Review Quizzes Flashcards
A 43 year old male presents to the primary care clinic with complaints of a cough that has persisted for 6 weeks. How with the APRN classify this patient’s cough? *
A. Acute cough
B. Subacute cough
C. Chronic cough
D. Chronic obstructive pulmonary disease
B
Feedback: Rationale: coughs may be classified as acute (lasting <3 weeks), subacute (lasting 3 to 8 weeks), and chronic (persisting beyond 8 weeks).1 Most coughs are acute and self-limited; 90% are caused by viral upper
Which statement below regarding chronic cough is true? *
A. A postinfectious cough, by definition, lasts no longer than 8 weeks;
B. Chest radiographs are abnomal in postinfectious cough
C. Intervention is usually required for postinfectious cough to resolve
D. All of the above
A. A postinfectious cough, by definition, lasts no longer than 8 weeks;
Feedback: Rationale: A postinfectious cough, by definition, lasts no longer than 8 weeks; chest radiograph findings are normal, and the cough eventually resolves, generally without intervention.
The pathogenic triad of chronic cough in immunocompetent nonsmoking adults includes all but the following: *
A. Use of ace inhibitors
B. GERD
C. upper airway cough syndrome
D. corticosteroid-responsive eosinophilic airway diseases
A.
Which of the following processes are not involved in pathophysiology that produces a cough? *
A. A neural receptor along the respiratory tree is stimulated
B. An afferent signal is transmitted to the “cough center” of the brain
C. The cough begins with a deep inspiration to approximately 50% of the vital capacity
D. The glottis rapidly closes and the abdominal and intercostal muscles contract, increasing the intrapleural pressures to 300 to 400 mm Hg
D.
the pressures are usually 100 - 200
A sudden onset of cough in the supine position with an associated sour taste in the mouth
suggests: *
A. esophageal reflux
B. upper airway cough syndrome
C. a virus or common cold
D. none of the above
A
A loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is
associated with emotional stress may suggest: *
A. Allergic rhinitis
B. Use of lisinopril
C. Psychogenic cough
D. Asthma
C.
A loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is associated with emotional stress may suggest psychogenic cough.
Ace inhibitors can cause a nonproductive cough more commonly in all of the following groups
except: *
A. Women
B. Nonsmokers
C. Persons of Chinese ethnicity
D. Person’s older than age 50
D. Asians, non-smokers, and Women seem to be more prone to the cough side effect of ACE inhibitors for reasons that are not clear
Which physical examination finding is typical in in a patient with cough from COPD? *
A. Inspiratory wheezes
B. Fine crackles
C. Course rhonchi
D. Expiratory wheezes
D
An APRN is evaluating a patient with persistent cough. The patient’s chest radiograph is
normal. Which condition cannot be ruled out as the cause of the cough? *
A. Bronchiectasis
B. Sarcoidosis
C. Acute Bronchitis
D. Malignant lung cancer
C. Acute bronchitis
A normal chest film would exclude a malignancy, and bronchiectasis, and sarcoidosis. Acute bronchitis often presents no changes on imaging.
An APRN suspects that her patient has asthma. The patient’s pulmonary function test is
normal. What should the APRN do? *
A. Tell the patient “you don’t have asthma because your PFT was normal”
B. Order a methacholine challenge test
C. Repeat the pulmonary function test
D. Prescribe Advair and see if the patient’s symptoms improve
B
Pulmonary function testing (PFT) and oxygen saturation levels may suggest a diagnosis of COPD, asthma, or restrictive lung disease. Intermittent asthma may occur with a normal PFT, and if no other cause is suspected then a challenge may be indicated.
A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccinations?
country specific guidelines are provided by individual embassies
malaria vaccine is the most important vaccine for worldwide travel
requirements should be reviewed at least 4 to 6 weeks prior to travel
There are at least five required vaccines for entry into certain countries
Feedback: Patients seeking immunizations prior to international travel should have these reviewed at least four to six weeks prior so that anybody responses and completion of vaccines series may occur. Country specific guidelines may be found on the CDC website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines that are required
The nurse practitioner is establishing a plan for routine health maintenance for a new patient who is 80 years old. The patient has never smoked and has been in good health. What will the Nurse practitioner include in routine care for this patient? Select all that apply
annual hypertension screening
Baseline abdominal aorta ultrasound
colonoscopy every 10 years
One time hepatitis B vaccine
pneumovax vaccine if not previously given
yearly influenza vaccine
annual hypertension screening
pneumovax vaccine if not previously given
yearly influenza vaccine
She is past the colonoscopy age (50-74), and AAA ultrasound is for men who ever smoked, Hep B is a three dose series
A pregnant woman reports not having had any vaccinations as a child but requests vaccines
during her pregnancy. Which vaccines may be given? Select all that apply
human papillomavirus HPV
Inactivated influenza
live attenuated influenza
measles months and rubella MMR
tetanus diphtheria and ancellular pertussis Tdap
varicella
Inactivated influenza, TdaP, and Hep B are the major vaccines given during pregnancy if needed. A TdaP is usually given every pregnancy.
The MMR, live vaccines, shingles, and varicella should not be given!
A 76 year old patient is being seen in the clinic to establish care. She reports smoking for 20 years but quit 15 years ago with no current respiratory complaints but also not seeing a medical provider in many years. Which priority screening would the FNP recommend based on USPSTF guidelines?
Colonoscopy
Lung cancer screening
Osteoporosis screening
Pulmonary function tests
The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
You are a nurse practitioner working at an addiction clinic. Today, a 45-year-old male presents to your clinic with the chief complaint, “I am about to lose my family; I have to stop drinking.” You understand that it is important to fully screen this patient and you decide to use a tool to do so. The most common tool used in screening for alcohol abuse in this particular patient age group and setting is:
CAGE
CRAFFT
AUDIT
COWS
CAGE is the most sensitive and specific (better than AUDIT). CRAFFT is for teenagers / pediatrics while COWS is for opiates
a 70-year-old male presents to clinic for routine annual physical. He reports a 30 year pack a day cigarette smoking history but no current respiratory complaints. Which screening would be most appropriate for this patient?
Pulmonary function test
Colonoscopy
AAA
bone density
AAA
Feedback: U.S. Prevent Svcs recommends 1x screen for AAA by US in: Men 65-75 w/ HX of smoke >100 cigs lifetime or Men ≥60 with fam HX of AAA in parent/sibling
bone densit
According to MyPlate guidelines, How much of your plate should be filled with Fruits and
Veggies?
1/4
1/2
3/4
1/8
1/2 should be veggies, 1/4 protein, 1/4 grains
What would the FNP consider a priority vaccination for a patient presenting in the clinic for a
routine physical prior to starting college as a freshman?
Influenza
HPV
Varicella
Meningococcal
Meningococcal
College students, especially those living in residence halls, are prone to contracting the disease because of their close proximity to each other
A 55 year old patient who is currently undergoing chemotherapy for breast cancer presents to
the clinic requesting the shingles vaccine. What would the FNP do in this instance?
administer the Shingrix vaccine today
recommend no vaccines until she has finished her chemotherapy
ask her to return in a few weeks to ensure she is well enough for the vaccine instruct her that she is not an appropriate candidate for this vaccine
Administer the Shingrix vaccine today
The recently approved Shingrix vaccine is a recombinant protein and can be given to patients with cancer even if they are receiving or have recently received radiation or chemotherapy. Patients with lymphoma or leukemia also are eligible for the recombinant vaccine but not the non-Shingrix vaccine!
What is Hemoccult testing used to evaluate?
GI tumors (especially colorectal)
Inflammatory Bowel Disease (UC or Crohn’s)
Hemorrhoids
all of the above
GI tumors and colorectal cancer are the usual uses for hemoccult as IBS and IBD may not cause bleeding, and hemorrhoids can be usually visualized without testing
Paget Disease
Bone pain
Increased bone turn over and blood flow
May be warm / tender due to increased blood vessels in bone
Bone may be deformed on x-ray (bow shaped)
Elevated ALP or N-telopeptide level are diagnostic
Treat with biphosphanates and calcitonin
Herben v Bouchard Nodes
Bouchard - Closer to knuckle, can occur on both (osteo and rhuematoid)
Herbden - On joint closer to fingernail, occurs more often in OA
RA v OA
OA - pain / stiffness first thing that lessens after 30 mins
RA - pain / stiffness first thing that lasts longer, usually 2 hours
Addison Disease
Adrenal underproduction of ACTH
Malaise, dizziness, cramps, hyper-pigment of skin, salt loss, weight loss
Hypotension and hypoglycemia can occur
Hydrocortisone PO matching diurnal pattern - 20-30mg per day total
Addison Crisis
Severe symptoms from lack of corticoids during times of stress
Needs IV steroids
Severe hyponatremia and hyperkalemia can occur and renal failure
Diabetes Second Line Med
ASCVD patient - SGLT2i (-flozin) or DDP4i (-gliptin)
HF/Renal patient - SGLT2i (-flozin) avoid TZDs (-glitazone)
Weight Issue - GLP1 (-tide) or SGLT2i (-flozin)
Cost Issues - Sulfonyurea or TZD
Urinary Incontinence Types
Stress - loss of urine associated with increased intra-abdominal pressure
Urge - involuntary loss of urine preceded by strong urge to void
Mixed - Urge and Stress
Overflow - Incomplete emptying
General Anxiety Disorder Med
Buspirone has been shown to be very effective
Escitalopram is also effective
A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is always out of breath and has no more energy. His only medications are bronchodilators, which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left chest. What is the most likely cause of this physical finding? *
A. Asthma
B. Pneumonia
C. Emphysema
D. Pneumothorax
B
Egophony is an increased resonance of voice sounds when a medical professional auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is enhanced transmission of high frequency noise across fluid. Similarly, bronchophony and whispered pectoriloquy can be used to assess the lungs.
A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit. Her LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago and is adherent to her triple drug ART regimen with an undetectable viral load. At 35 weeks her viral load is still undetectable and she gives birth via normal vaginal delivery at 39 weeks. At discharge ART regimens for the mother and child are finalized. Which of the following recommendations about breastfeeding in HIV positive mothers is most accurate? *
A. There is no significant risk of HIV transmission via breastfeeding in mothers under 30 years of age.
B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV transmission
C. Maternal antibodies in breastmilk will protect the infant from HIV infection
D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable
D. There is a 15% chance of HIV transmission via breastmilk
A 43 year old IV drug user who has been on ART treatment complains of continuous diarrhea that is watery, epigastric pain and difficulty swallowing. His CBC shows a hemoglobin of 7.0 mg/dl, total leukocyte count of 2900cmm and a platelet count of 70,000. A CD4+ cell count was requested and it came out to be 90/cmm. Which of the following laboratory investigations would best help with the further evaluation of his diarrhea?
A. Stool tests for oocysts of cryptosporidium
B. Blood cultures for progressive disseminated histoplasmosis
C. Microscopy for pseudohyphae of Candida albicans
D. A stool for ova and parasites test for giardiasis
A. Stool tests for oocysts of cryptosporidium
The scenario is indicative of diarrhea due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm.
A 45 year old patient with a history of alcohol use disorder has developed weakness, fatigue, loss of appetite, weight loss and physical exam reveals ascites, hepatosplenomegaly, spider nevi, clubbing, and dupuytren contracture. His ALT/AST ratio is 2.7 and hemoglobin is 8.8 mg/dL. His MCV is 104 and ultrasonography detects nodularity and increased echogenicity of the liver. Which of the following would confirm a diagnosis of the suspected condition in this patient? *
Biopsy of the Liver
A 38-year-old woman presents to the clinic with a painful, tender keratinized lesion on the sole of her right foot. She says that the lesion developed two months ago and is slowly enlarging. She now has difficulty bearing weight on her affected foot. Her past medical history is significant for type II diabetes mellitus managed on rosiglitazone. Her last menstrual period was three weeks ago. She is sexually active with three partners, and inconsistently uses condoms. Vital signs are within normal limits. The examination of the foot shows a hyperkeratotic lesion with a dark center. The palpation of the lesion causes immense pain. What cancer is linked with the etiology of this lesion?
A. Basal Cell Carcinoma
B. Melanoma
C. Cervical Cancer
D. Burkitt’s lymphoma
C
This lesion is most likely a plantar wart. However, with skin contact, the HPV can be transferred to any part of the body. HPV tends to cause genital warts, flat warts, and palmoplantar warts. HPV is linked to cervical cancer.
A 58-year-old man presented to the hospital with right-sided decreased hearing for two years. His wife mentions he has started snoring recently. He has been a smoker for the last 25 years and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which key anatomical area is the pathology most likely to be situated in? *
A. Right Middle Meatus
B. The roof of the nasal cavity
C. Right vallecula
D. Postnasal space
D
In a patient with recent-onset unilateral hearing loss and nasal obstruction with a social history of smoking one must rule out a nasopharyngeal pathology most likely a malignancy.
A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure. After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in reducing immunity. What is the next preferred step to avoid rejection? *
A. Prescribe tacrolimus
B. Increase the dose of cyclosporine
C. Prescribe amoxicillin
D. Prescribe paracetamol
A
Tacrolimus is efficient more than ten folds when compared to cyclosporine. • Calcineurin inhibitors’ dosages should be monitored cautiously as an increase in its blood concentration could cause many complications like kidney failure.
A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has been exposed to someone with chickenpox but has not developed any skin lesions. She has no varicella-zoster antibodies. What would be the best possible treatment for her? *
A. Chickenpox vaccine
B. Immunoglobulins
C. Antivirals
D. No medication is required
B
An immunocompromised patient, when exposed to someone with chickenpox, is given immunoglobulins unless he develops the disease. • An immunocompromised patient, when exposed to someone with chickenpox, is given antivirals when he develops the disease. • When a pregnant patient is exposed to someone with chickenpox, and she has not developed the disease. Her varicella-zoster antibodies are checked. If she has antibodies, no further treatment is required. • If a pregnant patient is exposed to someone with chickenpox and she has developed skin lesions, then antivirals are given.
A 55-year-old male with a 75 pack-year history of smoking presents to the clinic to establish primary care and discuss age-appropriate screening options for cancer. His pulse rate is 78/min, blood pressure is 140/80 mmHg, and saturation at room air is 96%. Air entry is decreased bilaterally with occasional rhonchi and crepitations on chest auscultation. He is advised by the primary care provider to undergo a low dose CT scan (LDCT) for screening. Which of the following are the criteria for undergoing this screening test for this patient?
A. All adults between ages 55 and 80 years
B. Adults more than 40 years of age with a 20 pack-year smoking history
C. Adults aged 55 to 80 years with a 30 pack-year smoking history
D. Adults less than 60 years of age who are active smokers and have no other risk factors
C
recommendations are for patients more than 55 years of age with an additional risk factor such as family history, occupational exposure to carcinogens, or personal history of chronic obstructive pulmonary disease (COPD). According to the National Lung Screening Trial, patients aged 55 to 80 years with a 30 pack-year history of smoking who are active smokers or quit within the last 15 years qualify for annual low-dose CT screening. Patients with a life-limiting condition should not be screened.
A preventative medicine task force is trying to identify and combat peripheral arterial disease among the rural population they serve. They seek information regarding a rapid, low cost, and sensitive tool to detect this disease that can be used at health fairs scheduled to take place in the rural town centers. Which of the following would be the best screening tool for this situation?
Doppler ultrasound
5-minute treadmill test
Ankle-brachial pressure index (ABI)
Pedal pulse palpation
In a study of over 18,000 men, the presence of bilateral dorsalis pedis and posterior tibial pulses ruled out peripheral arterial disease (PAD) with enough reliability for the authors to conclude it could be used as an appropriate initial screening tool for PAD.
Pedal pulse palpation
A 35-year-old woman with a history of gestational diabetes at age 23 is seen for an annual physical exam. Based on the American Diabetes Association (ADA) recommendations for screening for type 2 diabetes in those with a prior history of gestational diabetes, what is the maximum recommended testing interval for screening this patient for diabetes?
Every 3 years. Gestational diabetes often heralds Type 2 DM later in life.
A 63-year-old female patient presents for an annual exam. She has a history of a hysterectomy 10 years ago in Germany, but us not sure why she had the hysterectomy. She had an abnormal pap smear and a cold knife cone 2 years before she had the hysterectomy but never had followed up with that clinician. She has not been sexually active for the last 3 years. She denies any vaginal bleeding or pain, denies any unusual vaginal discharge or odor. She does not have insurance, so she does not want any test done that is not needed. What is the best next step?
Pap smear with HPV test. A history of a cold knife cone indicates some sort of pre-cancerous condition prior to the hysterectomy and a lack of any follow up indicates a need for a PAP and HPV.
A 66-year-old man with a history of 40 pack-year smoking presents to the clinic for a routine medical examination. He has no active symptoms. His routine chest X-ray shows a solitary pulmonary nodule. Which of the following is the next best step in the evaluation of this patient?
a PET CT is the best diagnostic test that is minimally invasive
An 87-year-old woman is brought to the office for a routine appointment. The patient has an extensive bruise to the side of her face, which she attributes to “being clumsy and falling”. Which of the following possible patient factors is the strongest indicator to contact Adult Protective Services in this case?
Residence with a first-degree relative
Extensive medication list
Wheelchair-bound
A strong “independent streak” to her personality
Wheelchair bound. Factors making elderly abuse more common include functional impairment, poor physical health, and residence in a nursing home.
A 40-year-old female of Japanese descent presents to the clinic wanting to know if she should be screened for diabetes because her second cousin was recently diagnosed with diabetes mellitus. The patient’s body mass index (BMI) is 23 kg/m2, her blood pressure is 135/85 mmHg, her triglycerides level is 200 mg/dL, and her high-density lipoprotein (HDL) level is 40 mg/dL. Which of the following warrants screening for diabetes mellitus according to the American Diabetes Association Standards of Care published in January 2020?
Her BMI. In persons of Asian ancestry, a BMI of 23 or more should be screened for DM.
A 21-year-old female presents to the office for a health maintenance visit. She has no complaints at the moment. Her medical and surgical histories are insignificant. Her family history is significant for breast cancer in her mother and hypertension in her father. The physical exam is unremarkable. The clinician counsels her about starting cervical cancer screening. She states that she had received the human papillomavirus (HPV) vaccine and, for that reason, wants the screening to be delayed. What is the appropriate response?
HPV vaccination does not change the recommendations for screening guidelines. Pap smear screening with HPV testing should begin at age 21.
An 18-year-old male college student is brought to the emergency department with fever, headache, and confusion. He lives in a dormitory at a boarding school. He has no significant past medical history. His vital signs reveal temperature 39 C, blood pressure 105/77 mmHg, respiratory rate 22/min, and pulse 98/min. Physical examination shows mild neck stiffness, photophobia, and petechiae on his shins bilaterally. A vaccine with which of the following properties is most likely to have prevented this patient’s disease?
Live attenuated antigen
Conjugated capsular polysaccharide (CPS)
Activated antigen
Antibiotic-enhanced
The conjugation of a bacterial CPS to a protein induces stronger antibody responses. The use of this vaccine has eliminated all Hib disease, providing strong evidence that the conjugate vaccine is highly effective.
A 35-year-old G2P1001 woman at 36 weeks and 5 days gestation presents to the clinic for a prenatal follow-up visit. Since her last visit, the patient denies any major issues including vaginal discharge, vaginal bleeding, contractions, or decreased fetal movement. Her vital signs on arrival are within normal limits, with blood pressure noted to be 122/76 mmHg. Her prenatal course has been uncomplicated thus far. She is currently taking prenatal vitamins. Which of the following is the next best step in the management of this patient?
A. Counsel patient regarding signs and symptoms of early labor, and schedule next prenatal visit in 4 weeks
B. Schedule the patient for induction of labor at term 39 weeks if the patient does not go into spontaneous la-
bor during the next 2 weeks
C. Obtain group b streptococcus screening
D. Tdap vaccination
C
A is incorrect because prenatal visits occur every week past 36 weeks. B is incorrect because induction is only scheduled at 40 weeks. D is incorrect because she should have gotten a TdaP at her first visit.
