Exam 4 Flashcards by Maressa Cooley

Sandra is 70 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit?
A.	Acute lymphoblastic leukemia (ALL)
B.	Acute myelogenous leukemia (AML)
C.	Chronic myelogenous leukemia (CML)
D.	Chronic lymphocytic leukemia (CLL)

D. Chronic lymphocytic leukemia (CLL)

How well did you know this?

Not at all

Perfectly

Which type of bone marrow transplant is obtained from an identical twin?
A.	Xenograft
B.	Autologous
C.	Allogeneic
D.	Syngeneic

D. Syngeneic

How well did you know this?

Not at all

Perfectly

During treatment for anaphylaxis, which site is used for the initial injection of epinephrine?
A.	Antecubital vein
B.	Abdomen
C.	Upper lateral thigh
D.	Deltoid

C. Upper lateral thigh

How well did you know this?

Not at all

Perfectly

After the initial treatment for anaphylaxis, which medication should be added to prevent late-phase anaphylactic reactions?
A.	Albuterol
B.	Diphenhydramine
C.	H2 blocker
D.	Corticosteroid

D. Corticosteroid

How well did you know this?

Not at all

Perfectly

When analyzing synovial fluid, if it has 10,000 white blood cells/mcL with 80% polymorphonuclear neutrophils (PMNs), it may be indicative of which of the following conditions?
A.	None, this is a normal result
B.	Scleroderma
C.	Rheumatoid arthritis
D.	Sickle cell disease

C. Rheumatoid arthritis

How well did you know this?

Not at all

Perfectly

Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist?
A.	Methotrexate (Rheumatrex)
B.	Etanercept (Enbrel)
C.	Rituximab (Rituxan)
D.	Anakinra (Kineret)

A. Methotrexate (Rheumatrex)

How well did you know this?

Not at all

Perfectly

Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate?
A. PEP treatment regimens contain two antiretroviral medications.
B. PEP should be started within 72 hours of exposure.
C. PEP follow-up requires renal function tests at 6 weeks after beginning PEP.
D. PEP will prevent potential hepatitis C infection, if present.

B. PEP should be started within 72 hours of exposure.

How well did you know this?

Not at all

Perfectly

For which patient would the clinician recommend annual HIV testing?
A. One who is in a mutually monogamous relationship that engages in anal sex
B. One who is a migrant worker
C. One who is diagnosed with viral hepatitis
D. One who is pregnant with second child from another male

C. One who is diagnosed with viral hepatitis

How well did you know this?

Not at all

Perfectly

Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?
A. A favorable prognostic trend
B. Disease progression
C. The need to be more aggressive with Reuben’s medications
D. Drug resistance mutations

A. A favorable prognostic trend

How well did you know this?

Not at all

Perfectly

A patient with atrial fibrillation is taking warfarin (Coumadin) and has an international normalized ratio (INR) of 4.0 with no active bleeding. How should the clinician manage this patient?
A. Stop the medication for 1 week, and then repeat the INR.
B. Withhold 1 or more days of anticoagulant therapy.
C. Restart therapy at a lower dose immediately.
D. Slowly increase the dose over 3 days.

B. Withhold 1 or more days of anticoagulant therapy.

How well did you know this?

Not at all

Perfectly

The patient with severe iron deficiency anemia is eating ice chips. Which term should the clinician use to document this finding?
A.	Cheilosis
B.	Anorexia
C.	Hypochromasia
D.	Pica

D. Pica

How well did you know this?

Not at all

Perfectly

As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin?
A.	Two
B.	Three
C.	Four
D.	Five

B. Three

How well did you know this?

Not at all

Perfectly

What is the most common cause of microcytic anemia?
A.	Anemia of chronic disease
B.	Sideroblastic anemia
C.	Iron-deficiency anemia
D.	Pernicious anemia

C. Iron-deficiency anemia

How well did you know this?

Not at all

Perfectly

Which symptom is the cardinal subjective symptom of sickle cell crisis?
A.	Pain
B.	Nausea
C.	Light-headedness
D.	Palpitations

A. Pain

How well did you know this?

Not at all

Perfectly

Which phrase describes rheumatoid arthritis (RA)?
A. Localized synovial joint destruction
B. Chronic exocrine dysfunction
C. Systemic inflammatory disease
D. Antibody-mediated cellular cytotoxicity response

C. Systemic inflammatory disease

How well did you know this?

Not at all

Perfectly

Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?
A.	Erythrocyte sedimentation rate
B.	White blood cell count
C.	Polymorphonuclear cells
D.	C-reactive protein (CRP)

D. C-reactive protein (CRP)

How well did you know this?

Not at all

Perfectly

Infectious mononucleosis results from an acute infection with which of the following?
A.	Epstein-Barr virus
B.	Acute HIV infection
C.	Guillain-Barré
D.	Hepatitis

A. Epstein-Barr virus

How well did you know this?

Not at all

Perfectly

Which condition is the most common cause of generalized musculoskeletal pain in women ages 20 to 55?
A.	Chronic fatigue syndrome
B.	Anemia
C.	Fibromyalgia syndrome
D.	Sports-related injuries

C. Fibromyalgia syndrome

How well did you know this?

Not at all

Perfectly

After returning from visiting his grandchildren in Connecticut, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. Which disease should the clinician be considering?
A.	Rubella
B.	Lyme disease
C.	Fibromyalgia syndrome
D.	Shingles

B. Lyme disease

How well did you know this?

Not at all

Perfectly

Dryness of the eyes and mouth is typical of which condition?
A.	Sjögren’s syndrome
B.	Allergic reaction
C.	Hypothyroidism
D.	Sideroblastic anemia

A. Sjögren’s syndrome

How well did you know this?

Not at all

Perfectly

Exposure to ultraviolet (UV)-B and UV-A rays is a triggering factor for acute exacerbations of which condition?
A.	Rheumatoid arthritis
B.	Gout
C.	Systemic lupus erythematosus
D.	Sjögren’s syndrome

C. Systemic lupus erythematosus

How well did you know this?

Not at all

Perfectly

What is the current goal of treatment for a patient with HIV infection?
A. Viral suppression to undetectable levels
B. Compete eradication of the virus
C. Limit contact with uninfected individuals
D. Total abstinence

A. Viral suppression to undetectable levels

How well did you know this?

Not at all

Perfectly

Which test should the clinician use to initially screen for HIV?
A. Western blot
B. Enzyme-linked immunosorbent assay
C. HIV-1/2 antigen/antibody combination immunoassay
D. Nucleic acid amplification testing

C. HIV-1/2 antigen/antibody combination immunoassay

How well did you know this?

Not at all

Perfectly

Which lab test would the clinician order to monitor for a significant side effect from tenofovir disoproxil fumarate?
A.	Urine protein
B.	Allele genetic testing
C.	Sodium level
D.	Hemoglobin

A. Urine protein

How well did you know this?

Not at all

Perfectly

Which drug category of antiretroviral (ARV) therapy is generally effective in crossing the blood–brain barrier and may be useful in managing HIV-associated dementia? A. Nucleoside reverse transcriptase inhibitors B. Protease inhibitors C. Integrase inhibitors D. Nonnucleoside reverse transcriptase inhibitors

D. Nonnucleoside reverse transcriptase inhibitors

``` Spontaneous bruising may be seen with platelet counts below what level? A. 100,000 cells/mL B. 75,000 cells/mL C. 50,000 cells/mL D. 30,000 cells/mL ```

D. 30,000 cells/mL

``` Which type of fatigue may improve with exercise after awakening? A. Functional B. Acute C. Persistent D. Anemia associated ```

A. Functional

Which assessment finding presents with early rheumatoid disease? A. Pain and swelling in both small and large peripheral joints B. Rigid joints with diminished range of motion C. Joint swelling and immobility on rising D. A cardiac rub with pulmonary friction rub

C. Joint swelling and immobility on rising

``` Which test is diagnostic of RA? A. Rheumatoid factor B. Erythrocyte sedimentation rate C. C-reactive protein D. Anti-citrulline-containing peptide titers ```

D. Anti-citrulline-containing peptide titers

``` What is the mainstay of management for infectious mononucleosis? A. Antivirals B. Symptom control C. Corticosteroids D. Isolation ```

B. Symptom control

Chronic fatigue syndrome (CFS) tends to occur in which individuals? A. Active, highly functional adults B. Depressed middle-aged adults C. Individuals with a depressed immune system D. Individuals who are hypochondriacs

A. Active, highly functional adults

``` What is the bulls-eye rash of Lyme disease called? A. Erythema infectiosum B. Viral exanthem C. Erythema migrans D. Morbilliform exanthem ```

C. Erythema migrans

``` Which condition if left untreated will progress to complaints that include multiple joint arthritis? A. Sjögren’s syndrome B. HIV/AIDS C. Guillain-Barré D. Lyme disease ```

D. Lyme disease

``` Keratoconjunctivitis sicca is a classic sign of which condition? A. Systemic lupus erythematosus B. Sjögren’s syndrome C. Fibromyalgia syndrome D. Lyme disease ```

B. Sjögren’s syndrome

``` Which person is four times more likely to develop systemic lupus erythematosus (SLE) than a Caucasian? A. One of African descent B. An Asian C. A Hispanic D. One from the Middle East ```

A. One of African descent

``` The older adult patient has an infection. The clinician should assess for which clinical manifestation? A. Fever B. Dementia C. Confusion D. Ecchymosis ```

C. Confusion

``` Which aspect should the clinician consider when trying to determine the cause of lymphadenopathy? A. Prothrombin time B. Marital status C. Patient’s age D. Blunt trauma ```

C. Patient’s age

``` The patient has a fever of 104.2°F (40.1°C). Which condition should the clinician be considering as the etiology of the fever? A. Urinary tract infection B. Infectious hepatitis C. Tuberculosis D. Pancreatitis ```

D. Pancreatitis

``` Which type of hypersensitivity reaction should the clinician suspect in a patient who has an elevated IgE level? A. 1 B. 2 C. 3 D. 4 ```

A. 1

``` In which area would the clinician evaluate a tender point in a patient with suspected fibromyalgia syndrome (FMS)? A. Fifth rib B. Trapezius C. Maxillary D. Midforearm ```

B. Trapezius

``` A patient has CFS. Which strategy should the clinician consider to manage this patient? A. Bedrest B. High-impact exercise C. Thermal biofeedback D. Cognitive-behavioral therapy ```

D. Cognitive-behavioral therapy

``` Which classic rash should the clinician assess for in a patient with SLE? A. Butterfly B. Bulls-eye C. Ringworm D. “Slapped” cheeks ```

A. Butterfly

``` Which blood cell is excessively elevated in a person who has polycythemia? A. Platelets B. Neutrophils C. Red blood cells D. All types of blood cells ```

C. Red blood cells

``` Which treatment would the clinician recommend for a patient who has relative polycythemia? A. Rehydration B. Antihistamines C. Weekly phlebotomies D. Referral to hematologist ```

A. Rehydration

``` Which behavior would the clinician advise the patient with sickle cell anemia to avoid? A. Becoming overhydrated B. Taking folic acid supplements C. Becoming physically overtaxed D. Taking rest periods during the day ```

C. Becoming physically overtaxed

The clinician must differentiate chronic vitamin B12 deficiency anemia from folate deficiency anemia. Which action should the clinician take? A. Obtain a complete blood count B. Assess for peripheral neuropathy C. Inspect for smooth surface on tongue D. Determine the size of the red blood cell

B. Assess for peripheral neuropathy

``` Which finding from the bone marrow aspiration is typical in a patient with CML? A. Schistocytes B. Howell-Jolly bodies C. Hemoglobin S gene D. Philadelphia chromosome ```

D. Philadelphia chromosome

``` How long would the clinician inform the patient to rest after onset of infectious mononucleosis? A. 4 days B. 10 days C. 2 weeks D. 4 weeks ```

D. 4 weeks

``` A patient presents with symptoms of infectious mononucleosis. Which lab chemistry test should the clinician order? A. Viral load B. Hemoglobin A1c C. Western blot assay D. Heterophile antibody test ```

D. Heterophile antibody test

``` The advance practice registered nurse (APRN) is providing a community health program for the prevention of Lyme disease. Which information should be included? A. Safe sex practices B. Hiking precautions C. Smoking cessation D. Vaccination schedules ```

B. Hiking precautions

``` The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Dopamine D. Serotonin ```

B. Gamma-aminobutyric acid (GABA)

``` The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least: A. 1 month B. 3 months C. 6 months D. 12 months ```

C. 6 months

``` A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack? A. Pheochromocytoma B. Hyperthyroidism C. Cardiac arrhythmias D. All of the above ```

D. All of the above

Which of the following is considered first-line treatment for panic disorders? A. Benzodiazepines B. Selective serotonin reuptake inhibitors (SSRIs) C. Tricyclic antidepressants D. Cognitive behavioral therapy

D. Cognitive behavioral therapy

Which of the following symptoms is NOT part of the diagnostic criteria for post-traumatic stress disorder (PTSD)? A. Hypersomnolence B. Blunted feelings C. Loss of interest in significant activities D. Intrusive recurrent recollections of the event

A. Hypersomnolence

Which of the following neuroendocrine abnormalities is implicated in depression? A. Decrease in adrenal size B. Hypersecretion of cortisol C. An exaggerated response of thyrotropin (TRH) to infusion of thyroid-releasing hormone D. Increased inhibitory response of glucocorticoids to dexamethasone

B. Hypersecretion of cortisol

The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is NOT true concerning SSRIs in comparison to tricyclic antidepressants? A. SSRIs are more effective than TCAs. B. SSRIs take less time to work than TCAs. C. SSRIs have a more favorable side-effect profile than TCAs. D. SSRIs are not lethal in overdose.

A. SSRIs are more effective than TCAs.

``` After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor? A. 2 weeks B. 3 weeks C. 4 weeks D. 5 weeks ```

D. 5 weeks

It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period? A. Prior to the antidepressant reaching therapeutic levels B. As the mood lifts in response to antidepressant treatment C. During dosage or medication adjustments D. After the patient reveals suicidal thoughts or plans

B. As the mood lifts in response to antidepressant treatment

A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the following approaches to treating these side effects? A. Give the patient a “drug holiday” until the symptoms resolve and then restart the medication. B. Switch the patient to a different antipsychotic. C. Treat the patient with anticholinergics. D. Treat the patient with anticonvulsants.

C. Treat the patient with anticholinergics.

According to Kübler-Ross, the stages of grief occur in which order? A. Anger, denial, depression, bargaining, acceptance B. Anger, denial, bargaining, acceptance, depression C. Denial, anger, depression, bargaining, acceptance D. Denial, anger, bargaining, depression, acceptance

D. Denial, anger, bargaining, depression, acceptance

The clinician is educating a patient about the effects of marijuana. The patient stated that she has been smoking for years and believes the use does not interfere with her life. What is the potential long-term sequelae of marijuana use that the clinician should educate this patient about? A. Memory impairment B. Sexual dysfunction C. Dry mouth D. There are no long-term consequences of marijuana use

A. Memory impairment

``` Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter? A. GABA B. Acetylcholine C. Dopamine D. Serotonin ```

C. Dopamine

``` What blood alcohol level corresponds with the signs of stupor and confusion? A. 0.05 B. 0.1 C. 0.2 D. 0.3 ```

D. 0.3

``` Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep? A. Every 30 to 40 minutes B. Every 60 to 80 minutes C. Every 90 to 100 minutes D. Every 180 to 200 minutes ```

C. Every 90 to 100 minutes

``` Which of the following is a laboratory finding commonly found in patients with anorexia nervosa? A. Hypophosphatemia B. Hypermagnesmia C. Leukocytosis D. Decreased TRH ```

A. Hypophosphatemia

``` Which of the following is the only drug used to treat bulimia that is approved by the U.S. Food and Drug Administration? A. Sertraline B. Fluoxetine C. Citalopram D. Imipramine ```

B. Fluoxetine

``` Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)? A. Liver function B. Vision C. Growth parameters D. Renal function ```

C. Growth parameters

``` It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault? A. Depression B. Obsessive-compulsive disorder C. Substance abuse D. PTSD ```

D. PTSD

``` Women are at the highest risk for developing peripartum depression for up to how long after childbirth? A. 1 to 3 weeks B. 1 month C. 3 to 6 months D. 7 months to 1 year ```

A. 1 to 3 weeks

``` Which is the most prevalent psychiatric condition in the United States? A. Depression B. Anxiety C. Substance-related addictions D. Gambling addiction ```

B. Anxiety

What is recorded as clinical category two of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)? A. Clinical disorder or focus of clinical attention B. Personality or environmental problems C. Environmental and psychosocial stressors D. Global assessment of functioning

C. Environmental and psychosocial stressors

``` Which of the following may be used to evaluate a person’s suicide risk? A. CAGE B. SANE C. SAD PERSONAS D. DIGFAST ```

C. SAD PERSONAS

``` What is the essential feature of bipolar-I? A. Hyperactivity B. Mania C. Depression D. Anxiety ```

B. Mania

Bipolar disorder requires differential diagnosis from all of the following except? A. Substance abuse and medication effects B. Medical and neurological disorders C. Cluster B personality disorders and depression D. Obsessive-compulsive disorder

D. Obsessive-compulsive disorder

``` All benzodiazepines are associated with: A. Potential anterograde amnesia B. Dopamine-related movement disorders C. Serotonin syndrome D. Xerostomia and agitation ```

A. Potential anterograde amnesia

``` Which medication is used as a first-line treatment in the management of bipolar disorder? A. Gabapentin B. Lamotrigine C. Carbamazepine D. Topiramate ```

C. Carbamazepine

HITS is a validated instrument used to identifying intimate partner violence. What does HITS stand for? A. Hit, Injured, Threatened, Scared B. Hurt, Insult, Threaten, Scream C. Humiliated, Isolated, Tortured, Scarred D. Harm, Injury, Terror, Shame

B. Hurt, Insult, Threaten, Scream

Emotional dysregulation is common in: A. Children with obsessive-compulsive disorder B. Adults with schizophrenia C. Adults with attention deficit-hyperactivity disorder D. Children with tic disorders

C. Adults with attention deficit-hyperactivity disorder

``` The stooped posture, motor slowness, and minor cognitive impairments of patients with major depressive disorders are similar to the signs of disorders of the basal ganglia, such as: A. Parkinson’s disease B. Stevens-Johnson syndrome C. Neurological disease D. Huntington’s disease ```

A. Parkinson’s disease

A serious physical illness in any organ category is: A. An independent risk factor for geriatric suicide B. Likely to occur with body dysmorphic disorder C. Associated with mood disorders D. Likely to produce anxiety or panic disorders

A. An independent risk factor for geriatric suicide

``` Suicide plans are assessed on all of the following, EXCEPT: A. Specificity B. Possibility C. Availability D. Lethality ```

B. Possibility

``` What is the median reduction in life expectancy among those with mental illness? A. 15.4 years B. 10.1 years C. 5.7 years D. 9.2 years ```

B. 10.1 years

``` Which of the following is a potential adverse reaction to clozapine (Clozaril)? A. Prolonged QT interval B. Hyperprolactinemia C. Postural hypotension D. Myocarditis ```

D. Myocarditis

``` Each of the following antidepressants does NOT have significant liver CYP P450 interaction effects? A. Paroxetine B. Fluoxetine C. Fluvoxamine D. Olanzapine ```

D. Olanzapine

``` What term describes random quick jerking movements that flow from joint to joint? A. Dystonia B. Chorea C. Myoclonus D. Compulsions ```

B. Chorea

Instead of reporting symptoms of body dysmorphic disorder (BDD) to the primary-care provider, patients often request which of the following? A. Referrals to plastic surgeons, orthodontists, or dermatologists B. Antidepressant medications C. Nutritional counseling services D. Unnecessary laboratory tests

A. Referrals to plastic surgeons, orthodontists, or dermatologists

``` What is the leading preventable cause of death and disability? A. Opioid addiction B. Obesity C. Tobacco use D. Stress ```

C. Tobacco use

``` What is a common adverse reaction for children prescribed Risperdal for autism-associated irritability? A. Gynecomastia B. Parkinsonian-like syndrome C. Bradycardia D. Rebound hypertension ```

B. Parkinsonian-like syndrome

What is the advantage of guanfacine (i.e., Tenex, Intuniv) over clonidine (i.e., Catapres, Kapvay) for the treatment of ADHD? A. Tapering off is not required on discontinuation B. Therapeutic effect is instantaneous C. Wider range of available dosages D. Less sedation and longer duration of action

D. Less sedation and longer duration of action

``` What is a differential diagnosis of autism spectrum disorder? A. Speech sound disorder B. Duchenne muscular dystrophy C. Structural brain malformations D. Hypoxic ischemic brain injury ```

A. Speech sound disorder

Which intervention has been shown to diminish feelings of isolation, improve coping skills, and decrease the need for hospitalization in schizophrenia? A. Cognitive behavioral therapy B. Peer-delivered services C. Family-based therapy D. Assertive community treatment (ACT) model of care

B. Peer-delivered services

``` What is the likely result of the over-prescription, over-supply, and over-production of opioids? A. Opioid use B. Opioid abuse C. Opioid dependence D. Opioid resistance ```

B. Opioid abuse

What is the health impact of low-dose alcohol consumption? A. Increased risk of developing alcohol addiction B. Increased risk of coronary artery disease C. Increased excitation of critical ion channels D. Increased high-density lipoproteins

D. Increased high-density lipoproteins

``` Echolalia is sometimes demonstrated by people with which disorder? A. Autism B. Alcoholism C. ADHD D. Asperger’s ```

A. Autism

What prenatal factor could increase risk for ADHD? A. Exposure to lead B. Zinc deficiency C. Maternal allergies D. Central nervous system (CNS) infections

B. Zinc deficiency

``` If stimulant drugs are not tolerated or contraindicated for the treatment of ADHD, what medication may produce a therapeutic effect? A. Daytrana B. Vyvanse C. Warfarin D. Atomoxetine ```

D. Atomoxetine

What is the presentation of a complex motor tic? A. Simultaneous shoulder shrugs and head turns B. Eye blinks and extension of extremities C. Throat clearing and finger raising D. Barking, screaming, and snorting

A. Simultaneous shoulder shrugs and head turn

``` What is the most prevalent psychiatric comorbidity of ADHD? A. Antisocial personality disorder B. Generalized anxiety disorder C. Oppositional defiant disorder D. Social phobias ```

C. Oppositional defiant disorder

``` What severity level of intellectual disability is demonstrated by a child whose language and academic skills markedly lagging behind peers, misperceive social cues, and have a simpler spoken language than their peers? A. Mild B. Moderate C. Severe D. Profound ```

B. Moderate

``` Which type of heat-related illness involves a core body temperature of at least 104°F and may present with hot dry skin, acute mental status changes, absent sweat, and tachypnea? A. Heat cramps B. Heat syncope C. Heat exhaustion D. Heat stroke ```

D. Heat stroke

``` What percentage of burns is involved using the rule of nines if both front legs are burned? A. 9% B. 18% C. 24% D. 36% ```

B. 18%

``` Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries? A. Clotrimazole cream (Lotrimin) B. Mafenide acetate (Sulfamylon) C. Silver nitrate D. Silver sulfadiazine (Silvadene) ```

D. Silver sulfadiazine (Silvadene)

``` A sunscreen with a sun-protection factor of at least what number will block most harmful ultraviolet radiation? A. 4 B. 8 C. 10 D. 15 ```

D. 15

``` Which clinical feature is a late sign of increased intracranial pressure? A. Dilated, nonreactive pupils B. Altered level of consciousness C. Loss of judgment D. Amnesia ```

A. Dilated, nonreactive pupils

``` What number represents normal neurological function on the Glasgow Coma Scale? A. 7 B. 9 C. 10 D. 15 ```

D. 15

``` Which diagnostic test is the best to diagnose a subdural hematoma? A. History B. Positron emission tomography C. Magnetic resonance imaging (MRI) D. Computed tomography (CT) scan ```

C. Magnetic resonance imaging (MRI)

``` Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point? A. 5% to 15% B. 20% to 25% C. 30% to 50% D. 60% to 80% ```

C. 30% to 50%

``` Most adult poisonings are: A. Intentional and self-inflicted B. Accidental C. Caused by someone wishing to do harm to the person D. Not attributed to any reason ```

A. Intentional and self-inflicted

``` Which method is used to remove heavy metals, such as lead? A. Chelation B. Dialysis C. Gastric lavage D. Bowel irrigation ```

A. Chelation

If a previously frostbitten area becomes frostbitten again after it has healed, what might occur? A. Permanent tissue damage may occur, resulting in necrosis to that body part. B. The area will be super sensitive. C. The area is prone to a repeat frostbite. D. The area is as susceptible as any other area.

A. Permanent tissue damage may occur, resulting in necrosis to that body part.

``` What population represents almost 75% of wounds? A. Boys in the mid-to-late teens B. Men in their early 20s C. Women in the mid-40s D. Toddlers between 18 and 30 months ```

B. Men in their early 20s

Which solution should be used when irrigating lacerated tissue over a wound on the arm? A. Dilute povidone-iodine solution B. Hydrogen peroxide (H2O2) C. Saline solution infused with an antibiotic D. Saline irrigation or soapy water

D. Saline irrigation or soapy water

``` Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact? A. Superficial burns B. Superficial partial-thickness burns C. Deep partial-thickness burns D. Full-thickness burns ```

C. Deep partial-thickness burns

``` Which carboxyhemoglobin (COHb) level correlates with the clinical symptoms of confusion, lethargy, and ST-segment depression on the electrocardiogram? A. Less than 10% B. 20% COHb C. 30% COHb D. 40% to 60% COHb ```

C. 30% COHb

``` Which causes the greatest percentage of mammalian bites? A. Dogs B. Cats C. Humans D. Rodents ```

A. Dogs

``` Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue? A. Tick B. Brown recluse spider C. Wasp D. Stinging caterpillar ```

B. Brown recluse spider

``` What condition is sometimes confused with anaphylaxis from an insect sting? A. Heat stroke B. Toxic syndrome C. Vasovagal reaction D. Inflammatory response ```

C. Vasovagal reaction

Delayed serum sickness–type reactions in response to multiple bee, wasp, or fire-ant stings can be managed with which of the following? A. A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2 weeks B. An oral antihistamine, such as hydroxyzine, for 2 weeks C. An H2 blocker such as cimetidine for 1 week D. 0.1 mg (1 mL of 1:10,000 solution epinephrine) in 10 mL of normal saline and administer as a slow IV push over 10 minutes

A. A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2 weeks

``` After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)–filled spaces within the head? A. Pneumocephalus B. Hemotympanum C. Battle’s sign D. Raccoon sign ```

A. Pneumocephalus

``` CSF may leak through the cribriform plate region of the skull following a head injury and cause which of the following? A. Ear CSF otorrhea B. Leakage of CSF from the eye C. Nasal CSF rhinorrhea D. Leakage of CSF from the mouth ```

C. Nasal CSF rhinorrhea

``` What condition is characterized by a brief loss of consciousness, then a brief “lucid” moment, followed by momentary unconsciousness minutes after the injury? A. Concussive hematoma B. Bleeding dyscrasias C. Subdural hematoma D. Epidural hematoma ```

D. Epidural hematoma

``` A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? A. CN II B. CN III C. CN IV D. CN V ```

C. CN IV

``` A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? A. A sprain B. A strain C. A partial fracture D. A fracture ```

B. A strain

``` In a healthy adult, the process of remodeling after fracture of the humerus takes how long? A. Approximately 4 weeks B. Approximately 2 months C. Approximately 3 months D. Approximately 4 months ```

B. Approximately 2 months

A patient who sustains blunt chest trauma and/or penetrating chest trauma must have which of the following imaging examinations? A. Upright anterior/posterior and lateral chest x-ray B. Supine anterior/posterior and lateral chest x-ray C. Upright bilateral chest x-ray D. Supine anterior/posterior chest x-ray

A. Upright anterior/posterior and lateral chest x-ray

If a suspected pneumothorax is discovered in the primary-care setting, what should happen first? A. Emergency medical services should be activated. B. Support cardiovascular and respiratory status as needed. C. Administer supplemental oxygen to reabsorb the pneumothorax. D. Initiate stabilizing treatments, including emergency chest-tube placement.

A. Emergency medical services should be activated.

``` Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication? A. Phenobarbital B. Diazepam C. Ritalin D. Acetaminophen ```

D. Acetaminophen

``` Pink, cherry-red tissues and skin may result from which type of poisoning? A. Arsenic B. Lead C. Carbon monoxide D. Strychnine ```

C. Carbon monoxide

``` In which type of burn is the injury more extensive than it appears, and the cardiac conduction system may be affected, leading to sudden death or arrhythmias? A. Chemical burns B. Electrical burns C. Radiation burns D. Thermal burns ```

B. Electrical burns

Eddie, age 4, presents to the emergency department with a live insect trapped in his ear canal causing a lot of distress. What should be your first step? A. Remove the insect with tweezers. B. Immobilize the insect with 2% lidocaine. C. Sedate Eddie with diazepam. D. Shine a light in the ear for the insect to “find its way out.”

B. Immobilize the insect with 2% lidocaine.

When giving discharge instructions to a patient with a laceration injury to his lower leg, which is the most important one? A. Recommend isometric exercises to prevent a deep vein thrombosis (DVT). B. Recommend cleansing the wound every 4 hours to prevent an infection. C. Keep the leg elevated at waist level to prevent any edema. D. Keep the leg completely immobile to prevent extension of the laceration.

A. Recommend isometric exercises to prevent a deep vein thrombosis (DVT).

``` Cerebellar function may be assessed by performing which examination/test? A. Gag reflex B. Pupillary response C. Romberg’s test D. Apley’s test ```

C. Romberg’s test

``` In the epithelialization phase of wound healing, the wound will have only what percentage of its normal tensile strength at 3 weeks? A. Less than 15% B. 15% to 20% C. 25% to 40% D. Greater than 50% ```

B. 15% to 20%

Which of the following statements is true about antibiotic prophylaxis for most wounds? A. Antibiotics are not indicated. B. Antibiotics should always be ordered for a wound. C. Antibiotics need to be ordered for at least 2 weeks. D. Antibiotics should be ordered only if sutures are in place.

A. Antibiotics are not indicated.

``` Which condition is often an unrecognized contributor to heat-related illness? A. Autonomic neuropathy B. Beta-adrenergic blockade C. Myocardial infarction D. Acclimatization ```

B. Beta-adrenergic blockade

Why do benzodiazepines have less potential for toxicity than barbiturates? A. They cause decreased neuronal activity, depressed central sympathetic tone, and inhibit cardiac contractility. B. They increase ligand affinity and the frequency of ion channel opening, but not the duration of time the channel remains open. C. They act directly on inhibitory gamma-aminobutyric acid (GABA) receptors. D. They increase the average opening time of chloride ion channels.

B. They increase ligand affinity and the frequency of ion channel opening, but not the duration of time the channel remains open.

``` What is the most common cause of infectious conjunctivitis? A. Adenovirus B. Rhinovirus C. Staphylococcus aureus D. Streptococcus ```

A. Adenovirus

``` A patient presents to the emergency department with delirium, dilated pupils bilaterally, and hypoactive bowel sounds. Skin is flushed and dry; mucous membranes are dry. Upon admission, a urinary catheter was inserted with no output. These clinical manifestations describe which common toxidrome? A. Cholinergic B. Sedative-hypnotic C. Anticholinergic D. Sympathomimetic ```

C. Anticholinergic

Why are people with cystic fibrosis (CF) especially vulnerable to heat stroke? A. Intravascular coagulation prevents the production of chloride. B. Blood flow to the skin is impaired in temperatures above 95 C. Sweat glands are inactive in CF. D. Salts from perspiration are not reabsorbed after sweating.

D. Salts from perspiration are not reabsorbed after sweating.

``` What is true about an acclimatized person? A. Aldosterone secretions are diminished B. Heat dissipation is impeded C. Cardiac output increases D. Aerobic muscle metabolism decreases ```

C. Cardiac output increases

If no clinical decompensation is noted when evaluating a poisoned patient, what should you do next? A. Evaluate for signs of trauma and central nervous system involvement. B. Evaluate the airway, breathing, and circulation. C. Order a basic metabolic panel and liver function test panel. D. Obtain a urine sample for a toxicology screen.

A. Evaluate for signs of trauma and central nervous system involvement

``` What should you use to alkalinize urine to a pH of greater than 7.0? A. Dextrose B. Sodium bicarbonate C. Activated charcoal D. Ipecac syrup ```

B. Sodium bicarbonate

``` What is the most dangerous complication of acute mastoiditis? A. Otitis media with effusion B. Meningitis C. Tympanic membrane rupture D. Intracranial abscess ```

D. Intracranial abscess

What would confirm if the joint was tapped in a knee fracture? A. A presence of hemarthrosis with fat globules B. The inability to flex the knee joint C. A large effusion D. Pain is elicited during passive range of motion

A. A presence of hemarthrosis with fat globules

``` Hyperhidrosis (trench foot) is a differential diagnosis for what condition? A. Hyperthermia B. Necrosis C. Frostbite D. Erythema pernio ```

C. Frostbite

What is the aim of gastrointestinal decontamination for poisoned patients? A. Evacuating toxins from the stomach before they can be absorbed. B. Neutralizing the poison by inducing vomiting and diarrhea. C. Restricting the amount of xenobiotic from reaching the systemic circulation. D. Absorbing the toxins that have reached systemic circulation.

C. Restricting the amount of xenobiotic from reaching the systemic circulation.

What must be present for a diagnosis of acute diarrhea? A. Positive test for bacterial, viral, or parasitic infection B. Passing six or more stools daily without improvement for at least 3 days C. Loose stools with fever greater than 100F D. Greater than 50%

B. Passing six or more stools daily without improvement for at least 3 days

``` Which of the following is not a cause of secondary constipation? A. Hard stools B. Diet C. Pregnancy D. Medications ```

A. Hard stools

``` Which of the following is not a differential diagnosis of heat stroke? A. Cerebrovascular accident B. Central nervous system infections C. Diabetic ketoacidosis D. Alcohol intoxication ```

D. Alcohol intoxication

Which of the following statements is TRUE regarding pain? A. If a patient complains of pain but has no physical signs, he or she is most likely exhibiting drug-seeking behaviors. B. Acute pain is more intense and severe than chronic pain. C. Pain is a subjective experience related to actual or potential tissue damage. D. Nociceptive pain represents a normal response to injury of tissue.

D. Nociceptive pain represents a normal response to injury of tissue.

``` Which of the following would be a cause of neuropathic pain? A. Bone metastases B. Poststroke pain C. Musculoskeletal inflammation D. Postsurgical incisional pain ```

B. Poststroke pain

``` Which drug is considered the MOST effective medication for pain in terminally ill patients? A. Codeine B. Hydrocodone C. Morphine D. Hydromorphone ```

C. Morphine

Unlike palliative care, hospice provides: A. Emotional support B. Care to patients at end of life only C. Spiritual services D. Relies on combined knowledge and skill

B. Care to patients at end of life only

``` An 8-year-old patient is admitted to the hospital due to Reye’s syndrome. Which medication was most likely the cause? A. Tylenol B. Motrin C. Aspirin D. Advil ```

C. Aspirin

``` A patient is 11 years old and recently had her tonsils removed. Which of the following medications is safe to give to this patient? A. Ultram B. Ultracet C. Codeine D. Tylenol ```

D. Tylenol

``` Which of the following best describes the onset of action for a fentanyl patch after application? A. 12 to 16 hours B. 1 to 2 hours C. 17 to 19 hours D. 4 to 6 hours ```

A. 12 to 16 hours

``` How often should clinicians reassess a patient that is on chronic opioids? A. 2 weeks B. 1 week C. 4 weeks D. 3 weeks ```

C. 4 weeks

``` Which antiepileptic medication is an effective treatment for nerve pain? A. Amitriptyline B. Codeine C. Methadone D. Gabapentin ```

D. Gabapentin

``` Which type of pain arises from muscle joints and cutaneous tissue? A. Somatic pain B. Neuropathic pain C. Visceral pain D. Nociceptive pain ```

C. Visceral pain

Which best describes a challenge with creating palliative care provision in community health centers and primary care? A. Providing an important service to the community B. Working with long-term patients with known history C. Help with responsibilities in a primary-care setting D. Not enough time to work with patients and families on goals of care and advanced directives

D. Not enough time to work with patients and families on goals of care and advanced directives

Which of the following is the best description of dyspnea? A. An oxygen saturation of less than 90% B. Respiratory rate greater than 24 C. A psychological state resulting in the feeling of air hunger D. A subjective feeling of breathlessness

D. A subjective feeling of breathlessness

``` For acute pain, how many days are considered sufficient for treatment with opioids? A. 3 B. 5 C. 4 D. 9 ```

A. 3

``` Scopolamine patch is one drug of choice to manage which of the following conditions that can contribute to dyspnea? A. Copious secretions B. Cough C. Anxiety D. Effusion ```

A. Copious secretions

``` Which option best defines delirium? A. Sudden onset B. Impaired attention C. Affective changes D. Delusions ```

A. Sudden onset

``` Which of the following classes of drugs should be used as first-line therapy for treatment of delirium? A. Benzodiazepines B. Antipsychotics C. Anticonvulsants D. Antidepressants ```

B. Antipsychotics

Which of the following is a role of the palliative-care team? A. Detecting cancer in asymptomatic patients B. Coordinating care provided by all health-care providers C. Identifying the patient’s quality of life D. Providing goal options to family and patients

B. Coordinating care provided by all health-care providers

``` Which of the following is an example of how to assess pain? A. Description of the pain B. Timing of the pain C. When the pain stopped D. What improved the pain ```

C. When the pain stopped

``` According to the American Pain Society, an example of the first-line therapy for mild pain includes which of the following? A. Tylenol B. Hydrocodone C. An opioid D. Muscle relaxant ```

A. Tylenol

``` You are providing end-of-life care to an elderly patient with a history of heart failure. The patient complains of dyspnea. What is often the first line treatment for this condition? A. Oxygen B. Benzodiazepines C. Opioids D. Nonpharmacological solution ```

A. Oxygen

Which statement about the American Nurses Association Code of Ethics is accurate? A. Each state’s legal requirements exceed those of the Code. B. A primary purpose of the Code is to show physicians that nurses are professional. C. Nurses, with input from physicians, formulated the Code for all nurses. D. The Code sets forth the values and ethical principles that guide clinical decisions.

D. The Code sets forth the values and ethical principles that guide clinical decisions.

``` Which ethical principle reflects respect for all persons and their self-determination? A. Autonomy B. Beneficence C. Justice D. Veracity ```

A. Autonomy

``` The clinician is using the mnemonic ETHICAL to solve a practice dilemma. What does the “A” represent? A. Accountability B. Autonomy C. Assess D. Act ```

D. Act

``` In an outpatient setting, what is the most common reason for a malpractice suit? A. Breach of confidentiality B. Failure to diagnose correctly C. Medication-related errors D. Lack of informed consent ```

B. Failure to diagnose correctly

``` Which type of liability insurance covers only situations in which the incident occurred and the claim was made while the policy was in effect? A. Claims made policy B. Occurrence policy C. An employment coverage policy D. A “tail policy” ```

A. Claims made policy

``` Which insurance plan was the first to allow members to choose nurse practitioners as their primary-care provider and pay them the same rate as physicians for the same care? A. Blue Cross/Blue Shield Plan B. Medicare/Medicaid Plan C. Oxford Health Plan D. United Health Insurance Plan ```

C. Oxford Health Plan

``` What is the primary rationale for using a decision tree to analyze ethical dilemmas? A. Shows the best solution B. Explains the ethical principles C. Delineates the legal parameters D. Allows all options to be considered ```

D. Allows all options to be considered

``` In the model for future Advanced Practice Registered Nurse (APRN) practice, what does the “C” of LACE represent? A. Commitment B. Consensus C. Certification D. Collaboration ```

C. Certification

``` Which action is best to employ in order to avoid a lawsuit? A. Obtain good liability insurance. B. Work with a collaborating physician. C. Follow documentation principles. D. Maintain open communication. ```

D. Maintain open communication.

Which statement or question made by the clinician represents paternalism in health care? A. “Continuing to drink is not healthy. I don’t want to have to give your eulogy.” B. “If you do not follow my instruction, I will remove myself from your case.” C. “I will help you in this process, but in the end you must make the decision.” D. “You don’t want to come across as uncooperative, do you?”

B. “If you do not follow my instruction, I will remove myself from your case.”

What is the purpose of the Nurse Practice Act of each state? A. Establishing legal standards B. Promoting high-quality nursing care C. Protecting the nurse after licensure D. Determining exceptions to credentialing

A. Establishing legal standards

Which phrase describes deontology? A. The greatest amount of happiness or the least amount of harm for the greatest number B. The consideration of consequences with the calculation of benefits C. The belief that the ends justify the means D. The principle of universalizability

D. The principle of universalizability

``` Which element is a primary focus of health-care reform? A. Illness management B. Fee-for-service C. Disease prevention D. Bankruptcy reduction ```

C. Disease prevention

``` Which ethical principle and concept are most congruent? A. Veracity – fairness B. Nonmaleficence – do no harm C. Beneficence – keeping promises D. Justice – truth telling ```

B. Nonmaleficence – do no harm

The Joint Commission mandates that all health-care organizations have which component in place? A. A mechanism for the consideration of ethical issues B. A standing ethics committee C. A resident parish nurse D. A lawyer who is knowledgeable about ethics

A. A mechanism for the consideration of ethical issues

What is the relationship between ethics and law? A. Ethical codes are legally binding. B. What one ought to do is the legal aspect. C. Legal actions may be both ethical and unethical. D. There is no relationship between the law and ethics.

C. Legal actions may be both ethical and unethical.

Which statement accurately describes the APRN’s scope of practice? A. Regulation of the APRN’s practice ensures public understanding. B. This delineates the permissible boundaries of APRN professional practice. C. It expands the APRN’s practice outside each state’s nurse practice act provisions. D. Each APRN defines his or her own aspect of practice to be included in a protocol.

B. This delineates the permissible boundaries of APRN professional practice.

``` Which board administers and defines advanced nursing practice in all states? A. The Board of Nursing B. The Board of Medicine C. The Board of Pharmacy D. It is different for each state. ```

D. It is different for each state.

Which condition must be present to establish malpractice? A. The APRN must be paid for the services in question. B. The provider must have a duty to the patient. C. The clinician must act in a similar manner as a prudent person. D. The plaintiff must prove an indirect link between harm and duty breach.

B. The provider must have a duty to the patient.

Which requirement regarding prescriptive privilege is granted to APRNs in all states? A. Additional medication training B. Need for countersignatures by physicians C. Statutory independent prescribing authority D. Certification in prescription drug administration

C. Statutory independent prescribing authority

``` Identify the primary challenge for insurance carriers in today’s health delivery model. A. Preventing illness B. Screening for disease C. Educating the public D. Reducing health-care spending ```

D. Reducing health-care spending

``` Medicare benefits were offered to U.S. beneficiaries beginning in 1965. What was the service added with the Medicare D plan in 2006? A. Health-care screening B. Health-care education C. Pharmaceutical coverage D. Durable medical equipment coverage ```

C. Pharmaceutical coverage

``` The cost of care provided by an APRN is approximately: A. One-quarter that of a physician B. One-third that of a physician C. One-half that of a physician D. One and one-half that of a physician ```

C. One-half that of a physician

How do bundled payments differ from fee-for-service or global capitation? A. Bundled payments are designed to reduce the number of payments to providers. B. Bundled payments align payment to care outcomes delivered by the team. C. Bundled payments reduce the amount of paperwork required for payment. D. Bundled payments allow for streamlined and coordinated billing for providers.

B. Bundled payments align payment to care outcomes delivered by the team.

Patients require education prior to accessing health-care services for the following reason: A. Many patients do not understand policy benefits and payment responsibility. B. Services may change across the beneficiary year. C. Copayments and deductibles may have already been met by the patient. D. Coding may need to be adjusted to meet the terms of the patient’s benefits.

A. Many patients do not understand policy benefits and payment responsibility.

What replaced the Sustainable Growth Rate (SGR) formula? A. Advanced Alternate Payment Model (APM) B. Merit-Based Incentive System (MIPS) C. Medicare Access and CHIP Reauthorization D. Quality Payment Program (QPP)

D. Quality Payment Program (QPP)

``` Accounting keeps track of the financial state of a business. The accounting report that demonstrates the growth in assets is: A. Net income statement B. Balance sheet C. Cash flow statement D. Operating statement ```

A. Net income statement

``` Medicare advantage plans are Medicare managed care organizations (MCOs). These plans must be approved by the Centers for Medicare and Medicaid Services (CMS) as alternative carriers for Medicare beneficiaries. Which of the following is not a characteristic of these plans? A. Offer additional benefits B. Offer lower copayments C. Follow Medicare benefit rules D. Follow the Commercial Carriers rules ```

C. Follow Medicare benefit rules

The Current Procedural Terminology (CPT) and payment fee values are applicable only to CMS services and are regulated and paid by the regional CMS carriers. How does this impact MCOs? A. MCOs are the only groups able to adjust standard payment rules. B. MCOs can independently determine whether to utilize certain CPT code rules and/or the reimbursement values for the payment year. C. MCOs can create personalized CPT codes. D. MCOs must continue to use modifiers.

B. MCOs can independently determine whether to utilize certain CPT code rules and/or the reimbursement values for the payment year.

All medical practices are required by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services. Why is this so critical? A. Electronic software allows CMS to audit all medical practices’ performance. B. Electronic filing protects patient information as required by the Health Insurance Portability and Accountability Act. C. Electric billing and automated electronic filing sets makes timely transition to new provider fee schedule rates possible. D. Medical record software eliminates the possibility for duplicate bills and overcharging patients.

C. Electric billing and automated electronic filing sets makes timely transition to new provider fee schedule rates possible.

All health-care practices should develop a compliance plan. Compliance plans offer practice safeguards that prevent which of the following? A. Malpractice claims B. Conflict-of-interest claims C. Health Insurance Portability and Accountability Act violations D. Occupational Safety and Health Administration violations

B. Conflict-of-interest claims

What is the purpose of an Evaluation and Management Audit Tool? A. To justify CPT coding B. To provide guidelines for CMS review C. To assist in estimating profit/loss for patient visits D. To allow hospitals to comply with CMS guidelines

A. To justify CPT coding

Each state has criteria defining the level of collaboration required between the Advanced Practice Registered Nurse (APRN) and an oversight physician. Which is among the questions an APRN should seek when selecting a practice setting? A. List of practice limitations as an APRN B. Standard hourly rate as office staff C. Expectation for net revenue generation D. Standard benefit package offered to office staff

C. Expectation for net revenue generation

Identify one of the primary reasons for an APRN to develop a business plan: A. To monitor monthly actual expense to budgeted expense B. To reduce the likelihood of litigation action C. To identify the marketing needed to grow the APRN practice D. To assure accreditation standards are met

C. To identify the marketing needed to grow the APRN practice

Despite the growth in the numbers of APRNs over the last decades, the role of the profession is often not understood by the public. What actions should APRNs undertake to market their services to the public? A. Request that the physician act as an APRN spokesperson. B. Increase articles in nursing professional journals about the APRN role. C. Personally seek out the news media to communicate their value. D. Rely on patients to communicate their benefits to neighbors.

C. Personally seek out the news media to communicate their value.

``` According to the World Health Organization data on 1,500 patients around the world, how many patients presenting with medical/somatic complaint had a psychiatric problem? A. 25% of all patients B. One-quarter of all patients C. One-half of all patients D. 60% of all patients ```

A. 25% of all patients

Integrating mental health techniques and approaches, such as the 15-minute hour, into the primary-care patient encounter is important for a number of reasons. These include: A. Decreasing the patient’s stress and increasing your reimbursement B. Encouraging coping strategies and increasing professional satisfaction C. Assisting patients in reliving traumatic experiences D. Decreasing care clinician stress

B. Encouraging coping strategies and increasing professional satisfaction

Valliant (1979) discusses the “ubiquity of stress.” Ubiquity of stress maintains that: A. In a current and rapidly changing society, stress can be viewed as a positive. B. Eustress is counterproductive. C. The overwhelmed can functionally regress. D. Dream therapy has been found to be an effective treatment of overwhelming stress.

C. The overwhelmed can functionally regress.

``` Basic human needs are identified as: A. Autonomy and feeling valued by others B. Exhilaration and productivity C. Spirituality D. Career success and material rewards ```

A. Autonomy and feeling valued by others

Commonalities among psychotherapeutic techniques include the following: A. Dream therapy, listening, and reflection B. Psychodrama, group psychotherapy, and 12-step programs C. Self-help groups D. Obtaining external perspective and participation in a helping relationship

D. Obtaining external perspective and participation in a helping relationship

The goals of the 15-minute hour approach include: A. Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning B. Emerge with a higher level of functioning and commitment to long-term psychotherapy C. Accept need for antidepressant therapy and psychiatric referral; share concerns with primary-care clinician D. Improve family functioning and sexual performance as well as accept need for antidepressant medication

A. Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning

BATHEing the patient refers to: A. A technique used in primary care to get the patient to accept the need for psychological or psychiatric referral B. A technique used to facilitate cultural understanding C. A technique used to perform psychotherapy D. A technique that is a quick screen for psychiatric issues and interventions for psychological problems

D. A technique that is a quick screen for psychiatric issues and interventions for psychological problems

BATHEing the patient is an advanced practice nursing intervention that allows the practitioner to: A. Develop a therapeutic relationship without “owning” the patient’s problem B. Conduct psychological counseling within the context of the primary-care encounter C. Focus on the “process” and not the assessment D. Make the patient and family happier

A. Develop a therapeutic relationship without “owning” the patient’s problem

The BATHE technique was developed more than 20 years ago and has been used extensively in primary care and family practice. The new “Positive BATHE” stresses: A. A belief that all things are possible through positive affirmations B. A belief that one should only refer to practitioners who embrace the viewpoint of positive psychology C. Health promotion, gratitude, autonomy, and positive thought D. The patient’s problems and concerns

C. Health promotion, gratitude, autonomy, and positive thought

Which of the following scenarios best demonstrates the relationship between physical health and distress? A. A patient’s high-calorie diet contributes to his diagnosis of type 2 diabetes. B. A patient with an elevated HbA1C reports that he was recently evicted from his home. C. A patient with depression reports an increase in suicidal thoughts. D. A patient reports feeling “numb” after learning that her malignant tumor is inoperable.

B. A patient with an elevated HbA1C reports that he was recently evicted from his home.

One benefit of BATHEing a patient is that: A. It allows providers an in-depth exploration of patient’s presenting problems. B. It assumes that ambivalence is a normal part of the change process. C. It utilizes the therapeutic relationship to help patients in a time-sensitive approach. D. It can be done only with extensive training in therapeutic technique.

C. It utilizes the therapeutic relationship to help patients in a time-sensitive approach.

One benefit of motivational interviewing (MI) is: A. It assumes that ambivalence is a normal part of the change process. B. It can be utilized during routine office visits. C. It is a therapeutic technique which is not necessarily time intensive. D. All are benefits of MI.

D. All are benefits of MI.

Which is not a basic principle of MI? A. People often continue behaviors with negative consequences for reasons unknown to the provider. B. The patient is the expert on his/her behavior. C. Providers are obligated to inform each patient of the negative consequences of their behaviors. D. Helping patients understand ambivalence for change is often more powerful than direct instruction.

C. Providers are obligated to inform each patient of the negative consequences of their behaviors.

The primary purpose of the “Positive BATHE” is intended to help patients by: A. Focusing on autonomy and accomplishment B. Creating a stronger therapeutic alliance C. Helping the patient change negative behaviors D. Engaging the patient during the psychosocial assessment

A. Focusing on autonomy and accomplishment

The World Health Organization defines self-care as: A. An important global activity for all health-care providers B. A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health C. Essential to efficacious advanced practice nursing practice D. An awareness by the Advanced Practice Registered Nurse (APRN) of their self-care behaviors as related to diet, activity, and mental attitude

B. A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health

Nurse theorist Dorothea Orem defines self-care activities as: A. Attainment of professional self-development goals B. Ability to persevere through hardship C. Striving to attain balance and harmony in one’s life D. Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life

D. Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life

Self-care and personal development are built into the standards of practice of: A. The American Holistic Nurses Association B. The American Nurses Association C. The American Association of Nurse Practitioners D. The American Academy of Nursing

A. The American Holistic Nurses Association

There are many pressures inherent in primary-care practice today for APRNs. These pressures include all of the following: A. Electronic medical record, the Affordable Care Act, and the implementation of socialized medicine B. Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants C. Uncertainty, the team approach to care, and the need for patient-centered care D. Availability of medical information on the Internet, educational programs for patients, and Medicare drug benefits

B. Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants

A new era of health care leads to: A. Greater opportunity for independent practice, yet increased legal risk in accountability for patients B. Lowered reimbursement for all health-care services and providers C. Decrease in status for health-care providers D. No ability to individualize care

A. Greater opportunity for independent practice, yet increased legal risk in accountability for patients

Compassion fatigue is another side effect of today’s health-care delivery system. This term means: A. The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN. B. This happens over time related to the need to see increasing numbers of patients in busy primary-care practices. C. This may persist over time, even when the APRN transfers to a new and different setting. D. Patients’ problems and circumstances can be so overwhelming that the APRN needs to set severe boundaries to maintain safe function.

A. The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN.

Another term used, burn out, is differentiated by: A. Numbness of feelings leading to substance abuse B. How novice APRNs feel at the end of the day in primary care C. Feelings of aloneness, desperation, and despair D. A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale

D. A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale

The following statement is TRUE: A. APRNs are often sensitive to patients’ deficiencies but not their own. B. APRNs always respond appropriately to patients, families, and team members. C. APRNs are well-equipped from their APRN educational programs to care for self. D. Re-licensure in some states mandates continuing education units in self-care.

A. APRNs are often sensitive to patients’ deficiencies but not their own.

Emotional intelligence is defined as: A. Being highly attuned to the needs of others B. The ability to engage in self-care C. Being able to recognize and understand the meaning of emotions, and how they affect other people D. The holistic integration of self-care and self-development practices

C. Being able to recognize and understand the meaning of emotions, and how they affect other people

APRNs need to develop their own self-care management plans. Two key elements of self-care management plans are: A. Taking vacations and keeping up with new knowledge and developments in medicine B. Resilience and positive intentionality C. Family support and a healthy diet D. Being physically and emotionally “fit”

B. Resilience and positive intentionality

The term resilience implies: A. Ability to look to a higher power to get you through a crisis B. Response to difficult and adverse circumstances through positively adjusting to stressors C. That the APRN can weather any emergency D. Learning to set appropriate boundaries

B. Response to difficult and adverse circumstances through positively adjusting to stressors

Qualities associated with resilience include: A. Hope, self-efficacy, and positivity B. Stick-to-it-ness, belief in a higher power C. Education, self-regulation, and use of activity to decrease stress D. Ability to take vacations and the availability of support systems and a secure work environment

A. Hope, self-efficacy, and positivity

Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no backup and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies? A. Patsy distanced Sue by listening to her as little as possible. B. Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining. C. Patsy spoke privately with their supervisor, Pamela, stating that she did not think Sue could be successful in this environment. D. Patsy requested that Sue be assigned to a different APRN for orientation.

B. Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining.

The qualities of resilience that Patsy demonstrated when responding to Sue include: A. Protecting her own positive attitude by lessening her contact with Sue, a negative person B. The ego strength to admit failure in her ability to orient Sue, a destructive person C. Protecting her organization by sharing Sue’s deficiencies with their supervisor D. Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her

D. Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her

According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice? A. Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy B. Review of materials on primary care before going into the work environment to increase one’s confidence, leading to caring energy C. Travel to sacred places D. Helping the poor and homeless—volunteering at a domestic violence shelter, for example—in addition to one’s regular practice

A. Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy