Exam study Flashcards by Ward Erickson

The most commo  cancer found on the aurcle is
Actinic keratosis
Basal cell carcinoma
Squamous cell
carcinoma
Acral-lentiginous
melanoma

Basal cell carcinoma

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Which of the following medication classes should be avoided in patients with acute or
chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the
patient?
Xanthines

Antihistimine

Steroids

Anticholinergics

Antihistimines

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A 47 year old male patient presents to the clinic with a single episode of a moderate
amount of bright red rectal bleeding. On examination, external hemorrhoids are noted.
How should the nurse practitioner proceed?
Instruct the patient on measures to prevent hemorrhoids such as
bowel habits and diet.

Order a topical hemorrhoid cream along with a stool softener.

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy.

Refer the patient for a barium enema and sigmoidoscopy.

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Which of the following patient characteristics are associated with chronic bronchitis?

Overweight, cyanosis, and normal or slightly increased
respiratory rate

Underweight, pink skin, and increased respiratory rate

Overweight, pink skin, and normal or slightly increased
respiratory rate

Normal weight, cyanosis, and greatly increased
respiratory rate

Overweight, cyanosis, and normal or slightly increased

respiratory rate

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A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and
polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain.
Her current medications include omeprazole 20 milligrams po daily, lisinopril 20
milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po
daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The
most appropriate diagnostic test for this patient at this time is

CBC/diff

Erythrocyte
sedimentation rate

Abdominal ultrasound

CT scan

CT Scan

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A patient reports “something flew in my eye” about an hour ago while he was splitting
logs. If there were a foreign body in his eye, the nurse practitioner would expect to find
all except:

Purulent drainage

Tearing

Photophobia

A positive fluorescein
stain

Purulent drainage

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A 21 year old college student presents to the student health center with copious,
markedly purulent discharge from her left eye. The nurse practitioner student should
suspect

Viral conjunctivitis

Common pink eye

Gonococcal
conjunctivitis

Allergic
conjunctivitis

Gonococcal Conjuctivitis

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A 35 year old man presents with radicular pain followed by the appearance of grouped
vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He
complains of pain, burning, and itching. The nurse practitioner should suspect:

A common case of shingles and prescribe an analgesic and an antiviral
agent

A complicated case of shingles and prescribe acyclovir, an analgesic,
and a topical cortisone cream

Herpes zoster and consider that this patient may be
immunocompromised

A recurrence of chickenpox and treat the patient’s symptoms

Herpes zoster and consider that this patient may be

immunocompromised

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Which type of lung cancer has the poorest prognosis?

Adenocarcinoma

Epidermoid
carcinoma

Small cell
carcinoma

Large cell
carcinoma

Small cell

carcinoma

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An 83-year-old female presents to the office complaining of diarrhea for several days.
She explains she has even had fecal incontinence one time. She describes loose stools 3–
4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The
history suggests that the patient has:

Acute diarrhea

Chronic diarrhea

Irritable bowel

Functional bowel
disease

Chronic Diarrhea

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Margaret, age 32, comes into the office with painful joints and a distinctive rash in a
butterfly distribution on her face. The rash has red papules and plaques with a fine scale.
What do you suspect?

An allergic reaction

Relapsing
polychondritis

Lymphocytoma cutis

Systemic lupus
erythematosus

Systemic lupus

erythematosus

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Antibiotic administration has been demonstrated to be of little benefit to the treatment of
which of the following disease processes?

Chronic sinusitis
Acute bronchitis
Bacterial pneumonia
Acute exacerbation of chronic
bronchitis

Acute bronchitis

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Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2
agonist daily. Her exacerbations affect her activities and they occur at least twice weekly
and may last for days. She is affected more than once weekly during the night with an
exacerbation. Which category of asthma severity is Lisa in?

Mild
intermittent

Mild persistent

Moderate persisent

Moderate persistent

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Which of the following is the most appropriate therapeutic regimen for an adult patient
with no known allergies diagnosed with group A B-hemolytic strep?

Penicillin V 500 milligrams PO every 8 hours
for 10 days

Ampicillin 250 milligrams PO twice a day for
10 days

Clarithromycin 500 milligrams po daily for 7
days

None of the above

Penicillin V 500 milligrams PO every 8 hours for 10 days

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A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by
leg elevation. She occasionally has edema in her lower legs at the end of the day. What is
the most likely cause of these problems?

Congestive heart
failure

Varicose veins

Deep vein
thrombosis

Arterial
insufficiency

Varicose veins

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Which statement below is correct about pertussis?

It is also called whooping cough

It begins with symptoms like strep throat

It lasts about 3 weeks

It occurs most commonly in toddlers and
young children

It is called whooping cough

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Which of the following is the most important diagnosis to rule out in the adult patient
with acute bronchitis?

Pneumonia

Asthma

Sinusitis

Pertussis

Pneumonia

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A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly
tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which
correctly describes the suspected condition?

Diverticulitis

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Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This
morning she noticed a rash with erythematous papules in that site. What do you suspect?

Varicella

Herpes
zoster

Syphilis

Rubella

Herpes zoster

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A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows
that the most common cause of pancreatitis is:

Alcohol

Gallstones

Medications

Pregnancy

Gallstones

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When a patient presents with symptoms of acute gallbladder disease, what is the
appropriate nurse practitioner action?

Order abdominal x-rays

Order an abdominal ultrasound

Refer the patient to a surgeon for
evaluation

Prescribe pain medication

Order an abdominal ultrasound

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A false-positive result with the fecal occult blood test can result from:

ingestion of large amounts of
vitamin C

a high dietary intake of rare
cooked beef

colonic neoplasm that is not
bleeding

stool that has been stored
before testing

a high dietary intake of rare

cooked beef

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A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and
pain. Physical findings include an abdominal mass and stool positive for occult blood. The
nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test
for this patient is

Colonoscopy

Small bowel follow through

Barium enema

CT abdomen

Small bowel follow through

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A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity
edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner
knows that these findings are consistent with:

Mitral
regurgitation

Systolic heart
failure

Cardiac myxoma

Diastolic heart
failure

Systolic heart failure

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Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? Multilobar involvement on chest x-ray with the inability to take oral medications Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home Sputum and gram positive organisms A complete blood count showing leukocytosis

Multilobar involvement on chest x-ray with the inability to take oral medications

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: “It is the most common cause of death in patients with skin cancer.” “It can be cured with surgical excision or radiation therapy.” “It is a slow growing skin cancer that rarely undergoes malignant changes.” “It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”

“It can be cured with surgical excision or radiation therapy.”

Expected spirometry readings when the patient has chronic emphysema include: Decreased residual volume (RV) Increased vital capacity (VC) Increased forced expiratory volume (FEV-1) Increased total lung capacity (TLC)

Increased total lung capacity (TLC)

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is: Esophageal cancer Chest pain GERD A and C All of the above

A and C

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect? Squamous cell carcinoma Malignant melanoma A common nevus Basal cell carcinoma

Malignant melanoma

Which of the following is not a goal of treatment for the patient with cystic fibrosis? ``` Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water-soluble vitamins ```

Replace water-soluble vitamins

The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? ``` Scalp Nails Feet B and C All of the above ```

B and C

An adult presents with tinea corporis. Which item below is a risk factor for its development?

topical steroid use

A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? ``` Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours. ``` Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management. Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction. Order stool cultures.

Prescribe a broad-spectrum antibiotic such as ciprofloxacin and symptom management

Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? Aspirin NSAIDs Opioids Antihistamines

Antihistamine

Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Peripheral edema Weight gain Shortness of breath Nocturnal dyspnea

Weight gain

A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe? Ibuprofen Erythromyci n Amoxicillin Acetam

Amoxicillin

A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans? “Are you wearing your usual shoes?” “Do you also have chest pain when you have leg pain?” “Is your leg pain relieved by rest?” “Do you ever have the same pain in the other leg?”

Is your leg pain relieved by rest

Which of the following statements about malignant melanomas is true? They usually occur in older adult males The patient has no family history of melanoma They are common in blacks The prognosis is directly related to the thickness of the lesion

The prognosis is directly related to the thickness of the lesion

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?

Heart failure

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? Erythromycin Clarithromycin (Biaxin) Doxycycline (Vibramycin) Penicillin

Clarithromycin | Biaxin

Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction? Powders Gels Creams Lotion

Powders

A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to: Squamous cell carcinoma Basal cell carcinoma Malignant melanoma Acne vulgaris

Squamous cell Carcinoma

An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? Assist the patient to a standing position and take her blood pressure. Assess the patient’s cranial nerves. Compare the patient’s blood pressure lying first, then sitting, and then standing. Compare the amplitude of the patient’s radial and pedal pulses.

Compare the patient’s blood pressure lying first, then sitting, and then standing. `

What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Ursodiol Ibuprofen Prednisone Surgery is the only answer

Ursodiol

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is: Staphylococcus aureus Group A beta hemolytic streptococcus Haemophilus influenza Pseudomonas aeruginosa

Pseudomonas aeruginosa

Which of the following is not a symptom of irritable bowel syndrome? Painful diarrhea Painful constipation Cramping and abdominal pain Weight loss

Weight loss

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed? Any recent trauma Difficulty swallowing Stiffness in the right shoulder Change in sleeping habits

Any recent trauma

Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? ACE Inhibitor Beta Blocker Calcium channel blocker Diuretic

Beta Blocker

The differential diagnosis for a patient complaining of a sore throat includes which of the following? Gonococcal infection Thrush Leukoplakia B only A, B, and C

A,B and C

A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is: Rhus dermatitis Ophthalmic zoster Chemosis Optic neuritis

Opthalmic zoster

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered? Serologic markers for hepatitis Serum bilirubin Serum cholesterol with HDL and LDL A liver biopsy

Serologic markers for hepatitis

A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: A drug interaction Hepatic dysfunction Hypersensitivity to lovastatin Rhabdomyolysis

Rhabdomyolysis

Treatment of acute vertigo includes: Bedrest and an antihistamine Fluids and a decongestant A sedative and decongestant Rest and a low sodium diet

Bedrest and an | antihistamine

Treatment of H.pylori includes which of the following? Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate A and B A, B, and C

A, B, and C

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect? Cataracts Glaucoma Retinal detachment Iritis

Retinal detachment

In order to decrease deaths from lung cancer: All smokers should be screened annually All patients should be screened annually Only high risk patients should be screened routinely Patients should be counseled to quit smoking

Patients should be counseled to quit smoking

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? Every 5 years Every 2 years Every year Whenever blood work is done

Every 5 years

Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? Mort is black Mort also has congestive heart failure Mort has benign prostatic hyperplasia Mort has frequent migraine headaches

Mort has benign prostatic | hyperplasia

John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Actinic keratosis Eczema Psoriasis Seborrheic dermatitis

Psoriasis

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? Increase her Lisinopril to 20mg daily Add a thiazide diuretic to the Lisinopril 5mg daily Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker Discontinue the Lisinopril and start a diuretic

Add a thiazide diuretic to the Lisinopril 5mg daily

An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: defer any further dental work until his valve replacement is completed instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed. suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications.

suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis

Appropriate therapy for peptic ulcer disease (PUD) is: Primarily by eradication of infection Based on etiology Aimed at diminishing prostaglandin synthesis Dependent on cessation of NSAID use

Based on etiology

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? A calcium channel blocker A beta blocker An ACE Inhibitor No hypertension medication

An ACE Inhibitor

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices? It is important to “undercode” so that one does not get charged with Medicare fraud The practice of “overcoding” is essential in this age of decreasing reimbursements Failing to bill for billable services will lead to unnecessarily low revenues Time spent with the patient is a very important determinant of billing

Failing to bill for billable services will lead to unnecessarily low revenues

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? Viral conjunctivitis Glaucoma Corneal abrasion Retinoblastoma

Retinoblastoma

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? Pharmacological therapy A labyrinthectomy A vestibular neurectomy Wearing an earplug in the ear with the most hearing loss

A Vestibular neurectomy

Which of the following is not a risk factor for coronary arterial insufficiency? Hyperhomocysteinemia Smoking Genetic factors Alcohol ingestion

Alcohol ingestion

An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms? Allergic conjunctivitis Bacterial conjunctivitis Gonococcal conjunctivitis Viral conjunctivitis

Allergic conjunctivitis

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? A long-acting bronchodilator An inhaled corticosteroid and cromolyn Theophylline and a short acting bronchodilator A bronchodilator PRN and an inhaled corticosteroid

A bronchodilator PRN and an inhaled corticosteroid

Acute rheumatic fever is an inflammatory disease which can follow infection with: Group A Streptococcus Staphlococcus areus Β-hemolytic Streptococcus Streptococcus

Β-hemolytic Streptococcus

A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to: Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days Order mandibular x-rays and question the patient about physical abuse Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic Initiate a parenteral antibiotic and consider hospital admission

Initiate a parenteral antibiotic and consider hospital admission

If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Iritis Allergic conjunctivitis Viral conjunctivitis Bacterial conjunctivitis

Iritis

The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than: 160 mg/dL 130 mg/dL 100 mg/dL 70 mg/dL

100 mg/dL

A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is: Referral for surgical intervention such as a partial or complete fundoplication Dependent upon how sever the practitioner believes the condition To repeat the 8 week course of drug therapy while continuing lifestyle modifications Investigation with endoscopy, manometry, and/or pH testing

Investigation with endoscopy, manometry, and/or pH testing

Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? Under 3 years of age Preschool children 6 to 12 years of age Adolescents

6 to 12 years of age

The most appropriate treatment for a child with mild croup is: A bronchodilator An antibiotic A decongestant A cool mist vaporizer

A cool mist vaporizer

A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis? Peritonsillar abscess Thyroiditis Mononucleosis Epiglottitis

Peritonsillar abscess

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? It is not effective during an acute asthma attack. It may take 2 to 3 days to begin working. This drug works within 10 minutes. This drug may be used by patients 6 years and

It is not effective during an acute asthma attack.

Which intervention listed below is safe for long term use by an adult with constipation? Stool softeners Laxatives Osmotic agents Bulk-forming agents

Bulk-forming agents

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Apply a topical antibiotic and warm compresses. Apply cool compresses and avoid touching the hordeolum. Use an oral antibiotic and eye flushes. Apply light palpation to facilitate drainage.

Apply a topical antibiotic and warm compresses.

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate? An antihistamine intranasal spray A decongestant nasal spray Ipratropium Omalizumab

A decongestant nasal spray

What is the Gold standard for the diagnosis of asthma? Patient’s perception of clogged airways Validated quality-of-life questionnaires Bronchoscopy Spirometry

Spirometry

A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough? Methyldopa Enalapril Amlodipine Hydrochlorothiazide

Enalapril

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Aphthous ulcers Candidiasis Oral cancer Herpes simplex

Candidiasis

Risk factors for acute otitis media (AOM) include all of the following except: Household cigarette smoke Group daycare attendance Sibling history of acute otitis media African-American ethnicity

African-American ethnicity

Which of the following can result from chronic inflammation of a meibomian gland? A chalazion Uveitis Keratitis A pterygium

A chalazion

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient

The physician must be on-site and engaged in patient care

Of the following choices, the least likely cause of cough is: Asthma Gastroesophageal reflux Acute pharyngitis Allergic rhinitis

Acute pharyngitis

The most common correlate(s) with chronic bronchitis and emphysema is(are): Familial and genetic factors Cigarette smoking Air pollution Occupational environment

Cigarette smoking

Which choice below is least effective for alleviating symptoms of the common cold? Antihistamines Oral decongestants Topical decongestants Antipyretics

Antihistamines

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control Sodium restriction can cause serious adverse effects A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable Seventy-five of sodium intake is derived from processed foods

Seventy-five of sodium intake is derived from processed foods

Which of the following heart murmurs warrants the greatest concern? Systolic murmur Venous hum murmur Diastolic murmur Flow murmur

Diastolic murmur

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated? Hordeolum; treat with a topical antibiotic and warm compress Conjunctivitis; treat with topical antibiotic and warm compresses Blepharitis; treat with warm compresses and gentle debridement with a cotton swab Chalazion; refer to an ophthalmologist for incision and drainage

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? Inferior wall Anterior wall Apical wall Lateral wall

Inferior wall

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: Acute otitis media (AOM) Otitis media with effusion Mucoid otitis media Serous otitis media

Acute otitis media (AOM)

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as: epigastric hernia umbilical hernia incisional hernia inguinal hernia

epigastric hernia

A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder? Omeprazole Ranitidine An antacid None of the above

Omeprazole

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to: Quit smoking Maintain aggressive hypertension therapy Stick to a low-fat, low-sodium diet Continue with his exercise program

Quit smoking

Risk factors for acute arterial insufficiency include which of the following? Recent myocardial infarction Atrial fibrillation Atherosclerosis All of the above

All of the above

Impetigo and folliculitis are usually successfully treated with: Systemic antibiotics Topical antibiotics Topical steroid creams Cleansing and debridement

Topical antibiotics

What are signs & symptoms of SIADH (Syndrome of inappropriate antidiuretic hormone)?

Increased production of ADH (antidiuretic hormone), hyponatremia, concentrated urine (from excess water resorption), elevated urine osmolality, mental status changes from cerebral edema.

Diabetes insipidus is associated with what sodium level?

Hypernatremia

Psychogenic polydipsia results in urine that is:

diluted with low osmolality and hyponatremia

How would you determine the cause of a patient's AKI who presents with decreased urine output, history of neurogenic bladder, chronic foley, dark urine, and Cr increase from 1.3 to 2.1 over 3 months?

Flush the foley catheter to see if urine comes out and assess the patency of the catheter. This action will unblock clogged sediment or biofilm from chronic bacteriuria.

When a female patient presents to the ER after sexual assault, what medications should be offered prior to discharge?

Ceftriaxone, azithromycin, Plan B, and Metronidazole.

Manifestations of Conn syndrome (hyperaldosteronism)?

hypernatremia, hypokalemia, and hypertension

What causes Cushing syndrome?

Increased levels of glucocorticoids, can be exogenous (from therapy) or endogenous (from adenoma or neoplasm).

Manifestations of Cushing syndrome?

hypertension, truncal obesity, osteoporosis, skin fragility, and hyperglycemia.

What differentiates primary adrenocortical insufficiency from secondary adrenocortical insufficiency?

Skin hyperpigmentation is present in primary adrenocortical insufficiency

What is Trousseau's sign?

A carpal spasm elicited by compression of the upper arm with a BP cuff that indicates hypocalcemia.

What is Chovstek's sign?

A hemifacial tic that is induced by tapping the facial nerve below the maxilla that indicates hypocalcemia.

What is Babinski's sign?

An upward response (extension) of the hallux when the sole of the foot is stimulated with a blunt instrument. Can identify spinal cord disease in adults.

What is Romberg's sign?

Loss of balance in standing when eyes are closed. Usually indicating a loss of proprioception or lesion in the cerebellum.

What is Homan's sign?

pain on passive dorsiflexion of ankle, associated with DVT.

What is the clinical presentation of Goodpasture's syndrome?

Urinalysis: Specific gravity: 1.020. pH 5.5, 1+ albumin and large blood present. Chest XR positive for bilateral diffuse infiltrates. BUN 30, Cr 3.0 Symptoms: dyspnea with hemoptysis

What is Goodpasture syndrome?

Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.

Initial treatment for Goodpasture's syndrome?

Hospitalization, pulse dose of steroids, begin plasmapheresis and cyclophosphamide therapy.

Characteristics of Grave's disease

Ophthalmopathy (lid retraction, scleral show, proptosis) and hyperthyroidism

What organism causes the formation of a staghorn calculus?

Proteus mirabilus

What organism causes Toxic shock syndrome?

Staphylococcus aureus

What electrolyte disturbance is most likely to lead to tetany and neuromuscular irritability?

Hypocalcemia

Features of hypercalcemia include?

"Stones, groans, moans, and bones." Delirium and renal stones

When you see hypochloremia, the patient may have?

Metabolic Alkalosis

Hyperkalemia is associated with what cardiac abnormalities?

peaked T-waves, wide QRS, and ventricular arrhythmias.

A patient presents with arcus cornea, LDL 285, TG 110, HDL 45, and father died of an MI at age 45. What is his most likely diagnosis?

Heterozygous familial hypercholesterolemia

A fasting blood glucose level of 130 mg/dL indicates:

Diabetes

What are risk factors for ectopic pregnancy?

smoking, previous tubal surgery, previous ectopic pregnancy, exposure to diethylibestrol, current IUD, PID, advanced maternal age, infertilitiy for more than 2 years.

What hormones are most critical to replace in a patient at risk for anterior pituitary insufficiency?

Glucocorticoids, and thyroid hormone

What is diabetes insipidus?

a disorder caused by inadequate amounts of ADH which causes excessive water loss

CKD Stage 1

GFR >90 with evidence of renal damage, as indicated by proteinuria.

CKD Stage 2

GFR 60-89

CKD Stage 3a

GFR 45-59

CKD Stage 3b

GFR 30-44

What is the diagnosis and initial treatment of a patient with history of nonfunctional pituitary macroadenoma with severe retro-orbital headache, nausea, vomiting, mental status change, right third nerve palsy with stiff neck, and pituitary adenoma (enlarged) hemorrhage?

Pituitary apoplexy | dexamethasone 2mg IV q 6hr then surgery if mental status change present.

What causes hypocalcemia in patients with end stage renal disease?

Decreased conversion of Vitamin D.

What condition is associated with recurrent nephrolithiasis?

Primary hyperparathyroidism

What stabilizes the cardiac membrane in treatment of hyperkalemia?

Calcium gluconate

What medication acts rapidly to antagonize the membrane effects of potassium in hyperkalemia?

Calcium is cardioprotective

What is the most common cause of euvolemic hyponatremia?

SIADH (syndrome of inappropriate antidiuretic hormone secretion)

What causes are associated with hypervolemic hyponatremia?

Cirrhosis and CHF

What is a long-term complication of radio-active iodine therapy?

Hypothyroidism

80% of acute pyelonephritis cases in women are caused by what pathogen?

E coli

Most common cause of acute scrotal pain in adults?

epididymitis

What are predisposing factors for hypocalcemia?

hypoparathyroidism, pancreatitis, vitamin D deficiency, chronic alcohol use disorder, and medications such as phenytoin, cisplatin, and estrogen.

What are prerenal causes of AKI?

decrease in extracellular fluid volume, decreased renal blood flow, or altered intrarenal hemodynamics.

Post-renal causes of AKI

benign prostatic hyperplasia, bladder cancer, nephrolithiasis, neuromuscular disorders, prostate cancer, strictures, trauma

What is are intrinsic causes of renal failure?

Acute glomerulonephritis, ischemic injury, nephrotoxins, malignant hypertension

What classification of drugs cause urinary retention?

anticholinergics (ipratropium)

Common secondary causes of nephrotic syndrome

lupus and diabetes

Presenting symptoms of nephrotic syndrome

loss of appetite, fatigue, ascites, lower extremity edema, proteinuria, low blood albumin, and hyperlipidemia.

What is the initial insulin loading dose for a patient in DKA?

0.1 to 0.15 units/kg/hr | with hourly glucose monitoring

What is Hashimoto's thyroiditis?

autoimmune destruction of thyroid gland, Anti-thyroid stimulating hormone (TSH) receptor antibodies inhibit release of thyroid hormone.

What would you do first for an incidental finding of an adrenal mass?

Overnight dexamethasone suppression test.

Clinical signs of PCOS

oligomenorrhea, infertility, hirsutism, obesity, and 2/3 Rotterdam criteria: oligo-ovulation or anovulation clinic of biochemical signs of hyperandrogenism polycystic ovaries on US

Treatment for simple cystitis

5 days of nitrofurantoin

Define the acronym MUDPILES

``` Acronym for identifying a high anion gap metabolic acidosis: Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, isoniazid Lactate Ethanol, ethylene glycol Salicylates ```

First-line evaluation of vulvovaginal candidiasis

wet mount

Prolonged nausea and vomiting can result in:

Metabolic alkalosis loss of gastric acid

Clinical signs/symptoms of uremic pericarditis

worsening anemia, absence of diffuse ST-segment T-wave elevations, fever, pleuritic chest pain, pain that increases in recumbent position. Hemodialysis treatment should be heparin free.

What is hepatorenal syndrome?

chronic or acute renal disease with advanced hepatic failure and portal hypertension.

What complaint is common with patients who have acute on chronic urinary retention?

urinary incontinence

For a patient who is lethargic and hyperkalemic, what is the first line therapy?

Calcium gluconate or calcium chloride

Priapism is a known side effect of what medication?

Trazodone

What is the maximum compensation of PaCO2 in metabolic acidosis?

signs of preeclampsia

``` BP > 140/90 proteinuria >300 mg of protein in urine in 24 hours headache visual changes 2+ pitting edema ```

Which of the following is a potential acquired cause of thrombophilia Homocysteinuria Protein C deficiency Factor V Leiden Antiphospholipid antibodies

Antiphospholipid antibodies

Phalen's test, 90°wrist flexion for 60 seconds, reproduces symptoms of: Ulnar tunnel syndrome Carpal tunnel syndrome Tarsal tunnel syndrome Myofascial pain syndrome

Carpal tunnel syndrome

Which patient would benefit most from screening for type 2 diabetes? A 30 year old female with unintended weight loss. A 25 year old male with family history of type 1 diabetes An obese female with recurrent vaginitis A 50 year old hyperlipidemic male

An obese female with recurrent vaginitis

A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? Rheumatoid arthritis (RA) Osteoarthritis (OA) Lupus Peripheral neuropathy

Osteoarthritis (OA)

A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be: Trimethoprim-sulfamethoxazole for 3 days Ciprofloxacin for 7-10 days Trimethoprim-sulfamethoxazole for 14 days Ciprofloxacin for 3 days

Trimethoprim-sulfamethoxazole for 3 days

A thymectomy is usually recommended in the early treatment of which disease? Parkinson's disease Multiple sclerosis Myasthenia gravis Huntington's chorea

Myasthenia gravis

The diagnosis of human papilloma virus (HPV) infection in males is usually made by Clinical appearance Viral culture Tzanck smear KOH prep

Clinical appearance

The most effective intervention(s) to prevent stroke is (are): 81 mg of aspirin daily Carotid endarterectomy for patients with high-grade carotid lesions Routine screening for carotid artery stenosis with auscultation for bruits Smoking cessation and treatment of hypertension

81 mg of aspirin daily

What is the most common cause of Cushing's syndrome? Excessive ACTH production Administration of a glucocorticoid or ACTH Pituitary adenoma or a non-pituitary ACTH-producing tumor Autonomous cortisol production from adrenal tissue

Administration of a glucocorticoid or ACTH

Diagnostic radiological studies are indicated for low back pain: Routinely after 3 weeks of low back pain symptoms. To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection As a part of a pre-employment physical when heavy lifting is included in the job description.

When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection

After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured? An enzyme-linked immunosorbent assay titer A urea breath test A rapid urease test A repeat endoscopy

A urea breath test

Which appropriate test for the initial assessment of Alzheimer's disease provides the performance ratings on 10 complex, higher order activities? MMSE CAGE questionnaire FAQ - Functional Activities Questionnaire Holmes and Rahe social readjustment scale

FAQ - Functional Activities Questionnaire

Major depression occurs most often in which of the following conditions? A. Myocardial infarction Parkinson's disease Stroke Alzheimer's disease

Stroke

Which of the following statements about multiple sclerosis (MS) is correct? MS is a chronic, untreatable illness that is almost always fatal. MS is a disease of steadily progressive and unrelenting neurologic deterioration. MS is a chronic, treatable illness with unknown cause and a variable course. Patients with MS who take active steps to improve their health have the best cure rate.

MS is a chronic, treatable illness with unknown cause and a variable course

Diagnostic evaluation of hypothyroidism reveals: Elevated TSH and decreased T4 Decreased TSH and increased T4 Decreased TSH and decreased T3 Elevated TSH and increased T4

Elevated TSH and decreased T4

Risk factors for prostate cancer include all of the following except: Family history Benign prostatic hypertrophy African American race Age

Benign prostatic hypertrophy

What information should patients with diabetes and their families receive about hypoglycemia? Hypoglycemia is a rare complication. Hypoglycemia requires professional medical treatment. Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly. Hypoglycemia occurs only as a result of insulin overdose.

Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly.

Which history is commonly found in a patient with glomerulonephritis? Beta-hemolytic strep infection Frequent urinary tract infections Kidney stones Hypotension

Beta-hemolytic strep infection

Which of the following is characteristic of a manic episode? weight loss of gain insomnia or hypersomnia diminished ability to think or concentrate grandiose delusions

grandiose delusions

Central obesity, "moon" face, and dorsocervical fat pad are associated with: Metabolic syndrome Unilateral pheochromocytoma Cushing's syndrome None of the above

Cushing's syndrome

Which of the following is the most common cause of low back pain? Lumbar disc disease Spinal stenosis Traumatic fracture Osteoporosis

Lumbar disc disease

A middle-aged female presents complaining of recent weight loss. The physical exam reveals an enlarged painless cervical lymph node. The differential diagnosis for this patient's problem includes: ``` Infection Toxoplasmosis Mononucleosis All of the above None of the above ```

Infection

An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects? Weight gain Fracture risk Hypoglycemia Weight loss

Hypoglycemia

A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is cryptococcosis toxoplasmosis cryptosporidiosis cytomegalovirus

cryptosporidiosis

Which of the following is the most common causative organism of nongonococcal urethritis? Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Trichonomas vaginalis

Chlamydia trachomatis

The most common symptoms of transient ischemic attack (TIA) include Nausea, vomiting, syncope, incontinence, dizziness, and seizure. Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes. Headache and visual symptoms such as bright spots or sparkles crossing the visual field. Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness

Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes.

What is the first symptom seen in the majority of patients with Parkinson's disease? Rigidity Bradykinesia Rest tremor Flexed posture

Rest tremor

A 21-year-old female presents to the office complaining of urinary frequency and urinary burning. The nurse practitioner suspects a urinary tract infection when the urinalysis reveals 1-4 red blood cells per high-powered field Specific gravity 1.012 Urobilinogen 10- white blood cells per high-powered field

10- white blood cells per high-powered field

A 26 year old female presents with elbow pain that is described as aching and burning. There is point tenderness along the lateral aspect of the elbow and painful passive flexion and extension. She reports she has been playing tennis almost daily for the past month. The most likely diagnosis is: Radial tunnel syndrome Ulnar collateral ligament sprain Olecranon bursitis Lateral epicondylitis: Tennis Elbow

Lateral epicondylitis: Tennis Elbow

Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis? Depression Panic disorder Anxiety Post-traumatic stress disorder

Post-traumatic stress disorder

An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient's pain is: Trauma Tight shoes Arthritis flare Hydrochlorothiazide

Hydrochlorothiazide

Which of the following is a contraindication for metformin therapy? Insulin therapy Creatinine > 1.5 Edema None of the above

Creatinine > 1.5

A positive drawer sign supports a diagnosis of: Sciatica Cruciate ligament injury Meniscal injury Patellar ligament injury

Cruciate ligament injury

Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid? Apples Peppermint Cucumbers Popsicles

Peppermint

A patient taking levothyroxine is being over-replaced. What condition is he at risk for? Osteoporosis Constipation Depression Exopthalmia

Osteoporosis

Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following: HbA1C 2-hour 75 gram oral glucose tolerance test C-peptide level A and B All of the above

A and B

Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? Prescribe systemic antibiotics Prescribe antibiotic ear drops Prescribe nasal steroids and oral decongestants Refer him to an ear, nose, and throat specialist

Prescribe nasal steroids and oral decongestants

Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following? Maintain moderate bed rest for 3-4 days Call the office for narcotics if there is no relief with the NSAID in 24-48 hours Begin lower back strengthening exercises depending on pain tolerance Wear a Boston brace at night

Begin lower back strengthening exercises depending on pain tolerance

Risk factors for Addison's disease include which of the following? Tuberculosis Autoimmune disease AIDS All of the above

All of the above

Urine cultures should be obtained for which of the following patients? Suspected urinary tract infection in pregnancy Febrile patients Young men All of the above

All of the above

Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? "Caffeine has not effect on osteoporosis." "A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly." "Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix." "Caffeine increase bone resorption."

"A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly."

The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is: Migraine headache Subarachnoid hemorrhage Glaucoma Meningitis

Meningitis

What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient

The physician must be on-site and engaged in patient care

The most commonly recommended method for prostate cancer screening in a 55 year old male is: Digital rectal examination (DRE) plus prostate specific antigen (PSA) Prostate specific antigen (PSA) alone Transrectal ultrasound (TRUS) alone Prostate specific antigen (PSA) and transrectal ultrasound (TRUS)

Digital rectal examination (DRE) plus prostate specific antigen (PSA)

The primary goals of treatment for patients with alcohol abuse disorder are: Reduction in withdrawal symptoms and reduction in desire for alcohol Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol Abstinence or reduction in use, relapse prevention, and rehabilitation Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment

Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol

You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: Lateral meniscus Cruciate ligament Medical meniscus Collateral ligament

Cruciate ligament

Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia? Musculoskeletal pain Difficulty sleeping Depression Fatigue

Musculoskeletal pain

Differential diagnosis of proteinuria includes which of the following? Orthostatic proteinuria Nephrotic syndrome Infection Trauma A and B

A and B

A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as: Underweight Normal weight Overweight Obese

Overweight

Reed-Sternberg B lymphocytes are associated with which of the following disorders: Aplastic anemia Hodgkin's lymphoma Non Hodgkin's lymphoma Myelodysplastic syndromes

Hodgkin's lymphoma

A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: Arthritis Ulnar neuritis Septic arthritis Olecranon bursitis

Olecranon bursitis

Establishment of a definitive diagnosis of osteomyelitis requires: A known causative injury such as a puncture wound, bite, or decubitus ulcer. Biopsy of culture of the pathogen from blood or bone aspirate. Visualization of purulent material draining into soft tissue. Lucent areas identified on plain x-ray.

Biopsy of culture of the pathogen from blood or bone

The most accurate measure of diabetes control is: Avoidance of micro- and macro-vascular complications. Insulin sensitivity. Early morning glucose levels. HgbA1c

HgbA1c

A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder? Alprazolam or diazepam Venlafaxine or buspirone Trazodone or sertraline Venlafaxine or hydroxyzine pamoate

Alprazolam or diazepam

The most common presentation of thyroid cancer is: Generalized enlargement of the thyroid gland. A solitary thyroid nodule. A multinodular goiter. Abnormal thyroid function tests.

Generalized enlargement of the thyroid gland.

Which of the following accounts for half of the bladder tumors among men and one-third in women? Cigarette smoke, both active and passive inhalation Chemicals from plastic and rubber Chronic use of phenacetin-containing analgesic agents Working long hours and not voiding often

Cigarette smoke, both active and passive inhalation

You have a new patient that presents with generalized lymphadenopathy. You know that this is indicative of: Sjogren's syndrome Pancreatic cancer Disseminated malignancy of the hematologic system Cancer of the liver

Disseminated malignancy of the hematologic system

Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to: Refer her to a hand surgeon Take a more complete history Try neutral position wrist splinting and oral NSAID Order a nerve conduction study such as am electromyography

Try neutral position wrist splinting and oral NSAID

Which drug category contains the drugs that are the first line Gold standard therapy for COPD? Corticosteroids Inhaled beta-2 agonist bronchodilators Inhaled anticholinergic bronchodilators Xanthines

Inhaled beta-2 agonist bronchodilators

Potential causes of septic arthritis include which of the following? Lyme disease Prosthetic joint infection Reiter's syndrome A and B All of the above

A and B

The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is: Oral ciprofloxacin (Cipro) Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone Oral trimethoprim-sulfamethoxazole (Bactrim DS) Intramuscular penicillin

Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone

A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioner's recommendation? Advise the patient to stop the antidepressant medication Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication Recommend that the patient continue the antidepressant medication for at least 4 more months Discuss with the patient the need to take the antidepressant medication indefinitely

Recommend that the patient continue the antidepressant medication for at least 4 more months

Your patient has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis? Iron-deficiency anemia Hemolytic anemia Lead poisoning Liver disease

Liver disease

Which of the following medications increase the risk for metabolic syndrome? Antihistamines Proton pump inhibitors Protease inhibitors A and C All of the above

All of the above

The hallmark of neurofibromatosis (von Recklinghausen's disease) present in almost 100% of patients is Acoustic neuroma Astrocytoma of the retina Distinctive osseous lesions Café au lait spots

Café au lait spots

The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is: Acetaminophen or an NSAID A muscle relaxant as an adjunct to an NSAID An oral corticosteroid and diazepam (Valium) Colchicine and an opioid analgesic

Acetaminophen or an NSAID

Legal authority for advanced practice nursing rests with: The Health Care Financing Administration Federal statutes State laws and regulations Certifying bodies

State laws and regulations

Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long term pain relief? Superficial and deep heat Application of cold Transcutaneous electrical nerve stimulation (TENS) Exercise

Transcutaneous electrical nerve stimulation (TENS)

A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? Obtain a thorough history and physical, and check serum cortisol and ACTH levels. Obtain a diet history and check CBC and FBS. Provide nutritional guidance and have the patient return in 1 month. Consult home health for intravenous administration of fluids and electrolytes.

Obtain a thorough history and physical, and check serum cortisol and ACTH levels

Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be? Start him on an ACE Inhibitor Start him on a diuretic Have him monitor his blood pressure at home Try nonpharmacological methods and have him monitor his blood pressure at home

Try nonpharmacological methods and have him monitor his blood pressure at home

Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: Parkinson's disease Epilepsy Multiple sclerosis Diabetes mellitus

Diabetes mellitus

Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus? Hypertriglyceridemia and low high-density lipoprotein (HDL) Gestational diabetes and polycystic ovarian syndrome Hispanic, African-American, Native-American, and Pacific Islander ethnicity Postprandial hypoglycemia

Postprandial hypoglycemia

A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that: The patient should start anticoagulant therapy immediately. Hereditary thrombophilia does not always require anticoagulation therapy. Women of childbearing age cannot take anticoagulant therapy. Genetic and risk management counseling are recommended. B and D

B and D

The 4 classic features of Parkinson's disease are Mask-like facies, dysarthria, excessive salivation, and dementia. Tremor at rest, rigidity, bradykinesia, and postural disturbances. Depression, cognitive impairment, constipation and shuffling gait. Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy.

Mask-like facies, dysarthria, excessive salivation, and dementia.

Which of the following set of symptoms should raise suspicion of a brain tumor? Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances. Vague, dull headaches that are accompanied by a reported sense of impending doom. Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia. Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.

Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.

The most common cause of elevated liver function tests is: Hepatitis Biliary tract obstruction Chronic alcohol abuse A drug-induced injury

Hepatitis

The physiological explanation of syncope is: Accelerated venous return and increased stroke volume resulting in deactivation of the parasympathetic nervous system. A cycle of inappropriate vasodilation, bradycardia, and hypotension. A sudden rise in blood pressure due to overly efficient vasoconstriction. Emotional stress resulting in hypertension, tachycardia, and increased venous return.

A cycle of inappropriate vasodilation, bradycardia, and hypotension

A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem? Thiazide diuretic Insulin Famotidine (Pepcid) Albuterol

Thiazide diuretic

The cardinal sign of infectious arthritis is: Affected joint is painful at rest, with movement and weight bearing Rapid onset that wakes the patient during the night Long history of severe pain with associated joint swelling None of the above

Affected joint is painful at rest, with movement and weight bearing

A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains: Primary hyperparathyroidism is treated with Vitamin D restriction Primary hyperparathyroidism is treated with parathyroidectomy Primary hyperparathyroidism is treated with daily magnesium Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

Primary hyperparathyroidism is treated with parathyroidectomy

Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis? Doxycycline 100 mg qd Nitrofurantoin 100 mg qd Bactrim DS qd Erythromycin qd

Erythromycin qd

Who is at a higher risk for developing nephrolithiasis? Jack, who exercises every day and drinks copious amounts of water Mary, who watches her weight and eats a low-sodium diet Harvey, a "couch potato" who drinks a lot of no-sodium soda Bill, who runs every day and takes excessive amounts of vitamin C

Bill, who runs every day and takes excessive amounts of vitamin C

Potential side effects of levofloxacin include which of the following? Confusion Hypoglycemia Achilles tendon rupture All of the above

All of the above

A patient has just been diagnosed with Bell's palsy. He is understandably upset and has questions about the prognosis. You response should be: Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard Unfortunately there is no cure but you have a mild case The condition is self-limiting and most likely complete recovery will occur With suppressive drug therapy you can minimize the symptoms

The condition is self-limiting and most likely complete recovery will occur

A diabetic patient is taking low-dose enalapril for hypertension. A record of the patient's blood pressure over 4 weeks ranges from 130 to 142 mmHg systolic and 75 to 85 mmHg diastolic. How should the nurse practitioner respond? Change to a different class of antihypertensive medication to get better control. Increase the dosage of the current BP medication. Continue the current medication and dosage for 4 more weeks. Add a beta-blocker to the current medication regimen.

Increase the dosage of the current BP medication.

What diabetic complications result from hyperglycemia? 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis

1, 2, 3

Diagnostic confirmation of acute leukemia is based on: Bone marrow aspiration and biopsy Pancytopenia Hyperuricemia All of the above

Bone marrow aspiration and biopsy

The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy: A dipstick strip done during routine urinalysis in the office A 24-hour urine collection An early morning spot urine collection A serum albumin test

A serum albumin test

Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester? Trimethoprim-sulfamethoxazole Erythromycin Cefuroxime Levofloxacin

Trimethoprim-sulfamethoxazole

Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet? Wash your feet with cold water daily See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily Go to a spa and have a pedicure monthly See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes; inspect your feet daily for lesions; apply lotion to dry areas

See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes;

The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is: Psychotherapy Electroconvulsive therapy (ECT) A selective serotonin reuptake inhibitor (SSRI) A tricyclic antidepressant (TCA)

Electroconvulsive therapy (ECT)

The initial clinical sign of Dupuytren's contracture is: Pain with ulnar deviation Painless nodule on palmer fascia Pain and numbness in the ring finger Inability to passively extend finger

Painless nodule on palmer fascia

Which of the following is the most common complication of the myelodysplastic syndromes Fatigue Cardiomyopathy Falls Bleeding

Bleeding

What information should a 42 year old patient with newly diagnosed diabetes receive about exercise? Buy good walking shoes with support and a flexible sole. Exercise at least 5 days per week. Snack before exercise. Do not exercise if your blood sugar is greater than 180 mg/dL

Snack before exercise.

What is the most commonly abused substance? Heroin Cocaine Alcohol Marijuana

Alcohol

Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting "better." How do you respond? "You're right; it seems like your diabetes is improving." "Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it." "You have watched your diet for all these years and as a result, your body is using less insulin." "I will have to change your oral hyperglycemic agents as it seems your body is making more insulin."

"Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it."

A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition? Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am. Instruct the child's parents on physical activities to help weight loss. Increase the evening insulin dose and check CBG at 2:00 am. Refer the child for instruction on a strict diabetic diet.

Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am

At what age is screening most likely to detect scoliosis? 4 to 6 years 8 to 10 years 12 to 14 years 18 to 20 years

12 to 14 years

The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are) Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs. History of significant trauma relative to the patient's age. Decreased reflexes, strength, and sensation in the lower extremities. Patient report of pain with the crossed straight leg raise.

Decreased reflexes, strength, and sensation in the lower extremities.

A patient who has had a swollen, nontender scrotum for one week is found to have a mass within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects: a. ) a hydrocele. b. ) a varicocele. c. ) an indirect inguinal hernia. d. ) carcinoma of the testis.

a.) a hydrocele

A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A) Prerenal inflammation B) Bladder outlet obstruction C) Tubular necrosis D) Intrarenal nephrotoxicity

B) Bladder outlet obstruction

Mr. S. comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain? A. Inguinal herniation and peritonitis B. Renal colic and cardiac ischemia C. Pancreatitis and Crohn ' s disease D. Polyarteritis nodosa and ulcerative colitis

A. Inguinal herniation and peritonitis

``` The most common type of hernia is a(n): A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. umbilical hernia. ```

A. indirect inguinal

Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states that it is not painful, but it is annoying. You note that the origin of swelling is above the inguinal ligament directly behind and through the external ring. You diagnose this as a(n): A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. strangulated hernia.

direct inguinal hernia.

A 35 year old sexually active man presents with a 1 week history of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to touch. He denies flank pain, nausea, and vomiting. He reports that eh pain is lessend when he uses scrotal-support briefs. The urinalysis shows 2 + blood and a large number of leukocytes. What is the most likely diagnosis? A. Acute urinary tract infection B. Acute pyelonephritis C. Acute orthitis D. Acute epididymitis

D. Acute epididymitis

Orchitis is caused by which of the following? A. Mumps virus B. Measles virus C. Chlamydia trachomatis D. Chronic urinary tract infections that are not treated adequately

A. Mumps virus

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

C. Testicular torsion

What type of follow up should this patient receive? A. Refer to a urologist within 48 hours B. Refer him to the emergency department as soon as possible C. Prescribe ibuprofen (advil) 600 mg QID for pain D. Order a testicular ultrasound for further evaluation

B. Refer him to the emergency department as soon as possible

A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having intermittent unilateral testicular pain in the past but not as severe as this current episode. Confirmation of testicular torsion would include all of the following findings except: A. unilateral loss of the cremasteric reflex. B. the affected testicle held higher in the scrotum. C. testicular swelling. D. relief of pain with scrotal elevation.

D. relief of pain with scrotal elevation.

In assessing a man with testicular torsion, the NP is most likely to note: A. elevated PSA level. B. white blood cells reported in urinalysis. C. left testicle most often affected. D. increased testicular blood flow by color-flow Doppler ultrasound.

C. left testicle most often affected.

Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion? A. 1 B. 6 C. 16 D. 24

B. 6

To prevent a recurrence of testicular torsion, which of the following is recommended? A. use of a scrotal support B. avoidance of testicular trauma C. orchiopexy D. limiting the number of sexual partners

C. orchiopexy

Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. You are trying to differentiate between epididymitis and testicular torsion. Which test to determine whether swelling is in the testis or the epididymis should be your first choice? A. X-ray B. Ultrasound C. Technetium scan D. Physical examination

B. Ultrasound

The nurse practitioner recognizes that the most common cause of epididymitis in a young man is: A chlamydia B E. coli C mycoplasma D Proteus species

A chlamydia

Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema. Which of the following is likely the diagnosis? A acute bacteria prostatitis B acute pyelonephritis C epididymitis D urinary tract infection

C epididymitis

The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:

reduce action of androgens in the prostate.

The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:

reduce action of androgens in the prostate.

Milton, a 72 year old unmarried, sexually active white man presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect benign prostatic hypertrophy, what else should your differential diagnosis include?

``` Urethral stricture (may develop as a result of sexually transmitted diseases and should be considered in a sexually active individual no matter what the age) ```

Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow incontinence would be to order a:

Post void residual urine measurement

Lower urinary tract symptoms in males can present as a constellation of storage or voiding symptoms. Storage symptoms include:

urgency and nocturia

A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a moderately enlarged prostate that is smooth. The client's PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?

Prescribe an alpha adrenergic blocker, which will relax bladder and prostate smooth muscle to improve flow and relieve symptoms.

According to the AUA guideline on the management of BPH, when is referral for invasive surgery automatically warranted?

With the presence of refractory retention and bladder stones.

What differentiates prostate cancer symptoms from BPH?

Symptoms of prostate cancer in general tend to progress more rapidly than those of BPH.

The most common gram-negative bacteria that causes both acute and chronic bacterial prostatitis is A. Staphylococcus aureus B. Klebsiella C. Escherichia coli D. Enterobacteriaceae

C. Escherichia coli

A history of urinary tract infections in males is often seen in men with chronic bacterial prostatitis. Other signs and symptoms of chronic bacterial prostatitis includes A. irritative voiding symptoms, low back pain, and perineal pain. B. nausea and vomiting, as well as fever. C. loss of appetite and weight loss. D. irritative voiding symptoms, inability to ambulate, and fever.

A. irritative voiding symptoms, low back pain, and perineal pain.

When performing a prostate examination, you note a tender, warm prostate. What do you suspect? A. Benign prostatic hypertrophy B. Prostatic abscess C. Prostate cancer D. Bacterial prostatitis

D. Bacterial prostatitis

Gerard is complaining of a scrotal mass; however, the scrotum is so edematous that it is difficult to assess. How do you determine if it is a hernia or a hydrocele?

Bowel sounds may be heard over a hernia.

Mr. S comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain?

Inguinal hernia and peritonitis

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

D. Varicocele

What risk factors contribute to varicocele? A. Younger age B. Current cigarette smoker C. Multiple sex partners D. None of the above

D. None of the above

``` Treatment options for varicocele repair include all of the following except: A. Open surgery B. Laparoscopic surgery C. Treatment with a thrombolytic agent D. Percutaneous embolization ```

C. Treatment with a thrombolytic agent

There is a higher risk of balanitis in which of the following conditions? A. Renal Insufficiency B. Diabetes Mellitus C. Graves' disease D. Asthma

B. Diabetes Mellitus

Balanitis is caused by: A. Staphylococcus aureus B. Streptococcus pyogenes C. Candida albicans D. Trichomonads

C. Candida albicans

Balanitis is a symptom of which one of the following diseases A. Psoriatic arthritis B. Reactive arthritis C. Alkylosing Spondylitis D. Rheumatoid arthritis

B. Reactive arthritis

The average American man has an approximately % lifetime risk of prostate cancer and an approximately % likelihood of clinical disease. A. 15, 5 B. 25, 8 C. 40, 10 D. 60, 15

C. 40, 10

All of the following can cause an elevated PSA level except: A. Current prostate infection B. Recent cystoscopy C. BPH D. Prostatectomy

D. Prostatectomy

According to recent epidemiologic studies, prostate cancer is the number cause of cancer death in men residing within the US. (B) A. 1 B. 2 C. 3 D. 4

B. 2

You perform a DRE on a 72-year old man and find a lesion suspicious for prostate cancer. The findings are described as: A. a rubbery, enlarged prostatic lobe. B. an area of prostatic induration C. a boggy gland. D. prostatic tenderness

B. an area of prostatic induration

A 54 year old white man with no obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. The DRE findings are normal and his PSA is 3..7ng/ml. You recommend: A. Repeating the PSA test immediately. B. Repeat screening in 1 yr. C. Repeat screening in 2 yrs. D. Repeat screening in 5 yrs.

B. Repeat screening in 1 yr.

Which of the following mediations is associated with the highest incidence of erectile dysfunction? a. Lamotrigine (Lamictal) b. Clonazepam (Klonopin) c. Paroxetine (Paxil) d. Doxepin (Sinequan)

c. Paroxetine (Paxil)

Which of the following is not a common risk factor for erectile dysfunction (ED)? A. diabetes mellitus B. hypertension C. cigarette smoking D. testosterone deficiency

testosterone deficiency

When taking a phosphodiesterase-5 (PDE-5) inhibitor, concomitant use of which medication must be avoided? A. statins B. sulfonylurea C. angiotensin-converting enzyme (ACE) inhibitors D. nitrates

D. nitrates

What percent of patients with genital warts have spontaneous regression of the lesions? a. A. 10% B. 50% C. 25% D. 75%

B. 50%

Which HPV types are the most likely to cause genital warts or condyloma acuminatum? A. 1,2, & 3 B. 16 & 18 C. 6 & 11 D. 22 & 24

C. 6 & 11

Treatment for patients with condyloma acuminatum include all of the following except: A. Topical acyclovir B. Podofilox C. cryotherapy D. trichloroacetic acid

A. Topical acyclovir

What antibiotic would you expect NOT to give to a pregnant woman with a UTI?

Bactrim - TMP | avoid use during pregnancy secondary to possible risk of teratogenicity

What is the most common symptom of upper UTI in young children?

Fever

What lab result will be altered if a patient has taken an antibiotic?

Urine Culture

What is the preferred method to collect a urine specimen in children who are not toilet-trained?

catheterization

When would you consider a CT scan or renal ultrasound for patients with acute pyelonephritis?

If the | patient has not improved after 48-72 hours on an appropriate antibiotic.

What four reasons would you consider the infection complicated until proven otherwise?

If the | patient is a man, an older adult, or child, or has symptoms lasting more than 7 days

What medication would you expect not to use in acute pyelonephritis?

Do not use nitrofurantoin | because poor tissue concentrations are achieved in the renal parenchyma

To decrease the production of uric acid stones, the family nurse practitioner orders which medication? A. allopurinol (zyloprim) B. indomethacin (indocin) C. bethanechol (urecholine) D. phenazopyridine (pyridium)

A. allopurinol (zyloprim)

You see a 58-year-old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except: A. improved hydration. B. alpha blocker use. C. prescribing a diuretic. D. analgesia use

C. prescribing a diuretic.

Your 35-year-old patient is being worked up for microscopic hematuria. All of the following are differential diagnoses of microscopic hematuria except: A) Kidney stones B) Bladder cancer 527 C) Acute pyelonephritis D) Renal artery stenosis

Renal artery stenosis

A 65-year-old carpenter complains of stiffness and pain in both hands and right knee shortly after waking and worsens in the afternoon. He feels some relief with rest. On, exam the nurse practitioner notices the presence of Heberden's nodes. Which of the following is most likely? a. Osteoporosis b. Rheumatoid Arthritis c. Osteoarthritis d. Reiter's syndrome

c. Osteoarthritis

Mary, age 72, has severe osteoarthritis of her right knee. She obtains much relief from corticosteroid injections. When she asks you how often she can have them, how do you respond? A. Only once a year in the same joint B. No more than twice a year in the same joint C. No more than three to four times a year in the same joint D. No more than five to six times a year in the same joint

C. No more than three to four times a year in the same joint

Your 75-year-old client with osteoarthritis of the knee will be starting on a course of NSAIDs for pain management. The most important teaching point for your patient currently is: A. You should start with a high dose first and taper down the dose as needed. B. You should continue to take your Coumadin as you have been. C. Report any excessive stomach upset or if you notice that your stools become dark or bloody. D. At this point, it will not be helpful to lose weight.

C. Report any excessive stomach upset or if you notice that your stools become dark or bloody.

A 45-year-old woman in complaining of generalized stiffness, especially in both her wrist and hands. It is much worse in the morning and last a few hours. She also complains of fatigue and generalized body aches that have been present for the past few months. Which of the following is most likely? a. Osteoporosis b. Rheumatoid arthritis c. Osteoarthritis d. Gout

b. Rheumatoid arthritis

Ginny, age 48, has rheumatoid arthritis and gets achy and stiff after sitting through a long movie. This is referred to as A. longevity stiffness B. gelling C. intermittent arthritis D. molding

B. gelling

``` Mrs. Matthews has rheumatoid arthritis. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? A. Antigen-antibody formation B. Lymphocyte response C. Immune complex formation D. Lysosomal degradation ```

D. Lysosomal degradation

``` treatment for Myasthenia Gravis Includes: A. IVIG or Plasmapheresis B. Antibiotics C. Analgesic's D. Sedation ```

A. IVIG or Plasmapheresis

``` What specific treatment is given patients diagnosed with Myasthenia Gravis that will focus on improving conduction? A. Surgery B. Physical Therapy C. Mestinon (pyridostigmine) Neostigmine D. Fluroquinolones ```

C. Mestinon (pyridostigmine) Neostigmine

``` First-line treatment of SLE in a patient with mild symptoms is: A. systemic corticosteroids. B. hydroxychloroquine plus NSAIDs. C. anakinra. D. methotrexate. ```

B. hydroxychloroquine plus NSAIDs.

Common physical findings of SLE include all the following except: A. weight gain. B. joint pain and swelling. C. fatigue. D. facial rash.

A. weight gain.

Which of the following is not characteristic of rheumatoid arthritis (RA)? A. It is more common in women than in men at a 3:1 ratio. B. Family history of autoimmune conditions often is reported. C. Peak age for disease onset in individuals is age 50 to 70 years. D. Wrists, ankles, and toes often are involved.

C. Peak age for disease onset in individuals is age 50 to 70 years.

The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.

B. statins.

Which of the following dietary supplements is associated with increased risk for gout? A. vitamin A B. gingko biloba C. brewer's yeast D. glucosamine

C. brewer's yeast

Which of the following conditions places a patient at an increased risk of plantar fasciitis? A. Diabetes B. Pregnancy C. Alcoholism D. Thyroid disease

A. Diabetes

A 48-year old obese female presents to the clinic with complain of pain on the bottom of her feet with the first few steps in the morning that gets worse with prolonged walking. You would suspect: A. Gout B. Morton's Neuroma C. Rheumatoid Arthritis D. Plantar fasciitis

D. Plantar fasciitis

Which of the following is used to evaluate patients with medial collateral ligament injury? a. Varus test b. McMurray test c. Lachman test d. Valgus test

c. Lachman test

The Lachman maneuver is used to detect which of the following? A. instability of the knee B. nerve damage of the knee due to past knee injuries C. integrity of the patellar tendon D. tears on the meniscus of the

D. tears on the meniscus of the

A positive drawer sign supports a diagnosis of: a. sciatica b. cruciate ligament injury c. hip dislocation d. patellar ligament injury

b. cruciate ligament injury

A 15-year-old high school athlete complains of a painful area below both knees. He tells you they feel bone-like and are tender to palpation. He denies any hot joints, fever, rash, or difficulties with weight- bearing. Which of the following conditions is most likely? a) osteomyelitis b) internal tibial torsion c) Osgood-Schlatter Disease d) Calve-Perthe's Disease

c) Osgood-Schlatter Disease

When caring for the child with Osgood-Schlatter Disease, the nurse practitioner would know her treatment has been effective when a. The child no longer complains of pain at lower knee at rest b. The child no longer complains of pain at the ankle at rest. c. The child no longer complains of pain at the hip during exercise. d. The child no longer complains of pain at lower knee during exercise.

d. The child no longer complains of pain at lower knee during exercise.

Common risk factors for Osgood Schlatter Disease include: a. Highly active with open growth plates b. Significant Growth Spurt c. Typically asymmetrical but can occur bilaterally d. Boys> Girls e. All of the above

e. All of the above

What must you you do to diagnose a distal femur, patellar, and proximal tibia fracture?

Obtain imaging according to Ottawa knee rules

What are the key physical findings of patellar fractures?

palpable DEFECT on patella, HEMARTHROSIS, Failure to do STRAIGHT LEG RAISE = failure of EXTENSOR MECHANISM (retinaculum displaced)

Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple "mechanical" backache and order A) Bedrest for 2 days B) Muscle relaxants C) "Let pain be your guide" and continue activities D) Back-strengthening exercises

C) "Let pain be your guide" and continue activities

``` Beth, age 49, comes in with low back pain. An x-ray of the lumbar/sacral spine is within normal limits. Which of the following diagnoses do you explore further? A. Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus ```

D. Herniated nucleus pulposus

John, age 17, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago from improperly lifting heavy boxes. In discussing proper body mechanics with him to prevent future injuries, you tell him, A. " Bend your knees and face the object straight on. " B. " Hold boxes away from your body at arm 's length. " C. " Bend and twist simultaneously as you lift. " D. " Keep your feet firmly together.

A. " Bend your knees and face the object straight on. "

``` With the straight-leg-raising test, the NP is evaluating tension on which of the following nerve roots? A. L1 and L2 B. L3 and L4 C. L5 and S1 D. S2 and S3 ```

C. L5 and S1

``` The most common sites for lumbar disk herniation are: A. L1 to L2 and L2 to L3. B. L2 to L3 and L4 to L5. C. L4 to L5 and L5 to S1. D. L5 to S1 and S1 to S2 ```

C. L4 to L5 and L5 to S1.

Immediate diagnostic imaging for low back pain should be reserved for all of the following EXCEPT: A. presence of signs of the cauda equina syndrome. B. presence of severe neurological deficits. C. presence of risk factors for cancer. D. presence of moderate pain lasting at least 2 weeks.

D. presence of moderate pain lasting at least 2 weeks.

``` irst-line therapy for prepatellar bursitis should include: A. bursal aspiration. B. intrabursal corticosteroid injection. C. acetaminophen. D. knee splinting. ```

A. bursal aspiration.

``` Clinical conditions with a presentation similar to acute bursitis include which of the following? (More than one can apply.) A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout E. All of the above ```

E. All of the above

Patients with subscapular bursitis typically present with: A. limited shoulder ROM. B. heat over affected area. C. localized tenderness under the superomedial angle of the scapula. D. cervical nerve root irritation

C. localized tenderness under the superomedial angle of the scapula.

``` Which of the following is usually NOT part of treatment of a sprain? A. immobilization B. applying ice to the area C. joint rest D. local corticosteroid injection ```

D. local corticosteroid injection

``` If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured by using A. Phalen ' s test. B. skeletometry. C. the Thomas test. D. a goniometer. ```

D. a goniometer.

In assessing the skeletal muscles, you turn the forearm so that the palm is up. This is called A. supination. B. pronation. C. abduction. D. eversion.

A. supination.

``` The most common cause of acute bursitis is: A. Inactivity B. Joint overuse C. Fibromyalgia D. Bacterial infection ```

B. Joint overuse

First-line treatment options for bursitis usually include: A. corticosteroid bursal injection. B. heat to area. C. weight-bearing exercises. D. nonsteroidal anti-inflammatory drugs (NSAIDs).

D. nonsteroidal anti-inflammatory drugs (NSAIDs).

``` Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy. B. infection. C. inflammatory reaction. D. soreness at the site of injection. ```

D. soreness at the site of injection.

Patients with lateral epicondylitis typically present with: a. electric-like pain elicited by tapping over the median nerve b. reduced joint pain c. pain that is worst with elbow flexion (elbow ROM is usually normal) d. decreased hand grip strength the pain is worse with resisted wrist extension

d. decreased hand grip strength the pain is worse with resisted wrist extension

``` Risk factors for lateral epicondylitis include all of the following EXCEPT: A. repetitive lifting B. playing tennis C. hammering D. gout ```

D. gout

Up to what percentage of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95%

D. 95%

Initial treatment of lateral epicondylitis includes all of the following EXCEPT: A. rest and activity modifications B. corticosteroid injections C. topical or oral NSAIDS D. counterforce bracing brace centered over the back of the forearm can help relieve symptoms

B. corticosteroid injections

``` Carpal tunnel syndrome is inflammation of the: A) Ulnar nerve B) Radial nerve C) Brachial nerve D) Median nerve ```

D) Median nerve

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

A) Inflammation of the median nerve

Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to A. refer her to a hand surgeon. B. take a more complete history. C. try neutral position wrist splinting and order an oral NSAID. D. order a nerve conduction study such as an electromyography (EMG)

C. try neutral position wrist splinting and order an oral NSAID.

Alexander, age 18, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What do you tell him? A. " Use continuous heat for the first 12 hours, then use heat or cold to your own preference. " B. " Use continuous cold for the first 12 hours, then use heat or cold to your own preference. " C. " Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. " D. " Alternate between cold and heat for 20 minutes each for the first 24 - 48 hours.

C. " Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. "

When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. You are trying to differentiate between a sprain and a strain. You know that a sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. does not result in joint instability.

A. is an injury to the ligaments that attach to bones in a joint

``` Which of the following is usually not a part of treatment of a sprain? A. Immobilization B. Applying ice to the area C. Joint rest D. Local corticosteroid injection ```

D. Local corticosteroid injection

Janice is recovering from osteomyelitis of her leg. She asks you for advice as to what she can do to promote healing. You tell her to: A. put weight on the affected leg more frequently to promote increased circulation, oxygenation, and nutrition to the tissues of the wound area. B. eat foods high in vitamins and calcium and increase her calorie and protein intake. C. spend time in the fresh air and expose the wound to fresh air and sunlight. D. be sure to use strict aseptic technique when changing the dressing, which should be kept wet at all times to improve wound healing.

B. eat foods high in vitamins and calcium and increase her calorie and protein intake.

Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct? A. Integumentary effects include swelling, erythema, and warmth at the involved site. B. There is a low-grade fever with intermittent chills C. Musculoskeletal effects include tenderness of the entire leg. D. Cardiovascular effects include bradycardia.

A. Integumentary effects include swelling, erythema, and warmth at the involved site.

What is the protein lacking or absent in muscular dystrophy a. coronin b. tubulin c. dystrophin d. keratin

c. dystrophin

Type of muscular dystrophy that is most common in adulthood a. Becker md b. Duchenne md c. facioscapulohumeral md d. myotonic md.

d. myotonic md.

``` What type of muscular dystrophy do females get? A. becker md b. Duchenne md c. myotonic md d. none ```

d. none

The following are causes of scoliosis except: a. unknown b. spinal congenital deformity c. arthritis d. herniated

d. herniated

It is defined as a true deformity of the spine a. functional scoliosis b. structural scoliosis c. arthritic scoliosis d. neurofibroma scoliosis

b. structural scoliosis

``` Screening for females are recommended at what age? A. 5 and 12 B. 7 and 11 C. 14 and 15 D. 10 and 12. ```

D. 10 and 12.

``` Bouchard's nodule is found in which of the following? A) Rheumatoid arthritis B) Degenerative joint disease C) Psoriatic arthritis D) Septic arthritis ```

B) Degenerative joint disease

``` Podagra is associated with which of the following? A) Rheumatoid arthritis B) Gout C) Osteoarthritis D) Septic arthritis ```

B) Gout

Which of the following statements is most consistent with fibromyalgia? A. It is predominantly diagnosed in African Americans. B. It affects less than 1% of the general population. C. It is four to seven times more common in women than in men. D. It is most often initially diagnosed in adults younger than 20 years old and older than 55 years old.

B. It affects less than 1% of the general population.

Fibromyalgia is more common in patients with: A. type 2 diabetes. B. rheumatoid arthritis and systemic lupus erythematosus. C. migraine headaches. D. chronic obstructive pulmonary disorder (COPD).

B. rheumatoid arthritis and systemic lupus erythematosus.

``` Which of the following is inconsistent with the clinical presentation of fibromyalgia? A. widespread body aches B. joint swelling C. fatigue D. cognitive changes ```

C. fatigue

``` Jonas, age 62, experienced a temporary loss of consciousness that was associated with an increased rate of respiration, tachycardia, pallor, perspiration, and coolness of the skin. How would you describe this? A. Lethargy B. Delirium C. Syncope D. A fugue state ```

C. Syncope

``` The Hallpike maneuver is performed to elicit A. a seizure. B. vertigo. C. syncope. D. a headache. ```

B. vertigo.

Common signs of high-grade aortic stenosis in an individual during exercise include all of the following except: A. dyspnea. B. angina. C. seizure. D. syncope.

C. Seizure

All of the following are possible etiologies for papilledema a. Intracranial abscess b. Ruptured aneurysm c. Migraine headaches d. Cerebral edema

c. Migraine headaches

The following measures are used for treating various types of headache. Which is not considered to be effective therapy for migraine? a. Propanolol prophylaxis b. Resting in a quiet and darkened room c. Trimethobenzamide suppositories for nausea d. Sodium restriction to decrease water retention

d. Sodium restriction to decrease water retention

Which of the following is indicated in the prophylactic treatment of migraine headache a. ibuprofen (Motrin) b. Naproxen sodium (Anaprox) c. Propanolol (Inderal) d. Sumatriptan (Imitrex)

c. Propanolol (Inderal)

An adult woman comes to the clinic presenting with gradual onset of throbbing headaches behind one eye worsening over several eyes is diagnosed as a. Cluster headache b. Migraine headache c. Trigeminal neuralgia d. Temporal arteritis

b. Migraine headache

In tension-type headache, which of the following statements is true? a. Photophobia is seldom reported. b. The pain is typically described as "pressing" in quality c. The headache is usually unilateral d. Physical activity usually makes the discomfort worse

b. The pain is typically described as "pressing" in quality

A first-line prophylactic treatment option for the prevention of tension-type headache is a. Nortriptyline b. Verapamil c. Carbamazepine d. valproate

Nortriptyline

Migraine associated with muscle or neck pain, which is NOT an International Headache Society migraine diagnostic criterion, is often diagnosed as a. Sinus headache b. Cluster headache c. Increased intracranial pressure d. Tension-type headache

d. Tension-type headache

Acute cerebral hemorrhage is best identified with which of the following imaging techniques? a. transesophageal echocardiogram b. CT Scan c. Cerebral angiogram d. MR angiography

b. CT Scan

``` A 64-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She claims her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has A. open-angle glaucoma. B. angle-closure glaucoma. C. herpetic conjunctivitis. D. diabetic retinopathy. ```

B. angle-closure glaucoma.

Sylvia has glaucoma and has started taking a medication that acts as a diuretic to reduce the intraocular pressure. Which medication is she taking? A. A carbonicanhydrase inhibitor B. A beta-adrenergic receptor blocker C. A miotic D. A mydriatic

A. A carbonicanhydrase inhibitor

``` Signs and symptoms of acute angle-closure glaucoma include A. painless redness of the eyes. B. loss of peripheral vision. C. translucent corneas. D. halos around lights. ```

D. halos around lights.

When evaluating the person who has bacterial meningitis, the NP expects to find CSF results of: a. low protein b. predominance of lymphocytes c. glucose at about 30% of serum levels d. low opening pressure

c. glucose at about 30% of serum levels

An 18-year-old college freshman is brought to the student health center with a chief complaint of a 3-day history of progressive headache and intermittent fever. On physical examination he has a positive Kernig and Brudzinski sign. The most likely diagnosis is: a. viral encephalitis b. bacterial meningitis c. acute subarachnoid hemorrhage d. epidural hematoma

b. bacterial meningitis

Which of the following diseases is associated with a high risk of giant cell arteritis? A. history of transiet ischemia attacks (TIA) B. Frequent migraine headaches with focal neurological findings C. Polymalgia rheumatica (PMP) D. Systemic lupus erythematous (SLE)

C. Polymalgia rheumatica (PMP)

``` Which of the following diagnostic tests would be most helpful in the diagnosis of this illness? A. CT scan of the brain B. Cranial nerve exam C. Sedimentation rate D. CBC with differential ```

C. Sedimentation rate

``` Which of the following conditions is most likely? A. cluster headache B. migraine headache with aura C. migraine headache D. Giant cell arteritis ```

D. Giant cell arteritis

``` Of the four types of strokes, which one is the most common and has a gradual onset? A. Thrombotic B. Embolic C. Lacunar D. Hemorrhagic ```

A. Thrombotic

``` Which of the following risk factors for a stroke can be eliminated? A. Hypertension B. Carotid artery stenosis C. Smoking D. Hyperlipidemia ```

C. Smoking

``` Which of the following complications is the leading cause of death shortly after a stroke? A. Septicemia B. Pneumonia C. Pulmonary embolus D. Ischemic heart disease ```

B. Pneumonia

``` Risk factors for transient ischemic attack (TIA) include all of the following except: A. atrial fibrillation. B. carotid artery disease. C. combined oral contraceptive use. D. pernicious anemia. ```

D. pernicious anemia.

``` A TIA is characterized as an episode of reversible neurological symptoms that can last: A.1 hour. B.6 hours. C.12 hours. D.24 hours ```

D.24 hours

When caring for a patient with a recent TIA, you consider that: A. long-term antiplatelet therapy is likely indicated. B. this person has a relatively low risk of future stroke. C. women present with this disorder more often than men. D. rehabilitation will be needed to minimize the effects of the resulting neurological insult.

A. long-term antiplatelet therapy is likely indicated.

``` A 56-year-old man complains of several episodes of severe lacerating pain that shoots up to his right cheek and is precipitated by drinking cold drinks or chewing. These episodes start suddenly and end spontaneously after a few seconds with several episodes per day. He denies any trauma, facial weakness, or difficulty swallowing. He has stopped drinking cold drinks because of the pain. Which of the following is most likely? A. Trigeminal neuralgia B. Cluster headache C. Acute sinusitis D. Sinus headache ```

A. Trigeminal neuralgia

``` Which of the following cranial nerves is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? A. CN II B. CN III C. CN IV D. CN V ```

D. CN V

``` You examine a 29-year-old woman who has a sudden onset of right sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her exam is otherwise unremarkable. This presentation likely represents paralysis of CN: A: lll B. lV C. Vll D. Vlll ```

C. Vll

``` Which represents the most appropriate diagnostic test for the patient in the previous question? A. CBC with WBC Differential? B. Lyme disease antibody titer? C. CT scan of the head with contrast? D. BUN and Creatine levels? ```

B. Lyme disease antibody titer?

In prescribing prednisone for the patient with Bells palsy, the NP considers that its use: A. Has not been shown to be helpful in improving outcomes in the condition. B. Should be initiated asap after the onset of facial paralysis. C. Is likely to help minimize ocular symptoms. D. May prolong the course of the disease.

B. Should be initiated asap after the onset of facial paralysis.

Treatment options for an adult with seizures include all of the following agents EXCEPT: a. Carbamazepine b. Phenytoin c. Gabapentin d. tamsulosin

d. tamsulosin

tamsulosin Which of the following best describes patient presentation during tonic-clonic (grand mal) seizure? a. Blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness b. Awake state with abnormal motor behavior lasting seconds c. Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness d. Abrupt muscle contraction with autonomic signs

c. Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness

Central obesity, “moon” face, and dorsocervical fat pad are associated with:\

Cushing's syndrome

An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is: ``` A Trauma . B Tight shoes . C Arthritis flare . D Hydrochlorothiazide ```

D Hydrochlorothiazide

The most effective treatment of non-infectious bursitis includes: Conservative treatment includes rest, cold and heat treatments, elevation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs), bursal aspiration, and intrabursal steroid injections You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient

The physician must be on-site and engaged in patient care

Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?

The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension.

Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)? A. Nocturia B. Urgency incontinence C. Strong urinary stream flow D. Straining to void

C. Strong urinary stream flow

Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?

Food that is very hot or very cold Fatty or fried foods Peppermint or spearmint, including flavoring Coffee, tea, and soft drinks that contain caffeine Spicy, highly seasoned foods Fried food DT caffeine, chocolate and anticholinergics

Which drug category contains the drugs that are the first line Gold standard therapy for COPD?

Beta antagonist

The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:

Nsaid

A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? A Obtain a thorough history and physical, and check serum cortisol and ACTH levels. B. Perform a diet history and check CBC and FBS. C. Provide nutritional guidance and have the patient return in one month. D. Consult home health for intravenous administration

A Obtain a thorough history and physical, and check serum cortisol and ACTH levels.

``` You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: he A. lateral meniscus B. cruciate ligament C. medial meniscus D. collateral ligament. ```

B. cruciate ligament

A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is:

Include 500 mg of oral ciprofloxacin (Cipro) twice per day for seven days; 1,000 mg of extended-release ciprofloxacin once per day for seven days; or 750 mg of levofloxacin (Levaquin) once per day for five days.

A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is:

epicondylitis

The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy

LABSs to measure albumin in a spot urine sample, collected either as the first urine in the morning or at random, for example, at the medical visit. This method is accurate,:Early morning

What is the first symptom seen in the majority of patients with Parkinson’s disease?

Tremor at rest

The most commonly recommended method for prostate cancer screening in a 55 year old male is:

digital rectal exams,

Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect?

Otitis externa/ swimmer’s ear

Which of the following symptoms suggests a more serious cause of back pain?

Pain associated with lying down at night

A patient taking levothyroxine is being over-replaced. What condition is he at risk for?

osteoporosis

Which of the following is the most common cause of low back ``` A Lumbar disc disease . B Spinal stenosis . C Traumatic fracture . D Osteoporosis ```

A Lumbar disc disease

Which is the most common cause of end-stage renal disease in the United States?

Diabetes

A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: ``` A Arthritis . B Ulnar neuritis . C Septic arthritis . D Olecranon bursitis ```

D Olecranon bursitis

A 60 year old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis? Trigeminal neuralgia Temporal arteritis Parotiditis Bell's palsy

Trigeminal neuralgia

Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which diagnoses do you explore further?

Arthritis, C

Obtain a thorough history and physical, and check serum cortisol and ACTH levels.

Which of the following is a potential acquired cause of thrombophilia?

Antiphospholipid antibodies

How do you respond when Jessica, age 42, asks you what constitutes a good minimum cardiovascular workout?

20 3x per week

The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:

electroconvulsive therapy (ECT).

The initial clinical sign of Dupuytren’s contracture is:

Answer: Painless nodule on palmer fascia

Osteoarthritis

Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?

"A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly."

Diagnostic confirmation of acute leukemia is based on:

Bone marrow aspiration and biopsy

Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting “better.” How do you respond?

Because your kidneys are not functioning well, your insuling is not being metabolized and excreted as it should, so you need less of it

patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient’s TSH?

Answer: 6 – 8 weeks