Quiz Flashcards
A 30-year-old male patient with no previous history of urinary tract infection (UTI) has both positive leukocyte esterase and nitrites on a random urine dipstick during a well-patient exam.
This represents a(n):
Complicated UTI. All UTIs in men are complicated.
A patient with a purulent skin and soft tissue infection (SSTI) presents to the clinic. A history reveals a previous MRSA infection in a family member. The primary care provider performs an incision and drainage of the lesion and sends a sample to the lab for culture.
What is the next step in treating this patient?
Prescribe oral clindamycin. MRSA is not responsive to Augmentin, and empiric treatment for presumed MRSA should begin until the cultures return.
A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice daily ketoconazole cream prescribed by the primary care provider.
What will the provider order for this patient?
Oral itraconazole. An oral antifungal is an alternative but special attention to liver risk must be evaluated.
A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes.
What will the primary care provider recommend as first-line treatment?
Famiciclovir
Acyclovir
Topical medications
Valacyclovir
Acyclovir is the least expensive and just as effective in preventative therapy.
A patient is diagnosed with herpetic whitlow and in a follow-up evaluation, is noted to have paronychial inflammation of the tendon sheath in one finger.
What is a priority treatment for this patient?
Immediate referral to the ED or surgery. Tendon sheath infection in herpetic whitlow places the finger/hand at risk.
A 40-year-old woman reports pain at the thumb base in one hand radiating to the distal radius. The primary care provider learns that the woman knits for a hobby and is able to elicit the pain by asking the patient to pour water from a pitcher.
Which condition is suspected in this patient?
De Quervain tenosynovitis. Pain and numbness at the thumb base and a history of repetitive finger motions are classic signs. Rest and immobilization is the usual treatment.
A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. Upon examination, the patient’s lungs are clear and oxygen saturation is 97% on room air.
What will the provider recommend?
Symptomatic treatment and follow up. There are no serious complication risks like comorbidity and antivirals may take a day or two for effect. Respiratory distress signs would indicate need for ED referral.
A 25-year-old patient has a tuberculosis skin test which reveals an area of induration of 12 mm. The patient is a recent immigrant from Mexico and lives in a homeless shelter.
What is the recommended treatment for this patient?
INH preventative therapy is indicated in patients younger than 35 with skin test of >10mm.
What is the recommended treatment for a patient with mild symptoms of babesiosis who is diagnosed with a positive PCR assay?
Atovaquone and azithromycin for seven to ten days
Patients with mild to moderate symptoms of babesiosis and a positive PCR assay should be treated, and atovaquone plus azithromycin is the treatment of choice. A negative PCR would indicated observation and symptomatic treatment.
A patient comes to a clinic with reports of unilateral arm pain and weakness with mild neck pain. The provider notes that the patient prefers holding the affected arm crossed in front of the throat. A history reveals a recent onset of sexual dysfunction.
What does the provider suspect based on this history?
Cervical myelopathy
Patients with neurological symptoms have radicular neck pain, which is usually greater in one arm and involves neurological findings. Patients with concurrent lower extremity findings may have cervical myelopathy and should be evaluated immediately.
Which policy has the Centers for Medicare and Medicaid Service (CMS) implemented to reduce adverse events associated with care transitions?
Reduction of payments for patients readmitted within 30 days after discharge
What is the purpose of clinical research trials in the spectrum of translational research?
Examination of safety and effectiveness of various interventions
What is the purpose of clinical research trials in the spectrum of translational research?
Examination of safety and effectiveness of various interventions
What would be considered a secondary prevention strategy?
Lipid screening
Primary - Vaccines, Lifestyle Recommendations
Secondary - Screenings
Tertiary - Disease Management, Support Groups
Who is a chlamydia screening recommended for, according to USPSTF guidelines?
Sexually active women ages 24 and younger
Which two types of wellness exams are applicable for the first year of coverage for those who turn 65 years of age and enroll in Medicare?
A Welcome to Medicare visit and an annual wellness visit
During the annual wellness visit with a 56-year-old patient, the primary care provider notes that the patient rarely exercises.
What exercise regimen will the provider recommend for this patient?
At least 150 minutes of moderate-intensity exercise and muscle-strengthening exercises at least two days per week.
Which vaccines may be given to a pregnant woman who reports not having had any vaccinations as a child but requests vaccines during her pregnancy?
Hep B, Inactivated Flu, TdaP
MMR and live vaccines are not recommended in pregnancy
A 38-year-old patient with obesity and a strong family history of diabetes expresses interest in losing weight, but is intimidated by the need to lose 60 pounds in order to reach normal weight and reduce the risk of chronic disease.
What can the primary care provider say that could help motivate the patient in losing weight?
Sustained weight loss of just 7% body weight is associated with decreased risk of obesity-related chronic disease
A primary care provider administers the “Newest Vital Sign” health literacy test to a patient newly diagnosed with a chronic disease.
What is gained by administering this test?
Understanding of and ability to discuss health care concerns. This test is a screening tool for health literacy.
During a routine wellness exam, the primary care nurse practitioner notes an irregular radial pulse and irregular heart sounds. The patient’s vital signs are: BP 126/84, HR 105, RR 16, T 98.8°F (37.1°C).
What should the nurse practitioner do next?
Order a STAT ECG. The patient is stable, if there were signs of hemodynamic compromise an ED referral is appropriate.
A patient reports using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The primary care provider notes redness and discharge along the eyelid margins with clear conjunctivae.
What is the recommended treatment?
Compresses, lid scrubs, and antibiotic ointment. This patient has symptoms of blepharitis without conjunctivitis. Initial treatment involves lid hygiene and antibiotic ointment may be applied after lid scrubs.
A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge.
What is the initial treatment for this patient?
Prescribe antibiotic ear drops. The tear is likely a result of the infection. Refer the patient to an otolaryngologist may be considered but is not the initial treatment.
A patient has a sore throat, a temperature of 101.3°F (38.5°C), tonsillar exudates, and cervical lymphadenopathy.
What will the primary care provider do next to manage this patient’s symptoms?
Perform a rapid antigen swab to determine if group A b-hemolytic streptococcus GAS is present. (Strep swab)
A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted.
What is the next step in managing this patient?
Increase the dose of the antibiotics
Administer the pneumonia vaccine
Perform a diagnostic bronchoscopy
Perform an open lung biopsy
Perform a diagnostic bronchoscopy. You need to exclude or confirm possible carcinoma, fungal, or other disease as the cause.
A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The primary care provider notes both direct and rebound tenderness with palpation of the abdomen.
What is the significance of this finding?
It suggests severe acute pancreatitis with peritonitis. Having both direct and rebound tenderness is a sign suggesting severe peritonitis.
Which diagnostic test will the primary care provider order for a 30-year-old woman who has right upper quadrant abdominal pain, nausea, and vomiting?
Abdominal ultrasound. Any woman of child bearing age should get ultrasound before CT. A good rule of thumb is ultrasound (cheaper, in-office) before CT.
What will the primary care provider initially recommend to a patient who develops diarrhea after gastric surgery?
Avoiding liquids with meals. Initial suggestions for treating postoperative diarrhea will include avoiding fluids during meals and lying down after meals.
A young adult patient is being treated for hypertension and is noted to have a resting blood pressure of 135/88 mm Hg just after finishing a meal. After standing, the patient has a blood pressure of 115/70 mm Hg.
What is the likely cause of this change in blood pressure?
Neurogenic orthostatic hypotension
Postprandial hypotension
A hyperglycemic episode
Antihypertensive medications
Antihypertensive medications. Medications used to treat hypertension may cause orthostatic hypotension and neurogenic and postprandial are more common in older patients.
Which symptoms exhibited by a patient with abdominal pain are suggestive of appendicitis?
Patients with appendicitis typically have pain that begins in the epigastric or periumbilical area and migrates to the right lower quadrant. Abdominal rigidity is common, as are low-grade fever and nausea and vomiting. Pain precedes other symptoms and when the symptoms occur in any other order, the diagnosis of appendicitis should be questioned.
An advanced practice registered nurse (APRN) is working with a patient who has had recurrent cystitis. The patient has implemented many changes, including drinking cranberry juice, increasing water intake, urinating after intercourse and discontinued use of a diaphragm, and replacing with oral contraceptives. In discussion with the patient, the APRN learns that the cystitis symptoms seem to be linked to frequency of intercourse.
Which order should the APRN make for prophylactic treatment?
Ciprofloxacin 125 mg within 24 hours of intercourse. Prophylactic pharmacotherapy for postcoital cystitis is recommended. Ciprofloxacin 125–250 mg within 24 hours of intercourse is appropriate.
A daycare worker is assessed by an advanced practice registered nurse (APRN) due to complaints of sudden-onset of scattered macular and vesicular lesions on the palms and between fingers, arms, and soles of the feet, buttocks, and legs. The patient has a temperature of 101.2°F (38.4°C). The APRN diagnoses hand, foot, and mouth disease.
Which action should the APRN take to assist this patient?
With hand, foot, and mouth disease, fluid intake should be increased to alleviate dehydration.
A 35-year-old patient meets with an advanced practice registered nurse (APRN) to discuss a low back pain that began three days earlier and has never occurred before. The pain and stiffness intensifies after sitting for long periods of time, and the patient is concerned about the problem impacting work.
Which action should the APRN take first to assist this patient?
Normal activities should not be eliminated in acute, first-time low back pain. Alternating between sitting and standing should be considered.
A patient presents to the clinic with a sudden onset of fever, chills, headache, and malaise during the winter months. Upon assessment, the advanced practice registered nurse (APRN) notes a temperature of 103°F (39.4°C), clear nasal discharge, a dry cough, and enlarged cervical lymph nodes. Abdominal exam reveals no splenomegaly.
Which diagnosis should the APRN suspect for this patient?
Influenza is an acute infection of the respiratory tract that occurs primarily during the winter months. Symptoms include fever, chills, headache, malaise, clear nasal discharge, a dry cough, and enlarged cervical lymph nodes.
An adult patient with chronic obstructive pulmonary disease (COPD) is seen by an advanced practice registered nurse (APRN) with complaints of a productive cough that is worse in the morning and improves throughout the day.
The patient reports smoking a half a pack of cigarettes each day for the past 15 years. Assessment results include a respiratory rate of 30 breaths per minute with rhonchi and wheezing bilaterally. The spirometry results reveal the FEV1 is 65%, and the FVC is 45%.
How should the APRN classify this patient’s stage of COPD?
Mild chronic obstructive pulmonary disease (COPD) has spirometry results of FEV1 (forced expiratory volume in 1 sec.) of 70–79% and FVC (forced vital capacity) of 60–69%.
An advanced practice registered nurse (APRN) is assessing a patient who presents to the clinic with complaints of morning cough, sputum production, and dyspnea with activity for the last three months. Vital signs are within normal limits. Chest X-ray is unremarkable. Office spirometry is conducted and pre- and post-bronchodilator administration shows no improvement with expiratory and capacity values of less than 70%.
Which diagnosis should be suspected by the APRN?
Chronic obstructive pulmonary disease (COPD) presents with morning cough, sputum production, and increasing dyspnea with activity. The spirometry results post-bronchodilator administration with expiratory and capacity values of less than 70% indicate COPD.
A patient arrives at a clinic for a regularly scheduled visit. During the examination, the patient shares that they have been experiencing angina, radiating pain, and tingling and numbness in the right hand over the past week. The advanced practice registered nurse (APRN) establishes that the patient is not in acute distress but suspects the patient has coronary artery disease.
Which initial action should the APRN take?
Conduct a thorough history and physical examination
The optimum assessment of coronary artery disease (CAD) is a thorough history and physical examination that includes prior medical history of myocardial infarction (MI) or CAD and the patient’s present complaints, such as angina, radiating pain, tingling, or numbness.
A patient is being evaluated by an advanced practice registered nurse (APRN) for a follow-up visit after being discharged from the hospital for a transient ischemic attack (TIA).
Which action should the APRN perform as part of the patient’s long-term treatment plan?
A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain and may be a warning sign of a future cerebrovascular accident (CVA, stroke). It is important for the patient to be able to recognize and report signs of a stroke.
A patient is being evaluated by an advanced practice registered nurse (APRN) about problems with watery, liquid stools. The patient had been on a broad-spectrum antibiotic for two weeks. The APRN suspects a secondary complication.
Which test will confirm the APRN’s suspicion?
Because this patient presents with watery, liquid stools and a recent history of antibiotic usage, a secondary complication of clostridium difficile (c. diff) is suspected. A positive polymerase chain reaction (PCR) test will confirm the patient has c. diff.
A patient is speaking with an advanced practice registered nurse (APRN) about problems with chronic gastroesophageal reflux disease that is no longer responding to the previously prescribed proton pump inhibitor medication.
Which disease should the APRN suspect in this patient?
Barrett esophagus is a complication of chronic GERD, even in patients who take PPIs.
An advanced practice registered nurse (APRN) is assessing and screening a new patient for primary preventative measures. The patient asks the APRN about the purpose of these measures.
Which explanation should be provided by the APRN?
They identify behaviors needing intervention before problems occur.
A 28-year-old male is being seen in the primary care office for his annual wellness exam. During the assessment, the patient notes that he has a girlfriend and is sexually active. He states that he is concerned about sexually transmitted illnesses and asks the advanced practice registered nurse (APRN) if he should get the human papillomavirus (HPV) vaccination.
How should the APRN respond?
It is recommended that the human papillomavirus (HPV) vaccination be given to males aged 13 to 21 years who have not previously received the HPV vaccination or who have not completed the three-dose series.
An advanced practice registered nurse (APRN) in a large accountable care organization (ACO) sees patients of many different cultures and ethnic backgrounds and wants to ensure each patient’s values and perspectives are acknowledged.
Which form of ongoing training is required to meet this goal?
Cultural sensitivity and awareness training
A 40-year-old female patient is being seen in the primary care clinic for an annual exam and wants to arrange any preventative screenings needed for her age. The advanced practice registered nurse (APRN) conducts a blood pressure (BP) screening and orders laboratory tests to evaluate blood glucose and cholesterol level.
Which additional screening should the APRN order for this patient?
A mammography screening for women, with or without a clinical breast examination, is recommended every two years for women age 40 through age 74.
A 48-year-old patient who recently immigrated to the United States, comes to the office for an evaluation of their recently diagnosed diabetes mellitus (DM). The patient is fluent in written and verbal English. However, during the teaching session planning, the advanced practice registered nurse (APRN) notices the patient appears disengaged and rarely makes eye contact during the session. The APRN recognizes that health literacy components need to be incorporated into the presentation.
How should the APRN plan to collect assessment information from this patient?
Ask for clarification on the cultural context for the planned treatment. If a patient is a recent immigrant, the cultural conflicts are more common in planned treatment.
An adult patient is being assessed by an advanced practice registered nurse (APRN). During the exam, the APRN witnesses the patient suddenly losing consciousness.
Which action should the APRN take first to assist this patient?
This represents an emergency and the first priority is to check for a pulse. If the APRN does not definitely feel a pulse, cardiopulmonary resuscitation (CPR) should be started.
An 18-year-old patient is being evaluated by an advanced practice registered nurse (APRN) because of a severe sore throat, difficulty swallowing, and a fever of 102°F (38.9°C). Upon visual inspection of the throat, purulent drainage is noted behind the right tonsil. A diagnosis of peritonsillar abscess is suspected.
Which referral should the APRN make?
To an emergency department. A peritonsillar abscess (PTA) is an accumulation of pus within the peritonsillar tissues, between the tonsil and the pharyngeal constrictor muscle. This should be considered an emergency and surgical intervention would likely be required with needle aspiration, incision and drainage, or tonsillectomy.
A 45-year-old patient comes to the clinic complaining of generalized malaise, fever, productive cough, and intermittent chest pain with respiration that began two days before. The symptoms have increased in severity and have not improved with the use of over-the-counter (OTC) pain and cold medication. There is no history of current or past smoking, and the patient is not on any routine medications.
Assessment data reveals a temperature of 102°F (38.9°C); pulse of 86 beats per minute; and respirations of 24 breaths per minute. Decreased breath sounds with wheezing noted bilaterally with dullness to lung percussion are present. The advanced practice registered nurse (APRN) suspects bacterial community-acquired pneumonia.
Which chest X-ray finding supports the APRN’s suspicions?
Alveolar consolidation and pleural effusion seen on a chest X-ray would confirm the diagnosis of bacterial community-acquired pneumonia.
Which method of treatment is used for traumatic pneumothorax?
Tube thoracostomy
Placement of a small-bore catheter
Needle aspiration of the pneumothorax
Observation for spontaneous resolution
Tube thoracotomy in trauma, a small bore or needle may be considered in minor simple pneumothorax
Which diagnostic test will confirm the presence of a pulmonary embolism (PE) in a patient who has undergone surgical immobilization for a femur fracture and reports dyspnea and chest pain with inspiration and has a heart rate of 120 beats per minute?
CT Angiography
ABGs guide oxygen therapy, and D-Dimer/EKG can rule out other
Which initial treatment will be helpful for a patient who is diagnosed with mild restless leg syndrome (RLS) that occasionally interferes with sleep?
Supplemental iron
A dopaminergic agonist
A continuous positive airway pressure (CPAP) device
Hot baths and exercise
Patients with mild restless leg syndrome (RLS) may benefit from massage, hot baths, exercise, and good sleep hygiene.
A patient reports abdominal and back pain with anorexia and nausea. During an examination, the primary care provider notes a pulsatile abdominal mass.
What is the provider’s initial action?
This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by ultrasound. After a size is estimated, referral to surgery or the ED may be needed.
During a routine health maintenance examination, the primary care provider auscultates a carotid bruit. The patient denies syncope, weakness, or headache.
What will the provider do, based on this finding?
Carotid duplex ultrasound is the primary diagnostic tool for carotid stenosis. A carotid bruit in an asymptomatic patient is an indication for this test.
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The primary care provider administers a nitroglycerin tablet which does not relieve the discomfort.
What is the provider’s next action?
Patients with these symptoms who do not respond to nitroglycerin are likely to have microvascular angina. Treatment is effective with beta blockers.
A patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision, nausea, and shortness of breath. The primary care provider notes a blood pressure of 185/115.
What is the recommended initial action for this patient?
Patients with a blood pressure >180/120 or those with signs of target organ symptoms should be admitted to inpatient treatment with specialist consultation.
