leik- Pediatrics- Hematologic disorders; Congenital and Inherited Disorders, injury, GI/GU

72.The lipid panel results of an otherwise healthy 17-year-old female show total cholesterol of 192 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, low-density lipoprotein (LDL) of 120 mg/dL, and triglycerides of 170 mg/dL. The nurse practitioner asks the patient: A.Did you fast for 12 hours before the blood work was drawn? B.Did you eat a high-fat meal the evening before the blood work was drawn? C.Have you been exercising at least three times a week? D.Have you been eating more than usual?

A) "Did you fast for 12 hours before the blood work was drawn?" A complete lipid panel requires 12 hours of fasting to ensure accurate results and interpretation. If the patient does not fast, it may impact the triglyceride level. Triglycerides of 170 mg/dL in an otherwise healthy 17-year-old female patient may indicate that the patient did not fast. The nurse practitioner should schedule a follow-up lipid panel in 3 months to confirm whether the result was accurate.

108.Which is the most common type of cancer in young children? A.Acute lymphoblastic leukemia B.Multiple myeloma C.Aplastic anemia D.Non-Hodgkin's lymphoma

A) Acute lymphoblastic leukemia. Acute lymphoblastic leukemia, a malignancy of the bone marrow, is the most common type of cancer in children. It is more common in boys and in children between the ages of 2 and 4 years. Aplastic anemia is bone marrow suppression (not cancer) usually caused by medications or a viral infection. Multiple myeloma and non-Hodgkin's lymphoma are more common in older adults.

34.The nurse practitioner is performing screenings for scoliosis. What will the nurse practitioner do to accurately perform this screening? A.Ask patient to stand firmly on both feet and bend forward at the hips while arms hang free B.Abduct the patient's hips and listen for a clicking sound C.Ask patient to shrug their shoulders as the nurse practitioner applies pressure to both shoulders D.Ask patient to raise the heel of the right foot and slide the heel down the knee of the left leg while in a standing position

A) Ask patient to stand firmly on both feet and bend forward at the hips while arms hang free. To screen for scoliosis, a lateral curvature of the spine, the patient should stand firmly on both feet with the trunk exposed and arms hanging free. The nurse practitioner examines the adolescent from behind, checking for asymmetry of the shoulders, scapulae, and hips. The nurse practitioner should ask the patient to bend forward at the hips and then inspect for a rib hump, which is another sign of scoliosis. The nurse practitioner would listen for a clicking sound while the patient abducts the hips when screening for congenital hip dysplasia. Having the adolescent shrug their shoulders against mild resistance helps evaluate the integrity of cranial nerve XI. The heel-to-shin test evaluates cerebellar function.

103.What dietary guidance will the nurse practitioner provide to a patient newly diagnosed with celiac disease? A.Avoid all gluten-containing foods indefinitely B.Eat wheat breads sparingly C.Avoid all milk and dairy products D.Consume pasta in moderation

A) Avoid all gluten-containing foods indefinitely. Persons with celiac disease must avoid gluten and gluten-containing cereals and foods throughout their lifetime. Wheat and pasta contain gluten and must be avoided. Milk and dairy products are gluten-free.

2.A young adult male visits the urgent care clinic after falling and landing on his buttocks. He complains of feeling electrical impulses traveling down both legs and inability to urinate. Upon physical examination, the nurse practitioner notes decreased lower extremity strength and reflexes. Which diagnosis is most likely? A.Cauda equina syndrome B.Lumbar stenosis C.Fibromyalgia D.Paget's disease of bone

A) Cauda equina syndrome. Cauda equina syndrome is an acute-onset saddle anesthesia that affects the nerve roots from L1 to L5 and S1 to S5. Symptoms may include bladder incontinence or retention, fecal incontinence, weakness, and bilateral leg numbness. It results from trauma, disease, or infection that puts pressure on the sacral nerve roots and causes inflammatory changes to the nerves. Scoliosis is a sideways curvature of the spine that is most often noted during the growth spurt just before puberty. Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Paget's disease of bone interferes with the body's normal recycling process in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen.

101.A 2-day-old full-term infant presents with jaundice symptoms. Which of the following interventions should be implemented first? A.Check bilirubin level B.Schedule a follow-up visit C.Advise parent to feed infant 5 to 6 times per day D.Prescribe phototherapy

A) Check bilirubin level. The first intervention is to assess the bilirubin level of the infant before treatment is initiated. If the bilirubin level is >15 mg/dL, phototherapy should be prescribed. The parent should be advised to feed the infant 10 to 12 times per day, and a follow-up visit is indicated once a diagnosis is confirmed.

100.Which assessment finding is associated with a diagnosis of proximal hypospadias? A.Chordee B.Hydrocele C.Micropenis D.Inguinal hernia

A) Chordee. Chordee, the presence of ventral shortening and curvature of the penis, is commonly associated with a more proximal urethral defect. Hydrocele, micropenis, and inguinal hernia are not specifically associated with a diagnosis of proximal hypospadias.

114.Which hematologic finding would be expected in an 18-month-old patient diagnosed with beta thalassemia minor? A.Decreased hemoglobin A B.Normochromic red blood cells C.Elevated mean corpuscular volume D.Elevated mean corpuscular hemoglobin concentration

A) Decreased hemoglobin A. Decreased hemoglobin A is associated with beta thalassemia minor. The red blood cells in beta thalassemia are hypochromic. A decrease in mean corpuscular volume and mean corpuscular hemoglobin concentration are associated with beta thalassemia.

124.The mother of an 8-year-old boy reports the presence of a round red rash on the child's left lower leg. It appeared 1 week after the child returned from visiting his grandparents, who live in Massachusetts. During the skin exam, the maculopapular rash is noted to have areas of central clearing, making it resemble a round target. Which condition is most likely? A.Erythema migrans B.Rocky Mountain spotted fever C.Meningococcemia D.Larva migrans

A) Erythema migrans. Erythema migrans is a symptom of early Lyme disease. It is an annular lesion that slowly enlarges with time (days to weeks) and has central clearing. It is caused by a bite from an infected (Borrelia burgdorferi) blacklegged tick. If untreated, infection will spread to the joints, nervous system, and heart. Most cases of Lyme disease occur in the Northeast, mid-Atlantic states, Wisconsin, Minnesota, and northern California.

118.A 20-year-old college athlete presents with weight loss and amenorrhea for 6 months. She had a period 7 months ago and denies sexual activity. The patient's body mass index (BMI) has decreased to 16.4, her pulse is 52 beats/min and weak, and her blood pressure is 84/54 mmHg. What will the nurse practitioner assess next? A.Fingerstick glucose B.Exercise routine C.Eating habits D.Medication use

A) Fingerstick glucose. Assessing blood glucose level on this patient is a priority, as hypoglycemia is a complication from secondary amenorrhea. Exercise, eating habits, and medication use would be assessed to determine differential diagnosis, after the glucose test is administered.

17.The nurse practitioner recently increased a patient's antipsychotic medication and is assessing the patient in a follow-up appointment. All of the following symptoms suggest the patient is experiencing malignant neuroleptic syndrome, except: A.Headache B.Tremors C.Muscular rigidity D.Fever

A) Headache. Malignant neuroleptic syndrome is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, mental status changes, and diaphoresis. Headache is not a manifestation of malignant neuroleptic syndrome and would not contribute to confirmation of this diagnosis.

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

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

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

A) Inflammation of the median nerve. The Phalen maneuver is a diagnostic test for carpal tunnel syndrome. The test is performed by pushing the back of the hands together for 1 minute. This compresses the median nerve within the carpal tunnel. Characteristic symptoms (burning; tingling; numbness over the thumb, index, middle, and ring fingers) convey a positive test result.

44.The Lachman maneuver is used to detect: A.Instability of the knee B.Nerve damage of the knee due to past knee injuries C.Integrity of the patellar tendon D.Tears on the meniscus of the knee

A) Instability of the knee. The Lachman maneuver is a test performed to assess for knee instability (i.e., damage to the motion of anterior translation [laxity] of the anterior cruciate ligament [ACL]) or tear of the ACL. The maneuver should be tested on both knees, comparing the injured and the opposite knee; the uninjured knee is used as the "control." The test is positive if the injured knee slips back further (laxity). Perform the test by bending the knee 30 degrees. Stabilize the femur with one hand. Place the other hand under the proximal tibia at the level of the joint line and then pull forward. The laxity is graded on a 0 (normal)-to-3 scale (1.0-1.5 cm of translation).

62.Which hemopoietic disorder will the nurse practitioner assess for in a 3-year-old child with lead poisoning? A.Iron-deficiency anemia B.Thalassemia minor C.Pernicious anemia D.Normocytic anemia

A) Iron-deficiency anemia. There is a strong association between lead poisoning and iron deficiency in children as both diagnoses are common in patients of lower socioeconomic status. Iron deficiency has also been shown to increase lead retention in the tissues, leading to increased absorption and toxicity. Thalassemia minor is an inherited blood disorder. Pernicious anemia is a consequence of the inability to absorb vitamin B12. Normocytic anemia results from a long-term chronic disease and generally occurs in older adults rather than children.

157.The nurse practitioner is reviewing the bilirubin level of a 3-day-old, full-term neonate and notes that it is 10 mg/dL. The infant has a slight yellow color to his skin, mucous membranes, and sclerae. The infant is feeding well, is not irritable, and has 8 to 10 wet diapers per day. Which of the following is a true statement? A.Keep monitoring the infant's bilirubin level until it returns to normal in about 1 week B.Recommend that the infant be treated with phototherapy 10 minutes a day until the bilirubin level is back to a normal range C.Refer the infant to a neonatologist as soon as possible D.Refer the infant to the neonatal intensive care unit

A) Keep monitoring the infant's bilirubin level until it returns to normal in about 1 week. Bilirubin is excreted through the urine and feces. Increased fluids and wetting 8 to 10 diapers a day is sufficient fluid intake/excretion to help bring down the bilirubin level. Levels should continue to be monitored and should improve in approximately 1 week.

125.The nurse practitioner is assessing a 14-year-old female who is 20% underweight for her height. The nurse practitioner notes the patient has thinning hair and brittle nails as well as fine, downy body hair on her back. How will the nurse document the body hair finding on the back? A.Lanugo B.Actinic keratosis C.Russell's sign D.Telogen effluvium

A) Lanugo. The appearance of fine, downy body hair should be documented as lanugo, commonly associated with anorexia nervosa. Actinic keratosis is a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck. Russell's sign is a sign defined as calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time. Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair, resulting from the early entry of hair in the telogen phase (temporary hair loss).

128.A red, raised serpiginous-shaped rash is noted by the nurse practitioner on the right foot of a 4-year-old child brought in for a preschool physical by the mother. The child complains of severe itch and keeps scratching the lesion. The mother reports that the child frequently plays in the yard without wearing shoes or sandals. Which of the following is most likely? A.Larva migrans B.Erythema migrans C.Tinea pedis D.Insect bites

A) Larva migrans. Larva migrans results from infection with the eggs of parasites (worms) that are commonly found in the intestines of dogs and cats. Children are at high risk of developing this infection if they come in contact with dirt that is contaminated with dog or cat feces. Eating foods that are grown in contaminated soil and/or raw liver are other means of transferring the infection. After the eggs hatch, the parasite can migrate to other organs of the body if left untreated.

60.A patient presents with fever, fatigue, headache, and joint pain. The patient has recently returned from a camping trip in the Northeast. On physical examination, the nurse practitioner notes a large macule on the patient's back with central clearing. Which diagnosis is most likely? A.Lyme disease B.Brown recluse spider bite C.Erythema infectiosum D.Rocky Mountain spotted fever

A) Lyme disease. The classic lesion in Lyme disease is an expanding red rash with central clearing that resembles a target. This "bull's-eye" rash (erythema migrans) appears 7 to 14 days after a bite from an Ixodes tick (deer tick) infected with the Borrelia burgdorferi bacterium. Lyme disease is accompanied by flu-like symptoms. The bite of a brown recluse spider appears as a reddened skin area that may be followed by a blister that forms at the bite site, and it leads to mild-to-intense pain and itching for 2 to 8 hours following the bite. An open sore (ulcer) with a breakdown of tissue (necrosis) develops a week or more following the bite. Erythema infectiosum is known as fifth disease and generally occurs in children. Rocky Mountain spotted fever is also a tick-borne illness with similar symptoms but has a rash that begins in the extremities and has smaller red spots or macules.

53.The nurse practitioner refers a 12-year-old boy with a swollen, red scrotum and ascending testicle to the ED with a diagnosis of testicular torsion. Which additional objective finding led the nurse practitioner to this diagnosis? A.Missing cremasteric reflex B.Present cremasteric reflex C.Hematuria D.Pyuria

A) Missing cremasteric reflex. Testicular torsion presents with a sudden onset of pain in the scrotum/testicles, and initially it may be felt in the abdomen and groin. The scrotum will be swollen, in severe cases acute hydrocele is present, and the affected testicle is higher than the unaffected one. Severe nausea and vomiting are common features. The cremasteric reflex is missing, not present. If not corrected within 24 hours, 100% of testicles become gangrenous and must be surgically removed. Hematuria and pyuria are not symptoms of testicular torsion, and urinalysis is generally normal.

37.Which of the following medications is indicated for the treatment of obsessive-compulsive disorder? A.Paroxetine (Paxil CR) B.Haloperidol (Haldol) C.Alprazolam (Xanax) D.Imipramine (Elavil)

A) Paroxetine (Paxil CR). The first-line medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). Paroxetine (Paxil CR) is in the SSRI drug class. Haloperidol (Haldol) is an antipsychotic, alprazolam (Xanax) is a benzodiazepine, and imipramine (Elavil) is a tricyclic antidepressant.

54.Which of the following is a warning sign for scoliosis? A.Raised right iliac crest B.Thoracic kyphosis C.Lumbar lordosis D.Osteopenia

A) Raised right iliac crest. A raised iliac crest can be a warning sign of curvature secondary to the attachment of the pelvis to the spine. Kyphosis or the kyphotic curve causes the spine to be bent forward. The official medical term for an abnormal curvature of the thoracic spine is hyperkyphosis. Lumbar lordosis is the normal inward curvature of the lumbar region of the spine. The curve helps the body to absorb shock and remain stable but flexible. However, if the curve arches too far inward, it is known as an increased lumbar lordosis or "swayback" posture. Osteopenia is a condition where the bones are weaker than normal and is often a precursor to osteoporosis.

81.A mother brings her 1-month-old infant to the clinic for evaluation, stating the infant has poor weight gain despite constant hunger and projectile vomits after eating. The nurse practitioner notes that the infant has a distended abdomen. Upon palpation, the nurse practitioner detects an olive-shaped mass in the epigastrium. The nurse practitioner will: A.Refer the child for ultrasound testing B.Perform blood analysis to determine red blood cell (RBC) status C.Provide the mother with education on infant feeding D.Place the infant on lactose-free feedings

A) Refer the child for ultrasound testing. The infant presents with signs and symptoms of pyloric stenosis: abdominal distention, dehydration, projectile vomiting, and failure to thrive. The infant requires an ultrasound to view the pylorus and confirm this diagnosis. Fluid and electrolyte status must be assessed in order to determine hydration and imbalances. The infant will require surgery if pyloric stenosis is confirmed. Educating the mother on feedings is not required until the diagnosis is confirmed. Placing the infant on lactose-free feeding will not treat the condition.

78.The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant? A.Rule out any physiologic cause for the crying spells B.Make sure that the infant is well clothed C.Evaluate the environment D.Order laboratory and diagnostic testing

A) Rule out any physiologic cause for the crying spells. For infants who cry for several hours during the day, ruling out a physiologic problem that may be causing the distress is recommended.

111.What is an abnormal assessment finding in a male newborn at 39 4/7 weeks' gestation? A.Smooth scrotum B.Pendulous scrotum C.Increased scrotal pigmentation D.Smegma beneath the prepuce

A) Smooth scrotum. An infant at 39 4/7 weeks' gestation is considered term newborn. The presence of a smooth scrotum is associated with prematurity. Scrotal rugae and a pendulous scrotum are anticipated newborn assessment findings for a male infant's genitalia. Increased scrotal pigmentation is an incidental finding associated with ethnicity and can also be familial. The presence of smegma beneath the prepuce is normal assessment finding.

23.The nurse practitioner is reviewing a patient's laboratory results and notes a normal ferritin level, high serum iron, normal total iron-binding capacity, low mean corpuscular hemoglobin concentration, and abnormal hemoglobin electrophoresis. Which diagnosis is most likely? A.Thalassemia B.Iron deficiency C.Sickle cell anemia D.Normocytic anemia

A) Thalassemia. Laboratory findings associated with thalassemia include a normal to high ferritin level, normal to high serum iron, normal total iron-binding capacity, normal red blood cell color, and abnormal electrophoresis. Laboratory findings associated with iron deficiency include low ferritin level, decreased serum iron, elevated total iron-binding capacity, decreased mean corpuscular hemoglobin concentration, and normal hemoglobin electrophoresis. Laboratory findings associated with sickle cell anemia include abnormal electrophoresis findings. Diagnostic testing for sickle cell anemia does not include ferritin or iron serum level, total iron-binding capacity, or mean corpuscular hemoglobin concentration. Mean corpuscular cell volume is used to assess for normocytic anemia.

65.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 culture and sensitivity (C&S) B.24-hour urine for protein and creatinine clearance C.24-hour urine for microalbumin D.Intravenous pyelogram

A) Urine culture and sensitivity (C&S). 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 C&S is the best evaluation for diagnosing a UTI.

31.new mother is planning to breastfeed her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (AAP) during the first few days of life? A.Vitamin D drops B.Vitamin E drops C.It is not necessary to give breastfed infants vitamin supplements, because breast milk contains enough vitamins and minerals that are necessary for the infant's growth and development. D.Folic acid drops

A) Vitamin D drops. According to the American Academy of Pediatrics (APA), all infants should be given vitamin D supplementation within the first few days of life. Mothers who plan to breastfeed their infants should be taught how to use vitamin D drops. Infant formula is supplemented with vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately

42.A 14-year-old female is brought by her stepfather to the clinic with complaints of nausea and vomiting. Upon initial assessment, the patient states that she does not recall her last menstrual period and denies sexual activity. Blood work confirms a positive pregnancy test. The patient appears nervous when the stepfather is present and refuses to answer the nurse practitioner's questions. What guidelines will the nurse practitioner follow during the physical exam? (Select all that apply.) A.Interview the adolescent without the stepfather present B.Report the suspected abuse to the state/local authority C.Ask another healthcare professional to be present during the physical exam D.Address the findings and concern with the stepfather and mother in order to get an explanation E.Test the patient for sexually transmitted infections

A, B, C, E) Interview the adolescent without the stepfather present; report the suspected abuse to the state/local authority; ask another healthcare professional to be present during the physical exam; test the patient for sexually transmitted infections. In cases of suspected abuse, the nurse practitioner should follow very specific guidelines to obtain information and assess the patient. The patient should be interviewed without the stepfather present to make the patient feel safer. If the patient feels safer, she may provide more information. Information and suspicions should be reported to the proper authorities. While assessing the patient, there should be another healthcare professional present for safety and ethical reasons. The patient should be tested not only for trauma but also for sexually transmitted infections.

79.A high school football player suffered a deceleration pivoting injury of his left knee during a game. He states he felt a sudden "pop" with subsequent swelling and the knee seemed to buckle. The nurse practitioner will: (Select all that apply.) A.Conduct a Lachman test B.Apply ice to the joint C.Perform isometric exercises D.Support the joint with a compression wrap E.Refer to an orthopedic specialist

A, B, D, E) Conduct a Lachman test; apply ice to the joint; support the joint with a compression wrap; refer to an orthopedic specialist. A Lachman test should be used to test for anterior cruciate ligament (ACL) damage. An ACL injury is classically associated with a sudden "pop" and swelling. The RICE mnemonic should be followed for musculoskeletal trauma; applying ice and compression are part of the RICE protocol. Referral should be made to an orthopedic specialist for repair and follow-up. Isometric exercises should be avoided during the early phases of recovery from a musculoskeletal injury.

149.The nurse practitioner would test the obturator and iliopsoas muscles to evaluate for: A.Cholecystitis B.Acute appendicitis C.Inguinal hernia D.Gastric ulcer

B) Acute appendicitis. Signs and symptoms of an acute abdomen include involuntary guarding, rebound tenderness, boardlike abdomen, and positive obturator and psoas signs. A positive obturator sign occurs when pain is elicited by internal rotation of the right hip from a 90-degree hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on their side with knees extended, or when pain occurs with active flexion of the thigh at the hip.

104.A 7-year-old child presents at the clinic with pain in the wrist after falling at recess. Upon examination, the nurse practitioner identifies pain to be more prominent on the side of the thumb area. X-ray of the wrist appears normal. The nurse will do all of the following, except: A.Apply a thumb spica splint B.Administer a steroid injection C.Refer patient to a hand surgeon D.Repeat wrist x-ray in 2 weeks

B) Administer a steroid injection. Symptoms represent a navicular fracture, which is notable for pain on axial loading of the thumb. This can be caused by falling with an outstretched hand to break the fall. The best treatment plan is to apply a thumb spica splint and refer to a hand surgeon for further examination. Initially the x-ray may appear normal, but in 2 weeks it probably will show a scaphoid fracture. Administering a steroid injection is not recommended for this injury, as movement can exacerbate the injury. Immobilization is the proper treatment.

103.Which of the following effects is seen in women 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.

139.The nurse practitioner is evaluating a 16-year-old female fatigue and headaches. The patient is wearing multiple layers of clothing and her hair is limp and dry. Upon examination, the nurse practitioner finds the patient's skin to have a yellow cast and a fine, downy hair on her body. Which diagnosis is most likely? A.Alopecia B.Anorexia nervosa C.Bulimia D.Amenorrhea

B) Anorexia nervosa. Anorexia nervosa usually has an onset during adolescence and is characterized by an irrational preoccupation with weight gain that presents with a distorted perception of body weight and size. Anorexia nervosa is characterized by marked weight loss (body mass index [BMI] <18.5), lanugo, thinning hair, and general poor health, as the body is depleted of vital nutrients. Amenorrhea is a common symptom in young females. Purging, alopecia, and use of laxatives may be involved in the restriction of food intake, but based on the assessment data, it is not the primary diagnosis.

50.An 11-year-old male presents with lower right-sided abdominal pain, an elevated temperature, and a white blood cell (WBC) count of 17,000. He complains of nausea and vomiting over several days. The nurse practitioner flexes his right leg at his hip and knee, which results in moderate discomfort. Which diagnosis is most likely? A.Hepatitis B.Appendicitis C.Cholecystitis D.Nephrolithiasis

B) Appendicitis. The patient is exhibiting signs of acute appendicitis. He demonstrates a positive Psoas sign, which is indicative of acute appendicitis. Hepatitis is not a viable diagnosis based on the results of the diagnostic testing. Cholecystitis presents with right upper quadrant pain. Nephrolithiasis (kidney stones) does not respond to a Psoas test.

152.A 24-year-old male presents with a history of major depression with occasional bouts of elevated mood. During the bouts of elevated mood, he reports racing thoughts and an intense desire for risky behaviors but denies hallucinations. He works a steady job and maintains a home. Which diagnosis is most likely? A.Schizoaffective disorder B.Bipolar disorder type II C.Dysthymia D.Bipolar disorder type I

B) Bipolar disorder type II. Bipolar disorder is characterized by mania and depression. Bipolar disorder type II is associated with major depression and low levels of mania. Bipolar disorder type II is not usually associated with impairment of social function, and many patients maintain work and family requirements. Schizoaffective disorder is characterized by the combination of schizophrenia and major depression. Dysthymia is characterized by a constant depressed mood but does not meet the requirement of a major depressive disorder. Bipolar disorder type I is associated with a major depressive disorder and hypermania. Patients with bipolar disorder type I experience significant impairment with social function and work life.

5.The nurse practitioner is assessing a 13-year-old male who presents with back pain and nausea and vomiting for the past 24 hours. The patient reports feeling a dull pain and muscle spasms in the back after a direct hit to the side during football practice. His vital signs are blood pressure of 140/84 mmHg, temperature of 99.1°F, pulse of 98 beats/minute, and respirations of 26 breaths/minute. Which diagnosis is most likely? A.Appendicitis B.Bruised kidney C.Cholecystitis D.Ruptured vertebral disc

B) Bruised kidney. The findings (back pain and muscle spasms, nausea with vomiting, and a direct hit to the side of the body) indicate a potential bruised kidney. Appendicitis typically begins with anorexia, nausea, and vomiting for the first 12 to 24 hours. Abdominal pain, a late sign, is usually diffuse at first and gradually localizes to the right lower quadrant. Cholecystitis may cause radiating pain to the back but would not be due to a direct hit and would not manifest as muscle spasms. A ruptured vertebral disc would manifest as pain and muscle spasm but without nausea and vomiting.

110.When assessing an infant during a well-baby visit, the nurse practitioner notes pale and damp skin, fussiness, and shortness of breath. There is a delay of the femoral pulse when compared with the brachial pulse. To confirm diagnosis, all of the following should be ordered, except: A.Echocardiogram B.Complete blood count C.EKG D.Chest x-ray

B) Complete blood count. Based on exam findings, the nurse practitioner suspects coarctation of the aorta. An absence or delay of the femoral pulse compared with the brachial pulse is considered diagnostic. To further confirm diagnosis, an echocardiogram, EKG, and chest x-ray should be ordered. A complete blood count is not diagnostic for coarctation of the aorta.

97.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.

64.A 53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitioner diagnoses a grade II sprain. The initial treatment plan includes which of the following? A.Intermittent application of cold packs the first 24 hours followed by applications of low heat at bedtime B.Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours C.Rechecking the knee in 24 hours and encouraging isometric exercises D.Application of an elastic bandage wrap to the affected knee

B) Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours. Elevation of the injured knee above the heart will reduce the amount of swelling that can occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 to 20 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30 to 45 minutes between icing of the limb is recommended.

52.An infant is born with microcephaly, narrow eyes, a flat nasal bridge, a thin upper lip, and underdeveloped ears. Which diagnosis is most likely? A.Down syndrome B.Fetal alcohol syndrome C.Failure to thrive (FTT) D.Fragile X syndrome

B) Fetal alcohol syndrome. The classic signs of fetal alcohol syndrome are microcephaly, narrow eyes, thin lips, and a smooth philtrum. Its effects can range from severe intellectual disability to attention deficit hyperactivity disorder (ADHD) in adolescents. Down syndrome causes a flat, round face; low-set ears; macroglossia; and hypotonia. Parents should be educated about high-risk sports and potential spinal cord injuries. FTT is most likely diagnosed in the first few months of life when there is a weight decrease over two or more major percentile lines (90th, 75th, 50th, 25th, and 5th). FTT can be caused by inadequate nutritional intake, neglect, or poor maternal bonding. Fragile X syndrome is an inherited intellectual disability. The face is long and narrow with a prominent forehead and chin and large ears.

46.Which of the following is a true statement regarding genu valgum? A.Genu valgum is a term for hyperextension of the knees B.Genu valgum is a term for misalignment of the knees and is often called "knock-knees" C.Genu valgum is a term for a bow-legged stance D.Genu valgum is caused by a misalignment of the knees and resulting asymmetry of the hips

B) Genu valgum refers to a misalignment of the knees and is often called "knock-knees." Genu valgum is the term for knock-knees, a misalignment of the knees that causes the knees to turn inward. If you think of gum stuck between the knees, it helps you remember "valgum." Bow-leggedness is termed genu varum. Hyperextension or backward curvature of the knees is genu recurvatum.

4.A 14-year-old girl with short stature, swollen hands and feet, and a webbed neck presents to the primary care clinic. Upon assessment she is found to be at Tanner stage I. Which test will the nurse practitioner order to confirm a diagnosis? A.CT scan B.Karyotype C.Prolactin level D.X-ray of the hand

B) Karyotype. Tanner stage I is prepubertal. At 14 years of age, an absence of Tanner stage II characteristics, along with a webbed neck, swollen hands and feet, and short stature, suggests Turner's syndrome. Confirmation of Turner's syndrome is done with karyotype analysis to confirm the partial or complete absence of the second sex chromosome. Prolactin level would indicate the presence of a tumor in the pituitary as the possible cause of delayed puberty but would need to be confirmed with a CT scan. An x-ray of the hand is used for estimating "bone age." A prolactin level to rule out prolactinoma-induced amenorrhea and a CT scan and x-ray of the hand to determine if true age matches stated age would all be useful for determining the cause of delayed puberty; however, in the presence of a webbed neck, swollen hands and feet, and short stature, Turner's syndrome is the primary suspect.

83.An underweight 15-year-old female cross-country runner presents with a complaint of progressive bilateral leg pain for 5 to 6 weeks. Upon examination, the nurse practitioner notes inflammation in the left tibial area and that the patient has pes planus. Patient history reveals amenorrhea for 1 year. Which diagnosis is most likely? A.Plantar fasciitis B.Medial tibial stress syndrome C.Morton's neuroma D.Degenerative joint disease

B) Medial tibial stress syndrome. The patient presents with a classic case of medial tibial stress syndrome. Overuse of the muscles and tendons can cause inflammation of the tibia. It is more common in runners and people with pes planus (flat feet), as well as in female athletes who have eating disorders and amenorrhea. Plantar fasciitis is inflammation of the thick band of tissue at the bottom of the foot that runs from the heel to the toes. Morton's neuroma is a painful condition affecting the ball of the foot, most commonly the area between the third and fourth toes. Degenerative joint disease (osteoarthritis) is caused by inflammation and the breakdown and eventual loss of joint cartilage.

93.A 17-year-old female patient tells the nurse practitioner that she is sexually active with her long-term boyfriend and asks for contraception information and a prescription. What is the responsibility of the nurse practitioner? A.Call the parent and obtain consent B.Prescribe the contraceptive after educating the patient about the medication C.Counsel the patient on the dangers of early sexual activity D.Ask the patient to include the boyfriend in the contraceptive decision

B) Prescribe the contraceptive after educating the patient about the medication. A 17-year-old patient has the right to consent for the use of contraceptives. She may give full consent without the involvement of her parents or boyfriend. The nurse practitioner should provide all necessary education regarding safe sexual practices and choice of contraception. The patient is due all confidentiality in this matter.

118.A sexually active adult female presents to the clinic complaining of genital ulcers. Upon examination, white wartlike papules are found in the inguinal area and a maculopapular rash is noted on the palms and soles of the feet. The nurse practitioner will order: A.Gram stain B.Rapid plasma reagin test C.Nucleic acid amplification test (NAAT) D.HIV-1/HIV-2 antibody and P24 antigen test

B) Rapid plasma reagin test. These wartlike lesions (condylomata lata) and rash on palms and soles of feet indicate a probable syphilis infection. Two types of syphilis serologic tests (treponemal and nontreponemal tests) are needed to diagnose syphilis. Step 1—Order screening test (nontreponemal tests): rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL). If reactive, order confirmatory test. Step 2—Order confirmatory test (treponemal tests): fluorescent treponemal antibody absorption (FTA-ABS), microhemagglutination test for antibodies to Treponema pallidum (MHA-TP). A Gram stain to look for gram-negative diplococci in clusters is not typically used in primary care. It is useful in diagnosing gonorrhea. NAATs are highly sensitive tests for both gonorrhea and chlamydia. HIV-1/HIV-2 antibody and P24 antigen tests (combination assay) are ordered for suspected infection with HIV.

A 10-year-old boy complains of a sudden onset of scrotal pain upon awakening that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum. The cremasteric reflex is negative, and the urine dipstick is negative for leukocytes, nitrites, and blood. 37.What type of follow-up should this patient receive? A.Refer him to a urologist within 48 hours B.Refer him to the ED as soon as possible C.Prescribe ibuprofen (Advil) 600 mg QID for pain D.Order a testicular ultrasound for further evaluation

B) Refer him to the ED as soon as possible. Immediate referral to the ED is required to prevent irreversible ischemia. Success of treatment is usually 100% if treated within the first 6 hours and 0% if treated after 24 hours. The diagnosis of testicular torsion is often made clinically, but if it is in doubt, an ultrasound is helpful in evaluating the condition. Emergency diagnosis and treatment are usually required within 4 to 6 hours to prevent necrosis.

115.A 15-year-old girl who attends a public school is referred to the nurse practitioner by one of her teachers. The teen's parents are recently divorced. The teen has been missing school and is falling behind in her schoolwork. After closing the exam room door, the nurse practitioner starts to interview the teen, asking about her moods, her appetite, her sleep, whether she has any plan of hurting herself or others, and other questions. In what type of health prevention activity is the nurse practitioner engaging? A.Primary prevention B.Secondary prevention C.Tertiary prevention D.Dropout prevention program

B) Secondary prevention. The nurse practitioner is evaluating the teenager for major depression. Secondary prevention includes detecting disease at an early stage to halt or slow its progress. All screening tests and lab tests (e.g., mammography, Pap smears) are secondary prevention activities.

7.A sexually active 16-year-old girl is brought by her mother for a physical exam. During the exam, the nurse practitioner notices some bruises on both breasts. All of the following are important areas to evaluate in this patient during this visit, except: A.Depression B.Tanner stage C.Sexual history D.Sexually transmitted diseases (STDs)

B) Tanner stage. The stem of the question is asking for the important areas to evaluate in this patient "during this visit." This is a priority-type question. The priorities to evaluate in this patient are depression, STD testing, and sexual history. The Tanner staging does not have to be done "during this visit."

102.The nurse practitioner is reviewing the laboratory results for an adult patient, which reveal macrocytosis and reticulocytopenia. The nurse practitioner will evaluate the patient for all of the following, except: A.Alcoholism B.Thalassemia C.Hypothyroidism D.Liver dysfunction

B) Thalassemia. Laboratory findings of macrocytosis and reticulocytopenia (an abnormal decrease in reticulocyte levels) are associated with vitamin B12 deficiency. Alcoholism, hypothyroidism, and liver dysfunction are strongly correlated with vitamin B12 deficiency. Thalassemia is a hemoglobin disorder in which red blood cells are often small and abnormally shaped, which makes them prone to hemolysis, causing the resulting anemia. That causes excessive destruction of red blood cells, causing hemolytic anemia.

121.A 14-year-old girl with amenorrhea is tested for pregnancy and has a positive result. The patient tells the nurse practitioner (NP) that she is seriously considering terminating the pregnancy. She tells the NP that she wants to be referred to a Planned Parenthood clinic. The NP's personal beliefs and religious beliefs are pro-life. Which of the following is the best action for the NP? A.The NP should tell the patient about her personal beliefs and advise her against getting an abortion B.The NP should advise the patient that a peer who is working with the NP can help answer the patient's questions more thoroughly C.The NP should excuse herself from the case D.The NP should refer the patient to an obstetrician

B) The NP should advise the patient that a peer who is working with the NP can help answer the patient's questions more thoroughly. In general, discussing personal beliefs is considered unprofessional behavior. Respecting the patient's right to choose is an example of supporting patient autonomy.

86.Which of the following is a true statement regarding pes planus in an infant? A.It should be evaluated by a pediatric orthopedist if spontaneous correction does not occur by age 12 months B.The fat pads on an infant's feet can mimic pes planus C.It is always corrected by wearing special orthotic shoes D.It is also called talipes equinovarus

B) The fat pads on an infant's feet can mimic pes planus. The fat pads on an infant's feet can resemble pes planus, or flat feet.

119.While reviewing some lab reports, the nurse practitioner notes that one of the results for her teenage male patient is abnormal. The liver function tests are all normal except for a slight elevation in the alkaline phosphatase level. The patient is a member of a soccer team and denies any recent injury. Which of the following statements is true? A.It is an indication of possible liver damage from alcohol; order a liver ultrasound to rule out fatty liver B.This is a normal finding due to the skeletal growth spurt in this age group C.The patient needs to be evaluated further for pancreatic disease D.The patient needs an ultrasound of the liver to rule out fatty liver and a referral to a pediatric rheumatologist

B) This is a normal finding due to the skeletal growth spurt in this age group. Alkaline phosphatase is part of a group of related enzymes. The bone form of the enzyme creates the alkaline conditions it requires to be most active with a chemical reaction involving the osteoblasts. The rapid bone growth and increased deposit of calcium during growth spurts and adolescence elevates the alkaline phosphatase level.

91.A 5-year-old child is assessed for dysuria and frequency. Which antibiotic would the nurse practitioner prescribe upon finding the urine culture positive for gram-negative bacteria? A.Ciprofloxacin (Cipro) B.Trimethoprim-sulfamethoxazole (Bactrim DS) C.Levofloxacin (Levaquin) D.Doxycycline

B) Trimethoprim-sulfamethoxazole (Bactrim DS). Trimethoprim-sulfamethoxazole (Bactrim DS) is appropriate for treating gram-negative bacteria such as Escherichia coli, which is a common cause of urinary tract infections. It is also appropriate for patients older than 2 months. Ciprofloxacin and levofloxacin are quinolones and should not be administered to children younger than 18 years of age. Doxycycline should not be prescribed for children younger than 9 years of age.

66.Which assessment finding is expected in a 3-year-old male with penopubic epispadias? A.Fused pelvic bones B.Urine leakage with stress C.Narrow penis that curves down D.Urinary meatus found along shaft of penis

B) Urine leakage with stress. In penopubic epispadias, the urethral meatus is found near the pubic bone. The position of the meatus helps predict how well the bladder stores urine. When the bladder sphincter is shaped more like a horseshoe than a ring, it does not close all the way. Because of this, urine leaks out. Most boys with penopubic epispadias and about two of three with penile epispadias leak urine with stress. In most cases of penopubic epispadias, the bones of the pelvis do not come together in the front. In boys with epispadias, the penis tends to be broad, short, and curved up. In penile epispadias, the urinary meatus is found along the shaft. In penopubic epispadias, it is found on or near the pubic bone.

145.A left-hand-dominant high-school tennis player presents with a concern of left elbow pain. Which signs and symptoms suggest that the patient is suffering from tennis elbow? (Select all that apply.) A.Elbow pain that worsens with pulling activity B.Lateral elbow pain with tenderness at the lateral epicondyle C.Elbow pain with grasping movement D.Medial elbow pain with tenderness at the medial epicondyle E.Elbow pain that worsens with extension

B, C) Lateral elbow pain with tenderness at the lateral epicondyle; elbow pain with grasping movement. Tennis elbow, or lateral epicondylitis, is inflammation of the tendon insertion of the extensor carpi radialis brevis muscle. It is associated with lateral tenderness at the insertion site. Pain worsens with grasping or twisting movements. Pulling is associated with medial epicondylitis, or golfer's elbow. Elbow pain with extension is indicative of hyperextension.

6.Which hematologic findings on a peripheral smear support a diagnosis of sickle cell anemia? (Select all that apply.) A.Burr cells B.Target cells C.Schistocytes D.Howell-Jolly bodies E.Anisopoikilocytosis

B, D) Target cells; Howell-Jolly bodies. Target cells and Howell-Jolly bodies are found on a peripheral smear in patients with sickle cell anemia. Burr cells and schistocytes are cell shapes categorized as poikilocytosis. Anisopoikilocytosis is associated with beta thalassemia major, not sickle cell anemia

13.What is the pedigree symbol for a diseased male? A.An empty square B.An empty circle C.A filled-in square D.A filled-in circle

C) A filled-in square. A filled-in square is a diseased or affected male, and a filled-in circle is a diseased or affected female. An empty square is a healthy male, and an empty circle is a healthy female.

32.Which of the following is a contraindication of the influenza vaccination? A.Asthma B.Sickle cell anemia C.Age <5 months D.American Indian heritage

C) Age <5 months. The influenza vaccine should not be given before 6 months of age because of the immaturity of the immune system. The flu vaccine is recommended for everyone aged 6 months or older (with rare exceptions), but especially for children 6 months to 4 years of age; people with congenital heart disease, asthma, cystic fibrosis, sickle cell anemia, heart disease, and chronic obstructive pulmonary disease (COPD); women who will be pregnant during the influenza season; American Indians/Alaska Natives; healthcare personnel; and the elderly.

74.A 13-year-old female visits the urgent care clinic with complaints of right lower abdominal pain that began 4 hours ago in volleyball practice. The nurse practitioner assesses rebound tenderness at McBurney's point. What does this assessment finding indicate? A.Crohn's disease B.Ulcerative colitis C.Appendicitis D.Diverticulitis

C) Appendicitis. In up to 50% of presenting cases of appendicitis, local tenderness is elicited at McBurney's point when pressure is applied. Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present and is considered a positive diagnostic sign. Crohn's disease is characterized by bloody diarrhea along with right lower quadrant pain. Ulcerative colitis affects the colon and is characterized by bloody diarrhea with mucus, along with left-sided abdominal pain. Diverticulitis is characterized by pain that may be constant and may persist for several days. The lower left quadrant of the abdomen is the usual site of the pain. Signs and symptoms include nausea and vomiting, fever, and abdominal tenderness.

42.A 25-year-old male presents to the clinic with a low-grade fever and single eschar on his back. He complains of burning at the site and states, "The area was white, then red. Now there is a red spot in the center." The patient notes that he recently traveled to the Southeast for a camping trip. Which diagnosis is most likely? A.Rocky Mountain spotted fever B.Early Lyme disease C.Brown recluse spider bite D.Melanoma

C) Brown recluse spider bite. This is a classic description of a brown recluse spider bite. These bites begin with burning at the site, followed by blanching with a red halolike center. The central area of the bite becomes necrotic, and black eschar forms. Rocky Mountain spotted fever, also a tick-borne disease, starts as a rash on the wrists and hands and rapidly progresses toward the trunk. Early Lyme disease presents as a circular red rash that slowly expands as a "target" or "bull's-eye," which is called erythema migrans. This disease is spread by black-legged ticks that are usually infected with Borrelia burgdorferi. It is more common in the northeastern states. A melanoma is a cancerous growth that generally has a dark-brown appearance.

111.The nurse practitioner orders a 24-hour urine collection for a patient with suspected kidney disease. This test measures all of the following, except: A.Proteinuria B.Albuminuria C.Microalbuminuria D.Glomerular filtration rate

C) Glomerular filtration rate. A 24-hour urine collection measures creatinine clearance to assess for proteinuria, albuminuria, and microalbuminuria. Glomerular filtration rate is the amount of fluid filtered by the glomerulus within a certain unit of time.

132.While examining the genitalia of a male patient, the nurse practitioner observes distended scrotal veins. The nurse practitioner will: A.Examine the patient in a supine position B.Examine the patient in a sitting position C.Instruct the patient to perform a Valsalva maneuver D.Assess the testicular size with an orchidometer

C) Instruct the patient to perform a Valsalva maneuver. The nurse practitioner will instruct the patient to perform a Valsalva maneuver, generally in a standing position. This action will cause the distention of the veins of the pampiniform plexus and assist in evaluation for possible scrotal abnormalities such as varicocele. The patient sitting or laying supine may not yield accurate assessment findings. An orchidometer is used to measure the size of the testes, not to evaluate for scrotal abnormalities.

119.A recreational soccer player presents with knee pain following a game. On examination, the nurse practitioner notes swelling and joint line tenderness in the knee. McMurray's test is positive, and a Lachman test is negative. Which diagnosis is most likely? A.Anterior cruciate ligament (ACL) tear B.Lateral collateral ligament (LCL) tear C.Meniscus tear D.Traumatic knee sprain

C) Meniscus tear. A meniscus tear would produce a positive McMurray test. ACL and lateral collateral ligament tears are plausible but would result only in a positive Lachman test, not a positive McMurray's test. A knee sprain would not elicit a positive McMurray's test.

18.During a physical examination, the nurse practitioner palpates the right upper quadrant while the patient takes a deep inspiration. Which diagnostic test is being performed? A.Markle test B.Rovsing's sign C.Murphy's sign D.Psoas test

C) Murphy's sign. Murphy's sign is performed by pressing deeply in the right upper quadrant during inspiration. Mid-inspiratory arrest is a positive finding that aids in the diagnosis of cholecystitis. Rovsing's sign is deep palpation of the lower left quadrant of the abdomen. The Markle test involves having the patient raise their heels and drop them suddenly. The Psoas test is positive when the patient experiences abdominal pain while flexing the hip and knee.

49.A 15-year-old basketball player who is 6 ft (1.83 m) tall is seen for complaints of painful lumps on his knees. Upon inspection, the nurse practitioner notes a bonelike growth on the upper tibia midline below the kneecap on both knees. The patient has full range of motion with no joint tenderness, redness, or swelling. Which of the following conditions is best described? A.Osteosarcoma of the tibia B.Juvenile rheumatoid arthritis C.Osgood-Schlatter disease D.Paget's disease of the bone

C) Osgood-Schlatter disease. Osgood-Schlatter disease is characterized by pain over the tibial tuberosity with palpation of a bony mass over the anterior tubercle of one or both knees. Exercise worsens the pain.

61.A 13-year-old male visits the clinic with his mother. The patient's chief complaint is persistent unilateral knee pain for several weeks. A history reveals no traumatic injury or health issues. He has a painful, bony bump below the affected knee. Upon movement, there is no laxity, but the patient feels pain. The mother reports that a recent x-ray was negative. Which diagnosis is most likely? A.Polymyositis B.Baker's cyst C.Osgood-Schlatter disease D.Meniscus tear

C) Osgood-Schlatter disease. The most likely diagnosis in a 13-year-old male with persistent unilateral knee pain is Osgood-Schlatter disease, which causes inflammation of the anterior tibial tubercle. Osgood-Schlatter disease is caused by overuse while the bone is still growing and is most common in prepubescent boys. Polymyositis is caused by immune disorders or disease and presents with bilateral muscle weakness and wasting. A Baker's cyst is swelling caused by fluid from the knee joint protruding to the back of the knee. With no history of trauma, a meniscal tear is not likely, particularly in a younger patient.

146.Which treatment is recommended for an infant with noncommunicating hydrocele? A.Surgery B.Medication C.Reassess in 1 year D.Centesis

C) Reassess in 1 year. A noncommunicating hydrocele occurs when the sac closes normally around the testicle during development, but the body does not absorb the fluid inside it. This type of hydrocele is common in newborns and usually disappears without treatment by 1 year of age. Surgery is recommended for a communicating hydrocele (when the sac does not seal) because the scrotum may swell more over time. There are no drugs available to treat hydrocele. Needle aspiration (centesis) is commonly performed on adult men who are at high risk for complications during surgery.

9.Three days after delivering a healthy baby girl, a mother calls the office with concerns that her daughter's vagina is swollen with a small amount of bleeding. The nurse practitioner will: A.Refer the patient to ED B.Instruct the mother to bring the newborn into the office for evaluation C.Reassure the mother that this is normal D.Instruct the mother to cleanse the newborn's genitals with soap and warm water

C) Reassure the mother that this is normal. At approximately 2 to 3 days of age, a newborn female may have bleeding from the vagina, and the labia may be swollen. This is normal and caused by withdrawal of hormone exposure in the womb. There is no need for evaluation in the office or ED unless the bleeding does not stop or increases in amount. Though it is important to gently cleanse the genitals, there is no need to use soap, which can irritate the vaginal mucosa.

58.All of the following are hematologic changes associated with pernicious anemia, except: A.Hypersegmented granulocytes B.Mean corpuscular volume of 120 fL C.Red cell distribution width of 12.3% D.Serum cobalamin level of 130 pg/mL

C) Red cell distribution width of 12.3%. Hematologic changes associated with pernicious anemia include hypersegmented granulocytes, elevated mean corpuscular volume (normal range is 80-100 fL), decreased serum cobalamin level (normal range is 200-900 pg/mL), and elevated mean cell hemoglobin concentration (normal range is 27.5-33.2 pg). Red cell distribution width is an indicator of anisocytosis and is significantly higher in the megaloblastic group. Megaloblastic red blood cells are associated with pernicious anemia; therefore, the red cell distribution width for a patient with pernicious anemia will be higher than the normal range of 11.8% to 14.5%.

140.A 15-year-old female patient in Tanner stage II states, "I had my first period about 6 months ago, but I haven't had one since." Which diagnostic would be ordered first? A.CT scan B.Prolactin levels C.Serum pregnancy test D.Examination of chromosomes

C) Serum pregnancy test. Tanner stage II indicates normal physical development congruent with menarche. A serum pregnancy test would be ordered first to determine if the patient is not menstruating because of pregnancy. If there is no pregnancy, further testing would be done. Prolactin levels would be high in pregnancy and during lactation. A CT scan of the abdomen and pelvis would identify tumors in the ovaries or adrenal glands. Examination of chromosomes in a sample of tissue (such as blood) would be performed to check for genetic disorders.

136.The nurse practitioner is reviewing the medical record of a 6-month-old infant with normocytic hemolytic anemia and notes an electrophoresis result of hemoglobin S with a 20% concentration of hemoglobin F (fetal hemoglobin). Which additional diagnosis is most likely? A.Aplastic anemia B.Hemolytic anemia C.Sickle cell anemia D.Thalassemia major

C) Sickle cell anemia. A patient with normocytic hemolytic anemia who has electrophoresis results of hemoglobin S with a 20% concentration of hemoglobin F has sickle cell anemia. Electrophoresis is not used to diagnose hemolytic or aplastic anemia. Thalassemia major appears within the first 2 years of life and is associated with life-threatening anemia. Thalassemia major is associated with nonhemolytic, normocytic anemia.

A 10-year-old boy complains of a sudden onset of scrotal pain upon awakening that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum. The cremasteric reflex is negative, and the urine dipstick is negative for leukocytes, nitrites, and blood. 36.The most likely diagnosis is: A.Acute epididymitis B.Severe Salmonella infection C.Testicular torsion D.Acute orchitis

C) Testicular torsion. Signs and symptoms of testicular torsion include a sudden onset of unilateral scrotal pain, nausea, vomiting, and abdominal pain. Acute epididymitis causes fever, chills, nausea, and unilateral pain and is most commonly seen in sexually active men. Unilateral scrotal pain does not occur with Salmonella infection. Acute orchitis is often based on having a recent mumps infection (parotitis) with testicular edema.

5.A female adult patient presents with complaints of "bad burns" that are very painful. A large pot of boiling water tipped over and spilled on her arms and her anterior chest and abdomen. During the physical exam, the nurse practitioner notices bright-red skin with numerous bullae on the left arm and hand and large patches of bright-red skin on the anterior chest and abdominal area. On a pain scale of 1 to 10, she reports the pain as 9. Her vital signs are stable with tachycardia (pulse is 100 beats/min). She does not appear to be in shock. Using the rule of nines, what are the total body surface area (TBSA) and the depth of the burns in this patient? A.The patient has a TBSA of 15% with full-thickness burns of the left arm and left hand and partial-thickness burns of the anterior chest and abdominal area B.The patient has a TBSA of 20% with partial-thickness burns on the left arm and left hand and mild burns on

C) The patient has a TBSA of 27% with partial-thickness burns on the left arm and left hand, and superficial burns on the anterior chest and abdominal area. Using the rule of nines, the anterior thorax is 18% and the left arm/hand is 9%, totaling 27%. A standard Lund-Browder (rule of nines) chart is readily available in most emergency departments. A partial-thickness burn is the same as a second-degree burn. A superficial burn is a first-degree burn.

121.At what age should healthy full-term infants be screened for anemia? A.0 to 3 months B.3 to 6 months C.6 to 9 months D.9 to 12 months

D) 9 to 12 months Hemoglobin and hematocrit are not routinely screened at birth, because hemoglobin is elevated from maternal red blood cells (RBCs) that are mixed with fetal RBCs. Healthy infants have enough iron stores for 4 to 6 months after birth, and the introduction of complementary foods are typically rich in iron, so they should not be screened until 9 to 12 months.

127.In an adolescent with scoliosis, what degree of spinal curvature requires a referral for surgical correction? A.10 to 20 degrees B.20 to 30 degrees C.30 to 40 degrees D.>40 degrees

D) >40 degrees. A spinal curvature of >40 degrees requires surgical intervention with a Harrington rod. Curvatures between 5 and 20 degrees should be monitored for changes. Bracing is necessary for curvatures between 20 and 40 degrees.

8.The nurse practitioner does not need to obtain parental consent from all of the following patients, except: A.A 17-year-old who wants to be treated for a sexually transmitted infection B.A 12-year-old who wants a serum pregnancy test C.A 15-year-old who wants birth control pills D.A 14-year-old who wants to be treated for dysmenorrhea

D) A 14-year-old who wants to be treated for dysmenorrhea. Treatment for teenagers may be done without parental consent for sexually transmitted infections, pregnancy testing, and contraception counseling and treatment. Parental consent is required for any type of physical exam or for other problems that require more invasive testing.

84.A patient presents to the clinic stating that her cat bit her left hand a few days prior, and it has become swollen, reddened, and painful to move around. The nurse practitioner notes there is purulent discharge at the site of the bite. The nurse practitioner will prescribe: A.Gentamicin B.Tetanus toxoid C.Rabies prophylaxis D.Amoxicillin-clavulanate

D) Amoxicillin-clavulanate. The patient presents with symptoms associated with Pasteurella multocida, which is an anaerobic gram-negative coccobacillus found in the oropharynx of healthy cats, dogs, and other animals. The diagnosis of the bacteria can be made with a gram-stain culture; however, a broad-spectrum antibiotic that targets Pasteurella, as well as other gram-positive and gram-negative bacteria, is preferred for prophylaxis. Amoxicillin-clavulanate is a recommended antibiotic for prophylactic treatment. Aminoglycosides such as gentamicin have demonstrated poor activity against P. multocida. Tetanus toxoid is only necessary if the patient has received their last tetanus vaccine >5 years prior. Rabies prophylaxis is not necessary unless there is a possibility of exposure after a risk assessment. Trimethoprim-sulfamethoxazole can be prescribed for patients with penicillin allergies.

96.Signs and symptoms of depression include all of the following, except: A.Anhedonia B.Low self-esteem C.Apathy D.Apraxia

D) Apraxia. Apraxia is characterized by loss of the ability to execute or carry out learned purposeful movements despite the desire and the physical ability to perform the movements. Apraxia is not a sign or symptom of depression; it is a disorder of motor planning caused by damage to specific areas of the cerebrum. Common signs of depression include anhedonia (loss of interest in activities that the patient finds pleasurable), unintentional weight loss or gain, fatigue, change in appetite, insomnia or hypersomnia, feelings of guilt and worthlessness, and recurrent thoughts of suicide.

115.The nurse practitioner finds multiple types of bacteria in a patient's urine sample. Which of the following interventions is most appropriate? A.Order an intravenous pyelogram (IVP) B.Order an MRI C.Perform a microscopic urine analysis D.Ask the patient to resubmit a clean catch specimen

D) Ask the patient to resubmit a clean catch specimen. Multiple bacteria in a urine sample is indicative of a contaminated sample. It should be repeated following appropriate procedure guidelines to obtain a clean catch specimen. An MRI or IVP would be ordered only if the clean catch specimen indicates a need, such as with kidney stones or pyelonephritis.

64.Which of the following drugs that are used to treat attention-deficit hyperactivity disorder (ADHD) is not classified as an amphetamine/stimulant? A.Dexmethylphenidate (Focalin XR) B.Mixed salts of amphetamine (Adderall) C.Methylphenidate (Ritalin) D.Atomoxetine (Strattera)

D) Atomoxetine (Strattera). Strattera is classified as a norepinephrine reuptake inhibitor. It is not a stimulant or an amphetamine. Strattera is contraindicated during/within 14 days of taking a monoamine oxidase inhibitor (MAOI) in patients with narrow-angle glaucoma or a heart disorder that will worsen with increases in blood pressure or heart rate or in those with pheochromocytoma. Children and teenagers should be monitored for suicidal thoughts/plans.

2.A 14-year-old boy is brought in by his mother who reports that her son has been complaining for several months of recurrent bloating, stomach upset, and occasional loose stools. She reports that he has difficulty gaining weight and is short for his age. She has noticed that his symptoms are worse after eating large amounts of crackers, cookies, and breads. She denies seeing blood in the boy's stool. Which of the following conditions is most likely? A.Amebiasis B.Malabsorption C.Crohn's colitis D.Celiac disease

D) Celiac disease. Celiac disease is also known as celiac sprue. Patients should avoid foods containing gluten, which causes malabsorption (diarrhea, gas, bloating, and abdominal pain). Foods to avoid are wheat, rye, and barley. Oats do not damage the mucosa in celiac disease. Antigliadins IgA and IgG are elevated in almost all patients (90%).

11.A 14-year-old male patient presents with acute pain in his left testicle radiating to the lower abdomen lasting for 2 hours. Which of the following is the best intervention? A.Manual detorsion B.Radioisotope scrotal scanning C.Referral for immediate surgery D.Color Doppler ultrasonography

D) Color Doppler ultrasonography. These symptoms are an indication of testicular torsion, which is a medical emergency. Since all blood for the testicle comes through the spermatic cord, the blood supply is cut off with a twist. The testicle will shrink (atrophy) if the blood supply is not restored within 6 hours. The spermatic cord needs to be untwisted (detorsion) to restore the blood supply. An equivocal diagnosis may be resolved by immediate imaging, if available. Color Doppler ultrasonography of the scrotum is preferred and needs to be performed immediately. Radioisotope scrotal scanning is also diagnostic but takes longer and is less useful. Immediate manual detorsion without imaging can be attempted during the initial examination with variable success. Because testes usually rotate inward, for detorsion the testis is rotated in an outward direction (e.g., for the left testis, detorsion is clockwise when viewed from the front, underneath the testis). More than one rotation may be needed to resolve the torsion. If detorsion fails, immediate surgery is indicated, because exploration within a few hours offers the only hope of testicular salvage. One study found that nearly three in four patients require testicle removal (orchidectomy) if surgery is delayed past 12 hours.

A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. 36.All of the following symptoms characterize this disorder, except: A.Ritualistic behaviors that the patient feels compelled to repeat B.Increased anxiety when attempting to ignore or suppress the repetitive behaviors C.Frequent intrusive and repetitive thoughts and impulses D.Disorganized speech or behavior

D) Disorganized speech or behavior. Obsessive-compulsive disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. Signs and symptoms of obsessive-compulsive disorder include ritualistic behaviors that are repeated, increased anxiety when the patient attempts to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses. Disorganized speech or behavior is a symptom of schizophrenia.

30.A 21-year-old woman complains of left-sided pelvic pain accompanied by dyspareunia. During the gynecologic exam, the nurse practitioner notices green cervical discharge. The patient mentions a new onset of a painful and swollen left knee and denies a history of trauma. This best describes: A.Septic arthritis B.Reiter's syndrome C.Chondromalacia of the patella D.Disseminated gonorrheal infection

D) Disseminated gonorrheal infection. Symptoms of pelvic inflammatory disease (PID) with painful, swollen joints of extremities indicate disseminated gonorrheal infection. Untreated disseminated gonorrhea can lead to septic arthritis. Symptoms may be mild, ranging from slight joint pain and no fever to severe joint pain with high fever. PID symptoms do not occur with septic arthritis, Reiter's syndrome, or chondromalacia of the patella.

56.What is a positive Kernig's sign? A.Flexing of hips and knee to relieve pain B.Inability to touch chin to chest C.Toes spread like a fan with plantar stroke D.Resistance to leg straightening from back pain

D) Resistance to leg straightening from back pain. A patient with a positive Kernig's sign will resist leg straightening when the hip is flexed as a result of painful hamstrings from lumbar nerve root inflammation. A positive Brudzinski sign is seen when the patient's neck is passively flexed and there is flexing of the hips and knees to relieve pressure and pain. Nuchal rigidity is present when touching the chin to the chest causes pain. A positive Babinski reflex is seen when the toes fan when the plantar surface is stroked from the heel to the great toe. Adults should have a negative Babinski reflex.

41.The nurse practitioner is discussing tetracycline with a young sexually active female patient being treated for a bacterial sinus infection. The nurse practitioner will advise the patient to: A.Not take birth control pills while on tetracycline B.Practice abstinence while on the antibiotic and then resume birth control pills C.Not take tetracycline and birth control pills at the same time D.Employ an additional method of contraception while on the antibiotic and for one pill cycle after treatment is complete

D) Employ an additional method of contraception while on the antibiotic and for one pill cycle after treatment is complete. Patients should be advised to use an additional, alternative form of birth control, such as condoms, when taking tetracycline and for one pill cycle afterward because of reduced efficacy of the oral contraceptive when taken concurrently with the antibiotic. The two medications do not have to be taken separately, as this does not change the effect of the medication. The birth control pill should not be discontinued while taking the antibiotic. It is important that an additional form of birth control be continued for one pill cycle after the course of antibiotic is completed.

61.The nurse practitioner is completing a health assessment on a 15-year-old female patient who is in the office for her annual physical. The patient reports feelings of hopelessness and sadness for several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores an 11 on Beck's Depression Inventory. The nurse practitioner will prescribe: A.Sertraline (Zoloft) B.Lithium carbonate (Eskalith) C.Bupropion (Wellbutrin) D.Escitalopram (Lexapro)

D) Escitalopram (Lexapro). Escitalopram (Lexapro) is a safe antidepressant for an adolescent who has severe depression and no history of suicidal ideations. Sertraline (Zoloft) is not a safe option for patients <24 years of age due to increased risk of suicidal ideation. Bupropion (Wellbutrin) is an atypical antidepressant and is not a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium carbonate (Eskalith) is indicated for patients with bipolar disorder.

22.A sexually active young adult is diagnosed with Chlamydia trachomatis and treated with doxycycline 100 mg BID 7 days. During a follow-up visit, the patient reports a new onset of right upper quadrant pain and tenderness on palpation. Alanine aminotransferase (ALT) is 43 U/L, and aspartate aminotransferase (AST) is 24 U/L. The nurse practitioner suspects: A.Jarisch-Herxheimer reaction B.Reiter's syndrome C.Stevens-Johnson syndrome D.Fitz-Hugh-Curtis syndrome

D) Fitz-Hugh-Curtis syndrome. The patient is most likely presenting with Fitz-Hugh-Curtis syndrome, a pelvic inflammatory disease. Signs and symptoms include right upper quadrant pain and pain on palpation, normal liver function, and "violin string" adhesions revealed on laparoscopy exam. Reiter's syndrome is more common in men and is a secondary reaction to bacteria such as chlamydia. Treatment is supportive, and the syndrome spontaneously resolves. Stevens-Johnson syndrome is an adverse reaction to an antibiotic that produces a severe rash and flu-like symptoms. A Jarisch-Herxheimer reaction is an acute response from syphilis or other spirochete treatment in the first 24 hours and produces acute fever, chills, headache, and myalgia.

54.All of the following assessment findings are associated with Crohn's disease, except: A.Mass palpated in abdomen B.Weight loss and dehydration C.Fistula formation D.Inflammation limited to mucosal layer of colon

D) Inflammation limited to mucosal layer of colon. In Crohn's disease (CD), fistula formation and anal disease may occur. If the colon is involved, bloody diarrhea with mucus is present. If a mass has developed in the abdomen, anorexia, weight loss, dehydration, and fatigue are commonly found. Periumbilical to right lower quadrant pain occurs more frequently in CD, and left lower quadrant pain is more classically associated with ulcerative colitis (UC). CD is distinguished from UC by its transmural inflammation in skip lesions throughout the intestines versus the mucosal inflammation found throughout the colon in UC.

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

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

113.A 29-year-old male has a 2-year history of deep depression alternating with periods of high energy levels, which has impacted his ability to hold a job. After changing jobs for the third time in 2 years, he seeks assistance. Which medication will the nurse practitioner prescribe? A.Haloperidol (Haldol) B.Phenelzine (Nardil) C.Diazepam (Valium) D.Lithium carbonate (Eskalith)

D) Lithium carbonate (Eskalith). The patient is exhibiting signs of bipolar disorder I, including alternating periods of euphoria and high energy levels with periods of extreme depression and exhaustion, so the treatment of choice would be lithium carbonate (Eskalith). Haloperidol (Haldol) is not first-line treatment due to serious side effects such as neuroleptic malignant syndrome and cardiovascular dysfunction. Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) antidepressant that is not used to treat bipolar disorder alone, so it is not first-line treatment. Diazepam (Valium) is a sedative.

41.A 22-year-old male athlete presents with knee pain for which the nurse practitioner performs a McMurray's test. A positive sign is indicative of which condition? A.Anterior cruciate ligament tear B.Posterior cruciate ligament tear C.Patellar tendon rupture D.Meniscal tear

D) Meniscal tear. A positive McMurray's test is suggestive of an injury or tear to the medial meniscus. An anterior cruciate ligament tear is associated with a positive Lachman's or anterior drawer test. A posterior cruciate ligament tear is associated with a positive posterior drawer test. A patellar tendon rupture is associated with the inability to raise the straightened leg against gravity.

5.Which pain medication will the nurse practitioner prescribe for an 11-year-old patient with a fractured ulna? A.Capsaicin topical cream B.Hydrocodone-acetaminophen C.Aspirin D.Regular-strength acetaminophen

D) Regular-strength acetaminophen. Regular-strength acetaminophen is the safest pain medication for a child <12 years. Capsaicin topical cream provides temporary relief of muscle, joint, and neuropathic pain. Aspirin contains salicylates and should not be prescribed for children <12 years due to the risk of Reye's syndrome. Hydrocodone-acetaminophen is not recommended because of abuse potential.

85.The nurse practitioner is caring for a 4-year-old patient with sickle cell disease who is experiencing a febrile illness. Which hemopoietic laboratory value will the nurse practitioner use to evaluate the efficiency of the patient's bone marrow response? A.B lymphocyte B.C-reactive protein C.Prothrombin time D.Reticulocyte count

D) Reticulocyte count. Hemopoietic evaluation of a patient with sickle cell disease who is experiencing a febrile illness includes a complete blood count (CBC) with a differential and reticulocyte count, as well as liver function tests, urinalysis, and blood cultures. The reticulocyte count reflects the efficiency of the bone marrow's response to illness in a patient with sickle cell disease. An elevated B lymphocytic count is associated with an inflammatory condition and is not explicitly evaluated in febrile patients with sickle cell disease. C-reactive protein is produced in the liver and is a marker for inflammation. Prothrombin time (PTT) is used to assess overall platelet function and evaluate how long it takes for the blood to clot.

78.A 4-week-old boy is seen in the family practice clinic for a complaint of forceful vomiting that occurs immediately after feeding. The vomitus is composed of infant formula and is not bilious. The infant is bottle-fed with infant formula that was recommended by the pediatrician. The mother reports that the infant seems hungry and sucks on the bottle without any problems. His birth weight was 7 lb, 5 oz (3.4 kg). The current weight is 7 lb (3.2 kg). Which of the following clinical findings is an important clue regarding the possible cause of the infant's vomiting? A.Irritable and crying infant B.Sunken anterior fontanel and dry lips C.Positive rooting reflex D.Round olive-like mass located in the right upper quadrant of the abdomen

D) Round olive-like mass located in the right upper quadrant of the abdomen. The stem of the question is asking about the "possible cause of the infant's vomiting" (it is not asking about symptoms). Projectile or forceful vomiting after feeding (postprandial vomiting) is a classic symptom of infantile hypertrophic pyloric stenosis. A hypertrophied pylorus is a pathognomonic finding of the disease. An ultrasound of the pylorus is the imaging study of choice. The other signs and symptoms are dehydration (sunken anterior fontanel, dry lips, weight loss), irritability, and crying (usually due to hunger). A positive rooting reflex is a normal finding in a 4-week-old infant.

82.The nurse practitioner will consider referring patients with all of the following burns to the ED or a specialist, except: A.Facial burns B.Electrical burns C.Burns that involve the cartilage of the ear D.Second-degree burn on the lower arm

D) Second-degree burn on the lower arm. Burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees. A second-degree (superficial partial thickness) burn extends into the superficial (papillary) dermis. It appears red with clear blisters, blanches with pressure, has a moist texture, and is painful to sensation. A second-degree burn takes 2 to 3 weeks to heal. First- and second-degree burns are appropriately treated by a nurse practitioner. Third-degree burns should be referred to a physician. Examples of third-degree burns include electrical burns, severe burns on the face, and burns involving cartilage, such as the ear and nose.

125.Which oral antibiotic will the nurse practitioner prescribe for an 18-month-old infant with a symptomatic urinary tract infection? A.Ampicillin B.Ceftriaxone C.Ciprofloxacin D.Trimethoprim-sulfamethoxazole

D) Trimethoprim-sulfamethoxazole. In children younger than 24 months, the American Academy of Pediatrics (AAP) recommends empiric treatment of suspected UTI. If the child is being treated with oral antibiotics, first-line choices include trimethoprim-sulfamethoxazole, first-generation cephalosporins, and amoxicillin-clavulanate, although due to resistance to amoxicillin, this may be avoided as a first line. The top choice for empiric parental (IM/IV) therapy is ceftriaxone. Ampicillin can be used as a treatment choice for more serious genitourinary infections, and it is dosed as an IV or IM formulation in this age group. Currently, fluoroquinolones such as ciprofloxacin are approved only for complicated UTIs (including pyelonephritis) and for postexposure prophylaxis and treatment of inhalation anthrax in individuals younger than 18 years of age.

66.Which of the following laboratory tests is the most sensitive test for evaluating an active Helicobacter pylori infection of the stomach or duodenum? A.H. pylori titer B.Fasting gastrin level C.Upper gastrointestinal (GI) series D.Urea breath test

D) Urea breath test. The urea breath test is a very sensitive test used to evaluate a patient for an active H. pylori infection. It can also be used to document treatment response after a treatment regimen of antibiotics (14 days) and proton-pump inhibitor (PPI) therapy.

167.A 17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a "bag of worms" are noted underneath the scrotal skin. The testicle is not swollen or reddened. The most likely diagnosis is: A.Chronic orchitis B.Chronic epididymitis C.Testicular torsion D.Varicocele

D) Varicocele. Palpation of varicose veins, described as a "bag of worms," in the scrotum is a classic symptom of a varicocele, an abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord. It is most common on the left side and may be associated with pain. It occurs in boys and young men and is associated with reduced fertility. The condition is often visible only when the patient is standing. Chronic epididymitis and chronic orchitis are caused by a bacterial infection and commonly cause burning, urinary frequency, and pain. Testicular torsion is an emergent condition in which the testicle becomes twisted, interrupting the blood supply to the testis; to avoid damage, the condition must be corrected within 6 hours.