Practice Questions LEIK - some questions may not apply to our unit Flashcards
I just put in any question with the health issues we have that came up in my search - you may or may not want to study them.
- A 73-year-old patient complains of recent episodes of acute-onset left-sided facial asymmetry, slurred speech, weakness, and dizziness, accompanied by
weakness of the left arm and left leg. She reports that the episodes occur at random and last from 30 minutes to about 2 hours. Each episode resolved completely. The patient has type 2 diabetes with hyperlipidemia, peripheral arterial disease,
hypertension, and osteoporosis. Her symptoms suggest:
A) Benign paroxysmal positional vertigo
B) Ménière’s disease
C) Transient ischemic attack (TIA)
D) Cerebrovascular accident (CVA)
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- C) Transient ischemic attack (TIA) Transient ischemic attack (TIA) is a transient episode of ischemia in the brain, retina, or spinal cord without acute
infarction. About 10% to 20% of patients with TIA will have a stroke within 90
days. TIA signs and symptoms are acute onset of facial asymmetry, slurred speech,
weakness, monocular visual loss, headache, and hemiplegia that resolves within
minutes to several hours. TIA is a neurological emergency; should undergo brain
imaging (MRI preferred) within 24 hours of onset.
- A lipid profile for a newly diagnosed hypertensive patient with a BMI (body mass index) of 27 shows a triglyceride level of 950 mg/dL, total cholesterol of
240 mg/dL, LDL (low density lipoprotein) of 145 mg/dL, and HDL (high-density lipoprotein) of 45 mg/dL. What is the best intervention for this patient?
A) Educate the patient about lifestyle changes that will help lower cholesterol levels
B) Initiate a prescription of metformin (Glucophage)
C) Recommend that the patient exercise at least 30 minutes daily
D) Initiate a prescription of fenofibrate (Tricor)
D) Initiate a prescription of fenofibrate (Tricor) A triglyceride level above 800 mg/dL is considered to be “very high”; there is an increased risk of acute pancreatitis, especially if the patient also drinks alcohol. Two fibrate drugs have been approved for
use in the United States: fenofibrate (Tricor) and gemfibrozil (Lopid). Another option is nicotinic acid, but fibrates are more potent and better tolerated. In
addition, lifestyle changes are important; these include avoiding foods with concentrated sugars, alcohol, weight loss if overweight or obese, and regular,
moderate to intense aerobic exercise.
The nurse practitioner notices a gray ring on the edge of both irises of an 80-year-old woman. The patient denies visual changes or pain. She reports that she has had the “ring” for many years.
312. Which of the following causes is most likely? A) Arcus senilis B) Pinguecula C) Peripheral cataracts D) Macular degeneration
- A) Arcus senilis Arcus senilis (arcus senilis corneae) is a white, gray, or blue opaque ring in the corneal margin (peripheral corneal opacity), or white ring in
front of the periphery of the iris. It is present at birth, but then fades; however, it is commonly present in older adults. It can also appear earlier in life as a result of
hypercholesterolemia. It does not affect vision. Unilateral arcus is a sign of decreased
blood flow to the unaffected eye due to carotid artery disease or ocular hypotony.
The nurse practitioner notices a gray ring on the edge of both irises of an 80-year-old woman. The patient denies visual changes or pain. She reports that she has had the “ring” for many years.
- What is the clinical significance of this finding in a 35-year-old patient?
A) The patient has a higher risk of blindness
B) The patient should be evaluated for hyperlipidemia
C) The patient should be evaluated by an ophthalmologist
D) The patient should be evaluated for acute glaucoma
- B) The patient should be evaluated for hyperlipidemia Arcus senilis is caused
by lipid deposits deep in the edge of the cornea and is quite commonly present in the
elderly. However, it can also appear earlier in life as a result of hypercholesterolemia.
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- A 25-year-old man with schizophrenia comes in for a routine annual physical. He
is a heavy smoker and has a body mass index (BMI) of 28. The patient has been on
olanzapine (Zyprexa) for 10 years. Regarding the patient’s prescription, which of the
following laboratory tests is recommended for monitoring the adverse effects of
atypical antipsychotics?
A) Fasting blood glucose, fasting lipid profile, and weight
B) Urinalysis, serum creatinine, 24-hour urine for protein and creatinine clearance
C) Liver function tests only
D) CBC with differential, liver function tests, and weight
- A) Fasting blood glucose, fasting lipid profile, and weight Patients on atypical antipsychotics commonly gain weight and are at risk for obesity, hyperglycemia, and type 2 diabetes. Zyprexa will increase lipids (cholesterol, low-density lipoprotein [LDL], and triglycerides). Atypical antipsychotics also increase the risk of death among frail elders and older adults living in nursing homes.
- An 80-year-old man with hypertension and hyperlipidemia presents with
complaints of the rapid onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area with her hand.
Which of the following conditions is most likely?
A) Abdominal aortic aneurysm
B) Cauda equina syndrome
C) Acute diverticulitis
D) Adenocarcinoma of the colon
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- A) Abdominal aortic aneurysm Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The aneurysm is usually asymptomatic and is
discovered incidentally during a routine chest x-ray or abdominal ultrasound.
Although small aneurysms are usually not detectable during abdominal exams, the
larger aneurysms may be palpable during an abdominal exam, but abdominal obesity
will obscure the findings.
The symptoms in this case point toward a rapidly
dissecting aneurysm. The best action is to call 911 stat.
- The 2013 American College of Cardiology/American Heart Association
(ACC/AHA) Arteriosclerotic Cardiovascular Disease (ASCVD) risk calculator measures the risk of a cardiovascular event within 10 years after measurement.
What is the cutoff value when treatment for hyperlipidemia is recommended?
A) 6.5% or higher
B) 7.5% or higher
C) 8% or higher
D) 10 % or higher
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- B) 7.5% or higher The estimated 10-year ASCVD risk score is 7.5% or higher.
The 2013 ACC/AHA guidelines recommend treatment with high-intensity statins for patients aged 40 to 75 years with very high low-density lipoprotein (LDL) values
who have a score of 7.5% or higher.
- A 55-year-old male patient with a body mass index (BMI) of 30 has a history of angina and type 2 diabetes. His lipid profile results are total cholesterol of 280 mg/dL, low-density lipoprotein (LDL) of 195 mg/dL, and high-density lipoprotein
(HDL) of 25 mg/dL. The nurse practitioner diagnoses him with hyperlipidemia and wants to start him on statin therapy. What intensity of treatment is recommended
for this patient?
A) Low-intensity statin
B) Moderate-intensity statin
C) High-intensity statin
D) Very high-intensity statin
713. C) High-intensity statin This patient fulfills the criteria for high-intensity statin dosing criteria from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol guideline. He already has heart disease (angina), type 2 diabetes, low-density lipoprotein (LDL) of 195 mg/dL, and low high-density lipoprotein (HDL) of 25 mg/dL.
This patient is at very high risk
for heart disease and warrants a high-intensity dose of statin. There are only two choices at this level: atorvastatin (Lipitor) 40 to 80 mg or rosuvastatin (Crestor) 20 to 40 mg.
168. Which of the following would you recommend on an annual basis for an elderly patient with type 2 diabetes? A) Eye exam with an ophthalmologist B) Follow-up visit with a urologist C) Periodic visits to an optometrist D) Colonoscopy
- A) Eye exam with an ophthalmologist Elderly patients with type 2 diabetes should have a dilated eye exam done annually by an ophthalmologist. They should also see a podiatrist once or twice a year. Preventive care also includes receiving a flu
shot annually, receiving a Pneumovax vaccine if older than 60 years of age, and taking a 81-mg baby aspirin each day.
- An obese Asian patient with BMI (body mass index) of 33 complains of fatigue,
and excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing
to confirm diagnosis can include:
A) Fasting plasma glucose level
B) Glycated hemoglobin level (A1C)
C) Oral glucose tolerance testing
D) All of the above
- D) All of the above Type 2 diabetes mellitus screening tests include fasting plasma glucose level (>126 mg/dL), random plasma glucose level (>200 mg/dL), and oral glucose tolerance testing (2-hour blood glucose level >200 mg/dL) with a 75-g
glucose load. Normal A1C levels are less than 6%.
218. Which chronic illness disproportionately affects the Hispanic population? A) Diabetes mellitus B) Hypertension C) Alcohol abuse D) Skin cancer
- A) Diabetes mellitus The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.
462. Women with polycystic ovary syndrome (PCOS) are at higher risk for the following: A) Heart disease and endometrial cancer B) Uterine fibroids and ovarian cancer C) Premature menopause D) Pelvic inflammatory disease (PID)
- A) Heart disease and endometrial cancer Chronic anovulation results in high levels of estrogen and androgens in the body.
The risk of heart attack is four to seven times higher in women with polycystic ovary syndrome (PCOS) than women of the same age without PCOS.
Women with PCOS are at greater risk of having high
blood pressure and have high levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL) cholesterol. Lack of ovulation is usually the reason for fertility problems in women with PCOS.
More than 50% of women with PCOS have diabetes or prediabetes (impaired glucose tolerance) before the age of 40.
Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not progesterone. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia and cancer.
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190. In the United States, the most common cause of cancer deaths in men is: A) Lung cancer B) Prostate cancer C) Colon cancer D) Skin cancer
- A) Lung cancer Lung cancer is the most common cause of cancer deaths in men (Centers for Disease Control and Prevention, 2017). Prostate cancer and colon cancer are the second and third causes of cancer death in men.
297. The most common cause of cancer deaths for women in the United States is: A) Breast cancer B) Lung cancer C) Colon cancer D) Uterine cancer
- B) Lung cancer Lung cancer is the most common cause of cancer deaths in women as well as men (U.S. Cancer Statistics Working Group, 2017).
- At what level of prevention would you classify screening for lung cancer?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Screening for lung cancer is not currently recommended
- D) Screening for lung cancer is not currently recommended
Primary prevention involves methods to avoid occurrence of disease in the general
population.
Secondary prevention involves screening, diagnosis, and treatment of existing disease in early stages before it causes significant morbidity.
Tertiary prevention involves methods to reduce the negative impact of an existing disease by
restoring function and reducing disease-related complications.
Screening for lung cancer is not currently recommended for the general population.
- According to the U.S. Preventive Services Task Force, which of the following tests
should be used to screen for lung cancer?
A) Chest radiograph
B) Bronchoscopy with biopsy
C) Low-dose computed tomography (LDCT)
D) Sputum for cytology
- C) Low-dose computed tomography (LDCT) The U.S. Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30-pack-year smoking history
and currently smoke (or quit within the past 15 years).
Discontinue screening once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or willingness to have curative lung surgery.
- A 36-year-old woman is seen by the nurse practitioner for a Pap smear and
gynecological exam. The patient is of Ashkenazi Jewish ethnicity. Her mother
died of breast cancer at age 50 years. Her 57-year-old sister has recently been
diagnosed with breast cancer. The breast exam is negative for a dominant mass and
the axillae do not contain any masses. All of the following are appropriate measures
for this patient except:
A) Mammogram and MRI of the breast
B) Referral to a breast specialist
C) Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125
levels
D) Genetic counseling and BRCA testing
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- C) Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels
The patient is a woman who is of Ashkenazi Jewish background with a positive family history of breast cancer (mother, sister).
She is at very high risk for BRCA1 or BRCA2 mutations (hereditary breast cancer).
The U.S. Preventive Services Task Force (2013) recommends that primary care providers screen women for a family history of breast, ovarian, tubal, or peritoneal cancer.
Women with positive screening results should receive genetic screening, and, if indicated after counseling,
BRCA testing. These high-risk women are screened with a mammogram and breast MRI and are best managed by breast cancer specialists.
- A patient with a history of mitral valve prolapse (MVP) is requesting prophylaxis
before her dental surgery. Which of the following would you prescribe this patient?
A) Amoxicillin a half hour before and 2 hours after the procedure
B) Amoxicillin 1 hour before the procedure
C) Amoxicillin 1 hour before and 3 hours after the procedure
D) Prophylaxis is not recommended for this patient
- D) Prophylaxis is not recommended for this patient Current American Heart Association guidelines (2017) do not recommend endocarditis prophylaxis for most
patients with aortic or mitral valve disease, including those with mitral valve prolapse with regurgitation or for patients with hypertrophic cardiomyopathy.
Patients at highest risk for infective endocarditis (IE) are those with prosthetic heart valves,
including mechanical, bioprosthetic, and homograft valves; prior history of IE; unrepaired cyanotic congenital heart disease; prosthetic material used for valvular repair; repaired congenital heart disease with residual shunts or with catheter-based
intervention; and others.
The high-risk procedures are dental work with
manipulation of tissue, tooth extractions, and certain respiratory tract procedures.
