Quiz #3

Question 1

You are approached by 47 year old Emma who is very concerned about osteoporosis. Her dad’s side of the family has women who have experienced serious cases of the condition. Her mom’s side has no notable history with this condition. Now that Emma is getting close to the age of menopause, she wants to know how likely it is that she will experience effects of osteoporosis. She is especially interested in how she compares to others her own age. Which dual-energy xray absorptiometry score is most relevant in this case?

a) Z score
b) T score
c) D score
d) C score

Answer 1

Ans: Z score

T scores compare the patient to the population mean
With Z scores, your bone mineral density is compared to that of a typical individual whose age is matched to yours.

Question 2

A college athlete comes to clinic complaining of malaise and a cough. His physical findings include a fever, and a chest film reveals lung consolidation. You note that he has no other previous health conditions. According to the latest guidelines of the IDSA and the ATS, which treatment is best for this patient?

a) Cefotaxime
b) Levofloxacin
c) Moxifloxacin
d) Azithromycin

Answer 2

Ans: D Azithromycin (macrolide)

Resp fluoros are not indicated in this case

Cefotaxime is a third generation cephalosporin and works against S. pneumoniae but not against H. Flu and M. Catarrhalis

Question 3

Which of the following genetic syndromes is associated with congenital cardiac defects?

a) Tay-Sach’s Disease
b) Klinefelter’s syndrome
c) Turner’s syndrome
d) DiGeorge Syndrome

Answer 3

Ans: D Not sure this is right since:

DiGeorge Syndrome: aortic arch anomalies
Turner Syndrome: Coarctation of the aorta and Bicuspid aortic valves

Question 4

Gayle who is 50, comes to clinic and complains of “twitches” that occur in her right shoulder. You administer an electromyography test and determine that these findings occur as a result of lower motor neuron dysfunction. Which of the following is the most likely diagnosis?

a) Nystagmus
b) Clonus
c) Tremors
d) Fasciculations

Answer 4

Ans: D Fasciculations

Fasciculations are small, localized involuntary muscle twitches
Nystagmus is the eyes
Clonus are continuous succession of seizure like twitches
Tremors occur as rhythmic oscillations not twitches

Question 5

Which of the following is NOT considered by Native Americans to be an “Indian Problem” treatable with “Indian Medicine”?

a) Mental illness
b) Cancer
c) Pain
d) Alcoholism

Answer 5

Ans: B Cancer

Cancer is considered to be a White Man’s disease.
Mental health, alcoholism, and pain are all considered to be naturally indian disorders and are treatable with Indian Medicine

Question 6

You are a nurse practitioner assessing the neurological system of a patient. Which of the following is the best question to ask in order to test the patient’s declarative memory?

a) What did you have for breakfast this morning?
b) Can you repeat the words: rose, hose, nose, and clothes?
c) Can you repeat the words: brown, chair, textbook, and tomato”
d) How old were you when you got your first job?

Answer 6

Ans: C
Can you repeat the words: brown, chair, textbook, and tomato”

Declarative is the patient’s ability to use memory to learn new information.
A and D deal with long and short term memory-episodic memory
B words rhyme so they are not diverse

Question 7

After giving birth to Sarah, 28 year old Samantha and her husband leave the hospital after one day. When should she come back so that Tabitha can have her first well-child check?

a) 3-5 days
b) 4-6 days
c) 2-3 days
d) 1-2 days

Answer 7

Ans: A 3-5 days

Bright futures states that if an infant is discharged from the hospital before 48 hours, he/she should be seen in clinic within 3-5 days

Question 8

Kerrie is looking to start a new birth control regimen after not using any for several years. She avoided birth control because of her somewhat high sensitivity toward estrogen. Her history also indicates that she sometimes has bouts of iron deficiency anemia. Which of the following is best as a recommendation for her?

a) Ortho-Evra
b) NuvaRing
c) Depo-Provera
d) IUD

Answer 8

Ans: C Depo provera

The advantage of Depo is prolonged amenorrhea
Estrogen based choices include Ortho Eva and the Nuva ring which trigger the intolerance
the IUD can lead to excess bleeding so that would not be a good choice with intermittent hx of Iron deficiency anemia

Question 9

Cimetidine, and OTC agent that complicates polypharmacy, inhibits what enzyme in the liver, prolonging the effects of other drugs in the body?

a) Glucose oxidase
b) Cytochrome P450
c) Cox-1
d) Lactate dehydrogenase

Answer 9

Ans: B Cytochrome P450

Question 10

There are three general strategies when interviewing an adolescent. Which of the following is NOT one of those strategies?

a) DRUGSS format
b) SAFETEENS format
c) PACES format
d) HEADSS format

Answer 10

Ans: A DRUGSS IS INVENTED
These are strategies for interviewing teens

HEADSS: Home environment, Employment and education, activities, drugs, social sexuality
PACES: Parents and peers, accident: alcohol/drugs, Cigarettes, emotional issues, school/sexuality
SAFETEENS: Sexuality, Accident/abuse, firearms/homicides,Emotions/toxins, environment, exercise, nutrition and shots/immuniz

Question 11

You are assessing a 2 month old girl for developmental warning signs. By what age should she pick up a toy, according to normal developmental guidelines?

a) 6 months
b) 3 months
c) 5 months
d) 4 months

Answer 11

Ans: A 6 months

It is a dev warning sign if an infant cannot pick up a toy or try to pick up a toy by 6 months. While a child may be able to pick up a toy before the age of 6 months, it is not considered a warning sign until 6 months

Question 12

a 51 year old man comes to clinic complaining of inflammation of his penile head. Upon assessment, you find that the glans is covered in a rash and is releasing a malodorous discharge. He tells you that the affected area is very painful. Which of the following medications would be best to prescribe for him?

a) Griseofulvin
b) Metronidazole
c) Ceftriaxone
d) Miconazole

Answer 12

Ans: D Miconazole

Candida balanitis: a fungal infection of the penile head.
Miconazole is the topical antifungal used to treat this problem. It seems like it could be GC but there is no discharge and the patient has no other symptoms.

Griseofulvin is for Tinea Capitus
Metronidazole is an antibiotic for Rosacea, UTI and other bact infections
Ceftriaxone is for GC

Question 13

Alison, 25, checked into your hospital 2 weeks ago as an inpatient. When you make your rounds, she complains about a painful redness on her skin that seems to have spread overnight. She is shivering and states the she feels cold, although the infected skin is actually rather warm to the touch. You suspect cellulitis which you know may be caused by one of a few organisms. Which of the following is the leading cause of cellulitis in the inpatient setting?

a) E. coli
b) S. aureus
c) Staphylococcus
d) S. pyogenes

Answer 13

Ans: A

E. Coli: Inpatient cellulitis is most often a gram neg organism E. coli.

S. aureus that can cause inpatient cellulitis though less common than E. coli
S. pyogenes is the leading cause of OUTpatient cellulitis
Staphlococcus is just too general a reference

Be careful with these questions….when there are 3 Staphs and one is so general, that is a hint!

Question 14

You are checking on a 6 year old whom you saw last month for strep throat. Since you know that rheumatic fever can follow strep throat by approximately 20 days, you wanted to make sure he has not developed this secondary condition. Which of the following is a major clinical manifestation of rheumatic fever?

a) Polyarthritis
b) Inflammatory changes in the oral cavity
c) Inflammatory changes of the lips
d) Polymorphous rash

Answer 14

Ans: A polyarthritis

Polyarthritis, a form of arthritis, is a major clinical manifestation of Rheumatic Fever. The affected joints will change every 1-2 days, and it is the large joints that are usually affected.

A polymorphous rash and inflam changes in both the lips and oral cavity are diagnostic of Kawasaki Disease which causes another cardiac defects: Coronary vasculitis, myocarditis, Mitral regurg, and dysrhythmias

Question 15

You have been treating Edwina, 68, for a long-term fever. Since this is a prolonged presentation, you screen for infection. All of the following would indicate infections except:

a) 2 or more measurements of oral temperature equal or greater than 99F (37.2)
b) Rectal Temp equal to 99F (37.5)
c) Increase in temp of equal to or greater than 2F (1.1C) from baseline
d) Single measurement of temp equal or greater than 100F (37.8C)

Answer 15

Ans: B

A rectal temp equal to or greater than 99.5 F (37.5C) NOT 99F (37.2 C) indicates infection.

All of the other values are indicators of infection in the elder

Question 16

A mom and her 13 year old daughter come to clinic reporting that the daughter complains of painful menstrual cramping and back pain requiring her to miss school several days per month. You suspect a diagnosis of Dysmenorrhea. Which of the following is NOT an example of supportive treatment of this diagnosis?

a) Heat application
b) High iron diet
c) Psychological counseling
d) Ibuprofen

Answer 16

Ans: B High iron diet

Support measures include psych support, heat, and OTC NSAIDs (for prostaglandin support)

Question 17

Which of the following components of Continuous Quality Improvement monitors the numbers of qualified staff, equipment, and resources?

a) Appropriateness
b) Processes
c) Establishments
d) Structures

Answer 17

Ans: D
In the system of Continuous Quality Improvement, structures include the resources, equipment, and the size and qualifications of staff.

Processes of care include assessment, planning, performing treatments and management of complications.

Establishments are the businesses or institutions where CQI are implemented

Question 18

Max, age 2 months, is brought to clinic for a checkup. His mom tells the NP that she has noticed that Max has a seemingly permanent head tilt, and he seems cross eyed. You suspect the child may have strabismus. Which of the following, if present, would indicate another possible problem?

a) Squinting
b) Head shaking
c) Face turning
d) Decreased visual acuity

Answer 18

Ans: B

Head shaking

Head shaking is NOT a sign associated with strabismus. All the other choices are findings of patients with suspected strabismus. In addition, exotropia, hyper or hypotropia, and an unequal Hirschberg pupillary reflex also may present

Question 19

Which of the following would not be true about a genetic disorder?

a) Only 30-35% of genetic disorders are diagnosed in the neonatal period
b) Major malformations occur in approximately 2% of live births
c) About 80% are identified before the age of 6 months
d) Of the major malformations, 80% are associated with a genetic cause and an increased risk of recurrence

Answer 19

Ans: a
False: That only 30-35% of genetic disorders are diagnosed in the neonatal period.

In fact, genetic disorders are diagnosed at 40-45% in the neonatal period. All the other statements are true

Question 20

Mary comes to your facility and asks for privacy. the 24 year old says that there is a fishy smelling gray discharge from her vagina. Of the following, which is the most likely diagnosis?

a) Candida
b) GC
c) Trich
d) BV

Answer 20

Ans: D

Bacterial Vaginosis presents with a fishy odor.
Trich is “frothy” Yellow-green
Candida is white curd-like
GC is green gook but does not reflect fishy

Question 21

Shannon , 34, is in for diagnostic tests for Multiple sclerosis. Before you initiate assessment, you engage in a brief conversation concerning her disorder and the lab exams that surround it. Of the following statements, which is incorrect regarding lab diagnosis of MS?

a) An edrophonium test can be administered as a differential diagnostic
b) Lab diagnostics often find an increased number of lymphocytes in the circulating blood
c) Slightly elevated protein can be found in the CSF
d) Lab diagnostics can never be definitive for MS.

Answer 21

Ans: A

It is false that the edrophonium test can be administered as a differential diagnostic

Edrophonium is used as a differential diagnostic between MG and a cholinergic crisis, and thus is irrelevant for MS.

For MS labs, you find an increase in lymphs in the blood and elevated protein in the CSF however lab diagnostics can never be definitive for MS

Question 22

A newborn delivered via caesarean section at 38 weeks gestation without complications is in the nursery for initial assessment. If the child physical measurements are all average, which of the following measurements should you most expect?

a) Wt. 3 kg; Head circ 33 cm; length 51 cm
b) Wt 2.8 kg; Head circ 30 cm; length 50 cm
c) Weight 1.8 kg; Head circ 33 cm; Length 52 cm
d) Weight 4 kg; Head circ 36 cm; Length 51 cm

Answer 22

Ans: A

Wt. 3 kg; Head circ 33 cm; length 51 cm

Average measurements for a term baby are
Weight 3.1 Kg
Head circ: 33-35 cm
Length: 51 cm

Question 23

An 18 year old female comes to the office 2 weeks before leaving for college. She is anxious but also excited to live in the dorms. She however had an active TB infection and needs to begin treatment NOW. You tell her that if the condition proves susceptible to her medication regimen, the initial course of the medication could last for:

a) 9 months
b) 6 months
c) 2 months
d) 1 month

Answer 23

Ans: C

the INITIAL part of the med regimen of RIPE lasts for 2 months

After 2 months, the med regimen is reduced to only INH and rifampin for the next 4 months….this is the latter part of treatment.

Patients with HIV should be treated for 9 months

Question 24

Maggie, 2 months old, is due to receive the polio vaccine. Which of the following statements is true regarding polio vaccine administration to the patient?

a) The oral polio vaccine should be given on the normal vaccination schedule
b) The final dose of the inactivated polio vaccine would typically be given when the patient is 6-10 years old
c) The oral vaccine should be given when Maggie is 6 years old
d) The inactivated polio vaccine must be given when Maggie is 6 years of age

Answer 24

Ans: D

The inactivated polio vaccine must be given when Maggie is 6 years old

The inactivated Polio vac should be administered in a series of 4 doses at 2, 4, and 6 months with the final dose at 6 years. The oral dose is discouraged and is only an option for the 3rd and 4th doses.

It is not recommended that Maggie receive her final polio at age 10

Question 25

A patient with a history of migraine headaches is taking propranolol. However, it is noted that she does not have cardiac issues or anxiety. Given this information, which is the most likely reason that she is on Propranolol?

a) To prevent macular degeneration as a result of chronic headaches
b) To lessen the severity of migraine headaches
c) To diminish the recurrence of migraine headaches
d) To improve alertness during headache attacks

Answer 25

Ans: B
to lessen the severity of migraine HAs

Propranolol is migraine prophylaxis: prevention. It’s action is to lessen the severity of migraine symptoms.

It does not improve alertness, prevent Macular degeneration, or diminish the recurrence of migraine headaches.

Question 26

Pervasive development disorders are a collection of disorders known as autism spectrum disorders. These are characterized by altered response to environmental stimuli and impaired social interactions. Which of the following is a true fact of PDDs?

a) PDD occur in approximately 1 in 100,000 children
b) PDD are more common in boys than in girls
c) PDD are most severe in males
d) Neurological disorders are not a cause of PDD

Answer 26

Ans: B
PDD are more common in boys than in girls.

Autism is more common in boys than in girls, however, when it occurs in girls, It is not only more severe, but it can usually associated with Rett’s Syndrome
PDD presents in 2-5/10,000 children
and Neuro disorders as a result of brain insult in utero have been known to cause PDD

Question 27

A mom brings her infant son to you because he has been breathing rapidly and tires easily. You suspect the baby’s symptoms indicate a cardiac condition. Where are you most likely to feel a thrill if he has a VSD?

a) LRSB
b) Pulmonic
c) Erb’s point
d) Mitral

Answer 27

Ans: C Erb’s point

A holosystolic thrill at the Erb’s point located at the LLSB is associated with VSD.

Question 28

When diagnosing ADHD, the NP must be mindful that certain behaviors such as distractibility, impulsivity, and hyperactivity are often seen in all types of children. Which of the following is one of the symptomatic requirements for a diagnosis of ADHD?

a) Symptoms must interfere with school, play, and home
b) Symptoms must interfere with school
c) Symptoms must be present before 6 years old
d) Symptoms must persist for at least 6 months

Answer 28

Ans: D
Symptoms must persist for at least 6 months

Another diagnostic requirement is the presence of symptoms that disrupt 2 life settings, not three
Symptoms need to occur before the age of 7, not 6

Question 29

James and Devin’s first son is diagnosed with Down’s Syndrome. Amongst their many concerns, they want to know if this could affect their son’s heart. Which of the following is the most common heart defect associated with Down’s Syndrome?

a) Tetralogy of Fallot
b) Transposition of the great arteries
c) Atrioventricular septal defect
d) Patent ductus arteriosus

Answer 29

Ans: C
Atrioventricular septal defect

15-20% of newborns with down’s have an AV septal defect.

Tetralogy of Fallot is associated with Downs but is very uncommon
PDA and Transposition are not associated with Downs’
CoArc is associated with Turners
AR and MVP are associated with Marfan’s

Question 30

A 36 year old male has jaundice and fatigue after returning from travelling abroad. Lab results show the presence of anti-HBsAg and Anti-HBc as well as the absence of IgM. What type of hepatitis B do these findings indicate?

a) Active
b) Chronic
c) Recovered
d) Acute

Answer 30

Ans: C

Recovered: Anti-HBsAg and Anti-HBc indicate recovered Hep B.
Lab results for active and chronic Hep would include the IgM which is absent in this patient.

Acute Hepatitis is a form of Hep C, not Hep B

Question 31

Your 32 year old patient reports that he has been having trouble interacting with customers at work. He recently got a job as a clerk, and now he feels frightened when he has to speak with customers. He says that he has been taking more breaks than allowed just to run to the bathroom to catch his breath. Which of the following disorders best matches his experience?

a) Panic disorder
b) OCD
c) PTSD
d) Generalized Anxiety Disorder

Answer 31

Ans: A Panic Disorder

Panic disorder is dread of seemingly harmless objects or situations

Generalized anx disorder is excessive worry about general life circumstances
OCD is OCD
and PTSD is anxiety/flashbacks for at least 6 months after a traumatic event

Question 32

The NP examines Martin, a 3 month old in clinic who came because of poor weight gain. The NP conducts an exam and palpates an olive-shaped mass in the abdomen. Which of the following would the NP expect to find in Martin’s case?

a) Choking and coughing
b) Abdominal distention
c) Projectile vomiting
d) Hematemesis

Answer 32

Ans: C Projective vomiting

A condition noted on physical exam in the patient with PS is the presence of an olive-shaped mass in the abdomen. Though projectile vomiting is classic, there is no hematemesis, choking and coughing (as in GERD), and abdominal distention is characteristic of AGE

Question 33

You are performing a complete neuro exam on Adam, a 40 year old male patient. Which of the following should be performed and /or examined so as to locate abnormalities?

a) Mental status, CN, motor function, sensory function, reflexes
b) Mental status, motor function, sensory function, reflexes, CN
c) Cranial nerves, mental status, sensory function, motor function, reflexes
d) Mental status, sensory function, cranial nerves, motor function, reflexes

Answer 33

Answer: A

According to the assessment book, Mental status comes first. Then CN. Then Motor/Cerebellar, then reflexes, sensory, finally station/gait.

None of these match exactly but A was the closest.