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A72-year-oldwomanhasbeenonhydrochlorothiazide12.5mgformanyyearstocontrol herStageIIhypertension.Herbloodpressure(BP)atthisvisitis168/96.Sheiscurrently complainingofpainonherrighthipandonbothknees.Shehasincreasedherdoseof ibuprofen(Motrin)from400mg3timesday(TID)to800mgTID.Sheisstillinpainand wouldlikesomethingstronger.Whichofthefollowingstatementsisthebestexplanationof theeffectsofibuprofen(Motrin)onherdisease?
A)Itincreasesthechancesofadverseeffectstoherhealth
B)Itinhibitstheeffectofrenalprostaglandinsandbluntstheeffectivenessofthediuretic
C)Itprolongsthetherapeuticeffectsofhydrochlorothiazideandotherdiuretics
D)Noneofthestatementsaretrue B)Itinhibitstheeffectofrenalprostaglandinsand bluntstheeffectivenessofthediuretic.
NSAIDsandASAinhibitthevasodilatoryeffectsofprostaglandins,whichpredisposesthe kidneytoischemia.NSAIDsanddiureticscancauseacuteprerenalfailurebydecreasing renalbloodflow.
2.Allofthefollowingareinfectionsthataffectmostlythelabiaandvaginaexcept:
A)Bacterialvaginosis
B)Candidiasis
C)Trichomoniasis
D)Chlamydiatrachomatis-D)Chlamydiatrachomatis
Infectionsthatcommonlyaffectthelabiaandvaginaincludebacterialvaginosis, candidiasis,andtrichomoniasis.Chlamydiatrachomatiscommonlyaffectsthecervix, endometriallining,fallopiantubes,andpelviccavity.
Thenursepractitionerwouldtesttheobturatorandiliopsoasmuscletoevaluatefor:
A)Cholecystitis
B)Acuteappendicitis
C)Inguinalhernia
D)Gastriculcer B)Acuteappendicitis.
Signsandsymptomsofanacuteabdomenincludeinvol-untaryguarding,rebound tenderness,boardlikeabdomen,andapositiveobtu ratorandpsoassign.Apositive obturatorsignoccurswhenpainiselictedbyinternalrotationoftherighthipfrom90 degreeship/kneeflexion.Thepsoassignispositivewhenpainoccurswithpassive extensionofthethighwhilethepatientislyingonhis/hersidewithkneesextended,or whenpainoccurswithactiveflexionofhis/herthighatthehip.
Treatmentformildpreeclampsiaincludesallofthefollowingexcept:
A)Bedrestexceptforbathroomprivileges
B)Closemonitoringofweightandbloodpressure
C)Closefollow-upofurinaryprotein,serumcreatinine,andplateletcount
D)Aprescriptionofmethyldopa(Aldomet)tocontrolbloodpressure D)Aprescriptionof methyldopa(Aldomet)tocontrolbloodpressure
Recommendedcareforwomendiagnosedwithpreeclampsiaincludesbedrestwithbath roomprivileges,weightandBPmonitoring,andcloselyfollowingurineproteinandserum protein,creatinine,andplateletcounts.Oralmedicationsarenotusedasfirst line treatment.
AllofthefollowingservicesarecoveredunderMedicarePartAexcept:
A)Inpatienthospitalizations
B)Medicinesadministeredtoapatientwhilehospitalized
C)Nursinghomecare
D)Surgeons C)Nursinghomecare
MedicareAcoverageincludesinpatienthospitalizationandskilledcaregiveninacertified skillednursingfacility.Mostnursinghomecareiscustodialcare(helpwithbathing, dressing,usingabathroom,andeating).ThiscareisnotcoveredbyMedicareA.
A28 year oldstudentisseenintheschoolhealthclinicwithcomplaintsofahackingcough thatisproductiveofsmallamountsofsputumandarunnynose.Hedoesnottakeany medications,deniesanyallergies,andhasnosignificantmedicalhistory.Physical examinationrevealsalow gradetemperatureof99.9degreesFahrenheit,respirationsof 16/min,apulseof90beatsperminute,anddiffusefinecracklesinthebaseofthelungs.A chestradiograph(x ray)showsdiffuseinfiltratesonthelowerlobeoftherightlung.The totalwhitebloodcellcountis10,500/uL.Whatisthemostlikelydiagnosis?
A)Streptococcalpneumonia
B)Mycoplasmapneumonia
C)Acutebronchitis
D)Legionnairesdisease B)Mycoplasmapneumonia
Mycoplasmapneumoniaistheorganismmostcom monlyseeninchildrenandyoung adults.Itiseasilyspreadfromdroplets,fromsneezingandcoughing,incloseproximity. Diagnosisisbasedonsymptomsandx-rayresultsofinfiltratesinlowerlobes.
A39 year oldmigrantworkerpresentstotheclinic2.5daysafterapurifiedprotein derivative(PPD)test.Whatminimumsizeofindurationwouldbeconsideredposi tivefor thispatient?
A)3mmB)5mmC)10mmD)15mm C)10mm
ThePPDisadministeredonthevolaraspectofthelowerarmandread48hoursafterthe testisgiven.ThePPDresultmusthaveindurationandmeasure10mmorgreatertobe positiveinalow riskpatient.Induration(firmnesswithpalpation)mustbepresent.Ifthe sitehaserythemabutnoinduration,resultwouldbenegative.Colorisnotimportant.
Allofthefollowingarecorrectstatementsregardingtheroleofthepersonnamedina durablepowerofattorneyexcept:
A)Theagent'sdecisionsarelegallybinding
B)Theagentcanmakedecisionsinotherareasofthepatient'slifesuchasfinancial issues
C)Theagentcandecideforthepatientwhoisonlifesupportwhenthatlifesupport canbeterminated
D)Thepatient'sspousehasarighttooverridetheagent'sdecisions D)Thepatient's spousehasarighttooverridetheagent'sdecisions
Thepersonnamedinadurablepowerofattorney(theagent)isdesignatedbythepatient tomakeallmedicaldecisions,aswellasanydecisionsregardingthepatient'sprivate affairsintheeventthatthepatientbecomesincompetentandunabletomakehis/herown decisions.Noonehastheabilitytooverridetheagent'sdecision.
AllofthefollowingaretruestatementsregardingMunchausensyndromeexcept:
A)Itisconsideredamentalillness
B)Thepatienthasamedicalillnessthatcausesananxietyreactionanddenial
C)Thepatientfakesanillnessinordertogainattentionfromhealthcareproviders
D)Thepatienthasaninconsistentmedicalhistoryalongwithapasthistoryof frequenthospitalizations B)Thepatienthasamedicalillnessthatcausesananxiety reactionanddenial
Munchausensyndromeisapsychiatricdisorderinwhichthepatientfakesamedicalillness ordisordertogainattentionfromhealthcareprovid ers.Thesepatientscommonlyusethe emergencydepartmentfrequentlytogainattention.
Whichofthefollowingantihypertensivemedicationsshouldthenursepractitioneravoid whentreatingpatientswithemphysema?
A)Calciumchannelblockers
B)Angiotensin-convertingenzyme(ACE)inhibitors
C)Beta blockers
D)Diuretics C)Beta blockers
Beta-blockersshouldbeavoidedinpatientswithahistoryofemphysema.Studieshave shownevidenceofareductioninforcedexpiratoryvolumein1second(FEV1),increased airwayhyperresponsiveness,andinhibitionofbronchodilatorresponsetobetaagonistsin
patientsreceivingnon selectivebeta blockersandhighdosesofcardioselectivebeta blockers.
A30 year oldchefcomplainsofpruritichivesoverherchestandarmsbutdeniesdifficulty swallowingorbreathing.Shereportsafamilyhistoryofallergicrhinitisandasthma.Which ofthefollowinginterventionsismostappropriate?
A)Performacompleteandthoroughhistory
B)Prescribeanoralantihistaminesuchasdiphenhydramine25mgPOQID
C)Giveaninjectionofepinephrine1:1000intramuscularlystat
D)Call911 A)Performacompleteandthoroughhistory
Priortoprescribingmedications,acompleteandthoroughhistorymustbeperformedto determinepossiblecausesofhives.Thepatientdenieddifficultywithswallowingand breathing,sotherewasnomedicalemergencytorequirecalling911.
Whichofthefollowingfindingsismostlikelyinyoungprimigravidaswithpregnancy inducedhypertension?
A)Abdominalcrampingandconstipation
B)Edemaofthefaceandtheupperextremities
C)Shortnessofbreath
D)Dysuriaandfrequency B)Edemaofthefaceandtheupperextremities
Commonsignsandsymptomsofpregnancy inducedhypertensionincludeedemaofthe faceandtheupperextremities,weightgain,blurredvision,elevatedBP,proteinuria,and headaches.
WhichofthefollowingsymptomsisassociatedwithB12deficiencyanemia?
A)Spoon-shapednailsandpica
B)Anabnormalneurologicalexam
C)Avegandiet
D)Tinglingandnumbnessofbothfeet D)Tinglingandnumbnessofbothfeet
VitaminB12deficiencyanemiacancausenervecelldamageifnottreated.Symptomsof B12deficiencyanemiamayincludetinglingornumbnessinfingersandtoes,difficulty walking,moodchangesordepression,memoryloss,disorientation,anddementia.
Asecondtriplescreenona35-year-oldprimigravidarevealsabnormallylowlev-elsofthe alphafetoproteinandestriolandhighlevelsofhumanchorionicgonad otropin.Whichof thefollowinginterventionsisthebestchoiceforthispatient?
A)Orderanultrasound
B)Orderacomputedtomography(CT)scanoftheabdomen
C)Ordera24 hoururineforproteinclearance
Abnormallylowlevelsofalphafetoproteinandestriolandhighlevelsofhumanchorionic gonadotropinareabnormalduringpregnancy.Anultrasoundshouldbeorderedtofurther evaluatethefetusforcharacteristicsofDownsyndromeand/orfetaldemise.
Allofthefollowingaretruestatementsaboutdiverticulaexcept:
A)Diverticulaarelocatedinthecolon
B)Alow fiberdietisassociatedwiththecondition
C)Mostdiverticulainthecolonareinfectedwithgram negativebacteria
D)Supplementingwithfibersuchaspsyllium(Metamucil)isrecommended C)Most diverticulainthecolonareinfectedwithgram negativebacte ria
Diverticuliinthecoloncanbeinfectedwithbothgram negativeandgram positive bacteria.
Patientswhoarediagnosedwithgonorrheashouldalsobetreatedforwhichofthe followinginfections?
A)Chancroid
B)Chlamydiatrachomatis
C)Herpesgenitalis
D)PID(pelvicinflammatorydisease) B)Chlamydiatrachomatis
Whendiagnosedwithgonorrhea,thepatientshouldalsobetreatedforChlamydia trachomatis.
Kyphosisisalatesignof:
A)Oldage
B)Osteopenia
C)Osteoporosis
D)Osteoarthritis C)Osteoporosis
Kyphosisisacurvatureofthespinethatcausesaroundingoftheback,whichleadstoa slouchingposture.Severethinningofthebones(osteoporosis)contributestothis curvatureinthespine.Symptomsthatmayoccurwithseverecasesofkyphosisinclude difficultybreathing,fatigue,andbackpain.
A35 year oldprimigravidawhoisat28weeksofgestationisexpectingtwins.Whatwould youwouldexpectheralphafetoprotein(AFP)valuestobe?
A)Normal
B)Higherthannormal
C)Lowerthannormal
D)Noneoftheabove B)Higherthannormal
Alphafetoproteinisproducedinthefetalandmaternalliver.Higherlevelsofalpha fetoproteinarecommonlyseeninmultiplegestationsduetothegrowingfetusesand enlargementofthelivers.
Whichofthefollowingantihypertensivemedicationshasbeneficialeffectsforanelderly Whitefemalewithosteoporosis?
A)Calciumchannelblocker
B)Angiotensin convertingenzyme(ACE)inhibitor
C)Beta blocker
D)Diuretic-A)Calciumchannelblocker
Calciumchannelblockersactbyblockingthecal ciumchannelsintheheartmuscleandthe bloodvessels,therebykeepingmorecalciuminthebones.
TheLachmanmaneuverisusedtodetectwhichofthefollowing?
A)Kneeinstability
B)Nervedamageofthekneeduetopastkneeinjuries
C)Theintegrityofthepatellartendon
D)Tearsonthemeniscusoftheknee A)Kneeinstability
TheLachmanmaneuverisatestperformedtoassessforkneeinstability.Kneeinstability indicatesatearoftheanteriorcruciateligament.
Whenanadolescentmale'spenisgrowsmoreinlengththanwidth,atwhichofthe followingTannerstagesisheclassified?
A)TannerStageII
B)TannerStageIII
C)TannerStageIV
D)TannerStageV B)TannerStageIII
TannerStageIIIinmalesconsistsofpenislengtheninganddarker,coarsepubichair,which beginstocurl
FetalTORCHinfectionscancausemicrocephaly,mentalretardation,hepatospleno-megaly, andintrauterinegrowthretardation.TheacronymTORCHstandsfor:
A)Toxoplasmagondii,otherinfections,rubella,cytomegalovirus,andherpes
B)Toxicshocksyndrome,ocularinfections,rubella,cytomegalovirus,andherpes zoster
C)Tetanus,ophthalmicinfections,roseola,cancer,andheadabnormalities
D)Toxins,otherinfections,roseola,candidiasis,andheadabnormalities A) Toxoplasmagondii,otherinfections,rubella,cytomegalovirus,andherpes
TheacronymTORCHstandsforToxoplasmagondii,otherinfections,rubella, cytomegalovirus,andherpes.Althoughseveraloftheconditionslistedintheotheranswer optionscanalsocausefetalproblems,theyarenotincludedintheTORCHacronym.
Humanpapillomavirus(HPV)infectionofthelarynxhasbeenassociatedwith:
A)Laryngealneoplasia
B)Esophagealstricture
C)Cervicalcancer
D)Metaplasiaofesophagealsquamouscells A)Laryngealneoplasia
HPVinfectionofthelarynxhasbeenassociatedwithlaryngealneoplasia;HPVinfectionof thecervixisassociatedwithcervicalcancer.
Mr.Brownisa65-year-oldcarpentercomplainingofmorningstiffnessandpaininbothhis handsandrightkneeuponawakening.Hefeelssomereliefafterwarmingup.Onexam,the nursenoticesthepresenceofHeberden'snodes.Whichofthefol lowingismostlikely?
A)Osteoporosis
B)Rheumatoidarthritis
C)Degenerativejointdisease
D)Reiter'ssyndrome C)Degenerativejointdisease
Heberden'snodesarecommonlyseenindegenerativejointdisease.Heberden'snodesare bonynoduleslocatedonthedistalinterphalangealjoints(DIPs).
Whatdoesapositiveposteriordrawersignina10 year oldsoccerplayersignify?
A)Anabnormalknee
B)Instabilityoftheknee
C)Alargeamountofswellingontheknee
D)Aninjuryofthemeniscus B)Instabilityoftheknee
Thedrawersignisperformedonthekneeorankletoassessforkneeinstability.The affectedkneewillhavemorelaxitywhencomparedtotheunaffectedknee.
Amultigravidawhoisat28weeksofgestationhasafundalheightof29cm.Whichofthe followingisthebestrecommendationforthispatient?
A)Advisethemotherthatherpregnancyisprogressingwell
B)Orderanultrasoundoftheuterus
C)Referhertoanobstetricianforanamniocentesis
D)Recommendbedrestwithbathroomprivileges A)Advisethemotherthather pregnancyisprogressingwell
From20 35weeks'gestation,fundalheightshouldequalweeksgestation.Ifgreaterthan2 cmwithinthegestationalweekofpregnancy,furthertestingshouldbeperformedto evaluatefetalgrowth
Amultigravidawhoisat34weeksofgestationwantstoknowatwhatlevelheruterine fundusshouldbe.Thebestansweristoadvisethemotherthatherfun dusis:
A)Midwaybetweentheumbilicusandthelowerribs
B)Attheleveloftheumbilicus
C)From33to35cm
D)From32to34cm-C)From33to35cm
After20weeksgestation,fundalheightincentimetersshouldmeasureapproximatelythe sameasthenumberofweeksofgestation
Whichofthefollowinglaboratorytestsisusedinprimarycaretoevaluaterenalfunction?
A)Electrolytepanel
B)Creatinine
C)Alkalinephosphatase
D)Bloodureanitrogen(BUN)tocreatinineratio B)Creatinine
Serumcreatinineismeasuredtoevaluaterenalfunction.Creatinineistheendproductof creatinemetabolism.Creatinineclearanceisnotaffectedbyfluidordietaryintakeofmeat.
Allofthefollowingarefalsestatementsregardingacutegastritisexcept:
A)Chronicintakeofnonsteroidalanti-inflammatorydrugs(NSAIDs)cancausethedisorder
B)Chroniclackofdietaryfiberisthemaincauseofthedisorder
C)Thescreeningtestforthedisorderisthebariumswallowtest
D)Thegoldstandardtoevaluatethedisorderisacolonoscopy C)Thescreeningtestfor thedisorderisthebariumswallowtest
Thegoldstandardfordiagnosinggastricdiseaseisbiopsyofgastricand/orduodenaltissue byupperendoscopy.ChronicuseofNSAIDsdisruptstheproductionofprostaglandins, whichdecreasesbloodsupplyandthenbreaksdowntheprotectivelayerofthemucosa, whichleadstogastricdisease.
Signsandsymptomsofdepressionincludeallofthefollowingexcept:
A)Anhedoniaandchangesinappetite
B)Decreasedenergyandirritability
C)Apathyandlowself esteem
Apraxiaisadisorderofthenervoussysteminwhichthebrainisaffectedandthepatientis unabletomovethearms/legswhenaskedtodoso.Commonsignsofdepressioninclude anhedonia(lossofinterestinactivitiesthatthepatientfindspleasurable),unintentional weightlossorgain,fatigue,changeinappetite,insomniaorhypersomnia,feelingsofguilt andworthlessness,andrecurrentthoughtsofsuicide.
WhichofthefollowingisanaccuratedescriptionofelicitingforMurphy'ssign?
A)Upondeepinspirationbythepatient,palpatefirmlyintherightupperquad rantofthe abdomenbelowthecostovertebralangle
B)Bendthepatient'shipsandkneesat90degrees,thenpassivelyrotatehipexter nally, theninternally
C)Askthepatienttosquat,thenplacethestethoscopeontheapicalarea
D)Pressintotheabdomendeeply,thenreleaseitsuddenly A)Upondeepinspirationby thepatient,palpatefirmlyintherightupperquad rantoftheabdomenbelowthe costovertebralangle
Murphy'ssignispositiveifpainoccurswhenperformingRUQpalpationwhilethepatient takesadeepinspiration,causingthepatienttoabruptlystopthedeepbreathduetopain. Astheliverispalpated,itwilldescendandpushupagainsttheinflamedgallbladderand causesharppain(cholecystitis).
A28 year oldmultiparawhoisat32weeksofgestationpresentstoyouroffice complainingofasuddenonsetofsmallamountsofbrightredvaginalbleeding.Shehashad severalepisodesandappearsanxious.Onexam,heruterusissofttopalpation.Whichof thefollowingismostlikely?
A)Placentaabruptio
B)Placentaprevia
C)Acutecervicitis
D)Molarpregnancy(hydatidiformmole) B)Placentaprevia
Placentapreviaoccurswhenabnormalimplantationoftheplacentaoccurs.Acommon symptomofplacentapreviaispainless,brightredbleeding.
EpidemiologicstudiesshowthatHashimoto'sdiseaseoccursmostcommonlyin:
A)Middle agedtoolderwomen
B)Smokers
C)Obeseindividuals
D)Oldermen A)Middle agedtoolderwomen
Hashimoto'sdiseasecommonlyoccursinmiddle agedtoolderwomen.
A48 year oldwomanistoldbyaphysicianthatsheisstartingmenopause.Allofthe followingarepossiblefindingsexcept:
A)Hotflashes
B)Irregularmenstrualperiods
C)Severevaginalatrophicchanges
D)Cyclicmoodswings C)Severevaginalatrophicchanges
Aswomenreachmenopause,changesthatmayoccurincludehotflashes,irregular menstrualperiods,andcyclicmoodswings.Vaginalchanges,suchasdrynessandthinning, mayalsobegintooccur
A63 year oldpatientwitha10 yearhistoryofpoorlycontrolledhypertensionpresents withaclusterofphysicalexamfindings.Whichofthefollowingindicatetargetorgan damagecommonlyseeninhypertensivepatients?
A)Pedaledema,hepatomegaly,andenlargedkidneys
B)Hepatomegaly,AVnicking,bibasilarcrackles
C)Renalinfection,S3,neuromuscularabnormalities
D)Glaucoma,jugularveinatrophy,heartfailure B)Hepatomegaly,AVnicking,bibasilar crackles
Withlong term,uncontrolledhypertension,organdamagemayoccur.Organscommonly affectedinclude:brain(stroke),eyes(retinopathy,AVnicking,bleeding,blindness),heart (heartdis ease,leftventricularhypertrophy,MI,and/orCHF),andkidneys(renalfailure, proteinuria).
A30-year-oldprimigravidaisdiagnosedwithapossiblethreatenedabortion.Theresultof theurinepregnancytestispositive.Whichofthefollowingstatementsistrueregardinga threatenedabortion?
A)Vaginalbleedingandcrampingarepresent,butthecervixremainsclosed
B)Vaginalbleedingandcrampingarepresentalongwithadilatedcervix
C)Thefetusandplacentaareallexpelled
D)Theproductsofconceptionandtheplacentaremaininsidetheuterusalong withadilatedcervix A)Vaginalbleedingandcrampingarepresent,butthecervixremains closed
Threatenedabortionisdefinedasvaginalbleedingandcrampingwith outthepresenceof cervicaldilation.
A30 year oldfemalewhoissexuallyactivecomplainsofalargeamountofmilk like vaginaldischargeforseveralweeks.Amicroscopysliderevealsalargeamountof squamousepithelialcellsthathaveblurredmargins.Veryfewwhitebloodcellsareseen. ThevaginalpHisat6.0.Whatismostlikely?
A)Trichomonasinfection
B)Bacterialvaginosis
C)Candidalinfection
D)Anormalfinding B)Bacterialvaginosis
Bacterialvaginosisisabacterialinfectionofthevagina.Signsandsymptomsinclude copiousoff whitetograydischargewithfoulodorwithoutvaginalerythemaorirritation. Wetprepwillshowpositiveforcluecells.Whenperformingawetprep,the"whifftest"will bepositiveforastrong"fishy"odorwhenvaginaldischargeismixedwithonedropofKOH.
ThePapsmearresultona20 year oldsexuallyactivestudentwhousescondoms inconsistentlyshowsalargeamountofinflammation.Whichofthefollowingisthebest follow-upaction?
A)TheNPneedstodocervicalculturestoverifythepresenceofgonorrhea
B)Prescribemetronidazolevaginalcreamforthepatientoverthephone
C)CallthepatientandtellhersheneedsarepeatPapsmearin6months
D)AdvisethepatienttouseaBetadinedoucheatbedtimex3days A)TheNPneedstodo cervicalculturestoverifythepresenceofgonor rhea
CulturesshouldbetakenatthetimeofthePapsmear,asthepatientmaynotreturnfor laterdiagnostictesting.
WhileperformingaPapsmearonapostmenopausalpatient,severalareasofflatwhiteskin lesionsthatareirregularlyshapedarefoundonthepatient'slabia.Thepatientreportsthat thelesionsareextremelyitchyandhavebeenpresentforseveralyearswithoutmuch change.Whichconditionisbestdescribed?
A)Chronicscabiesinfection
B)Lichensclerosus
C)Chroniccandidalvaginitis
D)Aphysiologicvariantfoundinsomeolderwomen
B)Lichensclerosus
Lichensclerosusisadiseaseoftheskin,inwhichwhitespotsappearontheskinand changeovertime.Itismostcommonlyseeninthegenitalandrectalareas,butcanappear inotherareas.Thespotsareusuallyshinyandsmoothandcaneventuallyspreadinto patches.Theskinappearsthinandcrinkled.Thentheskintearseasily,andbrightredor purplebruisesarecommon.Sometimes,theskinbecomesscarred.Ifthediseaseisamild case,theremaybenosymptoms
TheheartsoundS2iscausedby:
A)Closureoftheatrioventricularvalves
B)Closureofthesemilunarvalves
C)Openingoftheatrioventricularvalves
D)Openingofthesemilunarvalves B)Closureofthesemilunarvalves
TheheartsoundS2iscausedbyclosureofthesemilunarvalves.
Apelvicexamonawomanwhois12weekspregnantwouldrevealthatheruterusis locatedatwhichofthefollowingareas?
A)Betweentheumbilicusandthesuprapubicbone
B)Justrisingabovethesuprapubicbone
C)Betweenthesuprapubicboneandthexiphoidprocess
D)Betweentheumbilicusandthexiphoidproces B)Justrisingabovethesuprapubicbone
At12weeksgestation,theuterusmeasuresapproximatelythesizeofagrapefruit,which wouldbefeltjustabovethesuprapubicboneonbimanualexam.
AllofthefollowingarecoveredunderMedicarePartBexcept:
A)Personsage65yearsorolder
B)Durablemedicalequipment
C)Mammogramsannuallystartingatage50
D)Anesthesiologist'sservices D)Anesthesiologist'sservicesMedicarePartBcovers:1) outpatientphysicianvisits,labs,x-rays;2)durablemedicalequipment;3) mammograms/colonoscopyafterage50yearsannually;4)rehabilitation.
Anesthesiologist'sservicesarecoveredbyMedicarePartA.
Allofthefollowingpatientsareathigherriskforsuicideexcept:
A)A66 year oldWhitemalewhosewifeof40yearsrecentlydied
B)Ahighschoolstudentwithahistoryofbipolardisorder
C)Adepressed45 year oldfemalewithfamilyhistoryofsuicide
D)A17 year oldteenwhohasonly1closefriendinschool D)A17 year oldteenwhohas onlyoneclosefriendinschoolRiskfactorsforsuicideinclude:1)elderlywhitemales (especiallyafterthedeathofaspouse);2)pasthistoryofsuicide;3)familyhistoryof suicide;4)plansforuseofalethalweaponsuchasagunorknife;5)femalegenderhasa higherattemptrate,butmaleshaveahighersuccessrate;6)personalhistoryofbipolar disorderordepression.
A70 year oldmalepatientcomplainsofabrightredspotinhislefteyefor2days.He denieseyepain,visualchanges,orheadaches.Hehasanewonsetofcoughfromarecent viralupperrespiratoryinfection.TheonlymedicineheisonisBayeraspirin1tabletaday. Whichofthefollowingismostlikely?
A)Cornealabrasion
B)Acutebacterialconjunctivitis
C)Acuteuveitis
D)Subconjunctivalhemorrhage-D)Subconjunctivalhemorrhage
Subconjunctivalhemorrhageisabenigndisorderthatoccursfromanincreasein intraocularpressurethatmaybecausedbycoughing,vomiting,forcefulexerrtioninlabor duringchildbirth,strainingwhilehavingabowelmovement,weightlifting,orliftinga heavyobject.
Whichofthefollowingisappropriatefollow upforthis70 year oldpatient?
A)Referraltoanoptometrist
B)Referraltoanophthalmologist
C)Advisethepatientthatitisabenignconditionandwillresolvespontaneously
D)Prescribeanophthalmicantibioticsolution C)Advisethepatientthatitisabenign conditionandwillresolvespontaneously
Asubconjunctivalhemorrhageisabenigndisorderthatresolveswithoutanytreatment
Jason,an8 year oldwithtype1diabetes,isbeingseenfora3 dayhistoryoffre quency andnocturia.Hedeniesflankpainandisafebrile.Theurinalysisresultisnegativeforblood andnitritesbutispositiveforalargeamountofleukocytesandketones.Hehasatrace amountofprotein.Whichofthefollowingisthebesttesttoorderinitially?
A)Urineforcultureandsensitivity
B)24 hoururineforproteinandcreatinineclearance
C)24 hoururineformicroalbumin
D)Anintravenouspyelogram A)Urineforcultureandsensitivity
An8 year oldmalepatientwiththediagnosisofdiabeteshasahighriskofurinarytract infections.Alargeamountofleukocytesintheurinalysisisabnormalandhehasbeen havingsymptomsoffrequencyandnocturiaforthepast3days.Theurineculturewouldbe orderedbecausehehasahighriskofinfection.Theurinecultureandsensitivity(C&S)is thebestevaluationfordiagnosingaurinarytractinfection.
Allofthefollowingarenotrecommendedfortheoutpatienttreatmentofmild preeclampsiaexcept:
A)Severesodiumrestriction
B)Restrictfluidintaketolessthan1literper24hours
C)Aldomet(methyldopa)250mgPO(orally)BID
D)Bedrestontheleftsidewithbathroomprivileges-D)Bedrestontheleftsidewith bathroomprivileges
Outpatienttreatmentformildpre eclampsiaincludesbedrestontheleftlateralsidewith bathroomprivileges.
Thebesttestfordiagnosingcongenitalglaucomaiswhichofthefollowing?
A)Fluoresceinstaining
B)Tonometry
C)Snellenvisionexam
D)Therefractiveindex B)Tonometry
Atonometerisusedtomeasuretheintraocularpressure(IOP)oftheeyetoscreenfor glaucoma.NormalrangeIOPis10 22mmHg.
RockyMountainspottedfeveriscausedbythebiteofthe:
A)Mosquito
B)Tick
C)Insect
D)Flea B)Tick
RockyMountainspottedfeveriscausedbyatickbitefromatickthatwasinfectedwiththe parasiteRickettsiarickettsii.Themortalityrateis1% 7%ifleftuntreated.
Allofthefollowingarefalsestatementsaboutatopicdermatitisexcept:
A)Contactwithcoldobjectsmayexacerbatethecondition
B)Itdoesnothavealineardistribution
C)Itisassociatedwithbullae
D)Thelesionshavevesiclesthatarefullofserousexudate B)Itdoesnothavealinear distribution
Atopicdermatitisisaskinconditioninwhichthelesionsoccurinalinearfashion.They mayhavemanydifferentstages,includingerythematouspapulesandvesicles,with weeping,drainage,and/orcrusting.Lesionsarecommonlyfoundonthescalp,face, forearms,wrists,elbows,andbacksoftheknees.Commonlypruritic.Alsoknownas eczema.
Amotherbringsinher4 year olddaughterwhojuststartedattendingpreschool.Shetells thenursepractitionerthatherchildiscomplainingofburninganditchinginbotheyes alongwitharunnynose.Duringthephysicalexam,thechild'seyesappearinjected bilaterally.Thethroatisredandherinferiornasalturbinatesareswollen.Whichofthe followingismostlikely?
A)Herpeskeratitis
B)Cornealulcer
C)Viralconjunctivitis
Viralconjunctivitisisinflammationoftheconjunctivawithcommoncomplaintsofred, itchyeyes,withoutsignsofinfection.
Asexuallyactivewomaniscomplainingofamenorrheaandvaginalspotting.Onexam,her leftadnexaistenderandcervicalmotiontendernessispositive.Whichtestshouldthe nursepractitionerinitiallyorder?
A)Flatplateoftheabdomen
B)Completebloodcount(CBC)withwhitecelldifferentials
C)Urinepregnancytest
D)Pelvicultrasound C)Urinepregnancytest
Aurinepregnancytestshouldbeperformedtoruleoutmiscarriageand/ortubal pregnancy.
Atoddlerwithcongenitalheartdiseaseisseenfora1-weekhistoryoffacialandlowerextremityedemaaccompaniedbyshortnessofbreath.Thechild'smotherreportsthatthe child'sappetitehasbeenpoor.Thechestx rayrevealsthatthechildhascongestiveheart failure(CHF).Whichofthefollowingheartsoundsarefoundinthesepatients?
A)S1andS2
B)S1,S2,andS3
C)S1,S2,andS4
D)Still'smurmurandS4 B)S1,S2,andS3
Congestiveheartfailureistheinabilityofthehearttopumpasufficientamountofbloodto theorganstomeetthebody'srequirements.ItiscommontohearS1,S2,andS3heart soundsonexam.Commonsignsandsymptomsincludefatigue,shortnessofbreathwith activity,andedemaoflowerextremities.
A53 year oldcrossingguardcomplainsoftwistinghisrightkneewhileworkingthat morning.Thekneeisswollenandtendertopalpation.Thenursepractitionerdiagnosesa GradeIIsprain.Theinitialtreatmentplanincludeswhichofthefollowing?
A)Applicationofcoldpacksthefirst24hoursfollowedbyapplicationsoflowheatat bedtime
B)Elevationoftheaffectedlimbandintermittentapplicationsofcoldpacksforthenext48 hours
C)Recheckingthekneein24hoursandisometricexercises
D)TheapplicationofanAcebandagetotheaffectedkne B)Elevationoftheaffectedlimb andintermittentapplicationsofcoldpacksforthenext48hours
Elevationoftheinjuredkneeabovetheheartwillreducetheamoutofswellingthatcan occur.Useoficepacksimmediatelyaftertheinjuryismosteffectiveandwillreduce
swellinginthetissue.Icetheaffectedareafor15minutesatatimeintermittentlyto preventfrostbiteandfurtherdamagetotissue.Allowing30 45minutesbetweenicingsof thelimbisrecommended.
Erythromycin200mgwithsulfisoxazole600mgsuspension(Pediazole)iscontraindicated inwhichofthefollowingconditions?
A)G6PDdeficiencyanemia
B)Leadpoisoning
C)Betathalassemiaminor
D)B12deficiencyanemia
A)G6PDdeficiencyanemia
Glucose 6 phosphatedehydrogenase(G6PD)defi ciencyisahereditaryconditionthat occurswhentheredbloodcellsbreakdown,causinghemolysis,duetoamissingorlackof asufficientenzymethatisneededtohelptheredbloodcellsworkefficiently.Certainfoods andmedicationsmaytriggerthisreactionandhemolysiswilloccur.Someofthese medicationsincludeantimalarialdrugs,aspirin,nitrofurantoin,NSAIDs,quinidine,quinine, andsulfamedications.
Themotherofan11 year oldboywithsicklecellanemiacallsonthephonecomplaining thathersonwokeupbecauseofapainfulpenileerectionthatwillnotgoaway.Thenurse practitioner'smostappropriateinterventionis:
A)InsertaFoleycatheterandmeasurethechild'sintakeandoutputforthenext24hours
B)InsertaFoleycathetertoobtainaspecimenforaurinalysisandurineforC&S(culture andsensitivity)
C)Recommendanincreaseinthechild'sfluidintake
D)RecommendimmediatereferraltotheER D)RecommendimmediatereferraltotheED
Priapism(painfulpenileerectionnotrelatedtosexualactivity)isatrueurologic emergencythatmayleadtopermanenterectiledysfunctionandpenilenecrosisifnot treatedappropriately.Itcanbeassociatedwithanumberofmedicalconditions(sicklecell anemia,leukemia,orspinalcordinjury)and/orsomepharmacologicagents
ApositiveCoombstestonanRh negativepregnantwomanmeans:
A)ThemotherhasautoantibodiesagainstRh positiveredbloodcells(RBCs)
B)ThefetushasautoantibodiesagainstmaternalRBCs
C)ThemotherdoesnothaveRhfactoragainstfetalRBCs
D)ThefetusdoesnothaveRBCautoantibodies-A)Themotherhasautoantibodiesagainst Rh positiveredbloodcells (RBCs)
Themother'sautoantibodiescanattackthefetus'sRh-positiveredbloodcellsandcause destructionofthesecells,whichcancausesevereanemiaandcom plicationsinthefetus. Todaythisispreventablewiththeadministrationofanti RhDimmunoglobulin(Rho(D)
immuneglobulin)toanRh negativemotherat28weeksgestationandafterbirthifthe newbornisRhpositive.
Folicacidsupplementationisrecommendedforwomenwhoareplanningpregnancyin orderto:
A)Preventrenalagenesis
B)Preventanencephaly
C)Preventkidneydefects
D)Preventheartdefects B)Preventanencephaly
Folicacidsupplementationduringpregnancyhasbeenshowntodecreasetheriskofneural tubedefectsofthefetus
Allofthefollowingarepossiblecausesforsecondaryhypertensionexcept:
A)Acutepyelonephritis
B)Pheochromocytoma
C)Renovascularstenosis
D)Coarctationoftheaorta A)Acutepyelonephritis
Pheochromocytomaisanadrenalglandtumorinwhichthereisincreasedproductionof thehormonesadrenalineandnoradrena line,whichmaycauselong termelevationin bloodpressure.Renovascularsteno sisisanarrowingofoneorbotharteriesleadingto thekidneys.Itcancauseseverehypertensionandirreversiblekidneydamage.Coarctation oftheaortaisacon genitalheartdefectoftheaorta;itisanarrowingoftheaortathat causesthehearttoworkhardertogetbloodtoflowthroughthenarrowaorticpassageway tootherorgans,whichinturncausesanincreaseinbloodpressure.
Fitz Hugh Curtissyndromeisassociatedwithwhichfollowinginfection?
A)Syphilis
B)Chlamydiatrachomatis
C)Herpesgenitalis
D)Lymphogranulomavenereum B)Chlamydiatrachomatis
Fitz Hugh Curtisisacomplicationofhavingpelvicinflammatorydiseasethatwascaused byavaginalinfection,suchasgonorrheaorChlamydiatrachomatis.Thiscauses inflammationandinfectioninthepelviccavity.Leftuntreated,thisinfectioncancause adhesionsthatstretchfromtheperitoneumtotheliver.
Anursinghomeresidentreportstohisphysicianthathispreviousroommatewasrecently startedontuberculosistreatment.AMantouxtestandchestx rayareorderedforthe patient.Whatistheminimumsizeofindurationconsideredpositiveforthispatient?
B)5mm
C)10mm
D)15mm B)5mm
ToperformtheMantouxtest,adoseof5tuberculinunitsin0.1mLsolutionisinjected intradermallyintotheforearmandread48to72hourslater.Resultsaremeasuredbythe sizeoftheinduration,notery thema.Standardresultsof10mmorlessareconsidered negativeforalow riskpopulation.Forahigh riskpopulation,suchasarecentexposure,5 mmofindurationorgreaterisapositiveresult.
Insmallchildrenwithacquiredimmunodeficiencysyndrome(AIDS),whichofthefollowing vaccinesiscontraindicated?
A)Diphtheriaandtetanus(Td)
B)HepatitisBandmumps
C)Varicella
D)Tdandoralpolio C)Varicella
Thedataregardingefficacyofthevaricellavaccineareinsufficient;therefore,varicella vaccineiscontraindicatedinHIV infectedindividuals.
A44 year oldfemalewhoisundergoingtreatmentforinfertilitycomplainsofnothavinga menstrualperiodforafewmonths.Thenightbefore,shestartedspottingandisnow havingcramp typepainsinherpelvicarea.Herbloodpressure(BP)is160/80,thepulse rateis110,andsheisafebrile.Herlabsrevealamildanemiawithmildleukocytosis.On pelvicexam,theuterinefundusisfoundabovethesymphy sispubis.Thecervicalosis dilatedat3cm.Whichofthefollowingismostlikely?
A)Inevitableabortion
B)Threatenedabortion
C)Incompleteabortion
D)Acutepelvicinflammatorydisease A)Inevitableabortion
Inevitableabortionisdefinedasvaginalbleedingwithpainandcervicaldilationand/or effacement.Threatenedabortionisdefinedasvaginalbleedingwithabsentorminimalpain andaclosed,long,andthickcervix.Incompleteabortionismoderatetodiffusevaginal bleeding,withthepassageoftissueandpainfuluterinecrampingorcontractions.Acute pelvicinflammatorydiseaseisasuddenonsetofinflammationandpainthataffectsthe pelvicarea,cervix,uterus,andovaries,whichiscausedbyinfection.
A14 year oldfemalewhoissexuallyactiveisbroughtinbyhermotherforan immunizationupdate.Accordingtothemother,herdaughterhad1doseofhepatitisB vaccine.Whichofthefollowingvaccineswouldyouadministeratthisvisit?
A)TdandhepatitisB
B)DTaP(diphtheria,tetanus,acellularpertussis)andhepatitisB
C)HepatitisBonly
D)MMR(measles,mumps,rubella)andTd A)TdandhepatitisB
TheCDCrecommendsTdandhepatitisBfor14 year oldfemales.Itisrecommendedfor hertocontinuethehepatitisseries,whichincludesatotalof3injections.
AnRh negativepregnantwomanwithnegativerubellatitersshouldbevaccinatedatwhat timeperiodinpregnancy?
A)Shecanbevaccinatedatanytimeinherpregnancy
B)Duringthesecondtrimester
C)Duringthethirdtrimester
D)Duringthepostpartumperiod D)Duringthepostpartumperiod
Rubellashouldbeadministeredtothewomanduringthepostpartumperiod.Rubellais contraindicatedduringpregnancy.
MedicarePartBwillpayforallofthefollowingservicesexcept:
A)Outpatientphysicianvisitsthataremedicallynecessary
B)Durablemedicalequipment
C)Outpatientlaboratoryandradiologytests
D)Eyeglassesandroutinedentalcare D)Eyeglassesandroutinedentalcare
MedicarePartBcovers:1)outpatientphysicianvisits,labs,x rays;2)durablemedical equipment;3)mammograms/colonoscopyafterage50yearsannually;and4) rehabilitation.
Whichofthefollowingisusedtoscreenforcolorblindnessina7 year oldboy?
A)Snellenchart
B)Ishiharachart
C)Cover/uncovertest
D)Redreflex B)Ishiharachart
TheIshiharachartisusedforscreeningforcolorblindness.
A67 year oldretiredclerkpresentswithcomplaintsofshortnessofbreathandweightgain overa2 weekperiod.Anonproductivecoughaccompanieshersymptoms.Thelungexam ispositiveforfinecracklesinthelowerlobeswithnowheezing.Theexamispositivefor egophony.Whichofthefollowingconditionsismostlikely?
A)Acuteexacerbationofasthma
B)Left-heartfailure
C)Right heartfailure
D)Chronicobstructivepulmonarydisease B)Left heartfailure
Signsandsymptomsofleft heartfailureincludetachypnea,laboredbreathing,andralesor cracklesinthelowerbasesofthelungs,whichcandevelopintopulmonaryedema.
Whichofthefollowingdrugsismostlikelytorelievethepatient'ssymptoms?
A)Atenolol(Tenormin)
B)Trimethoprim/sulfamethoxazole(BactrimDS)
C)Furosemide(Lasix)
D)Hydrocodone/guaifenesinsyrup(Hycotuss) C)Furosemide(Lasix)
Lasixwouldbeusedtohelpremovetheextrafluidload.
Apatienthasrecentlybeendiagnosedwithmigraineheadachewithaura.Shewantsadvice onwhatsheshouldeliminatefromherdiettoreduceherriskofheadaches.Thebest responseistoadvisethispatienttoavoid:
A)Foodswithaspartame(Equal)becausetheycantriggermigraines
B)Foodswithmonosodiumglutamatebecausetheypromotediuresis
C)Foodswithgarlicbecausetheypromotehypertension
D)Foodswithnitratesbecausetheydonotinduceflushing A)Foodswithaspartame (Equal)becausetheycantriggermigraines
Dietarytriggersformigraineheadachesincludefoodsthatcontainaspartame,tyramine, nitrites,MSG,and/orredwine.Thesefoodsarethoughttocauseachangeintheblood vesselsandincreasedbloodflowtothebrain.
Apatientwithahistoryofmitralvalveprolapse(MVP)isrequestingprophylaxisbefore herdentalsurgery.Whichofthefollowingwouldyouprescribethispatient?
A)Amoxicillinahalfhourbeforeand2hoursaftertheprocedure
B)Amoxicillin1hourbeforetheprocedure
C)Amoxicillin1hourbeforeand3hoursaftertheprocedure
D)Prophylaxisisnotrecommendedforthispatient D)Prophylaxisisnotrecommended forthispatient
TheAmericanHeartAssociationdoesnotrecommendroutineantibioticprophylaxisprior todentalproceduresexceptforpatientswhoareathighriskforbacterialendocarditis(a prostheticcardiacvalve,previoushistoryofbacterialendocarditis,congenitalheart defects,etc.).
Koplik'sspotsareassociatedwith:
A)Poxvirusinfections
B)Measles
C)Kawasaki'sdisease
D)Reye'ssyndrome B)Measles
Signsandsymptomsofthemeaslesincludefeverover101°F,coryza,cough,conjunctivitis, rash,andKoplik'sspotsonbuccalmucosa.
Stella,anewmother,complainstoyouthatshehasbeenfeelingirritableandjitteryalmost dailyforthepastfewmonths.Shecomplainsoffrequentpalpitationsandmorefrequent bowelmovementsalongwithweightloss.HerBPis160/70,herpulseis110,andsheis afebrile.Allofthefollowingconditionsshouldbeconsideredinthedifferentialdiagnosis forthispatientexcept:
A)Mitralregurgitation
B)Graves'disease
C)Generalizedanxietydisorder
D)Illicitdruguse A)Mitralregurgitation
Signsandsymptomsofmitralregurgitationdonotincludefrequentbowelmovementswith weightloss.
Anelderlypatientwithaproductivecoughandfeverisdiagnosedwithpneumonia.Allof thefollowingorganismsarecapableofcausingcommunity acquiredpneumoniaexcept:
A)Haemophilusinfluenzae
B)Mycoplasmapneumoniae
C)Treponemapallidum
D)Streptococcuspneumoniae-C)Treponemapallidum
Treponemapallidumisagram negativespirochetebacteriumthatcausessyphilis
Humanchorionicgonadotropin(hCG)isproducedbythe:
A)Placenta
B)Hypothalamus
C)Anteriorpituitary
D)Ovaries A)Placenta
HCGisproducedbytheplacenta.
Themajorityofserumalphafetoproteinisproducedbythe:
A)Fetalliver
B)Mother'sliver
C)Placenta
D)Fetalneuraltube A)Fetalliver
Serumalphafetoproteinisproducedbythefetalliver.
Stellaworksinthehousekeepingdepartmentofahospital.Shepresentstotheemployee healthclinicwithacomplaintofaneedlesticktoherleftthumb.Theneedlewasinoneof thegarbagebagsfromtheemergencyroom.Thepatienthadalittlebleedingthatstopped spontaneously.Whichofthefollowingisthenextstep?
A)Orderanenzyme linkedimmunosorbentassay(ELISA)testassoonaspossible
B)Recommendatetanusboosterin1week
C)OfferthepatienthepatitisBimmunoglobulin
D)Orderachestx ray A)Orderanenzyme linkedimmunosorbentassay(ELISA)testas soonaspossible
EmployeehealthclinicprotocolsforneedlesticksrecommendorderinganELISAtestas soonaspossibletoestablishbaselinebloodworkfortheemployee.
Anelderlywomanhasbeenondigoxin(Lanoxin)for10years.Herelectrocardio graph (EKG)isshowinganewonsetofatrialfibrillation.Herpulseis64/min.Shedeniessyncope anddizziness.Whichofthefollowinginterventionsismostappropriate?
A)Orderanelectrolytepanelandadigoxinlevel
B)Orderaserumthyroid stimulatinghormone(TSH),digoxinlevel,andanelectrolyte panel
C)Orderaserumdigoxinlevelanddecreaseherdigoxindosebyhalfwhilewaitingfor results
D)Discontinuethedigoxinandorderanother12 leadEKG B)Orderaserumthyroid stimulatinghormone(TSH),digoxinlevel,andanelectrolytepanel
Obtainingbaselinebloodworktoevaluateforcausesofnew onsetatrialfibrillationis recommendedpriortodecreasingorstoppingmedications.Thyroiddiseaseisacommon causeofnew-onsetatrialfibrillation.
Younotethefollowingresultonaroutineurinalysisofa37 year oldprimigravidawhois at30weeksofgestation.Leukocyte=trace,nitrite=negative,protein=2+,blood= negative.Herweighthasincreasedby5lbsduringthepastweek.Whichofthefollowingis mostlikely?
A)HELLPsyndrome
B)Pregnancy inducedhypertension(preeclampsia)
C)Eclampsiaofpregnancy
D)Primaryhypertension B)Pregnancy inducedhypertension(preeclampsia)
Theclassictriadofsymptomsofpreeclampsiaincludeshypertension,edema(weightgain), andproteinuria.
ThenursepractitionerwhosuspectsthatoneofherhypertensivepatientshasCushing's syndromewouldexpecttofindwhichofthefollowinglaboratoryresults?
A)Hyponatremia
B)Hypoglycemia
C)Elevatedserumcortisollevels
D)Decreasedurine17 ketosteroids C)Elevatedserumcortisollevels
ElevatedserumcortisollevelsareseenwithCushing'ssyndrome.
Thefirstteethtoeruptduringinfancyarewhichofthefollowing?
A)Firstmolars
B)Secondmolars
C)Incisors
D)Canines C)Incisors
Theincisorsarethefirstteethtoeruptduringinfancy.
Thepositivesignsofpregnancyinclude:
A)Palpationofthefetusandauscultationofthefetalhearttonesbythenursepractitioner
B)Palpationofthefetusandapositivequantitativeserumpregnancytest
C)Fetalhearttonesandapositivequantitativeserumpregnancytest
D)Fetalhearttonesandfeelingofmovementofthebabybythemother
A)Palpationof thefetusandauscultationofthefetalhearttonesbythenursepractitioner
Presumptivesignsofpregnancyaresymptomsexperiencedbythewoman,suchas amenorrhea,breasttenderness,nausea/vomiting,fatigue,andincreasedurinaryfrequency. Probablesignsofpregnancyaresignsdetectedbytheexaminer,suchasanenlarged uterus.Positivesignsofpregnancyaredirectevidenceofpregnancysuchasaudiblefetal hearttonesorcardiacactivityonultrasound.
Chadwick'ssignischaracterizedby:
A)Softeningofthecervix
B)Bluecolorationofthecervixandvagina
C)Softeningoftheuterineisthmus
D)Nauseaandvomitingduringthefirsttrimesterofpregnancy
B)Bluecolorationofthe cervixandvagina
Chadwick'ssignisdefinedasabluishdiscolorationofthecervixandvagina.Thesechanges arecausedbytheincreasedvascularityandcongestioninthepelvicareaduringpregnancy.
AcollegestudenthasrecentlybeeninformedthathehasanHPV(humanpapillomavirus) infectionontheshaftofhispenis.Whichofthefollowingmayrevealsubclinicallesionson thepenileskin?
A)PerformaKOH(potassiumhydroxide)exam
B)Scrapeoffsomeoftheaffectedskinandsenditforacultureandsensitivity
C)Applyaceticacidtothepenileshaftandlookforacetowhitechanges
D)Orderaserumherpesvirustiter C)Applyaceticacidtothepenileshaftandlookfor acetowhitechanges
LesionsofHPVinfectionwillturnwhitewithapplicationofaceticacid.
CarolM.isa40 year oldbanktellerwhohasrecentlybeendiagnosedwithobsessive compulsivedisorderbyhertherapist.Hersymptomswouldinclude:
A)Ritualisticbehaviorsthatthepatientfeelscompelledtorepeat
B)Attemptstoignoreorsuppresstherepetitivebehaviors,whichincreaseanxiety
C)Frequentintrusiveandrepetitivethoughtsandimpulses
D)Alloftheabove D)Alloftheabove
Signsandsymptomsofobsessive compulsivedisorderincluderitualisticbehaviorsthatare repeated,increasedanxietywithattemptingtoignorerepetitivebehaviors,andfrequent intrusiveandrepetitivethoughtsandimpulses.
Whichofthefollowingmedicationsisindicatedforthetreatmentofobsessive compulsive disorder?
A)Paroxetine(PaxilCR)
B)Haldoperidol(Haldol)
C)Lorazepam(Xanax)
D)Imipramine(Elavil-A)Paroxetine(PaxilCR)
AntidepressantsarethemostcommonmedicationsusedforOCD.Thoseantidepressants thatareapprovedforOCDbytheFoodandDrugAdministration(FDA)include clomipramine(Anafranil),fluvox amine(Luvox),fluoxetine(Prozac),paroxetine(Paxil, Pexeva),andsertraline(Zoloft).
Youwouldadvisean18 year oldfemalestudentwhohasbeengivenaboosterdoseof MMRatthecollegehealthclinicthat:
A)Shemighthavealow gradefeverduringthefirst24to48hours
B)Sheshouldnotgetpregnantwithinthenext4weeks
C)Herarmwillbeverysoreontheinjectionsitefor24to48hours
D)Herarmwillhavesomeindurationontheinjectionsitein24to48hours-B)Sheshould notgetpregnantwithinthenext4weeks
MMRshouldnotbeadministeredtowomenknowntobepregnant.Inaddition,women shouldbecounseledtoavoidbecomingpregnantfor28daysfollowingvaccination.
Jean,a68 year oldfemale,issuspectedofhavingAlzheimer'sdisease.Whichofthe followingisthebestinitialmethodforassessingthecondition?
A)Computedtomographyscanofthebrain
B)MiniMentalStatusExam
C)Obtainthehistoryfromthepatient,friends,andfamilymembers
D)EEG(electroencephalography) B)MiniMentalStatusExam
BeginwithadministeringtheMMSEforabaselineassessment,followedbytakingahistory fromthepatientandothers.
A55 year oldwomanwhohastype2diabetesisconcernedaboutherkidneys.Shehasa historyof3urinarytractinfectionswithinthepast8months.Shedeniesdysuriaand frequencyatthisvisit.Whichofthefollowingisthebestinitialcoursetofollow?
A)Recheckthepatient'surineandorderaurineforcultureandsensitivity
B)OrderanIVP(intravenouspyelogram)
C)Advisethepatienttofollowupwithaurologist
D)Evaluatethepatientforapossiblekidneyinfection A)Recheckthepatient'surineand orderaurineforcultureandsensitivity
Aurinarytractinfectionisdefinedasthepresenceof100,000organismspermLofurinein asymptomaticpatientsorgreaterthan100organismspermLorurinewithpyuria(more than7WBCs/mL)inasymptomaticpatient
Anursepractitionerisgivingdietarycounselingtoamalealcoholicwhohasrecentlybeen diagnosedwithfolicaciddeficiencyanemia.Whichofthefollowingfoodsshouldthenurse practitionerrecommendtothispatient?
A)Tomatoes,oranges,andbananas
B)Cheese,yogurt,andmilk
C)Lettuce,beef,anddairyproducts
D)Spinach,liver,andwholewheatbread D)Spinach,liver,andwholewheatbread
Foodsthatarehigherinfolicacidincludespinach,liver,andwholewheatbread.
TheELISAandWesternBlottestsarebothusedtotestforHIV.Whichofthefollowing statementsiscorrect?
A)ItisatesttodetectviralRNA
B)ApositiveELISAscreeningdoesnotmeanthepersonhasHIVinfection
C)Itisatesttodetectviruses
D)ItisadiagnostictestfortheAIDSvirus B)ApositiveELISAscreeningdoesnotmeanthe personhasHIVinfection
TheELISAtestisalwaysfollowedbyaWesternblottesttoconfirmdiagnosis.
Hegar'ssignisconsidereda:
A)Positivesignofpregnancy
B)Probablesignofpregnancy
C)Presumptivesignofpregnancy
D)Probleminpregnancy B)Probablesignofpregnancy
Hegar'ssignissofteningofthelowerportionoftheuterusandisconsideredaprobable signofpregnancy.
Whenpalpatingawomanwhoisat20weeksofgestation,thenursepractitionershouldbe abletofeeltheuterinefundusatwhatlevel?
A)Justrisingabovethelevelofthepubicsymphysis
B)Betweenthepubicsymphysisandtheumbilicus
C)Attheleveloftheumbilicus
D)Abovetheleveloftheumbilicus C)Attheleveloftheumbilicus
Uterinegrowthat12weeksgestation,palpablejustabovethesymphysispubis;20weeks gestation,attheleveloftheumbilicus;afterthis,measurementsincmshould approximatelyequalweeksofgestation.
A67 year oldfemalewitha50pack/yearhistoryofsmokingpresentsforaroutineannual physicalexamination.Shecomplainsofbeingeasilyshortofbreathandisfrequently fatigued.Physicalexaminationrevealsdiminishedbreathsounds,hyperresonance,and hypertrophiedrespiratoryaccessorymuscles.HerCBCresultsrevealthatherhematocrit levelisslightlyelevated.Herpulmonaryfunctiontest(PFT)resultsshowincreasedtotal lungcapacity.Whatisthemostlikelydiagnosisforthispatient?
A)Bronchogeniccarcinoma
B)COPD(chronicobstructivepulmonarydisease)
C)Chronicbronchitis
D)Congestiveheartfailure B)COPD(chronicobstructivepulmonarydisease)
Commoncomplaintsandsigns/symptomsofCOPDincludeshortnessofbreath,fatigue, chroniccough,wheezing,difficultyperformingtasksandspeaking,pursed lipbreathing, digitalclubbing,diminishedbreathsounds,useofaccessorymuscles,andpolycythemia duetochronichypoxia.Pulmonaryfunctiontests/spirometryincludeforcedexpira tory volume,forcedvitalcapacity,andFEV1/FVCratios.
Yourpatientof10years,Mrs.Leman,isconcernedabouthermostrecentdiagnosis.She wastoldbyherdermatologistthatshehasanadvancedcaseofactinickeratosis.Whichof thefollowingisthebestexplanationforthispatient?
A)Itisabenigncondition
B)Itisaprecancerouslesionandshouldbefollowedupwithherdermatologist
C)Applyhydrocortisonecream1%BIDfor2weeksandmostofitwillgoaway
D)Itisimportantforhertofollowupwithanoncologist B)Itisaprecancerouslesionand shouldbefollowedupwithherdermatologist
Actinickeratosisisasmall,raisedskinlesionfromhavingbeeninthesunforalongperiod oftime.Someactinickeratosesmaydevelopintoskincancer;therefore,furtherevaluation isneededtodetermineifremovalisrequired.
Patientconfidentialityisbreachedwhen:
A)Medicalinformationisgiventoaspouse
B)Recordsaresubpoenaed
C)ReportsaresenttothePublicHealthDepartment
D)Recordsarereleasedtoinsurancecompanies A)Medicalinformationisgiventoa spouse
Patientconfidentialityisbreachedwhenmedicalinformationisgiventoaspouseorany otherindividualwithoutconsentofthepatient.
A25 year oldwoman'slastmenstrualperiodwas6weeksago.Sheiscomplainingof nauseawithvomitinginthemorningandfatigue.Herbreastsfeelbloated.Thenurse practitionersuspectsthatsheispregnant.Hersymptomswouldbeconsidered:
A)Positivesignsofpregnancy
B)Probablesignsofpregnancy
C)Presumptivesignsofpregnancy
D)Possiblesignsofpregnancy C)Presumptivesignsofpregnancy
Presumptivesignsofpregnancyaresymptomsexperiencedbythewoman,suchas amenorrhea,breasttenderness,nausea/vomiting,fatigue,andincreasedurinary frequency.
A55 year oldmalepatientdescribestoyouanepisodeofchesttightnessinhissubsternal areathatradiatedtohisbackwhilehewasjogging.Itwasrelievedimmediatelywhenhe stopped.Whichofthefollowingconditionsdoesthisbestdescribe?
A)Anginapectoris
B)Acutemyocardialinfarction
C)Gastroesophagealrefluxdisease
D)Acutecostochondritis A)Anginapectoris
Symptomsofanginapectorisincludeapressing,squeezing,orcrushingpain,usuallyinthe chestorback,arms,neck,orearlobes.Weakness,fatigue,andshortnessofbreathandpain radiatinginthearms,shoulders,jaw,neck,and/orbackmayalsooccur.Anginapectorisis mostcommonlybroughtonbyphysicalexertion,butcanalsobetriggeredbystressand otherstressorstothebody.
Whichofthefollowingwouldyourecommendtothis55 year oldpatient?
A)Startanexerciseprogrambystartingwithwalkinginsteadofjogging
B)Consultwithacardiologistforfurtherevaluation
C)Consultwithagastroenterologisttoruleoutacutecholecystitis
D)Takeibuprofen(Advil)600mgforpainevery4to6hoursPRN B)Consultwitha cardiologistforfurtherevaluation
Physicalassessmentandexaminationbyacardiologistareadvisedtoruleoutcardiac problemsanddeter minethesafetyofphysicalexercise.
Carol,a73 year oldpatient,complainsofepisodicvertigo,slightconfusion,andweakness thatlastnearlyanhoureachtime.Movementdoesnotworsenthevertigo.She"rests"and hersymptomssubside,butsheispuzzledbecausetheweakness"jumpsfromsidetoside," sometimesontherightandsometimesontheleftofherbody.Hersymptomssuggest:
A)Benignparoxysmalpositionalvertigo
B)Ménière'sdisease
C)TIA(transientischemicattack)
D)CVA(cerebrovascularaccident)-C)TIA(transientischemicattack)
Transientischemicattack(TIA)iscausedbyvascularocclusion.SymptomsofaTIAusually lastlessthan1hour;however,thesymptomsmayalsobepermanent.Common signs/symptomsincludeneurologicdeficits,vertigo,confusion,weakness,hemiparesis, temporarymonocularblindness,ataxia,anddiplopia.
Allofthefollowingmeasureshavebeenfoundtohelplowertheriskofosteoporosis except:
A)Drinkingorganicjuice
B)Eatinglow fatdairyfoods
C)Performingweight bearingexercises
D)VitaminDsupplementation-A)Drinkingorganicjuice
VitaminDlevelsmustbesufficientforthebodytoabsorbcalcium.Eatingfoodshighin vitaminDandcalciumalongwithcalciumandvitaminDsupplementsareadvisedto protectthebonesandpreventboneloss.Performingweight-bearingexercisesdailyalso increasesbonestrength.
A28 year oldmalenurseofHispanicdescentreportsahistoryofacoldthatresolved2 weeksagoexceptforadrycoughandpainoverhisrightcheekthatworsenswhenhe bendsdown.Thepatientdeniesfever.Hetellstheemployeehealthnursepractitionerthat heisveryallergictobothcephalexin(Keflex)anderythromycin.Thevitalsignsshowthat thepatient'stemperatureis99.2degreesFahrenheit,apulseof72beatsperminute,anda respiratoryrateof12breathsperminute.Whichofthefollowingconditionsismostlikely?
A)Acutesinusitis
B)Acutebronchitis
C)FeversecondarytothepreviousviralURI(upperrespiratoryinfection)
D)Munchausen'ssyndrome A)Acutesinusitis
Acutesinusitissymptomsincludecough,facialpain,andlow gradefever.
A38 year oldmultigravidawhoisat32weeksofgestationcallsthefamilynurse practitionercomplainingofbrightredvaginalbleeding.Thereisnowaterydis charge.She complainsthatheruterusfeelshardandisverypainful.Whichofthefollowingconditions ismostlikely?
A)Placentaprevia
B)Placentaabruptio
C)Amolarpregnancy
D)Anectopicpregnancy
B)Placentaabruptio
Abruptioplacentasymptomsarebrightredvaginalbleeding,board likeuteruson palpation,andpain.However,therecanbeconcealedhemorrhageandthepatientmaynot havevaginalbleeding.Placentapreviaispainlessbleeding.Ectopicandmolarpregnancy wouldnotprogressto32weeksgestation
TheJarisch Herxheimerreactionisbestdescribedas:
A)Animmune mediatedreactionprecipitatedbythedestructionofalargenumberof spirochetesduetoanantibioticinjection
B)Severechillsandelevatedbloodpressure
C)CausedbyinfectionwitheitherChlamydiatrachomatisorgonorrhealinfectionofthe livercapsule
D)Associatedwithcertainviralillnesses A)Animmune mediatedreactionprecipitated bythedestructionofalargenumberofspirochetesduetoanantibioticinjection
TheJarisch-Herxheimerreactionisdefinedasanimmune-mediatedreactionprecipitated bythedestructionofalargenumberofspirochetesduetotheantibioticinjection.
Duringabreastexamofa30 year oldnulliparousfemale,thenursepractitionerpalpates severalrubberymobileareasofbreasttissue.Theyareslightlytendertopalpation.Both breastshavesymmetricalfindings.Therearenoskinchangesoranynippledischarge.The
patientisexpectinghermenstrualperiodin5days.Whichofthefollowingwouldyou recommend?
A)Referraltoagynecologistforfurtherevaluation
B)Tellhertoreturn1weekafterherperiodsoherbreastscanberechecked
C)Advisethepatienttoreturnin6monthstohaveherbreastsrechecked
D)Schedulethepatientforamammogram B)Tellhertoreturn1weekafterherperiods soherbreastscanberechecked
Priortohavingmenses,womenwillexperiencebreastchangesoftendernesswith palpation,withsymmetricalsoft,mobileareasofbreasttissuethatarebenign.Her symptomsshouldimproveafterhermensesandrepeatingtheexamin1weekwouldbe recommended.
Whenevaluatingthebloodpressureonboththearmsandlegsofaninfantwhohasa diagnosisofcoarctationoftheaorta,whichofthefollowingisthecorrectfinding?
A)Thebloodpressureishigherinthearmsthaninthelegs
B)Onlythediastolicbloodpressureishigherinthelegsthaninthearms
C)Thebloodpressureishigherinthelegsthanthearms
D)Thebloodpressureislowerinbotharmsthaninthelegs A)Thebloodpressureis higherinthearmsthaninthelegs
Incoarctationoftheaorta,bloodpressureishigherinthearmsthaninthelegsduetothe narrowingintheaorta.Bloodpressuremustrisetogetadequatebloodflowtothelower extremities;therefore,thebloodpressureabovethecoarctationrisestocompensatefor this.
Whichofthefollowingshouldyouexpecttofindonawet mountslideofapatient diagnosedwithbacterialvaginosis?
A)Tzanckcells
B)Alargeamountofleukocytesandepithelialcells
C)Alargeamountofbacteriacoatingthesquamouscellsandveryfewleukocytes
D)Epithelialcellsandasmallamountofblood 108 C)Alargeamountofbacteriacoatingthesquamouscellsandveryfewleukocytes
Resultsofthewetmountforbacterialvaginosisincludebacteriacoatingthesquamous cells(cluecells)andveryfewleukocytesorRBCs
A40 year oldwomanisintheofficecomplainingofpalpitationsandsomelight headednessforthepast6months.Thesearerandomepisodes.Thenursepractitioner noticesamid systolicclickwithalatesystolicmurmurthatisbestheardintheapicalarea duringauscultationofthechest.TheNPwouldsuspect:
B)Sinusarrhythmia
C)Mitralstenosis
D)Mitralvalveprolapse D)Mitralvalveprolapse
Mitralvalveprolapseoccurswhenthemitralvalvedoesnotclosealltheway,causingalate systolicmurmurheardbestintheapicalareaduringauscultationofthechest.Symptoms patientsmayexperienceattimesincludepalpitationsanddizziness.
Your35 year oldpatientisbeingworkedupformicroscopichematuria.Allofthefollowing aredifferentialdiagnosesofmicroscopichematuriaexcept:
A)Kidneystones
B)Bladdercancer
C)Acutepyelonephritis
D)Renalstenosis D)Renalstenosis
Renalstenosisisanarrowingoftherenalartery.Nobloodwouldbenotedonexam. Evidenceofbloodintheurinecanbeseenwithkidneystones,bladdercancer,andacute pyelonephritis.
Duringaroutinephysicalexamofanelderlywoman,atriangularthickeningofthebulbar conjunctivaonthetemporalsideisnotedtobeencroachingonthecornea.Shedeniesany eyepainorvisualchanges.Whichofthefollowingismostlikely?
A)Cornealarcus
B)Pterygium
C)Pinguecula
D)Chalazion B)Pterygium
Pterygiumisatriangulargrowthonthewhitepartoftheeyethatalsoextendsontothe cornea.Cornealarcusisaringaroundtheedgeofthecornea.Chalazionisastyeintheeye thatmaycausepainandswelling.Pingueculaisabenigngrowthontheconjuctivacaused bythedegenerationofitscollagenfibers.Thick,yellowfibersmaybeseen.
Mr.Jones,whohasbeenonpravastatin(Pravachol)20mgatbedtimeforthepastfew months,complainsoflatelyfeelingextremelyfatigued.Thepatientalsonoticedthathis urinehasbeenadarkercolorduringthepast2weeks.Whichofthefollowingisthebest treatmentplantofollow?
A)Discontinuehispravastatinandorderaliverfunctionprofile
B)Continuethepravastatinbutonhalfthedose
C)Schedulehimforacompletephysicalexam
D)Schedulehimforaliverfunctionprofile A)Discontinuehispravastatinandordera liverfunctionprofile
Sideeffectsofstatindrugsincludemyalgia,fatigue,andelevatedliverenzymes.Routine labsshouldincludeliverenzymestoassesstheeffectsontheliver.
Jane,ayoungprimigravida,reportstoyouthatsheisstartingtofeelthebaby'smovements inheruterus.Thisisconsideredtobewhichofthefollowing?
A)Presumptivesign
B)Probablesign
C)Positivesign
D)Possiblesign B)Probablesign
Probablesignsofpregnancyaresymptomsofpregnancythatarefeltbythewoman.
A14-year-oldteenisworriedthatshehasnotstartedtomenstruatelikemostofher friends.Duringthegynecologicalexamination,thenursepractitionertellsthemother,who isintheroomwiththepatient,thatherdaughterisstartingTannerStageII.Whatarethe physicalexamfindingsduringthisstage?
A)Breastbudsandsomestraightpubichair
B)Fullydevelopedbreastsandcurlypubichair
C)Breasttissuewiththeareolaonaseparatemoundwithcurlypubichair
D)Nobreasttissueandnopubichair A)Breastbudsandsomestraightpubichair
TannerStageIIinfemalesincludesbreastbudsandfewstraight,finepubichairs.
ThePhalentestisusedtoevaluate:
A)Inflammationofthemediannerve
B)Rheumatoidarthritis
C)Degenerativejointchanges
D)Chronictenosynovitis-A)Inflammationofthemediannerve
ThePhalentestisusedtoidentifyinflammationofthemediannerveseenwithcarpal tunnelsyndrome.Phalen'stestisperformedbyexaminingthewristwithfullflexionofthe wristfor60seconds.Positivefindingsarereproductionofthesymptomssuchasnumbness andtin glingofthethumb,indexfinger,andmiddlefingerareas.
Physiologicanemiaofpregnancyisdueto:
A)Anincreaseinthecardiacoutputattheendofthesecondtrimester
B)AphysiologicdecreaseintheproductionofRBCsinpregnantwomen
C)Anincreaseofupto50%oftheplasmavolumeinpregnantwomen
D)Anincreaseintheneedfordietaryironinpregnancy C)Anincreaseofupto50%ofthe plasmavolumeinpregnantwomen
Physiologicanemiaofpregnancyiscausedbytheincreasedvolumeofplasmaduring pregnancywhencomparedtotheproductionofRBCs.
Allofthefollowingareimplicatedincausingchroniccoughexcept:
A)Chronicbronchitis
B)Allergicrhinitis
C)Acuteviralupperrespiratoryinfection
D)Gastroesophagealrefluxdisease C)Acuteviralupperrespiratoryinfection
Chroniccoughcanbecausedbychronicbronchitis,allergicrhinitis,andGERD.
Whichofthefollowingisatruestatementregardingtheeffectofaspirinonplatelet function?
A)Theeffectonplateletsisreversible
B)Theeffectonplateletsisreversibleandlastsonly1week
C)Ithasaminimaleffectonplateletfunction
D)Theeffectonplateletfunctionisirreversibleandlasts15to20days D)Theeffecton plateletfunctionisirreversibleandlasts15to20days
Theuseofaspirinaffectstheplateletfunction,isirreversible,andcanlastupto15 20days
Allofthefollowingagentsareusedtocontroltheinflammatorychangesseeninthelungs ofasthmaticsexcept:
A)Albuterolinhaler(Proventil)
B)Triamcinolone(Azmacort)
C)Montelukast(Singulair)
D)Cromolynsodiuminhaler(Intal) A)Albuterolinhaler(Proventil)
Proventilinhalerisashort actingbronchodilatorandisusedforimmediatereliefof shortnessofbreath.Itactsquicklytodilatethetubesinthelungs.Medicationsthathave steroidsandleukotrieneshelptheinflamedchannelstoremainopenandclearbuttake longertogetintothesystemtowork.
Rovsing'ssignisassociatedwithwhichofthefollowing?
A)Anacuteabdomen,suchasduringarupturedappendix
B)Kneeinstability
C)Damagetothemeniscusoftheknee
D)Acutecholelithiasis A)Anacuteabdomen,suchasduringarupturedappendix
Rovsing'ssignidentifiesanacuteabdomen,suchasacuteappendicitis.Rovsing'smaneuver isper formedwiththepatientinthesupineposition,palpatingdeepintotheleftlower quadrantoftheabdomenandhavingreferredpaintotherightlowerquadrant.
Whichofthefollowingiscontraindicatedinthecareofpregnantwomenwithplacenta previa?
A)Echocardiogram
B)Intravaginalultrasound
C)Abdominalultrasound
D)Pelvicultrasound B)Intravaginalultrasound
Notypeofvaginalexamshouldbeperformedinpatientsdiagnosedwithplacentaprevia. Intravaginalultrasoundandpelvicexamsarecontraindicated
Apatientispositiveforanti HCV(hepatitisCvirusantibody).Whatisthenextstepto furtherevaluatethispatient?
A)Referthepatienttoagastroenterologist
B)OrderahepatitisCPCR(polymerasechainreaction)test
C)OrderahepatitisBcomprehensivepanel
D)ThepatientisimmunetohepatitisCandnofurthertestingisindicated B)Ordera hepatitisCPCR(polymerasechainreaction)test
Whenapatienttestspositiveforanti HCV(hepatitisCvirusantibody),labsorderedshould includehepatitisCPCRtofurtherevaluatethepatient.
A62 year oldfemalecomplainsofchronicseverelowbackpain.Shealsoreportsmild episodesoffecalincontinenceandnumbnesstoherlowerlegsoverthepastweek.You wouldsuspectwhichofthefollowing?
A)Fractureofthelowerspine
B)Aherniateddisc
C)Caudaequinasyndrome
D)Ankylosingspondylitis C)Caudaequinasyndrome
Caudaequinasyndromeisasurgicalemergency.Signsandsymptomsincludeachangein bowelandbladdercontrol(incontinence).Acutepressureonthesacralnerverootcauses inflammatoryandischemicchangestothenerveandcanleadtopermanentnervedamage.
A40 year oldWhitefemalewithaBMI(bodymassindex)of32complainsofcol ickypain intherightupperquadrantofherabdomenthatgetsworseifsheeatsfriedfood.During thephysicalexam,thenursepractitionerpressesdeeplyontheleftlowerquadrantofthe abdomen.Afterreleasingherhand,thepatientcomplainsofpainontherightsideofthe lowerabdomen.Whatisthenameofthisfinding?
A)Reboundtenderness
B)Rovsing'ssign
C)Murphy'ssign
D)Psoastest-B)Rovsing'ssign
Rovsing'ssignisreferredpaintotheoppositesideoftheabdomenafterreleaseof palpation.
124.Whichofthefollowingviralinfectionsisassociatedwithoccasionalabnormalformsof lymphocytesduringanacuteinfection?
A)Cytomegalovirus(CMV)
B)Epstein-Barrvirus(EBV)
C)Humanpapillomavirus(HPV)
D)Coxsackievirus B)Epstein Barrvirus(EBV)
AtestforanacuteinfectionoftheEpstein-Barrviruswillshowabnormalformsof lymphocytes.
Afauntailnevusisasignofwhichofthefollowing?
A)Downsyndrome
B)Infantilescoliosis
C)Congenitalheartdisease
D)Spinabifida D)Spinabifida
Afauntailnevusisanabnormaltuftofhairinthelumbosacralarea,whichcanbeasignof spinabifida.
Jenny,a21-year-old,complainstoyouofa1-weekepisodeofdysuria,frequency,anda strongodortoherurine.Thisishersecondepisodeoftheyear.Whatisthemost appropriatefollow upforthispatient?
A)Orderaurinalysisandurineforcultureandsensitivity(C&S)andtreatthepatientwith antibiotics
B)OrderaurineC&Sandholdtreatmentuntilyougettheresultsfromthelab
C)Treatthepatientwitha7 daycourseofantibioticsandorderaurineforculture andsensitivity(urineC&S)nowandaftershecompletesherantibiotics
D)Treatthepatientwithastrongerdrugsuchasofloxacin(Floxin)for10days-A)Ordera urinalysisandurineforcultureandsensitivity(C&S)andtreatthepatientwithantibiotics
ThebesttreatmentforthispatientistoordertheurinalysisandurineC&Stoidentifythe organismcausingtheinfection.Treatmentmaybeginwhilewaitingforthecultureresults.
However,occasionallytreatmentmayhavetobechangedaftertheculture/sensitivity resultsreturn,duetoresistancetotheantibioticused.
Café au laitspotslookliketan to lightbrownstainsthathaveirregularborders.Theycan belocatedanywhereonthebody.Whichofthefollowingisacorrectstatement?
A)TheyareassociatedwithneurofibromatosisorvonRecklinghausen'sdisease
B)Theymaybeconsideredasprecancerousafterabiopsy
C)Theyaremorecommonindarker skinnedchildren
D)TheyareassociatedwithWilson'sdisease A)Theyareassociatedwith neurofibromatosisorvonRecklinghausen'sdisease
Café-au-laitspotsarecausedbyanincreaseinmelanincontent,oftenwiththepresenceof giantmelanosomes.Theyhaveirregularbordersandvaryincolorfromlighttodark brown.Neurofibromatosiscausestumorstogrowinthenervoussystem,andthesetumors commonlycauseskinchangesthatareseenascafé au laitspots.
Duringtheeyeexamofa50 year oldhypertensivepatientwhoiscomplainingofanonset ofasevereheadache,youfindthatthebordersofthediscmarginsonbotheyesare blurred.Whatisthenameofthisclinicalfinding?
A)Normalopticdisc
B)Opticneuropathy
C)Papilledema
D)Hypertensiveretinopathy C)Papilledema
Papilledemaisdefinedashavingopticdiscswellingthatiscausedbyincreasedintracranial pressure.Itiscommonlyseeninbotheyesandcandevelopoveratimeperiodofhoursor weeks.Headacheisacommoncomplaint.
Ahighschoolteachercomplainsofadrycoughforthepast6weeks.Itworsenswhenheis supine.Hehasepisodesofheartburn,whichheself treatswithanover the counter(OTC) antacid.Hechewsmintsforhis"badbreath."Whichofthefol lowingisapossiblecausefor thispatient'scough?
A)Asthma
B)Gastroesophagealreflux
C)Pneumonia
D)Chronicpostnasaldrip-B)Gastroesophagealreflux
GERDisaconditioninwhichfoodcomesupfromthestomach/esophagusduetoaweak sphincter.Itusuallyworsenswithlyingdownandcancauseacoughandesophageal irritationifnottreated.
Theredreflexiselicitedbyshiningalightintheeyesoftheinfantatananglewiththelight about15in.away.Thenursepractitionerisscreeningfor?
A)Cataracts
B)Strabismus
C)Blindness
D)Theblinkingresponse A)Cataracts
Screeningforcataractsisperformedbyshiningalightintotheeyesatanangle, approximately15inchesaway.Iftheredreflexisnotelicited,thencataractsarepresent.
A44 year oldpatientwithDownsyndromestartstodevelopimpairedmemoryand difficultywithhisusualdailyliferoutines.Heishavingproblemsfunctioningatthejobthat hehasdoneforthepast10years.Thephysicalexamandroutinelabsareallnegative.The vitalsignsarenormal.Hisappetiteisnormal.Themostlikelydiagnosisis:
A)Ticdouloureux
B)Astroke
C)Alzheimer'sdisease
D)Delirium C)Alzheimer'sdisease
Deliriumisanacutedeclineinmentalstatusandistemporary.Commoncausesarefever, shock,drugs,alcohol,anddehydration.Alzheimer'sdiseaseisapermanentchangetothe brainthatcausesshort termmemoryloss,agnosia,apraxia,andaphasia.Inthiscase,the patient'sphysicalexamisnormal;however,heishavingmemorylossanddifficulty workingandcarryingouthisnormaltasks
Whichofthefollowingfindingsisassociatedwiththechronicuseofchewingtobacco?
A)Cheilosisandxerostomia
B)Glossitis
C)Ageographictongue
D)Leukoplakiaandoralcancer D)Leukoplakiaandoralcancer
Thechronicuseoftobaccoincreasestheriskoforalcancerandleukoplakia.Cheilosisis skinfissures/macerationinthecornerofthemouth,mostcommonlycausedbyanemia, bacterialinfection,vitamindeficiencies,oroversalivation.
WhichofthefollowingisrecommendedtreatmentforerythemamigransorearlyLyme disease?
A)Doxycycline(Vibramycin)100mgPOBIDx21days
B)Ciprofloxacin(Cipro)250mgPOBIDx14days
C)Erythromycin(E-mycin)333mgPOTIDx10days
D)Dicloxacillin500mgPOBIDx10days A)Doxycycline(Vibramycin)100mgPOBIDx 21days
TheCDC recom mendedtreatmentforerythemamigransorLymediseaseisdoxycycline 100mgPOBIDx21days.
Nursepractitionersandclinicalnursespecialistsderivetheirlegalrighttopracticefrom:
A)TheNursePracticeActofthestatewheretheypractice
B)Thelawsofthestatewheretheypractice
C)TheMedicarestatute
D)TheBoardofNursinginthestatewheretheypractice
A)TheNursePracticeActofthe statewheretheypractice
TheNursePracticeActprovidesnurseswiththelegalrighttopracticenursing.TheState BoardofNursingistheagencythatenforcestheNursePracticeAct.TheMedicarestatute providesthefundsforpayingforhealthservicesattheageof65yearsandolder.
Youarecheckinga75-year-oldwoman'sbreastduringanannualgynecologi-calexam.The leftnippleandareolaarescalyandreddened.Thepatientdeniespainandpruritis.Shehas noticedthisscalinessonherleftnippleforthepast8months.Herdermatologistgavehera potenttopicalsteroid,whichsheusedtwiceadayfor1month.Thepatientneverwent backforthefollow up.Shestillhastherashandwantsanevaluation.Whichofthe followingisthebestinterventionforthispatient?
A)Prescribeanotherpotenttopicalsteroidandtellthepatienttouseittwiceadayfor4 weeks
B)Orderamammogramandreferthepatienttoabreastsurgeon
C)Advisehertostopusingsoaponbothbreastswhenshebathestoavoiddrying uptheskinonherareolaeandnipples
D)Orderasonogramandfine needlebiopsyofthebreast B)Orderamammogramand referthepatienttoabreastsurgeon
Ascaly,reddenedrashonthebreastthatdoesnotresolveafterafewweeksofmedical treatmentmayindicatebreastcancer.Sheshouldhaveamammogramperformedandseea breastsurgeonforevaluationandtreatment.
Thefollowingchildrenareconsideredathigherriskfortuberculosis(TB)except:
A)Achildwhohasrecentlybeendiagnosedwithleukemia
B)Aninfantwhosefamilyishomeless
C)AchildwhowasborninJapan
D)AHispanicchildwithasthmawhoisusingasteroidinhaler C)Achildwhowasbornin Japan
Riskfactorsfortuberculosisincludecompromisedimmunesystem,high riskpopulations (minorities,foreign bornpeople,prisoners,nursinghomeresidents,indigents,migrant
workersandhealthcareproviders).Steroidtherapyandblooddisordersalsoincreasethe riskofTB.
Duringasportsphysicalexamofa14 year oldhighschoolathlete,thenursepractitioner noticesasplitoftheS2componentoftheheartsoundduringdeepinspiration.Shenotes thatitdisappearsuponexpiration.Theheartrateisregularandnomurmursare auscultated.Whichofthefollowingiscorrect?
A)Thisisanabnormalfindingandshouldbeevaluatedfurtherbyacardiologist
B)Astresstestshouldbeordered
C)Thisisanormalfindinginsomeyoungathletes
D)Anechocardiogramshouldbeordered C)Thisisanormalfindinginsomeyoung athletes
ItiscommontohearasplitoftheS2overthepulmonicareaoftheheartwithinspirationas longasitdisappearswithexpiration,withnootherabnormalsymptoms.Thisiscausedby split tingoftheaorticandpulmoniccomponents.
Mrs.J.L.isa55 year oldfemalewithabodymassindex(BMI)of24andahistoryof asthma.Shehashypertensionthathasbeenundercontrolwithhydrochlorothiazide12.5 mgPOdaily.Hertotalcholesterolis230g/dl.Howmanyriskfactorsforcoronaryheart disease(CAD)doesshehave?
A)1riskfactor
B)2riskfactors
C)3riskfactors
D)4riskfactors-C)3riskfactors
Riskfactorsforcoronaryheartdiseaseincludehypertension,hypercholesterolemia,and women55yearsofageandolder
Acommonsideeffectofmetformin(Glucophage)therapyis:
A)Weightgain
B)Lacticacidosis
C)Hypoglycemicepisodes
D)Gastrointestinalproblems D)Gastrointestinalproblems
Commonsideeffectsofmetforminincludediarrhea/gastrointestinalproblems.
Whiledoingacardiacexamona45 year oldmale,younoteanirregularrhythmwitha pulserateof110beatsperminute.Thepatientisalertandisnotindistress.Whatisthe mostlikelydiagnosis?
A)Atrialfibrillation
B)Ventricularfibrillation
C)Cardiacarrhythmia
D)First degreerightbundlebranchblock A)Atrialfibrillation
Atrialfibrillationischaoticelectricalactivityoftheheart,causedbyseveralectopicfociin theatriawithoutanysignsofdistress.
Thefollowingarepatientswhoareathighriskforcomplicationsduetourinarytract infections.Whodoesnotbelonginthiscategory?
A)A38 year olddiabeticpatientwithaHbA1Cof7.5%
B)Awomanwithahistoryofrheumatoidarthritiswhoiscurrentlybeingtreatedwitha regimenofmethotrexateandlow dosesteroids
C)A21-year-oldwomanwhoisundertreatmentfor2sexuallytransmittedinfections
D)Pregnantwomen C)A21 year oldwomanwhoisundertreatmentfor2sexually transmittedinfections
Riskfactorsforcomplicationsduetourinarytractinfectionincludepregnancy,diabetes, andsteroidtherapy.
A68 year oldwomanwithhypertensionanddiabetesisseenbythenursepractitionerfor adrycoughthatworsensatnightwhensheliesinbed.Shehasshortnessofbreath,which worsenswhensheexertsherself.Thepatient'spulserateis90/minandregular.The patienthasgained6lbsoverthepast2months.Sheisonanitro glycerinepatchand furosemidedaily.Thebestexplanationforhersymptomsis:
A)Kidneyfailure
B)Congestiveheartfailure
C)ACEinhibitor inducedcoughing
D)Thyroiddisease B)Congestiveheartfailure
Signsandsymptomsofcongestiveheartfailure(CHF)includedyspneaonexertion,edema, fatigue,hemoptysis,cough,orthopnea,hypertension,andnocturnaldyspnea.
Anursepractitionerisdoingafunduscopicexamona35 year oldfemaleduringaroutine physicalexam.Henoticesthatshehassharpdiscmarginsandayellowish orangecolorin themaculararea.Theratioofveinstoarteriesis3:2.Whatisthenextmostappropriate action?
A)Advisethepatientthatshehadanormalexam
B)Advisethepatientthatshehadanabnormalexam
C)Referthepatienttotheemergencyroom
D)Referthepatienttoanophthalmologist A)Advisethepatientthatshehadanormal exam
Anormalfunduscopicexamwouldincludesharpdiscmargins,withthemaculaappearing yellow orangeincolor.Theratiocomparingthearterytoveinwidthis2:3.
Duringasportsphysical,younotethatthevisionofan18 year oldmaleathleteis20/30in botheyes.Whichofthefollowingstatementsistrue?
A)Thepatientcanseeat20ftwhatapersonwithnormalvisioncanseeat30ft
B)Thepatientcanseeat30ftwhatapersonwithnormalvisioncanseeat20ft
C)Thepatientcannotengageincontactsports D)Thepatientneedstobereferredtoanophthalmologist
A)Thepatientcanseeat20ft whatapersonwithnormalvisioncanseeat30ft
Whenvisionresultsare20/30inbotheyes,thismeansthatthepatientcanseeat20ft whatapersonwithnormalvisioncanseeat30ft.
Carol,a30 year oldtype2diabetic,isonregularinsulinandlenteinsulininthemorning andintheevening.Shedenieschangesinherdietoranyillness,butrecentlystarted attendingaerobicclassesintheafternoon.Becauseofherwork-outs,herbloodsugars havedippedbelow50mg/dLveryearlyinthemorning.
Herfastingbloodsugarbeforebreakfastisnowelevatedandhigherthannormal.Whichof thefollowingisbestdescribed?
A)Somogyiphenomenon
B)Dawnphenomenon
C)Raynaud'sphenomenon
D)Insulinresistance-A)Somogiphenomenon
TheSomogiphenomenoniswhennocturnalhypoglycemia(2a.mto3a.m.)stimulatesthe livertoproduceglucagontoraisethebloodsugar.Thefastingbloodglucoselevelswillbe elevatedfromthisglucagonproduction.
A40 year oldfemaleispositiveforanti hepatitisCvirus(HCV).Whichtestisappropriate forfollow up?
A)HCVRNA
B)HCVantibodies
C)HCVcoreantigen
D)HepatitisCsurfaceantigen
A)HCVRNA
HCVRNAisperformedfollowingapositiveanti hepatitisCvirustest.
Whenthenursepractitionerisevaluatingapatientforintermittentclaudication,he/she wouldfirst:
A)Orderavenogram
B)OrderT.E.D.anti embolismstockings
C)Checktheankleandbrachialbloodpressurebeforeandafterexercise
D)Checkthepedalandposteriortibialpulses C)Checktheankleandbrachialblood pressurebeforeandafterexcercise
Initialevaluationforintermittentclaudicationwouldincludecheckingtheankleand brachialbloodpressurebeforeandafterexercise.
Allofthefollowingdrugscaninteractwiththeophylline(Theo 24)except:
A)Erythromycin
B)Montelukast(Singulair)
C)Phenytoinsodium(Dilantin)
D)Cimetidine(Tagamet)-B)Montelukast(Singulair)
Medicationsthatarecontraindicatedwiththeophyllineincludeerythromycin,phenytoin sodium,andcimetidine.
Younoteahigh pitchedandblowingpansystolicmurmurina70 year oldmale.ItisGrade II/VIandisbestheardattheapicalarea.Whichofthefollowingismostlikely?
A)Ventricularseptaldefect
B)Tricuspidregurgitation
C)Mitralregurgitation
D)Mitralstenosis C)Mitralregurgitation
Mitralregurgitationisbestheardattheapicalarea,andmanifestsasahigh pitched, blowingpansystolicmurmur.
Thecover/uncovertestisascreeningtoolfor:
A)Colorblindness
B)Strabismus
C)Visualacuity
D)Cataracts B)Strabismus
Thecover/uncovertestscreensforstrabismus.Colorblindnessisevaluatedbyusingthe Ishiharatool.VisualacuityisevaluatedusingtheSnellenchart.Cataractsarescreenedby usingtheophthalmoscopeandshiningalightintotheeyesatanangle,approximately15 inchesaway.Iftheredreflexisnotelicited,thencataractsarepresent
Themotherofa4-week-oldinfantisconcernedthatherinfant'seyesarecrossedforafew secondsoccasionally.Thenursepractitionerwould:
A)Recommendreferraltoapediatricophthalmologist
B)Advisethemotherthatthisisanormalfindingininfantsupto2monthsofage
C)Recommendthatmultivitaminsupplementsbegiventotheinfantdaily
D)Educateheronhowtopatchtheinfant'seyeevery4hours B)Advisethemotherthat thisisanormalfindingininfantsupto2monthsofage
Infants'eyescommonlycrossoverattimes,andthisisanormalfindingupto2monthsof age.
Allofthefollowingarefactorsimportantindeterminingthepeakexpiratoryflowvolume except:
A)Weight
B)Height
C)Age
D)Gender A)Weight
Peakexpiratoryflowvolumeisdeterminedbyusingheight,gender,andage.
YouarereviewingaPapsmearreportona25 year oldfemale.Whichofthefollowingcells shouldbeonaPapsmeartobeclassifiedasasatisfactoryspecimen?
A)Cluecellsandendometrialcells
B)Vaginalcellsandcervicalcells
C)Squamousepithelialcellsandendocervicalcells
D)LeukocytesandRBCs C)Squamousepithelialcellsandendocervicalcells
SquamousepithelialcellsandendocervicalcellsmustbeobtainedwhenperformingaPap smeartobeconsideredsatisfactorytoevaluatethecellsfromtheendocervix.
Whenassessingapatientsuspectedofhavingvertigo,whichdescriptionprovidedbythe patientismostconsistentwiththediagnosis?
A)Asensationofimbalancewhilewalking
B)Asensationofspinningorrotating
C)Asensationof"passingout"
D)Asensationoflightheadednesswhenchangingpositionsfromrecliningtostanding B) Asensationofspinningorrotating
Vertigoisdefinedashavingasensationofspinningorrotating
A56 year oldmancomplainsofepisodesoflancinatingpainthatshootsuptohisright cheekwhenheeatsordrinks.Hehasstoppeddrinkingcolddrinksbecauseofthepain. Whichofthefollowingismostlikely?
B)Clusterheadache
C)Acutesinusitis
D)Sinusheadache A)Trigeminalneuralgia
Painshootinguptherightcheekwithfoodordrinkisseenwithtrigeminalneuralgia.
WhatdoesaKOH(potassiumhydroxide)prephelpthenursepractitionerdiagnose?
A)Herpeszosterinfections
B)Yeastinfections
C)Herpessimplexinfections
D)Viralinfections B)Yeastinfections
TheKOHpreptestisperformedbyplacingasampleofdis-chargeonaglassslide,withone dropofpotassiumhydroxideandacoverslipontoptoevaluateforyeastinfections.
BuddingsporesandpseudohyphaewillbeseenwithCandida,withapHof3.5 4.5.
Allofthefollowingareconsideredselectiveserotoninreuptakeinhibitors(SSRIs)except:
A)Imipramine(Elavil)
B)Fluoxetine(Prozac)
C)Sertraline(Zoloft)
D)Paroxetine(PaxilCR) A)Imipramine(Elavil)
Prozac,Zoloft,andPaxilCRareselectiveserotoninreuptakeinhibitors.Elavilisatricyclic antidepressant.
Allofthefollowingtestsrequirethepatient'svoicetoperformcorrectlyexcept:
A)Egophony
B)Tactilefremitus
C)Whisperedpectoriloquy
D)Auscultation D)Auscultation
Egophony,tactilefremitus,andwhisperedpectoriloquyrequirethepatienttospeak. Auscultationislisteningtoanorganwiththeuseofastethoscope.
Whilecheckingfortheredreflexona3 year oldboyduringawellchildvisit,awhite reflectionisseenonthechild'sleftpupil.Whichofthefollowingconditionsshouldberuled out?
A)Unilateralstrabismus
B)Unilateralcataracts
C)Retinoblastomaofthelefteye
D)Colorblindnessofthelefteye C)Retinoblastomaofthelefteye
Retinoblastomaisararetypeofcancerinwhichacanceroustumoroftheretinaispresent. Thisisdiagnosedbynotingapupilthatappearswhiteorhaswhitespotsonit.Oneorboth eyesmaybeaffected.Itisoftenseeninphotographs,wheretherewillbeawhiteglowin theeyeinsteadoftheusual"redeye"notedinpicturesfromtheflash.
Allofthefollowinginfectionsarereportablediseasesexcept:
A)Lymedisease
B)Gonorrhea
C)Nongonococcalurethritis
D)Syphilis C)Nongonococcalurethritis
ThepublichealthdepartmentrequiresallagenciestoreportLymedisease,gonorrhea,and syphilis.Statisticsofthesereportablediseasesarekeptineachstate.
Amenopausalwomanwithosteopeniaisattendingadietaryeducationclass.Whichofthe followingfoodsarerecommended?
A)Yogurtandsardines
B)Spinachandredmeat
C)Cheeseandredmeat
D)Low fatcheeseandwholegrain A)Yogurtandsardines
Postmenopausalwomenareadvisedtoincreasetheirdietaryintakeofcalciumandvitamin Dtohelpprotecttheirbonesfromosteope-nia/osteoporosis.Foodsthatarehighin calciumandvitaminDincludeyogurtandsardines.
Apatientwhoisonwarfarinsodium(Coumadin)isadvisedtoavoideatinglargeamounts ofleafygreenvegetablesbecause:
A)ThehighVitaminKlevelswillincreasebleedingtime
B)Theyhavetoomuchascorbicacid,whichcaninteractwiththemedicine
C)ThehighfibercontentwilldecreasetheabsorptionoftheCoumadin D)ThevitaminsinthevegetableswillbindandinactivateCoumadin A)ThehighVitamin Klevelswillincreasebleedingtime
FoodscontainingVitaminKmayenhancetheanticoagulationeffectofCoumadin,thus increasingbleedingtime.
Youarefollowingupa65 year oldmalewhohasbeenonanewprescriptionoffluvastatin (Lescol)for6weeks.Duringafollow-upvisit,hereportsfeelingextremelyfatiguedand havingdark coloredurine.Hedeniesanygeneralizedmusclesoreness.Whichofthe followingisthemostappropriatetreatmentplan?
A)OrderaCBCwithdifferential
B)Orderaliverfunctionprofile
C)Recommendanincreaseinfluidintakeandrest
D)OrderaurineforC&Stest-B)Orderaliverfunctionprofile
Statinmedications,suchasLescol,canaffectliverfunctionandincreaseliverenzymes,as wellascausethepatienttofeelweak,fatigued,andhavemuscleaches.Therefore,checking theliverfunctionprofileisrecommended.
Whichofthefollowingdiagnosesismostlikelyinthispatient?
A)Rhabdomyolysis
B)Acutedrug-inducedhepatitis
C)Acutemononucleosis
D)Amajordepressiveepisode B)Acutedrug inducedhepatitis
Liverenzymes,suchasALTandAST,canbeelevatedwiththeuseofmedications,suchas statinmedications.Highliverenzymescancauseanacutedrug inducedhepatitis.
Whatwouldyouadvisehimregardinghisfluvastatin(Lescol)prescription?
A)Continuetakingthemedicineuntilthelabresultsareavailable
B)Takehalftheusualdailydoseuntilthelabresultsareavailable
C)Takethemedicineeveryotherdayinsteadofdailyuntilthelabresultsareavailable
D)Stoptakingthemedicineuntilthelabresultsareavailable D)Stoptakingthemedicine untilthelabresultsareavailable
Whenliverenzymesareaffectedbymedications,suchasstatinmedications,thepatientis advisedtostoptakingthemedicineuntilthelabresultsareavailable.
Allofthefollowingchildrenarewithintheparametersofnormalgrowthanddevelopment fortheiragegroupexcept:
A)A2 month oldwhocoosandsmiles
B)A14 month oldwhounderstandscomplexcommands
C)A20 month oldwhocanwalkwithoutsupport
D)A3 year oldwhocanspeakinthree tofour wordsentences B)A14 month oldwho understandscomplexcommands
A14 month oldchildshoulddevelopmentallybeabletosay"mama"and"dada,"knowhis ownname,andknowatleast2-4words.A2-year-oldisabletounderstandsimple commands.
Youarereviewingthebilirubinlevelona3 day oldfull termneonate.Younotethatitis10 mg/dL.Theinfanthasaslightyellowcolortohisskin,mucousmembranes,andsclera.The infantisfeedingwell,isnotirritable,andhas8to10wetdiapersperday.Whichofthe followingisatruestatement?
A)Keeponmonitoringtheinfant'sbilirubinleveluntilitreturnsbacktonormalinabout1 week
B)Recommendthattheinfantbetreatedwithphototherapy10minutesadayuntilthe bilirubinlevelisbackdowntoanormalrange
C)Refertheinfanttoaneonatologistassoonaspossible
D)Refertheinfanttotheneonatalintensivecareunit A)Keeponmonitoringtheinfant's bilirubinleveluntilitreturnsbacktonormalinabout1week
Bilirubinisexcretedthroughtheurineandfeces.Increasedfluidsandwetting8 10diapers adayissufficientfluidintake/excretiontohelpbringdownthebilirubinlevel.Levels shouldcontinuetobemonitoredandshouldimproveinapproximately1week.
AllofthefollowingstatementsarecorrectregardingtheTdvaccineexcept:
A)Feveroccursinupto80%ofthepatients
B)Apossiblesideeffectisindurationontheinjectionsite
C)TheTdisgivenevery10years
D)TheDPTandDTshouldnotbegivenbeyondtheseventhbirthday A)Feveroccursin upto80%ofthepatients
SideeffectsoftheTdvaccineincludeindurationattheinjectionsite.Tdisgiveninadults every10years.TheDPTandDTshouldnotbegivenbeyond7yearsofage.Fevermay occur,butstudiesdonotsupport80%ofpatientshavingfever.
WhichofthefollowingisrecommendedbyJNC7asfirst linetreatmentforhypertensionin patientswithmicroalbuminuria?
A)Angiotensin convertingenzyme(ACE)inhibitors
B)Diuretics
C)Calciumchannelblockers
D)Beta blockers A)Angiotensin convertingenzyme(ACE)inhibitors
FirstlineoftreatmentforhypertensioninpatientswithmicroalbuminuriaisACE inhibitors.ACEinhibitorsarerenalprotective.
Awomanisbeingevaluatedbythenursepractitionerforcomplaintsofdyspareunia.A microscopysliderevealsalargenumberofatrophicsquamousepithelialcells.Thevaginal pHis4.0.ThereareveryfewleukocytesandnoRBCsareseenonthewetsmear.Whichof thefollowingismostlikely?
A)Atrophicvaginitis
B)Bacterialvaginosis
C)Trichomoniasis
D)Thisisanormalfinding-A)Atrophicvaginitis
Symptomsofatrophicvaginitisincludepainfulintercourse,atrophicsquamousepithelial cells,andadecreaseinpH.Vaginalatrophyiscausedbylackoforimbalanceofestrogen. NormalpHofthevaginais4.0 5.0(acidic).
Atestcalledthevisualfieldsbyconfrontationisusedtoevaluatefor:
A)Peripheralvision
B)Centraldistancevision
C)Narrow angleglaucoma
D)Accommodation A)Peripheralvision
Thevisualfieldsofconfrontationtestisusedtoevaluateperipheralvision.TheSnellen chartisusedtomeasurecentraldistancevision.Atonometerisusedtoassessfor glaucoma.Theophthalmoscopeisusedtoassessforcataracts.
Thefollowingskinfindingsareconsideredmaculesexcept:
A)Afreckle
B)Petechiae
C)Acne
D)Aflat,0.5 cmbrownbirthmark C)Acne
Amaculeisaflat,non raisedlesionontheskin.Acnelesionsarepap ulesbecausethey consistofraised,erythemiclesionsontheskin.Afreckle,petechiae,andaflatbirthmark areallconsideredmacules.
Claraisa20 year oldcollegestudentwhoreportstothestudenthealthclinicwitha lacerationinherlefthand.Shetellsthenursepractitionerthatshecutherhandwhile workinginhergarden.HerlastTdboosterwas5.5yearsago.Whichofthefollowingis correct?
A)AdministeraboosterdoseoftheTdvaccine
B)AdministertheTdvaccineandtheTdimmunoglobulin(HyperTet)
C)AdministerTdimmunoglobulin(HyperTet)only
D)ShedoesnotneedanyTdimmunoglobulin(Hypertet)oraTdbooster A)Administera boosterdoseoftheTdvaccine
Tdboostervaccineisrecommendedforrecentinjuriesifithasbeenmorethan5years sincethelastTd.
Theapexoftheheartislocatedat:
A)SecondICS(intercostalspace)totherightofthesternalborder
B)SecondICStotheleftofthesternalborder
C)Theleftlowersternalborder
D)TheleftsideofthesternumatthefifthICSbythemidclavicularline D)Theleftsideof thesternumatthefifthICSbythemidclavicularline
TheapexoftheheartislocatedattheleftsideofthesternumatthefifthICSbythe midclavicularline.
Whichofthefollowingstatementsisfalseregardingjaundiceinbreastfedinfants?
A)Breastfedinfantshaveahigherincidenceofhyperbilirubinemiacomparedwith formula fedinfants
B)Themechanismofbreastmilkjaundiceisstillnotknown
C)Phytotherapyisusuallynotindicatedfortheseinfants
D)Itusuallystartsinthefirstweekoflife B)Themechanismofbreastmilkjaundiceis stillnotknown
Jaundiceoccursafterthefirstweekoflifeforbreastfedinfants.Breastfedinfantsusually haveahigherincidenceofjaundice,andtheconditionmaylastfor2 3weeks.Bilirubinis brokendownandexcretedintheurineandstool.Themechanismofbreastmilkjaundiceis stillunknown.
Koilonychiaisassociatedwithwhichofthefollowingconditions?
A)Leadpoisoning
B)Betathalassemiatrait
C)B12deficiencyanemia
D)Iron deficiencyanemia D)Iron deficiencyanemia
Koilonychiaisanabnormalshapeofthenail.Thenailbedisthin,withirregularedges,and curvesinward.Koilonychiaiscommonlyassociatedwithiron deficiencyanemia.
Whichofthefollowinglaboratorytestsispositiveinalargenumberofpatientswith systemiclupuserythematosus?
A)Antinuclearantibody(ANA)
B)Rheumatoidfactor
C)Antiparietalantibody
D)Immunoglobulin-Antinuclearantibody(ANA)
Screeningtestsforsystemiclupuserythematosusincludeantinuclearantibody.The rheumatoidfactortestisperformedtodiagnoserheumatoidarthritis.Antiparietalantibody testingisdonetoevaluateforanti bodiesagainsttheparietalcells.Theparietalcellsmake asubstancethatthebodyneedstoabsorbVitaminB12.Immunoglobulintestingisdoneto assessfortheamountofantibodiesinthebloodforaspecificdisease.
AllofthefollowingarecorrectstatementsregardingtheS3componentoftheheartsoundexcept:
A)Itoccursveryearlyindiastoleandissometimescalledanopeningsnap
B)Itisanormalfindinginsomechildren,healthyyoungadults,andathletes
C)Itcanbeanormalvariantifheardinapersonage40orolder
D)ItsignifiesCHF(congestiveheartfailure) C)Itcanbeanormalvariantifheardina personage40orolder
S3heartsoundsoccurearlyindiastoleandaresometimesreferredtoasan"openingsnap." Itisanormalvariantinchildren,healthyyoungadults,andathletes.Bibasilarcracklesin lungbasesandthepresenceofS3heartsoundsareclassicfindingsofCHF.
Apositivestraight legraisingtestisindicativeofwhichofthefollowing?
A)Myastheniagravis
B)Inflammationofthesciaticnerve/herniateddisc
C)Multiplesclerosis
D)Parkinson'sdisease B)Inflammationofthesciaticnerve/herniateddisc
Toperformthestraight legtest,havethepatientliesupineonanexamtable.Liftthe patient'slegtowardtheheadwhilethekneeisstraight.Ifthepatientexperiencessciatic painwhenthestraightlegisatanangleofbetween30and70degrees,thenthetestis positiveandaherniateddiscislikelytobethecauseofthepain.Thestraight legtest shouldbedoneonthepain freesidefirsttofindoutwhichrangeofmovementisnormal andtoenablethepatienttodistinguishbetween"normal"stretchingofmusclesanda differentsortofpain.
Whichofthefollowingwouldyourecommendonanannualbasisforanelderlytype2 diabetic?
A)Eyeexamwithanophthalmologist
B)Follow upvisitwithaurologist
C)Periodicvisitstoanoptometrist
D)Colonoscopy-A)Eyeexamwithanophthalmologist
Elderlypatientswithtype2diabetesshouldhaveadilatedeyeexamdoneannuallybyan ophthalmologist.Itisalsorecommendedtoseeapodiatristonceortwiceayear. Preventivecarealsoincludesreceivingaflushotannually,receivingapneumovaxvaccine ifover60yearsofage,andtakingababyaspirinof81mgeachday.
A72 year oldfemalecomplainstoyouofacrustyandnon healingsmallulceronherupper lipthatshehashadforseveralyears.Whichofthefollowingwouldyourecommend?
A)Triamcinoloneacetonide(Kenalog)creamBIDfor2weeks
B)TripleantibioticointmentBIDx2weeks
C)Hydrocortisone1%creamBIDfor2weeks
D)Thepatientneedstobeevaluatedbyadermatologist D)Thepatientneedstobe evaluatedbyadermatologist
Nonhealingulcersoftheskinareariskforskincancerandshouldbeevaluatedbya dermatologistfortreatment.
Allofthefollowingstatementsaboutphototherapyarecorrectexcept:
A)Lightfromthebluetowhitespectrumisused
B)Itisnotalwaysnecessarytouseashieldfortheinfant'seyes
C)Unconjugatedbilirubinintheskinisconvertedtoawater solublenontoxicsubstance thatisexcretedinthebile
D)Theinfant'seyesshouldbeshielded B)Itisnotalwaysnecessarytouseashieldforthe infant'seyes
Whenusingphototherapy,theeyesshouldalwaysbeprotectedbyusingashieldorgoggles topreventdamagetotheeyes.
Heberden'snodesarecommonlyfoundinwhichofthefollowingdiseases?
A)Rheumatoidarthritis
B)Degenerativejointdisease
C)Psoriaticarthritis
D)Septicarthritis B)Degenerativejointdisease
Heberden'snodesarebonynodulesonthedistalinterphalangealjoints,commonlyseenin degenerativejointdisease.
Theredbloodcellsinperniciousanemiawillshow:
A)Microcyticandhypochromiccells
B)Microcyticandnormochromiccells
C)Macrocyticandnormochromiccells
D)Macrocyticandhypochromiccells-C)Macrocyticandnormochromiccells
Thebloodcellsinperniciousanemiawilldisplaymacrocytic,normochromiccells.RBCsin iron deficiencyanemiaaremicrocyticandhypochromic.
Younoticeamedium pitchedharshsystolicmurmurduringanepisodicexam.Itisbest heardattherightupperborderofthesternum.Whatismostlikely?
A)Mitralstenosis
B)Aorticstenosis
C)Pulmonicstenosis
D)Tricuspidregurgitation-B)Aorticstenosis
Aorticstenosisisbestheardattherightupperborderofthesternum,radiatingtotheneck withamedium pitchedsystolicmurmur.Mitralstenosisisheardattheapexoftheheart andsoundslikealow pitcheddiastolicrumblingmurmur.Itissuggestedthatthismurmur isheardbestwiththebellsideofthestethoscope.
Asmallabscessonahairfollicleontheeyelidiscalled:
A)Hordeolum
B)Pterygium
C)Pinguecula
D)Ptosis A)Hordeolum
Hordeolumisapainful,acutebacterialinfectionofthehairfollicleontheeyelid.Pinguecula isathickeningofthebulbarconjunctiva,locatedontheinnerandoutermarginsofthe cornea.Pterygiumisathickeningoftheconjunctivalocatedonthenasalortemporal cornea.PingueculaandpterygiumarebothcausedbytheUVlightoflong termsun exposure.SunglasseswithUVprotectionarerecommendedtopreventdamagetothe conjunctiva.Ptosisisthedroopingoftheuppereyelid.
Whichofthefollowingisindicatedfortheprophylactictreatmentofmigraineheadache?
A)Ibuprofen(Motrin)
B)Naproxensodium(Anaprox)
C)Propranolol(Inderal)
D)Sumatriptan(Imitrex)-C)Propranolol(Inderal)
Medicationsusedtoprophylacticallypreventmigraineheadachesincludebeta blockers (propranolol)andtricyclicantidepressants(ami triptyline).Motrin,Anaprox,andImitrex areallmedicationsusedtotreatmigraineheadache.
A40 year oldmalecomplainstothenursepractitionerofseverestabbingpainsbehindhis lefteyeforthepast2days.Itisaccompaniedbysomenasalcongestionandrhinorrhea, whichisclearincolor.Thepatientdeniespharyngitisandfever.Whichofthefollowing conditionsismostlikely?
A)Migraineheadachewithaura
B)Clusterheadache
C)Ticdouloureux
D)Cranialneuralgia B)Clusterheadache
Signs/symptomsofclusterheadachesincludeseverestabbingpainbehindtheeyes,with nasalcongestionandrhinorrhea.Migrainehead acheswithauraincludevisualchanges, suchasblindspotsorflashinglightsthatappearbeforetheonsetoftheheadache. Trigeminalneuralgia(ticdouloureux)isaunilateralheadachefromcompressionor inflammationofthetrigeminalnerve(cranialnerve5).
Kenhastype2diabetesmellitusanda"sensitivestomach."Whichmedicationisleastlikely tocausehimgastrointestinaldistress?
A)Naproxensodium(Anaprox)
B)Aspirin(Bayer'saspirin)
C)Erythromycin(E mycin)
D)Sucralfate(Carafate) D)Sucralfate(Carafate)
Naproxensodium,aspirin,anderythromycinallhavegastrointestinalsideeffects. Sucralfateisusedtoprotectthestomachliningbybuildingaprotectivelayeroverthe stomachlining;itallowshealingtooccur
Allofthefollowingstatementsaretrueregardingdomesticabuseexcept:
A)Thereisnodelayinseekingmedicaltreatment
B)Thepatternofinjuriesisinconsistentwiththehistoryreported
C)Injuriesareusuallyinthe"central"areaofthebodyinsteadoftheextremities
D)Pregnantwomenhaveahigherriskofdomesticabuse A)Thereisnodelayinseeking medicaltreatment
Whenassessingfordomes-ticabuse,themostcommonbodyareathatisabusedisthe "swim suit"area,whichisusuallycoveredbyclothing.Suspectabusiverelationshipswhen thehistoryisinconsistentwiththeinjury.Mostvictimsdonotseekmedicalattentionuntil afterseveralepisodesofviolence.Studieshaveshownthattheincidenceofbattery escalatesduringpregnancy.
Anewmotherisbreastfeedingherfull term4 week oldinfant.Shewantstoknow whethersheshouldgivetheinfantvitaminsupplements.Thebestadviceis:
A)Sincesheisbreastfeeding,theinfantdoesnotneedanyvitaminsupplementsuntilheis atleast6monthsofage
B)Breastmilkgivestheinfantallthevitaminsheneedsuntil12monthsofage C)BreastfedinfantsrequireironandVitaminDsupplementationrightaway D)BreastfedinfantsrequireironandVitaminEsupplementationat3monthsof age C)BreastfedinfantsrequireironandVitaminDsupplementationrightaway
WhileinfantsdoreceiveVitaminDthroughhumanmilk,theAAPrecom mendsadaily supplementof200IUVitaminDforallbreastfedinfants.
Betathalassemiaminorisconsidereda:
A)Macrocyticanemia
B)Normocyticanemia
C)Microcyticanemia
D)Hemolyticanemia-C)Microcyticanemia
Betathalassemiaminorisageneticdisorderinwhichthebonemarrowproducessmall, paleRBCsinwhichmildhypochromic,microcyticanemiaoccurs.
Potentialcomplicationsofmitralvalveprolapse(MVP)includeallofthefollowingexcept:
A)Severemitralregurgitation
B)Endocarditis
C)IncreasedriskofstrokeandTIA
D)Mitralstenosis D)Mitralstenosis
ComplicationsofMVPincludemitralregurgitation,endocarditis,andincreasedriskof strokeandTIAs.
Anewpatientiscomplainingofseverepruritusthatisworseatnight.Severalfamily membersalsohavethesamesymptoms.Uponexamination,areasofexcoriatedpapulesare notedonsomeoftheinterdigitalwebsofbothhandsandontheaxillae.Thisfindingismost consistentwith:
A)Contactdermatitis
B)Impetigo
C)Larvamigrans
D)Scabies D)Scabies
Theclassicsymptomofscabiesisseverepruritisthatworsensatnight.Thepruriticrashis commonlyseenonthetrunkandbetweenthefingers,andappearsasexcoriated,erythemic papules.Scabiesiscontagiousandcanaffectotherfamilymembers.
Anelderlywomanwithahistoryofrheumatoidarthritisreportstothenursepractitioner thatshehadbeentakingibuprofenBIDformanyyears.Whichofthefollowingorgan systemshasthehighestriskofdamagefromchronicnon steroidalanti inflammatorydrug (NSAID)use?
A)Cardiovascularsystem
B)Neurologicalsystem
C)Gastrointestinalsystem
D)Renalsystem D)Renalsystem
The2mainadversedrugreactionsassociatedwithNSAIDsrelatetogastrointestinal(GI) effectsandrenaleffectsoftheagents.Themainadversedrugreactionsassociatedwithuse ofNSAIDsrelatetodirectandindirectirritationoftheGItract.Ulcerationriskincreases
withtherapydurationandwithhigherdoses.NSAIDscaninduce2differentformsofacute kidneyinjury:hemodynamicallymediated,andacuteinterstitialnephritis,whichisoften accompaniedbynephroticsyndrome.
Ted,whois15yearsold,hasjustmovedintothecommunityandisstayinginafosterhome temporarily.Thereisnorecordofhisimmunizations.Hisfostermotherwantshimtobe checkedbeforeheentersthelocalhighschool.Whichofthefol lowingdoesthispatient need?
A)Meningococcal
B)MMR
C)Tdap
D)Alloftheabove D)Alloftheabove
Themeasles,mumps,andrubella(MMR)isrecommendedasoneofthe"catch up" immunizationsforthispatient'sagegroup.Thetetanusimmunizationthatis recommendedasa"catch up"forthatagegroupistheTdapinsteadofjusttheTd.
Whichcranialnerve(CN)isbeingevaluatedwhenpatientsareinstructedtoshrugtheir shoulders?
A)CNIX
B)CNX
C)CNXI
D)CNXII C)CNXICranialnervesIX,X,XI,andXIIare:glossopharyngeal,vagal,spinal accessory,andhypoglossal,respectively.
Alabtechnicianhasa10.5 mmareaofrednessandindurationinhisleftforearmafter gettingaMantouxtest72hoursago.Thelasttest,whichwasdone12monthsago,was negative.Hedeniescough,nightsweats,andweightloss.Whatisthenextbest intervention?
A)Obtainasputumcultureandachestx ray
B)Obtainachestx ray
C)ObtainasputumforC&Sandanacidfaststain
D)ObtainaCBCandchestx ray B)Obtainachestx ray
Mantouxresultsarenegativeifresultsshowlessthan10mmindurationontheforearmfor low riskclients.Ifresultsaregreaterorequalto10mm,thenachestx rayshouldbe orderedforfurtherscreening.
Swimtherapyfora13 year oldwithcerebralpalsyisanexampleof:
A)Primaryprevention
B)Secondaryprevention
C)Tertiaryprevention
Tertiarypreventionisanytypeofrehabilitationforaparticularcondition.Examples includephysicalrehab(swimming),cardiacrehab,and/orspeechtherapy.
Whichofthefollowingindividualsismostlikelytobeathigherriskforosteoporosis?
A)70 year oldfemaleofAfricanancestrywhowalksdailyforexercise
B)42 year oldobesewomanfromCubawhohasbeentakingprednisone10mgdailyfor thelast12yearstocontrolhersevereasthma
C)55 year oldCaucasianfemalewhoisanaerobicsinstructor
D)4 year oldAsianfemalewhohasbeenonhigh dosesteroidsfor1week B)42 year old obesewomanfromCubawhohasbeentakingprednisone10mgdailyforthelast12years tocontrolhersevereasthma
Riskfactorsforosteoporosisincludepostmenopause,earlymenopause,useofchronic steroids,smoking,excessiveuseofalcohol,sedentarylifestyle,insufficientintakeof calciumandVitaminDinthediet,andbeinganAsianorCaucasianfemale.
Whatistheprimarycarbohydratefoundinbreastmilkandcommercialinfantformulas?
A)Fructose
B)Lactose
C)Glucose
D)Sucrose B)Lactose
Lactoseistheprimarycarbohydratefoundinbreastmilkandformula
Whichofthefollowingpatientsisleastlikelytobecomeanalcoholic?
A)Apatientwhosefatherhasahistoryofalcoholism
B)Apatientwhosewifecomplainsthathedrinkstoomuch
C)Apatientwhodrinksonecupofwinenightlywithdinner
D)Apatientwhofeelshedrinksallthetime C)Apatientwhodrinksonecupofwine nightlywithdinner
Excessiveuseorexposuretoalcoholputsthatpatientatriskforbecominganalcoholic.A patientwhodrinksoneglassofwineatdinnerhasalowerriskofbecominganalcoholic thansomeonewhohasbeenexposedtoalcoholwhilegrowingup,onewhodrinksallthe time,oronewhosefamilybelievesheisdrinkingexcessively.
Thefollowingconditionsareabsolutecontraindicationsfortheuseoforalcontraceptives except:
A)Hepatomas
B)Historyofembolithatresolvedwithheparintherapy15yearsago
C)Afamilyhistoryofmigraineswithaura
D)Ahistoryofgallbladderdiseaseduringpregnancy
C)Afamilyhistoryofmigraineswith aura
Alloftheitemsarecontraindications,butafamilyhistorydoesnotsubstantiateaneedto avoidoralcontraceptives.
Themostcommoncauseofcancerdeathsinmalesis:
A)Lungcancer
B)Prostatecancer
C)Coloncancer
D)Skincance A)Lungcancer
Lungcanceristhemostcommoncauseofcancerdeathsinmen.Prostatecancerandcolon cancerarethesecondandthirdcausesofcancerdeathinmen.
Whichofthefollowingfindingsareseeninapatientwithfolate deficiencyanemia?
A)MicrocyticandhypochromicRBCs
B)MicrocyticandnormochromicRBCs
C)NormalsizeandcoloroftheRBCs
D)MacrocyticandnormocyticRBCs D)MacrocyticandnormocyticRBCs
Folate deficiencyanemiaisdiagnosedbymacrocytic,normocyticredbloodcell.
Whenconfirmingacaseoftemporalarteritis,theerythrocytesedimentationrate(ESR)is expectedtobe:
A)Normal
B)Lowerthannormal
C)Elevated
D)Indeterminateresult C)Elevated
Temporalarteritiscanbediagnosedbyhavinganelevatederythrocytesedimentationrate.
Mrs.Green,age45,iscomplainingofgeneralizedmorningstiffness,especiallyinbothher wristandhands.Itismuchworseinthemorningandlastsforafewhours.Shealso complainsoffatigueandgeneralizedbodyachesthathavebeenpresentforthepastfew months.Whichofthefollowingismostlikely?
A)Osteoporosis
B)Rheumatoidarthritis
C)Osteoarthritis
Signsandsymptomsofrheumatoidarthritisincludesymmetricaljointstiffness,swelling, andpaininthehands,wrists,elbows,ankles,andshoulders.Othercommoncomplaints includefatigue,malaise,fever,andgeneralizedbodyaches.
Duringawellchildvisit,anewfatherwantstoknowifhecangivefreshwholemilktohis 6 month oldson.Thenursepractitionerwouldrecommendthat:
A)Hecanstartgivingwholemilkbutnotskimmilkby6monthsofage
B)Heshouldnotgivewholemilktohissonuntiltheboyisatleast12monthsofage
C)Hecangivewholemilktohissonatanytime
D)Heshouldnotgivewholemilktohissonwithoutdilutingitwithwater-B)Heshould notgivewholemilktohissonuntiltheboyisatleast12monthsofage
TheAmericanAcademyofPediatricsdoesnotrecommendofferingwholemilktochildren youngerthan12monthsofage.
Whichofthefollowingdrugsiseffectivetherapyfortreatingpaininpatientswhoare havinganacuteexacerbationofgout?
A)Acetaminophen(Tylenol)
B)Systemicsteroids
C)Indomethacin(Indocin)
D)Allopurinol(Zyloprim) C)Indomethacin(Indocin)
Commonmedicationsusedforacuteflare upsofgoutincludetwoNSAIDs,suchas indomethacinandnaproxensodium,BIDprn.ColchicinemaybeaddedtotheNSAIDsif reliefisnotobtained.Maintenancetherapyconsistsofallopurinoland/orprobenecid.
Thecomplicationsofuntreatedgoutinclude:
A)Lossofjointmobilityandrenalfailure
B)Lossofjointmobilityandliverfailure
C)Anincreasedriskofurinarytractinfections
D)Bladdercancer A)Lossofjointmobilityandrenalfailure
Complicationsofuntreatedgoutarelossofjointmobilityandrenalfailure.Highuricacid levelscanalsoleadtokidneystones.
A21 year oldfemalewhoiscomplainingofrandompalpitationsisdiagnosedwithmitral valveprolapse(MVP).Herechocardiogram(EKG)revealsredundantandthickenedleaflets. YounoteaGradeIII/VIsystolicmurmurwithanejectionclickduringphysicalexamination. Youwouldrecommend:
A)Endocarditisprophylaxisformostdentalandurologicprocedures
B)Endocarditisprophylaxisisnotnecessary
C)Lifetimeanticoagulationtherapywithwarfarinsodium
D)Endocarditisprophylaxisfordentalproceduresonly B)Endocarditisprophylaxisisnot necessary
ProphylaxistreatmentforendocarditisisnolongerrecommendedforMVP.
Younotebonynoduleslocatedattheproximalinterphalangealjointsonboththehandsof your65 year oldfemalepatient.Whichofthefollowingismostlikely?
A)Bouchard'snode
B)Heberden'snode
C)Osteoarthriticnodules
D)Tophideposits A)Bouchard'snode
BonynodulesattheproximalinterphalangealjointsofthehandsarecalledBouchard's nodes.Heberden'snodesarenodulesonthedistalinterphalangealjoints.Tophideposits areseenwithgout,wherehighlevelsofuricacidinthebloodoccurandcausenodulesin thejointthatcaneventuallydestroythebone.Osteoarthriticnodulesdevelopinthejoints ofthehands.
WhichchronicillnessdisproportionatelyaffectstheHispanicpopulation?
A)Diabetesmellitus
B)Hypertension
C)Alcoholabuse
D)Skincancer A)Diabetesmellitus
Diabetesmellitusis2 3timeshigherinMexicanAmericansversusnon HispanicAmericans.
Alipidprofiledoneonanewlydiagnosedhypertensivepatientshowsatriglyceridelevelof 650mg/dL,totalcholesterol240mg/dL,LDL145mg/dL,andanHDLof35mg/dL.Whatis thebestinterventionforthispatient?
A)Educatethepatientaboutlifestylechangesthatwillhelplowercholesterollevels
B)Initiateaprescriptionofpravastatin(Pravachol)
C)Recommendthatthepatientexerciseatleasteveryotherdayandavoideating fattyorfriedfoods
D)Initiateaprescriptionofnicotinicacid(Niacin,Niaspan)-D)Initiateaprescriptionof nicotinicacid(Niacin,Niaspan)
Niacinisrecommendedfortreatmentofhightriglycerideandcholesterollevels.Exercise andhealthyeatinglifestyleisalsorecommended,butwiththehighleveloftriglyceridesat 650mg/dLandtotalcholesterol240mg/dL,niacinisrecommended.
Cullen'ssignismostcommonlyassociatedwithwhichofthefollowing?
A)Acutepancreatitis
B)Myocardialinfarction
C)Acutepyelonephritis
D)Preeclampsia A)Acutepancreatitis
Cullen'ssigniscommonlyseeninacutepancreatitis.Itisayellowish blueskincolorchange aroundtheumbilicus.Itisthoughttooccurduetothepancreaticenzymesthatrunalong theligamentandsubcutaneoustis suesaroundtheumbilicus.
The"goldstandard"forthediagnosisofactiveHelicobacterpyloriinfectionofthestomach orduodenumis:
A)AHelicobacterpylorititer
B)Anendoscopywithtissuebiopsy
C)AnupperGIseries
D)Aureabreathtest-B)Anendoscopywithtissuebiopsy
The"goldstandard"fordiagnosingHelicobacterpyloriinfectionistoperformtissuebiopsy viaendoscopy.
Whichofthefollowingfoodswouldyouadviseanewmothertointroducetoher6 month oldinfantfirst?
A)Iron fortifiedricecereal
B)Plainricecereal
C)Iron fortifiedpureedchickenmeat
D)Plainpureedcarrots A)Iron fortifiedricecereal
At6monthsofage,itisrecommendedthattheinfantbefediron-fortifiedricecereal. Introducingonlyonenewfoodatatimeisrecommended;incaseanallergydoesdevelop, youwillbeabletoidentifywhichfoodcausedtheallergy.
JimWheelerisobese(BMIof33),fatigued,andcomplainingofexcessivethirstandhunger. Yoususpecttype2diabetesmellitus.Initialtestingtoconfirmdiagnosiscaninclude:
A)Fastingplasmaglucoselevel
B)Glycosylatedhemoglobinlevel(HbA1c)
C)Glucosetolerancetesting
D)Alloftheabove D)Alloftheabove
Type2diabetesmellitusscreeningtestsinclude:fastingplasmaglucoselevel(>126 mg/dL),randomplasmaglucoselevel(>200mg/dL),andglucosetolerancetesting(2hr bloodglucoselevel>200mg/dL)with75gglucoseload.NormalHbA1clevelsare<6%
Abullaisdefinedas:
A)Asolidnodulelessthan1cminsize
B)Asuperficialvesiclefilledwithserousfluidgreaterthan1cminsize
C)Amaculopapularlesion
D)Ashallowulcer B)Asuperficialvesiclefilledwithserousfluidgreaterthan1cminsize
Abullaisdefinedasasuperficialvesiclefilledwithserousfluidgreaterthan1cminsize.
Anewborn'smotherisdiscoveredtobeHBsAg(hepatitisBsurfaceantigen)positive.
Whichofthefollowingwouldyourecommendforthisinfant?
A)GivethebabyhepatitisBimmunoglobulin
B)GivethebabybothhepatitisBvaccineandhepatitisBimmunoglobulin
C)GivethebabyhepatitisBvaccineonly
D)Sendthebabyhomebecauseheisnotinfected-B)GivethebabybothhepatitisB vaccineandhepatitis Bimmunoglobulin
ForamotherwhotestspositiveforHBsAg,thenewborninfantshouldbegivenhepatitisB vaccineandhepatitisBimmunoglobulinforprotection.
WhichofthefollowingistheconfirmatorytestfortheHIVscreeningtest?
A)ELISAtestforHIV
B)Westernblot
C)HIVpolymerasechainreactiontest
D)HIVantibody B)Westernblot
ApositiveWesternblottestconfirmsanHIVscreeningtest.
Allofthefollowingfindingsareassociatedwiththesecondarystageofaninfectionbythe organismTreponemapallidumexcept:
A)Condylomaacuminata
B)Maculopapularrashofthepalmsandsoles
C)Lymphadenopathy
D)Condylomalata-A)Condylomaacuminata
Findingsconsistentwiththediagnosisofsyphilis,causedbytheTreponemapallidum organism,includemaculopapularrashofthepalmsandsoles,lymphadenopathy,and condylomalata.Condylomaacuminata(genitalwarts)arecausedbythehumanpapilloma virus(HPV)andspreadtooth ersbyskin to skincontact.
Thefollowingareacceptablemethodsofbirthcontrolforbreastfeedingmothersexcept:
A)Diaphragmwithspermicidalgel
B)Progesterone-onlypills(Micronor)
C)Condoms
D)Low doseoralcontraceptiveswithatleast20mcgofestradiol(Alesse,Lo estrin) D) Low doseoralcontraceptiveswithatleast20mcgofestradiol(Alesse,Lo estrin)
Low doseoralcontraceptivesthatcontainestradiolarecontraindi catedforbreastfeeding mothers.
Womenwithahistoryofpelvicinflammatorydisease(PID)haveanincreasedriskforallof thefollowingcomplicationsexcept:
A)Ectopicpregnancy
B)Scarringofthefallopiantube(s)
C)Infertility
D)Ovariancysts D)Ovariancysts
Womenwithahistoryofpelvicinflammatorydisease(PID)haveahigherriskofectopic pregnancy,scarringofthefallopiantubes,andinfertilityduetothescarringandtrauma causedbythepelvicinflammation.
Thedifferentialdiagnosisforgenitalulcerationincludesallofthefollowingexcept:
A)Syphilis
B)Genitalherpes
C)Chancroid
D)Molluscumcontagiosum D)Molluscumcontagiosum
Genitalulcersmayoccurwithsyphilis,genitalherpes,andchancroid.Molluscum contagiosumisaviralinfectionthatcausessmooth,roundtinypapules,approximately5 mmorless,thathaveacentralumbilicationwithawhiteplugpresent.
Leadpoisoningcancausewhichtypeofanemia?
A)Amildmacrocyticanemia
B)Normocyticanemia
C)Microcyticanemia
D)Amildhemolyticanemia C)Microcyticanemia
Leadpoisoningcancausemicrocyticanemia.Signsandsymptomsofleadpoisoningare abdominalpain,constipation,vomiting,andblue-blacklineonthegums.Leadcauses anemiabymimickinghealthfulmineralssuchascalcium,iron,andzinc.Itisabsorbedby
thebones,whereitinterfereswiththeproductionofRBCs.Thisabsorptioncanalso interferewithcalciumabsorptionthatisneededtokeeptheboneshealthy.
Hypovolemicshockwouldmostlikelyoccurwithfracturesofthe:
A)Spine
B)Pelvis
C)Femur
D)Humerus B)Pelvis
Hypovolemicshockcanoccurfromafracturedpelvissecondarytointernalbleedingfroma fracturedbonefragmentthatlaceratesanarteryorvein.Thepelviscanaccommodatea largeamountoffluid.
Podagraisassociatedwithwhichofthefollowing?
A)Rheumatoidarthritis
B)Gout
C)Osteoarthritis
D)Septicarthritis B)Gout
Podagraispaininthejointofthegreattoeduetotheaccumulationofuricacidandsaltsin thejoint.
Whileassessingforacardiacmurmur,thefirsttimethatathrillcanbepalpatedisat:
A)GradeII
B)GradeIII
C)GradeIV
D)GradeV C)GradeIVAthrillispalpatedatgradeIV.
Amedium pitchedharshmid systolicmurmurisbestheardattherightsecondICSofthe chest.Itradiatesintotheneck.Whichofthefollowingisthecorrectdiagnosis?
A)Aorticstenosis
B)Pulmonicstenosis
C)Aorticregurgitation
D)Mitralstenosis A)Aorticstenosis
Themurmurassociatedwithaorticstenosiscanbeauscul-tatedasharshandhighpitched intherightsecondintercostalspace;ittypicallyradiatestothecarotidarteriesandapex.
Whichtypeofhepatitisvirusinfectionismorelikelytoresultinchronichepatitisand increasedriskofdevelopinghepatocellularcarcinoma?
B)HepatitisBvirus
C)HepatitisCvirus
D)BothhepatitisBandhepatitisC D)BothhepatitisBandhepatitisC
Oftheprimaryhepatitisviruses,onlyBandCareassociatedwithhepatocellularcancer.
Whatisthecaloriccontentofinfantformulaandbreastmilk?
A)10kcal/30mL
B)15kcal/30mL
C)20kcal/30mL
D)25kcal/30mL C)20kcal/30mL
Thecaloriccontentofinfantformulaandbreastmilkis20kcal/30mL.
A19 year oldfemalehasrecentlybeendiagnosedwithacutehepatitisB.Sheissexually activeandismonogamous.Shereportsusingcondomsinconsistently.Whatwouldyou recommendforhermalesexualpartnerwhowasalsotestedforhepatitiswiththe followingresults:HBsAg(−),anti HBs(−),anti HCV(−),anti HAV(+)?
A)AhepatitisBvaccination
B)HepatitisBimmunoglobulin
C)HepatitisBvaccinationandhepatitisBimmunoglobulin
D)Novaccinationisneededatthistime C)HepatitisBvaccinationandhepatitisB immunoglobulin
HepatitisBvaccinationisgivenforlong-termprophylaxistreatmenttopreventhepatitisB infection.HepatitisBimmunoglobulinisgivenforpreventionofhepatitisBinfectionwhen thepersonhasbeendirectlyexposedtothehepatitisBinfection.Theimmnoglobulinisnot avaccineanddoesnotprotectagainstlong termprophylaxis.
Allofthefollowingconditionsareassociatedwithanincreasedriskfornormocyticanemia except:
A)Rheumatoidarthritis
B)Lupus
C)Chronicautoimmunedisorders
D)Pregnancy D)Pregnancy
Duringpregnancy,womenmayexperiencemicrocytic,hypochromicanemiaduetothe dilutionaleffectoftheincreasedbloodvolumeduringthepregnancy.
Youcandetermineapulsedeficitbycountingthe:
A)Apicalandradialpulsesatthesametime,thenfindingthedifferencebetweenthetwo
B)Apicalpulsefirst,thentheradialpulse,andsubtractingtofindthedifferencebetween thetwo
C)Apicalpulseandthefemoralpulseatthesametimeandfindingthedifferencebetween thetwo
D)Radialpulsefirst,thencountingthefemoralpulse,andsubtractingtofindthedifference betweenthetwo A)Apicalandradialpulsesatthesametime,thenfindingthedifference betweenthetwoThepulsedeficitisdeterminedbycountingtheapicalandradialpulsesat thesametime,thensubtractingtofindthedifferencebetweenthetwo.
Aninfantwhodoesnothaveahistoryofreactiveairwaydiseaseandallergyhasboth inspiratoryandexpiratorywheezingaccompaniedbyfeverandprofuseclearnasal discharge.Whichofthefollowingismostlikely?
A)Tracheobronchitis
B)Bronchiolitis
C)Croup
D)Asmallforeignbodythatislodgedontheleftmainbronchus B)Bronchiolitis
Symptomsoftracheobronchitisincludeprominentdry,non productivecough;later, coughingupphlegmiscommon.BronchiolitisisaviralinfectioncausedbyRSVthatis commonlyseenduringthewinter/springmonthsininfantsandyoungchildren.Typical signs/symptomsincludefever,inspiratory/expiratorywheezing,withcleardrainage. Croupisaviralinfectionwiththeclassic"barking"cough;thepatientmayhavearunny nose,buttypicallynofever.Whenachildswallowsaforeignobject,choking,wheezing,and shortnessofbreathmayoccur,butnofeverorcleardrainageispresent.
PatientswhoarebeingscreenedforTBandareimmunocompromisedshouldbeevaluated foranergy.Whichofthefollowingisthebestdescriptionofanergytesting?
A)ApplyCandidaormumpsantigentotherightforearmandthePPDontheleftforearm andreadresultsin48to72hours
B)ApplyCandidaormumpsantigenandPPDonleftforearmonlyandcheckforareaction in24hours
C)MixtheCandidaormumpsantigenwiththePPDandapplyittobothforearms
D)ApplytheCandidaormumpsantigen24hoursbeforethePPDontheleftforearm A) ApplyCandidaormumpsantigentotherightforearmandthePPDontheleftforearmand readresultsin48to72hours
Anergyiswhentheimmunesystemisunabletoperformahealthy,normalimmune responsewhenthebodyischallengedwithaparticularantigen.
Anursepractitionerisevaluatingan80 year oldwomanfromanursinghome.Sheis instructingthepatienttorememberthewords"orange,""house,"and"world."Afew minuteslater,thepatientistoldtorecallthese3words.Whichofthefollowingisbeing described?
A)TheLachmantest
B)Aneurologicexam
C)TheRombergtest
D)TheMiniMentalStatusExam
TheLachmantestisperformedonthekneetoassessstability;theRombergtestis performedtoassessforbalance;aneurologicexamisperformedbyassessingthe12 cranialnerves;theMMSEisperformedtoassessforcognitiveimpairment.
Inmoststates,patientsyoungerthanage18yearsmayconsenttohealthcarewithout parentalorlegalguardianconsentexceptforwhichofthefollowing?
A)Contraception
B)Pregnancy
C)Schoolphysicals
D)STDevaluationandtreatment C)Schoolphysicals
Anystudentyoungerthan18yearsofagemusthaveparen talpermissiontohaveaschool physicalexamdone
Ahypertensivemiddle agedmanwhoisNativeAmericanhasrecentlybeendiagnosedwith mildrenalinsufficiency.Hehasbeenonlisinopril(Accupril)formanyyears.Whichofthe followinglaboratoryvaluesshouldbecarefullymonitored?
A)Hemoglobin,hematocrit,andtheMCV(meancorpuscularvolume)
B)Serumcreatinineandpotassiumlevels
C)Aspartateaminotransferaseandalanineaminotransferase
D)Serumsodium,potassium,andmagnesium
B)Serumcreatinineandpotassiumlevels
NativeAmericanshaveamuchhigherrateofkidneydiseaseandrenalfailurewhen comparedtootherraces.NativeAmericanshavea1in3incidenceofhypertension. Hypertensionisthesecondleadingcauseofkidneyfailure.BUN,creatinine,estimatedGFR, andurinalysisareperformedtoassessthefunctionofthekidneys.
Yoususpectanenterobiasisinfectionina6 year oldgirl.Whichofthefollowingtests wouldyourecommend?
A)Stoolcultureandsensitivity
B)Stoolforovaandparasites
C)Thescotchtapetest
D)AHemocculttest-C)Thescotchtapetest
Enterobiasisinfection(pinworms)iscausedbysmallwormsthatinfecttheintestines. Symptomsincludeitchingaroundtheanus,whichisusuallyworseatnight.Thescotchtape testisdonebyapplyingthescotchtapeontheanalareainthemorning;theworms commonlycomeoutatnightandwillsticktothetape,whichisusedfordiagnosis.
WhatisthemostcommoncauseofleftventricularhypertrophyintheUnitedStates?
A)Chronicatrialfibrillation
B)Chronichypertension
C)Mitralvalveprolapse
D)Pulmonaryhypertension B)Chronichypertension
ThemostcommoncauseofLVHischronichypertension.
Asthmaticsmayhaveallofthefollowingsymptomsduringanexacerbationexcept:
A)Rapidpulse
B)Wheezing
C)Chroniccoughing
D)Tachypnea C)Chroniccoughing
Signsandsymptomsofanacuteexacerbationofasthmaincludebreathlessness,coughing, wheezing,andchesttightness.Agitation,increasedrespiratoryandpulserate,and decreasedlungfunctionarealsonoted.A"chronic"coughisnotasymptom.
Lawsgoverningnursepractitionerauthorityaredeterminedbythe:
A)BoardofNursing
B)StateLegislature
C)AmericanNursingAssociation
D)StateMedicalAssociation A)BoardofNursing
EachstatehaslawsestablishingaBoardofNursingthatregulatestheroleofthenurse practitioner.
A10 year oldmalewhowasrecentlyacceptedintohisschool'ssoccerteamhasahistoryof exercise-inducedasthma.Thechildwantstoknowwhenheshouldtakehisalbuterol inhaler.Thenursepractitionerwouldadvisethepatient:
A)Premedicatehimself20minutespriortostartingexercise
B)Waituntilhestartstoexercisebeforeusingtheinhaler
C)Premedicate60minutesbeforestartingexercise
D)Waituntilhefinisheshisexercisebeforeusinghisinhaler A)Premedicatehimself20 minutespriortostartingexercise
Exercise-inducedasthmaisbestcontrolledbyusingtheProventilinhaler(bronchodilator) approximately20minutespriortoexercise,topreventvasospasmofthebronchiolesand shortnessofbreathwithexercise.Thesebronchodilatorsusuallylastapproximately4 hours.Theyalsoworkquicklytoopenupthebronchiolesifanacuteattack/shortnessof breathoccurs
Atrophicmaculardegenerationoftheaged(AMD)istheleadingcauseofblindnessinthe elderlyintheUnitedStatesWhichofthefollowingstatementsiscorrect?
A)Itisasloworsuddenpainlesslossofcentralvision
B)Itisasloworsuddenpainlesslossofperipheralvision
C)Itisanocclusionofthecentralretinalveincausingdegenerationofthemaculararea
D)Itiscommonlycausedbydiabeticretinopathy A)Itisasloworsuddenpainlesslossof centralvision
Maculardegenerationcausesthelossofcentralvision.
A12 year oldgirliscomplainingofa2 weekhistoryoffacialpressurethatworsenswhen shebendsover.Shecomplainsoftoothpaininheruppermolarsontherightsideofher face.Onphysicalexam,herlungandheartsoundsarenormal.Whichofthefollowingisthe mostlikelydiagnosis?
A)Anacutedentalabscess
B)Chronicsinusitis
C)Acutesinusitis
D)Severeallergicrhinitis C)Acutesinusitis
Signs/symptomsofacutesinusitisincludesheadache,facialpainthatworsenswith bendingover,eye/earpressureandpain,achinginupperjaw/teeth,reducedsmelland taste,cough(especiallyatnightduetothenasaldrainage),sorethroat,badbreath,and fatigue.
Whichofthefollowingfindingsisassociatedwiththyroidhypofunction?
A)Gravesdisease
B)Eyedisorder
C)Thyroidstorm
D)Myxedema D)Myxedema
Myxedemaisarare,andsometimesfatal,diseaseinwhichthethyroidisseverely underactiveandcauseslife threateningsymptoms.Thesesymptomsincludelowblood
pressure,decreasedbreathing,decreasedbodytemperature,unresponsiveness,andeven coma.Graves'disease,thyroidstorm,andeyedisorderareseenwithanoveractivethyroid diseaseknownashyperthyroidism.
Whatisthebestprocedureforevaluatingacornealabrasion?
A)Tonometry
B)Fluoresceinstain
C)Visualfieldtest
D)Funduscopy B)Fluoresceinstain
Fluoresceinstainisaneyestainusedtodetectabrasionsorforeignobjectsinthecorneaof theeye.Orangedye(fluorescein)isusedtostaintheeyeandabluelightisusedto detect/visualizeanyforeignbodiesorabrasionsintheeye.Visualfieldtestassessesvision. Tonometrymeasuresthepressureinsidetheeye.Thefunduscopicexamisperformedwith anophthalmoscopetovisualizetheinsideoftheeye.
YouareexaminingapatientwhohasjustbeendiagnosedwithBell'spalsy.Bell'spalsyis characterizedbyallofthefollowingexcept:
A)Drooling
B)Inabilitytoswallow
C)Inabilitytoclosetheeyeontheaffectedside
D)Droopingofthecornerofthemouthontheaffectedside B)Inabilitytoswallow
Bell'spalsyaffectscranialnerveVII,whichaffectstheabilitytosmile,closetheeyeonthe affectedside;droopinganddroolingontheaffectedsidecanalsooccur.Swallowingisnot affectedbythefacialnerve.
Anewmotherwhoisonherfourthdayofbreastfeedingcomplainstothenurse practitionerofverysorebreasts.Thenursepractitionerwould:
A)Recommendadecreaseinthenumberoftimesshebreastfeedsherinfantperday
B)Recommendthatshestopbreastfeedinganduseinfantformulaforthenext48hours
C)Educatethemotherthatthisisnormalduringthefirstweekor2ofbreastfeedingand thesorenesswilleventuallygoaway
D)Recommendthatshepurchaseplasticnipplepadsforhernursingbraandusethem daily-C)Educatethemotherthatthisisnormalduringthefirstweekor2ofbreastfeeding andthesorenesswilleventuallygoaway
Nursingduringthefirst2weeksafterdeliverymaycausetendernessandsorenessofthe nipplesandusu allyresolvesafterthis.Themothershouldcontinuetobreastfeedasshe hasbeenadvised,andsheshouldmakesuretheinfantislatchingonappropriately.
A12 year oldmale'speakexpiratoryflowresultsindicate60to80%ofthepredicted range.Howwouldyouclassifyhisasthma?
A)Mildintermittentasthma
B)Mildpersistentasthma
C)Moderatepersistentasthma
D)Severeasthma C)Moderatepersistentasthma
Asthmaclassifications:Intermittent:normalFEVbetweenexacerbations,FEV>80%;mild persistent,FEV>80%;moderatepersistent,FEV60 80%;severepersistent,FEV<60%.
WhichofthefollowingconditionsisassociatedwithapositiveAuspitzsign?
A)Contactdermatitis
B)Seborrheicdermatitis
C)Systemiclupuserythematosus
D)Psoriasis-D)Psoriasis
Auspitzsignisthepresenceofpinpointbleedingspotsfrompsoriasiswheretheskinis scrapedoff.
WhichofthefollowingisusedtoconfirmadiagnosisofHashimoto'sthyroiditis?
A)SerumTSH
B)FreeT4test
C)Antimicrosomalantibodytest
D)Anyoftheabove D)Anyoftheabove
Inadditiontoconductingaphysicalexaminationandtakingathoroughhistoryand symptomsintoaccount,1ormorelaboratorytestsareusedtodiagnoseHashimoto's thyroiditis.The3mostcommondiagnosticteststhatdetectthiscommonthyroiddisorder are:serumthyroid stimulatinghormonetest(TSH),anti thyroidantibodiestests,andthe freeT4hormonetest.
Afirst graderpresentstoaschoolnursepractitionerwithafewblistersononearmandon theface.Thechildkeepsscratchingtheaffectedareas.Someofthelesionshaveruptured withyellowserousfluidthatcrustseasily.Thisbestdescribes:
A)Acutecellulitis
B)Herpeszoster
C)Bullousimpetigo
D)Erysipelas-C)Bullousimpetigo
Bullousimpetigoisaskininfection,commonlyseenonthefaceandhands,withyellow, honey coloredfluidblisterswithdrainagethatturnintoscabbedlesionsthatcontinueto spreaduntiltreated.
Allofthefollowingstatementsreflectinadequatebreastmilkproductionexcept:
A)Full terminfantisatbirthweightbythesecondweekoflife
B)Lessthan6wetdiapersperdayorlessthan4stoolsperday
C)Infantisnursingfewerthan8timesper24 hourperiod
D)Weightlossof>10%ofbirthweight A)Full terminfantisatbirthweightbythe secondweekoflife
Thefull terminfantshouldbebacktobirthweightat2weeksofage.Theinfantshouldbe nursingevery2-4hoursandshouldwet6-10diapersaday(24h).
Thebestscreeningtestfordetectingandmonitoringbothhyperthyroidismand hypothyroidismis:
A)ThetotalT3 4
B)Thyroid stimulatinghormone(TSH)
C)Thyroidprofile
D)Palpationofthethyroidgland B)Thyroid stimulatinghormone(TSH)
Thebest"screening"testofhypothyroidismandhyperthyroidismistheTSH.Ifthisresult isabnormal,thenfurtherdiagnostictestsshouldbeperformed.
ApatientwhorecentlyreturnedfromavacationinLatinAmericacomplainsofasevere headacheandstiffneckthatareaccompaniedbyahighfeverforthepast12hours.While examiningthepatient,thenursepractitionerflexesboththepatient'shipsandlegsand thentellsthepatienttostraightenthemagainstresistance.Thenameofthistestis:
A)Kernig'smaneuver
B)Brudzinski'smaneuver
C)Murphy'ssign
D)Homan'ssign A)Kernig'smaneuver
Kernig'smaneuverisperformedbyhavingthepatientflexbothhipsandlegsandthen straightenthelegsagainstresistance,testingformeningitis.Flexionofhip/kneesisa positivesignformeningitis.Brudzinski'smaneuverisperformedbyplacingthepatient's handsbehindhishead,andgentlytuckingchintochest.Murphy'ssigniselicitedbyhaving thepatientinspirewiththetipsoftheexaminer'sfingersplacedontherightupper quadrant,attheliverborder,undertheribs.Painoninspirationissuggestiveof cholecystitis.Homan'ssignisflexionofthefoot,causingpainintheposteriorcalfarea, suggestiveofaDVT.
Whichofthefollowinggroupshasbeenrecommendedtobescreenedforthyroiddisease?
A)Women50yearsorolder
B)Adolescentfemales
C)Elderlymales
D)School agechildren A)Women50yearsorolder
Screeningforthyroiddiseaseisrecommendedforwomen50yearsofageandolder.
A65 year oldHispanicwomanhasahistoryoftype2diabetes.Aroutineurinalysisreveals afewepithelialcellsandisnegativeforleukocytes,nitrites,andprotein.Whichofthe followingwouldyourecommendnext?
A)OrderaurineforC&S
B)Ordera24 hoururineformicroalbumin
C)Becauseitisnegative,nofurthertestsarenecessary
D)RecommendascreeningIVP(intravenouspyelogram) B)Ordera24 hoururinefor microalbumin
Epithelialcellsarecellsthatarepresentontheinsideliningoftheorgans.Fewepithelial cellscanbenormal;however,withherhistoryoftype2diabetes,a24 hoururinefor microalbuminshouldbeorderedtoassesskidneyfunction.
RhoGAM'smechanismofactionis:
A)ThedestructionofRh positivefetalRBCsthatarepresentinthemother'scirculatory system
B)ThedestructionofmaternalantibodiesagainstRh-positivefetalRBCs
C)Thestimulationofmaternalantibodiessothatthereisadecreasedriskofhemolysis
D)ThedestructionofmaternalantibodiesagainstfetalRBCs A)ThedestructionofRh positivefetalRBCsthatarepresentinthemother'scirulatorysystem
RhoGAMisgiventomotherswithRh negativebloodwhenthefetushasRh positiveblood. RhoGAMprotectsthemotherfromdevelopingantibodiesbydestroyingtheRh positive fetalRBCsinthemother'sbloodsystem.
Achestradiographshowsanareaofconsolidationonthelowerlobe.Whichofthe followingconditionsismostlikely?
A)Bacterialpneumonia
B)Acutebronchitis
C)COPD
Consolidationisvisibleonx raywhenbacterialpneumoniaispresent.Consolidationisnot presentinthelungswithbronchitis,COPD,oratypicalpneumonia.
Whattypeofbreathsoundsarebestheardoverthebaseofthelungs?
A)Finebreathsounds
B)Vesicularbreathsounds
C)Bronchialsounds
D)Trachealbreathsounds B)Vesicularbreathsounds
Vesicularbreathsoundsareheardbestoverthebaseofthelungs.Vesicularsoundsaresoft and/orblowing,heardthroughoutinspiration,andfadeawaywithexpiration.Bronchial soundsareheardoverthebronchi,thelargesttubesintheanteriorchest.Soundsareloud andhighpitched.Trachealbreathsoundsareheardoverthetrachea.Thesesoundharsh andsimilartoairbeingblownthroughapipe.
ThemostcurrentrecommendationfromtheJointNationalCommissionontheEvaluation andTreatmentofHighBloodPressureinAdults(JNC8)forthebloodpressuregoalin diabeticsis:
A)<140/90
B)<130/85
C)<130/80
D)<125/75-A)<140/90
JNC8bpgoalsinclude<140/90inpatientswithdiabetes.
Allofthefollowingpharmacologicagentsareusedtotreatinflammationinthelungsof asthmaticsexcept:
A)Nedocromilsodium(Tilade)twospraysQID
B)Cromolynsodiuminhaler(Intal)twopuffsQID
C)Along actingoraltheophylline(Theo Dur)200mgevery12hours
D)Fluticasoneinhaler(Flovent)twopuffsBID C)Along actingoraltheophylline(Theo Dur)200mgevery12hours
Theophyllineisusedtocontrolinflammationofthelungs.Tilade,Intal,andFloventhelpto treatinflammation.
Allofthefollowingclinicalfindingsareconsideredbenignoralfindingsexcept:
A)Apatchofleukoplakia
B)Fordycespots
C)Toruspalatinus
D)Fishtailuvula A)Apatchofleukoplakia
AnearlysignofHIVisahairypatchofleukoplakiaonthetongue.
Thenursepractitionerexaminesa4 week oldboywhosemotherreportsthathehascried foratleast3hoursadayatthesametimeofdaysincebirth.Whatisthemaingoalinthe clinicalevaluationofthisinfant?
A)Ruleoutanyphysiologiccauseforthecryingspells
B)Makesurethattheinfantiswellclothed
C)Evaluatetheenvironment
D)Orderlaboratoryanddiagnostictesting A)Ruleoutanyphysiologiccauseforthe cryingspells
Forinfantsthatcryforseveralhoursduringtheday,rulingoutaphysiologicalproblem thatmaybecausingthedistressisrecommended.
Duringaroutinephysicalexamofa90 year oldwoman,alow pitcheddiastolicmurmur GradeII/VIisauscultated.ItislocatedonthefifthICSontheleftsideofthemidclavicular line.Whichofthefollowingisthecorrectdiagnosis?
A)Aorticregurgitation
B)Mitralstenosis
C)Mitralregurgitation
D)Tricuspidregurgitation B)Mitralstenosis
MitralstenosisisbestheardatthefifthICStotheleftofthemidclavicularline.Itis ausculatedasalow pitcheddiastolicmurmur,gradeII/VI.Aorticregurgitationisahigh pitcheddiastolicmurmur,heardatthesecondICStotherightofthesternum.Mitral regurgitationisapansystolicmurmurthatradiatestotheaxilla,loudandhighpitched whenausculated.
Whichofthefollowingsituationsisconsideredemergent?
A)Alacerationonthelowerlegofapatientonaspirin(Bayer)81mgeveryotherday
B)Rapidbreathingandtachycardiainapatientwithafever
C)Anelderlymanwithabdominalpainwhosevitalsignsappearstable
D)A37 year oldmalebikerwithaconcussionduetoafallwhoappearsslightlyagitated anddoesnotappeartounderstandinstructionsgivenbythemedicalassistantcheckinghis vitalsigns D)A37 year oldmalebikerwithaconcussionduetoafallwhoappears
slightlyagitatedanddoesnotappeartounderstandinstructionsgivenbythemedical assistantcheckinghisvitalsigns
Thebikerwhohadtheconcussionistheemergentsituationduetohisagitationandhis inabilitytofollowdirections,whichcouldmeanhehassometypeofbraintrauma.The lacerationcanbetreatedwithpressuretostopthebleedinguntilhelparrives.Theman withabdominalpainhasnormalvitalsigns.Tachycardiaiscommonwithfever.
Whichofthefollowingisconsideredanobjectivefindinginpatientswhohaveacaseof suppurativeotitismedia?
A)Erythemaofthetympanicmembrane
B)Decreasedmobilityofthetympanicmembraneasmeasuredbytympanogram
C)Displacementofthelightreflex
D)Bulgingofthetympanicmembrane B)Decreasedmobilityofthetympanicmembrane asmeasuredbytympanogram
FluidbehindtheeardrumwilldecreasethemobilityoftheTMwhenmeasuredbya tympanogram.Whenperforationoccurs,dischargewillflowthroughtheparstensaportion oftheeardrum.
Pulsusparadoxusismorelikelytobeassociatedwith:
A)Sarcoidosis
B)Acutebronchitis
C)Statusasthmaticus
D)Bacterialpneumonia C)Statusasthmaticus
Pulsusparadoxusismostlikelytobeseenwithstatusasthmaticus.Withinspiration, systolicpressuredropsduetotheincreasedpres-sure(positivepressure).Some pulmonaryrisksofhavingincreasedpressureincludeasthmaandemphysema.Cardiac causesforpulsusparadoxusincludetamponade,pericarditis,andcardiaceffusion.
A17 year oldboyreportsfeelingsomethingonhisleftscrotum.Onpalpation,softand movablebloodvesselsthatfeellikea"bagofworms"arenotedunderneaththescrotal skin.Itisnotswollenorreddened.Themostlikelydiagnosisis:
A)Chronicorchitis
B)Chronicepididymitis
C)Testiculartorsion
D)Varicocele D)Varicocele
Palpationofvaricoseveins,knownas"bagofworms"inthescrotum,isaclassicsymptom ofavaricocele.Chronicepididymitisandchronicorchi tisarecausedbyabacterial infectionandcommonlyhaveburning,frequency,andpain.Testiculartorsionisan
emergentconditioninwhichthetesticlebecomestwisted,interruptingthebloodsupplyto thetestis;toavoiddamage,theconditionmustbecorrectedwithin6hours.
Allofthefollowingaretruestatementsregardingelderabuseexcept:
A)Thoseaged80yearsorolderareatthehighestriskforabuse
B)Adelayinmedicalcareisacommonfinding
C)AnewonsetofanSTDinanelderlypatientmaysignalsexualabuse
D)Decreasedanxietyanddepressionarecommonsymptomsofabuseintheelderly D) Decreasedanxietyanddepressionarecommonsymptomsofabuseintheelderly
Elderabuseiscommonlyseeninelderlypatientsovertheageof80years.Common signs/symptomsincludeanxietyanddepression.AnewonsetofanSTDmayindicatesigns ofsexualabuse.Thesepatientswillcommonlydelaytreatmentforacute/chronic conditions.
TheS1heartsoundiscausedby:
A)Closureoftheatrioventricularvalves
B)Closureofthesemilunarvalves
C)Openingoftheatrioventricularvalves
D)Openingofthesemilunarvalves A)Closureoftheatrioventricularvalves
ClosureoftheAVvalvescausestheS1soundheardwhenauscultatingheartsounds.
PatientswithDownsyndromeareathigherriskforallofthefollowingexcept:
A)Atlantoaxialinstability
B)Congenitalheartdisease
C)EarlyonsetofAlzheimer'sdisease
D)Melanoma D)Melanoma
PatientswiththediagnosisofDownsyndromeareathigherriskforatlantoaxialinstability, congenitalheartdefects,andearlyonsetofAlzheimer'sdisease.ChildrenwithDown syndromewhoparticipateinsportactivitiesmustbecarefullyexaminedforthese conditionspriortoparticipationtopreventinjury.
DuvallandMilleruseddevelopmentaltheorytodescribethefamily.Whichofthefollowing statementsistrue?
A)Eachfamilyisdevelopmentallyuniqueincomparisontootherfamilies
B)Familiesdemonstratecommonformsofmembershipacrossdevelopmentalstages
C)Familiescompleteeachdevelopmentaltaskseparately
D)Familieschangeovertimebecauseoftheinfluenceofenvironmentalfactors B) Familiesdemonstratecommonformsofmembershipacrossdevelopmentalstages
Familiesprogressthroughsimilardevelopmentalstagesandexperiencesimilarchanges throughthisprocess.
Thefollowingabnormallabresultsmaybeseeninpatientswithacutemononucleosis except:
A)Lymphocytosisand/oratypicallymphocytes
B)PositiveEBVtitersforimmunoglobulin(Ig)MandIgG
C)Elevatedliverfunctiontests
D)ElevatedcreatinineandBUN A)Lymphocytosisand/oratypicallymphocytes
CommonsymptomsofmononucleosisincludepositiveEBVtiters,elevatedliverenzymes, andelevatedcreatinineandBUN.
WhichofthefollowingisconsideredanabnormalresultonaWebertest?
A)Lateralizationtooneear
B)Nolateralizationineitherear
C)Airconductionlastslongerthanboneconduction
D)Boneconductionlastslongerthanairconduction A)Lateralizationtooneear
TheWebertestisperformedbyplacingatuningforkontopofthehead.AnormalWeber testiswhennolateralizationoccurs.Lateralizationtooneearoccurswithhearing impairment.
Allofthefollowingareconsideredbenignphysiologicvariantsexcept:
A)Internaltibialtorsion
B)Supernumerarynipples
C)Splituvula
D)Cheilosis D)Cheilosis
Cheilosisisaskindisorderinwhichfissuresandmacerationoccurinthecornerofthe mouth
A65-year-oldwoman'sbonedensityresultshowsseveredemineralizationofcorticalbone. Allofthefollowingpharmacologicagentsareusefulintreatingthisconditionexcept:
A)Raloxifene(Evista)
B)Calcitonin(Miacalcin)
C)Medroxyprogesterone(Depo Provera)
D)CalciumwithVitaminD C)Medroxyprogesterone(Depo Provera)
CommontreatmentsforosteoporosisincludecalciumandVitaminD,Evista,Miacalcin,and bisphosphonates.Depo Proveraisatypeofcontraception.
Afractureonthenavicularareaofthewristisusuallycausedbyfallingforwardand landingonthehands.Theaffectedwristishyperextendedtobreakthefall.Thenurse practitionerisawarethatallofthefollowingstatementsaretrueexcept:
A)Ithashigherrateofnonunioncomparedwiththeotherbonesinthewristwhenitis fractured
B)Thefracturefrequentlydoesnotshowuponanx rayfilmwhenitistakenimmediately aftertheinjury
C)Thex-rayfilmwillshowthefractureifthefilmisrepeatedin2weeks
D)Thesefracturesalwaysrequiresurgicalinterventiontostabilizethejoint D)These fracturesalwaysrequiresurgicalinterventiontostabilizethejoint
Afractureofthenavicularareaofthewristoccurswhenonetriestobreakafallwiththe hands,thushyperextendingthewrist.Immediatelyfollowingtheinjury,thefracturemay notshowonx ray;however,fractureisusuallyvisibleonx rayifthex rayisrepeatedin2 weeks.Theneedforsurgeryisdependentontheextentofthefracture.
John,a10 year oldboy,hastype1diabetes.Hislateafternoonbloodsugarsoverthepast2 weekshaverangedbetween210mg/dLand230mg/ldL.Heiscurrentlyon10unitsof regularinsulinand25unitsofNPHinthemorningand15unitsofregularinsulinand10 unitsofNPHinsulinintheevening.Whichofthefollowingisthebesttreatmentplanfor thispatient?
A)Increasebothtypesofthemorningdose
B)IncreaseonlytheNPHinsulininthemorning
C)DecreasetheafternoondoseofNPHinsulin
D)DecreasebothNPHandregularinsulindosesinthemorning
Themotherofa13 year oldmalewithDownsyndromeisinthefamilynursepractitioner's officeandwantsasportsphysicaldoneforherson.Shereportsthathewantstojointhe footballteaminhisschool.Youwouldtellthemotherthatherson:
A)Canplayaregularfootballgameaslongashewearsmaximumprotectivefootballgear
B)Cannotplaysomecontactsportsbecauseofanincreasedriskofcervicalspineinjury
C)Canplaycertaincontactsportsafterhehasbeencheckedforcervicalinstability
D)Noneoftheabove B)Cannotplaysomecontactsportsbecauseofanincreasedriskof cervicalspineinjury
ChildrenwiththediagnosisofDownsyndromeareathigherriskforatlantoaxialinstability, congenitalheartdefects,andearlyonsetofAlzheimer'sdisease.Therefore,duetotherisk ofcervicalspineinjury,somecontactsportsarenotadvised
Themotherofan8-year-oldboyreportsthepresenceofaroundredrashonthechild'sleft lowerleg.Itappeared1weekafterthechildreturnedfromvisitinghisgrandparents,who liveinMassachusetts.Duringtheskinexam,themaculopapularrashisnotedtohaveareas ofcentralclearingmakingitresemblearoundtarget.Whichofthefollowingisbest described?
A)Erythemamigrans
B)RockyMountainspottedfever
C)Meningococcemia
D)Larvamigrans-A)Erythemamigrans
Erythemamigransisanannularlesionthatenlargesandwithtimehascentralclearing. ThisiscommonlycausedbyabitefromaninfectedtickandcancauseLymediseaseifnot treatedappropriately.LymediseaseismostcommonlyseeninthenortheasternUnited States.
Somepharmacologicagentsmaycauseconfusionintheelderly.Whichofthefollowing pharmacologicagentsismostlikelytocauseconfusioninthispopulation?
A)Cimetidine(Tagamet),digoxin(Lanoxin),diphenhydramine(Benadryl)
B)Acetaminophen(Tylenol),aspirin(Bayer),indomethacin(Indocin)
C)Sucralfate(Carafate),docusatesodium(Surfak),psyllium(Metamucil)
D)Cephalexin(Keflex),amoxicillin(Amoxil),clarithromycin(Biaxin) A)Cimetidine (Tagamet),digoxin(Lanoxin),diphenhydramine(Benadryl)
Medicationsthatcommonlycauseconfusionintheelderlyincludecimetidine,lanoxin,and diphenhydramine.
A55 year oldfemalewithahistoryofmigraineheadacheshasrecentlybeendiagnosed withStageIIhypertension.HerEKGstripsrevealsecond degreeheartblock.Thechestx rayisnormal.Whichofthefollowingdrugsshouldthispatientavoid?
A)ACEinhibitors
B)Angiotensinreceptorblockers
C)Diuretics
D)Calciumchannelblockers
D)Calciumchannelblockers
Commonsideeffectsofcalciumchannelblockersincludeheadaches,edemaofthelower extremities,andheartblockorbradycardia.Contraindicationsforcalciumchannelblockers includesecond orthird degreeAVblock,bradycardia,andcongestiveheartfailure.
Whichofthefollowingcranialnervesisevaluatedwhenawispofcottonislightlybrushed againstthecorneroftheeye?
A)CNII
B)CNIII
C)CNIV
D)CNV D)CNV
Cranialnervesareassessedasfollows:II(optic):distancevision,nearvision.III,IV,VI (oculomotor,trochlear,abducens):EOMs,visualfieldsofgaze.V1(trigeminal3branches: V19ophthalmic),V2(maxillary),V3(mandibular):motorportion,clenchjaws;sensory portion,cornealreflex/facialsensation
Whenapatientissuspectedofhavingacutepancreatitis,initialtestingshouldincludeallof thefollowingexcept:
A)Electrolytepanel
B)Serumamylaselevel
C)Serumlipaselevel
D)Abariumswallow D)Bariumswallow
Foranacuteabdominalpain,initiallabsperformedareserumelectrolytes,amylase,and lipase.Bariumswallowwouldnotbeperformedinitially.
Whichofthefollowingisatruestatementregardingpesplanusinaninfant?
A)Pesplanusshouldbeevaluatedbyapediatricorthopedistifitdoesnotspontaneously correctitselfbytheageof12months
B)Thefatpadsonaninfant'sfeetcanmimicpesplanus
C)Itisalwayscorrectedbywearingspecialorthoticshoes
D)Itisalsocalledtalipesequinovarus B)Thefatpadsonaninfant'sfeetcanmimicpes planus
Thefatpadsonaninfant'sfeetcanresemblepesplanusorflatfeet.
Allofthefollowingstatementsarefalseregardingtherehabilitationofalcoholicsexcept:
A)Al Anonisnotdesignedforfamilymembersofalcoholics
B)Disulfiram(Antabuse)isalwayseffective
C)AlcoholicsAnonymousisnotaneffectivemethodfortreatingthiscondition
D)Avoidfoodsordrinksthatcontainalcohol,suchascoughsyrups D)Avoidfoodsor drinksthatcontainalcohol,suchascoughsyrups
AlcoholicsAnonymousisdesignedforfamiliesandisaneffectivetreatmentforalcoholism. Antabuseiseffectiveforsomepatients.Theintakeoffoods/medicationsthatcontain alcoholmustbeavoided.
Amotherofa7 year oldboytellsthefamilynursepractitionerthathisteacherhas complainedtoherofherson'sfrequentepisodesofdaydreaming.Whilethechildisat home,themotherreportsthatsometimeshersonseemsnottohearher.Thechild"blanks out"forashortperiodoftime.Whichofthefollowingismostlikely?
A)Apartialseizure
B)Anabsenceseizure(petitmalseizure)
C)Agrandmalseizure
D)Ajacksonianseizure B)Anabsenceseizure(petitmalseizure)
Petitmalseizureisaseizurethatusuallylastslessthan15seconds,andthechildappears tonotbelistening.Thechildappearstobe"blackedout"ordaydreamingwhenthisoccurs.
AllofthefollowingarecorrectstatementsregardingtheHealthyPeople2020objectives except:
A)Thedocument'sobjectivesarenotonlyapplicablenationally,butalsointernationally
B)Oneoftheobjectivesofthedocumentistohelppeopleachievephysicalhealth C)Thedocument'sobjectivesareapplicableonlytopeopleoftheUnitedStatesofAmerica
D)Thedocumentisformulatedbyaspecialcommitteeformedbyanallianceofallthestate healthdepartments C)Thedocument'sobjectivesareapplicableonlytopeopleofthe UnitedStatesofAmerica
HealthyPeople2020waswrittenforallpeople
ThePapsmearresultfora20 year oldsexuallyactivecollegestudentwhousedcondoms inconsistentlyrevealsalargenumberofwhitebloodcellsandbloodalongwith inflammatorychanges.Duringthespeculumexam,thenursepractitionerwhoexamined thepatientnoticedthatthepatient'scervixbledveryeasily(friable)andasmallamountof purulentdischargewaspresentonthecervicalsurface.Nocervicalmotiontendernesswas notedduringthebimanualvaginalexam.Whatisthenextstepinthemanagementofthis patient?
A)TheNPneedstodocervicalculturestoverifygonorrhea
B)Prescribemetronidazolevaginalcreamforthepatientoverthephone
C)CallthepatientandtellhersheneedsarepeatPapsmearin6months
D)AdvisehertouseaBetadinedoucheatbedtimex3days A)TheNPneedstodocervical culturestoverifygonorrhea
CulturesshouldbetakenatthetimeofthePapsmear,asthepatientmaynotreturnfor laterdiagnostictesting.
A30 year oldfemalecomplainsofhavingnoperiodforthelast12weeks.Sheissexually activeandhasbeenusingcondomsinconsistently.Thepatienthasahis toryofirregular menstrualcyclesandseveredysmenorrhea.Theurinepregnancytestresultispositive.
Whichofthefollowingisatruestatementregardingthispregnancy?
A)Thefundusoftheuterusshouldbeatthelevelofthesymphysispubis
B)Thecervixshouldbedilatedabout0.5in.atthistimeofgestation
C)"Quickening"startsduringthisperiod
D)Hegar'ssignispresentduringthisperiodofpregnancy A)Thefundusoftheuterus shouldbeatthelevelofthesymphysispubis
At12weeksgestation,thefundusoftheuterusshouldbelocatedapproximatelyatthe symphysispubis.
Anewborninfantwhoissmallforgestationalageisnotedtohaveshortenedpalpebral fissuresandmicrocephalywithasmalljaw.Thisinfantismostlikelytobediagnosedwith:
A)Downsyndrome
B)Fetalalcoholsyndrome
C)Growthretardation
D)Hydrocephalus B)Fetalalcoholsyndrome
Classicsymptomsoffetalalcoholsyndromeincludesmallpalpebralfissuresand microcephalywithasmalljaw.
WhichofthefollowingisthemostcommoncauseofcancerdeathsforwomenintheUnited States?
A)Breastcancer
B)Lungcancer
C)Coloncancer
D)Heartdisease B)Lungcancer
Lungcanceristhemostcommoncauseofcancerdeathsinwomenaswellasmen.
Humanpapillomavirusinfectioninwomenhasbeenassociatedwiththedevelopmentof:
A)Ectopicpregnancy
B)Infertility
C)Cervicalcancer
D)Pelvicinflammatorydisease-C)Cervicalcancer
HPVisavirusassociatedwithcervicalcancer.HPVvaccineisnowavailableforgirlsand boysbetweentheagesof15 21yearsofagetohelpprevent4strainsofthisvirusthatis linkedtocervicalcancer.
AllofthefollowingareincludedinthecriteriausedtodiagnosepatientswithAIDSexcept:
A)Profoundfatigue
B)Thrush
C)Kaposi'ssarcoma
D)Hairyleukoplakiaofthetongu A)Profoundfatigue
CriteriausedtodiagnoseAIDSincludehairyleukoplakiaofthetongue,Kaposi'ssarcoma, andthrush.
Whichofthefollowingconditionsisthemostcommoncauseofsuddendeathamong athletes?
A)Brainaneurysm
B)Hypertrophiccardiomyopathy
C)Leftventricularhypertrophy
D)Aorticstenosis B)Hypertrophiccardiomyopathy
Hypertrophiccardiomyopathyisthemostcommoncauseofsuddendeathinathletes.
Thespanofthenormaladultliveris:
A)15to18cminthemidclavicularline
B)12to16cmintherightmidclavicularline
C)2to6cminthemidsternalline
D)4to8cminthemidsternalline A)15to18cminthemidclavicularline
Thisrangeisconsideredthenormalspanforadults.
Apatientwhoiscomplainingofanewonsetofsevereheadacheisbeingexamined.The patientisinstructedtoliedownontheexaminingtablewhilethenursepractitionerflexes
hisheadandneckforwardtohischest.Thepatientreactsbyquicklyflexinghishipand knee.Whatisthenameofthispositivefinding?
A)Kernig'ssign
B)Brudzinski'ssign
C)Rovsing'ssign
D)Drawer'ssign B)Brudzinski'ssign
Brudzinski'ssignispositiveformeningitiswhenapatientspontaneouslyflexeshis/her hipsandkneesafterlyingdownandhavinghis/herheadandneckflexedforwardtothe chest.
Aneighbor's14 year oldson,whoisactiveinbasketball,complainsofpainandswellingon bothknees.Onphysicalexam,thereistendernessoverthetibialtuberosityofbothknees. Whichofthefollowingismostlikely?
A)Chondromalaciapatella
B)Leftkneesprain
C)Osgood Schlatterdisease
D)Tearofthemedialligament C)Osgood Schlatterdisease
Osgood Schlatterdiseaseischaracterizedbybilateralpainoverthetibialtuberosityupon palpation,alongwithkneepainandedemawithexercise.
Awomanat32weeksgestationhasapositivethroatcultureforstreppyogenes.Shedenies allergiesbutgetsverynauseatedwitherythromycin.Whichofthefol-lowingisthebest choiceforthispregnantpatient?
A)Clarithromycin(Biaxin)
B)Trimethoprim/sulfamethoxazole(BactrimDS)
C)Ofloxacin(Floxin)
D)Penicillin(PenVK) D)Penicillin(PenVK)
PenVKissafetouseforstrepthroatduringpregnancy.PenVKisacategoryBmedication forpregnancyandlactation.
Duringasportsphysicalexam,a16 year oldpatientisnotedtohaveafewbeatsof horizontalnystagmusonextremelateralgazethatdisappearwhentheeyesmoveback towardmidline.Whichstatementbestdescribesthisclinicalfinding?
A)Itiscausedbyoccultbleedingoftheretinalartery
B)Thisisanormalfinding
C)Itisasignofapossiblebrainmass
D)Thisisaborderlineresultandrequiresfurtherevaluation B)Thisisanormalfinding
Anurgentcarenursepractitionerisassessinga45-year-oldWhitewomanwithaBMIof32 forcomplaintsofintermittentrightupperquadrantabdominalpainoverthepastfew weeksthatisprecipitatedbyeatingfriedfoodsandpeanutbutter.Onexam,thepatient's heartandlungsarenormal.Thereisnopainoverthecostovertebralangle.During abdominalexam,thebowelsoundsarepresentinallquadrants.Whilepalpatingdeeplyon therightupperquadrantduringdeepinspiration,thepatientcomplainsofseveresharp paintothenursepractitioner.
Whichofthefollowingisbestdescribed?
A)Acutecholecystitis
B)Acuteappendicitis
C)Acutegastroenteritis
D)Acutediverticulitis-A)Acutecholecystitis
Acutecholecystitiscanbediagnosedwhendeeppalpationoftherightupperquadrant causesthepatienttocomplainofpain.
WhichofthefollowingdrugsisrecommendedbytheCentersforDiseaseControland Prevention(CDC)asfirst linetreatmentfortreatinginfectionsbytheorgan ismBacillus anthracis(anthrax)?
A)Clindamycin(Cleocin)
B)Fluconazole(Diflucan)
C)PenicillinGinjection
D)Ciprofloxacin(Cipro) D)Ciprofloxacin(Cipro)
TheCDC'sfirst linetreatmentrecommendationforanthraxisCipro.
AmajorriskfactorforaDownsyndromeinfantis:
A)Maternalageyoungerthan16years
B)Maternalageolderthan35years
C)ApositivefamilyhistoryofDownsyndrome
D)Apositivefamilyhistoryofgeneticdisease B)Maternalageolderthan35years
Maternalagegreaterthan35yearsduringpregnancyisariskfactorforinfantDown syndrome.
Anewpatientwhoisa40-year-oldfemalepostalworkerisbeingevaluatedforcomplaints ofanewonsetofanerythematousrashonbothhercheeksandonthebridgeofthenose
thatisaccompaniedbyfatigue.ShereportsahistoryofHashimoto'sthyroiditisandis currentlybeingtreatedwithSynthroid1.25mgdaily.
Whichofthefollowingconditionsismostlikely?
A)Atopicdermatitis
B)Thyroiddisease
C)Lupuserythematosus
D)Rosacea C)Lupuserythematosus
Classicsymptomsoflupuserythematosusarebutterflyrashacrossbothcheeksandbridge ofnoseandfatigue.Riskfactorsalsoincludebeingfemaleand40yearsold.
Mary,whois65yearsofage,comesintotheclinicduringthefirstweekofNovemberfor herannualwellnessvisit.HerlastTdboosterwas9yearsago.Whichimmunization(s) wouldyourecommendforthisvisit?
A)Influenzavaccine
B)Tetanusandinfluenzavaccine
C)Pneumococcal(Pneumovax)andinfluenzavaccines
D)Shedoesnotneedanyvaccinationstobeadministeredinthisvisit C)Pneumococcal (Pneumovax)andinfluenzavaccines
At65yearsofage,Pneumovaxisrecommended.Influenzaisrecommendedannually.Tdis recommendedevery10years.
Acutebronchitisisbestcharacterizedby:
A)Feverandwheezing
B)Purulentsputumandfever
C)Paroxysmsofcoughingthatisdryorproductiveofmucoidsputum
D)Agradualonsetandfatigue C)Paroxysmsofcoughingthatisdryorproductiveof mucoidsputum
Acutebronchitisischaracterizedbyspasticcoughthatisdryorproductivewithmucus.
Thenursepractitionernoticesagrayringontheedgeofbothirisesofan80 year old female.Thepatientdeniesvisualchangesorpain.Shereportsthatshehashadthe"ring" formanyyears.Whichofthefollowingisthemostlikelydiagnosis?
A)Arcussenilis
B)Pinguecula
C)Peripheralcataracts
D)Maculardegeneration A)Arcussenilis
Arcussenilisisfrequentinolderadults.Arcussenilisdoesnotaffectvision.
Whatistheclinicalsignificanceoftheabovefindingona35 year old?
A)Thepatienthasahigherriskofblindness
B)Thepatientshouldbeevaluatedforhyperlipidemia
C)Thepatientshouldbeevaluatedbyanophthalmologist
D)Thepatientshouldbeevaluatedforacuteglaucoma B)Thepatientshouldbeevaluated forhyperlipidemia
Arcussenilisiscausedbylipiddepositsdeepintheedgeofthecornea.
Theconesintheretinaoftheeyeareresponsiblefor:
A)Centralvision
B)Peripheralvision
C)Nightvision
D)Doublevision-A)Centralvision
Theconesoftheeyesareresponsibleforcentralvision.
Thenursepractitionerwouldreferallofthefollowingtoaphysicianexcept:
A)Severefacialburns
B)Electricalburns
C)Burnsthatinvolvethecartilageoftheear
D)Second-degreeburnsonthelowerarm-D)Second-degreeburnsonthelowerarm
First andsecond degreeburnsareappropriatelytreatedbyanursepractitioner.Third degreeburnsshouldbereferredtoaphysician.Examplesofthird-degreeburnsinclude electricalburns,severeburnsontheface,andburnsinvolvingcartilage,suchastheearand nose.
Onauscultationofthechest,asplitS2isbestheardat:
A)Secondintercostalspace,rightsternalborder
B)Secondintercostalspace,leftsternalborder
C)Fifthintercostalspace,midclavicularline
D)Fourthintercostalspace,leftsternalborder-A)Secondintercostalspace,rightsternal border
AsplitS2isbestheardatthesecondICS,rightofthesternalborder.
AccordingtotheguidelinesoutlinedinJNC8inthoseyoungerthan60(without comorbitidites),thenormalbloodpressureshouldbe:
A)<140/90
B)<130/85
C)<120/80
D)<110/75-A)<140/90
TheJNCVIIIGuidelinesrecommendedthatbpbelessthan140/90inthoselessthan60. Thoseolderthan60,BPshouldbelessthan150/90.
Whichofthefollowingwouldbeclassifiedasasecond degreeburn?
A)Aseveresunburnwithblistering
B)Burnsthatinvolvethesubcutaneouslayerofskin
C)Areddenedfingeraftertouchingahotiron
D)Burnsthatinvolveescha A)Aseveresunburnwithblistering
Burns:Firstdegree:erythemawithoutblistering,painful;seconddegree:redskinwith superficialblisters,painful;thirddegree:entireskinlayering,involvingthesubcutaneous tissueandmayincludesofttissuefacia,painless.
Themotherofa16 year oldboyisconcernedthathersonisnotdevelopingnormally.On physicalexam,thepatientisnotedtohavesmalltesteswithnopubicorfacialhair.Whatis themostappropriatestatementtothemother?
A)Hersonisdevelopingnormally
B)Herson'sphysicaldevelopmentisdelayedandshouldbeevaluatedbyapediatric endocrinologist
C)Hersonshouldberecheckedin3months;ifhestilldoesnothavesecondarysexual characteristics,athoroughhormonalworkupshouldbeinitiated
D)Herson'sphysiologicaldevelopmentisslowerthannormalbutiswithinthelowerlimit ofnormalforhisagegroup-B)Herson'sphysicaldevelopmentisdelayedandshouldbe evaluatedbyapediatricendocrinologist
A16 year oldmalewithoutsecondarysexualcharacteristicsshouldbereferredtoan endocrinologist.Ifthereisnotesticulardevelopmentby14yearsofage,referraltoan endocrinologistisrecommended.
Themostcommontypeofskinmalignancyis:
A)Squamouscellcancer
B)Basalskincancer
C)Melanoma
D)Dysplasticnevi A)Squamouscellcancer
Squamouscellcanceristhemostfrequenttypeofskincancer.Itcanoccurinnormalskin orinflamedskin.CommonareasinvolvedarethosewhichareexposedtothesunorUV light.TheearliestformofsquamouscellcancerisknownasBowen'sdisease,inwhichthe cancerhasnotinvolvedthetissuenearby.
Theposteriorfontanelshouldbecompletelyclosedby:
A)3months
B)4months
C)5months
D)6months A)3months
Theposteriorfontanellenormallyclosesby3monthsofage.Theanteriorfontanellecloses between12and18monthsofage.
WhichcranialnerveisbeingevaluatedwhenRinnetestingisdone?
A)CNVII
B)CNVIII
C)CNIXandX
D)CNXI B)CNVIII
Theacousticnerve,cranialnerveVIII,isbeingevaluatedwhentheRinnetestisperformed.
Jane,amiddle agednurse,complainsoflocalizedpainonthesoleofherleftfootthatis locatedbetweenthethirdandfourthtoes.Thepainisaggravatedbyweightbearingand feelslike"apebbleinmyshoe."Duringthephysicalexamination,thenursepractitioner palpatesatendernoduleinthemetatarsalinterspaceontheleftfoot.Norednessor swellingisnoted.Whichofthefollowingconditionsisbeingdescribed?
A)Plantarwart
B)Foreignbody
C)Morton'sneuroma
D)Metatarsalgia C)Morton'sneuroma
Morton'sneuromaischaracterizedbyexperiencingpain,burning,ornumbnesswith weightbearingbetweentwotoes.Someexperienceasenseorfeelingliketheyarewalking onapebblebetweentwoadjacenttoes.
Laura,whois18yearsold,isbeingfollowedupforacnebythenursepractitioner.The facialexamrevealsthatpapulesandpustulesarepresentmostlyontheforeheadandthe chinareas.ThepatienthasbeenusingprescriptiontopicalsandOTCmedicatedsoapdaily for6monthswithoutmuchimprovement.Whichofthefollowingwouldyourecommend next?
A)Isotretinoin(Accutane)
B)Tetracycline(Sumycin)
C)Clindamycintopicalsolution(CleocinT)
D)Minoxidil(Rogaine) B)Tetracycline(Sumycin)
First linetreatmentforacnevulgarisincludesOTCmedicatedsoapandwaterwithtopical antibioticgels.Thenextstepoftreatmentwouldbetheinitiationoforaltetracycline.
Thefollowingstatementsarealltrueregardingherpeszosterexcept:
A)Itisduetoreactivationoflatentvaricellavirus
B)Thetypicallesionsarebullae
C)Itisusuallymoresevereinimmunocompromisedindividuals
D)Infectionofthetrigeminalnerveophthalmicbranchcancausecornealblindness-B) Thetypicallesionsarebullae
Herpeszosteroccurssecondarytoreactivationofthevaricellavirus.Thisinfectioncanbe moresevereintheimmunocompromisedpatientduetotheinabilitytofightinfection.This rashappearsasavesicular,painfulrash,commonlyinclusters,followingonedermatome ononesideofthebody.Whenthetrigeminalnerveisinvolved,thereisanincreasedriskof cornealblindness.
Amiddle agedBlackmalecomplainsofahistoryofoutbreaksofpainfullargenodulesand pustulesonbothhisaxillaethatresolveaftertreatmentwithantibiotics.Onphysical examination,thenursepractitionernoticeslargerednodulesthataretendertopalpation. Inaddition,severalpustulesarepresentalongwithmultiplescarsontheskin.Thenurse practitioneradvisesthepatientthattheconditioniscausedbyabacterialinfectionofthe sweatglandsintheaxillae.Whichofthefollowingconditionsisbeingdescribed?
A)Hidradenitissuppurativa
B)Severenodularacne
C)Granulomainguinale
D)Catscratchfever A)Hidradenitissuppurativa
Hidradenitissuppurativaisachronicskincondition,commonlyfoundintheapocrine glandsintheaxillaand/orgroin,thatcausespainfulnodulesundertheskin.These abscessestendtoopenanddrainfluidandpus.Significantscarringoftheskinmayresult fromtheseoutbreaks.
Apossiblesideeffectfromtheuseofnifedipine(ProcardiaXL)is:
A)Hyperuricemiaandhypoglycemia
B)Hyperkalemiaandangioedema
C)Edemaoftheanklesandheadache
D)Dryhackingcough C)Edemaoftheanklesandheadache
Commonsideeffectsofcalciumchannelblockers,suchasProcardia,includeedemaofthe ankles,dizziness,headaches,flushing,andweakness.ACEinhibitorstendtohavetheside effectsofangioedemaandadryhackingcough.Diureticscancausehyperkalemiaand hyperuricemia.
Whichofthefollowingmaneuversiscontraindicatedinpatientswithacuteprostatitis?
A)Massagingtheinfectedprostate
B)Serialurinesamples
C)Rectalexams
D)Palpationoftheepididymis
A)Massagingtheinfectedprostate
Massagingtheinfectedprostateiscontraindicatedforacuteprostatitisbecausethe massagecanspreadthebacteriafromtheprostateintothebloodsystemandleadtosepsis.
Erysipelasisaninfectionoftheskinmostcommonlycausedbywhichofthefollowingclass oforganisms?
A)Streptococci
B)Staphylococi
C)Gram negativebacteria
D)Fungi A)Streptococci
ErysipelasisaskininfectioncommonlycausedbygroupAbeta-hemolyticstreptococci. Thisinfectionisusuallymoresuperficialthanotherbacterialinfectionsoftheskin,suchas cellulitis.
Whatisthefirst-lineclassofantibioticsrecommendedbytheAmericanThoracicSociety (ATS)forpatientsyoungerthan60yearsofagewhoarediagnosedwithcommunity acquiredpneumoniawithnocomorbidity?
A)First generationcephalosporins
B)Second generationcephalosporins
C)Macrolides
D)Beta lactamantibiotics C)Macrolides
TheAmericanThoracicSocietyrecommendsmacrolidesasthefirstlineoftherapyfor community acquiredpneumoniawithoutcomorbidity.
Allofthefollowingareclinicaleyefindingsfoundinsomepatientswithchronic uncontrolledhypertension.Whichofthefollowingfindingsisnotassociatedwiththis disorder?
A)AVnicking
B)Copperwirearterioles
C)Flame shapedhemorrhages
D)Microaneurysms-D)Microaneurysms
"KeithWagenerBarker(KWB)Grades"foruncontrolledhypertension:
Grade1:generalizedarteriolarconstrictionseenas"silverwiring"andvascular tortuosities;Grade2:grade1plusirregularlylocated,tightconstric tionsknownas"AV nicking"or"AVnipping";Grade3:grade2pluscottonwoolspotsandflame shaped hemorrhages;Grade4,grade3butwithswellingoftheopticdisk(papilledema). Microaneurysmsoccurwithdiabeticretinopathy.
Whilereviewingsomelabreports,thenursepractitionernotesthatoneofherteenage malepatient'slabresultsisabnormal.Theliverfunctiontestsareallnormalexceptfora slightelevationinthealkalinephosphataselevel.Thepatientisamemberofasoccerteam anddeniesanyrecentinjury.Whatisthenextstepinthispatient'sevaluation?
A)Orderaliverultrasoundtoruleoutfattyliver
B)Thisisanormalfindingforhisagegroup
C)Thepatientneedstobeevaluatedfurtherforpancreaticdisease
D)Referthepatienttoapediatricrheumatologist B)Thisisanormalfindingforhisage group
Elevatedlevelsofalkalinephosphatasearecommonlyseeningrowingchildren.Growthof bonetissueelevatesthealkalinephosphataselevels.
Whichofthefollowingwouldbeappropriateinitialmanagementofasecond degreeburn?
A)IrrigatewithhydrogenperoxideandapplySilvadenecreamBID
B)IrrigatewithnormalsalineandapplySilvadenecreamBID
C)IrrigatewithtapwaterandapplyNeosporinointmentBID
D)UnroofallintactblistersandapplyantibioticointmentBID B)Irrigatewithnormal salineandapplySilvadenecreamBID
BurnsshouldbecleansedwithsalinesolutionandSilvadenecreamappliedBIDtothesite. Hydrogenperoxideisnolongerrecommended.Intactblistersshouldnotbeunroofed.
WhenMolluscumcontagiosumisfoundonthegenitalareaofchildren,whichofthe followingisthebestexplanation?
A)Itshouldraisethesuspicionofchildsexualabuse
B)Itisnotconsideredasexuallytransmitteddisease
C)Itiscausedbyatypicalbacteria
D)Itiscausedbythepoxvirusandwillresolveonitsown A)Itshouldraisethesuspicion ofchildsexualabuse
Molluscumcontagiosumisspreadbyskin-to-skincontact.Lesionsfoundinthegenitalarea ofyoungchildrenshouldbeevaluatedforsuspicionofchildsexualabuse.
An80 year oldwomancomplainsabouther"thin"anddryskin.Whichofthefollowingis thebestexplanationforhercomplaint?
A)Geneticpredisposition
B)Lossofsubcutaneousfatandlowercollagencontent
C)Lossofsebaceousglands
D)Damagefromseveresunexposure-B)Lossofsubcutaneousfatandlowercollagen content
Thinningoftheskininolderfemalesisduetothelossofsubcutaneousfatandlower collagencontent
Allofthefollowingstatementsarecorrectregardinglicensurefornursepractitioners except:
A)Itensuresaminimumlevelofprofessionalcompetency
B)Itgrantspermissionforanindividualtopracticeinaprofession
C)Itrequiresverificationofeducationaltrainingfromanaccreditedgraduateprogram
D)Itreviewsinformationviaanongovernmentalagency D)Itreviewsinformationviaa nongovernmentalagency
Licensurefornursepractitionersincludesaminimumlevelofprofessionalcompetency, grantsper-missionforonetopracticeintheprofession,andverifiescompletionofan accred itedgraduateprogram.
Whichofthefollowingisthecorrectstatementregardingthesizeofthearteriolesand veinsonthefundioftheeye?
A)Theveinsarelargerthanthearterioles
B)Thearteriolesarelargerthantheveins
C)Thearteriolesarehalfthesizeoftheveins
D)Theveinsandthearteriolesareequalinsize-A)Theveinsarelargerthanthearterioles
Onfunduscopicexamoftheeyeyouwillseethattheveinsarelargerinsizethanthe arterioles.
Allofthefollowingfactorshavebeenfoundtoincreasetheriskofatrialfibrillationin predisposedindividualsexcept:
A)Hypertension
B)Excessivealcoholintakeinsusceptibleindividuals
C)Theophylline(Theodur)andpseudoephedrine(Sudafed)
D)Acuteesophagitis-D)Acuteesophagitis
Factorsthatinfluencetheriskofatrialfibrillationincludehypertension,excessivealcohol consumption,andmedicationssuchasTheodurandSudafed.
Atwhatagecanachildcopyacrossandrideabicycle?
A)1year
B)2years
C)3years
D)4years D)4years
Developmentalstagesinchildrenincludethefollowing:1year:walk;2years:walksup stepswiththesamefoot;3years:pedalsatricycleandcopiesacircle;4years:ridesa bicycleandcopiesacrossanddrawsapersonwith2parts.
Youwouldassociateapositiveiliopsoasmuscletestresultwith:
A)Leftcerebralvascularaccident
B)Urinarytractinfection
C)Heelfractures
D)Acuteabdomen D)Acuteabdomen
Apositiveiliopsoasmuscletestisseenwithanacuteabdomen.Thistestisperformedby askingthepatienttoactivelyflexthethighatthehip.A"positivepsoassign"isnotedwhen thepatientexhibitspainintherightlowerquadrantduetotheinflamedtissue.Theright iliopsoasmuscleliesundertheappendix,sopainmaysuggestappendicitis.
Whichcranialnerveinnervatestheextraocularmusclesoftheeyes?
A)CNII,CNIII,andCNVI
B)CNIII,CNIV,andCNVI
C)CNIV,CNV,andCNVII
D)CNV,CNVI,andCNVIII B)CNIII,CNIV,andCNVI
TheextraocularmusclesoftheeyesareinnervatedbycranialnervesIII,IV,andVI.
Whichofthefollowingtestswouldyourecommendtopatientstoconfirmthediagnosisof betathalassemiaorsicklecellanemia?
A)Hemoglobinelectrophoresis
B)Bonemorrowbiopsy
C)Peripheralsmear
D)Reticulocytecount A)Hemoglobinelectrophoresis
Patientswiththediagnosisofbetathalassemiaand/orsicklecellanemiawouldbe screenedusinghemoglobinelectrophoresistoidentifytheblooddisorder.
Allofthefollowingpatientshaveanincreasedriskofdevelopingadverseeffectsfrom Metformin(Glucophage)except:
A)Patientswithrenaldisease
B)Patientswithhypoxia
C)Obesepatients
D)Patientswhoarealcoholics C)Obesepatients
MetforminisusedasahyperglycemicagentforNIDDM.However,increasedmortalityhas beenassociatedwithdrug inducedlacticaci dosis.Contraindicationsfortheuseof metforminincludepatientswithsignificantrenalandhepaticdisease,alcoholism,and conditionsassociatedwithhypoxia(cardiac/pulmonaryproblems),sepsis,dehydration, highdoses,andadvancedage.Metforminisusedinobesepatientsandeducationregarding thelacticacidosisriskshouldbediscussedwiththepatientandfamily.
Amiddle agedhypertensivemalepresentstoapublichealthclinicwithcomplaintsofan acuteonsetoffever,chills,andcoughthatisproductiveofrusty coloredsputum.The patientreportsepisodesofsharppainsontheleftsideofhisbackandchestwheneverheis coughing.Histemperatureis102.2degreesFahrenheit,thepulseis100/min,andtheBPis 130/80.Theurinalysisdoesnotshowleukocytes,nitrites,orblood.Thisfindingismost consistentwith:
A)Atypicalpneumonia
B)Anupperurinarytractinfection
C)Bacterialpneumonia
D)Acutepyelonephritis C)Bacterialpneumonia
Symptomsofbacterialpneumoniaincludehighfever,chills,productivecough,andpainin back/chestareawithdeepinspirationandcough.
Lifestylemodificationsareanimportantaspectinthetreatmentofhypertension.Whichof thefollowingstatementsisincorrect?
A)Reduceintakeofsodium,potassium,andcalcium
B)Reduceintakeofsodiumandsaturatedfats
C)Exerciseatleastthreetofourtimesperweek
D)Maintainanadequateintakeofpotassium,magnesium,andcalcium A)Reduceintake ofsodium,potassium,andcalcium
Lifestylemodificationsforhypertensionincludeexercise3 4timesaweek,diet modificationsofreducedintakeofsodiumandsaturatedfats,andadequatedietaryintake ofpotassium,magnesium,andcalcium
Whichofthefollowingclassesofantihypertensivedrugsshouldapatientbeweanedoff slowlytoavoidtheriskofseverereboundhypertension?
A)Diuretics
B)Beta blockers
C)ACEinhibitors
D)Calciumchannelblockers B)Beta blockers
Reversereboundhypertensioncanoccurifbeta blockersareabruptlystopped. Recommendationsincludeweaningoffthebeta-blockerswhenchangingmedications.
A70 year oldmalewithopen angleglaucomaisprescribedBetimol(timolol)ophthalmic drops.AllofthefollowingarecontraindicationstoBetimolophthalmicdropsexcept:
A)Overtheartfailureorsinusbradycardia
B)Asthmaticpatients
C)Second orthird degreeAVblock
D)Migraineheadaches D)Migraineheadaches
ContraindicationswithBetimol(timolol)includeheartfailureorsinusbradycardia, asthmaticpatients,andsecond orthird degreeAVblock
Atwhattimeofthedaywouldyourecommendascotchtapetestbedonetoevaluatefora suspectedcaseofenterobiasis?
A)Intheeveningafterdinner
B)Atnightbeforebed
C)Earlyinthemorning
D)Itdoesnotmatterwhattimeofthedaythetestisdone C)Earlyinthemorning
Thescotchtapetestisbestdoneinthemorningforseveraldaysinarow.Thefemalesdo notlayeggseverydayandthereforetestingforseveraldayswillbemoreaccurate.
Atwhatagecanachildcopyacircleandrideatricycle?
A)1year
B)2years
C)3years
D)4years C)3years
Developmentalstagesinchildrenincludethefollowing:1year:walk;2years:walksup stepswiththesamefoot;3years:pedalsatricycleandcopiesacircle;4years:ridesa bicycleandcopiesacrossanddrawsapersonwith2parts.
A30-year-oldmalepatientrefusestotakehisafternoondoseofpills.Thenursetellshimof thepossibleconsequencesofhisaction,butthepatientstillrefusestocooperate.Whichof thefollowingisthebestcourseforthenursetofollow?
A)Documentinthepatient'srecordhisbehaviorsandtheactiontakenbythenurse
B)Reassurethepatientthathewillbefineaftertakingthemedicine
C)Documentonlythepatientbehavior
D)Documentonlythenurse'saction A)Documentinthepatient'srecordhisbehaviors andtheactiontakenbythenurse
Ifapatientisnon compliant,documentationofthepatientbehaviorandtheactionstaken bythenursebothmustbedocumented.
Whileperformingasportsphysicalona16-year-oldgirl,thenursepractitionernotesa splitS2duringinspirationthatdisappearsduringexpiration.Thegirlisactiveandher growthanddevelopmenthavebeenuneventful.Whatisthebestrecommendationforthe child'smother?
A)Herdaughterneedstobereferredtoapediatriccardiologist
B)HerdaughterneedstobereferredforastressEKG
C)Advisethemotherthatthisisanormalfinding
D)Thechildshouldavoidstrenuousphysicalexertionuntilfurther evaluation-C)Advisethemotherthatthisisanormalfinding
Explaintothemotherthatinhealthyadolescents,asplitS2duringinspirationthat disappearsduringexpira tionisanormalvariation.
Patientswhoareconsideredmentallycompetenthavearighttoconsentorrefusemedical treatment.Whatisthelegaltermforthisright?
A)Informedconsent
B)Durablepowerofattorney
C)Competence
D)Advancedirectives C)Competence
Competenceishavingtheabilitytomakeone'sowndecisionsregardingone'sowncourse ofhealthcare,aslongasoneisdocumentedasbeingmentallycompetent.Informed consentisgivingpermissiontoperformaparticularprocedure,understandingthepurpose oftheprocedure/treatment,success/failurerate,otheralternativestotheprocedure,risks andbenefitsoftheprocedure,prognosis,andsuccessrate.Togiveinformedconsent,the patientmustbe18yearsoldorolder.Durablepowerofattorneyisthelegaldocument givingonepersontheauthoritytomakedecisionsregardinganotherperson'shealthcare
andpersonalaffairsonthatperson'sbehalf.Advancedirectivesarewritteninstructionsto beper formedintheeventthepatientisnotmentallycompetentandnotabletomake decisionsforhimself/herself.TheLivingWillisanexampleofanadvancedirective.
ThefollowingstatementsaretrueaboutWilmstumorexcept:
A)Themostfrequentclinicalsignisapalpableabdominalmass
B)Itisacongenitaltumorofthekidney
C)Microscopicorgrosshematuriaissometimespresent
D)Thetumorcommonlycrossesthemidlineoftheabdomenwhenitis discovered D)Thetumorcommonlycrossesthemidlineoftheabdomenwhenitis discovered
AWilm'stumorisacongentialtumorofthekidneythatshouldneverbepalpated,once diagnosed,toavoidspreadofthetumorcells.Microscopicorgrosshematuriamaybe present.
Atlevelofpreventionwouldyouclassifyscreeningforlungcancer?
A)Primaryprevention
B)Secondaryprevention
C)Tertiaryprevention
D)Screeningforlungcancerisnotcurrentlyrecommended D)Screeningforlungcancer isnotcurrentlyrecommended
WhichofthefollowingT scoresisindicativeofosteoporosis?
A)T scoreof0to 1.0
B)T scoreof 1.0to 2.0
C)T scoreof 2.5orless
D)Thediagnosisofosteoporosisisbasedonanx-rayseriesofthespine-C)T-scoreof-2.5 orless
OsteoporosisisdefinedashavingaT scoreof 2.5orless. RiskfactorsshouldalsobeconsideredwheninterpretingT scoresfordiagnosis.
Whichofthefollowingmethodsisusedtodiagnosegonorrhealpharyngitisorproctitis?
A)Serumchlamydiatiter
B)Gen-Probe
C)Thayer Martinculture
D)Cultureandsensitivityofthepurulentdischarge C)Thayer Martinculture
Thayer-Martincultureisrecommendedforscreeningtodiagnosegonorrhealpharyngitis orproctitis.
Thefirstnursepractitionerprogramwasstartedby:
A)AlfredBandura
B)PresidentJohnF.Kennedy
C)Federalgovernment
D)LorettaFord,PhD D)LorettaFord,PhD
ThefirstNPprogramwasstartedbyLorettaFord,PhD,attheUniversityofColorado;itwas acertificateprogramforNPs.
Terazosin(Hytrin),analphablocker,isusedtotreatwhichofthefollowingconditions?
A)Benignprostatichypertrophyandhypertension
B)Chronicprostatitisandatrialfibrillation
C)Urinarytractinfectionsandarrhythmias
D)Benignprostatichypertrophyandchronicprostatitis
A)Benignprostatichypertrophy andhypertension
Hytrinisusedtotreatbenignprostatichypertrophyandhypertension.
Aconcernednewmotherreportstoyouthatherson,whois3yearsofage,isnottoilet trainedyet.Whichofthefollowingisanappropriatereply?
A)Recommendareferraltoapediatricurologist
B)Advisethemotherthatherchildisdevelopingnormally
C)Recommendabed-wettingalarm
D)Recommendavoidingcystogram B)Advisethemotherthatherchildisdeveloping normally
Toilettrainingbeginsatapproximately2yearsofageandmaytake1-2yearstocomplete. Maleswhoarenottoilettrainedby3yearsofagemaystillbedevelopingnormally.
Whichofthefollowingclinicalfindingscanmimicacaseoftesticulartorsionbutisnot consideredanemergentcondition?
A)The"bluedot"sign
B)Oneswollentesticlewithyellow coloredpeniledischarge
C)Anacuteonsetofdysuriaandfrequency
D)Avaricocele-A)The"bluedot"sign
The"bluedot"signislocatedunderneaththeskinofthetesticleandappearsasaround, bluetopurplemass.Itisnotanemergentcondi tion.Alsoknownasthetorsionof testicularappendage.
Whichofthefollowingclassesofdrugsisimplicatedwithbluntingthesignsandsymptoms ofhypoglycemiaindiabetics?
A)Calciumchannelblockers
B)Diuretics
C)Beta blockers
D)ARBs(angiotensinreceptorblockers) C)Beta blockers
Beta blockersareknowntobluntthesigns/symptomsofhypoglycemiainpatientwith diabetes.
Allofthefollowingfactorsincreasetheriskofmortalityforpatientsdiagnosedwith bacterialpneumoniaexcept:
A)Alcoholism
B)Veryyoungageortheelderly
C)Multiplelobarinvolvement
D)Hypertension-D)Hypertension
Factorsthatincreasetheriskofmortalityforpatientsdiagnosedwithbacterialpneumonia includealcoholism,veryyoungorelderlypatients,andmultiplelobarinvolvement.
Thebacteriumresponsibleforthehighestmortalityinpatientswithcommunity acquired pneumoniais:
A)Streptococcuspneumoniae
B)Mycoplasmapneumoniae
C)Moraxellacatarrhalis
D)Haemophilusinfluenzae
A)Streptococcuspneumoniae
Steptococcuspneumoniaeisknownforbeingresponsibleforthehighestmortalityin patientswithcommunity acquiredpneumonia.
Mr.R.J.isa40 year oldasthmaticmalewithhypertension.Forthepast6months,hehas beenfollowingalow fat,low sodiumdietandwalking3timesaweek.HisBPreadings fromthepast2visitswere160/95and170/100.Onthisvisit,itis160/90.Whatisthe mostappropriateactionforthenursepractitionertofollowatthisvisit?
A)Continuethelifestylemodificationsandrecheckhisbloodpressureagainin4weeks
B)Initiateaprescriptionofhydrochlorothiazide12.5mgPOdaily
C)Initiateaprescriptionofatenolol(Tenormin)25mgPOdaily
D)ReferthepatienttoacardiologistforastressEKG B)Initiateaprescriptionof hydrochlorathiazide12.5mgPOdaily
ThepatientwouldbestartedonHCTZ12.5mgPOdailyforhishighBP.Hehasbeentrying lifestylemodificationsfor6monthswithdietchangesandexercise.
Wheninitiallytreatinganadultforacutebronchitis,whichofthefollowingshouldthe nursepractitionerbeleastlikelytoorder?
A)Expectorants
B)Antibiotics
C)Bronchodilators
D)Antitussives B)Antibiotics
Acutebronchititisisnormallyaviralinfection,soexpectorants,bronchodilators,and antitussiveswouldbeprescribedforthecough.Antibioticsarenoteffectiveagainstviral infections.
Allofthefollowingdescribenormalbehaviorfora3 year oldchildexcept:
A)Speaksin3-to4-wordsentencesthatareunderstoodbymoststrangers
B)Candrawacross
C)Candrawacircle
D)Canrideatricycle B)Candrawacross
Developmentalstagesinchildrenincludethefollowing:1year:walk;2years:walksup stepswiththesamefoot;3years:pedalsatricycleandcopiesacircle;4years:ridesa bicycleandcopiesacrossanddrawsapersonwith2parts
Mary,whohasrecentlybeendiagnosedwithlupus,complainsthatherhandsandfeet alwaysfeelcoldeveninthesummertime.Sometimesherfingertipsbecomenumbandturn abluecolor.Thefingertipseventuallyturntoadarkredcolor.Whichofthefollowingis mostlikely?
A)Chronicarterialinsufficiency
B)Thisisanormalreactionwhenonefeelsverycold
C)Peripheralvasculardisease
D)Raynaud'ssyndrome D)Raynaud'ssyndrome
Raynaud'ssyndromeoccursfromvasospasmsofthebloodvessels,leadingtodecreased bloodsupplytothehands/feet,whichcausesbluishdiscoloration,withfingertipsturninga darkredcolorifsevere.Stressandcoldweatherareclassictriggersforthis.
Mrs.Nottam,whohasaBMIof29,hasa20 yearhistoryofprimaryhypertension.Shehas beenonhydrochlorothiazide25mgPOdailywithexcellentresults.Onthisvisit,sheis complainingoffeelingthirstyallthetimeeventhoughshedrinksmorethan10glassesof waterperday.Shereportstothenursepractitionerthatshehasbeenhavingthisproblem forabout6months.Uponreadingthechart,thenursepractitionernotesthatthelasttwo
fastingbloodglucoselevelshavebeen140mg/dLand168mg/dL.Arandombloodglucose isat210mg/dL.
Whichofthefollowingisthebesttreatmentplantofollowatthisvisit?
A)Orderanotherrandombloodsugartestin2weeks
B)Initiateaprescriptionofmetformin(Glucophage)500mgPOBID
C)Ordera3 hourglucosetolerancetest
D)OrderaHgbA1cleve B)Initiateaprescriptionofmetformin(Glucophage)500mgPO BID
Initiatingmetforminisrecommendedbecauseshehasmetthecriteriafordiagnosisof diabetes.Criteriafordiagnosingtype2diabetes:fastingbloodglucose126mg/dLorhigher on2separateoccasions,2 hourbloodglucose200mg/dLorhigherduringOCTwith75g glucoseload,symptomsofdiabetes(polyuria,polydipsia,polyphagia)plusrandomblood glucosegreaterthan200mg/dL.
Anewlydiagnosedmiddle agedtype2diabeticwantstostartanexerciseprogram.Allof thefollowingstatementsaretrueexcept:
A)Ifthepatientisunabletoeatduetoillness,anti diabeticagentscanbecontinuedwith frequentglucosemonitoring
B)Strenuousexerciseiscontraindicatedfortype2diabeticsbecauseofahigherriskof hypoglycemicepisodes
C)Exerciseincreasesthebody'sabilitytometabolizeglucose
D)Patientswhoexercisevigorouslyintheafternoonmayhavehypoglycemicepisodesin theeveningoratnightiftheydonoteat B)Strenuousexerciseiscontraindicatedfortype 2diabeticsbecauseofahigherriskofhypoglycemicepisodes
Exerciseisrecommendedbecauseexercisehelpstousetheglucosestoresandreduce bloodsugar.Bloodsugarshouldbemonitoredclosely,especiallyifoninsulin,when exercisingtoavoidhypoglycemia.
Whatistheleastcommonpathogenfoundincommunity acquiredatypicalpneumonia?
A)Moxarellacatarrhalis
B)Streptococcuspneumoniae
C)Pseudomonasaeruginosa
D)Mycoplasmapneumonia C)Pseudomonasaeruginosa
PseudomonasaeruginosaisanuncommoncauseofCAPbutisaparticularlydifficult bacterialinfectiontotreat.
Allofthefollowingaretrueaboutstrawberryhemangiomasfoundininfantsexcept:
A)Mostwillinvolutespontaneouslybytheageof18to24months
B)Watchfulwaitingisthemostusefulstrategy
C)Hemangiomasshouldbetreatedwithlasertherapyiftheyhavenotresolvedbytheage of12months
D)Strawberryhemangiomasarebenign C)Hemangiomasshouldbetreatedwithlaser therapyiftheyhavenotresolvedbytheageof12months
Truestrawberryhemangiomaswilleventuallyresolvebythetimethechildgoesto kindergarten.Mostwillreduceordisappearinthefirst2years.Lasertreatmentisrarely needed.
A56-year-oldmechanicisbroughttoyourofficecomplainingofheavypressureinthe substernalareaofhischestthatisradiatingtohisjaw.Thepainbeganwhilehewaslifting upatire.Henowappearspaleandisdiaphoretic.Hisbloodpressureis100/60mmHg,and hispulserate50.Whatisthemostappropriateaction?
A)Performa12 leadEKG
B)Dial9 1 1
C)Administeramorphineinjectionforpain
D)Observethepatientintheoffice B)Dial9 1 1
Heavychestpressureinthesubsternalarea,radiatingtothejaw,diaphoresis,lowBP,and bradycardiaaresignsofcardiacdistressand9 1 1shouldbecalledimmediatelyfor transfertotheemergencydepartment.
Whichofthefollowingisindicatedforinitialtreatmentofanuncomplicatedcaseof Helicobacterpylorinegativepepticulcerdisease?
A)Omeprazole(Prilosec)
B)Misoprostol(Cytotec)
C)Ranitidine(Zantac)
D)Pepto Bismoltablets B)Misoprostol(Cytotec)
Misoprostolisrecommendedforshort term,uncomplicatedPUD;itactsbydecreasing gastricacidproductionandenhancingmucosalresistancetoinjury.
ErythromycininhibitsthecytochromeP 450system.Thefollowingdrugsshouldbe avoidedbecauseofapotentialforadruginteractionexcept:
A)Theophylline(Theo Dur)
B)Warfarin(Coumadin)
C)Diazepam(Valium)
D)Furosemide(Lasix) D)Furosemide(Lasix)
TherearemanymedicationsthatarecontraindicatedwiththecytochromeP 450system. Lasixisonemedicationthatcanbeused.
Ifleftuntreated,Zollinger Ellisonsyndromecancausewhichofthefollowing?
A)Severeulcerationofthestomachorduodenum
B)Toxicmegacolon
C)Chronicdiarrhea
D)Malabsorptionoffat solublevitamins A)Severeulcerationofthestomachor duodenum
UntreatedZollinger Ellisonsyndromecanleadtosevereulcerationofthestomachor duodenum.Zollinger-Ellisonsyndromeoccurswhentumors(gastrinomas)intheintestine, pancreas,orlymphnodesnearthepancreasproduceexcessiveamountsofgastrin,which inturnwillincreasetheamountofacidproducedbythestomach.Highamountsofacidin thestomachwillproduceulcerationofthestomachorduodenum.
AllofthefollowingareconsideredCategoryXdrugsexcept:
A)Misoprostol(Cytotec)
B)Isotretinoin(Accutane)
C)Finasteride(Proscar)
D)Meperidine(Demerol) D)Meperidine(Demerol)
DemerolisindrugCategoryCandandtreatedbytheFDAasacontrolleddrugScheduleII.
Younote,duringaphysicalexamona6 year oldchild,somepittingonthefingernails.This findingiscorrelatedwith:
A)Iron-deficiencyanemia
B)Psoriasis
C)Onychomycosis
D)VitaminCdeficiency B)Psoriasis
Fingernailpittingiscorrelatedwithpsoriasis.Psoriasiscancausepittingonallfingerand toenails,alongwiththickeningandirregularshapeofthenail.
Whichofthefollowingiscorrectregardingthebestsitetolistenformitralregurgitation?
A)TheapicalareaduringS2
B)ItisbestheardatthebaseatS1
C)ItisbestheardattheapexatS1
D)ItisbestheardatthebaseatS2-C)ItisbestheardattheapexatS1
Mitralregurgitationisbestheardattheapicalarea;itisahigh pitched,blowingpansystolic murmur.
ExtremetendernessandinvoluntaryguardingatMcBurney'spointisasignificantfinding forpossible:
A)Acutecholecystitis
B)Acuteappendicitis
C)Acutegastroenteritis
D)Acutediverticulitis B)Acuteappendicitis
Symptomsofanacuteabdomen,suchasappendicitis,includeextremetendernessand involuntaryguardingatMcBurney'spoint.
Allofthefollowingmayhelprelievethesymptom(s)ofGERDexcept:
A)Losingweight
B)Stoppingcaffeineintake
C)Chewingbreathmints
D)Stoppingalcoholintake C)Chewingbreathmints
GERDisaconditioninwhichfoodcomesupfromthestomach/esophagusthroughaweak sphincter.Itusuallyworsenswithlyingdown,fromthereflux,andcancauseacoughand esophagealirritationifnottreated.Effectivetreatmentmayincludeweightloss,decreased caffeineintake,andavoidanceofalcohol.
An18-year-oldwaitressisdiagnosedwithpelvicinflammatorydisease(PID).Thecervical Gen ProberesultispositiveforNeisseriagonorrhoeaeandnegativeforChlamydia trachomatis.Allofthefollowingstatementsaretrueregardingtheman agementofthis patientexcept:
A)ThispatientshouldbetreatedforchlamydiaeventhoughtheGen Probeforchlamydia isnegative
B)Ceftriaxone250mgIManddoxycycline100mgPOBIDx14daysareappropriate treatmentforthispatient
C)Advisethepatienttoreturntotheclinicforarepeatpelvicexamin48hours
D)RepeattheGen ProbetestforChlamydiatrachomatistoensurethattheprevioustest wasnotafalse negativeresult D)RepeattheGen ProbetestforChlamydiatrachomatisto ensurethattheprevioustestwasnotafalse negativeresult
TreatmentforbothgonorrheaandchlamydiaarerecommendedforthediagnosisofPID, regardlessifthechlamydiatestwasnegative.
WhatTannerstageisagirlatwhenherbreastsformasecondarymound?
A)TannerStageII
B)TannerStageIII
C)TannerStageIV
D)TannerStageV C)TannerStageIV
Tannerstagesforbreastdevelopment:I,prepuberty;II,breastbud;III,breastandareola onemound;IV,breastandareolasecondarymound;V,adultpattern.
A35 year oldsmokerisbeingevaluatedforbirthcontrolchoices.Thepatienthasahistory ofPIDalongwithanembolicepisodeafterherlastpregnancy.Whichofthefollowing methodsofbirthcontrolwouldyourecommend?
A)Condomsandthevaginalsponge(TodaySponge)
B)Estrogenpatches
C)Intrauterinedevice
D)Depo Provera(depotmedroxyprogesterone) A)Condomsandthevaginalsponge (TodaySponge)
Contraindicationsforhormonalcontraceptioninclude:Migraineheadaches;cigarette smokingorobesityinwomenolderthan35years;historyofthromboembolicdisease; hypertensionorvasculardiseaseifover35yearsofage;systemiclupuserythematosus withvasculardisease,nephritis,orantiphospholipidantibodies;breastfeeding(mayuse progestin onlypills);hypertriglyceridemia;CAD;CHF;andstrokes.
A21 year oldwomancomplainsofleft sidedpelvicpainaccompaniedbydyspareunia. Duringthegynecologicalexam,thenursepractitionernoticesgreencervicaldischarge.The patientmentionsanewonsetofapainfulandswollenleftkneeanddeniesahistoryof trauma.Thisbestdescribes:
A)Septicarthritis
B)Reiter'ssyndrome
C)Chondromalaciaofthepatella
D)Disseminatedgonorrhealinfection D)Disseminatedgonorrhealinfection
SymptomsofPIDwithpainful,swollenjointsofextremitiesindicatedisseminated gonorrhealinfection.Untreateddisseminatedgonorrheacanleadtosepticarthritis. Symptomsmaybemildfromslightjointpainandnofevertoseverejointpainwithhigh fever.PIDsymptomsdonotoccurwithsepticarthritis,Reiter'ssyndrome,or chondromalaciaofthepatella.
Youwouldrecommendthepneumococcalvaccine(Pneumovax)topatientswithallofthe followingconditionsexcept:
A)Sicklecellanemia
B)Splenectomy
C)PatientsinfectedwithHIV
D)G6PDdeficiencyanemia D)G6PDdeficiencyanemia
PneumococcalvaccineshouldnotbegiventopatientswithG6PDdeficiencyanemia.
A40 year oldcashiercomplainsofperiodsofdizzinessandpalpitationsthathaveasudden onset.TheEKGshowsPwavesbeforeeachQRScomplexandaheartrateof170 beats/minute.Acarotidmassagedecreasestheheartrateto80beats/min.Thesebest describe:
A)Ventriculartachycardia
B)Paroxysmalatrialtachycardia
C)Atrialfibrillation
D)Ventricularfibrillation B)Paroxysmalatrialtachycardia
Signs/symptomsofparoxysmalatrialtachycardiaincluderapid,regularheartratethat beginsandendsveryquickly.Theatriaarebeatingataveryfastrate,butitisnotlife threatening.Ventriculartachycardiaisusuallyassociatedwithheartdisease,occurswhen theventriclesarebeatingrapidlyandinefficiently,andcanleadtodeathifnottreated. Atrialfibrillationisanirregularheartbeatthatcanbelifethreateningifnottreated. Ventricularfibrillationoccurswhentheheartbeatisrapidandchaotic,anddeathwilloccur iftheconditionisnottreated.
A25 year oldwomancomplainsofdysuria,severevaginalpruritis,andamalodorous vaginaldischarge.Pelvicexaminationrevealsastrawberry coloredcervixandfrothy yellowdischarge.Microscopicexamofthedischargerevealsmobileorganismsthathave flagella.Thecorrectpharmacologictherapyfortheconditionis:
A)Metronidazole(Flagyl)
B)Ceftriaxonesodium(Rocephin)
C)Doxycyclinehyclate(Vibramycin)
D)Clotrimazole(Gyne Lotrimin) A)Metronidazole(Flagyl)
Trichomoniasissymptomsincludedysuria,severevaginalpruritis,andmalodorousvaginal discharge.Wetprepwillshowtrichomonadsthatarepear shapedandhaveseveralflagella (whipliketails)atoneend.CDCrecommendationfortreatmentismetronidazole
Anewmotherreportstoyouthather6 month oldinfanthasacoldandhasafeverof99.8 degreesFahrenheit.Theinfantisnotirritableandisfeedingwellwithoutproblems.The motherwantstoknowwhetheritisokayforhimtobeimmunizedatthistime.Whichof thefollowingstatementsistrue?
A)Theinfantshouldnotbeimmunizeduntilheisafebrile
B)Aninfantwithacoldcanbeimmunizedatanytime
C)Aninfantwithacoldcanbeimmunizedaslongastheinfant'stemperatureisnohigher than100.4degreesFahrenheit
D)Becauseimmunizationissoimportant,itshouldbegiventotheinfantasscheduled C) Aninfantwithacoldcanbeimmunizedaslongastheinfant'stemperatureisnohigher than100.4degreesFahrenheit
Immunizationisacceptableaslongasthetemperatureisnothigherthan100.4°F.
Metronidazole(Flagyl)producesthedisulfiram(Antabuse)effectwhencombinedwith alcoholicdrinksormedicine.Youwouldeducatethepatienttoavoid:
A)Alcoholicdrinksduringthetimeshetakesthemedicine
B)Alcoholicdrinks1daybefore,duringtherapy,andafewdaysaftertherapy
C)Alcoholicdrinksaftershetakesthemedicine
D)Thereisnoneedtoavoidanyfoodordrink. B)Alcoholicdrinks1daybefore,during, therapyandafewdaysaftertherapy
Alcoholiscontraindicatedduringtheuseandupuntil3daysfollowingtheadministration ofFlagyl.Severesideeffectsmayoccur,suchastachycardia,flushing,tinglingsensations, nausea,andvomiting.
ThetreatmentplanofpatientswithAIDSwhohaveCD4countsof<200/mmshould emphasize:
A)AdministeringanMMRvaccine
B)Preventivetherapyfortoxoplasmosis
C)PreventivetherapyforPneumocystiscariniipneumonia
D)Evaluationofthehomeenvironment
Apositiveobturatorsignmightsignifywhichofthefollowingconditions?
A)Acuteappendicitis
B)Acutepancreatitis
C)Acutecholecystitis
D)Acutehepatitis A)Acuteappendicitis
Apositiveobturatorsignmayindicateacuteappendicitis.Thetestisperformedbyhaving thepatientliedownsupine,androtatethehip,usingfullrangeofmotion.Apositivesignis whenpainisexperiencedwithmovementorflexionofthehip.
Spermatogenesisoccursatthe:
A)Vasdeferens
B)Seminalvesicles
C)Testes
D)Epididymis-C)Testes
Spermatogenesisoccursinthetestes,takingapproximately3monthstodevelop.
ProphylaxisforPneumocystiscariniipneumoniaincludesallofthefollowingdrugsexcept:
A)Trimethoprim sulfamethoxazole
B)Dapsone
C)Aerosolizedpentamidine
D)Aerosolizedalbuterolsulfate(Ventolin) D)Aerosolizedalbuterolsulfate(Ventolin)
ProphylaxisforPneumocystiscariniipneumoniaincludestheuseofBactrim,dapsone,and aerosolizedpentamidine.Aerosolizedpentamidineisaantimicrobialtreatmentfor prevention,alongwithBactrimanddapsone,whichareantibacterialmedications.
Mrs.Brandscomplainsofdizzinesswhenshemovesherhead.Yoususpectbenign paroxysmalpositionalvertigo.Thediagnosisissupportedbythepresenceof:
A)Tinnitus
B)Horizontalnystagmuswithrapidheadmovement
C)Newonsetofhearingloss
D)Durationofgreaterthan2years B)Horizontalnystagmuswithrapidheadmovement
Symptomsofbenignparoxysmalpositionalvertigoincludehorizontalnystagmuswith rapidheadmovement.ByperformingtheDix Hallpikemaneuverand/ortherolltest,the symptomsofvertigowillappear.
Whileperformingaroutinephysicalexamona60 year oldmale,thenursepractitioner noticesasoftbruitoverthecarotidareaontheleftsideoftheneck.Thepatienthasa historyofhypertension.Thepatientisathigherriskfor:
A)Temporalarteritisandbrainaneurysms
B)Dizzinessandheadaches
C)Abdominalaneurysmandcongestiveheartfailure
D)Strokeandcoronaryheartdisease D)Strokeandcoronaryheartdisease
Carotidstenosisputsthepatientatriskforstrokeandcoronaryheartdisease
Akindergartenteacherisdiagnosedwithacutepharyngitis.Onexam,thethroatisabright redcolorwithnotonsillarexudate,andclearmucusisseenonthelowernasalturbinates. Theresultofherurinalysisshowsalargeamountofwhitebloodcellsandispositivefor nitrites.Thepatienthasasulfaallergyandthinkssheisalsoallergictopenicillins.Whichof thefollowingisthebesttreatmentchoice?
A)Amoxicillin/clavulanicacid(Augmentin)500mgPOBID
B)Levoquinolone(Levaquin)250mgPOdaily
C)Trimethoprimsulfamethoxazole(BactrimDS)1tabletPOBID
D)Clarithromycin(Biaxin)500mgPOBID B)Levoquinolone(Levaquin)
PharyngitisandurinarytractinfectionarebothcoveredbyusingLevaquin,whichisa quinolone.AugmentinandBactrimcouldnotbeusedduetoherallergies.
Allofthefollowingdrugsinterferewiththemetabolismoforalcontraceptivesexcept:
A)Tetracycline
B)Rifampin
C)Phenytoin(Dilantin)
D)Ciprofloxacin(Cipro) D)Ciprofloxacin(Cipro)
Ciproistheonlymedicationlistedthatwillnotinterferewiththemetabolismand absorptionofOCPs.
Whenstartinganelderlypatientonanewprescriptionoflevothyroxine(Synthroid),the nursepractitionershouldkeepinmindthattherationaleforstartinganelderlypatienton alowerdoseiswhichofthefollowing?
A)Duetoitscentralnervoussystemeffects
B)Duetoitscardiaceffects
C)Duetoitsrenaleffects
D)Duetoitshepaticeffects B)Duetoitscardiaceffects
Levothyroxine(Synthroid)shouldbestartedonthelowestdoseinelderlypatientsdueto theseveresideeffectsthatcanoccur.Sideeffectsincludepalpitations,tachycardia,anxiety, irritability,elevatedBP,flushing,andinsomnia.
Womenwhoarepregnantduringthewintermonthsarerecommendedtohavewhichof thefollowing?
A)IncreasedintakeofVitaminCandfolate
B)Vaccinationagainsttheinfluenzavirus
C)Increasedcaloricintakeoffruitsandvegetables
D)Heavierwinterclothestoavoidchillingthefetus B)Vaccinationagainsttheinfluenza virus
Influenzavaccineisrecommendedforallpregnantpatientsforpreventionduetothe decreaseinimmunestatusduringpregnancy.Thevaccineissafetouseduringpregnancy.
TheearliestagethatanMMRcanbeadministeredisat:
A)4months
B)6months
C)8months
D)12months-D)12months
TheearliestagethatMMRisrecommendedis12months.Thisageisrecommended becausegivingitanyearliermaybelesseffectivebecausetheinfantstillhasantibodies fromthemother.Antibodiesstillpresentfromthemothermayinterferewiththe productionoftheantibodiesstimulatedbytheMMRvaccine.
WhichofthefollowingisaCDC recommendedtreatmentforacaseofuncomplicated gonorrhealandchlamydialinfection?
A)Metronidazole(Flagyl)250mgPOTIDx7days
B)Valacyclovir(Valtrex)500mgPOBIDx10days
C)Azithromycin1gorallyORdoxycycline100mgorallytwiceadayfor7days
D)1doseoforalfluconazole(Diflucan)150mg C)Azithromycin1gorallyORdoxycycline 100mgorallytwiceadayfor7days
Drugtherapyisbasedonthe2010CDCSTDguidelinesfortreatment.
Whichofthefollowingisnotarelativecontraindicationfororalcontraceptivepills?
A)ActivehepatitisAinfection
B)ThrombosisrelatedtoanIVneedle
C)Undiagnosedvaginalbleeding
D)Migraineheadachewithoutfocalaura B)ThrombosisrelatedtoanIVneedle
ThrombosisrelatedtoeitheraknowntraumaorIVneedledoesnotrepresenta contraindicationforuseoforalcontraceptives.
Anursepractitioneristakingpartinacommunityoutreachprogramforalocalhospital. Mostofheraudiencehasadiagnosisofhypertension.Theyareallinterestedinlearning moreaboutaproperdiet.Whendiscussingpotentialsourcesofpotassiumandmagnesium, whichofthefollowingisthebestadvice?
A)Mostfruitsandvegetables
B)Wholegrainsandsausages
C)Processedcornedbeefandyogurt
D)Mushroomsandsauerkraut A)Mostfruitsandvegetables
Fruitsandvegetablesarehigherinpotassiumandmagnesium.
A35 year oldsexuallyactivemalepresentswitha1 weekhistoryoffeverandpainover theleftscrotum.Itisaccompaniedbyfrequencyanddysuria.Thescrotumisedematous andtendertotouch.Hedeniesflankpain,nausea,andvomiting.Hereportsthatthepainis lessenedwhenheusesscrotalsupportbriefs.Hisurinalysisshows2+bloodandalarge numberofleukocytes.Whatisthemostlikelydiagnosis?
A)Acuteurinarytractinfection
B)Acutepyelonephritis
C)Acuteorchitis
D)Acuteepididymitis
Acuteepididymitisistheinfectionpresentedhere.Scrotaledemaandpainwithpalpation donotoccurinUTIorpyelonephritis.Acuteorchitissymptomsincludetesticularpainand edema,areusuallyassociatedwiththemumps,butdonothavefrequencyanddysuria.
Julia,a16 year oldpatient,isbeingtreatedforherfirsturinarytractinfection.Juliahadan allergicreactionwithhivesaftertakingsulfaasachild.Whichofthefollowingantibiotics wouldbecontraindicated?
A)Cephalexin(Keflex)
B)Ampicillin(Amoxil)
C)Trimethoprim-sulfamethoxazole(Bactrim)
D)Nitrofurantoincrystals(Macrobid) C)Trimethoprim sulfamethoxazole(Bactrim)
Withtheallergichistorytosulfadrugs,itwouldbesafesttoavoidBactrim.
Themotherofa4 month oldcallsyourofficeandreportsthattheinfanthasafeverof 101.4degreesFahrenheit.Theinfantreceivedherimmunizationsyesterday.Whichofthe followingiscorrect?
A)ThefeverismostlikelyduetothecombinationoftheMMRandpoliovaccines
B)ThefeverismostlikelyduetothepertussiscomponentoftheDTPvaccine
C)Theinfantisprobablystartingaviralupperrespiratoryinfection
D)Theinfanthadanallergicreactiontooneofthevaccinesgivenandshouldbebroughtto theemergencyroom-B)Thefeverismostlikelyduetothepertussiscomponentofthe DPTvaccine
Thepertussiscomponentofthevaccineismostlikelythecauseofthefever.
Thefollowingstatementsaboutbenignprostatichypertrophyarecorrectexcept:
A)Itisseeninupto50%ofmalesolderthan50
B)Dribblingandnocturiaarecommonpatientcomplaints
C)Sawpalmettoisalwayseffectiveinreducingsymptoms
D)ThePSAvalueisusuallyslightlyelevated C)Sawpalmettoisalwayseffectivein reducingsymptoms
Researchdoesnotsupportthetheorythatsawpalmettoreducesthesymptomsofbenign prostatichyperplasiainallcases.
Precociouspubertyisdefinedastheonsetofsecondarysexualcharacteristicsbeforethe ageof:
A)Age7ingirlsandage8inboys
B)Age8ingirlsandage9inboys
C)Age9ingirlsandage10inboys
D)Age9forbothgirlsandboys B)Age8ingirlsandage9inboys
Precociouspubertyisdefinedasonsetofsecondarysexualcharacteristicsbytheageof8 yearsingirlsand9yearsinboys.
AtwhatTannerstagedoespubertystart?
A)TannerStageI
B)TannerStageII
C)TannerStageIII
D)TannerStageIV B)TannerStageII
Pubertyisdefinedastheperiodinlifewhensecondarysexualcharacteristicsbeginto develop,identifiedasTannerStageIIforboysandgirls.
Orchitisiscausedbywhichofthefollowing?
A)Mumpsvirus
B)Measlesvirus
C)Chlamydiatrachomatis
D)Chronicurinarytractinfectionsthatarenottreatedadequately A)Mumpsvirus
Orchitisiscausedbythemumpsvirus.
Acuteprostatitiscanpresentwithallofthefollowingsignsandsymptomsexcept:
A)Feverandchills
B)Tendernessofthescrotumontheaffectedside
C)Perinealpain
D)Slowonsetofsymptoms D)Slowonsetofsymptoms
Acuteprostatitissymptomsincludefever,chills,tendernessofthescrotumontheaffected side,andabruptonsetofsymptoms.
411.Whichofthefollowingisthemostcommoncauseofnongonococcalurethritis?
A)Escherichiacoli
B)Chlamydiatrachomatis
C)Neisseriagonorrhoeae
D)Mycoplasma B)Chlamydiatrachomatis
ThemostcommoncauseofnongonococcalurethritisisChlamydiatrachomatis.
Whichofthefollowingisconsideredarelativecontraindicationforcombinedoral contraceptivepills?
A)Undiagnosedvaginalbleeding
B)Ahepatomaoftheliver
C)SuspectedhistoryofTIAs
D)Depression D)Depression
DepressionisarelativecontraindicationforcombinedOCPsduetothehormonaleffects thatcanaffectmood.Absolutecontraindicationsincludehepatomaoftheliver,historyof embolicepisode,historyofTIAs,andundiag nosedvaginalbleeding.OCPshouldnotbe consideredintheseinstancesduetothehighriskfactorsandhealthrisks.
Joe,a20-year-oldAsianmale,reportspaininhisrightkneeaftertwistingitplayingsoccer. Theinjuredkneelocksupwhenheattemptstostraightenhisleg.Whichofthefollowingis mostlikely?
A)Injurytothemeniscusoftherightknee
B)Injurytothepatellaoftherightknee
C)Injurytotheligamentsoftherightknee
D)Ruptureofthequadricepstendon A)Injurytothemeniscusoftherightknee
Paininthekneeaftertwistingitand"lockingup"whileattemptingtostraightenthelegis mostconsistentwithaninjurytothemeniscus.
Whichofthefollowingisthebestcourseoftreatmentforthispatient?
A)Referhimtoanorthopedicspecialist
B)Referhimtoachiropractor
C)Advisehimthattheclickingnoisewillresolvewithin2to4weeks
D)AdvisehimtouseanAcebandagewrapduringthefirst2weeksforkneesup portandtoseeyouagainforreevaluation A)Referhimtoanorthopedicspecialist
Referraltoorthopedicsisadvisedforevaluationoftheneedfortreatmentandsurgery. Delayingreferralandtreatmentcanbedetrimentalifthediagnosisisnotcorrect.
Allofthefollowingarecorrectstatementsregardingoralcontraceptivesexcept:
A)Theactualfailurerateoforalcontraceptivesis3%
B)Desogestrelbelongstotheprogesteronefamilyofdrugs
C)Thenewerlow dosebirthcontrolpillsdonotrequireback upduringthefirst2weeksof use
D)Oralcontraceptivesarecontraindicatedforwomen35yearsofageorolderwhosmoke-
C)Thenewerlow dosebirthcontrolpillsdonotrequirebackupduringthefirst2weeksof use
Low doseOCPsrequireasecondbackupmethodofcontraceptionduringthefirst2weeks ofuse.
A15-year-oldbasketballplayerwhois6fttallisseenforcomplaintsofpainfullumpson hisknees.Uponinspection,thenursepractitionernotesabonelikegrowthontheupper tibiamidlinebelowthekneecaponbothknees.Thepatienthasfullrangeofmotionwithno jointtenderness,redness,orswelling.Whichofthefollowingconditionsisbestdescribed?
A)Osteosarcomaofthetibia
B)Juvenilerheumatoidarthritis
C)Osgood Schlatterdisease
D)Paget'sdiseaseofthebone C)Osgood Schlatterdisease
Osgood Schlatterdiseaseischaracterizedbyhavingpainoverthetibialtuberositywith palpationofabonymassovertheanteriortubercleofoneorbothknees.Exerciseworsens thepain
Acauliflower likegrowthwithfoul smellingdischargeisseenduringanotoscopicexamof theleftearofan8 year oldboywithahistoryofchronicotitismedia.Notympanic membraneorossiclesarevisibleandthepatientseemstohavedifficultyhearingthenurse practitioner'sinstructions.Whichofthefollowingconditionsisbestdescribed?
A)Chronicperforationofthetympanicmembranewithsecondarybacterialinfection
B)Chronicmastoiditis
C)Cholesteatoma
D)Cancerofthemiddleea-C)Cholesteatoma
Cholesteatomaisanabnormalgrowththatoccursinthemiddleearthatcancausehearing loss.Difficultyhearingiscommon.
Sourcesoflegalriskforthenursepractitionerwouldincludeallofthefollowingexcept:
A)Invasiveprocedures
B)Electronicmedicalrecordentries
C)Prescribingmedication
D)In servicetraining D)In servicetraining
LegalrisksfortheNPincludeinvasiveprocedures,electronicmedicalrecordentries,and prescribingofmedications.Inservicetrainingdoesnotdirectlyaffectthepatient;therefore, legalrisksarenotaproblem.
Thebestformofaerobicexerciseforapatientwithsevererheumatoidarthritisis:
A)Yoga
B)Swimming
C)Ridingabicycle
D)Passiverangeofmotion A)Yoga
TheAmericanCollegeofRheumatologystatesthatexerciseisbeneficialforeveryone, includingthosewithRA,andcurrentlyrecommends150minutesofmoderate-intensity aerobicactivityeachweek.Safeformsofaerobicexercise,suchaswalking,aerobicdance, andaquaticexercise,helparthritispatientstocontrolweight,andimprovesleep,mood, andoverallhealth.
Thefirst linetreatmentconsiderationformanagingacutealcoholwithdrawaldelirium includes:
A)Intubation
B)Benzodiazepines
C)Avoidanceofphysicalrestraintstodecreaseagitation
D)Antipsychotics B)Benzodiazepines
Acutealcoholwithdrawaldeliriumismanagedwithbenzodiazepines.
A15 month oldinfantisinyourofficeforawellbabycheck.Themotherdenieshistoryof chickenpoxinfection.Whichofthefollowingimmunizationsisindicatedatthisvisit?
A)DTaP,Hib,IPV,hepatitisB
B)DTaP,Hib,PCV,IPV,MMR
C)MMR,hepatitisB,varicella
D)DTaP,IPV,MMR,varicella D)DTap,IPV,MMR,varicella
Immunizationsfora15 month oldchildincludeDTap,IPV,MMR,andvaricellavaccine.
Allofthefollowingareconsideredemancipatedminorsexcept:
A)15 year oldmalewhoismarried
B)14 year oldfemalewhoisasingleparent
C)17 year oldmalewhoisenlistedintheU.S.Army
D)13 year oldbeingtreatedforasexuallytransmitteddisease D)13 year oldbeing treatedforasexuallytransmitteddisease
Therearethreeprimarywaysforaminortobecomeemancipated:marriage,courtorder, andmilitaryservice.
Allofthefollowingfactorsarenotassociatedwithanincreasedriskofosteopeniain teenagegirlsexcept:
A)Drinkingoneglassoflow-fatmilkdaily
B)Anorexianervosa
C)Participationinsports
D)AnormalBMI(basalmetabolicindex) B)Anorexianervosa
Anorexianervosaincreasestheriskforosteopeniainteenagegirlsduetothepoorintakeof foodsthatarehighincalciumandVitaminD.
A28 year oldmalenursetellstheemployeehealthnursepractitionerthathewastreated foraUTItwicethepreviousyear.Thepatientdeniesfever,flankpain,orurethraldischarge duringthevisit.Whichofthefollowingisthebestfollow upforthispatient?
A)Referthepatienttoaurologist
B)Prescribethepatientofloxacin(Floxin)for2weeksinsteadof1week
C)Advisethepatientthatheneedstovoidevery2hourswhenawake
D)ReferthepatienttothelocalED,becausehehasaveryhighriskofsepsis A)Referthe patienttoaurologist
ItisrecommendedthatfrequentUTIsinmalesbereferredtoaurologistforevaluationand treatment.
Henry,a50 year oldmale,complainsofmarkedscalptendernessaccompaniedbyabad headacheonhislefttemple.Hereportsasuddenlossofvisioninthelefteyeforthepast severalhours.Theneurologicexamisnormalexceptforthelossofvisioninthelefteye.
Whichofthefollowingismostlikely?
A)Clusterheadache
B)Migraineheadachewithaura
C)Migraineheadachewithoutaura
D)Giantcellarteritis-D)Giantcellarteritis
Lossofvisiondoesnotoccurwithheadaches.Lossofvision,alongwithmarkedscalp tendernesswithabadheadacheonthelefttemple,aresymptomsofgiantcellarteritis. Giantcellarteritisisinflammationofthearteriesintheheadatthetemplearea,which causesthesesymptoms.
Whichofthefollowingdrugsisclassifiedasa5 alphareductaseinhibitor?
A)Terazosin(Hytrin)
B)Tamsulosin(Flomax)
C)Finasteride(Proscar)
D)Sildenafil(Viagra) C)Finasteride(Proscar)
Finasteride(Proscar)belongstothedrugclasscalled5 alphareductaseinhibitors.Ithelps tolowerserumtestosterone,whichhelpstodecreasethesizeoftheprostate.Itisalsoused formale-patternbaldness.Asmallerprostateresultsinlessobstructivevoidingsymptoms suchasweakstream,frequency,andnocturia.Bothterazosin(Hytrin)andtamsulosin (Flomax)arealpha blockersandmaystarttocontrolsymptomsinaslittleas3days.They
workbyrelaxingthesmoothmuscletissueoftheprostategland,whichenlargesthe diameteroftheurethra.
Apostmenopausalfemalecomplainsofrandomepisodesofvaginalbleedingforthepast6 months.Whichofthefollowingisrecommendedmanagementforthiscondition?
A)Cervicalbiopsy
B)Papsmear
C)Colposcopy
D)Endometrialbiopsy D)Endometrialbiopsy
Randomepisodesofvaginalbleedinginapostmenopausalwomanarenotnormal. Endometrialbiopsyisneededtobiopsytheendometrialliningforabnormalcells,which mayindicatecancer.
Whichofthefollowingisnotacharacteristicofdelirium?
A)Suddenonset
B)Patientiscoherent
C)Worseintheevenings
D)Ithasabriefduration B)Patientiscoherent
Characteristicsofdeliriumincludeanacuteanddramaticonsetofsymptomsthatis temporary,andusuallywillworsenintheevening.Maylasthourstodays.Patientis incoherentanddisoriented.Usuallybroughtonbyfever,shock,drugs,alcohol,or dehydration.
Thesignsandsymptomsofdementiamayincludeallofthefollowingexcept:
A)Personalitychanges
B)Difficultyinverbalizing
C)Difficultyinrecognizingfamiliarobjects
D)Abstractthinkingabilityisincreased D)Abstractthinkingabilityisincreased
Characteristicsofdementiaincludeirreversiblesymptomswithagradualonset.Short termmemorylossisanearlysignofdementia.Assymptomsprogress,thepatientmay becomeincoherent,unabletotalk,walk,feedself,orperformself care.
A4 year oldboyisbroughtinbyhismotherforawellnessvisit.Hismothertellsthefamily nursepractitionerthathehadabadcaseofchickenpox1yearago.Whichofthefollowing immunizationsareindicated?
A)IPV,Hib(hemophilusinfluenzaetypeB),hepatitisB
B)IPV,Hib,MMR
C)DTaP,IPV,MMR,hepatitisB
D)DTaP,IPV D)DTaP,IPV
DTapandIPVwouldbedueforthis4 year oldchild.
Youareperformingapelvicexamona25-year-oldsexuallyactivewoman.Youpalpatea tenderandwarmcysticmassontheloweredgeoftheleftlabiamajora,whichisred.The mostlikelydiagnosisis:
A)Skene'sglandcyst
B)Cystocele
C)Lymphogranulomavenereum
D)Bartholin'sglandabscess D)Bartholin'sglandabscess
Bartholin'sglandsarelocatedinthebaseofthelabiaminoraataboutthe4o'clockand8 o'clockpositions.Theirfunctionistoprovidemoistureforthevestibule.Theyaresmall (aboutpeasized)unlesstheybecomecloggedorinfected.Ifglandsbecomecloggedor infected,anabscessmayformandglandswillenlargeandbecomepainful.
MaryWalkerisa16 year oldwhopresentsintheclinicforaphysicalexam.Shetellsthe triagenursethatshewouldlikecontraceptionaswell.Howshouldthenursepractitioner proceed?
A)Refusetoseethepatientuntilconsentcanbeobtainedfromherparentorlegalguardian
B)Performaphysicalexamanddiscusscontraceptiveoptions
C)Speakwiththepatientaboutcontraceptionandhaveherobtainparentalconsentforthe physicalexam
D)Havethenursediscusscontraceptionwiththepatient C)Speakwiththepatientabout contraceptionandhaveherobtainparentalconsentforthephysicalexam
IntheUnitedStates,statelawsandpoliciesmayvaryregardingcontraceptivecounseling andtreatmentforanyoneundertheageof18years.Itisrequiredthatyoubefamiliarwith thestatelaws.Inallstates,anyoneundertheageof18yearsmusthaveparentalconsent forthephysicalexam.
Apatientdiagnosedwithbacterialvaginosisshouldbeadvisedthathersexualpartnerbe treatedwith:
A)Ceftriaxone(Rocephin)250mgIMwithdoxycycline100mgBIDfor14days
B)Metronidazole(Flagyl)500mgPOBIDfor7daysand1doseofazithromycin (Zithromax)
C)Herpartnerdoesnotneedtreatment
D)Clotrimazolecream(Lotrimin)onhispenisBIDfor1to2weeks-C)Herpartnerdoes notneedtreatment
Bacterialvaginosisisabacterialinfection,butisnotconsideredanSTDforwhichthe partnerneedstreatment.Studiesshowthatmenrarelycarrythisinfection.
Allofthefollowingarecorrectstatementsregardingphysiologicchangesfoundinthe elderlywiththeexceptionof:
A)Thereisanincreaseinthefat to leanbodyratio
B)Thereisadecreaseintheabilityofthelivertometabolizedrugs
C)Thereisanincreaseinrenalfunction
D)Lossofhearingforsoundsinthehigh frequencyrange(presbycusis) C)Thereisan increaseinrenalfunction
Physiologicalchangesintheelderlyincludeincreaseinthefat to leanbodyratio,decrease intheabilityofthelivertometabolizedrugs,lossofhearingforsoundsinthehighfrequencyrange,andadecreaseinrenalfunction.
ThefollowingclinicalsignsareseeninParkinson'sdiseaseexcept:
A)Pill rollingtremor
B)Difficultyinitiatinginvoluntarymovement
C)Shufflinggaitwithcogwheelrigidity
D)Increasedfacialmovementsduetotics D)Increasedfacialmovementsduetotics
ClinicalsignsofParkinson'sdis easeincludepill rollingtremors,difficultyinitiating involuntarymovements,andshufflinggaitwithcogwheelrigidity.Facialmovement decreasesandisknownasgeneralizedrigiditywithmaskedfacies.
Whichofthefollowingconditionsisapossiblecomplicationofsevereeclampsia?
A)Placentaprevia
B)Placentaabruptio
C)Erythroblastosisfetalis
D)Uterinerupture B)Placentaabruptio
Abruptioplacentaisapossiblecomplicationofsevereeclampsia.Withelevatedblood pressure,theplacentacanpullawayfromtheuterineliningandcausepainful,brightred bleeding.
ApossiblecomplicationfromBell'spalsyis:
A)Cornealulceration
B)Acuteglaucoma
C)Inabilitytoswallow
D)Lossofsensationintheaffectedside A)Cornealulceration
Duetotheparalysiscausedbytheseventhcranialnervedamage,theeyelidontheaffected sidemaynotclosevoluntarily.Thisleadstodryness,whichcaninturnresultinulceration.
Whichofthefollowingismostlikelytocausedelirium?
A)Dehydration
B)Multiplebraininfarcts
C)Malnutrition
D)Acuteinfection D)Acuteinfection
Deliriumisanacutedeclineinmentalstatusandistemporary.Commoncausesarefever, shock,drugs,alcohol,severedehydration,andacuteinfection.
A25-year-oldfemalepresentswithanonsetofsevereright-sidedpelvicpainforthepast 48hours.Shereportssmallamountsofvaginalbleeding.Thepainisaggravatedbyjumping oranymovementthatjarsherpelvis.Thebestinitialinterventioniswhichofthe following?
A)Follicle stimulatinghormone(FSH)
B)Serumquantitativepregnancytest
C)Pelvicultrasound
D)CBCwithwhitecelldifferentials B)Serumquantitativepregnancytest
Severeright sidedpainwithvaginalbleedingina25 year oldpatientrequiresan evaluationforpregnancy,byperformingaserumquantitativepregnancytest.Ectopic pregnancyand/ormiscarriageshouldberuledout.
Whichofthefollowinglaboratoryvaluesmaybefoundelevatedaloneontheliverfunction panelofpatientswhoarealcoholabusers?
A)SerumGGT(gammaglutamyltransaminase)
B)SerumALT(alanineaminotransferase)
C)Serumbilirubin
D)Bloodureanitrogen A)SerumGGT(gammaglutamyltransaminase)
Theserumgammaglutamyltransaminasealonewillbeelevatedwithalcoholabusers.
WhichofthefollowingeffectsisseenineverywomanusingDepo Provera (medroxyprogesteroneinjection)formorethan5years?
A)Melasma
B)Amenorrhea
C)Weightloss
D)Headaches-B)Amenorrhea
OnecommonsideeffectseeninwomenwhohavebeentakingDepo Proveraformorethan 5yearsisamenorrhea.Itisaprogesteronehormonethatcausescessationofperiods.
Thefollowingaretreatmentplansrelatedtomigraineheadaches.Whichoneofthe followingwouldnotbeconsideredeffectivetherapy?
A)Propranolol(Inderal)
B)Coldpackstotheforehead
C)Trimethobenzamide(Tigan)
D)Moderatesodiumrestriction
D)Moderatesodiumrestriction
Effectivetreatmentsformigraineheadachesincludepropranolol,trimethobenzamide,cold packstotheforehead/neck,andhydration.
Precociouspubertyisdefinedas:
A)Onsetofpubertybeforeage8ingirlsandage9inboys
B)Onsetofpubertybeforeage9ingirlsandage10inboys
C)Onsetofpubertybeforeage10ingirlsandage11inboys
D)Onsetofpubertyatanearlieragethanthechild'sparent(s) A)Onsetofpubertybefore age8ingirlsandage9inboys
Thedefinitionofprecociouspubertyistheonsetofpubertybeforeage8ingirlsandage9 inboys.
A19 year oldmaleathletecomplainsofacutekneepainafterafootballgame.Thenurse practitionerelicitsMcMurray'ssign,whichispositiveonthepatient'sinjuredknee.Thisis atestfor:
A)Meniscalinjury
B)Inflammationofthekneejoint
C)Osteophytesofthekneejoint
D)Tenosynovitis A)Meniscalinjury
Withanacutekneeinjury,thekneeshouldbeassessedusingMcMurray'ssign.Apositive McMurray'ssignindicatesameniscalinjury.Inflammationoftheknee,osteophytes,and tenosynovitiswouldnotelicitapositiveMcMurray'ssign.
A35 year oldmalehasahistoryofanupperrespiratoryviralinfection4weeksago.He reportsthathestartedfeelingshortofbreathandnowcomplainsofsharppaininthe middleofhischestthatseemstoworsenwhenheliesdown.Thepatient'sphysicalexamis withinnormallimitswiththeexceptionofaprecordialrubonauscultation.Themostlikely diagnosiswouldbe:
A)Pulmonaryembolism
B)Dissectinganeurysm
C)Pericarditis
Pericarditisisinflammationofthesacaroundtheheart.Commonsigns/symptomsinclude chestpainoverthecenter/leftsideofthechest;shortnessofbreath,especiallywithlying down;low gradefever;weakness;fatigue;drycough;andabdominalorlegswelling. Pericardialrubmaybeauscultated.
Whichtypeofexercisewouldyourecommendtoa65 year oldarthriticpatientwho complainsofanewonsetofapainful,swollenleftkneecausedbygardeningfor2days?
A)Quadriceps strengtheningexercisesoftheleftkneefollowedbytheapplicationofcold packsfor20minutes4timesaday
B)Restthejointandapplycoldpacksintermittentlyforthenext48hours
C)Passiverangeofmotionandcoldpacks
D)Acooltubbathwithwarmpacksonthekneetoavoidstiffeningofthejoint B)Restthe jointandapplycoldpacksintermittentlyforthenext48hours
Newonsetofapainful,swollenleftkneecausedbyunusualactivityshouldbetreatedwith restandalternatingicepackstoruleoutothercausesofpainfirst
Symptomssuggestiveofulcerativecolitisincludeallofthefollowingexcept:
A)Bloodydiarrheamixedwithmucus
B)Nauseaandvomiting
C)Weightgain
D)Abdominalpain-C)Weightgain
Symptomsofulcerativecolitisincludesbloodydiarrheamixedwithmucus, nausea/vomiting,abdominalpain,andpossibleweightlosswithlong termdiarrhea
Peakexpiratoryflow(PEF)metersareusedtomonitorasthmabyusingpersonalbest measurements.AllofthefollowingfactorsareusedtodeterminethePEFexcept:
A)Age
B)Gender
C)Height
D)Weight D)Weight
Peakexpiratoryflowvolumeisdeterminedbyusingheight,gender,andage.Weightisnot usedintheformula.
Ared,raisedserpiginous shapedrashisnotedbythenursepractitionerontherightfootof a4-year-oldchildbroughtinforapreschoolphysicalbythemother.Thechildcomplainsof severeitchandkeepsscratchingthelesion.Themotherreportsthatthechildfrequently playedintheyardwithoutshoesorsandalson.Whichofthefollowingismostlikely?
A)Larvamigrans
B)Erythemamigrans
C)Tineapedis
D)Insectbites-A)Larvamigrans
Larvamigransaffectstheintestinesofdogs/catsandiscausedbytheeggsofparasites (worms)fromtheanimals'intestine.Childrenareathighriskofdevelopingthisifthey comeincontactwithdirtthatiscontaminatedwithdog/catfeces.Eatingfoodsthatare grownincontaminatedsoiland/orrawliverareothermeansoftransferoftheinfection. Aftertheeggshatch,theparasitecanmigratetootherorgansofthebodyifleftuntreated
AllofthefollowingareconsideredriskfactorsforUTIsinwomenexcept:
A)Diabetesmellitus
B)Diaphragmsandspermicideuse
C)Pregnancy
D)Intrauterinedevice-D)Intrauterinedevice
RiskfactorsforUTIsincludediabetesmellitus,pregnancy,anduseofdiaphragmsand spermicide.
Thesentinelnodes(Virchow'snodes)arefoundatthe:
A)Rightaxillaryarea
B)Leftsupraclaviculararea
C)Posteriorcervicalchain
D)Submandibularchain B)Leftsupraclaviculararea
Thesentinelnodesarefoundatthesupraclavicularareaofthechest.Theyarethefirst lymphnodesthatacancerlesionwilldraininto.Therefore,whencancerisdiagnosed, thesenodesarebiopsiedtoseeifthecancerhasspreadintothelymphsystem.
PeteJ.,a20 year oldWhitemale,isbeingseenforaphysicalexambythenurse practitioner.Hecomplainsofpruriticmaceratedareasinhisgroinforthepast2weeks. Whichofthefollowingisthemostlikely?
A)Tineacruris
B)Tineacorporis
C)Tineacapitis
D)Tineapedis A)Tineacruris
Tineacrurisisafungalinfectionfoundinthegroinarea.Tineacorporisinvolvesthebody, tineacapitisinvolvesthehead,andtineapedisinvolvesthefeet.
Clusterheadachesaremostoftenseenin:
A)Adolescentfemales
B)Middle agedmen
C)Elderlymen
D)Postmenopausalwomen-B)Middle-agedmen
Clusterheadachesaremostcommonlyseeninmiddle agedmen.
An18 year oldmaleisfoundtohavea47,XXYkaryotypeandisdiagnosedwith Klinefelter'ssyndrome.Thepatientismostlikelytohaveallofthefollowingphysical characteristicsexcept:
A)Gynecomastia
B)Longlimbs
C)Lackofsecondarysexualcharacteristics
D)Largetestes D)Largetestes
Signs/symptomsofKlinefelter'ssyndromeincludegynecomastia,longlimbs,andlackof secondarysexualcharacteristics.Testesareusuallysmall.Infertilityisamajorconcernfor theseboys.Iftreatedearly,theymayhaveanormalsexual/reproductivesysteminthe future.
Whichofthefollowingdrugscanincreasetheriskofbleedinginpatientswhoareon anticoagulationtherapywithwarfarinsodium(Coumadin)?
A)Trimethoprim/sulfamethoxazole(BactrimDS)
B)Carafate(Sucralfate)
C)Losartan(Cozaar)
D)Furosemide(Lasix) A)Trimethoprim/sulfamethoxazole(BactrimDS)
CoumadininteractswithBactrimandwillincreasetheriskofbleeding;therefore,itis contraindicated.
Whenanadolescentfemale'sareolaandnippleselevateabovethelevelofthebreaststo formasecondarymound,whichofthefollowingisthecorrectTannerstageforthisphase ofbreastdevelopment?
A)TannerStageI
B)TannerStageII
C)TannerStageIII
D)TannerStageIV D)TannerStageIV
AtTannerStageIV,thebreasttissueisstillgrowing.Thisisthestageinwhichtheareola andthenippleseparatetoformadistinctmound.Themostimportantclueis"secondary mound."DuringTannerStageIII,thebreastandareolaandnipplesgrowtogetherinone mound.Thereisnoseparationyet.
Aboutone thirdofchildrenintheUnitedStatesareconsideredobese.Whichofthe followingmethodsareappropriateinterventionsforobeseschool agedchildren?
A)Severerestrictionofdietarycarbohydrates
B)Increasephysicalactivityandoutdoorplay
C)Prescribeappetitesuppressants
D)Over the counterherbalweight losspills B)Increasephysicalactivityandoutdoor play
Lifestylechangessuchasincreasingphysicalactivityandspendingmoretimeoutdoorsare appropriaterecommendationsforchildren.Considerreferraltoaregistereddieticianfor dietaryrecommendationsandcounseling.Participationinanexerciseprogramdesigned forchildren(ifavailable)isalsoappropriate.Severecaloricand/orcarbohydrate restrictionisnotrecommendedforthisagegroup.
Thecremastericreflexiselicitedby:
A)Askingthepatienttoopenhisorhermouthandtouchingthebackofthepharynxwitha tongueblade
B)Hittingthebicepstendonbrisklywithareflexhammerandwatchingthelowerarmfor movement
C)Hittingthepatellartendonbrisklywithareflexhammerandwatchingthelowerlegfor movement
D)Strokingtheinnerthighofamaleclientandwatchingthetesticleontheipsilateralside riseuptowardthebody D)Strokingtheinnerthighofamaleclientandwatchingthe testicleontheipsilateralsideriseuptowardthebody
Thecremastericreflextestisdonebystrokingtheinnerthighofamaleclientandwatching forthetesticleontheipsi-lateralsidetoriseuptowardthebody.
YouhavediagnosedTomJ.,a30 year oldmale,withcontactdermatitisontheleftsideof thefacesecondarytopoisonivy.Youwouldrecommend:
A)WashingwithantibacterialsoapBIDtoreduceriskofsecondarybacterialinfectionuntil itishealed
B)Hydrocortisonecream1%BIDuntilitishealed
C)Clotrimazole(Lotrimin)creamBIDfor2weeks
D)Halcinonide(Halog)1%ointmentBIDfor2weeks-B)Hydrocortisonecream1%BID untilitishealed
TreatmentforcontactdermatitisincludesusingasteroidcreamBIDuntilhealed.
Pulsusparadoxusisbestdescribedas:
A)Anincreaseinsystolicbloodpressureoninspiration
B)Adecreaseindiastolicbloodpressureonexhalation
C)Adecreaseinsystolicbloodpressureoninspiration
D)Anincreaseindiastolicbloodpressureonexpiration
C)Adecreaseinsystolicblood pressureoninspiration
Pulsusparadoxus:Withinspiration,systolicpressuredropsduetotheincreasedpressure (positivepres sure).Somepulmonaryrisksofhavingincreasedpressureincludeasthma andemphysema
A10 year oldboycomplainsofasuddenonsetofscrotalpainwhenhewokeupthat morning.Heisalsocomplainingofseverenauseaandvomiting.Duringthephysical examination,thenursepractitionerfindsatender,warm,andswollenleftscrotum.The cremastericreflexisnegativeandtheurinedipstickisnegativeforleukocytes,nitrites,and blood.Themostlikelydiagnosisis:
A)Acuteepididymitis
B)Aseveresalmonellainfection
C)Testiculartorsion
D)Acuteorchitis C)Testiculartorsion
Testiculartorsionsignsandsymptomsincludesuddenonsetofunilateralscrotalpain, nausea,vomiting,andabdominalpain.Acuteepididymitiscausesfever,chills,nausea,and unilateralpainandismostcom monlyseeninsexuallyactivemen.Unilateralscrotalpain doesnotoccurwithSalmonellainfection.Acuteorchitisisoftenbasedonhavingarecent mumpsinfec-tionorparotitiswithtesticularedema.
Whattypeoffollow upshouldthispatientreceive?
A)Referhimwithin48hourstoaurologist
B)Referhimtotheemergencydepartmentassoonaspossible
C)Prescribeibuprofen(Advil)600mgQIDforpain
D)Orderatesticularultrasoundforfurtherevaluation
B)Referhimtotheemergency departmentassoonaspossible
Immediatereferraltotheemergencydepartmentisrequired.Successoftreatmentis usually100%iftreatedwithinthefirst6hoursand0%iftreatedafter24hours.
Whichofthefollowingconditionsarepossiblecausesofsecondaryhypertension?
A)Leukemiaandthalassemiamajor
B)Hashimoto'sthyroiditisandpolycysticovaries
C)Renalstenosisandadrenaltumors
Secondaryhypertensionismostlikelyseenfollowingrenalstenosisandadrenaltumors. Renalstenosiscausessecondaryhypertensionbyplaqueformationinthearteries,causing damagetocoronaryarteries(atherosclerosis).Adrenaltumorswillinitiatesecondary hypertensionbyreleasingalargeamountofaldosterone,whichwillcausewaterandsalt retentionandlossoftoomuchpotassium.
Whatcholesterollevelisclassifiedasborderline?
A)180to199mg/dL
B)200to239mg/dL
C)>240mg/dL
D)>300mg/dL B)200to239mg/dL
Totalcholesterollevelsshouldbe<200.Thelevels200 239wouldbethebestanswer.
Younotethatyour11 year oldfemalepatientisatTannerStageII.Youwouldadviseher motherthatmenarchewillprobablystartin:
A)1to2years
B)2.5to3years
C)4years
D)Itisdependentonthegirl'sgeneticmakeup-A)1to2years
Menarchenormallybeginsapproximately1 2yearsfollowingTannerStageII.Averageage is11.8yearsold.
Allofthefollowingdonotrequireparentalconsenttobeobtainedbythenurse practitionerexcept:
A)A17 year oldwhowantstobetreatedforasexuallytransmittedinfection
B)A12 year oldwhowantsaserumpregnancytest
C)A15 year oldwhowantsbirthcontrolpills
D)A14 year oldwhowantstobetreatedfordysmenorrhea D)A14 year oldwhowants tobetreatedfordysmenorrhea
Treatmentforteenagersmaybedonewithoutparentalconsentforsexuallytransmitted infections,pregnancytesting,contraceptioncounselingandtreatment.Parentalconsentis requiredforanytypeofphysicalexamforotherproblems
Thereisahigherriskofbalanitisinwhichofthefollowingconditions?
A)Renalinsufficiency
B)Diabetesmellitus
C)Graves'disease
D)Asthma B)Diabetesmellitus
Balanitisisanyeastinfectionoftheglansofthepenis.Menwhoarenotcircumcisedand whohavediabetesmellitusareathigherriskfordevelopingbalanitis.
Whichofthefollowingisusefulintheprimarycareareawhenevaluatingapatientfor possibleacutesinusitisorhydrocele?
A)Checkingforthecremastericreflex
B)Transillumination
C)Ultrasound
D)CTscan-B)Transillumination
Transilliuminationisatechniqueusedwithalightsource,suchastheotoscope,tovisualize fluidbelowtheskinsurface,whichwillappearasa"glow."UltrasoundandCTscanarenot readilyavailableintheprimarycaresetting;thepatientmustbesenttoradiologyforthese teststobeperformed
Allofthefollowingareassociatedwithemphysemaexcept:
A)Abarrel shapedchest
B)Pursed lipbreathing
C)Achestradiographresultwithinfiltratesandflatteningofthecostovertebralangle
D)Dyspneawhenatrest-C)Achestradiographresultwithinfiltratesandflatteningofthe costovertebralangle
Emphysemaischaracterizedbyhavingabarrel shapedchest,pursed lipbreathing,and dyspneawhenatrest.Infiltratesonanx rayindicatebacterialinfection,suchaspneumonia
AsplitS2isbestheardatwhichofthefollowingareas?
A)Theaorticarea
B)Thepulmonicarea
C)Thetricuspidarea
D)Themitralarea B)Thepulmonicarea
ThesplitS2isbestheardatthepulmonicareaoftheheart.
Balanitisiscausedby:
A)Staphyloccocusaureus
B)Streptococcuspyogenes
C)Candidaalbicans
D)Trichomonads C)Candidaalbicans
Balanitisisanyeastinfectionoftheglansofthepenis.Candidaalbicansisthecausative source.StaphyloccocusaureusandStreptococcuspyogenesarebacterialinfections. Trichomonadsareprotozoansthatcauseinfection.
A22 year oldmaleisbroughttoanurgentcarecenterbyhisanxiousmother.Shereports thathersonreturnedfromacampingtrip2daysagowithahighfeverandbadheadache. Apparently,thepatienthadcomplainedtoherofapainfulandstiffneckalongwithnausea shortlyafterhearrived.Accordingtothemother,hersonstartedbreakingoutinarashthe daybefore,someofwhichisturningadarkredtopurplecolor.Duringthephysicalexam, thenursepractitionerevaluatesthepatientforKernig'ssign,whichispositive.Whichof thefollowingconditionsismostlikely?
A)Stevens Johnsonsyndrome
B)Meningococcemia
C)RockyMountainspottedfever
D)Erythemamultiforme B)Meningococcemia
Kernig'smaneuverisperformedbyflexingbothhipsandlegsandhavingthepatient straightenthelegsagainstresistance,testingformen-ingitis.Apositivetestindicates meningitis.Othercharacteristicsofmeningitisincludehighfever,headache,stiffneck,and nausea/vomiting.
Yournewlydiagnoseddiabeticpatientreportstoyouthatshehadseverehivesandswollen lipswhenshetookBactrimforabladderinfection2monthsago.Whichofthefollowing statementsiscorrect?
A)Shecannottakeanypillsinthesulfonylureaclass
B)Shecantakesomeofthepillsinthesulfonylureaclass
C)Shecantakeanyofthepillsinthesulfonylureaclass
D)Noneoftheabove A)ShecannottakeanypillsinthesulfonylureaclassIfanallergic reactionoccurswith
Bactrim,thepatientmustnottakeanymedicationsinthesulfonylureaclass.
Whichofthefollowingisresponsibleforthesymptomsofdysmenorrhea?
A)Estrogen
B)Humanchorionicgonadotropin
Prostaglandinsarehormonesthebodyproducespriortomenses;theyeventuallycausethe uterustocontracttoshedtheendometriallining.Contractionscausepain.Thegreaterthe amountofprostaglandinsthatarereleased,themorepainonewillexperience. Contractionsoftheuteruscausevasoconstrictionofbloodsupplytotheuterus,whichin turnwillcausepain.
Whichofthefollowingtestswouldyouorderforanolderdiabeticmalewiththefollowing CBCresults?Hb11g/dL,Hct38%,andanMCV105fl.Hisreticulocytecountisnormal.
A)Serumferritinandaperipheralsmear
B)Hemoglobinelectrophoresis
C)SerumfolateacidandB12level
D)Schillingtest C)SerumfolateacidandB12level
SerumfolateacidandB12levelswouldbeorderedtoevaluatehimforfolicaciddeficiency anemia.ManypatientswhoaredeficientinfolicacidarealsodeficientinB12.
Auscultationofnormalbreathsoundsofthechestwillreveal:
A)Bronchialbreathsoundsheardatthelowerbases
B)High pitchedvesicularbreathsoundsheardovertheupperlobes
C)Vesicularbreathsoundsheardoverthetrachea
D)Vesicularbreathsoundsinthelowerlobe D)Vesicularbreathsoundsinthelowerlobe
Normalsoundsofthechestwallincludevesicularbreathsoundsinthelowerlobes. Bronchialbreathsoundsareheardbestatthesecondandthirdintercostalspaces.Tracheal breathsoundsareheardoverthetrachea.
Thebellofthestethoscopeisbestusedforauscultationofwhichofthefollowing?
A)S3andS4andlow pitchedtones
B)S3andS4only
C)S1andS2andhigh pitchedtones
D)S1andS2only-A)S3andS4andlow-pitchedtones
ThebellofthestethoscopeisusedtoauscultatetheS3,S4,andlow pitcehdtones. Remembertheword"below"(Bell-Low).
Whichofthefollowingisthebestmethodfordiagnosingcandidiasisintheprimarycare setting?
A)Wetsmear
B)Tzancksmear
C)KOH(potassiumhydroxide)smear
D)Clinicalfindingsonly A)Wetsmear
Thewetprepsmearisbestusedtodiagnosecandidiasisintheprimarycaresetting.To performthewetprep,thevaginalsmearisplacedonaslide,thenadropofsalinesolution isapplied.OrganismsviewedunderthemicroscopecanincludeWBCs,cluecells,bacteria, yeastcells,andtrichomonads.
Duringasportsphysicalofa14 year oldfemale,younoteherbreastdevelopment.The areolaandthebreasttissueareallinonemound.InwhichTannerstageisthispatient?
A)TannerStageI
B)TannerStageII
C)TannerStageIII
D)TannerStageIV C)TannerStageIII
Tannerstagesforbreastdevelopment:I,prepuberty;II,breastbud;III,breastandareola onemound;IV,breastandareolasecondarymound;V,adultpattern.
A13-year-oldboywantstobetreatedforhisacne.Hehasalargenumberofclosedand opencomedonesonhisface.ThepatienthasbeentreatinghimselfwithOTCbenzoyl peroxideandsalicylicacidtopicalproducts.Whichofthefollowingwouldberecommended next?
A)Retinoicacid(Accutane)
B)Tetracycline
C)RetinA0.25%gel
D)Washfacecarefullywithmedicatedsoapatbedtime
C)RetinA0.25%gel
Topicalagentsarethefirst linetreatmentforacnevulgaris.RetinA0.25%gelwouldbethe nextstep.Oralpreparationswouldthenbeofferedforthenextstep(tetracycline),and Accutanewouldbethefinalstepoftherapy.
TheRombergtestisdonetocheckforproblemswithbalance.Whichareaofthebrainis responsibleforbalance?
A)Frontallobe
B)Temporallobe
C)Themidbrain
D)Thecerebellum D)Thecerebellum
TheRombergtestevaluatesthecerebellum,whichisresponsibleforbalance.Thistestis performedbyhavingtheclientstandupstraightwithfeettogetherandthenhaving him/herclosetheeyesandstandstillforatleast20seconds.ApositiveRombergexam woulddemonstratelossofbalance.
Allofthefollowingvaccinesarecontraindicatedinpregnantwomenexcept:
A)Influenza
B)Mumps
C)Varicella
D)Rubella-A)Influenza
Influenzavaccineisrecommendedforallpregnantpatientsforprevention,duetothe decreaseinimmunestatusduringpregnancy.Thevaccineissafetouseduringpregnancy. Theothervaccinesarelivevirusesandarecontraindicatedduringpregnancy.
Femaleswithpolycysticovariansyndromeareathigherriskfor:
A)Heartdiseaseandbreastcancer
B)Uterinefibroidsandovariancancer
C)Prematuremenopause
D)PID(pelvicinflammatorydisease) A)Heartdiseaseandbreastcancer
FemaleswithPCOSareathigherriskofdevelopingheartdisease,stroke,andbreastcancer.
A16-year-oldcomplainsofaseveresorethroatfor3daysalongwithageneralizedrash andfever.Theskinhasthetextureoffinesandpaper.Thisbestdescribes:
A)Kawasaki'sdisease
B)Scarletfever
C)Germanmeasles
D)Rubeola B)Scarletfever
ScarletfeverisabacterialinfectioncausedbythegroupAStreptococcusinfection.The patientwillexhibitsorethroat,highfever,andafinesandpaperrash,whichis characteristicofscarletfever.
Acollegefreshmanwhoisonoralcontraceptivescallsthenursepractitioner'sofficeasking foradvice.Sheforgottotakeherpills2daysinarowduringthesecondweekofthepill cycleandwantstoknowwhattodo.Whatisthebestadvice?
A)Startanewpackofpillsanddisposeoftheoldone
B)Take2pillstodayand2pillsthenextday;usecondomsfortherestofthecycle
C)Stoptakingthepillsrightawayandstartanewpillcyclein2weeks
D)Take1pillnowand2pillsthenextdayandusecondoms B)Take2pillstodayand2 pillsthenextday;usecondomsfortherestofthecycle
Whenforgettingtotakethebirthcontrolpillon2consecutivedays,itisrecommendedthat shetake2pillstodayand2pillstomorrow,thencontinuetherestofherpack.Stressthe importanceoftheuseofcondomsforprotectionagainstpregnancyandSTIs.
Allofthefollowingpatientsshouldbescreenedfordiabetesmellitusexcept:
A)AnobesemanofHispanicdescent
B)Anoverweightmiddle agedBlackwomanwhosemotherhastype2diabetes
C)Awomanwhodeliveredaninfantweighing9.5lb
D)A30 year oldWhitemanwithhypertension D)A30 year oldWhitemanwith hypertension
The30 year oldWhitemanwithhypertensionwouldbethelastpatienttobescreenedfor diabetes.Nothavinganyinformationabouthimalsoputshimloweronthelist.Obesity, ethnicity(Hispanic/LatinoAmericans,AfricanAmericans,NativeAmericans,Asian Americans,PacificIslanders,andAlaskanatives),familyhistoryofdiabetes,andgestational diabetes(motheroftheinfantweighing9.5lbs)areallriskfactors.Thesewerepresentin alloftheotherselections.Otherriskfactorsfordiabetesincludeimpairedglucose tolerancetest,sedentarylifestyle,PCOS,andhypertension.
A40 year oldnursecomplainsofanewonsetofbackpainsecondarytoherjobonthe medical surgicalfloorofahospital.Shereportsliftingsomeobesepatientswhileworking thepreviousnightshift.Shereportstotheworker'scompensationclinicwhereshewas referred.Shedescribesthepainasstartinginherrightbut-tocksareaandradiatingdown thebackofherthigh.Itbecomesworsewhenshesitsdownforlongperiods.Youwould suspect:
A)Sciatica
B)Acutemusclespasm
C)Caudaequinasyndrome
D)Acutemusclestrain A)Sciatica
Sciaticaisdefinedaspainthatbeginsinthebuttockareaandradiatesdownoneleg.Other symptomsincludeweaknessandtinglingsensation.Acutemusclespasmandstraindonot causetinglingdowntheleg.Caudaequinasyndromeisanemergentissue,inwhichthereis neurologicalinvolvementandpatientcomplaintsofweaknessandlossofbladderand bowelcontrol.
Asexuallyactive22 year oldmanisaskingtobescreenedforhepatitisBbecausehisnew girlfriendhasrecentlybeendiagnosedwithhepatitisBinfection.Hislabresultsarethe following:anti HBVisnegative,HBsAgispositive,andHBeAgisnegative.Whichofthe followingisindicated?
A)ThepatientisimmunetothehepatitisBvirus
B)ThepatientisnotinfectedwithhepatitisBvirus
C)ThepatientneedshepatitisBvaccineandhepatitisBimmunoglobulin
D)ThepatientneedsonlyhepatitisBimmunoglobulin C)ThepatientneedshepatitisB vaccineandhepatitisBimmunoglobu lin
BecauseheisHBsAgpositive,andanti-HBVnegativeandHBeAgnegative,heneeds hepatitisBimmunoglobulinandhepatitisBvaccine.
Threeofthefollowingareeyefindingsassociatedwithchronicuncontrolledhypertension. Whichoneofthefollowingisassociatedwithdiabeticretinopathy?
A)AVnicking
B)Copperwirearterioles
C)Flamehemorrhages
D)Microaneurysms D)Microaneurysms
Microaneurysmsareseenwithdiabeticretinopathy.AVnicking,copperwirearterioles, andflamehemorrhagesareseenwithuncontrolledhypertension.
YouwouldadviseapatientwhoisonaMAOI(monoamineoxidaseinhibitor)prescription toavoidtakingoneofthefollowingdrugsbecauseofincreasedpotentialforaserious reaction.Whichofthefollowingisthisdrug?
A)Alprazolam(Xanax)
B)Fluoxetine(Prozac)
C)Erythromycin(E mycin)
D)Amoxicillin(Amoxil) B)Fluoxetine(Prozac)
PatientstakingMAOIsshouldnotalsotakeSSRIs(Prozac),duetothepossibilityof developingserotoninsyndrome.Thiscausesexcessiveserotoninreleaseinthebrain,which willcausesymptomsofsevereanx-iety,restlessness,confusion,andmuscletwitching.If notstopped,thepatientmaydevelopmusclecontractions,renalfailure,respiratoryfailure, coma,andevendeath.
Inthemajorityofchildren,thefirstpermanentteethstarttoeruptattheageof6years. Whichofthefollowingarethefirstpermanentteethtoeruptinthistimeperiod?
A)Firstmolars
B)Secondmolars
C)Lowerorupperincisors
D)Canines A)Firstmolars
Thefirstmolarsarethefirstpermanentteethtodevelop;theyappearatapproximately6 yearsofage
Whichofthefollowingpathogenicbacteriaarecommonlyfoundinthelungsofolder childrenandadultswithcysticfibrosis?
A)Streptoccocuspneumoniae
B)Chlamydiapneumoniae
C)Pseudomonasaeruginosa
D)Staphylococcusaureus C)Pseudomonasaeruginosa
Pseudomonasaeruginosaisacommonchroniclunginfectionseeninolderchildrenand adultswithcysticfibrosis.Thisinfectionisdifficulttogetridofandsometimesisthecause ofdeath.
Allofthefollowingarephysiologicchangesthatoccurinthebodyasweageexcept:
A)Thehalf lifeofsomedrugsisprolonged
B)Thereisanincreaseincholesterolproductionbytheliver
C)Thereisamildincreaseinrenalfunction
D)Thereisaslightdecreaseintheactivityoftheimmunesystem C)Thereisamild increaseinrenalfunction
Physiologicchangesthatoccurintheelderlyincludedecreaseinrenalfunction,increased half lifeofsomemedica tions,increaseincholesterolproductionbytheliver,andslight decreaseintheimmunesystem.
A15 month oldchildwhoiseatingandbehavingnormallyisfoundtohaveahighfever. Afterafewdays,thefeverresolvesandtheinfantbreaksoutinamaculopapularrash.This isadescriptionofwhichofthefollowingconditions?
A)Erythemainfectiosum
B)Roseolainfantum
C)Fifthdisease
D)Scarletfever-B)Roseolainfantum
Thesigns/symptomsofroseolainfantumincludehighfeverforafewdayswitha maculopapularrashoccuringafterthefeverbreaks.Fifthdiseaseisalacy appearingrash thatusuallybeginsonthefaceandmovestotheextremitiesandtrunk.Itisknownbythe "slappedcheek"appearanceatonset.ErythemainfectiosumisthesameasFifthdisease. Scarletfeverisaredrashthatfeelslikesandpaperthatusuallybeginsontheneckand
trunkandspreadstotheextremities.Patientswillhaveothersymptomssuchasfever,sore throat,andbeefyredtongue.ThisiscausedbytheGroupAStreptococcusbacterium.
Whichofthefollowingconditionsisassociatedwiththreestagesofrashes?
A)Fifthdisease
B)Erythemainfectiosum
C)Varicella
D)RockyMountainspottedfever A)Fifthdisease
Fifthdiseasehasthreestages:Prodromalstage:Beginswithsymptomsofanupper respiratoryinfection,suchaslow gradefever,headache,chills,andmalaise.Secondstage: Aredrashappearsonthecheeks,knownasthe"slappedcheek"rash.Usuallyresolvesin23days.Thirdstage:Therashmovestothearmsandlegsandbecomesa"lacy" appearing rashthatisflat/purpleinappearance.Maylastforafewweeks.
Whichofthefollowingdrugclassesisrecommendedforthetreatmentofpost-herpetic neuralgia?
A)TCAs(tricyclicantidepressants)
B)SSRIs(selectiveserotoninreuptakeinhibitors)
C)Atypicalantidepressants
D)Benzodiazepines A)TCAs(tricyclicantidepressants)
Tricyclicantidepressantsandanticonvulsantsarerecommendedforpost herpetic neuralgia.Thesemedicationsmayhelpwiththeneuropathicpain.
AnewpatientwhorecentlyvisitedarelativeinNorthCarolinacomplainsofanonsetof feverandredrashesthatstarted2daysago.Therashfirstappearedonthewristandthe anklesandincludedthepalmsofthehands.Thepatientreportsthatitisspreadingtoward histrunk.Thepatient'seyesarenotinjectedandnoenlargednodesarepalpatedonhis neck.Thereisnodesquamationoftheskin.Whichofthefollowingismostlikely?
A)Kawasaki'sdisease
B)Meningococcemia
C)RockyMountainspottedfever
D)Measles C)RockyMountainspottedfever
GiventhelocationintheEast,RockyMountainspottedfeverismostlikelytheinfection causingsymptomsoffever,rashonankles/wristsmovingtothepalmsofthehandsandthe trunk.RockyMountainspottedfeverisatickbornediseasecausedbythebacterium Rickettsiarickettsii,whichistransmittedbyabitfromaninfectedtick.
Carpaltunnelsyndromeisduetoinflammationofthe:
A)Ulnarnerve
B)Radialnerve
C)Brachialnerve
D)Mediannerve D)Mediannerve
Carpaltunnelsyndromeisduetoinflammationofthemediannerve.
TheSomogyieffectischaracterizedbywhichofthefollowing?
A)Itisacomplicationofhighlevelsofgrowthhormone
B)Itisthephysiologicspikeofserumbloodglucoseintheearlymorning
C)Itischaracterizedbyhighfastingbloodglucoseinthemorning
D)Itisararephenomenonthatonlyoccursintype1diabeticpatient-B)Itisthe physiologicspikeofserumbloodglucoseintheearlymorning
TheSomogyiphenomenoniswhennocturnalhypoglycemia(2-3a.m.)stimulatestheliver toproduceglucagontoraisethebloodsugar.Thefastingbloodglucoselevelswillbe elevatedfromthisglucagonproduction.
Thefollowingfindingsareconsideredbenignlesionsoftheskinexcept:
A)Lentigo
B)Seborrheickeratosis
C)Actinickeratosis
D)Rosacea-C)Actinickeratosis
Actinickeratosisisasmall,raisedskinlesiononskinthathasbeeninthesunforalong periodoftime.Actinickeratosesareusuallybenign,butcandevelopintoskincancer; therefore,furtherevaluationisneededtodeter mineifremovalisrequired.
Whichofthefollowingisrecommendedasfirst linetreatmentforessentialtremor?
A)Propranolol(Inderal)
B)Phenytoin(Dilantin)
C)Amitriptyline(Elavil)
D)Fluoxetine(Prozac) A)Propranolol(Inderal)
Propranolol(Inderal)isapprovedfor"treatment"ofessentialtremor.Ithelpscontrolthe symptoms.Essentialtremorsarepermanentandcannotbecured.Beforeprescribing, orderanEKG.Donotusebeta-blockersifapatienthassecond-orthird-degreeheartblock orchroniclungdisease.
Themajordifferencebetweenthequasi experimentaldesigniswhichofthefollowing?
A)Thequasi experimentaldesignisatypeofobservationalstudy
B)Thequasi experimentaldesignusesconveniencesamplinginsteadofrandomsampling torecruitsubjects
C)Thequasi experimentaldesignisalsoknownasasurvey
D)Thequasi experimentaldesigndoesnothaveaninterventiongroup B)Thequasi experimentaldesignusesconveniencesamplinginsteadofrandomsamplingtorecruit subjects
Thequasi experimentaldesignusesanintervention(itisnotanobservationalstudyora survey).Ithasmanysimilaritiestoanexperimentalstudyexceptthatthehumansubjects arerecruitedbyconvenienceandnotatrandom(asinanexperimentalstudy).
Amotherbringsinher6 year olddaughtertoseethenursepractitioner(NP).She complainsthattheschoolnursefoundafewnitsonherdaughter'shair.Themotherstates thattheschoolhasa"nonits"policyregardingheadliceandthechildcannotgobackto schooluntilallthenitshavebeenremoved.Thechildwastreatedwithpermethrin shampoo(Nix)twiceabout3monthsago.Duringthephysicalexam,theNPseesafewnits thatareabout2inchesawayfromthescalp.Thechilddeniesitchinessonherscalp.Which ofthefollowingisthebestactionfortheNPtofollow?
A)Prescribelindane(Kwell)forthechildbecauseshemayhaveheadlicethatareresistant topermethrin
B)Advisethemothertouseanitcombaftersprayingthechild'shairwithwhitedistilled vinegar,waitingfor15minutes,andthenrinsingthechild'shair
C)Advisethemothertore treatthegirlwithpermethrincreaminsteadofshampoo
D)Reassurethemotherthatthenitswillprobablydropoffafterafewweeks B)Advise themothertouseanitcombaftersprayingthechild'shairwithwhitedistilledvinegar, waitingfor15minutes,andthenrinsingthechild'shair
AccordingtotheCDC,nitsthataremorethan1⁄4inchfromthechild'sscalpareusually notviable.Thechildalsodoesnothaveanitchyscalp.Onemethodofremovalistosoakthe child'sheadwithdistilledvinegar(andthenrinseafter),whichwillbreakdowntheprotein ofthenitcasings,makingiteasytocombthemoutofthehair.
Whatisthepedigreesymbolforadiseasedmale?
A)Anemptysquare
B)Anemptycircle
C)Afilled insquare
D)Afilled-incircle-C)Afilled-insquare
Afilled insquareisadiseasedoraffectedmaleandafilled incircleisadiseasedoraffected female.Anemptysquareisahealthymaleandanemptycircleisahealthyfemale.
A25 year oldmalewhowasinvolvedinacaraccidentisbroughtintothelocalemergency department.Hereportswearingaseatbeltandwasthedriverofthevehicle.Thepatientis complainingofpainonhisrightleg.Theskinisintact,buttherightfootisabducted slightly.Therightkneeistenderandswollen.Whichofthefollowingtestsis/arethebest choiceforevaluatingforpossiblefracturesandjointdamage?
A)Plainradiographsoftherighthipandknee
B)UltrasoundwithaCTscanoftherightleg
C)PlainradiographoftherighthipandlegwithanMRIofthekneejoint
D)Radiographoftherighthipandkneewithspecialviewofthehip C)Plainradiographof therighthipandlegwithanMRIofthekneejoint
Thestemisaskingfortwothings"...evaluatingforpossiblefracturesjointdamage."Plain x-raysarethefirstexamorderedforsuspectedorobviousbonyfractures.AnMRIscanis thebesttestforanytypeofjointpathology(swollenrightknee).
Systemiclupuserythematosus(SLE)ismorecommonamongthefollowingracial backgroundsexcept:
A)AfricanAmericans
B)Asians
C)Hispanics
D)Mediterranean-D)Mediterraneans
LupusismorecommonamongwomenofAfricanAmerican,Asian,andHispanicracial backgroundscomparedwiththosewithMediterraneanbackground(Italians,Greeks,etc.).
Whichofthefollowingphysicalexamfindingsismostspecificforsystemiclupus erythematosus(SLE)?
A)Swollenandpainfuljointinvolvement
B)Fatigueandmyalgia
C)Stiffnessandswellingofmultiplejoints
D)Malarrash D)Malarrash
Amalarrashisthebutterfly shapedrashonthemiddleofthefacethatiscausedbyatype ofphotosensitivityreaction.ItisassociatedwithSLE.Theotheransweroptionsarefound withotherdiseases,suchasrheumatoidarthritis,polymyalgiarheumatica,andsoon.
Anoldermaleisdiagnosedwithconductivehearinglossintheleftearbythenurse practitioner.Whichofthefollowingistheexpectedresultonthispatientwhenperforming aRinnetest?
A)AC(airconduction)>BC(boneconduction)
B)Lateralizationtothebadear
C)BC>AC
D)Lateralizationtothegoodear C)BC>AC
AnormalresultintheRinnetestisACgreaterthanBC.Whenthereisaconductionhearing loss(i.e.,cerumenosis,otitismedia),theresultwillbeBCgreaterthanAC.Thereasonis thatthesoundwavesareblocked(i.e.,cerumen,fluidinmiddleear).Therefore,thepatient cannothearthemaswellasthroughboneconduction.
Aphysicianisreferringoneofhispatientstoanursepractitioner.Whattypeof relationshipwillexistbetweenthephysicianandnursepractitioner?
A)Consultative
B)Collaborative
C)Professional
D)Advocate B)Collaborative
Acollaborativerelationshipexistswhenahealthcaregiverrefersapatienttoothers (physicians,specialists,physicaltherapy,etc.)tohelpwithpatienttreatmentand management.Consultreportsandprogressreportsaresenttotheprimarycaregiverto reportthepatient'sprogress.Consultativerelationshipsareinformal,suchastalkingtoa colleagueaboutapatienttreatment
Ahomeless47-year-oldmalewithahistoryofinjectiondruguse(IDU)andalcoholabuse presentstothePublicHealthClinicwitharecenthistoryoffever,nightsweats,fatigue,and weakness.Thepatienthasrecentlynoticedsomethinredstreaksonhisnailbedandred bumpsonsomeofhisfingersthathurt.Duringthecardiacexam,thenursepractitioner hearsaGrade3/6murmuroverthemitralarea.Thesubcutaneousred purplenodulesare tendertopalpation.Thethinredlinesonthenailbedsresemblesubungualsplinter hemorrhages.Whichofthefollowingconditionsismostlikely?
A)Pericarditis
B)Acutebacterialendocarditis
C)Rheumaticfever
D)Viralcardiomyopathy
B)Acutebacterialendocarditis
Bacterialendocarditisisalsoknownasinfectiveendocarditis(IC).Itisaseriousbacterial infectionoftheheartvalvesandtheendocardialsurface.Thebacteriamostcommonly
involvedareStaphylococcusandStreptococcusspecies.Subcutaneousredpainfulnodules onthefingerpadsarecalledOsler'snodes.Subungualsplinterhemorrhagesonthe nailbedsarecausedbymicroemboli.Janeway'slesionsarecausedbybleedingunderthe skin(usuallylocatedonthepalmsandthesoles)andarepainlessredpapulesandmacules. Otherfindingsareconjunctivalhemorrhages,petechaie,cardiacfric-tionrubs, arrhythmias,murmurs,andothers.Threebloodculturesobtainedatseparatesites1hour apartareusedtoidentifythecausativeorganism.Someoftheriskfactorsaredamaged prostheticvalves,historyofrheumaticfeverandinjectiondruguse
Whichofthefollowinganatomicareasareinvolvedwithsensorineuralhearingloss?
A)Outerear
B)Middleear
C)Innerear
D)CranialnerveVIIII C)Innerear
Sensorineuralhearingloss(i.e.,presbycusis)involvesdamagetoboththehaircellsinthe cochlea(sensoryportion)andcranialnerveVIII(neural).
A13 year oldadolescentfemaleisbroughtinbyhermotherforasportsphysical.The motherreportsthattheteen'slastvaccinesweregivenattheageof6years.Whichofthe followingvaccinesisrecommendedbytheCDCforthispatient?
A)TdandHPVvaccines
B)Tdap,MCV4,andtheHPVvaccines
C)DTapandthefluvaccine
D)DTandMCV4vaccines B)Tdap,MCV4,andtheHPVvaccines
Vaccinequestionsusuallyarenotthiscomplicated,butthereareseverallessonsthatcan belearnedwiththisquestion.The2012CDCrecommendationsfortheages13to18years aretheTdapcatch up(ifdidnotreceiveatage11 12years),HPVorGardasilcatch up(if didnotreceiveatage11 12years),andtheMCV4ormeningococcalconjugatevaccine (Menactra).OnlyonedoseofTdapisrecommended(lifetime).Thereafter,theTdformof thevaccineisindicatedevery10years.
An87 year oldmalereportstothenursepractitionerthathisgrandsonlockshiminthe bedroomwhenthegrandsongoesoutofthehouseandsometimeswith holdsfoodfrom himifhedoesnotgivethegrandsonspendingmoney.Thepatientappearsfrail,withpoor grooming,andhasastrongodorofurineonhisclothing.Whichofthefollowingisthebest actionforthenursepractitionertotake?
A)Reportthepatient'sgrandsonforelderabusetoprotectivehealthservicesofthestate
B)Callthegrandsonfromthewaitingroomandeducatehimabouttheimportanceof propergroomingforhisgrandfather
C)Advisethegrandsonthatifthepatientreportsthesamecomplaintsthenexttimeheis seenbythenursepractitioner,hewillbereportedforelderabusetothestateauthorities
D)Advisethepatientthatheshouldcallhissonassoonaspossible A)Reportthepatient's grandsonforelderabusetoprotectivehealthservicesofthestate
Speakingwiththegrandsonandwarninghimaboutelderabuseandreportingmayresult inharmtothepatientand/orrefusaltoreturntotheclinicinthefutureforfollow upofthe patient.OptionDisavagueanswer(callhissonassoonaspossibleforwhat?).
Apatientwithchronicobstructivepulmonarydisease(COPD)isreferredforpulmonary functiontesting.Whichofthefollowingpulmonaryfunctiontestsareabnormalinpatients withCOPD?
A)ReductionoftheTLC(totallungcapacity)andtheRV(residualvolume)
B)Complaintsofmildtoseveredyspneawithhypoxemia
C)Normalforcedvitalcapacity(FVC)withnochangesintheFEV1(forcedexpiratory volumein1second)
D)ReductionoftheFEV1(forcedexpiratoryvolumein1second)withincreaseintheTLC (totallungcapacity)andRV(residualvolume) D)ReductionoftheFEV1(forced expiratoryvolumein1second)withincreaseintheTLC(totallungcapacity)andRV (residualvolume)
COPDfindingsduringpulmonaryfunctiontestingarethereductionoftheFEV1(forced expiratoryvolumein1second)andreductionoftheFVC(forcedvitalcapacity).Thereisan increaseintheTLC(totallungcapacity)andRV(residualvolume).Thelungsofpatients withemphysemahavelosttheirrecoil(decreasesFEV1).Thelungsarealwaysfullofair thatishardto"squeezeout"ofthelungs(increasesresidualvolumeandtotallung capacity).Tosummarize,COPD=reductioninFEV1andFVCwithincreasedRVandTLC.
Thenursepractitionerisevaluatingamiddle agedfemalewhoiscomplainingofgradual weightgain,lackofenergy,dryhair,andanirregularperiodoveran8 monthperiod.The routineannuallaboratorytestingshowedaTSHresultof10mU/L.Thenursepractitioner decidestoorderathyroidprofile.TheTSHis8.50mU/LandtheserumfreeT4is decreased.Duringthephysicalexam,thepatient'sBMIis28.Theheartandlungexamsare bothnormal.Whichofthefol lowingisbesttreatmentplan?
A)AdvisethepatientthatbecausetheTSHlevelhasdecreased,shedoesnothaveathyroid problemanymore
B)Startthepatientonlevothyroxine(Synthroid)0.25mcgPOdaily
C)StartthepatientonArmourthyroid
D)Referthepatienttoanendocrinologist B)Startthepatientonlevothyroxine (Synthroid)0.25mcgPOdaily
Thepatientissymptomatic(weightgain,lackofenergy,andirregularperiods)withlow freeT4.EventhoughtheTSHwentdownslightly,thefreeT4remainslow.AnelevatedTSH andlowfreeT4areindicativeofhypothyroidism.Thenextstepistostartthepatienton levothyroxine(Synthroid)0.25mcgdailyandrechecktheTSHin6weeks.Thegoalisto normalizetheTSH(between1.0and3.5)andtoamelioratethepatient'ssymptoms (increasedenergy,feelsbetter,etc.).Armourthyroid(desic catedthyroid)isanatural supplementcomposedofdried(desiccated)porkthyroidglands.Itisusedinalternative medicineasanalternativetosyntheticlevothyrox ine/T4(Synthroid).
A75 year oldpatienthasahistoryofbenignprostatichypertrophy(BPH).Duringthe physicalexam,whichofthefollowingclinicalfindingsduringtheprostaticexamiscorrect?
A)Prostatefeelsfirmanduniformlyenlarged
B)Prostatefeelsboggyandenlarged
C)Prostatefeelsharderthannormal
D)Presenceoftendernodules
A)Prostatefeelsfirmanduniformlyenlarged
Theprostateshouldfeelfirmandwillbeuniformlyenlarged.Aboggyandwarmprostateis presentwithacuteprostatitis.
A55 year oldnursebringshermother,whois82yearsofage,totheemergency departmentofalocalhospital.Shereportsshefoundhermotheronthefloorwhenshe checkedonherthatmorning.Hermotherwasawakeandoriented,butneededhelpgetting up.Hermotherstatesthatshethinksshepassedout.Sheisbeingevaluatedbyaphysician whoordersanEKGandx raysofbothhips.Regardinglaboratorytesting,whichofthe followingisimportanttoperforminitially?
A)Urinalysis
B)Serumelectrolytes
C)Bloodglucose
D)Hemoglobinandhematocrit
C)Bloodglucose
Checkingthebloodglucoseisindicatedforpatientswithsyncopalandnearsyncopal episodes.TheNPhasperformedathoroughhistoryoftheincident(diabetic,rapidonsetor slow,position,provocation),medicalhistory,healthhistory,andthemedications.
Allofthefollowingareclinicalsignsandsymptomsseenearlyintesticulartorsionexcept:
A)Nauseaandvomiting
B)Absenceofthecremastericreflex
C)Affectedtesticleiselevatedcomparedwiththenormaltesticle
D)Affectedtesticleisswollenandfeelscoldtotouch-D)Affectedtesticleisswollenand feelscoldtothetouch
Theaffectedtesticlewillbeswollen,butitwillfeelverywarmtothetouch.Acoldtesticleis abnormalandisindicativeofgangrene(after24hours).
Theresearchterm/symbolthatisusedtoindicatethe"totalpopulation"inaresearch studyis:
A)Thesymbolcalled"n="
B)Thesymbolcalled"N="
C)Thesymbolcalled"p="
D)Thesymbolcalled"P=" B)Thesymbolcalled"N="
Thecorrectsymboltoindicatetotalnumberofsubjectsinastudy(totalpopulation)is"N." Forexample,aresearchstudyhasatotalnumberofsubjectsortotalpopulationof100(N= 100).Thesmallletternisusedtoindicateasubpopulation.Forexample,astudyusesa totalpopulationofN=100thatisdividedinto2groupsof50subjects(n=50).
A22 year oldmalepresentstotheurgentcareclinicwithburnscausedbyahotoilspill whilefryingfood.Hedeniesfacialinvolvement,dyspnea,orweakness.Duringthephysical exam,thenursepractitionernoticesbrightredskinwithnumerousbullaeontherightarm andhandandbrightredskinontherightthighandtherightlowerleg.Onapainscaleof1 10,hereportsthepainas8.BasedontheRuleofNines,whatistheTBSAofthispatient's burns?
A)36%
B)27%
C)18%
D)9%-B)27%
ThispatienthasaTBSAof27%andshouldbereferredtotheemergencydepartmentas soonaspossible.Checkthe"ABCs"andmonitorthepatientforshock.Donotpuncture bullae.
Theatypicalantipsychoticdrugshavemanyadverseeffects.Whichofthefollowingside effectsismostlikelytobeseenwiththisdrugclass?
A)Orthostatichypotensionandsedation
B)Malignanthypertensionandheadache
C)Skinhyperpigmentationandalopecia
D)Severeanxietyandincreasedappetite
A)Orthostatichypotensionandsedation
Orthostatichypotensionandsedationarecommonsideeffectsofatypicalantipsychotics suchasolanzapine(Zyprexa),quetiapine(Seroquel),andrisperidone(Risperdal).Itisalso acommonsideeffectoftheolderantipsychoticslikehaloperidol(Haldol).Antipsychotics donotcausesevereanxietyandhyperphagia(increasedappetite).Theyloweranxietyand
causesedation,sleepiness,anorexia,andhypotensionandincreasetheriskofsud den deathinfrailelders
A55 year oldwomanwhoisonaprescriptionofclindamycinforadentalinfection presentstothenursepractitionerwithcomplaintsofwaterydiarrheaforthepast4days. Shecomplainsofabdominalcrampingandbloatingwithdiarrhealstoolsupto10timesa day.Shedeniesseeingbloodorpusinherstool.Thereisnohistoryofrecenttravel.The patienthasbeentakingover the countermedicinewithnorelief.Thenursepractitioner suspectsthatthepatienthasamildcaseofClostridiumdifficilecolitis.Whichofthe followingantibioticsisindicatedforthisinfection?
A)Ciprofloxacin(Cipro)400mgPOBIDx7days
B)Metronidazole(Flagyl)500mgPOTIDx10days
C)Levofloxacin(Levaquin)750mgPOdailyx7days
D)Trimethoprim sulfamethoxazole(BactrimDS)1tabletPOBIDx10days B) Metronidazole(Flagyl)500mgPOTIDx10days
First linetreatmentforamildcaseofClostridiumdifficilecolitisismetronidazole(Flagyl) 500mgPOTIDx10days.Discontinuationoftheoffendingantibiotic(ifpossible)or switchingtoanotherantibioticclassisrecommended.Theroleofprobiotic supplementationiscontroversial.Complicationsarepseudomembranouscolitis,toxic megacolon,andfulminantcolitis.
A13 year oldpatienthasathroatculturethatispositiveforstrepthroat.Shereportsthat heryoungerbrotherwasrecentlydiagnosedwithstrepthroatandtreated.Thepatienthas asevereallergytopenicillinandreportsthaterythromycinmakesherverynauseated. Whichofthefollowingantibioticsisthebestchoice?
A)Azithromycin(Zithromax)
B)Cephalexin(Keflex)
C)Cefuroximeaxetil(Ceftin)
D)Levofloxacin(Levaquin) A)Azithromycin(Zithromax)
Ifthepatienthasaseverepenicillinallergy,thereisa10%chanceofcross reactivityto cephalosporins(especiallyfirstgeneration).Becausethepatientisachild,thelevofloxacin iscontraindicated.Nauseaisacom monadversereactiontoerythromycin(itisnotan allergicreaction).ThebestoptionistouseazithromycinbecauseofitsminimalGIadverse effects.Azithromycinhasfewerdruginteractionscomparedwithothermacrolides.
Allofthefollowinggroupsareclassifiedas"vulnerablepopulations"andhaveadditional protectionsashumansubjectsexcept:
A)Prisoners
B)Pregnantwomen,fetuses,andchildren
C)Frailelders
D)Mentallyincompetentindividuals C)FraileldersFrailelderswhoarementally competentarenotconsideredavulnerablepopulationgroup.
A60 year oldfemaletruckdriverpresentstotheoutpatienturgentcareclinicofahospital complainingoftheworseningofherlowbackpainthepastfewdays.Shedescribesthe painas"sharpandburning"andpointstotheleftbuttock.Shereportsthatthepainstarted onthemid buttockoftheleftlegandrecentlystartedtogodownthelateralaspectofthe legtowardthetopofthefoot.Duringthephysicalexam,theanklejerkandthekneejerk reflexis1+ontheaffectedlegand2+ontheotherleg.Thepedal,posteriortibialis,and poplitealpulsesarethesameonbothlegs.Whichofthefollowingtestsshouldthenurse practitionerconsiderforthispatient?
A)Orderbothaplainradiographandcomputedtomography(CT)scanofthespineassoon aspossible
B)Writeaprescriptionforibuprofen800mgPOQIDwithamusclerelaxantandadvisethe patienttofollowupwithherprimarycareproviderwithin3days
C)Referthepatienttoanorthopedicsurgeon
D)Orderinganimagingstudyofthespineisprematurebecausethemajorityoflowback paincasesresolvewithin10to12weeks A)Orderbothaplainradiographandcomputed tomography(CT)scanofthespineassoonaspossible
Thepatienthasaseverecaseofsciaticathatisworseningquickly(mayprogresstocauda equina).Inaddition,olderageandanabnormalneurologicexamareredflagsfor potentiallyseriousunderlyingpathology(osteoporosisfracture,cancer,infection, spondylolisthesis).Becausethepatient'ssymptomsareworsening,aCTscanisthebest choice.Aplainradiographcanonlydetectbonypathology,butaCTscancandetectnerve rootcompression,herniateddisc,cancer,andspinalstenosis(narrowingofthespinal canal).Inaddition,thepatientneedstofollowupwithaneurologistassoonaspossible.
A70 year oldwomancomplainsofleftlowerquadrantabdominalpainandfeverfor2 days.Herbloodpressureof130/80,pulse90/minute,respirations14/minuteanda temperatureof100.5°F.Duringtheabdominalexam,theleftlowerquadrantofthe abdomenistendertopalpation.TheNPdoesnotpalpateamass,guarding,orrigidity. Rovsing'ssignisnegative.Bowelsoundsarepresentinallquadrants.Thenurse practitionerisfamiliarwiththepatient,whoisalertandisaskingappropriatequestions abouthercondition.Thenursepractitionersuspectsthatthepatienthasacute diverticulitis.Whichofthefollowingtreatmentplansisappropriateforthispatient?
A)Thepatientshouldbereferredtothephysicianassoonaspossible
B)Thepatienthasamildcaseofacutediverticulitisandcanbetreatedwithantibioticsin theoutpatientsettingwithclosefollow up
C)Thispatienthasamoderatetoseverecaseofacutediverticulitisandneedstobe admittedtothehospitalforIVantibiotics
D)Referthepatienttotheemergencydepartmentassoonaspossible-B)Thepatienthasa mildcaseofacutediverticulitisandcanbetreatedwithantibioticsintheoutpatientsetting withclosefollow up
Thepatienthasamildcaseofacutediverticulitisandcanbetreatedasanoutpatientwith antibioticsandaclearfluiddiet.Ifoutpatienttreatmentisselected,closefollow up(within 24to48hours)isveryimportant.Instructpatientstogotothehospitalifsymptomsget worse,iffeverincreases,ifunabletotoleratePOtreatment,andifpainworsens.OrderCBC (leukocytosis,neutrophils,andpossibleshifttotheleft),chemistryprofile,andurinalysis (toruleoutrenalcauses)
Whatisthenameofthephysiologicallyactivecompoundthatisderivedfromsoybeans?
A)Isoflavones
B)Estrogen
C)Progesterone
D)Resveratrol A)Isoflavones
Soyisoflavonesmimictheactionofestrogeninthebody.Itisderivedfromsoybeansand soybeanproducts(soymilk,tofu).Resveratrolisfoundinredgrapesandredwine.Itis thoughttohelpprolonglifeandisconsideredoneofthereasonsthattheMediterranean dietincreaseslongevity
Allofthefollowingconditionsarecontraindicationsforbupropion(Wellbutrin,Zyban) except:
A)Anorexianervosaandbulimia
B)Seizuredisorders
C)Peripheralneuropathy
D)Within14daysafterdiscontinuationofamonoamineoxidaseinhibitor (MAOI) C)Peripheralneuropathy
Bupropionincreasestheriskofseizures.Contraindicationsareseizures,anorexianervosa, andbulimia.Avoidwithanyconditionthatincreasesseizures,suchasafterabrupt withdrawalofalcoholorsedativesandcertainheadinjuries.Forperipheralneuropathy, atypicalantide pressantssuchasduloxetine(Cymbalta)andTCAssuchasamitriptyline (Elavil)areused.
ThenursepractitioneriseducatinganewpatientwithRaynaud'sphenomenonabout lifestylechangesthathavebeenfoundhelpfulindecreasingexacerbationsofthedisorder. Whichofthelifestylerecommendationsisfalse?
A)Caffeine containingdrinksandfoodssuchaschocolatehavebeenfoundhelpfulwith decreasingtheincidenceofexacerbations
B)Wearglovesormittensduringcoldweatherandbecarefulwhenhandlingfrozenfoods
C)Stopsmokingandexerciseatleast3timesaweek
D)Decreaseemotionalstressandlifestylestressors A)Caffeine containingdrinksand foodssuchaschocolatehavebeenfoundhelpfulwithdecreasingtheincidenceof exacerbations
Lifestylechangesassociatedwithdecreasingexacerbationsarewearingglovesormittens duringcoldweather,takingcarewithhandlingfrozenfoods(weargloves)andavoiding vasoconstrictingagents(caffeine,smoking,cocaine,amphetamines)andemotionalstress. Exerciseandreducinglifestylestressarerecommended.Usuallyinvolvesthefingers and/ortoesduetoseverearteriolarvasospasmcausingischemia.Duringanexacerbation, thefingerschangecolorintowhite,blue,andred(thinkoftheAmericanflagasa reminder).Raynaud'sisclassifiedeitherasprimary(Raynaud'sdisease)orsecondary (Raynaud'sphenomenon).IndividualswithsecondaryRaynaud'shaveahigherriskof autoimmunedisorderssuchasscleroderma,Sjogrensyndrome,andsystemiclupus erythematosus.Affectsmostlyyoungwomen(ages15to30years).
TheHealthInsurancePortabilityandAccountabilityAct(HIPAA)waspassedbyCongress in2003.AllofthefollowingstatementsaboutHIPAAarecorrectexcept:
A)Itprovidesfederalprotectionsforpersonalhealthinformation
B)Itisapplicabletoallhealthcareprovidersandpayerswhobillelectronicallyand transmithealthinformationovertheInternet
C)Patientshavetherighttoviewtheirmentalhealthandpsychotherapy relatedhealth information
D)Itgivespatientstherighttoviewandcorrecterrorsintheirmedicalrecords C)
Patientshavetherighttoviewtheirmentalhealthandpsychotherapy relatedhealth information
Mentalhealthandpsychotherapy/psychiatricrecordsdonothavetobereleasedto patientseveniftheyrequestthoserecords.Otherwise,anytypeofmedicalrecordscanbe releasedifitisrequestedbythehealthinsuranceorhealthplanforbillingpurposesand reimbursement.HIPAAappliestoallhealthcareproviders,healthplans,healthinsurance companies,medicalclearinghouses,andotherswhobillelectronicallyandtransmithealth informationovertheInternet.
Duringthephysicalexamofa60 year oldadult,thenursepractitionerperformsan abdominalexam.Thenursepractitionerischeckingtheleftupperquadrantofthe abdomen.Duringpercussion,anareaofdullnessisnotedbeneaththelowerleftribcage. Whichofthefollowingisatruestatementregardingthespleen?
A)Thespleenisnotpalpableinthemajorityofhealthyadults
B)Thespleenis8cmto10cmintheleftmidaxillarylineatitslongestaxis
C)Thespleenis2cmto6cmbetweentheninthtoeleventhribsontheleftmidaxillaryline
D)Thesplenicsizevariesdependingonthepatient'sgender-A)Thespleenisnotpalpable inthemajorityofhealthyadults
Thespleenislocatedontheleftupperquadrantoftheabdomenunderthediaphragmand isprotectedbythelowerribcage.Inthemajorityofadults,itisnotpalpable.Thespleen's longestaxisisfrom11cmto20cm.Anyspleenlargerthan20cmisenlarged.Thebesttest forevaluatingsplenic(orhepatic)sizeistheabdominalultrasound.Disordersthatcan causesplenomegalyincludemononucleosis,sicklecelldisease,congestiveheartfailure, bonemarrowcancers(myeloma,leukemia),andseveralotherdiseases.
Allofthefollowingdrugclassesareapprovedfortreatinghypertension.Whichofthe followingantihypertensivedrugclassesisassociatedwiththelargestnumberofresearch studies?
A)ACEinhibitors
B)Angiotensivereceptorblockers(ARBs)
C)Thiazidediuretics
D)Calciumchannelblockers(CCBs) C)Thiazidediuretics
Thiazidediureticshavebeenusedtotreathypertensionformanydecadesandnumerous placebo controlledstudieshavedocumentedtheireffectivenessasanantihypertensive drugclass.
Whenadomesticdogissuspectedtobeinfectedwiththerabiesvirus,itcaneitherbekilled forabrainbiopsyoritcanbequarantined.Whatistheminimumnumberofdaysthatadog suspectedofrabiesmustbequarantined?
A)4weeks
B)21days
C)14days
D)10days D)10days
Theminimumnumberofdaystoquarantineananimalsuspectedofrabiesis10days.Ifthe animalishealthyandhasnosymptomsofrabiesat10days,itisnotinfectedwiththe rabiesvirusandcanbereturnedtotheowner.
Thiazidediureticshavebeenshowntohaveabeneficialeffectonthebones.Hypertensive womenwithosteopeniaorosteoporosisbenefitfromthiazidediuretics.Whatisthe mechanismofactionforitseffectonthebones?
A)Thiazidediureticsdecreasecalciumexcretionbythekidneysandstimulateosteoclast production
B)Thiazidediureticsincreasebothcalciumandmagnesiumretentionbythekidneys
C)Thiazidediureticsincreasebonemineraldensity(BMD)
D)Thiazidediureticsinfluenceelectrolyteexcretionbythekidneys A)Thiazidediuretics decreasecalciumexcretionbythekidneysandstimulateosteoclastproduction
Thispositivesideeffectofthiazidesresultsinadecreaseincalciumbonelossandan increaseinthebonemineraldensity.
Whatisthebestdescriptionofavariable?
A)Itisanimportantpartofeveryresearchstudy
B)Itistheprobabilitythatafactorisimportantfortheresearchdata
C)Itisthevalueornumberthatoccursthemostfrequently
D)Itisacondition,characteristic,orfactorthatisbeingmeasured
D)Itisacondition, characteristic,orfactorthatisbeingmeasured
Avariableisacondition,characteristic,orfactorthatisbeingmeasured.Anindependent variableistheonebeingmanipulatedthatisnotaffectedbytheothers.Adependent variablechangesdependingonthemanipulationoftheindependentvariable.
A30 year oldmalewithahistoryofgoutiswalkingtotheexaminationroomandthenurse practitionernoticesthatheislimping.Whenthepatientsitsdown,thenursepractitioner notesthatthemetatarsophalangealjointofthegreattoeisveryswollenandisbrightred. Thepatientreportsthathewasattendingapartythenightbeforeanddrank.Thepatientis requestingaprescriptiontotreathispainfultoe.Thenursepractitionerprescribesthe patientindomethacin(Indocin)50mgTIDPRNandcolchicine.Regardingcolchicine,which ofthefollowinginstructionsiscorrect?
A)Take1pilleveryhourtoevery2hoursuntilreliefisobtainedoradverse gastrointestinaleffectsoccur,suchasabdominalpain,nausea,ordiarrhea
B)Take1pilleveryhouruntilreliefisobtainedupto24hours
C)Take1pillevery4to6hoursuntilthepainisrelieved
D)Take2to3pillsQIDuntilreliefisobtainedoradverseGIeffectsoccur,suchas abdominalpain,nausea,ordiarrhea
A)Take1pilleveryhourtoevery2hoursuntilrelief isobtainedoradversegastrointestinaleffectsoccur,suchasabdominalpain,nausea,or diarrhea
Colchicineactsasananti inflammatoryandhelpstosuppressgoutyattacks.Itisusually takenas1tablet(0.6mg)every1to2hoursuntilreliefisobtained(oradverse gastrointestinaleffectsoccur,suchasabdominalpain,nausea,ordiarrhea).Prescribethe patientonly10tabletsatatime(donotrefill)duringaflare-up.Themaximumdoseis6 mg/day.ManypatientswilldevelopGIadverseeffectsevenbeforethepainisrelieved. Colchicinecanalsobetakendailyinsmallamountsforprophylaxis.
Whattypeoftestingisrecommendedbeforestartingapatientonaprescriptionof hydroxychloroquine(Plaquenil)?
A)CBC
B)Serumcreatinineandurineformicroalbumin
C)Liverfunctiontests
D)Comprehensiveeyeexam
D)Comprehensiveeyeexam
Acomprehensiveeyeexambyanophthalmologistisrecommendedbecause hydroxychloroquinecanadverselyaffecttheretina(scotomasorvisualfielddefects,lossof centralvision,lossofcolorvision).Higherdosesandlong termuseincreasetheriskof retinaltoxicity.
Apostmenopausalwoman'sdual energyx rayabsorption(DXAorDEXA)resultshows osteopenia.Whichofthefollowingt scoresisindicativeofosteopenia?
A)T scoreof 1.0orhigher
B)T scorebetween 1.0to 2.5
C)T scoreoflessthan 2.5
D)T-scoreof-2.50to-3.50
D)Normalresults B)T scorebetween 1.0and 2.5
Osteopeniaisdefinedasat scorebetween 1.0and 2.5.Osteoporosisisdefinedasat scoreoflessthan 2.5.
Anadultpatientwasrecentlydischargedfromthehospitalwithaprescriptionof clindamycin.Thepatientreportsthathetookhislastdoseyesterday.Hepresentsinthe primarycareclinicwithcomplaintsoftherecentonsetofwaterydiarrheafrom10to15 timesadaywithabdominalcramping.Hedeniesfeverandchills.Whichofthefollowing conditionsismostlikelyinthispatient?
A)Clostridiumdifficile associateddiarrhea(CDAD)
B)Giardiasis
C)Pseudomembranouscolitis
D)Irritablebowelsyndrome
A)Clostridiumdifficile associateddiarrhea(CDAD)
AnimportantriskfactorforClostridiumdifficile associateddiarrhea(CDAD)andC.difficile colitisisantibiotictherapyandhospitalization.Almostanyantibioticcancausethe condition,butthemostcommonareclindamycin,cephalosporins,andfluoroquinolones. Diarrheacanoccurduringtherapyaswellasaftertherapy(5to10days;upto10weeks). PseudomembranouscolitisisacomplicationofC.difficlecolitis.
Whichofthefollowingindividualsismorelikelytobeaffectedbyalphathalassemia anemia?
A)53 year oldGreekpatient
B)25 year oldChinesepatient
C)62 year oldRussianpatient
D)38 year oldAfricanAmericanpatient
B)25 year oldChinesepatient
Alphathalassemiaminor/traitordiseaseismoreprevalentamongAsianssuchasChinese andFilipinos.Betathalassemiaminor/traitordiseaseismorecommoninthecountriesin theMediterraneanarea,suchasGreeceandItaly.
WhatisthesignificanceofapositiveLachmansign?
A)Instabilityoftheaffectedkneecausedbydamage(i.e.,rupture)totheanteriorcruciate ligament(ACL)oftheknee
B)Posteriorcruciateligamentlaxitywhichmaycauselockingoftheaffectedknee
C)Achillestendonrupture
D)Patellartendonrupture A)Instabilityoftheaffectedkneecausedbydamage(i.e., rupture)totheanteriorcruciateligament(ACL)oftheknee
ApositiveLachmansignishighlysuggestiveofdamagetotheanteriorcruciateligamentof theknee.Theanteriordrawersignmayalsobepositive.Thereislaxityoftheabnormal kneejoint(comparedwiththenormalknee).TheLachmantestormaneuverisconsidered moresensitiveforACLdamagecomparedwiththeanteriordrawertest.
ApositiveChvostek'ssignisassociatedwith:
A)Hypocalcemia
B)Hypernatremia
C)Hypokalemia
D)Hyperkalemia A)Hypocalcemia
Chvostek'ssigniscontractionofthefacialmuscleswhenthefacialnerveistappedbriskly infrontoftheear(anteriortotheauditorycanal).Lowcalciumlevelscausetetanyand neuromusculardisturbances.Acutehypocalcemiawithsymptoms(tetany,weakness, arrhythmias)shouldbereferredtotheemergencydepartment.Conditionssuchasacuteor chronicrenalfailure,VitaminDormagnesiumdeficiency,oracutepancreatitisincreasethe riskofhypocalcemia
Thenursepractitionercallsapatienttodiscusstheresultsofroutinelaboratorytests, whichareallnormal.Shecallsthepatienttwiceandeachtime,theansweringmachineis on.Whichofthefollowingisthemostappropriateactionforthenursepractitioner?
A)Becausetheyareallnormal,leavethelaboratoryresultsontheansweringmachine
B)Whenthenursepractitionerisunabletospeakwiththepatientdirectly,sheshould leaveamessagewithhernameandtelephonenumberandinstructthepatienttocallback
C)Someclinicshaveapolicyofnotcallingpatientsbackiftheirlaboratoryresultsare normal
D)Itisuptothephysiciantodeterminewhetheralaboratoryresultcanbediscussedwith apatientonthetelephone B)Whenthenursepractitionerisunabletospeakwiththe patientdirectly,sheshouldleaveamessagewithhernameandtelephonenumberand instructthepatienttocallback
ItisagainstHIPAAregulationstoleavelaboratoryresultsonanansweringmachineevenif theyarenormal,routinelaboratorytests.HIPAAisalsoknownasthe"PrivacyRule."
Whichofthefollowingdrugsthatareusedtotreatattentiondeficithyperactivitydisorder (ADHD)isnotclassifiedasanamphetamine/stimulant?
A)Dexmethylphenidate(FocalinXR)
B)Mixedsaltsofamphetamine(Adderall)
C)Methylphenidate(Ritalin)
D)Atomoxetine(Strattera)-D)Atomoxetine(Strattera)
Stratteraisclassifiedasanorepinephrinereuptakeinhibitor.Itisnotastimulantoran amphetamine.Stratteraiscontraindicatedduring/within14daysoftakinganMAOI, narrow angleglaucoma,heartdisorderwhereincreasesinBPorheartratewillworsenit, orpheochromocytoma.Childrenandteenagersshouldbemonitoredforsuicidal thoughts/plans.
A25-year-oldmalewithschizophreniacomesinforaroutineannualphysical.Heisaheavy smokerandhasaBMIof28.Thepatienthasbeenonolanzapine(Zyprexa)for10years.
Regardingthepatient'sprescription,whichofthefollowinglaboratorytestsis recommendedformonitoringforadverseeffectsofatypicalantipsychotics?
A)Fastingbloodglucose,fastinglipidprofile,andweight
B)Urinalysis,serumcreatinine,24 hoururineforproteinandcreatinine clearance
C)Liverfunctiontestsonly
D)CBCwithdifferential,liverfunctiontests,weight A)Fastingbloodglucose,fastinglipid profile,andweight
Patientsonatypicalantipsychoticscommonlygainweightandareatriskforobesity, hyperglycemia,andtype2diabetes.Zyprexawillincreaselipids(cholesterol,LDL,and triglycerides).Atypicalantipsychoticsalsoincreasetheriskofdeathamongfraileldersand olderadultslivinginnursinghomes
NativeAmericansviewillnessordiseaseasbeingcausedbywhichofthefollowing?
A)Poorbloodcirculationinthebody
B)Apunishmentbythe"spirits"forwrongfulactionsagainstothersorforfailuretofollow spiritualrules
C)Animbalanceoftheflowofenergyinthebody
D)Animbalanceofthehotandcoldenergyforcesinthebody-B)Apunishmentbythe "spirits"forwrongfulactionsagainstothersorforfailuretofollowspiritualrules
NativeAmericansbelievethatillnessispunishmentbythespiritsforwrongactionsor fromfailuretofollowspiritualrules.Shamans"cure"theillnessbyperformingritualsand usingherbalmedicines.Medicinepouchesthataretiedtothepatientbyastringare believedtohelpcuretheillness.Donotremovesuchpoucheswithoutthepatient's(or parent's)permission.
A74 year oldmanpresentswithrecurrentabdominalcrampingassociatedwithdiarrhea thatoccursfrom4to5timesperday.Hereportsthatcurrentlyheishavingan exacerbation.Thestoolsarebloodywithmucusandpus.Thepatientreportsthathehas lostalittleweightandisalwaysfatigued.Thepatientdeniesrecenttraveloroutdoor camping.Whichofthefollowingconditionsismostlikely?
A)Giardiasis
B)Irritablebowelsyndrome(IBS)
C)Diverticulitis
D)Ulcerativecolitis D)Ulcerativecolitis
Themostimportantclueforulcerativecolitisisbloodystoolsthatarecoveredwithmucus andpusalongwiththesystemicsymptoms(fatigue,low-gradefever).
Amiddle agedmalewhoishomelessreportstothelocalPublicHealthCliniccom plaining ofapainlessandshallowulceronthepenileshaftforthepast2weeks.Heissexuallyactive andhadunprotectedintercoursewithtwomalepartnersoverthepastfewmonths.The patientistestedforHIV,syphilis,gonorrhea,hepatitisB,andherpestypes1and2.The syphilisandHIVtestsarebothpositive.Thegonorrhea,hepatitisB,andherpestestsare negative.ThenursepractitionerisawareofNationallyNotifiableInfectiousConditions. Whichofthefollowingistrueregardingreportingofanyofthesesexuallytransmitted infections?
A)Obtainthepatient'spermissionbeforereportingthepositiveHIVandsyphilistest resultstothelocalpublichealthdepartment
B)Obtainthepatient'sandsexualpartner'spermissionbeforereportingtheposi-tivetest resultstothelocalhealthdepartment
C)Healthcareprovidersaremandatedbylawtoreportcertaintypesofdiseasestothe localhealthdepartmentevenifthepatientdoesnotgivepermission
D)Thenursepractitionershouldconsultwiththesupervisingphysicianaboutthisissue-
C)Healthcareprovidersaremandatedbylawtoreportcertaintypesofdiseasestothe localhealthdepartmentevenifthepatientdoesnotgivepermission
Physiciansandlaboratoriesarelegallymandatedtoreportcertaintypesofdiseases.STDs, HIVinfection/AIDS,gonorrhea,andsyphilismustbereportedtothelocalhealth departmentevenifthepatientdoesnotgivepermission.Partnertracingandnotification aredonebythelocalhealthdepartment.TheCDCweb sitecontainsalistofnationally reportablediseases.OtherdiseasesthatareontheCDC2012listofreportablediseases (i.e.,diseasesthatmustbereported)areTB,diphtheria,hepatitisA,B,andC,measles, mumps,pertussis,Lymedisease,RockyMountainspottedfever,andmanyothers.
Amedicalassistantiscallingoutthenamesofpatientswhoareinthewaitingroom.The medicalassistantisfollowingtheHIPAAPrivacyRuleifsheperformswhichofthe followingactions?
A)Callpatientsbytheirfullnametoshowrespect
B)Callpatientsbytheirlastnameorsurname
C)Ifthepatientpreferstobecalledbyanickname,usethatnametocallhim/herinside
D)Callpatientsbyusingthefirstnameonly-D)Callpatientsbyusingthefirstnameonly
Patientswhoareinwaitingroomsorroomswithotherpeopleshouldbecalledbytheir firstnamesonly,toprotecttheirprivacy.
A14 year oldfemalewithamenorrheaistestedforpregnancyandhasapositiveresult. ThepatienttellstheNPthatsheisseriouslyconsideringterminatingthepregnancy.She tellstheNPthatshewantstobereferredtoaPlannedParenthoodclinic.TheNP'spersonal beliefsandreligiousbeliefsarepro-life.Whichofthefol-lowingisthebestactionforthe NP?
A)Thenursepractitionershouldtellthepatientaboutherpersonalbeliefsandadviseher againstgettinganabortion
B)TheNPadvisesthepatientthatanNPpeerwhoisworkingwiththeNPcanhelpanswer herquestionsmorethoroughly
C)TheNPshouldexcuseherselffromthecase
D)Thenursepractitionershouldreferthepatienttoanobstetrician B)TheNPadvisesthe patientthatanNPpeerwhoisworkingwiththeNPcanhelpanswerherquestionsmore thoroughly
Ingeneral,discussingpersonalbeliefsisconsideredunprofessionalbehavior.Respecting thepatient'srighttochooseisanexampleofsupportingpatientautonomy.
A22 yearoldisgoingona5 daycruiseforherhoneymoon.Shereportsahistoryofsevere motionsickness.Whichofthefollowingmedicinescanbeprescribedformotionsickness?
B)Metochlopramide(Reglan)
C)Ondansetron(Zofran)_
D)Scopolaminepatch(TransdermScop) D)Scopolaminepatch(TransdermScop)
Scopolaminepatch(TransdermScop)isaprescriptionmedicinethatisusedfor motion/seasickness.Itisasmall,circularpatchthatisplacedbehindtheearandis effectivefor3days.Advisethepatienttoapplyit4hoursbeforethetriptobeeffective.
Becausethequestionisaskingabouta"prescribed"med,answerswithOTCssuchas Dramamineareincorrect.Zofranisindicatedforcancer relatednauseaandvomiting (chemo,radiation,surgery).
WhichofthefollowingisconsideredaspiritualillnessbyLatinos/Hispanicsthatcancause symptomssuchaslossofappetite,crying,diarrhea,andweaknessordeathamonginfants andsmallchildren?
A)Malojoormaldeojo
B)Chronicnightmares
C)Trabajo
D)Malo A)Malojoormaldeojo
Malojoormaldeojoisaspiritualillnessthatcancausesymptomssuchaslossofappetite, crying,diarrhea,colic,fear,weakness,ordeath.Acuranderoorcuranderaisusually consultedanddoesspiritualcleansingofthepatient.Itmaytakeseveralcleansings (limpia)tocurethepatient.Trabajomeans"work"andmalomeans"bad";thesearebeing usedasdistractors.
A45 year oldmanfellasleepwhilesmokinginhisbedroomandstartedafire.Accordingto thepatient,herefusedtogototheemergencydepartmentbecausehehadonlyminor burns.About12hourslater,hepresentstoawalk inurgentcarecentercomplainingofa newcoughthatisproductiveofsalivawithclearmucuswithsmallcarbonaceousblack particles.Hisbrowsappearsinged.Whichofthefollowingistheprioritywhenevaluating thispatient?
A)Performamedicalhistory,includingprescription,OTC,andherbalmedicines
B)Assessthepatientforrespiratorydistress
C)Evaluatethepatientforasthmaandatopy
D)UsetheRuleofNinestoevaluatethetotalbodysurfacearea(TBSA) B)Assessthe patientforrespiratorydistress
AssessthepatientforrespiratorydistressASAP.Followthe"ABCs"andassessthepatient foranylife threateningsymptoms.Smokeinhalationlunginjuryisthemaincauseofdeath inthermalburnvictims.
Whichofthefollowingbenzodiazepineshastheshortesthalf life?
A)Lorazepam(Ativan)
B)Alprazolam(Xanax)
C)Triazolam(Halcion)
D)Clonazepam(Klonopin) C)Triazolam(Halcion)
Triazolam(Halcion)hasanaveragehalf lifeofabout2hours.Xanaxhasahalf lifeof12 hours.Ativanhasahalf lifeof15hours.Klonopinhasahalf lifeof34hours
Multiplemyelomaisamalignancyofthe:
A)Whitebloodcells(WBC)
B)Redbloodcells(RBC)
C)Plasmacells
D)Platelets C)Plasmacells
Myelomaisacanceroftheplasmacells(ormatureB-cells/lymphocytes),whichaffectsthe bonemarrow.Plasmacellsproduceantibodiesandresidemainlyinthebonemarrow. Signs/symptomsarebonepain,fractures,hypercalcemia,depressedimmunity,and anemia.ThebonemarrowproducesWBCs(neutrophils,lymphocytes,eosinophils, basophils),RBCs,andplatelets.Thetypicalpatientisanolderadultwhoisage60yearsor older.
Inadditiontosurgicalrepairofacompoundfracturethathasbrokenthroughtheskin, whichofthefollowingtreatmentplansisimportanttoconsiderinthispatient?
A)ApplicationofatopicalantibioticBIDuntilthewoundishealed
B)Woundirrigation
C)Tdapvaccine
D)Tetanusvaccineandsystemicantibiotics-D)Tetanusvaccineandsystemicantibiotics
Abreakintheskinwithacompoundfractureisanindicationforuseofatetanusvaccine(if lastdoseismorethan5yearsago)andsystemicantibiotics.
A62 year oldmalewithchronicobstructivepulmonarydisease(COPD)complainstothe nursepractitionerthathisprescriptionofipratropiumbromide(Atrovent)isnotworking. Hereportsthathestillfeelsshortofbreathevenafterusingit4timesadayfor3months. Whichofthefollowingactionsisthenextstepforthenursepractitioner?
A)Increasethepatient'sdoseofipratropiumbromide(Atrovent)to3inhalationsQID
B)Continuetheipratropiumbromideandstartthepatientonoxygenbynasalcannula
C)Continueipratropiumbromide(Atrovent)andaddalbuterol(Ventolin)inhaler2 inhalationsQID
D)StartthepatientonoxygenbynasalcannulaatbedtimeandPRNduringthedaytime C) Continueipratropiumbromide(Atrovent)andaddalbuterol(Ventolin)inhaler2 inhalationsQID
TreatmentofCOPDstartswithananticholinergic(ipratropiumbromide).Thenextstepis toaddashort actingbeta 2agonist(albuterol)
Acoworkercallsthenursepractitionerandwantstoknowaboutapatient'sprogress.She tellstheNPthattheyareneighborsandsheisworriedaboutthepatient'shealthstatus. Thecoworkerworksinthesamefacility,butisnotdirectlyinvolvedwiththispatient's care.Whichofthefollowingactionsisthemostappropriate?
A)Sharewiththecoworkerthepatient'shealthstatus
B)Advisethecoworkertocallthepatientrightawayandaskherforverbalpermission
C)Informthecoworkerthatyoucannotreleaseanyinformationaboutthispatientbecause thecoworkerisnotdirectlyinvolvedinthepatient'scare
D)Reassurethecoworkerthatthepatientisdoingfineandisgettingbetterquickly-C) Informthecoworkerthatyoucannotreleaseanyinformationaboutthispatientbecause thecoworkerisnotdirectlyinvolvedinthepatient's care
Releasinganyinformationaboutthispatienttoacoworkerwhoisnotdirectlyinvolvedin thepatient'scarewouldviolatetheHIPAAprivacyrules
Whatisthenameoftheimmuneprocessthatisresponsibleforanaphylacticreactions?
A)IgE mediatedreaction
B)Seriousallergicreaction
C)Antibodyreaction
D)Atopicreaction A)IgE mediatedreaction
AnaphylaxisisanimmunoglobulinE(IgE) mediatedreaction(alsoknownasIgE mediated type2).IgEimmediatereactionssuchasanaphylaxistriggermastcelldegranulationand releaseofpotentmediatorssuchashistamines,leukotrienes,andprostaglandins,which immediatelyinducecon strictionofsmoothmuscle,swelling,vasodilation,andother pathologicchangesinthebodythatmaybefatal.
A76 year oldwomanreportsthatfortheprevious4months,shehasnoticedsevere stiffnessandachinginherneckandbothshouldersandhipsthatisworsenedby movement.Shereportshavingadifficulttimegettingoutofbedbecauseofthesevere stiffnessandpain.Itisdifficultforhertoputonajacketorblouseortofastenherbra.
Alongwiththesesymptoms,shealsohasalow gradefever,fatigue,lossofappetite,and weightloss.Startingyesterday,thevisioninherrighteyehasprogressivelyworsened.She
hasannualeyeexamsanddeniesthatshehasglaucoma.Whichofthefollowingconditions ismostlikely?
A)Rheumatoidarthritis(RA)
B)Degenerativejointdisease
C)Polymyalgiarheumatica(PMR)
D)Fibromyalgia C)Polymyalgiarheumatica(PMR)
Polymyalgiarheumatica(PMR)isassociatedwithahighriskofgiantcellarteritis(GCA)or temporalarteritis(15% 30%).Thenewonsetofvisionlossandthelocationofthepain (neck,bothshoulders/hips)arethemostimportantclues.PMRisarheumaticcondition thatinvolvesjointsandthearteries.Temporalarteritiscancausepermanentblindness. Thesedimentationrateisveryhigh(40mm/hrto100mm/hr).Almostallwillhave elevatedC-reactiveproteinlevels(upto99%).Thesepatientsaremanagedby rheumatologistsvialong termsteroids.
Themostimportantjobofaninstitutionalreviewboard(IRB)is:
A)Protectingtheinterestsofthehospitalortheresearchinstitution
B)Protectingtherightsofthehumansubjectswhoparticipateinresearchdoneatthe institution
C)Protectingtheresearcherandresearchteamfromlawsuits
D)Evaluatingresearchprotocolsandmethodologyforappropriatenessandsafety B) Protectingtherightsofthehumansubjectswhoparticipateinresearchdoneatthe institution
Everyresearchinstitutionhasaninstitutionalreviewboard(IRB)whosejobistoreviewall theresearchthatisconductedinthatinstitution.TheIRB'smostimportantroleisto protecttherightsofthehumansubjectswhoparticipateinresearchdoneattheinstitution ofwhichtheIRBisapart(e.g.,researchhospitals,universities).
WhatisthemostcommoncauseofinfertilityamongwomenintheUnitedStates?
A)Scarringofthefallopiantubesduetoahistoryofpelvicinflammatorydisease(PID)
B)Ovulationdisorders
C)Ageolderthan35years
D)Endometriosis B)Ovulationdisorders
Ovulationdisordersarethetopcauseoffemaleinfertility(25%).Thereisnoovulation (anovulation)orinfrequentovulationthatresultsinoligoamenorrhea(i.e.,PCOS).The secondcauseisendometriosis(15%).About10%ofwomenintheUnitedStates(ages15 to44years)havedifficultygettingpregnant(CDC,2009).PCOSisoneofthemostcommon causesoffemaleinfertility.Infertilityinmalesisoftencausedbyavaricocele(heatsupthe testes)andabnormaland/orlowspermcount.
A35 year oldmalepresentscomplainingoftheacuteonsetofepisodesofdizzinesswith nauseathatstartedafewdaysafterhegotoveracold.Thepatientdescribesitasthe sensationoftheroommovingoroftheroomspinning.Itisworsenedbysuddenhead movement.Duringtheepisodes,hegetsverynauseated.Healsohastinnituswithhearing lossinhisrightear.Thepatientisatype2diabeticandisonaprescriptionofmetformin 500mgPOBIDandanACEinhibitor.Thebloodglucoseduringthevisitis80mg/dL.Which ofthefollowingconditionsismostlikely?
A)Vasovagalpresyncopalepisode
B)Ménière'sdisease
C)Atypicalmigraine
D)Hypoglycemia B)Ménière'sdisease
TheclassictriadofsymptomsofMénière'sdiseasearevertigo,tinnitus,andhearingloss. Theconditioncanresolvespontaneouslyormaybechronic.BPVhassimilarsymptoms exceptthatitdoesnotcausehearingloss.Vertigoisduetothedysfunctionofthe labyrinthinesystem.Differentialdiagnosesaremany(Ménière's,acutelabyrinthitis, acousticneuroma,etc.).Vasovagalsyncopedoesnotcausehearinglossortinnitus,norisit episodic.
Allofthefollowingphysiologicchangesarepresentinthelungsoftheelderlyexcept:
A)Decreaseintheforcedexpiratoryvolume(FEV1)
B)Slightincreaseintheresidualvolume(RV)
C)Increaseinlungcompliance
D)Airwaystendtocollapseearlier(thanyoungpatients)withshallow breathing C)Increaseinlungcompliance
Thereisadecreaseinlungcomplianceaswegetolder;therefore,theFEV1alsodecreases. Thereisminimalchangeinthetotallungvolume.Airwaystendtocollapseearlier(than youngpatients)withshallowbreathing,whichincreasestheriskofpneumonia.
A50 year oldwomanofIrishdescentpresentswithhistoryoflethargy,feelingweak, nausea,anorexiawithdiarrheaandabdominalpain.Thewoman'sskinappearstanned,but shedeniesprolongedsunexposure.Duringphysicalexam,theskinappearstanwith hyperpigmentationofthenipplearea,thegums,andthelips.Theelectrolytepanelreveals hyperkalemiaandhyponatremia.Shereportscravingsaltyfoods.Whichofthefollowingis mostlikely?
A)Addison'sdisease
B)Cushing'sdisease
C)Metabolicsyndrome
D)Cutaneousdrugreaction A)Addison'sdisease
Addison'sdiseaseisalsoknownasprimaryadrenalinsufficiency.Themostcommoncause ofdamagetotheadrenalcortex(theouterlayerofthegland)isautoimmunedestruction. Theadrenalcortexproducesglucocorticoids(cortisol)andmineralocorticoids (aldosterone).Aldosteroneregulatessodiumretentionandpotassiumexcretionthrough thekidneys(affectsbloodpressure).Electrolyteabnormalitiesarehighpotassiumandlow sodium.Inprimarydisease(Addison's),serumcortisolislow,ACTHishigh,andserum aldosteroneislow.Ifthepatientisnottreated,severestress(illness,accident)maycause anadrenalcrisis("Addisonian"crisis),whichcanbefatal.
Anadultfemalepresentswithcomplaintsof"badburns"thatareverypainful.Alargepot ofboilingwatertippedoverandspilledonherarmsandheranteriorchestandabdomen. Duringthephysicalexam,thenursepractitionernoticesbrightredskinwithnumerous bullaeontheleftarmandhandandlargepatchesofbrightredskinontheanteriorchest andabdominalarea.Onapainscaleof1 10,shereportsthepainas9.Hervitalsignsare stablewithtachycardia(pulseis100/minute).Shedoesnotappeartobeinshock.Using theRuleofNines,whatisthetotalbodysurfacearea(TBSA)andthedepthoftheburnsin thispatient?
A)ThepatienthasaTBSAof15%withfull thicknessburnsoftheleftarmandlefthand, andpartial thicknessburnsoftheanteriorchestandabdominalarea
B)ThepatienthasaTBSAof20%withpartial thicknessburnsontheleftarm,lefthand, andmildburnsontheanteriorchestandabdominalarea
C)ThepatienthasaTBSAof27%withpartial thicknessburnsontheleftarmandlefthand withsuperficialburnsontheanteriorchestandabdominalarea
D)ThepatienthasaTBSAof18%withfull-thicknessburnsoftheleftarmandlefthand, andsuperficialburnsontheanteriorchest D)ThepatienthasaTBSAof18%withfull thicknessburnsoftheleftarmandlefthand,andsuperficialburnsontheanteriorchest
Somenursepractitionersbilldirectlyfortheirservices.Regardingreimbursement,whois consideredathird partypayer?
A)Thepatient
B)Thehealthcareprovider
C)Thehealthinsurancecompanies,healthplans,MedicareandMedicaid
D)Thefederalgovernment C)Thehealthinsurancecompanies,healthplans,Medicare andMedicaid
Third partypayersarehealthinsurancecompanies,healthplans(HMOorPPO),Medicare andMedicaid.The"firstparty"isthepatient.The"secondparty"isthehealthcareprovider
A14-year-oldisbroughtinbyhismotherwhoreportsthatherchildhasbeencomplaining forseveralmonthsofrecurrentbloating,stomachupset,andoccasionalloosestools.She reportsthathersonhasdifficultygainingweightandisshortforhisage.Shehasnoticed
thathissymptomsareworseaftereatinglargeamountsofcrackers,cookies,andbreads. Shedeniesseeingbloodinthechild'sstool.Whichofthefollowingconditionsismost likely?
A)Amebiasis
B)Malabsorption
C)Crohn'scolitis
D)Celiacdisease D)Celiacdisease
Celiacdiseaseisalsoknownasceliacsprue.Patientsshouldavoidfoodscontaininggluten, whichcausesmalabsorption(diarrhea,gas,bloat ing,abdominalpain,etc.).Foodstoavoid arewheat,rye,andbarley.Oatsdonotdamagethemucosainceliacdisease.AntigliadinIgA andIgGareelevatedinalmostallpatients(90%).
Whichofthefollowingpharmacologicagentsisthebestchoiceforanelderlypatientwith insomnia?
A)Diazepam(Valium)
B)Zolpidem(Ambien)
C)Temazepam(Restoril)
D)Diphenhydramine(Benadryl) B)Zolpidem(Ambien)
Ambienhasaquickonsetofaction(15minutes)andashorthalf lifeof2hours.Avoid diphenhydramineintheelderly,asthereisahigherincidenceofadverseeffects(confusion, prolongedsedation)inthispopulation.Avoidlong-actingbenzodiazepinessuchas diazepam(half life12hours)andtemazepam(half lifeof10hours).Hypnoticscanbeused PRNupto2weeks;otherwise,benzodiazepinescancauseaddictionandwithdrawal symptoms.
AnelderlyHispanicmalehasbeentakingfinasteride(Proscar)forseveralmonths.The nursepractitionerdecidestochecktheprostatespecificantigen(PSA).ThePSAresultis10 ng/mL.Thepatient'sbaselinePSAwas30ng/mL.Whichofthefollowingisthenextstep?
A)AddthebaselinePSAvaluetothetreatmentPSAvalue
B)ThetreatmentPSAvalueisthecorrectvalue
C)MultiplythetreatmentPSAvalueby2
D)DividethebaselinePSAvaluebythetreatmentPSAvalue C)Multiplythetreatment PSAvalueby2
BeforestartingaprescriptionofProscar,obtainthebaselinePSA.RecheckthePSAagain within2to3monthsduringtreatmenttoassessthepatient'sresponse(treatmentPSA).
Forthisexample,thecorrectedtreatmentPSAis20(multiply10x2=20).Whencom paringthecorrectedtreatmentPSA(20)withthebaselinePSA(30),thevalueislower
(meanstheprostatehasshrunkinsize).Thepatient'ssymptomswillalsoimprove, includinglessnocturia,lessdribbling,andstrongerurinarystream.
AnadultpatientisbeingevaluatedfortuberculosisinfectionwithaMantouxtest.ThePPD resultis10.5mm.Thepatientdeniesweightloss,cough,andnightsweatsandhasa negativechestx ray.ThepatientreportsthatheisintheUnitedStatesillegallyandis fearfulaboutdiscovery.Whatisthemostappropriateactionforthenursepractitioner?
A)Thepatientisanillegalalien/migrantandthenursepractitionerhasthelegaldutyto reportthepatienttothelocalStateDepartmentresponsibleforillegalmigrants
B)Healthcareworkersarelegallymandatedtoreportillegalmigrantstostateauthorities.
C)Thenursepractitionershouldcallthestatehealthdepartmentandreportthatthe patienthasaTBinfection
D)Nursepractitionershavetheethicaldutytoprovidequalityhealthcaretopatients-D) Nursepractitionershavetheethicaldutytoprovidequalityhealthcaretopatients
Currently,healthcaregiversarenotlegallyrequiredtoreportillegalalienstothestateor localauthorities.ThispatientdoesnothavethesignsandsymptomsofactiveTBdisease (cough,weightloss,nightsweats)andhasanegativechestx ray.Therefore,hehaslatent TBinfectionandisnotcontagious.OnlypatientswithactiveTBdisease(has signs/symptoms)mustbereportedtothestatepublichealthdepartment.
CandidalintertrigoisthenameforaninfectionthatiscausedbytheyeastCandidaalbicans. Whatisthelocationofthistypeofcandidainfection?
A)Thescalp
B)Theflexorareasoftheelbowsandtheknees
C)Theareasofthebodywhereskinisrubbingtogether,suchasunderthebreastorinthe groinarea
D)Thehands-C)Theareasofthebodywhereskinisrubbingtogether,suchasunderthe breastorinthegroinarea
Candidalintertrigoinfectionsaremorecommonintheobeseandinwomenwith pendulousbreasts.Itisfoundinareaswhereskinrubsagainstskin(underbreasts,inthe groinarea,andonstomachfoldsintheobese).Itismorecommoninwarmandhumid weather(summer).
Anursepractitioneristeachinga54-year-oldwomanwithstressurinaryincontinence aboutKegelexercises.Thepatientisinstructedtotightenherpelvicfloormusclesfora countof10andthentorelaxthemforacountof10.Thenursepractitionerinstructsthe patientthatKegelexercisesshouldbedoneconsistentlyeverydayatwhatfrequency?
A)Perform30exerciseseachtimeinthemorningandtheevening
B)Perform20exerciseseachtime2timesaday
C)Perform15exerciseseachtime3to4timesaday
D)Perform10exerciseseachtime3timesaday
D)Perform10exerciseseachtime3 timesaday
Weakpelvicfloormusclesincreasetheriskofurinaryandfecalincontinence.Educatea femalepatientthatthepelvicfloormusclesaretheonesthatsheuseswhenshe consciouslyholds/stopstheflowofurinewhensheurinates.Warnherthattheanal sphincterwillalsotightenwiththevaginalmuscles.Advisethepatienttorelaxthe abdomenandthethighswhendoingtheexercises.Kegelexercisesarealsorecommended asconservativetreatmentforpatients(maleandfemale)withfecalincontinence.
A19 year oldstudentwhoisonaprescriptionofTriphasilisbeingseenforanannual gynecologicexaminthecollegehealthcenter.ThenursepractitionerhasobtainedthePap smearandisabouttoperformthebimanualexam.Shegentlyremovestheplasticspeculum fromthevagina.WhiletheNPisperformingthebimanualvaginalexam,thepatient complainsofslightdiscomfortduringdeeppalpationoftheovaries.Whichofthefollowing isatruestatement?
A)Theuterusandtheovariesarebothverysensitivetoanytypeofpalpation
B)Thefallopiantubesandovariesarenotsensitivetolightordeeppalpation
C)Theovariesaresensitivetodeeppalpationbuttheyshouldnotbepainful
D)Theuterusandtheovariesarenotimportantorgansofreproduction C)Theovaries aresensitivetodeeppalpationbuttheyshouldnotbepainful
Theovariesareusuallyslightlysensitivetodeeppalpation,buttheyshouldnotbepainful. Unilateraladnexalpainaccompaniedbycervicalmotiontendernessandpurulent endocervicaldischargeissuggestiveofPID.
AllofthefollowingstatementsaboutcommonhealthbeliefsofmanytraditionalAsian culturesaretrueexcept:
A)Animbalanceofthehotandcold(yin/yang)vitalforcescancauseillness,andtreatinga hotdiseasewitha"cold"treatment(i.e.,certainfoods/herbs)canhelptorestorebalance andcuretheillness
B)Ifthepatientisveryillordying,immediatefamilyandextendedfamilymemberswill visitthepatientdailyin"shifts"toprovideemotionalsupport
C)Babiesandsmallchildrenmaywearanamuletsuchasaredstringonthewristora pieceofclothontheneckorthewrist
D)Surgicalproceduresareregardedasimportanttreatmentformanyillnesses-D) Surgicalproceduresareregardedasimportanttreatmentformanyillnesses
TheVietnameseregardsurgeryasalastresortandconsiderlossofbloodasdepletingthe vitalforcesofthebodyandcausingillness.Westernmedicineisconsidered"hot,"and patientsmaydiscontinueorreducethedosesoftheirmedicinewithoutasking.An
imbalanceofthehotandcold(yin/yang)isbelievedtocauseillness.Treatinga"yin" disease(commoncold)meansavoidingeatingyinfoods(melons,cucumbers)becausethey willworsenit.Instead,yindiseasesaretreatedwithyangfoods(meat,spicyfoods)sothat thebodybecomesmorebalanced.Ifthepatientisveryillordying,immediatefamilyand extendedfamilymemberswillvisitthepatientdailyin"shifts"toprovideemotional support.Babiesandsmallchildrenmaywearanamuletsuchasaredstringonthewristor apieceofcloththattiesontheneckorthewrist.
A45 year oldgardenerisseenasawalk inpatientinaprivateclinic.Hereportsstepping onanailthatmorning.Hislasttetanusvaccinewas7yearsago.Whichofthefollowing vaccinesisrecommended?
A)DTaP
B)DT C)Td
D)Tdap D)Tdap
TheCDCrecommendsthat1ofthetetanusboostersbereplacedwiththeTdap(onceina lifetime).Thereafter,theTdformofthevaccineisindicatedevery10years.TheDTaP (diphtheria tetanus acellullarpertussis)andDT(diphtheria tetanus)formsofthetetanus vaccinearenotgivenaftertheageof7years.Puncturewoundsareathigherriskfor tetanusbecauseClostridiumtetanibacteriaareanaerobes(deeppuncturewoundsarenot exposedtoaircomparedwithsuperficialwounds).
Acanthosisnigricansisassociatedwithallofthefollowingdisordersexcept:
A)Obesity
B)Diabetes
C)Coloncancer
D)Tineaversicolor-D)Tineaversicolor
Acanthosisnigricansisabenignskincondition.Itappearsashyperpigmentedvelvetyareas ofskinthatareusuallylocatedontheneckandtheaxillae.Itisasignofinsulinresistance. Itisrarelyassociatedwithsometypesofadenocarcinomaofthegastrointestinaltract. Tineaversicolorisasuperficialinfectionoftheskin(stratumcorneumlayer)thatiscaused bydermatophytes(fungi)ofthetineafamily.Anothernameforitis"sunspots."
TheNPsuspectsthatamiddle-agedwomanmayhavesystemiclupuserythematosus(SLE). Whichofthefollowinglaboratorytestsisstronglyassociatedwiththisdisease?
A)Sedimentationrate
B)C-reactiveprotein
C)Antinuclearantibody(ANA)
D)Systemiclupuserythematosus(SLE) C)Antinuclearantibody(ANA)
TheANAisusuallypositiveinlupuspatients. Othertypesofautoantibodytestingrecommendedforthesepatients,inadditionto antinuclearantibody(ANA)tests,areantiphospholipidantibodies,antibodiestodoublestrandedDNA,andanti Smith(Sm)antibodies.Patientwithsuspected lupusshouldbereferredtoarheumatologist.ThesedimentationrateandtheC reactive proteinarenonspecificfindingsofinflammationandarepresentinautoimmunediseases, infections,andothers.
AnelderlyHmong,whoisfromThailand,isseenbythenursepractitionerforafollow up visit.Heisaccompaniedbyhiseldestdaughter.Thepatientpresented6weeksagowith complaintsoftherecentonsetofmorningheadaches.Thepatientwasdiagnosedwith Stage2hypertensionandprescribedhydrochlorothiazide,125mgtabletonceaday.On thisvisit,Mr.Nguyentellsthenursepractitionerthatthenewmedicinecuredtheheadache andhestoppedtakingthemedicine.Whatisthebestplantofollowduringthisvisit?
A)Educatethepatientabouthypertension,howthemedicineworksonhisbody,andthe importanceoftakinghispilldaily
B)Reassurethepatientthathecanresumehisprescriptionmedicineagainthenext morning
C)Tellthepatientthatyouwilllowerthedoseofthehydrochlorothiazideto12.5mgdaily
D)Speaktothepatientinaloudvoiceandconfronthimabouthisbehavior A)Educatethe patientabouthypertension,howthemedicineworksonhisbody,andtheimportanceof takinghispilldaily
WhenHmong(Thailand,Burma,Vietnamese)seeamedicaldoctorforasymptom,they expecttobetreatedand"cured"oftheirillness.Whenthesymptomsdisappear,manywill stoptakingthe medicine.Whenmedicationistobetakenonalong-termbasis,itisimportanttoeducate thepatient(andthepatient'sfamily)aboutthedisease(i.e.,hypertension),howthe medicineworksonthebody,andthereasonwhyhehastotakehismedicinedaily.Hmong andVietnameseareverypoliteandconsiderspeakinginaloudvoice,staring,or confrontationtoberudebehavior.
A68 year oldwomanhasrecentlybeendiagnosedwithpolymyalgiarheumatica.Thenurse practitionerisdiscussingthetreatmentoptionswiththepatient.Whichofthefollowing medicationsisthefirst linetreatmentforthiscondition?
A)Etanercept(Enbrel)
B)Oralprednisone
C)Indomethacin
D)Methotrexate-B)Oralprednisone
PatientswithPMRaretreatedwithoralsteroids(glucocorticoids).Oneofthehallmarksof thedisorderisthedramaticimprovementof symptomsafterstartingtreatmentwithoralprednisone.Usually,thesymptomscanbe controlledwithlong term(2 3years)low doseoralprednisone,whichcanbetapered whensymptomsareundercontrol.Formostpatients,PMRisaself-limitingillness(froma fewmonthsto3years).
Whichofthefollowingisatruestatementregardingthefirst passmetabolismprocess?
A)Drugsthatareadministeredbyintramuscularinjectionallgothroughtheprocessof first passmetabolism
B)Afterbeingswallowed,oraldrugsareabsorbedbytheGItractandmetabolizedbythe bacteriainthesmallintestinesbeforebeingreleasedintothegeneralcirculation
C)Drugsadministeredthroughtheskin(patches)aremetabolizedbythedermisofthe skin
D)Afteradrugistakenbytheoralroute,itisabsorbedinthesmallintestinesandenters theliverthroughtheportalcirculation,whereitismetabolizedbeforebeingreleasedinto thegeneralcirculation-D)Afteradrugistakenbytheoralroute,itisabsorbedinthesmall intestinesandenterstheliverthroughtheportalcirculation,whereitismetabolizedbefore beingreleasedintothegeneralcirculation
Afterdrugsaretakenbytheoralroute,theyareabsorbedbythesmallintestinesandenter theliverthroughtheportalcirculation,wheretheyaremetabolizedbeforebeingreleased intothe generalcirculation.First-passmetabolism(first-passeffect)determineshowmuchofthe activedrugisavailabletothebody(bioavailability).Dependingonthedrugandother factors,adrugmaybepoorlymetabolizedorextensivelymetabolizedbytheliver.
Thenursepractitionerordersanankle-brachialindex(ABI)testforapatient.Whichofthe followingdisordersistheABItestusedfor?
A)Venousinsufficiency
B)Osteoarthritisofthearmortheankle
C)Peripheralarterialdisease(PAD)
D)Rheumatoidarthritis
C)Peripheralarterialdisease(PAD)
Theankle-brachialindex(ABI)isatestthatisusedtostratifytheseverityofarterial blockageinthelowerextremitiesforpatientswithperipheralarterialdisease(PAD).An ABIscoreof1.0to1.4is normal.Anyvaluelessthan1.0isabnormal.Ascoreof0.5orlessisindicativeofsevere PAD.
Acollegestudentisseenasawalk inappointmentinacollegehealthclinic.Shecomplains oftheabruptonsetofsorethroat,nasalcongestion,runnynose,andmalaise.Vitalsignsare atemperatureof99.8degreesFahrenheit,pulse84,andrespiratoryrate14 breaths/minute.Thephysicalexamrevealsanerythematousthroat,swollennasal turbinates,andrhinitis.TheNPsuspectsviralURI.Allofthefollowingtreatmentsare appropriateexcept:
A)Salinenasalspray(Oceannasalspray)
B)Pseudoephedrine(Sudafed)
C)Ibuprofen(Advil)
D)Oralprednisone(MedrolDosePack) D)Oralprednisone(MedrolDosePack)
SymptomatictreatmentforviralURIaresalinenasalsprays(Oceanspray),decongestants (pseudoephedrine),NSAIDs(Advil),increasedfluidintake,andalternativeherbalremedies (echinachea, astralagus,elderberrysyrup,highdosesofVitaminC).
Allofthefollowingfoodsarebestavoidedbyindividualswithceliacsprueexcept:
A)Ricecereal
B)Blueberrymuffins
C)Organicwheatbread
D)Ryebread A)Ricecereal
Patientscaneatanyfoodexceptthosethatcontaintheproteingluten.Foodscontaining wheat,barley,andryeshouldbeavoided.
MedicarePartAwillpayforallofthefollowingservicesexcept:
A)Minorsurgeryinawalk insurgicalcenter
B)Plasticsurgerytorepairfacialdamagefromaburn
C)Kidneytransplantation
D)Medicalsuppliesanddrugsthatareusedwhilethepatientisinthehospital A)Minor surgeryinawalk insurgicalcenter
MedicarePartAwillpayformedicallynecessaryinpatientcareandsupplies.Therefore, anytypeofsurgerythatisdoneinoutpatientsettingssuchasawalk insurgicalcenterwill notbereimbursed.Ifplasticsurgeryismedicallynecessary(i.e.,plasticsurgerytorepair facialdamagefromaburn),thenitwillbereimbursed.Costsfororgantransplantation suchaskidneytransplantsarereimbursed.
A16 year oldmalewitharecenthistoryofacatbiteisbroughtinbyhisfather.Thebite occurredabout2hoursbeforethevisit.Thenursepractitionerevaluatesthewoundand notes2smallpuncturewounds.Thereisnorednessorpurulentdischarge.Thefather reportsthattheteenagerreceivedatetanusboosterwhenhewas12yearsold.Whichof thefollowingisthecorrectactiontotake?
A)Cleanthewoundwithsoapandwaterandapplytopicalantibioticandabandage
B)Becausethewoundiscleananddoesnotappearinfected,thereisnoneedforantibiotics
C)GivethepatientatetanusboosterusingtheTdapformofthevaccine
D)CleanthewoundwithsoapandwaterandprescribeAugmentin500mgPOBIDx10 daysforthepatient D)CleanthewoundwithsoapandwaterandprescribeAugmentin 500mgPOBIDx10daysforthepatient
Catwoundsaremorelikelytobecomeinfectedcomparedwithdogbites;inaddition,this patient'sbiteislocatedonanextremity.ThesefactsjustifytheprescriptionofAugmentin 500mgPOBIDx10 daysforthepatient.
A15 year oldWhitemaleisbroughtinbyhisfatherforaphysicalexam.Heisconcerned thathissonis"tooshort"forhisage.Thefatherreportsthatwhenhewasthesameage,he wasmuchtaller.Hissonwantstotryoutforthefootballteam,butthefatherisconcerned becausehissonmightbe"tooshort"tojoin.Whichofthefollow ingphysicalexamfindings isworrisome?
A)Smallsmoothtesticleswithnopubicorfacialhair
B)Smoothtesticleswithrugatedscrotumthatisadarkercolorthanhisnormalskincolor
C)Smoothtesticleswithcoarseandcurlypubichair
D)Straightpubicandaxillaryhairwithalongthinpenis
A)Smallsmoothtesticleswithno pubicorfacialhair
Small,smoothtesticleswithnopubicorfacialhair(TannerStageI)isaworrisomefinding attheageof14yearsbecauseitsignifiesthattheboyisnotinthepubertalstageyet.The averageageofonsetofpubertyamongboysis12years(range10to14years).The maximumgrowthspurtinboysoccursabout2yearsaftertheonsetofpuberty.Boysstart about1yearlaterthangirlsandcontinue togrowuntiltheirearly20s(college).
Researchnomenclatureassignswhichofthefollowingsymbolstoindicateasubpopulationorasubgroupwithinthetotalpopulation?
A)Thesymbol"n="
B)Thesymbol"N="
C)Thesymbol"p="
D)Thesymbol"P=" A)Thesymbol"n="
Thecorrectsymboltoindicateasubpopulationofasampleisthesmallletter"n."For example,ifaresearchstudyhasatotalpopulationof100(N=100),butitisdividedinto2 equalgroups,theneachgrouphas50subjects(n=50foreachgroup)
A17 year oldhighschoolstudentisconsideringherbirthcontroloptions.Shewantsto knowmoreaboutSeasonale.Whichofthefollowingstatementsisfalse?
A)TakingSeasonaleresultsinonly4periodsperyear
B)Herperiodwilloccurwithinthe7dayswhensheisontheinertpills
C)Itisaprogesterone onlymethodofbirthcontrolanddoesnotcontainestrogen
D)Take1tabletdailyfor84consecutivedaysfollowedby7daysofinertpills C)Itisa progesterone-onlymethodofbirthcontrolanddoesnotcontainestrogen
Seasonaleisanextended cycleformofbirthcontrol.Itcontainsbothlevonorgestreland ethinylestradiol.Thereare84pinktablets(active)and7whitepills(inert).Ingeneral, morespotting(breakthroughbleeding)isexperienced withextended cyclepillsduringthefirstfewmonthsofuse(comparedwiththemonthly birthcontrolpills).
Whichofthefollowingdiseasesisassociatedwithahighriskofgiantcellarteritis?
A)Historyoftransientischemiaattacks(TIA)
B)Frequentmigraineheadacheswithfocalneurologicfindings
C)Polymyalgiarheumatica
D)Systemiclupuserythematosus(SLE) C)Polymyalgiarheumatica
Giantcellarteritis(alsoknownastemporalarteritis)ismorecommonamongpatientswith PMR.Itcancausepermanentblindnessifitisnottreated.PMRpatientsaretaughthowto recognizeit.Thequickonsetofvisionlossinoneeye,accompaniedbyatenderindurated arteryandscalptendernessonthesameside,areclassicsymptoms.Thescreening testisthesedimentationrateandC reactiveproteintest.Bothwillbemarkedlyelevated.
Whichofthefollowingisagoodexampleofhowthe"utilitarian"principleisapplied?
A)Helpingapatientdecidethetypeoftreatmentthathe/shewants
B)Usinglimitedsocietalfinancialresourcesonprogramsthatwillpositivelyaffectthe largestnumberofpeoplepossibleandhavethelowestpossiblenegativeoutcomes
C)Minimizethebadoutcomewhenchoosingtreatmentchoicesforapatient
D)Healthcaregiversshouldbemorecarefulwhenusinghealthcarefinancialresources B) Usinglimitedsocietalfinancialresourcesonprogramsthatwillpositivelyaffectthelargest numberofpeoplepossibleandhavethelowestpossiblenegativeoutcomes
Generally,theutilitarianprinciplereferstosocietalprogramsthatwillaffectorbenefitthe largestnumberofpeopleinapositivemanner.Itisnot usedtorefertoanindividualortooneperson.
Allofthefollowingclinicalfindingsareclassifiedasmajorcriteriathatarenecessaryto diagnosepelvicinflammatorydisease(PID).Whichofthefollowingisclassifiedasaminor criterion?
A)Cervicalmotiontenderness
B)Adnexaltenderness
C)Uterinetenderness
D)Oraltemperatureofmorethan101°F(morethan38°C) D)Oraltemperatureofmore than101°F(morethan38°C)
PIDisaclinicaldiagnosis.Thepresenceofatleast1ofthemajorcriteria(cervicalmotion tenderness, adnexaltenderness,uterinetenderness)whencombinedwiththehistoryishighly suggestiveofPID.Minorcriteriaarenotnecessary,buttheyhelptosupportthediagnosis ofPID(oraltemperatureofmorethan101°Formorethan38°C),mucopurulentcervicalor vaginaldischarge,elevatedsedimentationrate,elevatedC reactiveprotein,largeamountof WBCsonsalinemicroscopyofthevaginalfluid,orlaboratorydocumentationofcervical infectionwithN.gonorrhoeaeorC. trachomatis).
Whatstructureoftheeyeisresponsiblefor20/20vision(sharpestvision)?
A)Rods
B)Cones
C)Opticdisc
D)Foveaofthemacula D)Foveaofthemacula
Thefoveaislocatedonthecenterofthemaculaandisresponsibleforthesharpestvision ("20/20vision")intheeyes.Onthefovea,theonlyreceptorsarethecones,whichallowus toseethingsincolorandindetail.Themaculaisresponsibleforcentralvision.
Annursepractitioner,whoisarecentgraduate,isaskinganexperiencednurse practitioner'sopinionaboutmanagingapatientwhohasmultiplehealthproblems.What typeofrelationshipexistsbetweenthenursepractitioners?
A)Collaborativerelationship
B)Consultativerelationship
C)Referralrelationship
D)Formalrelationship B)Consultativerelationship
Aconsultativerelationshipisaninformalprocessbetweentwoormoreproviderswho exchangeinformationaboutapatientoccasionally.
A15-year-oldfemalewhoattendsapublicschoolisreferredtothenursepractitionerby oneofherteachers.Theteenhasbeenmissingschoolandisfallingbehindinher schoolwork.Afterclosingtheexamroomdoor,thenursepractitionerstartstointerview theteen,askingabouthermoods,herappetite,hersleep,whethersheanyplanofhurting herselforothers,andotherquestions.Whatisthelevelofhealthpreventionthatthenurse practitionerisperforming?
A)Primaryprevention
B)Secondaryprevention
C)Tertiaryprevention
D)Dropoutpreventionprogram B)Secondaryprevention
Thenursepractitionerisevaluatingtheteenagerfor majordepression.Becausetheteenageralreadyhasthedisease(depression),itisa screening"test."Allscreeningtests/labs(mammography,Papsmears,etc.)are secondarypreventionactivities.
Allofthefollowingsignsandsymptomsarepresentwithananticholinergicdrugoverdose except:
A)Dilatedpupils
B)Flushingandtachycardia
C)Hypertension
D)Confusion C)Hypertension
Drugswithstronganticholinergicpropertiesincludediphenhydramine,scopolamine,TCAs, antipsychotics,andothers.Themnemonicis "dryasabone,redasabeet,madasahatter,blindasabat."Lookforalow grade temperature.
Awomanwhoisinthethirdtrimesterofpregnancypresentstothenursepractitionerfora physicalexam.Duringthephysicalexam,thenursepractitionerfindsallofthefollowing cardiacchangesassociatedwithpregnancyexcept:
A)Systolicejectionmurmur
B)Diastolicmurmur
C)Displacedapicalimpulse
D)LouderS1andS2-B)Diastolicmurmur
Diastolicmurmursaremorelikelytobepathologic.Theheartisdisplacedinamore transversepositionthatislateraltothemidclavicularline.Thesystolicejectionmurmuris duetoincreasedstrokevolumecausedbyincreasedcardiacoutputandhigherbasalheart rate.
An80 year oldmalewithhypertensionandhyperlipidemiapresentswithcomplaintsof thequickonsetofseverelowbackpainthatisaccompaniedbyabdominalpainwhichis graduallyworsening.Thepatientappearspaleandcomplainsthathedoesnotfeelwell.
Duringtheabdominalexam,thenursepractitionerdetectsasoftpulsatilemassjustabove theumbilicusasshepalpatesthisareawithherhand.Whichofthefollowingconditionsis mostlikely?
A)Abdominalaorticaneurysm
B)Caudaequinasyndrome
C)Acutediverticulitis
D)Adenocarcinomaofthecolon A)Abdominalaorticaneurysm
Elderlymaleswhoareex-smokersareathigher riskforabdominalaorticaneurysm.Itisusuallyasymptomaticandisdiscovered incidentallyduringaroutinechestx rayorabdominalultrasound.Althoughsmall aneurysmsareusuallynotdetectableduringabdominalexams,thelargeraneurysmsmay bepalpableduringanabdominalexam,butabdominalobesitywillobscurethefindings. Thesymptomsinthiscasepointtowardarapidlydissectinganeurysm.Thebestactionin thiscaseistocall911stat.
Whatisthepedigreesymbolforadiseasedoraffectedfemale?
A)Anemptysquare
B)Anemptycircle
C)Afilled insquare
D)Afilled-incircle-D)Afilled-incircle
Afilled incircleisadiseased/affectedfemaleandanemptycircleisahealthyfemale.Atip torememberisthatfemalesmakeeggs(orfollicles), whichresembleacircle.Bydefault,thesquaresymbolisthemale.
Thegold standardtestforvisualizingatornmeniscusorjointabnormalitiesisthe:
A)Computedtomography(CT)scan
B)Magneticresonanceimaging(MRI)scan
C)X raywithspecialviewsoftheaffectedknee
D)Lachman'smaneuver B)Magneticresonanceimaging
(MRI)scanMRIprovidesgoodvisualization
ofsofttissuesofthebody(mostcancers,brain,cartilage,muscles,inflammation,etc.).Itis bestusedintissueswithhighwatercontent.Patientswithmetalimplantssuchascochlear implantsandcardiacpacemakersshouldbecarefullyscreened. TheMRIdoesnotuseradiation,butusesstrongmagneticandradiowavestovisualize bodystructures.
WhatisthebestdescriptionofCullen'ssign?
A)Theonsetofhyperactivebowelsoundbeforetheonsetofileus
B)Areddish purplediscolorationthatislocatedontheflankarea
C)Abluishdiscolorationorbruisingthatislocatedontheumbilicalarea
D)Theacute onsetsubcutaneousbleedingseenduringacutepancreatitis C)Abluish discolorationorbruisingthatislocatedontheumbilicalarea
Cullen'ssignistheacuteonsetofbluishdiscolorationthatislocatedonthe umbilical/periumbilicalarea;itiscausedbybruisingunderneaththeskin.Thebluish discolorationthatislocatedontheflankareaiscalledtheGrey-Turnersign.Itisasignofa severecaseofpancreatitis.
Glucosaminesulfateisanaturalsupplementthatisusedforwhichofthefollowing conditions?
A)Rheumatoidarthritis
B)Osteoarthritis
C)Osteoporosis
D)Metabolicsyndrome-B)Osteoarthritis
Glucosaminesulfatehasbeenfoundtohaveabeneficialeffectoncartilagegrowthand repair.Itmayalsohaveananti-inflammatoryeffect.Many patientswithOAwhotakeitclaimthatithelpstorelievejointpain.Itcantakefrom1to3 monthsoftakingthemedicinetofeelitseffects.Glucosamineisacompoundmadeupof glucoseandanaminoacid.
Acharitablefoundationplanstobuildacommunityyouthcenterinalargeurbanareawith ahistoryofgangviolence.Whattypeofhealthpreventionactivityisbeingdoneinthis area?
A)Primaryprevention
B)Secondaryprevention
C)Tertiaryprevention
D)Healthprevention
A)Primaryprevention
Acommunityyouthcenterwithgoodstaffingcanbeaneffectivemethodofdrawingthe childrenoutofthestreetsintoasaferenvironment.Itcanreducetheriskofchildren becomingvictimsofgangviolence.Inaddition,staffmemberscanserveasrolemodelsor mentorsfortheolderchildren.
ThebacilleCalmette Guerin(BCG)vaccineisusedtoimmunizeapersonagainstwhichof thefollowing?
A)Enterobiasis
B)Tuberculosis
C)Anthrax
D)Smallpox B)Tuberculosis
TheBCGvaccineisgivenroutinelyinsomecountrieswheretuberculosisisendemic(or epidemic).OneofthefewexceptionsfortheBCGvaccineintheUnitedStatesisforhealth careworkerswhoseeahighpercentageofpatientswhoareinfectedwithM.tuberculosis strainsresistanttobothisoniazidandrifampin.BCGisconsideredabiohazardousmaterial (U.S.BlackBoxWarning)andproperhandlinganddisposalmustbefollowed.
An13 year oldgirlisbroughtinbythemotherbecauseherdaughteriscomplainingof vaginaldischargeandpain.Themothertellsthenursepractitionerthatherdaughterisnot sexuallyactiveyet.Themotherisdivorcedandliveswithherboy friendandworksfull time.Duringtheexam,thenursepractitionernotesthatthevaginalintroitusisred,with tearsandatornhymen.Thecervixiscoveredwithgreendischarge.Thenursepractitioner suspectsthatthechildhasbeensexuallyabusedbythemother'sboyfriend.Whatisthe bestactionforthenursepractitionertotake?
A)Askthemotherquestionsaboutherboyfriend'sbehaviors
B)Advisethemothertowatchhowherboyfriendinteractswithherdaughterandtocall within1weektodiscusshisbehaviorwithher
C)Advisethemotherthatyoususpectthatherdaughterhasbeensexuallyabusedandthat sheislegallyrequiredtoreportthecasetothechildprotectionprogram
D)Reportthechildabusetothelocalpolicedepartment C)Advisethemotherthatyou suspectthatherdaughterhasbeensexuallyabusedandthatsheislegallyrequiredto reportthecasetothechildprotectionprogram
TheNPislegallyrequiredtoreportthecasetothechildprotectionprogram.Ifthechildis indanger,childprotectiveservicesmayaskforacourt ordertotakethechildawayforprotectionuntiltheinvestigationiscompleted.Talking abouttheboyfriend'sbehaviorwillnotbeeffectiveandmayputthechildand/ormotherin dangeriftheboyfriendsuspectsthatheisbeingwatched.
A75 year oldwomanpresentscomplainingofasoftlumponherabdomenthatislocated ontheperiumbilicalarea.Shetellsthenursepractitionerthatshedoesnotknowhowlong
shehashadthelumporwhetherithaschangedinsizeorshape.Shedeniesabdominal pain,problemswithdefecation,lossofappetite,weightloss,ortrauma.Whenperforming anabdominalexam,whatisthebestmethodtodifferentiatebetweenanabdominalwall massandanintra abdominalmass?
A)Palpatetheabdominalwallwhilethepatientisrelaxed
B)Instructthepatienttoliftherheadoffthetablewhiletensingherabdominalmusclesto visualizeanymassesandthenpalpatetheabdominalwall
C)Instructthepatienttoliestillforfewsecondswhileyoupalpatetheabdominalwall
D)Palpatetheabdomendeeply,thenreleasethepalpatinghandquickly B)Instructthe patienttoliftherheadoffthetablewhiletensingherabdominalmusclestovisualizeany massesandthenpalpatetheabdominalwall
Anabdominalwallmasswillbecomemoreprominentwhentheabdominalwallmuscles aretense.Ifitisanintra abdominalmass,itwillbepresseddownbythemusclesandwill becomelessobviousordisappear.Someofthemostcommon abdominalwallmassesarehernias(epigastric,umbilical,incisional).Thispatienthada periumbilicalhernia(softlumponherabdomenthatislocatedontheperiumbilicalarea thatispainless).
Whichofthefollowingstructuresoftheeyesisresponsibleforcolorvision?
A)Rods
B)Macula
C)Cones
D)Pupils-C)Cones
Rodsandconesarephotoreceptorcellsoftheretina.Theconesoftheeyesareresponsible forcolorvision.Conesareverysensitivetocolors(red,blue,orgreen)andworkbetterin brighterlight.Rodsaregoodfornightvisionandforvisioninlowlightconditionsbecause theyaresensitivetolightanddark.Torememberthem,notethatbothconeandcolorstart withtheletter"C."
Anewpatientisbeinginterviewedbythenursepractitioner.Thepatientreportsthatshe hadagastrectomyprocedure5yearsagototreatsevereobesity.Currently,herBMIis25 andthepatientdeniescomplicationsfromtheprocedure.Thenursepractitionerisaware thatthepatientisathigherriskforwhichofthefollowingdisorders?
A)Folatedeficiencyanemia
B)B12 deficiencyanemia
C)Iron deficiencyanemia
D)Normocyticanemia-B)B12-deficiencyanemia
Intrinsicfactorismadebytheparietalcells,which arelocatedonthefundusofthestomach.Intrinsicfactorisneededtoeffectivelyabsorb VitaminB12(dairy,meat).Becausethegastricfundusisdamagedinthesepatients,they areathigherriskofB12 deficiencyanemia(MCVgreaterthan100).
Whatisthemostcommontypeofskincancer?
A)Basalcellskincancer
B)Squamouscellskincancer
C)Melanoma
D)Actinickeratose A)Basalcellskincancer
Skincanceristhemostcommontypeofcanceroverall,butthemostcommontypeofskin cancerisbasalcellcarcinomaoftheskin.Regardingmortality,theskincancerthatcauses themostdeaths(fromskincancer)ismelanomas(65%ofskincancerdeaths).
Whatisthemedian?
A)Itisthenumberthatoccursthemostfrequently
B)Itisthemiddlenumberinagroupofnumbers
C)Itistheaveragenumberinagroupofnumbers
D)Itameasureofcentraltendency B)Itisthemiddlenumberinagroupofnumbers
Themedianisthemiddlescoreofagroupofnumbers.Forexample,forthisgroupof numbers(2,3,6,7,7,8,10),thenumber"7"isthemedianvalue.
Grey Turner'ssignishighlysuggestiveofwhichofthefollowingconditions?
A)Acutepancreatitis
B)Acuteappendicitis
C)Acutediverticulitis
D)Gastriccancer A)Acutepancreatitis
Grey Turner'ssignistheacuteonsetofbluishdiscolorationlocatedontheflankareathatis causedbybruising.Itisusuallyassociated withsevereacutepancreatitis,butitcanalsobefoundinsomecasesofrupturedectopic pregnancy.
Anursepractitioneriswritingareferralforamiddle ageddiabeticwhohasanA1cof8.5% despitebeingon3antidiabeticmedications.Sheisreferringthepatienttoan endocrinologist.Whattypeofrelationshipexistsbetweenthenursepractitionerandthe endocrinologist?
A)Consultativerelationship
B)Collaborativerelationship
C)Referralrelationship
D)Formalrelationship B)Collaborativerelationship
Acollaborativerelationshipisaformalprocessof sharingresponsibilityfortreatingapatienttogether(sharingprogressreports);for example,referringapatienttoaspecialistorforrehabilitation.
Whichbacteriumisthemostcommonpathogenseeninotitisexternainfections?
A)Pseudomonasaeroginosa
B)Streptococcuspyogenes
C)Haemophilusinfluenza
D)Moraxellacatarrhalis A)Pseudomonasaeroginosa
ThemostcommonbacteriumisPseudomonas.The secondmostcommonbacteriumisStaphylococcusaureas.Polymyxinandneomycin combinationeardrops(Cortisporin)arethefirst linetreatmentforotitisexterna.Other eardropsthatarealsoeffectivearethequinoloneeardrops(ofloxacin,ciprofloxacin topicaldrops).
ThePatientProtectionandAffordableCareActisPresidentObama'splanfornational insurancecoverage.Allofthefollowingaretruestatementsaboutthislawexcept:
A)Preexistinghealthconditionswillbecoveredimmediately
B)Thehealthplanwillstarttobeeffectiveintheyear2013
C)Youngadultsuptotheageof26yearswholivewiththeirparentswillbecoveredunder theirparents'healthinsuranceplan
D)Thehealthinsuranceplanmandateswillfineemployerswhochoosenottoparticipate inthenationalhealthinsuranceplan B)Thehealthplanwillstarttobeeffectiveinthe year2013
PresidentObama'snationalhealthinsuranceplanisknownthe"PatientProtectionand Affordable CareAct."Itcoverspreexistinghealthconditionsimmediatelyandprohibitsaninsurance companyfromrejectingpeoplewithpreexistinghealthconditions.Thereisapenaltyfor employers(andindividuals)whochoosenottoparticipate inthenationalhealthplan.
Allofthefollowingareconsideredinstrumentalactivitiesofdailyliving(IADLs)except:
A)Groceryshopping
B)Managingone'sfinances
C)Groomingandhygiene
D)Usingatelephoneandacomputer C)Groomingandhygiene
Groomingandhygieneareclassifiedasbasicactivitiesofdailyliving(ADLs).Grocery shopping,payingbills,usingtelephones,anddrivingacarareallIADLs.
TheRinneandtheWebertestsareusedtoassesswhichofthefollowingcranialnerve(s)?
A)Cranialnerves3,4,and6
B)Cranialnerve7
C)Cranialnerve8
D)Cranialnerves9and10-C)Cranialnerve8
TheRinneandWebertestsareusedtoassesscranialnerve8ortheacousticnerve.The patient'shearingistestedbyairconduction(Rinneand Weber)andboneconduction(Rinneonly).
A68 year oldwomancomplainsofleakingasmallamountofurinewhenevershesneezes, laughs,and/orstrains.Theproblemhasbeenpresentformanymonths.Thepatientdenies dysuria,frequency,andnocturia.Theurinedipsticktestisneg ativeforwhitebloodcells, redbloodcells,ketones,andurobilinogen.Whatisthenameofthiscondition?
A)Urgeincontinence
B)Overflowincontinence
C)Urinaryincontinence
D)Stressincontinence D)Stressincontinence
Thesignsandsymptomsofstressincontinenceoccurwhenthestresscausedbysneezing, laughing,and/orstrainingresultsintheleaking ofasmallamountofurinethroughaweakenedsphincter.
Anelderlyfemalepatientwhoisaretirednursehasrecentlybeendischargedfromthe hospital.Afewdayslater,shestartedhavingrandomandrecurrentepisodesofdizziness, butdeniespassingout.Thepatientdescribesitasthesensationoftheroomspinningor moving,whichisworsenedbysuddenheadmovement.Duringtheepisodes,shegetsvery nauseatedandsometimesvomits.ThepatientreportsthatshewasgivenIVantibioticsand oneofthemwastobramycin.Whichofthefollowingmedicationsishelpfulintreatingher symptomofdizziness?
A)Scopolaminepatch(TransdermScop)
B)Meclizine(Antivert)
C)Dimenhydrinate(Dramamine)
Thecaseisdescribingvertigo.Meclizine(Antivert)
12.5mgto50mgTIDtoQIDisusedtotreatvertigo.Donotforgettoalsotreatnausea, whichcanbesevere.Anti nauseamedicinelikedimenhydrinate(Dramamine)or prochlorperazine(Compazine)areeffective.Advisethepatientthatthesedrugscancause drowsiness.
MedicarePartDwillreimburseforwhichofthefollowingservices?
A)PreventivehealthcaresuchasroutinePapsmearsandphysicalexams
B)Prescriptiondrugs
C)Alcoholmisuse/abusecounseling
D)Over the counterdrugsandvitamins B)Prescriptiondrugs
MedicarePartDisavoluntaryprogramthatchargesapremium.LikeallMedicareservices, patientsneedtoenrollduringthe"open enrollment"periodsduringtheyear(thereisapenaltyforlateenrollment).Thereisadrug formularyandnotalldrugsareavailableorreimbursed.Useofgenericdrugsispreferred, asthereisaspendinglimit.MedicarePartBwillreimburseforalcoholmisuse/abuse treatment.
A35 year oldwomaniscomplainingofgradualweightgain,lackofenergy,and amenorrhea.Theurinepregnancytestisnegative.TheCBCshowsahemoglobinof13.5g andMCV84.Thenursepractitionersuspectsthatthepatientmayhavehypothyroidism. TheTSHis10mU/L.Whichofthefollowingisthenextstepintheevaluation?
A)Checkthethyroidprofile
B)CheckthetotalT3andT4levels
C)Checkforantithyroidperoxidaseantibodies
D)RechecktheTSHin4to6months A)Checkthethyroidprofile
TheupperlimitoftheserumTSHlevelisabout 5.0mU/L(rangeof0.5to5.0).WithanelevatedTSHof10,itisimportanttoruleout hypothyroidism.Thenextstepinthispatient'sevaluationistoorderathyroidprofiletest. Serumassaysmeasureboundandunbound(free)formsofthyroxine(T4)and triiodothyronine(T3).ClassicfindingsofhypothyroidismarealowtotalT4,lowT3-resin uptake(THBI),andlowfreeT4index.
Duringaroutinephysicalexamonan82 year old,thenursepractitionerpalpatesan irregularmassonthemidabdomenthatisnottenderandisabout2cminsize.Whichof thefollowingisthebestinitialimagingtesttofurtherevaluatetheabdominalmass?
A)CTscanoftheabdomen
B)KUBstudy
C)Abdominalultrasound
D)MRIoftheabdomen C)Abdominalultrasound
Theultrasoundorsonogramisusedasaninitial imagingtestforabdominaltumors.ACTscancanbeorderedatalatertime,butitisnot consideredaninitialimagingtestintheprimarycarearea.
Aresearchparticipanttellsthenursepractitionerthathewantstowithdrawfromthe study.Regardingthiscase,thenursepractitionerisawarethatallresearchstudyconsent formsshouldcontainwhichofthefollowinginformation?
A)Thepatient'sdemographicinformation
B)Thepossiblerisksofthestudy
C)Informationthataresearchsubjectcanvoluntarilywithdrawfromthestudyatanytime withoutanypenaltiesoradverseconsequences
D)Thebenefitsfromthestudy C)Informationthataresearchsubjectcanvoluntarily withdrawfromthestudyatanytimewithoutanypenaltiesoradverseconsequences
Informationthatshouldbeincludedinthewrittenconsentformsisthattheresearch subjectcan voluntarilywithdrawfromthestudyatanytimewithoutanypenaltiesoradverse consequences.Inaddition,thehumansubjectshouldbeverballyinformedofthisright.
Allofthefollowingfactorsareassociatedwithahigherriskofosteopeniaandosteoporosis except:
A)Excessivealcoholintakeandcigarettesmoking
B)AsianorCaucasianancestry
C)Estrogenandprogesteronedeficiency
D)Olderage C)Estrogenandprogesteronedeficiency
Bonelossisnotassociatedwithprogesterone deficiency(onlyestrogendeficiency).Riskfactorsincludeexcessivealcoholintake, cigarettesmoking,ancestry(AsianorCaucasian),olderage,anorexia nervosa,smallboneframe,andothers.
Askillednursingfacility(SNF)canprovideallofthefollowingexcept:
A)Physicaltherapyandothertypesofrehabilitation
B)Skillednursingcareandmedicalcare
C)ReimbursementbyMedicare
D)Provisionofcustodialcare D)ProvisionofcustodialcareCustodialcareisdoneby nursinghomes.
SNFsarereimbursedbyMedicareandcanprovideskillednursingandmedicalcare.Ifa patientisdischargedfromahospital,butneedstherapyandskilledcare,he/sheisusually transferredtoanSNF.SNFshavetransferagreementswithlocal hospitals.Nursinghomepatientsareusuallymedicallystableandneedskilledormedical care.Thesepatientsareunabletoperformfrom2to6ADLs.PatientswithAlzheimer'sand othertypesofdementiaareusuallycaredforinnursinghomes.
Allofthefollowingareclassifiedasactivitiesofdailyliving(ADLs)except:
A)Abilitytofeedself(self-feeding)
B)Abilitytomanagebladderandbowelelimination
C)Personalhygieneandgrooming
D)Groceryshopping D)Groceryshopping
Groceryshopping,housework,andmanagingone's financesareconsideredinstrumentalADLs(IADLs).
Apositivepsoasandobturatorsignishighlysuggestiveofwhichofthefollowing conditions?
A)Ectopicpregnancy
B)Acuteappendicitis
C)Peritonitis
D)Abdominalaorticaneurysm B)Acuteappendicitis
Boththepsoasandobturatorsignsareassociatedwithacuteappendicitis.Whenthe appendixbecomesinflamedorruptured,theblood andpusirritatethepsoasand/orobturatormuscles,whicharebothlocatedinthe retroperitonealarea.Bothmusclesarehipflexorsandassistwithhipmovement.
Allofthefollowingaretruestatementsaboutsexualityintheolderadultexcept:
A)Erectiledysfunctionisverycommon
B)Itmaytakelongertobecomearoused
C)Frailelderlyarenotinterestedinsexualityanymore
D)Dyspareuniaisacommonsymptomofatrophicvaginitis C)Frailelderlyarenot interestedinsexualityanymore
Somestudieshaveshownthatolderadultsintheir80scanremainsexuallyactive.Bythe ageof
70years,about80%ofmaleshaveED.
Whichofthefollowingdrugsismostlikelytocausesexualdysfunctioninmales?
A)SSRIs
B)ACEinhibitors
C)Amphetamines
D)Atypicalantidepressants
A)SSRIs
AcommonsideeffectofSSRIs(e.g.,Prozac,Paxil,Zoloft)issexualdysfunctioninmales.For depressedmales,atypicalantidepressantssuchasbupropion(Wellbutrin)causeless sexualdysfunction.
Whichofthefollowingdrugsisclassifiedasa5 alphareductaseinhibitor?
A)Terazosin(Hytrin)
B)Tamsulosin(Flomax)
C)Finasteride(Proscar)
D)Sildenafil(Viagra) C)Finasteride(Proscar)
Finasteride(Proscar)belongstothedrugclasscalled5 alphareductaseinhibitors.
.Ithelpstolowerserumtestosterone,whichhelpstodecreasethesizeoftheprostate.Itis alsousedformale patternbaldness.Asmallerprostateresultsinlessobstructivevoiding symptomssuchasweak stream,frequency,andnocturia.Bothterazosin(Hytrin)andtamsulosin(Flomax)are alpha blockersandmaystarttocontrolsymptomsinaslittleas3days.Theyworkby relaxingthesmoothmuscletissueoftheprostategland,whichenlargesthediameterofthe urethra.
Oneofthedevelopmentalmilestonesforthisagegroupistheabilitytodrawastickfigure "person"with2to3separatebodyparts.Whatistheagegroupthatthisfindingis associatedwith?
A)3yearold
B)4yearold
C)5yearold
D)6yearold-A)3yearold
Theabilitytodrawapersonwith2to3separatebodypartsisoneofthedevelopmental milestonestoassessinchildrenwhoare3yearsofage.
Othersareclimbsupstairswithalternatingfeetwithouthandrails;ridesatricycle;knows name,age,andgender;andcanspeakin3 wordsentencesthatcanbeunderstoodbymost strangers.
Whendoesaninfanttripleitsbirthweight?
A)3months
B)6months
C)12months
D)15months C)12months
Bytheageof12months,aninfantisexpectedtohavetripleditsbirthweight.
Anewmotherisplanningonbreastfeedinghernewborninfantforatleast6months.She wantstoknowwhethersheshouldgivetheinfantvitamins.Whichofthefollowingvitamin supplementsisrecommendedbytheAmericanAcademyofPediatrics(APA)latest guidelineduringthefirstfewdaysoflife?
A)VitaminDdrops
B)Multivitamindrops
C)Itisnotnecessarytogivebreastfedinfantsvitaminsupplementsbecausebreastmilk containsenoughvitaminsandmineralsthatarenecessaryfortheinfant'sgrowthand development
D)Folicaciddrops A)VitaminDdrops
AccordingtotheAPA,allinfantsshouldbegivenVitaminDsupplementationwithinthe firstfewdaysoflife.Motherswhoplantobreastfeedtheirinfantsshouldbetaughthowto useVitaminDdrops.InfantformulaissupplementedwithVitaminD(andmanyother vitamins,minerals,andomega-3oil),sothereisnoneedtogiveitseparately.
Asexuallyactive16 year oldfemaleisbroughtinbyhermotherforaphysicalexam. Duringtheexam,thenursepractitionernoticessomebruisesonbothbreasts.Allofthe followingareimportantareastoevaluateinthispatientduringthisvisitexcept:
A)Depression
B)Tannerstage
C)Sexualhistory
D)STDs-B)Tannerstage
Thestemofthequestionisaskingfortheimportantareastoevaluateinthispatient "duringthisvisit."Thisisapriority-typequestion.Theprioritiestoevaluateinthispatient aredepression,STDtesting,andsexualhistory.TheTannerstagingdoesnothavetobe done"duringthisvisit."
Themotherofa12 month oldinfantreportstothenursepractitionerthatherchildhada highfeverforseveraldays,whichspontaneouslyresolved.Afterthefeverresolved,the childdevelopedamaculopapularrash.Whichofthefollowingisthemostlikelydiagnosis?
A)Fifthdisease(erythemainfectiosum)
B)Roseolainfantum(exanthemasubitum)
C)Varicella
D)Infantilemaculopapularrashes B)Roseolainfantum(exanthemasubitum)
Roseolainfantumisacommonviralrashthatiscausedbythehumanherpesvirus;the mostcommonagesofonsetarebetween6monthsand2years.Therashesare maculopapular(smallroundpinkcolored)rashesthatfirstappearonthetrunkandthen spreadtotheextremities.
A13 year oldmaleisbroughtinbyhismotherforaphysicalexam.Duringthegenital exam,thenursepractitionernoticesthatthepatientisatTannerStageII.Whichofthe followingisthebestdescriptionofthisTannerstage?
A)Thepenisisgrowingmoreinlengththaninwidthandthetesticlesbecomelargerwith darkerscrotalskinandthepubichairisstartingtocurl
B)Thepenisisgrowingmoreinwidththaninlengthwithdarkerscrotalskinandmore numerouspubichairsthataredarker,curly,andcoarser
C)Thetesticlesbecomelargerandtheskinofthescrotumstartstobecomedarkerwith straight,fine,countablehairsonthegenitalsandtheaxilla
D)Thetesticles,penilewidthandlengtharealldevelopingquickly-C)Thetesticles becomelargerandtheskinofthescrotumstartstobecomedarkerwithstraight,fine, countablehairsonthegenitalsandtheaxilla
TannerStageIIiswhenthetesticlesstarttogrow.Thescrotalskinbecomesthickerand startstogetdarker(hyperpigmentation).Thepubichairisofafinetextureandstraight andtherearefewcountablehairsonthegenitalsandtheaxilla.
An8 year oldisseenasawalk inappointmentbythenursepractitioner.Themother reportsthatherchildhasbeenfebrilefor2daysandisnoteatingwellduetopainfulsores insidethechild'smouth.Thechild'stemperatureis101degreesFahrenheit,thepulseis88 beats/minute,andtherespirationsareat14breathsperminute.Duringthephysical examination,thenursepractitionernoticesseveralsmallblistersandshallowulcersonthe child'spharynxandtheoralmucosa.Thechildhassmallroundredrashesonbothpalms andsoles.Whichofthefollowingconditionsismostlikely?
A)Herpessimplexinfection
B)Hand,foot,andmouthdisease(HFMD)
C)Varicellainfection
D)Secondarysyphilisinfection B)Hand,foot,andmouthdisease(HFMD)
Hand,foot,andmouthdisease(HFMD)iscausedbythecoxsackievirusA16.Thevirusis foundinthesaliva,sputum,nasalmucus,feces,andblisterfluid.Itistransmittedthrough directcontactofthesecretionorinfomites(e.g.,preschooltoys).Treatmentis symptomatic.
AccordingtoErikErikson,adolescentsareatwhatpsychosocialdevelopmentalstage?
A)Autonomyvs.shame
B)Industryvs.inferiority
C)Identityvs.roleconfusion
D)Intimacyvs.isolation-C)Identityvs.roleconfusion
Adolescents(age12to18years)areinthestage knownas"identityvs.roleconfusion."Atthistime,theteenistransitioningintoadulthood andreexamininghis/heridentityandbeliefs.Theteenwondersabouthimself/herself(e.g., "whoamI").Peersarehighlyvalued.
Atwhatagecanachildrideabicycle?
A)2to3yearsofage
B)3to4yearsofage
C)4to5yearsofage
D)5to6yearsofage-D)5to6yearsofage
Atabouttheageof5to6years,mostchildrencan rideabicyclewithtrainingwheels.Helmetsshouldalwaysbeworn(primaryprevention).
Whenaninfantisfoundtohavetuftsoffinedarkhaironthesacrum,whichofthefollowing testsisrecommended?
A)Anultrasoundofthesacrum
B)Aplainradiographofthelumbosacralspine
C)Noimagingtestisnecessary
D)Genetictesting A)Anultrasoundofthesacrum
Aninfantwithtuftsoffinedarkhaironthesacrumshouldbeevaluatedforoccultspina bifida.Thefirstimagingtesttoorderisanultrasoundofthelowerspine.
Allofthefollowingaretruestatementsaboutthehumanpapillomavirusvaccine(Gardasil) except:
A)TheCentersforDiseaseControlandPrevention(CDC)recommendsthefirstdoseatage 11to12years
B)TheCDCdoesnotrecommendtheHPVvaccineformales
C)Thevaccineisnotcompleteuntilatotalof3doseshavebeenadministered
D)Theminimumagethevaccinecanbegivenis9years B)TheCDCdoesnotrecommend theHPVvaccineformales
TheHPVvaccineisnowrecommendedforbothmalesandfemales.Itcanbegivenuntilthe ageof 26years,especiallyiftheindividualisathighrisk.Donotusethevaccineifageislessthan 9years.
AccordingtoDSM 5,allofthefollowingaresomeofthecriteriathatmustbepresentto diagnoseachildwithautisticdisorder.Whichofthefollowingcriterionisincorrect?
A)Onsetofsymptomsbeforeage3years
B)Lackofsocialinteractionorsocialreciprocity
C)Stereotypedandrepetitivemovementssuchashandflapping
D)Depressedaffect D)Depressedaffect
Depressionisnotincludedinthecriteriafordiagnosingautisticspectrumdisorders.Signs andsymptomsincludeavoidanceofeyecontactandsocialinteraction,markeddelayor absenceofverbalcommunication,repetitivemovements,fixedrituals,andsoon.Autism canrangefrommildtosevere.Earlydiagnosisisimportant.Forevaluation,referthe patientforpsychologicaltestingbyapsychologistwhospecializesinautisticspectrum disorders.
Anadolescentmalepresentstothenursepractitionerforawellnessexam.Thepatient's faceislongandnarrowwithaprominentforeheadandchin,andhehaslargeears.The motherreportsthathersonhasintellectualdisabilitiesandautisticdisorder.Whichofthe followingconditionsisbeingdescribed?
A)FragileXdisorder
B)Marfan'ssyndrome
C)Turner'ssyndrome
D)Downsyndrome A)FragileXdisorder
FragileXsyndromeisthemostcommonformofinheritedintellectualdisability.The disorderisassociatedwithahigherincidenceofautism(especiallyboys).Malesare affectedmoreseverelythanfemales.Thefacialfeaturescanvary.Theclassicfacieisalong, narrowfacewithaprominentforeheadandchinandlargeears.Otherfeaturesinclude
hyperlaxityofthejoints,flatfeet,higharchedpalate,andothers.Definitivediagnosisisby genetictesting.