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NURP 532 Exam 3 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Pt reports recent mild fatigue and palpitations. A CBC reveals a decreased hemoglobin level and normal ferritin level. What other findings are likely present?

A. decreased hematocrit
B. decreased MCV, MCH, MCHC
C. elevated total iron binding capacity
D. paresthesias, koilonychia, pica

A

A. decreased hematocrit

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2
Q

The pedi NP evaluates a 5 y.o. child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 and hematocrit of 31%. how will the NP manage this pt?

A. prescribe elemental iron and recheck labs in 1 month
B. reassure pt that this represents mild anemia
C. recommend diet high in iron-rich foods
D. Refer to hematologist for further eval

A

A. prescribe elemental iron and recheck labs in 1 month

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3
Q 
The pedi NP sees a 12 month old infant who is being fed goat's milk and a vegetarian diet. The child is pale with a beefy red, sore tongue and oral MM. Which tests will the NP order to evaluate the child's condition? 
A. hemoglobin electrophoresis
B. RBC, folate, iron, and B12 levels
C. reticulocyte levels
D. serum lead levels
A

B. RBC, folate, iron and B12 levels

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4
Q

A CBC on a 12 month old reveals microcytic, hypo-chromic anemia with a hemoglobin of 9.5. The infant has mild pallor with no hepatosplenomegaly. The PCP suspects what disorder?

A. hereditary spherocytosis
B. IDA
C. lead intoxication
D. sickle cell anemia

A

B. IDA

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5
Q

Pt reports a neck mass that has been present intermittently for 5- 6 weeks, which varies in size. The provider palpates a lymph node that measures 1.25c,. Which test will provide proper histologic dx of this pt?

A. bone marrow aspirate
B. CT w/ IV contrast
C. lymph node biopsy
D. PET scan

A

C. lymph node biopsy

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6
Q

Which situations are considered oncologic emergencies in pt dx w/ cancer and require urgent referral to oncologist? Select all that apply.

A. bone marrow suppression
B. metastasis of cancer cells 
C. superior vena cava syndrome 
D. SIADH
E. tumor lysis syndrome
A

C. superior vena cava syndrome
D. SIADH
E. tumor lysis syndrome

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7
Q

The NP is examining a 5 y.o. who has recurrent fevers, bone pain, and recent loss of weight. The PE reveals scattered petechiae, lymphadenopathy, and bruising. A CBC shows thrombocytopenia, anemia, and elevated WBC. The NP will refer this child to a specialist for what dx testing?

A. bone marrow biopsy
B. corticosteroids and IVIG
C. hemoglobin electrophoresis
D. immunoglobulin testing

A

A. bone marrow biopsy

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8
Q

PT being treated for CA has had chemo in past 2 weeks and comes to PCP clinic with fever of 38.5C. What is the initial action?

A. Obtain a STAT CBC w/ diff
B. order CXR
c. order blood & urine cultures
D. prescribe empirical abx

A

A. obtain STAT CBC w/ diff

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9
Q

What is the most important role of the PCP in cancer management?

A. counseling about healthy practices to reduce RF
B. performing regular screenings to detect CA
C. referring pts for genetic testing to identify those at risk
D. teaching pts about cancer management once diagnosed

A

A. counseling about healthy practices to reduce RF

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10
Q

During a well-child exam of a 2 y.o., the NP palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action?

A. Order a CT scan of chest, abdomen, and pelvis
B. Perform a UA, CBC, and Renal function tests
C. reevaluate mass in 1-2 wks
D. refer child to oncologist immediately

A

D. Refer child to oncologist immediately

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11
Q

which of the following is the most sensitive test to assess for iron deficiency?

A. MCV
B. serum iron
C. total iron binding capacity
D. ferritin

A

D. ferritin

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12
Q

which of the following is the most sensitive test to assess for iron deficiency?

A. MCV
B. serum iron
C. total iron binding capacity
D. ferritin

A

D. ferritin

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13
Q

A low reticulocyte count can be seen with which of the following?

A. Thalassemia minor
B. Iron or vit B12 deficiency
C. acute blood loss
D. hemolytic anemia

A

B. iron or vit b12 deficiency

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14
Q

A 25 y.o. F w/ mild microcytic anemia is dx w. beta thalassemia minor. Which of the following should be included in the pt management plan?

A. Referral to hematologist for further eval and tx
B. tx iron therapy indefinitely
C. refer genetic counselor if considering conceiving
D. check serum haptoglobin level

A

C. refer to genetic counselor if considering conceiving

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15
Q

A CBC shows low hemoglobin and hematocrit, low MCV, low MCHC, and high RDW. How should the anemia be classified?

A. macrocytic, normochromic
B. microcytic, hypochromic
C. normocytic, hypochromic
D. macrocytic, hyperchromic

A

B. microcytic, hypochromic

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16
Q

Pt has a CBC showing pancytopenia (low hemoglobin, decreased leukocytes, and platelets). Which of the following should be included in the diff dx?

A. idiopathic thrombocytopenia
B. Von Willebrand dx
C. aplastic anemia
D. anemia of chronic dx

A

C. aplastic anemia

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17
Q

An adult pt who is currently receiving tx for lymphoma presents for swelling of neck and face along w/ a cough. there are signs of venous distension in upper body on PE. the NP suspects which of the following?

A. tumor lysis syndrome
B. hyperviscosity syndrome
C. malignant spinal cord compression
D. superior vena cava syndrome

A

D. superior vena cava syndrome

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18
Q

The most common cause of croup is

A. second hand smoke
B. human parainfluenza virus
C. mycoplasma pneumoniae
D. chlamydia pneumoniae

A

B. human parainfluenza virus

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19
Q

the NP evaluates a child who awoke w/ a sore throat and high fever after a nap. the child appears anxious and is sitting on parent’s lap w/ neck hyperextended. The PE reveals stridor, drooling, nasal flaring, and retractions. What will the NP do next?

A. Administer a broad spectrum IV ABX
B. transport pt to hospital
C. send child to radiology for lateral neck xray
D. obtain blood and throat cultures and start ABX

A

B. transport to hospital

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20
Q

The NP is seeing a 3 y.o. male w/ sudden onset of braking cough last night. He appears well and is no acute distress. His temp is 100.5F, but his VS are otherwise normal. He has an occasional cough with mild retractions. His lungs are clear and there is no stridor noted at rest. Tx includes:

A. inhaled bronchodilator
B. single dose of dexamethasone
C. nebulized epinephrine
D. amoxicillin 80-90 mg/kg/day

A

B. single dose fo dexamethasone

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21
Q

A 5 month old who has a 3-day hx of low-grade fever, cough, and rhinorrhea has developed respiratory symptoms with audible expiratory wheezes and increased coughing. the infant’s immunizations are UTD. The PE reveals a RR of 42, coarse expiratory wheezing, and prolonged expirations. An o2 sat is 96% on RA. What is recommended tx?

A. order oral corticosteroid
B. obtain viral culture of nasal washings
C. administer trial of bronchodilators
D. recommend increased fluids and close follow up

A

D. recommend increased fluids and close follow up

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22
Q

Which of the following pts should be treated w/ oseltamivir? Select all that apply.

A. 18 y.o. healthy male w/ flu symptoms for 36 hrs
B. 70 y.o. male w/ HF who has positive flu test and ill for 4 days
C. asymptomatic, immunized 7 month old infant whos brother was diagnosed w/ flu yesterday
D. 25 y.o. F in 1st trimester of pregnancy with rapid test that is positive for influenza A

A

B. 70 y.o. male w/ HF who has positive flu test and ill for 4 days
C. asymptomatic, immunized 7 month old infant whos brother was diagnosed w/ flu yesterday
D. 25 y.o. F in 1st trimester of pregnancy with rapid test that is positive for influenza A

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23
Q

A 4 y.o. child is diagnosed with CAP and will be treated as an outpatient. Which ABX will the NP prescribe?

A. azithromycin
B. Amoxicillin
C. ceftriaxone
D. oseltamivir

A

B. amoxicillin

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24
Q

A 35 y.o. pt w/ NO PMH is dx w. acute bronchitis. What is the focus of management of this pt?

A. Bactrim
B. azithromycin
C. supportive care
D. short acting beta agonist

A

C. supportive care

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25
Q

A 19 y.o. pt presents with cough and fever. The NP auscultates rales in both lungs that do not clear w. cough. the pt reports having HA and sore throat prior to onset of coughing. A CXR shows patchy, nonhomgenous infiltrates. BAsed on these findings, which organism is most likely the cause of the PNA?

A. virus
B. mycoplasma
C. S. pneumoniae
D. TB

A

B. mycoplasma

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26
Q

the parent of a toddler and a 4 week old infant tells the NP that the toddler has been diagnosed with pertussis. what will the NP do to prevent transmission to infant?

A. instruct parent to limit contact between toddler and infant
B. order azithromycin 10mg/kg/day in single dose daily for 5 days
C. Administer diphtheria, pertussis, and tetanus vaccine
D. prescribe erythromycin 10mg/kg/dose 4xD for 14 days

A

B. order azithromycin 10mg/kg/day in single dose daily for 5 days

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27
Q

Which dx test will confirm the presence of PE?

A. ABGs
B. CTA
C. D-dimer
D. EKG

A

B. CTA

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28
Q

Which of the following best describes the symptoms associated with PE?

A. increased HR and sharp pleuritic chest pain
B. SOB and stridor
C. burning substernal chest pain & nausea
D. chest tightness radiating into left arm

A

A. increased HR and sharp pleuritic chest pain

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29
Q

Exam findings in pt w/ spontaneous pneumo include

A. pleural friction rub
B. hyper-resonance to percussion
C. increased tactile fremitus
D. positive egophany

A

B. hyper-resonance to percussion

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30
Q

What is included in initial dx workup fo suspected pneumothorax?

A. chest CT
B. CXR
C. needle aspiration
D. ventilation perfusion scan

A

B. CXR

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31
Q

A patient presents to PCP w/ pleuritic chest pain has a wells score of 1. Based on this score alone, what is an appropriate next step?

A. refer for cTA
B. order d-dimer
C. r/o PE and investigate further causes
D. transport to ED

A

B. order d- dimer

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32
Q

A 67 y.o. man w. alcoholism presents w/ 2 days of fever, chills, and cough productive of yellow sputum. On PE his temp is 101F, RR 22, and in no resp distress. His lower right lung field has inspiratory crackles. a CXR shows focal consolidation in right middle and lower lobes. Which organism likely the cause?

A. mycoplasma pneumo
B. chlamydia pnuemo
C. strep pneumo
D. legionella

A

C. strep pneumo

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33
Q

@3 y.o. F presents w/ right sided pleuritic chest pain, dyspnea, cough and low grade fever for 1 day. She is generally healthy and takes a COC for acne and BC. Three days ago, she returned from a trip to England with her family. He PE reveals a HR 102, mild edema of right lower extremity, normal cardiac and lung exa,. how should Np manage?

A. perform CXR and treat for atypical PNA
B. perform D-dimer and follow up closely w/ pt next day
C. refer to ED
D. refer for ventilation perfusion scan

A

C. refer to ED at risk for PE

34
Q

A 62-year-old with COPD calls the primary care clinic because she is concerned that her son was diagnosed with influenza yesterday and he is currently living with her. The patient received an annual flu shot 2 months ago and currently denies any symptoms. How should the nurse practitioner respond?

a. I will schedule an appointment for you to come for an influenza test
b. You should receive influenza prophylaxis with antiviral medication
c. Since you receive the influenza vaccine, you do not need to be concerned about infection
d. You should receive the live attenuated influenza vaccine

A

b. You should receive influenza prophylaxis with antiviral medication

35
Q

A 2-year-old presents with low grade fever, rhinorrhea and a barking, seal like cough. On exam, the child has a normal respiratory rate, no retractions wheezing or stridor at rest. What is the most likely diagnosis?

a. Bronchiolitis
b. Epiglottitis
c. Mild croup
d. Bacterial tracheitis

A

c. mild croup

36
Q

The diagnosis of bronchiolitis is based upon which of the following?

a. Findings on a chest x-ray
b. History and physical examination
c. Culture for respiratory syncytial virus (RSV)

A

b. History and physical examination

37
Q

When should the nurse practitioner obtain a chest x-ray on an otherwise healthy adult patient presenting with symptoms of acute bronchitis?

a. If the sputum purulent
b. If the patient has rhonchi
c. If the patient has tachypnea
d. If the patient fails to improve after 10 days of illness

A

c. If the patient has tachypnea

38
Q

An asymptomatic pregnant woman has a positive leukocyte esterase and positive nitrites on a urine dipstick screening. What will the nurse practitioner do next?

A Since she is asymptomatic, she does not require further testing or treatment

B Order a urine culture

C Order a renal ultrasound

D Prescribe trimethoprim-sulfamethoxazole (TMP-SMZ)

A

B Order a urine culture

39
Q

A 55-year-old male presents with dysuria, urinary frequency, urgency, and suprapubic pain. His urine dipstick reveals moderate leukocyte esterace and positive nitrites. He is afebrile and has a normal physical exam. The nurse practitioner diagnoses him with

A a complicated urinary tract infection

B acute pyelonephritis.

C an uncomplicated urinary tract infection.

D urethritis.

A

A a complicated urinary tract infection

40
Q

The daughter of an elderly female patient with mild cognitive impairment reports that her mother recently developed urinary incontinence occurring several times each day. Her mother denies fever, pain, or dysuria, and the daughter reports no change to her baseline mental status. What will the nurse practitioner do initially?

A Obtain a urine sample for urinalysis (UA) and culture

B Order serum creatinine and blood urea nitrogen tests

C Perform a bladder scan to determine distention and retention

D Tell the daughter that this is expected given her mother’s age and cognitive impairment

A

A Obtain a urine sample for urinalysis (UA) and culture

41
Q

An 18-year-old male presents for itchiness of the urethral meatus and and white urethral discharge for 2 days. He denies urinary symptoms, testicular pain, or fever. His abdominal and genital exam are normal. His urine dipstick is negative. Which of the following should the nurse practitioner include in the plan of care?

A Order a urine culture

B Treat for candida with a topical antifungal cream

C Treatment with azithromycin and ceftriaxone

D Treatment with oral metronidazole

A

C Treatment with azithromycin and ceftriaxone

42
Q

A 25-year-old female with no past medical history presents with several days of dysuria and urgency and today, developed pain in her right flank. She denies fever or chills, but has slight nausea without vomiting. On exam, she has no abdominal tenderness but the right CVA is tender. Her urine dipstick is positive for large amount of leukocyte esterace, trace blood, and is negative for nitrite. The nurse practitioner should

A treat her with ciprofloxacin

B order a urine culture and treat based on the result..

C treat her with nitrofurantoin.

D order a renal ultrasound.

A

A treat her with ciprofloxacin

43
Q

A 70-year-old male reports urinary hesitancy, postvoid dribbling, and a diminished urine stream. A digital rectal exam (DRE) reveals an enlarged nontender prostate gland that feels rubbery and smooth. Which tests will the nurse practitioner order based on these findings?

A Bladder scan for postvoid residual

B Prostate-specific antigen (PSA)

C Urinalysis

D CBC with differential

A

Urinalysis

44
Q

A 3-month-old male infant has edema and painless swelling of the left scrotum. On physical examination, the nurse practitioner can transilluminate the scrotum. What will the provider recommend?

A A Doppler ultrasound to evaluate the scrotal structuresA Doppler ultrasound to evaluate the scrotal structures

B A short course of empiric antibiotic therapy

C Immediate referral to a genitourinary surgeon for repair

D Observation and reassurance that spontaneous resolution may occur

A

D Observation and reassurance that spontaneous resolution may occur

45
Q

An adolescent male reports acute onset of severe pain in one testicle for 3 hours. The nurse practitioner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention?

A Doppler ultrasound to assess testicular blood flow

B Immediate referral to the emergency department

C Prescribing antibiotic to treat the infection

D Transillumination to assess for a “blue dot” sign

A

B Immediate referral to the emergency department

46
Q

A young adult male reports a mild, dull pain in the right scrotum for 1 week and the provider notes a bluish color showing through the skin on the affected side. There is no scrotal edema. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient?

A Treatment with ceftriaxone or doxycycline

B Consideration of underlying causes of this finding

C Reassurance that this is benign and may resolve spontaneously

D Referral to an emergency department for surgical consultation

A

B Consideration of underlying causes of this finding

47
Q

A 60-year-old male with a history of BPH presents for malaise, dysuria, weaker urine stream than usual, and perineal pain for several days. He denies fever, abdominal pain, flank pain, nausea, or vomiting. On exam, he appears well, he has no abdominal or flank tenderness, his prostate is tender and boggy, and his urine dipstick shows a large amount of leukocyte esterase. Which of the following is an appropriate management plan?

A Send the urine for culture and treat with ciprofloxacin for at least 10 days

B Massage the prostate gland and repeat the urine test

C Refer the patient to the hospital for treatment with IV antibiotics

D Treat empirically for chlamydia and gonorrhea with ceftriaxone and doxycycline

A

A Send the urine for culture and treat with ciprofloxacin for at least 10 days

48
Q

A 50-year-old man reports having erectile dysfunction (ED) that has developed gradually over time. What is an important response by the nurse practitioner when developing a plan of care for this patient?

A Considering testosterone hormone replacement therapy

B Evaluating the patient for cardiovascular disease

C Prescribing an oral phosphodiesterase type 5 inhibitor

D Referring the patient for psychotherapy and counseling

A

B Evaluating the patient for cardiovascular disease

49
Q

The nurse practitioner is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test, which yields 30 mL of urine. What is the interpretation of this result?

A The patient may have overflow incontinence.

B The patient probably has a urinary tract infection (UTI).

C This is a normal result.

D This represents incomplete emptying.

A

C This is a normal result.

50
Q

The nurse practitioner is counseling a patient who has stress incontinence about ways to minimize accidents. What will the nurse practitioner suggest initially?

A Increasing fluid intake to dilute the urine

B Referral to a physical therapist

C Taking pseudoephedrine daily

D Voiding every 2 hours during the day

A

D Voiding every 2 hours during the day

51
Q

The nurse practitioner prescribes the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction (ED) in a 65-year-old male patient. What will be included when teaching this patient about taking this medication? Select all that apply.
response - correct

A The medication does not initiate an erection, stimulation is required for an erection to occur

B Most common side effects include headache and flushing

C Most common side effects include urinary urgency and abdominal pain

D Take the medication 30–60 minutes prior to sexual activity, once daily as needed

E Seek immediate medical attention if you have an erection lasting longer than 2 hours

A

A The medication does not initiate an erection, stimulation is required for an erection to occur

B Most common side effects include headache and flushing

D Take the medication 30–60 minutes prior to sexual activity, once daily as needed

52
Q

Interstitial cystitis is a well-understood condition that is easily diagnosed in women presenting in with chronic pelvic pain.

True
Or
False

A

false

53
Q

A 68-year-old man presents to his primary care clinician with a complaint of urinary frequency. The patient has noted increased urinary urgency and frequency for approximately 1 year, which have progressively worsened. He now seems to have to urinate “all the time”, including four times each night and often feels like he has not completely emptied his bladder. In addition, in the past month he often has postvoid dribbling. The family history is negative for malignancy. On examination, he appears healthy. His prostate is diffusely enlarged without focal nodule or tenderness. What is the most likely diagnosis?

Select one:

a. Prostate cancer
b. Benign prostatic hyperplasia
c. Chronic prostatitis
d. Acute prostatitis

A

b. Benign prostatic hyperplasia

54
Q

A 73-year-old African American man presents to a primary care clinician to establish care. He has not seen a doctor for some time, but difficulty initiating and maintaining a stream of urine has prompted his visit today. His family history is notable for his father having prostate cancer. On physical examination, his digital rectal examination (DRE) reveals a firm, non-tender prostate with a focal nodule. What should the nurse practitioner do next?

Select one:

a. Order a prostate specific antigen (PSA), urinalysis and refer to urology
b. Order a bladder ultrasound to assess postvoid residual, urinalysis and culture
c. Order a transrectal ultrasound and treat empirically with oral antibiotics
d. Administer the AUA symptom index and prescribe an alpha blocker

A

a. Order a prostate specific antigen (PSA), urinalysis and refer to urology

55
Q

Which patients with asymptomatic bacteriuria should be treated with antibiotics?

Select one:

a. Patients living in a skilled nursing facility
b. Pregnant patients
c. It should not be treated in any patients
d. Patients with diabetes

A

b. Pregnant patients

56
Q

Which diagnostic testing is indicated in the work up of uncomplicated acute pyelonephritis in an adult?

Select one:

a. Renal ultrasound
b. Urinalysis and culture
c. CBC/differential, BUN and creatinine
d. Urinalysis and culture and renal ultrasound

A

b. Urinalysis and culture

57
Q

A 55-year-old male is diagnosed with epididymitis. The nurse practitioner prescribes an empiric antibiotic that will cover which organisms?

Select one:

a. Chlamydia
b. Gonorrhea
c. Enteric organisms
d. Treatment should be based on the result of the urine culture

A

c. Enteric organisms

58
Q

A 18-year-old male presents with mild aching in the left scrotum for a week. Palpation of the scrotum reveals a soft, non-tender mass that feels like a bag of worms on the proximal spermatic cord. The nurse practitioner informs the patient that he has which of the following?

Select one:

a. A hydrocele
b. A varicocele
c. An epidydimal cyst
d. A spermatocele

A

b. A varicocele

59
Q

Which of the following statements regarding methotrexate are correct? Select all that apply.
response - correct

A It is contraindicated during pregnancy to treat psoriasis or rheumatoid arthritis

B Adverse reactions include hematologic abnormalities

C Patients should restrict alcohol intake to decrease hepatic toxicity

D Patients taking methotrexate do not require any lab monitoring

A

A It is contraindicated during pregnancy to treat psoriasis or rheumatoid arthritis

B Adverse reactions include hematologic abnormalities

C Patients should restrict alcohol intake to decrease hepatic toxicity

60
Q

Which of the following occurs in rheumatoid arthritis?

A Inflammation of the synovial lining of the joint

B Bacteria invade the joint capsule

C Accumulation of uric acid in the joint space

D Degeneration of the ligamentous structures

A

A Inflammation of the synovial lining of the joint

61
Q

Which of the following is an articular structure of a joint, such as the knee and shoulder?

A Synovium

B Tendons

C Bursae

D Fascia

A

A Synovium

62
Q

A 50-year-old woman reports pain in one knee upon awakening each morning that goes away after about a half hour. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the nurse practitioner tell this patient?

A A magnetic resonance imaging study is necessary for diagnosis

B That the lack of findings indicates no disease process

C Take acetaminophen 1 gram, 3 times daily for pain

D Use a cyclooxygenase 2-selective NSAIDs to reduce inflammation

A

C Take acetaminophen 1 gram, 3 times daily for pain

63
Q

Which are symptoms of rheumatoid arthritis (RA) that distinguish it from osteoarthritis (OA)? Select all that apply.
response - correct

A Extra-articular inflammatory signs

B History of injury to affected joints

C Morning stiffness of at least 1 hour

D Symmetric, tender, swollen joints

E Unilateral joint involvement

A

A Extra-articular inflammatory signs

C Morning stiffness of at least 1 hour

D Symmetric, tender, swollen joints

64
Q

A patient who has osteoarthritis in the carpometacarpal joints of both thumbs asks about corticosteroid injections to treat symptoms. What will the nurse practitioner tell this patient about this therapy?

A Corticosteroid therapy reduces inflammation and improves joint mobility

B Injections may be administered as needed up to 6 times per year

C Intra-articular injections provide significant pain relief for 3–4 months

D This treatment may cause a temporary increase in pain, warmth, and redness

A

D This treatment may cause a temporary increase in pain, warmth, and redness

65
Q

A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A rheumatoid factor (RF) test is negative. What will the primary care nurse practitioner do next?

A Begin treatment with a biologic, disease-modifying anti-rheumatic (DMARD) drug

B Order radiographic tests, a CBC, and acute-phase reactant levels

C Reassure the patient that the likelihood of rheumatoid arthritis is low

D Refer the patient to an orthopedic specialist for evaluation and treatment

A

B Order radiographic tests, a CBC, and acute-phase reactant levels

66
Q

A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the nurse practitioner do next to manage this patient’s symptoms?

A Prescribe a trial of sulfasalazine or methotrexate

B Refer to rheumatology to begin a biologic anti-tumor necrosis factor agent

C Switch the patient to a COX-1 inhibitor medication

D Start the patient on corticosteroid injections every 3 months

A

C Switch the patient to a COX-1 inhibitor medication

67
Q

The primary care pediatric nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for what form of juvenile idiopathic arthritis (JIA)?

A Systemic JIA

B Oligoarticular JIA

C Polyarticular JIA

D Enthesitis-related JIA

A

B Oligoarticular JIA

68
Q

The primary care pediatric nurse practitioner is managing care for a child who has been diagnosed with juvenile idiopathic arthritis (JIA) and has a positive antinuclear antibody (ANA). Which specialty referral is critical for this child?

A Pain management

B Ophthalmology

C Cardiology

D Orthopedics

A

B Ophthalmology

69
Q

Which of the following statements about psoriatic arthritis is correct?

A It affects about 70% of patients who have psoriasis

B It’s asymmetric and involves the distal joints of the hands and feet

C It’s symmetric and usually involves the larger joints in the body

D The diagnosis is confirmed with a positive ANA and inflammatory markers

A

B It’s asymmetric and involves the distal joints of the hands and feet

70
Q

A patient reports a history of recurrent lower back pain for 6 months. The patient describes the pain as a deep ache and stiffness that is worse upon awakening and improves after walking. Which findings will the nurse practitioner elicit to help make a clinical diagnosis of ankylosing spondylitis? Select all that apply.
response - correct

A Assessment of the degree of lumbar lordosis

B Evaluation of lateral thoracic spine flexion

C Measurement of chest expansion

D Noting the degree of cervical kyphosis

E Observation for scapular asymmetry

A

A Assessment of the degree of lumbar lordosis

B Evaluation of lateral thoracic spine flexion

C Measurement of chest expansion

71
Q

A patient who is taking prednisolone 20 mg daily to treat polymyalgia rheumatica reports blurred vision. What will the nurse practitioner do?

A Discontinue the medication

B Increase the prednisolone dose to 60 mg daily

C Prescribe NSAIDs to treat the inflammation

D Refer to a rheumatologist or the emergency room immediately

A

D Refer to a rheumatologist or the emergency room immediately

72
Q

Which of these are symptoms associated with fibromyalgia? Select all that apply.
response - correct

A Gastrointestinal complaints

B Hepatosplenomegaly

C Musculoskeletal pain

D Nonrestorative sleep

E Renal complications

A

A Gastrointestinal complaints

C Musculoskeletal pain

D Nonrestorative sleep

73
Q

A 12-year-old child is brought to the clinic with joint pain, a 3-week history of low-grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An antinuclear antibody (ANA) test is positive. Which of the following tests has the highest sensitivity in confirming the diagnosis?

A Anti-Sm antibodies

B Anti-double-strand DNA antibodies

C Anti-Ro antibodies

D Anti-La antibodies

A

B Anti-double-strand DNA antibodies

74
Q

A 60-year-old patient reports new onset of bilateral shoulder pain with morning stiffness, lasting approximately 1 hour. Which of these will be included in initial diagnostic testing for this patient? Select all that apply.
response

A Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

B Serum complement

C Liver function tests (LFTs)

D Protein electrophoresis

E Serum calcitonin

A

A Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

C Liver function tests (LFTs)

D Protein electrophoresis

75
Q

The primary care pediatric nurse practitioner is reviewing the rheumatology plan of care for a child who is diagnosed with systemic lupus erythematosus (SLE). Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?

A Have the child rest between activities

B Obtain regular ophthalmology exams

C Participate in low-impact exercises

D Use ultraviolet A (UVA) and ultraviolet B (UVB) sunscreen daily

A

D Use ultraviolet A (UVA) and ultraviolet B (UVB) sunscreen daily

76
Q

Which of the following describes the presentation of osteoarthritis?

Select one:

a. Gradual onset of pain with morning stiffness lasting <30 minutes
b. Acute onset of pain associated with redness, swelling and warmth
c. Gradual onset pain and stiffness associated with fatigue
d. Pain and stiffness that is worse in the morning lasting longer than 1 hour

A

a. Gradual onset of pain with morning stiffness lasting <30 minutes

77
Q

Anti-cyclic citrullinated protein (anti-CCP) antibodies are positive in which of the following?

Select one:

a. Rheumatoid arthritis
b. Systemic lupus erythematosus
c. Ankylosing spondylitis
d. Fibromyalgia

A

a. Rheumatoid arthritis

78
Q

Which hematologic abnormalities can be seen in a patient with systemic lupus erythematosus?

Select one:

a. There are usually no hematologic abnormalities
b. Thrombocytosis
c. Neutrophilia and bandemia
d. Leukopenia

A

d. Leukopenia

79
Q

Which of the following exam finding in a patient presenting with joint pain would suggest psoriatic arthritis?

Select one:
a. Alopecia
b. Lymphadenopathy
c. Nail pitting 
d. Skin photosensitivity
Feedback
A

c. Nail pitting

80
Q

Which of the following is correct regarding ankylosing spondylitis?

Select one:

a. It usually develops after the 5th decade of life
b. The hand and finger joints are commonly affected
c. The first line treatment is NSAIDS
d. It is a non-inflammatory arthritis

A

c. The first line treatment is NSAIDS

81
Q

Which of the following is a first line treatment for acute gout in the absence of contraindications?

Select one:

a. NSAIDS
b. Corticosteriods
c. Colchicine
d. Allopurinol

A

a. NSAIDS

NURP 532 Exam 3 (1 decks)

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