Practice Questions

Question 1

A 17 yo pt presents at the clinic with the following reason for seeking care: “I have been sick for 3 days. I feel sick to my stomach and have diarrhea.” Which of the following would be most appropriate to document as her reason for her visit/chief complaint?
a. Flu Like symptoms
b. GI distress
c. “I feel sick to my stomach and have diarrhea”
d. Possible pregnancy, needs further evaluation.

Answer 1

c. “I feel sick to my stomach and have diarrhea”

Reason for a client’s visit/chief concern should be documented as a brief statement in the client’s own words.

Question 2

Which of the following would be considered a subjective assessment finding to be placed in the S section of SOAP format charting?
a. Motile trichomonads
b. Mucopurulent discharge
c. Trichomoniasis vaginitis
d. Vaginal itching

Answer 2

d. Vaginal itching

Subjective information is obtained as part of the health history and is what the client or caregiver tells you.

Question 3

Which of the following includes a pertinent negative that needs to be documented?
a. 16 yo F who has never been sexually active; no hx of STIs
b. 25 yo F with abdominal pain; no N/V/D
c. 40 y F with depression; past hx of suicidal attempt
d. 60 yo F with stress incontinence; no breast mass or nipple discharge

Answer 3

b. 25 yo F with abdominal pain; no N/V/D

The description of presenting symptoms should include pertinent negatives. When a symptom suggests that an abnormality may exist or may develop in that area, include documentation of absence of symptoms that may help eliminate some of the possibilities.

Question 4

Appropriate information in the review of systems section of the health history would include:
a. Alert, cooperative, well-groomed
b. Had measles and chickenpox as a child
c. Occasional loss of urine with coughing
d. Walks 2 miles a day for exercise

Answer 4

c. Occasional loss of urine with coughing

The review of systems is used to assess common symptoms for each major body system to avoid missing any potential or existing problems

Question 5

Which of the following would most appropriately be documented in the A section of SOAP charting format?
a. CBC ordered
b. Client states that she would like to quit smoking Medication instructions provided
c. Medication instructions provided
d. Mucopurulent cervicitis

Answer 5

d. Mucopurulent cervicitis

The A section of SOAP charting format includes your diagnosis of prioritized list of problems determined from your assessment of subjective and objective data

Question 6

The bell of the stethoscope should be used when listening for:
a. Bowel sounds
b. Carotid bruits
c. Lung sounds
d. S1 and S2 heart sounds

Answer 6

b. Carotid bruits

The bell of the stethoscope is best for listening to low-pitched sounds such as those heard over large blood vessels

Question 7

Evaluation of EOM movement includes:
a. Ophthalmoscopic examination
b. PERRLA evaluation
c. The six cardinal fields of gaze
d. Visual fields by confrontation

Answer 7

c. The six cardinal fields of gaze

EOM function is evaluated by assessing symmetry, lid lag, and nystagmus as the client holds her head still and follows your finger through the six cardinal fields of gaze.

Question 8

The adventitious lung sound most commonly associated with asthma is:
a. Crackles
b. Pleural rub
c. Rhonchi
d. Wheezes

Answer 8

d. Wheezes

Wheezes are high-pitched (sound like a squeak), continuous adventitious lung sounds that may be heard when air flows through constricted passageways that occur in conditions such as asthma

Question 9

When auscultating lung sounds, the normal finding over most of the lung field is:
a. Bronchial
b. Resonant
c. Tympanic
d. Vesicular

Answer 9

d. Vesicular

The lung sound over most of the lung fields is vesicular, with inspiratory sounds lasting longer than expiratory sounds

Question 10

Increased tactile fremitus would be an expected finding in a client with:
a. Asthma
b. Emphysema
c. Lobar pneumonia
d. Pleural effusion

Answer 10

c. Lobar pneumonia

Tactile fremitus refers to the palpable transmission of vibrations through the bronchus to the chest wall when the client is speaking. There is increased transmission through consolidated tissue, as is found with lobar pneumonia.

Question 11

The sound heard over the cardiac area if the client has pericarditis is mostly likely to be a(n):
a. Diastolic murmur
b. Fixed split S2
c. Friction rub
d. Increased S4

Answer 11

c. Friction rub

A pericardial friction rub may be heard over the cardiac area as a grating sound throughout the cardiac cycle when inflammation of the pericardium is present

Question 12

Which of the following is an abnormal abdominal examination finding in an adult?
a. Abdominal aorta 2.5 cm in width
b. Liver border nonpalpable
c. Liver span 8 cm at the right MCL
d. Splenic dullness at the left anterior axillary line

Answer 12

d. Splenic dullness at the left anterior axillary line

Splenic dullness may be percussed at the sixth to tenth ICS just posterior to the midaxillary line on the left side, with the client in the supine position. Splenic dullness at the anterior axillary line is indicative of an enlarged spleen.

Question 13

One of the cranial nerves for which you would test both motor and sensory function is:
a. CN II - optic nerve
b. CNV - trigeminal nerve
c. CN VI - abducens nerve
d. CN XI - spinal accessory nerve

Answer 13

b. CNV - trigeminal nerve

The cranial nerves with both motor and sensory functions are CN V (trigeminal nerve), CN VII (facial nerve), CN IX (glossopharyngeal nerve), and CNX (vagus nerve). Routinely, the only cranial nerve in which you test both motor and sensory function is CN V.

Question 14

A client with an Hgb of 10.2 g/dL and RBC indices indicating both microcytosis and hypochromia most likely has:
a. Folic acid deficiency
b. Iron deficiency
c. Severe dehydration
d. Vitamin B12 deficiency

Answer 14

b. Iron deficiency

RBC indices provide information about size, weight, and Hgb concentration of RBCs and are useful in classifying anemia when the individual has a low Hgb level. Iron-deficiency anemia is characterized by abnormally small (microcytic) and pale (hypochromic) RBCs.

Question 15

A client with an increased WBC count related to infectious hepatitis would most likely have an elevated level of:
a. Basophils
b. Eosinophils
c. Lymphocytes
d. Neutrophils

Answer 15

c. Lymphocytes

The WBC count with differential provides information useful in evaluating an individual with infection, neoplasm, allergy, or immunosuppression. Lymphocytes and monocytes are increased with acute viral infections and chronic bacterial infections.

Question 16

Expected thyroid function test findings with primary hypothyroidism include:
a. Decreased TSH and decreased FT4
b. Decreased TSH and increased FT4
c. Increased TSH and decreased FT4
d. Increased TSH and Increased FT4

Answer 16

c. Increased TSH and decreased FT4

An increased TSH level is seen with primary hypothyroidism and thyroiditis. A decreased FT4 level is seen with hypothyroidism

Question 17

A pregnant client presents with a recent-onset rash. Which of the following laboratory results would be reassuring that this is not likely rubella?
a. HAI titer of 1:10 at her initial visit 1 month earlier
b. HAI titer of 1:128 at the current visit
c. Increased IgG antibody levels at the current visit
d. Increased IgM antibody levels at the current visit

Answer 17

a. HAI titer of 1:10 at her initial visit 1 month earlier

The HAI test is used to detect immunity to rubella and to diagnose rubella infection. Titers of 1:10 or greater indicate immunity to rubella. High titers (1:64 or greater) indicate immunity to rubella.

Question 18

A client who had HBV 6 months ago currently has no symptoms but has a positive test for HbsAg. This most likely indicates that she:
a. Has immunity to future infection
b. Has persistent active infection
c. Is a chronic carrier of HBV
d. Is in the early stage of reinfection

Answer 18

c. Is a chronic carrier of HBV

HBsAg rises before onset of clinical symptoms, peaks during the first week of symptoms, and returns to normal by the time jaundice subsides. An individual is considered to be a carrier (remains infectious) if HBsAg persists.

Question 19

A false-negative TB PPD test may be the result of:
a. Dormant infection
b. Immunosuppression
c. Intradermal injection
d. Prior BCG vaccination

Answer 19

b. Immunosuppression

False-negative TB PPD tests may result from incorrect administration (must be intradermal) or immunosuppression

Question 20

A client with cholecystitis would most likely have a(n):
a. Decreased alkaline phosphatase
b. Decreased indirect bilirubin
c. Increased albumin level
d. Increased direct bilirubin

Answer 20

d. Increased direct bilirubin

An elevated direct (conjugated) bilirubin level occurs with gallstones and obstruction of the extrahepatic duct

Question 21

Measuring waist circumference is most appropriate when the client’s BMI places her in which of the following categories?
a. Underweight
b. Normal weight
c. Overweight
d. Extreme obesity

Answer 21

c. Overweight

Waist circumference provides measurement of abdominal fat as an independent prediction of risk for type 2 diabetes, DLD, HTN, and CVD in individuals with BMI between 25-39.9 (overweight and obesity). Waist circumference has little added value in disease risk prediction in individuals with BMI 40+ (extreme obesity).

Question 22

Which of the following lab values is not normally affected by pregnancy?
a. Cholesterol
b. MCV
c. T4
d. Triglycerides

Answer 22

b. MCV

Cholesterol and triglyceride levels may be elevated during pregnancy. T4 levels are affected by the amount of TBG, which is increased during pregnancy. The MCV is the average volume or size of a single RBC. Although the Hgb/Hct levels may be lower during pregnancy, the size of the RBCs should not change unless the woman has iron-deficiency anemia, thalassemia, vitamin B12 deficiency, or folic acid deficiency.

Question 23

A 65-yo F has done a densitometry test, with the results of T-score being -2.0. This indicates she has:
a. Bone density that is greater than that of most women her age
b. Bone density that is equal to that of a young normal adult
c. Bone density that is at the level for a diagnosis for osteopenia
d. Bone density that is at the level for a diagnosis for osteoporosis

Answer 23

c. Bone density that is at the level for a diagnosis for osteopenia

Osteopenia is defined as BMD between 1 and 2 SD below that of a young normal adult. This is a T-score of between -1 and -2.5

Question 24

Appropriate management for a 45-yo client who has no diabetic risk factors and no symptoms of diabetes with a fasting glucose of 130 mg/dL would include which of the following?
a. Inform client she has impaired glucose tolerance
b. Order HbA1c level
c. Repeat glucose testing on another day
d. Repeat glucose screening in 3 years.

Answer 24

c. Repeat glucose testing on another day

A fasting glucose of 126 mg/dL or greater is diagnostic for diabetes. Repeat testing should be done on a subsequent day to confirm the diagnosis.

Question 25

A client who either has acute active HBV infection or who is a carrier (chronic active state ) would have a positive test for:
a. HBsAg
b. HBsAb
c. HBeAg
d. HBeAb

Answer 25

a. HBsAg

HBsAg is present with both acute active infection and a chronic active (carrier) state.

Question 26

Tests for cerebellar function include:
a. Deep tendon reflex evaluation
b. Short-term memory evaluation
c. Discriminatory sensation tests
d. Romberg test for balance

Answer 26

d. Romberg test for balance

The cerebellum coordinates motor activity, maintains equilibrium, and helps to control posture.

Question 27

Which of the following statements is correct regarding autosomal recessive inheritance of a genetic disorder?
a. Both parents are unaffected but are carriers of the mutated gene
b. Disorder tends to occur in every generation of the affected family
c. Male offspring are more likely to be affected than females
d. One parent has the genetic disorder with the mutated gene

Answer 27

a. Both parents are unaffected but are carriers of the mutated gene

In autosomal recessive inheritance of a genetic disorder, the affected individual has two mutated copies of the responsible gene in each cell. The affected individual usually has unaffected parents (carriers), each of whom carries a single copy of the mutated gene.

Question 28

Obtaining a Z-score on a bone mineral density test might be appropriate for evaluating
a. A 40 yo F with nontraumatic hip fracture
b. A 46 yo F with a strong family hx of osteoporosis
c. A 60 yo F who smokes cigarettes and has low body weight
d. A 70 yo F with osteoporosis being treated with a bisphosphonate

Answer 28

a. A 40 yo F with nontraumatic hip fracture

A z-score may be used to compare bone density in a premenopausal woman to an age-, gender-, and ethnicity-matched reference population to evaluate for secondary causes of osteoporosis

Question 29

A client who was treated for primary syphilis one year ago now has the following test results: VDRL nonreactive and FTA-ABS positive. These findings indicate that the client most likely:
a. Was not adequately treated for primary syphilis one year ago
b. Has become infected since completion of treatment one year ago
c. Has some other condition that is causing a false-positive FTA-ABS
d. Was treated adequately for syphilis and has not become reinfected

Answer 29

d. Was treated adequately for syphilis and has not become reinfected

Nontreponemal tests (VDRL, RPR) usually become non reactive with time after treatment. Treponemal tests (FAT-ABS, TPI) usually remain positive indefinitely after treatment.

Question 30

Which of the following heart sounds may be a normal finding in the third trimester of pregnancy?
a. Diastolic murmur
b. Fixed split S2
c. S3
d. S4

Answer 30

c. S3

An increased S3 may be audible in late pregnancy. This heart sound is heard early in diastole during rapid ventricular filling

Question 31

Pelvic findings on examination of a 22-yo nulliparous client are uterus 7 cm in length and ovaries 3 cm x 2 cm x 1 cm. These findings are consistent with:
a. An enlarged uterus and enlarged ovaries
b. A normal-size uterus and enlarged ovaries
c. An enlarged uterus and normal-size ovaries
d. A normal-size uterus and normal-size ovaries

Answer 31

d. A normal-size uterus and normal-size ovaries

The uterus is 5.5-8 cm long and pear shaped in the nulliparous woman. During the reproductive years, the ovaries are approximately 3 cm x 2 cm x 1 cm

Question 32

A laboratory test finding of increased immature neutrophils (shift to the left) is consistent with a(n):
a. Acute bacterial infection
b. Acute viral infection
c. Allergic reaction
d. Chronic bacterial infection

Answer 32

a. Acute bacterial infection

Neutrophils are increased with acute bacterial infections and trauma. Increased immature neutrophil forms (band or stab cells), referred to as a “shift to the left,” are seen with ongoing acute bacterial infection

Question 33

An elderly woman has had gastroenteritis with vomiting and diarrhea for the past 3 days. Her mucous membranes appear dry, and she says she has not urinated yet today. Expected laboratory test findings related directly to her current condition might include:
a. Decreased urine specific gravity
b. Decreased hematocrit
c. Increased blood glucose
d. Increased blood urea nitrogen

Answer 33

d. Increased blood urea nitrogen

BUN is an indirect measure of renal and liver function. Increased levels may be seen with hypovolemia, dehydration, reduced cardiac function, GI bleeding, starvation, sepsis, and renal disease

Question 34

The blood type in which an individual has no antigens on his or her RBCs is:
a. AB+
b. AB-
c. O+
d. O-

Answer 34

d. O-

Blood types are grouped according to the presence or absence of antigens A, B, and Rh on RBCs. Blood type O negative has no antigens on RBCs.

Question 35

The heart sound heard best at the base of the heart is:
a. S1
b. S2
c. S3
d. S4

Answer 35

b. S2

The S2 heart sound is heard best at the base of the heart using the diaphragm of the stethoscope.

Question 36

A client who was sexually assaulted 3 weeks ago by an individual known to be HIV+ has a nonreactive rapid EIA test result using an oral mucosal transudate specimen. The most appropriate next step would be to:
a. Advise the client to return for repeat testing in 3 months
b. Repeat the rapid EIA test now using a blood sample
c. Order an HIV-1 p24 antigen test
d. Order a Western blot test to confirm the nonreactive EIA test result

Answer 36

c. Order an HIV-1 p24 antigen test

The HIV-1 p24 antigen test detects HIV-1 antigen as early as 2-6 weeks after infection; levels of this antigen decline once HIV antibodies develop. HIV antibodies are detectable in 95% of individuals within 6 months of infection. A combined HIV antibody and p24 antigen test is available.

Question 37

An abnormal finding on ophthalmoscopic examination would be:
a. Arterioles smaller than veins
b. A yellow optic disc
c. A presence of a red reflex
d. Tapering of the veins

Answer 37

d. Tapering of the veins

The normal retinal artery wall is transparent except for the column of blood going down the middle, so a vein crossing beneath the artery can be seen up to the column of blood on either side (arteriovenous crossing). When narrowing of the retinal artery occurs (as with HTN), the arterial wall thickens and becomes less transparent. The vein crossing under the married artery appears to taper down on either side of the artery.

Question 38

When examining the cervix of a 20 yo, you note that the cervix is pink, but there is a small ring of dark-red tissue surrounding the os. This is most likely:
a. An endocervical polyp
b. Due to cervical dysplasia
c. Due to cervical infection
d. The squamocolumnar junction

Answer 38

d. The squamocolumnar junction

The squamocolumnar junction is the area where the squamous epithelium (pink) and columnar epithelium (dark red) of the cervix meet. The junction may be inside the cervical os so that only squamous epithelium is visible, or a ring of columnar tissue may be visible to a varying extent around the os.

Question 39

The laboratory test that is done for definitive diagnosis of sickle cell disease is:
a. Hgb electrophoresis
b. Peripheral blood smear
c. RBC indices
d. Sickle cell preparation

Answer 39

a. Hgb electrophoresis

The sickle cell preparation is used to screen for sickle cell disease and trait. A positive test indicates the presence of Hgb S, indicating either sickle cell disease or trait. Hgb electrophoresis is the definitive test performed if the screening ets is positive as it identified Hgb type and quantity.

Question 40

A women who is currently pregnant, has had two full-term deliveries, and has had one first-trimester abortion would be considered:
a. G2P2
b. G3P2
c. G3P3
d. G4P2

Answer 40

d. G4P2

Gravida denotes the total number of pregnancies, including a current pregnancy. Para denotes total number of pregnancies reaching 20 weeks or longer gestation

Question 41

The best position for palpating the axilla is with the woman:
a. Laying down with her arm above the head on the side you are examining
b. Lying down with her arm at her side on the side you are examining
c. Sitting up with her arm raised above her head on the side you are examining
d. Sitting up with her arm down on the side you are examining

Answer 41

d. Sitting up with her arm down on the side you are examining

The examiner palpates the axillary lymph nodes and the breast tissue that extends into the axillary area (tail of Spence) with the woman sitting with arms relaxed at her side. The examiner supports the lower arm and uses the palmar surface of fingers to palpate the entire area.

Question 42

Which of the following would be considered a positive PPD result
a. General population: 5 mm induration
b. General population: 10 mm induration
c. Moderate-risk population: 5 mm induration
d. High-risk population: 5 mm induration

Answer 42

d. High-risk population: 5 mm induration

In the individual considered to be at high risk for TB, a PPD skin test resulting in a 5 mm or greater induration is a positive reaction.

Question 43

Abnormal findings on a UA would include:
a. pH 5.0
b. Specific gravity 1.5
c. WBVs 3 per HPV
d. Protein 4 mg/dL

Answer 43

b. Specific gravity 1.5

Normal values are as follows: specific gravity 1.005 to 1.030

Question 44

Adding KOH to a wet mount slide before viewing it under the microscope is useful in the detection of:
a. Clue cells
b. Pseudohyphae
c. Trichomonads
d. WBCs

Answer 44

b. Pseudohyphae

The addition of KOH to the vaginal wet mount slide facilitates visualization of Candida pseudohyphae and buds

Question 45

A 42 yo F is concerned she may be pregnant because she is 12 days late for her period. The best initial pregnancy test to obtain is a:
a. Qualitative sensitive urine hCG test
b. Qualitative serum hCG test
c. Quantitative sensitive urine hCG test
d. Quantitative serum hCG test

Answer 45

a. Qualitative sensitive urine hCG test

Sensitive urine hCG tests may detect pregnancy as early as 28 days from the last menstrual period. Cross-reactions with other hormones are not a problem. A qualitative (positive/negative) test is the appropriate pregnancy test.

Question 46

A client presents with no symptoms but is concerned because she had sexual intercourse 3 weeks ago with a new partner who has recently disclosed having a hx of genital herpes. The client wants to know if there is a test that can be performed at this visit to see if she has been infected. Which of the following would be the best response?
a. A pap test can be done at this visit that will show if she has been infected
b. A blood test can be done at this visit to see if she has recently been infected
c. If she does not develop lesions in the next 4-8 weeks, she is not infected
d. She can have a blood test in 1-2 months to determine whether she has herpes antibodies

Answer 46

d. She can have a blood test in 1-2 months to determine whether she has herpes antibodies

Type-specific serologic tests detect HSV-1 and HSV-2 antibodies. It may take 4 to 12 weeks for seroconversion to occur.

Question 47

The glands located posteriorly on each side of the vaginal orifice are the:
a. Bartholin’s glands
b. Bulbar glands
c. Nabothian glands
d. Skene’s glands

Answer 47

a. Bartholin’s glands

The glands located posteriorly on each side of the vaginal orifice are the Bartholin’s glands

Question 48

Which of the following statements regarding gene mutations is correct?
a. All gene mutations occur at the time of conception
b. Germ cell mutations occur after conception
c. Germ cell mutations may occur as a result of exposure to radiation
d. Somatic mutations may occur at any time in a person’s life

Answer 48

d. Somatic mutations may occur at any time in a person’s life

Somatic mutations are acquired and occur after conception. A DNA copying mistake may occur during cell division or from exposure to ionizing radiation, chemicals, or viruses during gestation or later in life

Question 49

The CDC recommended diagnostic test for Trichomonas is:
a. Culture
b. NAAT
c. Vaginal fluid sialidase test
d. Wet mount evaluation of motile trichomonads

Answer 49

b. NAAT

The CDC-recommended test for Trichomonas is the NAAT. It is more sensitive than a wet mount or culture.

Question 50

Which of the following statements concerning testing for strep throat in an adult client with sore throat, fever, and tonsillar exudate is correct?
a. A positive rapid streptococcal antigen test indicates the need for antibiotic treatment
b. No testing is needed, these findings are indicative of a viral infection
c. Throat culture is recommended rather than a rapid streptococcal antigen test
d. Throat culture is indicated if a rapid streptococcal antigen test is negative

Answer 50

d. Throat culture is indicated if a rapid streptococcal antigen test is negative

A positive rapid streptococcal antigen test indicates the presence of GABHS requiring antibiotic treatment. A negative test indicates that the infection is more likely viral. A culture is not needed to confirm a negative test.