as an alternative to synthetic levothyroxine/T4 (Synthroid).
A middle-aged patient newly diagnosed with type 2 diabetes wants to start an exercise program. All of the following statements are true except: A) If the patient is unable to eat due to illness, antidiabetic agents can be continued with frequent glucose monitoring B) Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes C) Exercise increases the body's ability to metabolize glucose D) Patients who exercise vigorously in the afternoon may have hypoglycemic episodes in the evening or at night if they do not eat
B) Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. When exercising, the patient should monitor blood sugar closely, especially if using insulin, to avoid hypoglycemia.
The result of a postmenopausal woman's dual-energy x-ray absorption (DXA) scan shows osteopenia. Which of the following T-scores is indicative of osteopenia? A) T-score of −1.0 or higher B) T-score between −1. 0 to −2.5 C) T-score of less than −2.5 D) T-score of −2.50 to −3.50 E) Normal results
B) T-score between −1. 0 and −2.5 Osteopenia is defined as a T-score between −1. 0 and −2.5. Osteoporosis is defined as a T-score of −2.5 or below. The T-score is sometimes called the Z-score.
A college freshman who is using oral contraceptives calls the nurse practitioner's office asking for advice. She forgot to take her pills 2 days in a row during the second week of the pill cycle and wants to know what to do. What is the best advice? A) Start a new pack of pills and dispose of the old one B) Take two pills today and two pills tomorrow, and have your partner use condoms for the rest of the pill cycle C) Stop taking the pills right away, and start a new pill cycle in 2 weeks D) Take one pill today and two pills tomorrow, and have your partner use condoms
B) Take two pills today and two pills tomorrow, and have your partner use condoms for the rest of the pill cycle When forgetting to take the birth control pill on 2 consecutive days, it is recommended to take two pills immediately and two pills the next day, then continue the rest of the pack. Stress the importance of the use of condoms for protection against pregnancy and STIs.
A 13-year-old adolescent girl is brought to the health clinic by her mother for a sports physical. The mother reports that the teen's last vaccines were given at the age of 6 years. Which of the following vaccines is recommended by the Centers for Disease Control and Prevention (CDC) for this patient? A) Td and HPV vaccines B) Tdap, MCV4, and the HPV vaccines C) DTap and the flu vaccine D) DT and MCV4 vaccines
B) Tdap, MCV4, and the HPV vaccines Vaccine questions usually are not this complicated, but there are several lessons that can be learned with this question. The 2017 Centers for Disease Control and Prevention (CDC) recommendations for individuals 13 to 18 years of age are the Tdap catch-up (if not received at age 11-12 years), human papillomavirus (HPV) catch-up (if not received at age 11-12 years), and the MCV4 or meningococcal conjugate vaccine (Menactra). Only one dose of Tdap is recommended (lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP (diphtheria-tetanus-acellular pertussis) and DT (diphtheria-tetanus) forms of the tetanus vaccine are not given after the age of 7 years.
An 18-year-old female patient is being followed up for acne by the nurse practitioner. During the facial exam, papules and pustules are noted mostly on the forehead and the chin areas. The patient has been using prescription topical medications and overthe-counter medicated soap daily for 6 months without much improvement. Which of the following would the nurse practitioner recommend next? A) Isotretinoin (Accutane) B) Tetracycline (Sumycin) C) Clindamycin topical solution (Cleocin T) D) Minoxidil (Rogaine)
B) Tetracycline (Sumycin) First-line treatment for acne vulgaris includes over-thecounter medicated soap and water with topical antibiotic gels. The next step in treatment would be the initiation of oral tetracycline.
All of the following are true statements about the human papillomavirus vaccine (Gardasil) except: A) The Centers for Disease Control and Prevention (CDC) recommends the first dose at age 11 to 12 years B) The CDC does not recommend the HPV vaccine for males C) For children younger than age 14 years, only two doses of the vaccine are needed D) The minimum age at which the vaccine can be given is 9 years
B) The CDC does not recommend the HPV vaccine for males The HPV vaccine is now recommended for both males and females. If it is given before age 14 years, only two doses are required, But if the child is older than 14 years, three doses are required to be given over 6 months. The vaccine can be given until the age of 26 years, especially if the individual is at high risk. Do not use the vaccine in children younger than 9 years. There are two types of HPV vaccine (Gardasil and Cervarix). Gardasil can be used for both genders, but Cervarix can only be used for females.
Which of the following is not an absolute contraindication for use of oral contraceptive pills? A) Active hepatitis A infection B) Thrombosis related to an IV needle C) Undiagnosed vaginal bleeding D) Transient ischemic attack (TIA)
B) Thrombosis related to an IV needle Thrombosis related to either a known trauma or an IV needle does not represent a contraindication for use of oral contraceptives.
The best screening test for both hyperthyroidism and hypothyroidism is: A) Free T4 (thyroxine) B) Thyroid-stimulating hormone (TSH) C) Thyroid profile D) Palpation of the thyroid gland
B) Thyroid-stimulating hormone (TSH) The best screening test for both hypothyroidism and hyperthyroidism is TSH level. A normal TSH rules out primary hypothyroidism in asymptomatic patients. Abnormal TSH should be followed by determination of thyroid hormone levels. Overt hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 μU/mL), and normal circulating thyroid hormone. Overt thyrotoxicosis is defined as the syndrome of hyperthyroidism associated with suppressed TSH and elevated serum levels T4 or T3. Subclinical thyrotoxicosis is devoid of symptoms, but TSH is suppressed, although there are normal circulating levels of thyroid hormone.
You have diagnosed a 30-year-old male patient with contact dermatitis on the left side of the face secondary to poison ivy. You would recommend: A) Washing with antibacterial soap BID to reduce risk of secondary bacterial infection until it is healed B) Zanfel poison ivy wash C) Clotrimazole (Lotrimin) cream BID for 2 weeks D) Halcinonide (Halog) 1% ointment BID for 2 weeks
B) Zanfel poison ivy wash Zanfel is a soap-like product (OTC) that removes urushiol oil from poison ivy, poison sumac, and poison oak. It will relieve the itch and pain quickly. A topical steroid can be used to speed up healing. For rashes, hydrocortisone cream 1% BID (OTC) is helpful.
Which of the following is used to confirm a diagnosis of Hashimoto's thyroiditis? A) Serum thyroid-stimulating hormone (TSH) B) Free T4 test C) Anti-thyroid peroxidase and anti-thyroglobulin antibodies D) Thyroid ultrasound
C) Anti-thyroid peroxidase and anti-thyroglobulin antibodies These are the two types of antibodies that are positive in Hashimoto's thyroiditis. Anti-thyroid peroxidase antibody is also known as antimicrosomal antibody. Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States. The serum TSH and free T4 test are tests for hypothyroidism, but they are not specific for Hashimoto's thyroiditis, an autoimmune disease.
Which of the following classes of drugs is implicated with blunting the signs and symptoms of hypoglycemia in diabetics? A) Calcium channel blockers B) Diuretics C) Beta-blockers D) Angiotensin receptor blockers (ARBs)
C) Beta-blockers Beta-blockers are known to blunt the signs and symptoms of hypoglycemia in patients with diabetes.
Candidal intertrigo is the name for an infection that is caused by the yeast Candida albicans. What is the location of this type of candida infection? A) Scalp B) Flexor areas of the elbows and the knees C) Body areas where skin rubs together, such as under breasts or in groin area D) Hands
C) Body areas where skin rubs together, such as under breasts or in groin area Candidal intertrigo infections are more common in obese individuals and in women with pendulous breasts. It is found in areas where skin rubs against skin (under breasts, in the groin area, and on stomach folds in the obese). It is more common in warm and humid weather (summer).
A first-grader presents to a school nurse practitioner with a few blisters on one arm and on his face. The child keeps scratching the affected areas. Some of the lesions have ruptured with yellow serous fluid that crusts easily. These findings best describe: A) Acute cellulitis B) Herpes zoster C) Bullous impetigo D) Erysipelas
C) Bullous impetigo Bullous impetigo is an infection of the skin caused by Staphylococcus aureus, which produces exfoliative toxin A. The infection is more common in young children. It is characterized by flaccid large blisters filled with serous fluid. When the bullae rupture, the serous fluid dries up and resembles honey-colored crusts. If the child has a limited number of skin lesions, topical therapy with mupirocin (Bactroban) is effective. But if lesions are extensive, systemic antibiotics, such as Dicloxacillin and cephalexin, are the treatment of choice.
Balanitis is caused by: A) Staphylococcus aureus B) Streptococcus pyogenes C) Candida albicans D) Trichomonads
C) Candida albicans Balanitis is a yeast infection of the glans of the penis. Candida albicans is the causative source. Staphylococcus aureus and Streptococcus pyogenes are bacterial infections. Trichomonads are protozoans that cause infection.
A 36-year-old woman is seen by the nurse practitioner for a Pap smear and gynecological exam. The patient is of Ashkenazi Jewish ethnicity. Her mother died of breast cancer at age 50 years. Her 57-year-old sister has recently been diagnosed with breast cancer. The breast exam is negative for a dominant mass and the axillae do not contain any masses. All of the following are appropriate measures for this patient except: A) Mammogram and MRI of the breast B) Referral to a breast specialist C) Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels D) Genetic counseling and BRCA testing
C) Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels The patient is a woman who is of Ashkenazi Jewish background with a positive family history of breast cancer (mother, sister). She is at very high risk for BRCA1 or BRCA2 mutations (hereditary breast cancer). The U.S. Preventive Services Task Force (2013) recommends that primary care providers screen women for a family history of breast, ovarian, tubal, or peritoneal cancer. Women with positive screening results should receive genetic screening, and, if indicated after counseling, BRCA testing. These high-risk women are screened with a mammogram and breast MRI and are best managed by breast cancer specialists.
The following conditions are absolute contraindications for the use of oral contraceptives except: A) Sexually active patient with amenorrhea B) History of emboli that resolved with heparin therapy 15 years ago C) Cigarette smoking at the age of 30 years D) Hepatitis C infection
C) Cigarette smoking at the age of 30 years Cigarette smoking at age 30 years is considered a relative—not absolute—contraindication. However, in a patient aged 35 years or older, smoking is an absolute contraindication. Pregnancy or suspected pregnancy is another absolute contraindication (sexually active woman who presents with amenorrhea). Liver tumors or impaired liver function is also an absolute contraindication (hepatitis C infection).
The nurse practitioner who suspects that one of her hypertensive patients has Cushing's syndrome would expect to find which of the following laboratory results? A) Hyponatremia B) Hypoglycemia C) Elevated serum cortisol levels D) Decreased urine 17-ketosteroids
C) Elevated serum cortisol levels Elevated serum cortisol levels are seen in patients with Cushing's syndrome.
A 19-year-old woman has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (−), anti-HBs (−), anti-HCV (−), anti-HAV (+)? A) Hepatitis B vaccination B) Hepatitis B immunoglobulin C) Hepatitis B vaccination and hepatitis B immunoglobulin D) No vaccination is needed at this time
C) Hepatitis B vaccination and hepatitis B immunoglobulin Hepatitis B surface antigen (HBsAg) is a marker of infectivity. If positive, it indicates either an acute or a chronic hepatitis B infection. Antibody to hepatitis B surface antigen (anti-HBs) is a marker of immunity. Antibody to hepatitis B core antigen (anti-Bc) is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection; it may be used in prevaccination testing to determine previous exposure to HBV. The hepatitis B panel results for the individual in this question (negative HBsAg, anti-HBc, and anti-HBs) indicates the partner is susceptible (not immune), has not been infected, and is still at risk of future infection—and thus needs vaccine. Interpretation of the negative hepatitis C anti-HCV screening test indicates that the partner is not infected. Hepatitis B immunoglobulin contains antibodies that provide "instant" immunity against hepatitis B, but its action lasts for several days, only. It is not a vaccine. It is given to infants and others who are at high risk of becoming infected and are not immune. The hepatitis B vaccine stimulates the body to make its own antibodies, which are permanent. A total of three doses are needed to gain full immunity against hepatitis B.
A 17-year-old high school student is considering her birth control options. She wants to know more about Seasonale. Which of the following statements is false? A) Taking Seasonale results in only four periods per year B) Her period will occur within the 7 days when she is on the inert pills C) It is a progesterone-only method of birth control and does not contain estrogen D) Take one tablet daily for 84 consecutive days followed by 7 days of inert pills
C) It is a progesterone-only method of birth control and does not contain estrogen Seasonale is an extended-cycle form of birth control. It contains both levonorgestrel and ethinyl estradiol. There are 84 pink tablets (active) and seven white pills (inert). In general, more spotting (breakthrough bleeding) is experienced with extended-cycle pills during the first few months of use (compared with the monthly birth control pills).
The Somogyi effect is characterized by which of the following? A) It is a complication of high levels of growth hormone B) It is the physiological spike of serum blood glucose in the early morning that is caused by secretion of growth hormone C) It is characterized by high fasting blood glucose in the morning that is caused by the secretion of glucagon by the liver D) It is a rare phenomenon that only occurs in type 1 diabetic patients
C) It is characterized by high fasting blood glucose in the morning that is caused by the secretion of glucagon by the liver The Somogyi phenomenon or Somogyi effect occurs when nocturnal hypoglycemia (2 a.m.-3 a.m.) stimulates the liver to produce glucagon, which causes the fasting blood glucose to become elevated. It is also known as the "rebound effect
A new patient who is a 40-year-old female postal worker is being evaluated for complaints of a new-onset erythematous rash on both cheeks and the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with Synthroid 1.25 mg daily. Which of the following conditions is most likely? A) Atopic dermatitis B) Thyroid disease C) Lupus erythematosus D) Rosacea
C) Lupus erythematosus Classic symptoms of lupus erythematosus are butterfly rash across both cheeks and the bridge of the nose, and fatigue. Risk factors also include being female and 40 years old.
A 65-year-old woman's bone density result shows severe demineralization of cortical bone. All of the following pharmacological agents are useful in treating this condition except: A) Raloxifene (Evista) B) Calcitonin (Miacalcin) C) Medroxyprogesterone (Depo-Provera) D) Calcium with vitamin D
C) Medroxyprogesterone (Depo-Provera) Long-term use (>3 years) of medroxyprogesterone (Depo-Provera) increases risk of bone loss. Avoid with osteopenia, osteoporosis, long-term amenorrhea, or in underweight women with anorexia. First-line treatment of osteoporosis is the biphosphanates. Lifestyle measures are weight-bearing exercises and adequate calcium and vitamin D intake.
All of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except: A) Patients with renal disease B) Patients with hypoxia C) Obese patients D) Patients who are alcoholics
C) Obese patients Metformin is used for initial therapy for type 2 diabetes. In patients who are obese, it can help with weight loss. The starting dose is 500 mg once a day. Maximum dose is 2 g or 2,000 mg/day. Titrate dose slowly to minimize side effects (flatus, bloating, and diarrhea). Contraindications to the use of metformin include significant renal and hepatic disease, alcoholism, conditions associated with hypoxia (cardiac/ pulmonary problems), sepsis, dehydration, and advanced age.
All of the following factors are associated with a higher risk of osteopenia and osteoporosis except: A) Excessive alcohol intake and cigarette smoking B) Asian or Caucasian ancestry C) Obesity D) Older age
C) Obesity Obesity is not a risk factor for bone loss. But being female, older age, in menopause, having a small thin frame, being of Caucasian or Asian race, family history of osteoporosis, excessive alcohol use, and long-term cigarette smoking are risk factors.
Kyphosis is a late sign of: A) Rheumatoid arthritis B) Osteopenia C) Osteoporosis D) Osteoarthritis
C) Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain.
A 65-year-old woman comes into the clinic during the first week of November for her annual wellness visit. Her last Td booster was 9 years ago. Which immunization(s) would you recommend for this visit? A) Influenza vaccine only B) Tetanus and influenza vaccine C) Pneumococcal (Pneumovax) and influenza vaccines D) She does not need any vaccinations to be administered in this visit
C) Pneumococcal (Pneumovax) and influenza vaccines The tetanus (Td) immunization is good for about 10 years. October/November is the beginning window of the flu season, and annual influenza vaccination is recommended. The pneumococcal (pneumonia) vaccine is indicated for patients older than 65 years.
Which of the following substances is responsible for the symptoms of dysmenorrhea? A) Estrogen B) Human chorionic gonadotropin C) Prostaglandins D) Progesterone
C) Prostaglandins Prostaglandins are hormones the body produces prior to menses; they eventually cause the uterus to contract to shed the endometrial lining. Contractions cause pain. The greater the amount of prostaglandins that are released, the more pain one will experience. Contractions of the uterus cause vasoconstriction of blood supply to the uterus, which, in turn, will cause pain.
A 13-year-old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with over-the-counter benzoyl peroxide and topical salicylic acid products. Which of the following would be recommended next? A) Isotretinoin (Accutane) B) Tetracycline C) Retin-A 0.25% gel D) Careful face washing with medicated soap at bedtime
C) Retin-A 0.25% gel Topical agents are the first-line treatment for acne vulgaris. Retin-A 0.25% gel would be the next step. Oral preparations (tetracycline) would then be offered, and Accutane would be the final step.
A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: A) Hot flashes B) Irregular menstrual periods C) Severe vaginal atrophic changes D) Cyclic mood swings
C) Severe vaginal atrophic changes As women reach menopause, changes that may occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal changes, such as dryness and thinning, may also begin to occur. Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause and worsens as women get older.
Which of the following T-scores is indicative of osteoporosis? A) T-score of 0 to −1.0 B) T-score of −1.0 to −2.0 C) T-score of −2.5 or less D) Diagnosis is based on an x-ray series of the spine
C) T-score of −2.5 or less Osteoporosis is defined as having a T-score of −2.5 or less. Risk factors should also be considered when interpreting T-scores for diagnosis.
All of the following are correct statements regarding oral contraceptives except: A) The actual failure rate of oral contraceptives is 3% B) Desogestrel belongs to the progesterone family of drugs C) The newer low-dose birth control pills do not require backup during the first 2 weeks of use D) Oral contraceptives are contraindicated for women 35 years of age or older who smoke
C) The newer low-dose birth control pills do not require backup during the first 2 weeks of use All forms of oral contraceptive pills require a second backup method of contraception during the first 2 weeks of use. It is possible to have "breakthrough" ovulation in the first week when taking birth control pills for the first time; therefore, a second backup (condoms) is recommended.
A 19-year-old student who is on a prescription of combined oral contraceptive pills is being seen for an annual gynecological exam in the college health center. The nurse practitioner has obtained the Pap smear and is about to perform the bimanual exam. She gently removes the plastic speculum from the vagina. While the NP is performing the bimanual vaginal exam, the patient complains of slight discomfort during deep palpation of the ovaries. Which of the following is a true statement? A) The uterus and the ovaries are both very sensitive to any type of palpation B) The fallopian tubes and ovaries are not sensitive to light or deep palpation C) The ovaries are sensitive to deep palpation but they should not be painful D) The uterus and the ovaries are not important organs of reproduction
C) The ovaries are sensitive to deep palpation but they should not be painful The ovaries are usually slightly sensitive to deep palpation, but they should not be painful. Unilateral adnexal pain accompanied by cervical motion tenderness and purulent endocervical discharge is suggestive of pelvic inflammatory disease (PID).
A sexually active 22-year-old man is asking to be screened for hepatitis B because his new girlfriend has recently been diagnosed with hepatitis B infection. His lab results are the following: anti-HBV is negative, HBsAg is positive, and HBeAg is negative. Which of the following is true? A) The patient is immune to the hepatitis B virus B) The patient is not infected with hepatitis B virus C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin D) The patient needs only hepatitis B immunoglobulin
C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin Because he is HBsAg positive, and anti-HBV and HBeAg negative, he needs hepatitis B immunoglobulin and hepatitis B vaccine.
The earliest age at which the MMR vaccine can be administered is: A) 4 months B) 6 months C) 8 months D) 12 months
D) 12 months The earliest age at which MMR vaccination should be given is 12 months. Giving the vaccine any earlier may be less effective because the infant still has antibodies from the mother, which may interfere with the production of the antibodies stimulated by the vaccine.
All of the following patients should be screened for diabetes mellitus except: A) An obese man of Hispanic descent B) An overweight middle-aged Black woman whose mother has type 2 diabetes C) A woman who delivered an infant weighing 9.5 lbs D) A 30-year-old White man with hypertension
D) A 30-year-old White man with hypertension The 30-year-old White man with hypertension would be the last patient to be screened for diabetes. Not having any information about him also puts him lower on the list. Obesity, ethnicity (Hispanic/Latino Americans, African Americans, Native Americans, Asian Americans, Pacific Islanders, and Alaska natives), family history of diabetes, and gestational diabetes (mother of the infant weighing 9.5 lbs) are all risk factors. These were present in all of the other selections. Other risk factors for diabetes include impaired glucose tolerance test, sedentary lifestyle, polycystic ovary syndrome (PCOS), and hypertension.
A 15-year-old boy has just moved into the community and is staying in a foster home temporarily. There is no record of his immunizations. His foster mother wants him to be checked before he enters the local high school. Which of the following immunizations does this patient need? A) Meningococcal vaccine B) Measles-mumps-rubella (MMR) vaccine C) Tdap vaccine D) All of the above
D) All of the above This 15-year-old teenage patient will follow the Centers for Disease Control and Prevention (CDC) "catch-up" schedule (CDC, 2017) and needs the meningococcal vaccine, MMR vaccine, and Tdap vaccine. In addition to these three vaccines, this patient needs the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and varicella vaccine (if no history of chickenpox).
An obese Asian patient with BMI (body mass index) of 33 complains of fatigue, and excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to confirm diagnosis can include: A) Fasting plasma glucose level B) Glycated hemoglobin level (A1C) C) Oral glucose tolerance testing D) All of the above
D) All of the above Type 2 diabetes mellitus screening tests include fasting plasma glucose level (>126 mg/dL), random plasma glucose level (>200 mg/dL), and oral glucose tolerance testing (2-hour blood glucose level >200 mg/dL) with a 75-g glucose load. Normal A1C levels are less than 6%.
A 5-year old boy is in your office for a school physical. The mother denies a history of chickenpox infection. Which of the following immunizations is indicated at this visit? A) Tdap, IPV, MMR B) DTaP, Hib, PCV, IPV C) MMR, hepatitis B, varicella D) DTaP, IPV, MMR, varicella
D) DTaP, IPV, MMR, varicella The best clue is that the mother denies a history of chickenpox infection; therefore, this child requires the varicella vaccine. Only two answer options include varicella. The child does not need hepatitis B vaccination.
Which of the following is considered a relative contraindication for combined oral contraceptive pills? A) Undiagnosed vaginal bleeding B) Hepatoma of the liver C) Suspected history of transient ischemic attacks (TIAs) D) Depression
D) Depression Depression is a relative contraindication for combined oral contraceptive pills (OCPs) due to their hormonal effects, which can affect mood. Absolute contraindications include hepatoma of the liver, history of embolic episode, history of transient ischemic attacks (TIAs), and undiagnosed vaginal bleeding. OCPs should not be considered for patients with a history of these problems due to the potential health risks.
A common side effect of metformin (Glucophage) therapy is: A) Weight gain B) Lactic acidosis C) Hypoglycemic episodes D) Diarrhea
D) Diarrhea Common side effects of metformin (Glucophage) include diarrhea, stomach pain, nausea, and flatulence.
An Rh-negative pregnant woman with negative rubella titers can be vaccinated at what time in pregnancy? A) At any time in pregnancy B) During the second trimester C) During the third trimester D) During the postpartum period
D) During the postpartum period The measles, mumps, and rubella (MMR) vaccine is contraindicated in pregnancy. The Advisory Committee on Immunization Practices recommends that regnancy be avoided for 4 weeks after vaccination, that women who become pregnant within that period be advised of the theoretical risk to the fetus (congenital rubella syndrome), and that vaccination during pregnancy is generally not a reason to terminate the pregnancy.
You would recommend the pneumococcal vaccine (Pneumovax) to patients with all of the following conditions except: A) Sickle cell anemia B) Splenectomy C) HIV infection D) G6PD-deficiency anemia
D) G6PD-deficiency anemia Pneumococcal vaccine is not indicated for glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia. There two types of pneumonia vaccine for adults: PPSV23 (Pneumovax 23) and PCV13 (Prevnar 13). Pneumococcal vaccine is recommended for individuals beginning at age 65 years, but the two types should not be given together. The Centers for Disease Control and Prevention (CDC) recommends administering Prevnar 13 first, then waiting at least 1 year (12 months) and giving the Pneumovax. The immunogenic response is better using this method. Prevnar 13 is recommended for all infants and children younger than 2 years of age, all adults aged 65 years or older, and people (2 to 64 years old) with certain medical conditions that increase risk of pneumococcal disease, such as functional or anatomic asplenia (sickle cell), HIV infection, chronic renal failure, leukemia, heart failure, cyanotic congenital heart disease, chronic lung disease (asthma, chronic obstructive pulmonary disease [COPD]), diabetes, and others.
Which of the following drug classes is associated with rhabdomyolysis? A) Biguanides B) Thiazolidinediones C) Tetracyclines D) HMG-CoA reductase inhibitors
D) HMG-CoA reductase inhibitors The HMG-CoA (hydroxy-methylglutaryl coenzyme A) reductase inhibitors, commonly referred to as statins, include simvastatin, atorvastatin, and others. High-dose statins or combining statins with fibrates and/or niacin will increase the risk of rhabdomyolysis and drug-induced hepatitis. Rhabdomyolysis can cause acute renal failure. If this complication is suspected, refer the patient to a physician or the emergency department. Biguanides (metformin), thiazolidinediones (pioglitazone), and tetracyclines (doxycycline) do not cause rhabdomyolysis.
All of the following are considered risk factors for urinary tract infections in women except: A) Diabetes mellitus B) Diaphragms and spermicide use C) Pregnancy D) Intrauterine device
D) Intrauterine device An intrauterine device (IUD) is not a risk factor for urinary tract infections (UTIs). In addition to causing increased urine glucose, diabetes may increase the risk of UTIs through mechanisms that include impaired immune cell delivery, inefficient white blood cells, and inhibition of bladder contractions that allow urine to remain stagnant in the bladder. Diaphragms are associated with an increased risk of UTIs. Urinating before inserting the diaphragm and also after intercourse may reduce this risk. Hormonal and mechanical changes increase the risk of urinary stasis and vesicoureteral reflux. These changes, along with an already short urethra (approximately 3-4 cm in females) and difficulty with hygiene due to a distended pregnant belly, increase the frequency of UTIs in pregnant women. Indeed, UTIs are among the most common bacterial infections during pregnancy.
The following are acceptable methods of birth control for breastfeeding mothers except: A) Diaphragm with spermicidal gel B) Progesterone-only pills (Micronor) C) Condoms D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Loestrin)
D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin) Low-dose oral contraceptives that contain estradiol are contraindicated for breastfeeding mothers. Estrogen is an FDA pregnancy category X drug and it should not be given to pregnant, suspect pregnant, or breastfeeding women. Breastfeeding women may use progestin-only pills (POP), but they are not as effective as combined oral contraceptives. They are more effective if breastfeeding (100%). Mechanical forms of birth control (condoms, diaphragms) and the IUD are other options of birth control for this population.
A 70-year-old man with open-angle glaucoma is prescribed Betimol (timolol) ophthalmic drops. All of the following are contraindications to Betimol ophthalmic drops except: A) Overt heart failure or sinus bradycardia B) History of asthma C) Second- or third-degree atrioventricular (AV) block D) Migraine headaches
D) Migraine headaches Migraines are not a contraindication to Betimol (timolol). Contraindications include bronchial asthma, asthma history, severe COPD, uncompensated heart failure, second- or third-degree AV block, sinus bradycardia, and cardiogenic shock. Caution should be used if the following conditions are present: closed-angle glaucoma, peripheral vascular disease, bronchospastic disease, diabetes, hyperthyroidism, and myasthenia gravis.
Which of the following findings is associated with thyroid hypofunction? A) Graves' disease B) Eye disorder C) Thyroid storm D) Myxedema
D) Myxedema Myxedema (or myxedema) is seen in patients with severe hypothyroidism. It refers to the skin changes (thickened skin) seen in chronic severe hypothyroidism. Myxedema coma is a medical emergency with mortality rates exceeding 20%. It is treated with very high doses of thyroid hormone. A thyroid storm occurs when there is extreme elevation of thyroid hormones. Thyroid storm is life-threatening; untreated, the mortality rate is about 90%. Call 911 if suspected.
A female patient, who has a BMI (body mass index) of 29 has a 20-year history of primary hypertension. She has been taking hydrochlorothiazide 25 mg PO daily with excellent results. On this visit, she complains of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. She reports to the nurse practitioner that she has been having this problem for about 6 months. Upon reading the chart, the nurse practitioner notes that the last two fasting blood glucose levels have been 140 mg/dL and 168 mg/dL. The result of a random blood glucose test is 210 mg/dL. Which of the following is the appropriate action to follow at this visit? A) Order another random blood glucose test in 2 weeks B) Initiate a prescription of metformin (Glucophage) 500 mg PO BID C) Order a 3-hour glucose tolerance test D) Order an A1C level
D) Order an A1C level. The next step is to check the A1C level. The treatment goal is an A1C less than 7%. But if the patient is frail or has frequent hypoglycemic episodes, the American Diabetes Association allows a goal of up to 8%. If the A1C level is 6.5 or higher, the patient has type 2 diabetes.
All of the following medications have drug interactions with levothyroxine (Synthroid) except: A) Antacids B) Tricyclic antidepressants C) Anticoagulants D) Penicillins
D) Penicillins Levothyroxine does not interact with penicillins. But it does have numerous drugs it interacts with such as anticoagulants, tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton-pump inhibitors, estrogens, statins, metformin, and others. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together, and should space these foods and drugs several hours apart. Levothyroxine (Synthroid) is a synthetic form of T4.
A 45-year-old gardener is seen as a walk-in patient in a private clinic. He reports stepping on a nail that morning. His last tetanus vaccine was 7 years ago. Which of the following vaccines is recommended? A) DTaP B) DT C) Td D) Tdap
D) Tdap The Centers for Disease Control and Prevention (CDC) recommends that one of the tetanus boosters be replaced with the Tdap (once in a lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP (diphtheria-tetanus-acellular pertussis) and DT (diphtheria-tetanus) forms of the tetanus vaccine are not given after the age of 7 years. Puncture wounds are at higher risk for tetanus because Clostridium tetani bacteria are anaerobes (deep puncture wounds are not exposed to air compared with superficial wounds).
A 72-year-old woman complains of a crusty and nonhealing small ulcer on her upper lip that she has had for several years. Which of the following would you recommend? A) Triamcinolone acetonide (Kenalog) cream BID for 2 weeks B) Triple antibiotic ointment BID × 2 weeks C) Hydrocortisone 1% cream BID for 2 weeks D) The patient needs to be evaluated by a dermatologist
D) The patient needs to be evaluated by a dermatologist Nonhealing ulcers of the skin are a risk for skin cancer and should be evaluated by a dermatologist for treatment.
Which of the following antihypertensive medications has beneficial effects for an elderly White woman with osteoporosis? A) Calcium channel blockers B) Angiotensin-converting enzyme (ACE) inhibitors C) Beta-blockers D) Thiazide diuretics
D) Thiazide diuretics Thiazide diuretics have a favorable effect in patients with osteopenia and osteoporosis by slowing down the kidney's excretion of calcium and increasing distal tubule calcium reabsorption. This results in decreased bone demineralization. Thiazide diuretics are a good choice of therapy for this population because they treat hypertension and slow bone loss.
Acanthosis nigricans is associated with all of the following disorders except: A) Obesity B) Diabetes C) Colon cancer D) Tinea versicolor
D) Tinea versicolor Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It appears as hyperpigmented velvety areas that are usually located on the neck and the axillae. It is rarely associated with some types of adenocarcinoma of the gastrointestinal tract. Tinea versicolor is a superficial infection of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the tinea family. Another name for it is sunspots.
