Leik bank 4

Question 1

What can you find in a peripheral smear for sickle cell anemia?

Answer 1

Target cells
Howell-Jolly bodies

Question 2

What would be on a peripheral smear for poikilocytosis?

Answer 2

Burr cells
schistocytes

Question 3

What would be on a peripheral smear for beta thalassemia major?

Answer 3

anisopoiilocytosis

Question 4

the S4 heart sound mimics the sound of what state?

Answer 4

Tennessee

Question 5

s3 heart sound mimics the sound of what state?

Answer 5

Kentucky

Question 6

The nurse practitioner recently increased a patient’s antipsychotic medication and is assessing the patient in a follow-up appointment. All of the following symptoms suggest the patient is experiencing malignant neuroleptic syndrome, except:

Headache
Tremors
Muscular rigidity
Fever

Answer 6

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

Question 7

Manifestations of NMS 7

Answer 7

rigidity
tremors
difficulty swallowing
fever
hypertension
mental status changes
diaphoresis

Question 8

A sexually active young adult is diagnosed with Chlamydia trachomatis and treated with doxycycline 100 mg BID 7 days. During a follow-up visit, the patient reports a new onset of right upper quadrant pain and tenderness on palpation. Alanine aminotransferase (ALT) is 43 U/L, and aspartate aminotransferase (AST) is 24 U/L. The nurse practitioner suspects:

Jarisch–Herxheimer reaction
Reiter’s syndrome
Stevens–Johnson syndrome
Fitz-Hugh–Curtis syndrome

Answer 8

Fitz-Hugh–Curtis syndrome

this is a PID
S/S:
-RUQ pain
-pain on palpation
-violin string adhesions on laparoscopy
-normal LFT

Question 9

What is Reiter’s syndrome?

Answer 9

r/t chlamydia

supportive treatment only

Question 10

what is stevens johnson syndrome?

Answer 10

adverse reaction to antibiotic that leads to severe rash and flu like symptoms

Question 11

what is a Jarisch-Herxheimer reaction?

cause and symptoms 4

Answer 11

acute response from syphillis or other spirochete treatment in the first 24 hours

s/s:
-fever
-chills
-headache
-myalgia

Question 12

For COPD people, who should not get anticholinergics?

Answer 12

hx narrow angle glaucoma
BPH
Bladder neck obstruction

Question 13

An otherwise healthy 4-year-old child presents with painful, itchy clusters of pustules around the nose and mouth. On assessment, the nurse practitioner notes honey-colored crusted lesions over an erythematous base. How will the nurse practitioner treat this condition initially?

Hydrocortisone cream
Mupirocin ointment
Topical azole antifungal
Sulfadiazine cream

Answer 13

Mupirocin ointment

Question 14

When an infant is found to have tufts of fine dark hair on the sacrum, which of the following tests is recommended?

Ultrasound of the sacrum
Plain radiograph of the lumbar sacral spine
No imaging test is necessary
Genetic testing

Answer 14

Ultrasound of the sacrum

An infant with tufts of fine dark hair on the sacrum should be evaluated for occult spina bifida. The first imaging test to order is an ultrasound of the lower spine.

Question 15

The nurse practitioner should avoid prescribing all of the following drug classes to patients with sulfa allergies, except:

Thiazides
Loop diuretics
Potassium-sparing diuretics
Protease inhibitors

Answer 15

Potassium-sparing diuretics

Question 16

A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient’s forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes:

Budesonide with formoterol
Budesonide with montelukast
Cromolyn or nedocromil
Fluticasone with salmeterol

Answer 16

Budesonide with formoterol.

The patient has moved from step 2 to step 3 on the asthma classification scale; therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States.

Question 17

What are the stages of Reye’s syndrome?

Answer 17

stage 1:
-severe vomiting, diarrhea, lethargy, stupor
-Elevated LFT

stage 2:
-personality changes
-hyperactive reflexes

Stages 3 to 5: delirium, seizures, death

Question 18

A 3-year-old child with a respiratory virus was given aspirin for an elevated temperature. The child subsequently became lethargic and developed severe vomiting and diarrhea. The nurse practitioner assesses for all of the following findings, except:

Elevated alanine aminotransferase (ALT)
Hyporeflexia
Confusion
Cerebral edema

Answer 18

Hyporeflexia.

The patient likely has Reye’s syndrome, which is a rare condition that can develop in children and young adults recuperating from febrile viral infections who ingest aspirin or salicylate medications. The condition can progress very quickly. Stage 1 symptoms are severe vomiting, diarrhea, lethargy, stupor, and elevated ALT and AST. Stage 2 includes personality changes, irritability, aggression, and hyperactive (not hypoactive) reflexes. Stages 3 to 5 present with confusion, delirium, cerebral edema, coma, seizures, and death.

Question 19

The nurse practitioner is reviewing the laboratory results for a 27-year-old patient with decreased energy, paresthesia, and oral ulceration. The patient’s vitamin B12 is 215 ng/mL, methylmalonic acid (MMA) is 175 mM/L, and homocysteine (HC) is 18 µM/L. Which diagnosis is most likely?

Folate deficiency
Pernicious anemia
Normocytic anemia
Vitamin B12 deficiency

Answer 19

Folate deficiency.

Diagnostic laboratory findings of folate deficiency include a borderline vitamin B12 level, an MMA level within the reference range, and an elevated HC. The standard reference range for vitamin B12 is 200 to 900 ng/mL; values between 200 and 300 ng/mL are considered to be borderline. The normal reference range for MMA is 70 to 350 mM/L. The normal reference range for HC is 5 to 15 μM/L. Mean corpuscular volume is used to evaluate for normocytic anemia. Elevated levels of MMA and HC, paired with an increase in antiparietal antibodies, are findings associated with pernicious anemia. Vitamin B12 deficiency is associated with elevated levels of MMA and HC

Question 20

What are the diagnostic lab findings for a folate deficiency?

Answer 20

borderline Vit B12 (200-900)
methylmalmonic acid (MMA) level within range (70 - 350)
Elevated homocysteine (HC) (5 - 15)

Question 21

What are the lab findings with vit B12 deficiency?

Answer 21

elevated MMA
elevated HC

Question 22

Question
Which of the following is a true statement regarding genu valgum?

Genu valgum is a term for hyperextension of the knees
Genu valgum is a term for misalignment of the knees and is often called “knock-knees”
Genu valgum is a term for a bow-legged stance
Genu valgum is caused by a misalignment of the knees and resulting asymmetry of the hips

Answer 22

Genu valgum refers to a misalignment of the knees and is often called “knock-knees.”

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

Question 23

what is genu valgum “gum stuck between knees”

vs

genu varum

Answer 23

genu valgum = knock knees

genu varum = bow legged

Question 24

How does rheumatic fever present?

Answer 24

fatigue
nosebleed
painful joints
lattice-like rash on chest and back

Question 25

A 74-year-old patient diagnosed with streptococcal pharyngitis was treated with oral penicillin V 500 mg BID × 10 days. During a follow-up visit, the patient presents with tonsillar exudate and a low-grade fever. The nurse practitioner will:

Prescribe a 5-day course of azithromycin
Refer patient to an ENT specialist
Prescribe another course of penicillin V
Repeat culture and sensitivity (C&S)

Answer 25

Repeat culture and sensitivity (C&S).

If a patient returns post strep-pharyngitis and has completed a course of treatment, a throat C&S should be repeated. It is not necessary to refer the patient to an ENT specialist. Another round of penicillin V may not be clinically appropriate without a repeat C&S first. Once the C&S report is back, it may or may not be appropriate to begin a new antibiotic such as azithromycin.

Question 26

Which type of exercise would you recommend to a 65-year-old arthritic patient who complains of a new onset of a painful, swollen left knee caused by overworking in the garden for 2 days?

Quadriceps-strengthening exercises of the left knee followed by the application of cold packs for 20 minutes QID
Rest the joint and apply cold packs intermittently for the next 48 hours
Passive range of motion and cold packs
A cool tub bath with warm packs on the knee to avoid stiffening of the joint
Solution

Answer 26

Rest the joint and apply cold packs intermittently for the next 48 hours.

New onset of a painful, swollen left knee (inflammation) should be treated using RICE: Rest the knee/joint, use alternating Ice packs for the first 24 to 48 hours, use Compression if knee feels unstable, and Elevate the limb to decrease swelling.

Question 27

Question
A 24-year-old patient with a history of epilepsy presents to the clinic with complaints of fatigue and unexplained bruising. The patient is taking valproic acid and has a diagnostic level of 75 mcg/mL. Which additional laboratory assessment will the nurse practitioner use to determine the patient’s diagnosis? (Select all that apply.)

Folate level
Blood smear
Reticulocyte count
Antiparietal antibodies
Complete blood count with differential

Answer 27

Blood smear; reticulocyte count; complete blood count with differential.

Valproic acid places patients at an increased risk for aplastic anemia. Based on the patient’s current treatment with valproic acid and clinical presentation, the nurse practitioner will evaluate for aplastic anemia. The standard laboratory assessment for aplastic anemia includes a blood smear, a reticulocyte count, and a complete blood count. Other laboratory tests include a complete metabolic panel, lactic acid dehydrogenase, haptoglobin, and coagulation parameters. The clinical presentation of unexplained bruising is not associated with a folate deficiency. Evaluation of the antiparietal antibodies is used to assess a patient for pernicious anemia caused by vitamin B12 deficiency. Clinical findings of vitamin B12 deficiency do not include unexplained bruising.

Question 28

The nurse practitioner is completing a health assessment on a 15-year-old female patient who is in the office for her annual physical. The patient reports feelings of hopelessness and sadness for several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores an 11 on Beck’s Depression Inventory. The nurse practitioner will prescribe:

Sertraline (Zoloft)
Lithium carbonate (Eskalith)
Bupropion (Wellbutrin)
Escitalopram (Lexapro)

Answer 28

Escitalopram (Lexapro).

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

Question 29

what is a therapeutic theophylline level

Answer 29

5 to 15

Question 30

where is the most common site for the development of diverticula?

Answer 30

sigmoid colon

Question 31

An elderly patient with chronic obstructive pulmonary disease (COPD) is diagnosed with an essential tremor of the left hand. Which medication is contraindicated?

Propranolol (Inderal)
Primidone (Mysoline)
Nimodipine (Nymalize)
Gabapentin (Neurontin)

Answer 31

Propranolol (Inderal).

Because this patient has COPD, beta-blockers such as propranolol (Inderal) are contraindicated. Primidone (Mysoline) is an antiepileptic medication that is effective for the management of an essential tremor. Nimodipine (Nymalize; third-line treatment) is a calcium channel blocker that has been successful in managing limb tremors associated with essential tremors. Gabapentin (Neurontin) is a safe alternative to essential tremors, especially in the elderly. It is an anticonvulsant that is also prescribed for neuropathic pain.

Question 32

what a normal intraocular pressure reading

Answer 32

8 to 21

Question 33

The nurse practitioner is performing a vision assessment on a 10-week-old infant. All of the following assessment findings require a referral to a pediatric ophthalmologist, except:

Pseudostrabismus
Intermittent esotropia
White reflex
Positive Hirschberg test

Answer 33

Intermittent esotropia.

Abnormal vision screenings that require a referral to a pediatric ophthalmologist include pseudostrabismus (epicanthal folds appear “crossed-eyed”); white reflex, which could indicate cataracts, leukocoria, or retinoblastoma; and a positive Hirschberg test. Intermittent esotropia is common in infants younger than 20 weeks and usually resolves spontaneously. Refer if esotropia is still present after age 20 weeks.

Question 34

Signs of lithium toxicity 4

Answer 34

seizures
slurred speech
increased urination
increased thirst

Question 35

signs of phenytoin (dilantin) toxicity and their levels 3

Answer 35

levels 10-20 nystagmus
30 - 40 ataxia
40 to 50 confusion

Question 36

signs of cabamazepine (tegretol) toxicity

Answer 36

skin rash and jaundice

Question 37

A 62-year-old man with chronic obstructive pulmonary disease (COPD) complains to the nurse practitioner that his prescription for ipratropium bromide (Atrovent) is not working. He reports that he still feels short of breath even after using it four times a day for 3 months. Which of the following actions is the next step for the nurse practitioner?

Increase the patient’s dose of ipratropium bromide (Atrovent) to three inhalations QID
Continue the ipratropium bromide and start the patient on oxygen by nasal cannula
Continue ipratropium bromide (Atrovent) and add two inhalations of an albuterol (Ventolin) inhaler QID
Start the patient on oxygen by nasal cannula at bedtime and PRN during the daytime

Answer 37

Continue ipratropium bromide (Atrovent) and add two inhalations of an albuterol (Ventolin) inhaler QID.

Treatment of COPD starts with an anticholinergic (ipratropium bromide [Atrovent]). The next step is to add a short-acting beta-2 agonist (albuterol [Ventolin]).

Question 38

What are the signs and symptoms of multiple myeloma? CRAB

Answer 38

hypercalcemia
renal dysfx
anemia
bone lesions

Question 39

A patient taking phenytoin (Dilantin) has a current level of 22 mcg/mL. Which assessment finding would the nurse practitioner expect to see in this patient?

Ataxia
Confusion
Seizures
Nystagmus

Answer 39

Nystagmus.

The therapeutic level of phenytoin (Dilantin) is 10 to 20 mcg/mL. Levels greater than this may cause adverse effects: 20 to 30 mcg/mL, nystagmus; 30 to 40 mcg/mL, ataxia; 40 to 50 mcg/mL, mental status changes; >50 mcg/mL, breakthrough seizures; and levels near 100 mcg/ mL may cause death.

Question 40

A 38-year-old patient who is 3 weeks postpartum presents for follow-up and reports frequent headaches and intermittent blurred vision when arising in the morning. Her blood pressure is 128/86 mmHg in the left arm and 122/78 mmHg in the right arm. The next day, the patient returns with worsening headaches and a 2-pound weight gain in 3 days. Her blood pressure is now 156/92 mmHg in the left arm and 148/94 mmHg in the right arm. Which diagnosis is most likely?

Pregnancy-induced hypertension
Preexisting chronic hypertension
Eclampsia
Migraine headaches

Answer 40

Pregnancy-induced hypertension.

Pregnancy-induced hypertension (preeclampsia) can occur in the late 3rd trimester or up to 4 weeks postpartum. Classic triad: Hypertension, proteinuria, and edema that occur after 20 weeks’ gestation and up to 4 weeks postpartum. Rapid weight gain of 2 to 5 pounds per week and edema is most obvious in the face around the eyes and on the hands. Preexisting/chronic hypertension is defined as elevated BP (>140/90 mmHg) before the 20th week of gestation. Eclampsia is similar to preeclampsia, but the patient typically experiences a seizure. Migraine headaches can occur on one or both sides of the head. This usually causes nausea, vision disturbances, and photophobia.

Question 41

A positive Coombs test on an Rh-negative pregnant woman means:

The mother has autoantibodies against Rh-positive red blood cells (RBCs)
The fetus has autoantibodies against Rh-negative RBCs
The mother does not have Rh factor antibodies
The fetus does not have Rh factor antibodies

Answer 41

The mother has autoantibodies against Rh-positive red blood cells (RBCs).

The mother’s autoantibodies can attack the fetus’s Rh-positive RBCs and cause destruction of these cells, which can cause severe anemia and complications in the fetus. Today this is preventable with the administration of anti-RhD immunoglobulin (Rho[D] immune globulin) to an Rh-negative mother at 28 weeks’ gestation and after birth if the newborn is Rh positive.

Question 42

When assessing an infant during a well-baby visit, the nurse practitioner notes pale and damp skin, fussiness, and shortness of breath. There is a delay of the femoral pulse when compared with the brachial pulse. To confirm diagnosis, all of the following should be ordered, except:

Echocardiogram
Complete blood count
EKG
Chest x-ray

Answer 42

Complete blood count.

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

Question 43

What is an abnormal assessment finding in a male newborn at 39 4/7 weeks’ gestation?

Smooth scrotum
Pendulous scrotum
Increased scrotal pigmentation
Smegma beneath the prepuce

Answer 43

Smooth scrotum.

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

Question 44

What is the presence of a smooth scrotum associated with?

Answer 44

prematurity

Question 45

All of the following medications have drug interactions with levothyroxine (Synthroid), except:

Antacids
Tricyclic antidepressants
Anticoagulants
Penicillins

Answer 45

Penicillins.

Levothyroxine (Synthroid) does not interact with penicillins, but there are numerous drugs with which it interacts, including anticoagulants, tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton pump inhibitors, estrogens, statins, metformin. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together and should space these foods and drugs several hours apart. Levothyroxine is a synthetic form of T4.

Question 46

All of the following are risk factors that could lead to hearing loss in an infant who was premature at birth, except:

Hyperbilirubinemia
Low Apgar scores
Rubeola
Seizures

Answer 46

Rubeola.

Use the HEARS mnemonic for risk factors that may lead to hearing loss: Hyperbilirubinemia; Ear infections that are frequent; low Apgar scores; Rubella/cytomegalovirus (CMV), not rubeola; and Seizures. Sickle cell disease is not a risk factor for hearing loss.

Question 47

What are the risk factors that lead to hearing loss in infants?

Answer 47

HEARS
hyperbilirubinemia
ear infections
low APGAR scores
Rubella/CMV
Seizures

Question 48

A score of 23 on the Folstein Mini-Mental State Exam (MMSE) indicates:

Severe dementia
Moderate dementia
Mild dementia
Parkinson’s disease

Answer 48

Mild dementia.

The MMSE measures cognitive decline. A score of 18 to 23 is considered mild dementia, a score of <17 is considered moderate-to-advanced dementia, and a score of <12 is considered severe dementia. Parkinson’s disease is a progressive neurodegenerative disease caused by decreased dopamine receptors. Depression, resting tremor, and muscular rigidity are common. The disease is not measured by the MMSE.

Question 49

The nurse practitioner assesses a 5-year-old for growth and development milestones. Which finding concerns the nurse practitioner?

Child cannot tie shoes
Child cannot copy a square
Child is unable to draw a person with two parts
Child is unable to copy a triangle

Answer 49

Child is unable to draw a person with two parts.

A 5-year-old child should be able to draw a person with up to four parts. Tying shoes and copying a triangle are advanced fine motor skills typical of a 6-year-old. Inability to copy a square would not be concerning at this point, as it is a 5-year-old milestone and the child may not have developed this skill yet.

Question 50

An elderly patient presents with right-sided hearing loss. On physical examination, there is lateralization to the right ear. The Rinne test shows BC>AC. Which diagnosis is most likely?

Ménière’s disease
Labyrinthitis
Acoustic neuroma
Cerumen impaction

Answer 50

Cerumen impaction.

Cerumen (ear wax) is obstructive to the middle and/or outer ear. Any type of obstruction to sound waves will cause conductive hearing loss. Sensorineural hearing loss occurs when there is damage to vital ear structures such as the cochlea/vestibule and/or to the auditory nerve pathways. Ménière’s disease, labyrinthitis, and acoustic neuroma are associated with sensorineural hearing loss.

Question 51

Which initial treatment will the nurse practitioner prescribe to a 23-year-old female allergic to sulfa drugs who is diagnosed with acute cystitis?

Cephalexin (Keflex) 500 mg BID × 5 days
Ciprofloxacin (Cipro) 250 mg BID × 3 days
Nitrofurantoin (Macrobid) 100 mg BID × 5 days
Amoxicillin 500 mg BID × 5 days

Answer 51

Nitrofurantoin (Macrobid) 100 mg BID × 5 days.

Nitrofurantoin (Macrobid) can be safely administered to a patient with a sulfa allergy to treat acute cystitis and is the first line of treatment. Cephalexin (Keflex) and amoxicillin are beta-lactam antibiotics that can be prescribed to a patient who has an allergy to sulfa and nitrofurantoin and who does not have a known allergy or resistance to beta-lactam antibiotics. A fluoroquinolone such as ciprofloxacin (Cipro) is recommended for a patient who is allergic to sulfa and beta-lactam drugs or has a sulfa allergy and a known resistance to beta-lactam antibiotics.

Question 52

An 18-year-old male patient is found to have a 47,XXY karyotype and is diagnosed with Klinefelter’s syndrome. The patient is likely to have all of the following physical characteristics, except:

Gynecomastia
Long limbs
Lack of secondary sexual characteristics
Large testes

Answer 52

Large testes.

Signs and symptoms of Klinefelter’s syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/reproductive system in the future.

Question 53

Klinefelter’s syndrome

karyotype
s/s 5
prognosis

Answer 53

XXY -boys

gynecomastia
long limbs
small testes
infertility

Question 54

A 13-year-old male patient complains of chronic low-back pain persisting for more than 3 months and hip joint pain that keeps him up at night. He has a temperature of 99.4°F. Which of the following would help confirm a diagnosis? (Select all that apply.)

MRI
X-ray
HLA-B27
C-reactive protein
Erythrocyte sedimentation rate (ESR)
Solution

Answer 54

MRI; x-ray; HLA-B27; C-reactive protein; erythrocyte sedimentation rate (ESR).

These symptoms are consistent with ankylosing spondylitis (AS), which is believed to be a genetically inherited autoimmune disorder that occurs most often in young men. It is an inflammatory disease that, over time, can cause some of the small bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. There is no single conclusive diagnostic test for AS. Diagnostics includes MRI and x-ray to assess for changes in joints and bones. HLA-B27 is a genetic marker present in 95% of those with the disorder. C-reactive protein and ESR are indicators of inflammation; however, they are not present in all AS patients.

Question 55

Which type of fracture is referred to as the dinner fork fracture?

Navicular fracture
Colles’ fracture
Axial fracture
Scaphoid bone fracture
Solution

Answer 55

Colles’ fracture.

The Colles’ fracture is the most common type of wrist fracture and is referred to as the dinner fork fracture because of the appearance of arm and wrist fracture. The navicular fracture is located on the anterior portion of the thumb as a scaphoid fracture. The axial fracture is not a type of fracture. Axial refers to the bones of the central axis of the body.

Question 56

A 45-year-old female presents with complaints of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling “gritty.” Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) of 0.02 mU/L, T3 of 253 ng/dL, T4 of 20 g/dL, and 6-hour radioactive iodine uptake (RAIU) of 85%. Which diagnosis is most likely?

Graves’ disease
Hashimoto’s thyroiditis
Primary hypothyroidism
Multinodular goiter

Answer 56

Graves’ disease.

Graves’ disease, an autoimmune disease that causes hyperthyroidism, is most prevalent in middle-aged females. Symptoms include rapid weight loss, anxiety, and insomnia. The patient may experience cardiac symptoms (e.g., palpitations, hypertension) and ophthalmopathy. Labs show low TSH (<0.5 mU/L) and elevated serum-free T4 and T3. A 6-hour RAIU shows diffuse uptake (goiter). In Hashimoto’s thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, RAIU is low (≤2%). A multinodular goiter will show an uptake in the high-normal range (3%–10%).

Question 57

What effect does finasteride (Proscar) have on prostate-specific antigen (PSA) levels in patients with prostate cancer?

Finasteride does not have an acute effect on the PSA
The chronic effect of finasteride is the stabilization of the PSA
When using finasteride for long-term management, the PSA will be doubled
An increase in PSA within the normal range may occur with the use of finasteride

Answer 57

The chronic effect of finasteride is the stabilization of the PSA.

The chronic effect of using finasteride to treat prostate cancer is the stabilization or gradual decline of the patient’s PSA. An acute effect of the finasteride on PSA is a reduction, rather than an increase, of approximately 50%. Any increase in PSA is a concern, even if the value is within a normal range.

Question 58

A 18-year-old college freshman presents at the campus clinic with reports of severe night sweats, lymphadenopathy, and severe pain over gland areas after drinking alcohol. Further assessment indicates that the patient has a positive Pel–Ebstein sign. Blood work reveals several Reed–Sternberg cells. Which diagnosis is most likely?

Leukemia
Acute lymphocytic leukemia (ALL)
Hodgkin’s lymphoma
Acute myelogenous leukemia (AML)

Answer 58

Hodgkin’s lymphoma.

Hodgkin’s lymphoma is typically diagnosed between the ages of 15 and 19 years. Patients present with enlarged cervical, axillary, and supraclavicular lymphadenopathy with fluctuating days of fever and no fever. Leukemia causes extreme fatigue, weakness, pale skin, and easy bruising. Some patients will experience petechiae. ALL is a fast-growing cancer of lymphoblasts that causes very high white blood cell (WBC) counts (>50,000 cells). AML is also a fast-growing cancer of the bone marrow; it affects immature WBCs, macrophages/monocytes, red blood cells (RBCs), and platelets.

Question 59

What are signs of Hodgkin’s lymphoma

Answer 59

cervical, axillary, and supraclavicular lymphadenopathy
-fluctuating days of fever/no fever

usually 15 to 19 years old

Question 60

What do people with leukemia present with?

Answer 60

extreme fatigue
weakness
pale skin
easy bruising

Question 61

A middle-aged adult reports rhinitis and an ice-pick headache behind the left eye. The patient has a body mass index (BMI) of 20.1, FEV1% of 63%, and a C-reactive protein (CRP) level of 3.7 mg/L. The nurse practitioner will:

Administer 100% oxygen at 12 L/minute by mask
Administer a dose of sumatriptan (Imitrex) by injection
Administer a dose of verapamil (Calan) orally
Advise patient to engage in stress-relieving activities
Solution

Answer 61

Administer a dose of sumatriptan (Imitrex) by injection.

The patient likely has a cluster headache. The best intervention to treat this patient’s cluster headache is to administer sumatriptan (Imitrex) by injection or nasally. According to the BODE (body mass index, oximetry, dyspnea, exercise) index score, the patient has chronic obstructive pulmonary disease (COPD) and should not receive oxygen at high doses (e.g., 12 L/minute via mask) because it will shut down the breathing center in the brain. The patient’s CRP level is slightly elevated at 3.7 mg/L (normal is <3 mg/L), indicating an inflammatory process. Verapamil (Calan) PO daily is prescribed for maintenance therapy. Stress-relieving activities are important for the treatment of muscle tension headaches.