Practice Questions Flashcards
1
Q
Causes of unstable angina include all of the following except: A. ventricular hypertrophy. B. vasoconstriction. C. nonocclusive thrombus. D. inflammation or infection.
A
A. ventricular hypertrophy.
2
Q
Which of the following is most consistent with a person presenting with unstable angina?
A. a 5-minute episode of chest tightness brought on by stair climbing and relieved by rest
B. a severe, searing pain that penetrates the chest and lasts about 30 seconds
C. chest pressure lasting 20 minutes that occurs at rest
D. “heartburn” relieved by position change
A
C. chest pressure lasting 20 minutes that occurs at rest
3
Q
The initial manifestation of coronary heart disease in men is most commonly: A. unstable angina. B. myocardial infarction. C. intracranial hemorrhage. D. stable angina.
A
B. myocardial infarction.
4
Q
In assessing a woman with or at risk for acute coronary syndrome (ACS), the NP considers that the patient will likely present:
A. in a manner similar to that of a man with equivalent disease.
B. at the same age as a man with similar health problems.
C. more commonly with angina and less commonly with acute MI.
D. less commonly with HF.
A
C. more commonly with angina and less commonly with acute MI.
5
Q
Rank the following signs and symptoms in the order of most common to least common in a 60-year-old woman in the time preceding an ACS event. A. dyspnea B. anxiety C. sleep disturbance D. unusual fatigue
A
D. unusual fatigue
C. sleep disturbance
A. dyspnea
B. anxiety
6
Q
The cardiac finding most commonly associated with unstable angina is: A. physiological split S2. B. S4. C. opening snap. D. summation gallop.
A
B. S4.
7
Q
Which of the following changes on the 12-lead ECG do you expect to find in a patient with acute coronary syndrome? A. flattened T wave B. R wave larger than 25 mm C. ST segment deviation (>0.05 mV) D. fixed Q wave
A
C. ST segment deviation (>0.05 mV)
8
Q
Beta-adrenergic antagonists are used in ACS therapy because of their ability to:
A. reverse obstruction-fixed vessel lesions.
B. reduce myocardial oxygen demand.
C. enhance myocardial vessel tone.
D. stabilize arterial volume.
A
B. reduce myocardial oxygen demand.
9
Q
Nitrates are used in ACS therapy because of their ability to: A. reverse fixed vessel obstruction. B. reduce myocardial oxygen demand. C. cause vasodilation. D. stabilize cardiac rhythm.
A
C. cause vasodilation.
10
Q
Which of the following is most consistent with a patient presenting with acute MI?
A. a 5-minute episode of chest tightness brought on by stair climbing
B. a severe, localized pain that penetrates the chest and lasts about 3 hours
C. chest pressure lasting 20 minutes that occurs at rest
D. retrosternal diffuse pain for 30 minutes accompanied by diaphoresis
A
D. retrosternal diffuse pain for 30 minutes accompanied by diaphoresis
11
Q
Match the clinical syndrome with its pathophysiologic characteristic: unstable angina.
A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms
B. predictable onset of chest pain or discomfort, usually with physical exertion
C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery
D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material
A
A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms
12
Q
Match the clinical syndrome with its pathophysiologic characteristic: stable angina.
A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms
B. predictable onset of chest pain or discomfort, usually with physical exertion
C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery
D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material
A
B. predictable onset of chest pain or discomfort, usually with physical exertion
13
Q
Match the clinical syndrome with its pathophysiologic characteristic: NSTEMI.
A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms
B. predictable onset of chest pain or discomfort, usually with physical exertion
C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery
D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material
A
D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material
14
Q
Match the clinical syndrome with its pathophysiologic characteristic: STEMI.
A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms
B. predictable onset of chest pain or discomfort, usually with physical exertion
C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery
D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material
A
C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery
15
Q
Which of the following changes on the 12-lead ECG would you expect to find in a patient with history of acute transmural MI 6 months ago? A. 2-mm ST segment elevation B. R wave larger than 25 mm C. T wave inversion D. deep Q waves
A
D. deep Q waves
16
Q
Which of the following changes on the 12-lead ECG would you expect to find in a patient with myocardial ischemia? A. 2-mm ST segment elevation B. S wave larger than 10 mm C. T wave inversion D. deep Q waves
A
C. T wave inversion
17
Q
Thrombolytic therapy is indicated in patients with chest pain and ECG changes such as:
A. 1-mm ST segment depression in leads V1 and V3.
B. physiologic Q waves in leads aVF, V5, and V6.
C. 3-mm ST segment elevation in leads V1 to V4.
D. T wave inversion in leads aVL and aVR.
A
C. 3-mm ST segment elevation in leads V1 to V4.
18
Q
An abnormality of which of the following is the most sensitive marker for myocardial damage? A. aspartate aminotransferase B. creatine phosphokinase (CPK) C. troponin I (cTnI) D. lactate dehydrogenase
A
C. troponin I (cTnI)
19
Q
All of the following should be prescribed as part of therapy in ACS except: A. aspirin. B. metoprolol. C. lisinopril. D. nisoldipine.
A
D. nisoldipine.
20
Q
You see a 54-year-old man who reports acute angina episodes with significant exertion. He is currently taking a beta blocker and clopidogrel. You consider the use of which of the following at the start of anginal symptoms?
A. an oral dose of a calcium channel blocker
B. a dose of nitroglycerin via oral spray
C. an extra dose of the beta blocker
D. a sustained-effect nitroglycerin patch
A
B. a dose of nitroglycerin via oral spray
21
Q
Which of the following is an absolute contraindication to the use of thrombolytic therapy?
A. history of hemorrhagic stroke
B. BP of 160/100 mm Hg or greater at presentation
C. current use of warfarin
D. active peptic ulcer disease
A
A. history of hemorrhagic stroke
22
Q
For a patient with a history of MI and who demonstrates intolerance to aspirin, an acceptable alternative antiplatelet medication is: A. ibuprofen. B. clopidogrel. C. warfarin. D. rivaroxaban.
A
B. clopidogrel.
23
Q
Routine use of the treadmill exercise tolerance test is most appropriate for:
A. a healthy 34-year-old woman.
B. a 56-year-old man following coronary artery angioplasty who needs to establish activity tolerance.
C. an 84-year-old man with stable angina who uses a walker.
D. a 52-year-old woman with dyslipidemia and no history of ACS.
A
B. a 56-year-old man following coronary artery angioplasty who needs to establish activity tolerance.
24
Q
According to the recommendations of the American Association of Clinical Endocrinologists, the recommended low-density lipoprotein goal for a 64-year-old man with diabetes mellitus who presented with a history of ACS 2 years ago should be less than: A. 70 mg/dL (<1.8 mmol/L). B. 100 mg/dL (< 2.6 mmol/L). C. 130 mg/dL (< 3.4 mmol/L). D. 160 mg/dL (< 4.1 mmol/L).
A
A. 70 mg/dL (<1.8 mmol/L).
25
```
Which of the following is least likely to be reported in ACS?
A. newly noted pulmonary crackles
B. transient MR murmur
C. hypotension
D. pain reproduced with palpation
```
D. pain reproduced with palpation
26
Heart failure pathophysiology is characterized by:
A. impaired atrial filling and ejection of blood.
B. incomplete closure of tricuspid valve.
C. near normal ventricular function.
D. inadequate cardiac output to meet oxygen and metabolic demands of the body.
D. inadequate cardiac output to meet oxygen and metabolic demands of the body.
27
```
A leading cause of heart failure is:
A. hypertensive heart disease.
B. atrial fibrillation.
C. pulmonary embolism.
D. type 2 diabetes.
```
A. hypertensive heart disease.
28
Which mechanism contributes to heart failure in pneumonia?
A. increase in circulating volume of blood
B. increased right-sided heart workload
C. decreased oxygen-carrying capacity of blood
B. increased right-sided heart workload
29
Which mechanism contributes to heart failure in anemia?
A. increase in circulating volume of blood
B. increased right-sided heart workload
C. decreased oxygen-carrying capacity of blood
C. decreased oxygen-carrying capacity of blood
30
Which mechanism contributes to heart failure in high sodium intake?
A. increase in circulating volume of blood
B. increased right-sided heart workload
C. decreased oxygen-carrying capacity of blood
A. increase in circulating volume of blood
31
```
The condition of a sudden shortness of breath that usually occurs after 2-3 of hours of sleep that leads to sudden awakening followed by a feeling of severe anxiety and breathlessness is known as:
A. dyspnea.
B. orthopnea.
C. resting dyspnea.
D. paroxysmal nocturnal dyspnea.
```
D. paroxysmal nocturnal dyspnea.
32
```
You examine an 82-year old woman who has a history of heart failure (HF). She is in the office because of increasing shortness of breath. When auscultating her heart, you note a tachycardia with a rate of 104 beats per minute and a single extra heart sound early in diastole. This sound most likely represents:
A. summation gallop.
B. S3.
C. opening snap.
D. S4.
```
B. S3.
33
You examine a 65-year-old man with dilated cardiomyopathy and HF. On examination, you expect to find all of the following except:
A. jugular venous distention.
B. tenderness on right upper-abdominal quadrant palpation.
C. point of maximal impulse at the fifth intercostal space, mid-clavicular line.
D. peripheral edema.
C. point of maximal impulse at the fifth intercostal space, mid-clavicular line.
34
In patients with heart failure, the point of maximum impulse:
A. remains unchanged near the fourth intercostal space.
B. remains unchanged near the fifth intercostal space.
C. shifts lower on the mid clavicular line.
D. shifts laterally by one or more intercostal spaces
D. shifts laterally by one or more intercostal spaces
35
Inotropic means it impacts what function of the heart?
A. cardiac rate
B. cardiac conduction
C. force of the cardiac contraction
C. force of the cardiac contraction
36
Chronotropic means it impacts what function of the heart?
A. cardiac rate
B. cardiac conduction
C. force of the cardiac contraction
A. cardiac rate
37
Dromotropic means it impacts what function of the heart?
A. cardiac rate
B. cardiac conduction
C. force of the cardiac contraction
B. cardiac conduction
38
The rationale for using beta blocker therapy in treating a patient with HF is to:
A. increase myocardial contractility.
B. reduce the effects of circulating catecholamines.
C. relieve concomitant angina.
D. stabilize cardiac rhythm.
B. reduce the effects of circulating catecholamines.
39
An ECG finding in a patient who is taking digoxin in a therapeutic dose typically includes:
A. shortened P-R interval.
B. slightly depressed, cupped ST segments.
C. widened QRS complex.
D. tall T waves.
B. slightly depressed, cupped ST segments.
40
```
A potential adverse effect of ACEI when used with spironolactone therapy is:
A. hypertension.
B. hyperkalemia.
C. renal insufficiency.
D. proteinuria.
```
B. hyperkalemia.
41
```
ECG findings in a patient with digoxin toxicity would most likely include:
A. atrioventricular heart block.
B. T wave inversion.
C. sinus tachycardia.
D. pointed P waves.
```
A. atrioventricular heart block.
42
```
Patients reporting symptoms of digoxin toxicity are most likely to include:
A. anorexia.
B. disturbance in color perception.
C. blurred vision.
D. diarrhea.
```
A. anorexia.
43
```
Which of the following is among the most common causes of HF?
A. dietary indiscretion
B. COPD
C. hypertensive heart disease
D. anemia
```
C. hypertensive heart disease
44
```
Which of the following medications is an aldosterone antagonist?
A. clonidine
B. spironolactone
C. hydrochlorothiazide
D. furosemide
```
B. spironolactone
45
Which of the following best describes orthopnea?
A. shortness of breath with exercise
B. dyspnea that develops when the individual is recumbent and is relieved with elevation of the head
C. shortness of breath that occurs at night, characterized by a sudden awakening after a couple of hours of sleep, with a feeling of severe anxiety, breathlessness, and suffocation
D. dyspnea at rest
B. dyspnea that develops when the individual is recumbent and is relieved with elevation of the head
46
Which of the following is unlikely to be noted in the person experiencing HF?
A. elevated serum B-type natriuretic peptide (BNP)
B. Kerley B lines noted on chest X-ray
C. left-ventricular hypertrophy on ECG
D. evidence of hemoconcentration on hemogram
D. evidence of hemoconcentration on hemogram
47
```
Which of the following medications is an alpha/ beta-adrenergic antagonist?
A. atenolol
B. metoprolol
C. propranolol
D. carvedilol
```
D. carvedilol
48
Which of the following best describes the patient presentation of New York Heart Association stage III heart disease?
A. Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations.
B. Ordinary physical activity results in fatigue, palpitations, dyspnea, or angina.
C. Less-than-ordinary activity leads to fatigue, dyspnea, palpitations, or angina.
D. Discomfort increases with any physical activity.
C. Less-than-ordinary activity leads to fatigue, dyspnea, palpitations, or angina.
49
```
The risk for digoxin toxicity increases with concomitant use of all of the following medications except:
A. amiodarone.
B. clarithromycin.
C. cyclosporine.
D. levofloxacin.
```
D. levofloxacin.
50
```
Which of the following is the preferred medication to reverse the anticoagulant effects of unfractionated heparin?
A. vitamin K
B. protamine sulfate
C. platelet transfusion
D. plasma components
```
B. protamine sulfate
51
```
Which of the following is the preferred medication to reverse the anticoagulant effects of warfarin?
A. vitamin K
B. protamine sulfate
C. platelet transfusion
D. plasma components
```
A. vitamin K
52
```
The onset of anticoagulation effect of warfarin usually occurs how soon after the initiation of therapy?
A. immediately
B. 1 to 2 days
C. 3 to 5 days
D. 5 to 7 days
```
C. 3 to 5 days
53
Compared with unfractionated heparin, characteristics of low-molecular-weight heparin (LMWH) include all of the following except:
A. more antiplatelet effect.
B. decreased need for monitoring of anticoagulant effect.
C. longer half-life.
D. superior bioavailability.
A. more antiplatelet effect.
54
```
When taken with warfarin, which of the following causes a possible increased anticoagulant effect?
A. clarithromycin
B. carbamazepine
C. pravastatin
D. sucralfate
```
A. clarithromycin
55
```
When taken concomitantly with warfarin, which of the following causes a possibly decreased anticoagulant effect?
A. cholestyramine
B. allopurinol
C. cefpodoxime
D. zolpidem
```
A. cholestyramine
56
```
What is the international normalized ratio (INR) range recommended during warfarin therapy as part of the management of a patient with DVT?
A. 1.5 to 2.0
B. 2.0 to 3.0
C. 2.5 to 3.5
D. 3.0 to 4.0
```
B. 2.0 to 3.0
57
T/F With the use of a direct thrombin inhibitor, ongoing INR monitoring is required.
False
58
T/F An abnormally elevated D-dimer test is highly sensitive and specific for the diagnosis of thromboembolic disease.
False
59
```
Worldwide, which of the following is the most common type of anemia?
A. pernicious anemia
B. folate-deficiency anemia
C. anemia of chronic disease
D. iron-deficiency anemia
```
D. iron-deficiency anemia
60
Most of the body’s iron is obtained from:
A. animal-based food sources.
B. recycled iron content from aged red blood cells (RBCs).
C. endoplasmic reticulum production.
D. vegetable-based food sources.
B. recycled iron content from aged red blood cells (RBCs).
61
Which of the following is most consistent with iron-deficiency anemia?
A. low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH)
B. low MCV, low MCH
C. low MCV, elevated MCH
D. normal MCV, normal MCH
B. low MCV, low MCH
62
One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is:
A. an increase in RBC distribution width (RDW).
B. a reduction in measurable hemoglobin.
C. a low MCH level.
D. an increased platelet count.
A. an increase in RBC distribution width (RDW).
63
```
A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her hematocrit (Hct) level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include:
A. a correction of mean cell volume.
B. an 8% increase in Hct level.
C. reticulocytosis.
D. a correction in ferritin level.
```
C. reticulocytosis.
64
A healthy 34-year-old man asks whether he should take an iron supplement. You respond that:
A. this is a prudent measure to ensure health.
B. iron-deficiency anemia is a common problem in men of his age.
C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload.
D. excess iron is easily excreted.
C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload.
65
```
Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption?
A. “Take with other medications.”
B. “Take on a full stomach.”
C. “Take on an empty stomach.”
D. “Do not take with vitamin C.”
```
C. “Take on an empty stomach.”
66
A 40-year-old woman with pyelonephritis is taking two mediations: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that:
A. she should take the medications with a large glass of water.
B. an inactive drug compound is potentially formed if the two medications are taken together.
C. she can take the medications together to enhance adherence to therapy.
D. the ferrous sulfate potentially slows gastrointestinal motility and results in enhanced ciprofloxacin absorption.
B. an inactive drug compound is potentially formed if the two medications are taken together.
67
```
One month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a:
A. Schilling test.
B. hemoglobin measurement.
C. reticulocyte count.
D. serum cobalamin.
```
B. hemoglobin measurement.
68
```
A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus?
A. iron
B. niacin
C. folic acid
D. vitamin C
```
C. folic acid
69
Risk factors for folate-deficiency anemia include:
A. menorrhagia.
B. chronic ingestion of overcooked foods.
C. use of nonsteroidal antiinflammatory drugs.
D. gastric atrophy.
B. chronic ingestion of overcooked foods.
70
```
Folate-deficiency anemia causes which of the following changes in the RBC indices?
A. microcytic, normochromic
B. normocytic, normochromic
C. microcytic, hypochromic
D. macrocytic, normochromic
```
D. macrocytic, normochromic
71
Pernicious anemia is usually caused by:
A. dietary deficiency of vitamin B12.
B. lack of production of intrinsic factor by the gastric mucosa.
C. RBC enzyme deficiency.
D. a combination of micronutrient deficiencies caused by malabsorption.
B. lack of production of intrinsic factor by the gastric mucosa.
72
```
Pernicious anemia causes which of the following changes in the RBC indices?
A. microcytic, normochromic
B. normocytic, normochromic
C. microcytic, hypochromic
D. macrocytic, normochromic
```
D. macrocytic, normochromic
73
```
Common physical examination findings in patients with pernicious anemia include:
A. hypoactive bowel sounds.
B. stocking-glove neuropathy.
C. thin, spoon-shaped nails.
D. retinal hemorrhages.
```
B. stocking-glove neuropathy.
74
```
You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram:
Hemoglobin (Hgb) = 15 g
Hct = 45%
RBC = 4.2 million mm3
MCV = 108 fL
MCHC = 33.2 g/dL
These values are most consistent with:
A. pernicious anemia.
B. alcohol abuse.
C. thalassemia minor.
D. Fanconi disease.
```
B. alcohol abuse.
75
You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows:
Hgb = 9.1 g (normal 12 to 14 g)
Hct = 28% (normal 36% to 42%)
RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3)
MCV = 68 fL (normal 80 to 96 fL)
MCHC = 33.2 g/dL (normal 32 to 36 g/dL)
RBC distribution width (RDW) = 13% (normal ≤15%).
Reticulocytes = 1.5%
This is most consistent with the laboratory assessment of:
A. iron-deficiency anemia.
B. Cooley anemia.
C. alpha-thalassemia minor.
D. hemoglobin Barts.
C. alpha-thalassemia minor.
76
```
A 68-year-old man who is usually healthy presents with new onset of “huffing and puffing” with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows:
Hgb = 7.6 g
Hct = 20.5%
RBC = 2.1 million mm3
MCV = 76 fL
MCHC = 28 g/dL
RDW = 18.4%
Reticulocytes = 1.8%
The most likely cause of these finding is:
A. poor nutrition.
B. occult blood loss.
C. malabsorption.
D. chronic inflammation.
```
B. occult blood loss.
77
```
You examine a 57-year-old woman with rheumatoid
arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram:
Hgb = 10.5 g
Hct = 33%
RBC = 3.1 million mm3
MCV = 88 fL
MCHC = 32.8 g/dL
RDW = 12.2%
Reticulocytes = 0.8%
The laboratory findings are most consistent with:
A. pernicious anemia.
B. anemia of chronic disease.
C. beta-thalassemia minor.
D. folate-deficiency anemia.
```
B. anemia of chronic disease.
78
```
You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram:
Hgb = 10.1 g
Hct = 32%
RBC = 2.9 million mm 3
MCV = 72 fL
MCHC = 28.2 g/dL
RDW = 18.9%
Physical examination is likely to include:
A. conjunctiva pallor.
B. hemic murmur.
C. tachycardia.
D. no specific anemia-related findings.
```
D. no specific anemia-related findings.
79
```
Results of hemogram in a person with anemia of chronic disease include:
A. microcytosis.
B. anisocytosis.
C. reticulocytopenia.
D. macrocytosis.
```
C. reticulocytopenia.
80
When prescribing erythropoietin supplementation, the NP considers that:
A. the adrenal glands are its endogenous source.
B. the addition of micronutrient supplementation needed for erythropoiesis is advisable.
C. its use is as an adjunct in treating thrombocytopenia.
D. with its use, the RBC life span is prolonged.
B. the addition of micronutrient supplementation needed for erythropoiesis is advisable.
81
```
In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for:
A. hypernatremia.
B. dehydration.
C. hypokalemia.
D. acidemia.
```
C. hypokalemia.
82
```
Which of the following conditions is unlikely to result in anemia of chronic disease?
A. rheumatoid arthritis
B. peripheral vascular disease
C. chronic renal insufficiency
D. osteomyelitis
```
B. peripheral vascular disease
83
```
In health, the ratio of hemoglobin to hematocrit is usually:
A. 1:1.
B. 1:2.
C. 1:3.
D. 1:4.
```
C. 1:3.
84
```
An increase in the normal variation of RBC size is known as:
A. poikilocytosis.
B. granulation.
C. anisocytosis.
D. basophilic stippling.
```
C. anisocytosis.
85
```
Erythropoietin is a glycoprotein that influences a stem cell to become a:
A. lymphocyte.
B. platelet.
C. neutrophil.
D. red blood cell.
```
D. red blood cell.
86
```
Intervention in anemia of chronic disease most often includes:
A. oral vitamin B12.
B. treatment of the underlying cause.
C. transfusion.
D. parenteral iron.
```
B. treatment of the underlying cause.
87
```
Poikilocytosis refers to alterations in a red blood cells:
A. thickness.
B. color.
C. shape.
D. size.
```
C. shape.
88
Which of the following is not consistent with anemia of chronic disease (ACD)?
A. NL RDW
B. NL MCHC
C. Hct less than 24%
D. NL to slightly elevated serum ferritin
C. Hct less than 24%
89
In children younger than age 6 years, accidental overdose of iron-containing products is:
A. easily treated.
B. a source of significant GI upset.
C. worrisome but rarely causes significant harm.
D. a leading cause of fatal poisoning in the age group.
D. a leading cause of fatal poisoning in the age group.
90
When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that:
A. these usually resolve within days with appropriate therapy.
B. if present for longer than 6 months, these changes are occasionally permanent.
C. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution.
D. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy.
B. if present for longer than 6 months, these changes are occasionally permanent.
91
```
When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following?
A. haptoglobin and reticulocyte count.
B. Schilling test and gastric biopsy.
C. methylmalonic acid and homocysteine.
D. transferrin and prealbumin.
```
C. methylmalonic acid and homocysteine.
92
T/F Anemia in children is potentially associated with poorer school performance.
True
93
T/F During pregnancy, folic acid requirements increase twofold to fourfold.
True
94
T/F The red blood cell content is approximately 90% hemoglobin.
True
95
T/F Approximately 90% of the body’s erythropoietin is produced by the kidney.
True
96
T/F The body’s normative response to anemia is reticulocytopenia.
False
97
```
Common sites of C. trachomatis infection in women include all of the following except:
A. ovaries.
B. cervix.
C. endometrium.
D. urethra.
```
A. ovaries.
98
```
The incubation period for C. trachomatis is approximately:
A. 24 hours.
B. 3 days.
C. 7 to 14 days.
D. 24 days.
```
C. 7 to 14 days.
99
Which of the following include characteristics of a friable cervix?
A. presence of a dull pain, particular prior to menses
B. a constant burning sensation
C. presence of multiple polyps
D. easily irritated and prone to bleeding, especially following intercourse
D. easily irritated and prone to bleeding, especially following intercourse
100
An annual screening for C. trachomatis infection is recommended for:
A. all sexually active women.
B. sexually active women 25 years of age and younger.
C. sexually active women who have had 2 or more partners in the past 12 months.
D. sexually active men 25 years of age and younger.
B. sexually active women 25 years of age and younger.
101
Which of the following is not a normal finding in a woman during the reproductive years?
A. vaginal pH of 4.5 or less
B. Lactobacillus as the predominant vaginal organism
C. thick, white vaginal secretions during the luteal phase
D. vaginal epithelial cells with adherent bacteria
D. vaginal epithelial cells with adherent bacteria
102
```
Which of the following findings is most consistent with vaginal discharge during ovulation?
A. dry and sticky
B. milky and mucoid
C. stringy and clear
D. tenacious and odorless
```
C. stringy and clear
103
```
What is the approximate incubation period for Neisseria gonorrhoea?
A. 1 to 5 days
B. 7 to 10 days
C. 18 days
D. 28 days
```
A. 1 to 5 days
104
```
A recommended treatment for rectal gonorrhea is:
A. oral amoxicillin.
B. oral azithromycin.
C. oral ciprofloxacin.
D. ceftriaxone injection.
```
D. ceftriaxone injection.
105
```
Physical examination of a 19-year-old woman with a 3-day history of vaginal itch reveals moderate perineal excoriation, vaginal erythema, and a white, clumping discharge. Expected microscopic examination findings include:
A. a pH greater than 6.0.
B. an increased number of lactobacilli.
C. hyphae.
D. an abundance of white blood cells.
```
C. hyphae.
106
```
Women with bacterial vaginosis typically present with:
A. vulvitis.
B. pruritus.
C. dysuria.
D. malodorous discharge.
```
D. malodorous discharge.
107
```
Treatment of vulvovaginitis caused by Candida albicans includes:
A. metronidazole gel.
B. clotrimazole cream.
C. hydrocortisone ointment.
D. clindamycin cream.
```
B. clotrimazole cream.
108
A 24-year-old woman presents with a 1-week history of thin, green-yellow vaginal discharge with perivaginal irritation. Physical examination findings include vaginal erythema with petechial hemorrhages on the cervix, numerous white blood cells, and motile organisms on microscopic examination. These findings most likely represent:
A. motile sperm with irritative vaginitis.
B. trichomoniasis.
C. bacterial vaginosis.
D. condyloma acuminatum.
B. trichomoniasis.
109
```
A preferred treatment option for trichomoniasis is:
A. oral metronidazole.
B. clindamycin vaginal cream.
C. topical acyclovir.
D. oral azithromycin.
```
A. oral metronidazole.
110
```
Treatment options for bacterial vaginosis include all of the following except:
A. oral metronidazole.
B. clindamycin cream.
C. oral clindamycin.
D. oral azithromycin.
```
D. oral azithromycin.
111
```
A 30-year-old woman presents without symptoms but states that her male partner has dysuria without penile discharge. Examination reveals a friable cervix covered with thick yellow discharge. This description is most consistent with an infection caused by:
A. Chlamydia trachomatis.
B. Neisseria gonorrhoeae.
C. human papillomavirus (HPV).
D. Trichomonas vaginalis.
```
A. Chlamydia trachomatis.
112
```
Which of the following agents is active against N. gonorrhoeae?
A. ceftriaxone
B. metronidazole
C. ketoconazole
D. amoxicillin
```
A. ceftriaxone
113
```
Which of the following agents is most active against C. trachomatis?
A. amoxicillin
B. metronidazole
C. azithromycin
D. ceftriaxone
```
C. azithromycin
114
Which of the following statements is true of gonococcal infection?
A. The risk of transmission from an infected woman to a male sexual partner is about 80%.
B. Most men have asymptomatic infection.
C. The incubation period is about 2 to 3 weeks.
D. The organism rarely produces beta-lactamase.
B. Most men have asymptomatic infection.
115
```
Complications of gonococcal and chlamydial genitourinary infection in women include all of the following except:
A. pelvic inflammatory disease (PID).
B. tubal scarring.
C. acute pyelonephritis.
D. acute peritoneal inflammation.
```
C. acute pyelonephritis.
116
```
What percentage of sexually active adults has serological evidence of human herpes virus 2 (HHV-2 or herpes simplex type 2)?
A. 5.8%
B. 14.5%
C. 18.9%
D. 35.6%
```
C. 18.9%
117
```
All of the following are likely reported in a woman with an initial episode of genital HSV-2 (HHV-2) infection except:
A. painful ulcer.
B. inguinal lymphadenopathy.
C. thin vaginal discharge.
D. pustular lesions.
```
D. pustular lesions.
118
```
In the person with HSV-2 infection, the virus can spread via:
A. genital secretions.
B. oral secretions.
C. normal-looking skin.
D. all of the above.
```
D. all of the above.
119
```
During asymptomatic HSV-2 infections, genital shedding of virus occurs during approximately ________ of days.
A. 10%
B. 25%
C. 50%
D. 100%
```
A. 10%
120
Diagnostic testing of a person with primary HSV-2 infection would likely show:
A. negative virological and serological test results.
B. negative virological test result and positive serological test result.
C. positive virological test result and negative serological test result.
D. positive virological and serological test results.
C. positive virological test result and negative serological test result.
121
```
Treatment options for HSV-2 genital infection include:
A. ribavirin.
B. indinavir.
C. famciclovir.
D. cyclosporine.
```
C. famciclovir.
122
```
Suppressive therapy reduces the frequency of genital herpes recurrences by:
A. 5% to 10%.
B. 20% to 25%.
C. 40% to 50%.
D. 70% to 80%.
```
D. 70% to 80%.
123
```
Recommended comprehensive STI testing includes testing for all of the following except:
A. hepatitis B.
B. syphilis.
C. hepatitis A.
D. HIV.
```
C. hepatitis A.
