APEA PRE-PREDICTOR 2024-2025 ACTUAL EXAM TEST BANK 850+ QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

Download APEA PRE-PREDICTOR 2024-2025 ACTUAL EXAM TEST BANK 850+ QUESTIONS AND CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! APEA PRE-PREDICTOR 2024-2025 ACTUAL EXAM TEST BANK 850+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? - answer-Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? - answer-6 weeks. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: - answer-testicular self- examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: - answer-a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis? - answer-Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. Which of the following is NOT a characteristic of the S3 heart sound? - answer-The sound is high-pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy. Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem preparing to review lab reports with the patient, the nurse practitioner knows all of the following are true EXCEPT: - answer-normal PSA is 10ng/ml or less. Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with malignancy of the prostate gland with bone metasasis. A 66 yo female presents to your clinic. She states that yesterday evening she had chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial infarction? - answer-Elevated Troponin I levels An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin measurement. What is a secondary cause of hyperlipidemia? - answer-hypothyroidism Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a patient with hyperlipidemia, a TSH should always be checked and corrected before attempting treatment for hyperlipidemia. Other possible causes of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake, insulin resistance or deficiency, obstructive liver disease, and uremia. Some medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-blockers, oral contraceptives, and corticosteroids. A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a: sterile in-and-out catheter urine specimen. - answer-A sterile in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women >65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? - answer-isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis. The diagnosis of Meniere's disease is based on: - answer-The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease. The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: - answer-Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia. An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight? - answer-135 lbs The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age. The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is: - answer- Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT: - answer-one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? - answer-Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? - answer-Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: - answer-alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to driving under the influence of alcohol are the leading cause of death in the 15-24 year old age group. A patient with moderate persistent asthma will probably be most effectively managed with daily: - answer-inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen. What is the biggest side effect of colchicine? - answer-diarrhea How would you describe the appearance of molluscum contagiosum? - answer-papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? - answer-no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - answer-week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - answer-week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? - answer-week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - answer-week 28 At what week of pregnancy is the fundus just below the xiphoid process? - answer-week 34 Increased sweat production is a sign of what endocrine disorder? - answer-hyperthyroidism If a patient on coumadin's INR is 3.1-4 ,what should you do? - answer-decrease the weekly dose by 5- 10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - answer-hold one dose then decrease the weekly dose by 10% If a patient's INR is greater than 5, what should you do? - answer-consult cards, likely would hold two doses then decrease the weekly dose An anorexic patient will have a BMI of what? - answer-less than 18 What is primary amenorrhea? - answer-when the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics Secondary amenorrhea is a lack of menses after of not having a period; but you have had one before - answer-3 months What do we need to do first when a patient comes in with secondary amenorrhea? - answer-rule out pregnancy Anorexia can put you at risk for what? - answer-osteoporosis, amenorrhea, cardiac damage Amenorrhea is considered a risk factor for what? - answer-osteoporosis What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - answer-they get their period back If a pregnant woman has syphilis, what should we do? - answer-treat it with penicillin while she is pregnant because there is risk for spontaneous abortion What is the causative organism of mastitis? - answer-staph What is the first line treatment for mastitis? - answer-keflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is one of the biggest risk factors for cervical cancer? - answer-numerous sexual partners Preeclampsia most commonly shows up at what time in pregnancy? - answer-around week 20 How do we treat UTIs in a pregnant woman? - answer-can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - answer-about 10 days before menses What can be a sequelae of an ectopic pregnancy? - answer-pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? - answer-test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? - answer-nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? - answer-give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? - answer-IUD The vaginal ring for contraception must be taken out how often? - answer-every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - answer-increase the progesterone How do we treat temporal arteritis? - answer-steroids If a patient is on birth control and they miss one pill, what should they do? - answer-double up If a patient is on birth control and they miss two pills, what should they do? - answer-double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - answer-do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, is used for screening and is used for diagnosis. - answer-mammogram; ultrasound When do we screen for group B strep in pregnancy? - answer-weeks 35-37 When do we perform alpha fetoprotein screening in pregnancy? - answer-15-20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - answer-spina bifida and anencephaly What is placenta previa? - answer-when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - answer-when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? - answer-in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? - answer-a placental abruption is painful whereas placenta previa is painless When will spinal or lumbar stenosis feel better? - answer-when the patient sits down What is Korsakoff syndrome? - answer-a deficiency in thiamine and folate caused by alcoholism What changes to the vagina occur with aging? - answer-dryness, loss of rugae, less pubic hair What is a navicular fracture? - answer-also known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - answer-osteoarthritis; rheumatoid arthritis What is Morton's neuroma? - answer-a mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes How is Morton's neuroma diagnosed? - answer-via a positive Muddler's or squeeze test causing pain What is the hook test? - answer-used to assess for a bicep tendon issue How do we treat any rotator cuff injuries? - answer-wear a sling to stabilize the arm and refer to ortho How long do migraine headaches last? - answer-4-72 hours How can we abort cluster headaches? - answer-calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? - answer-cluster headaches What does the apprehension test assess for? - answer-used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? - answer-when parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine What is the first line treatment for trigeminal neuralgia? - answer-carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - answer-steroids and anti-virals How is the pain of trigeminal neuralgia vs temporal arteritis different? - answer-in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? - answer-beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? - answer-adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? - answer-bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - answer-molar pregnancy What bacteria is the leading cause of urethritis? - answer-neisseria gonorrhea What is the most common cause of hypercortisolism? - answer-excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? - answer-Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - answer-5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? - answer-age 65 When should breast cancer screening begin and end with a biannual mammogram? - answer-age 50-74 When should colorectal cancer screening stop? - answer-age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? - answer-age 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - answer-Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? - answer-LSIL If a patient has LSIL with a negative HPV test, what would you do? - answer-repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - answer-refer for colposcopy If a patient's pap results show NILM, what should you do? - answer-repeat in 3 years If a patient's pap results show ASC-H or HSIL what should you do? - answer-refer for colposcopy The valgus stress test assesses what? - answer-the medial collateral ligament The varus stress test assesses what? - answer-the lateral collateral ligament Which of the following is the leading cause of cancer-related deaths in the majority of women? A. cervical Cancer B. Ovarian Cancer C. Breat Cancer D. Lung Cancer - answer-D. Lung Cancer A 29-year old male with noncomplicated Chlamidia infection may exhibit: A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer - answer-B. No remarkable clinical symptoms To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: A. The meaning of a common proverb B. What action the patient would take if their was a fire in the house C. To count backwards from 100 by 7s D. To spell a word backward. - answer-A. The meaning of a common proverb A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys. - answer-B. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly. A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3am, is reluctant to go out although she has family member living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A. Stroke, depression, and hyperthyroidism B. Depression, Unresolved grief, and hypothyroidism C. Migraine, anxiety disorder, and hypertension D. Dementia, delirium, and pna - answer-B. Depression, Unresolved grief, and hypothyroidism The parent of a 13-year old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that development of fever may: A. make the seizure medication less effective B. Lower the seizure threshold C. Increase the seizure threshold D. Have no effect on the seizure threshold - answer-B. Lower the seizure threshold After a 3-week camping trip, an 11-year old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A. trimethoprim-sulamethoxazole (Bactrim) B. Azithromycin (Zithromax) C. Metronidazole (Flagyl) D. Doxycycline (Doryx) - answer-D. Doxycycline An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale C. Minnesota Multiphasic Personality Inventory Myers-Briggs Test - answer-A. Folstein Mini-mental state examination During development of a treatment plan for an 84 year old patient with hypothyroidism, the nurse practitioner has to keep in mind the worsening of: A. renal insufficiency B. Osteoporosis C. Dementia D. Anemia - answer-B. Osteoporosis A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She hasn't missed any doses and uses no other medication. Which of the following is appropriate? A. Modifying use B. Double dosing for 2 days C. Changing to Ortho-Novum 1/35 D. Providing reassurance - answer-D. Providing reassurance The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex - answer-B. Prednisone A 50 year old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorthoriazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: A. loratadine B. hydrochlorthoriazide (HCTZ) C. lisinopril (Zestril) D. paroxetine (Paxil) - answer-D. Paroxetine (Paxil) A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid B. Vitamin B12 level C. Hemoglobin Electrophoresis D. 24-hour urine creatinine - answer-C. Hemoglobin electrophoresis A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? A. Nitrazine test B. Non-Stress test C. Ultrasound D. Bimanual cervical exam - answer-C. Ultrasound The common bacteria responsible for pneumonia in older adults residing in the community is: A. Staphylococcus aureus B. Streptococcus pneumoniae C. Pseudomonas Aeruginosa D. Moraxelle catarrhalis - answer-B. Strep Pneumo A 40 year old male patient presents with a 2 week history of rectal pain and itching. He reports a past history of constipation, and finding spots of bright red blood on toilet paper several times a week. Rectal exam reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. Which of the following actions should the nurse practitioner take? A. Prescribe diphenoxylate/atropine( Lomotil) B. Schedule a colonoscopy to rule out colon cancer C. Repeat the guaiac test three times and obtain complete blood count D. Prescribe bulk forming agents and hydrocortisone suppositories. - answer-D. Prescribe bulk forming agents and hydrocortisone suppositories. A 17 year old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: A. BUN, creatinine, electrolytes, and dehydroepiandrosterone(DHEA) B. CBC, BUN, creatinine, and estrone C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone binding globulin D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) - answer-D. FSH, LH, TSH Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? A. Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells B. Squamous epithelial cells with clear cytoplasm and distinct borders, many lactobacillus rods, and occasional WBC C. Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus rods, and many WBC D. Hyphae and spores, few lactobacillus rods, and occasional WBC - answer-Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells. A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? A. edema B. Tachycardia C. Palpitations D. Sweating - answer-D. Sweating A 67-year old with type 2 diabetes mellitus, congestive heart failure, and mild coronary artery disease is currently taking Digoxin, 0.25mg daily; HCTZ, 25mg daily; Metformin 500mg daily; glipizide 10mg daily; and Atorvastatin (Lipitor) 20mg HS. Which of the following is an accurate statement regarding the regimen? A. The glipizide will increase the risk of potassium depletion. B. The digoxin will increase the risk of hypoglycemia C. The HCTZ will predispose the patient to Digoxin toxicity D. The atorvastatin will worsen the diabetes. - answer-C. The HCTZ will predispose the patient to Digoxin toxicity The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula - answer-Smaller, more frequent feedings while holding infant. Which of the following best describes psoriatic lesions in an elderly patient? A. Shiny, purple, smooth lesions B. Localized erythematous vesicles C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales - answer-D. Red, sharply defined plaques with silvery scales A 68-yo female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other lab values are WNL. The headache is most likely due to: A. TIA B. NSAID induced headache C. Temporal arteritis D. Glaucoma - answer-C. Temporal arteritis A patient with Type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: A. Insulin resistance A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The infant's rash is most likely caused by. A. Candida albicans infections. B. Eczema C. Seborrheic dermatitis D. Contact dermatitis - answer-D. Contact dermatitis A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T=100F (37.8C). The patient does not apear toxic and can tolerate fluids. An appropriate plan should include: A. barium enema and nothing by mouth B. Clear liquids and antibiotics C. low-fiber diet and referral to gastroenterologist D. hospital admission for IV antibiotics - answer-B. Clear liquids and antibiotics. Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms - answer-D. absence of residual symptoms A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields - answer-B. In the center of the visual fields. Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck - answer-A. Electric-shock-like unilateral facial pain A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion - answer-C. Heart failure An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize - answer-A. Lateralize to the left. A 38-yo male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A. Testicluar cancer B. Testicular torsion C. Appendicitis D. Epididymitis - answer-B. Testicular Torsion Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen B. Anticholinergic drugs C. Systemic steroids D. Exercise - answer-A. Oxygen A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with alot of burning. The patient has not resumed sexual activity and has menstrated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? A. Urine pregnancy test B. Microscopic exam of urine C. Herpes simplex virus culture D. Repeat chlamydia test. - answer-B. Microscopic exam of urine. 14 year old patient who fell on a outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on xray. The most likely working diagnosis is: A. upper arm sprain B. lateral epicondylitis C. Radial head fracture D. Olecranon bursitis - answer-C. Radial head fracture. Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? A. Urinalysis and urine culture B. Scrotal palpation and urine culture C. Prostate-specific antigen (PSA) D. Complete blood count with differential (CBC with Diff) - answer-A. Urinalysis and urine culture A 39 yo patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of 101.2 and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse practitioner should encourage smoking cessation and prescribe: A. theolphylline B. A PCN antibiotic C. an inhalable corticosteroid D. a macrolide antibiotic - answer-D. A macrolide antibiotic Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection: A. WBC count and viral load B. CD4 count and viral load. C. CD4 count and Western blot test D. CD4 count and enzyme-linked immunosorbent assay (ELISA) - answer-B. CD4 count and viral load The best lab test to distinguish iron deficiency anemia from other anemias is: A. Serum ferritin level B. Mean corpuscular hemoglobin concentration C. Mean corpuscular volume D. Transferrin saturation - answer-A. Serum ferritin level The follow-up exam of a 12 month old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include: A. Consultation with an audiologist B. Prescription for an oral decongestant C. Follow-up evaluation of the ears in 2 months D. Referral to an ENT specialist for surgical consultation - answer-C. Follow-up evaluation of the ears in 2 months. Which of the following lab test should a nurse practitioner order when the suspected diagnosis is temporal arteritis? A. Antinuclear antibody B. Electrolyte profile C. Erythrocyte sedimentation rate (ESR) D. Complete Blood Count (CBC) - answer-C. Erythrocyte Sedimentation Rate (ESR) A 47-yo patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient is not currently taking any medications. The most likely differential diagnoses would include: A. colitis and peptic ulcer disease B. Colitis and small bowel disease C. Gastritis and Crohn's disease D. Gastritis and peptic ulcer disease - answer-D. Gastritis and peptic ulcer disease. To assess spinal function at the S1 level, which deep tendon reflex should be tested? A. Patellar B. Cremasteric C. Achilles D. Anal wink - answer-C. Achilles A 66- yo patient presents with bilateral otis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 x 4. The patient should be evaluated for: A. HIV infection B. Myelodysplastic syndrome C. Congenital lymphoproliferative disease D. non-Hodgkin's lymphoma - answer-A. HIV infection A nurse practitioner is suturing a simple laceration on an 11-yo patient. The use of lidocaine with epinephrine is contraindicated in all of the following areas EXCEPT the: A. Scalp B. Nose C. Fingers D. Earlobe - answer-A. Scalp A common rule to follow when prescribing many medications for the elderly is to: - answer-Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: - answer-the meaning of a common proverb Cremasteric Reflex - answer-a superficial (i.e., close to the skin's surface) reflex observed in human males. This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh- regardless of the direction of stroke. The normal response is an immediate contraction of the cremaster muscle that pulls up the ipsilateral testis. Edema from extravascular fluid retention is visible in conditions like - answer-heart failure, nephrotic syndrome and liver failure. Drugs associated with weight gain include - answer-Tricyclic antidepressants, insulin and sulfonulurea, contraceptives, glucocorticoids, progestational steroids, mirtazapine and paroxetine, gabapentin and valproate and propanolol Causes of weight loss include - answer-GI deases; endocrine disorders (diabetes, hyperthyroidism, adrenal insufficiency); chronic infections, HIV/AIDS; malignancy; chronic cardiac, pulmonary, or renal failure; depression; and anorexia nervosa or bulimia; Appendicitis is a common cause of acute abdominal pain. - answer-Assess for positive McBurney's point tenderness, Rovsing's sign, the psoas sign, and obturator sign. Rovsing's sign - answer-Pain in the RIGHT lower quadrant during LEFT-sided pressure is a positive Rovsing's sign. Indicates appendicitis All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping - answer-D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension - answer-B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria. The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes - answer-B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage - answer-D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? A. Atrophic vaginitis B. Bacterial Vaginosis C. Trichomoniasis D. This is a normal finding. - answer-A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0 (acidic) The most common type of skin malignancy is: A. Squamous cell cancer B. Basal skin cancer C. Melanoma D. Dysplastic nevi - answer-B. Basal skin cancer. It is several times more common that squamous cell skin cancer according to the NIH. Koplik's spots are associated with: A. Poxvirius infections B. Measles C. Kawasaki's disease D. Reye's syndrome - answer-B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa At what level of prevention would you classify for lung cancer? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Primordial prevention - answer-D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention. A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation - answer-A. Peripheral vision What is the most common cause of Cushing's syndrome? - answer-Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to: - answer-Elevate her legs periodically. The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed. A 25-yo female patient presents for a routine well-women exam. On physical exam, the NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph node enlargement. What is the most likely diagnosis? - answer-Itraductal papilloma. Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain. According to the ANA, the role of the NP who provides primary health care is the: - answer-Direct nursing care role. A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP? - answer-Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? - answer-Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT: - answer-Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face. What is the recommended treatment for cat scratch disease? - answer-usually self-limiting and presents with lymphadenopathy that goes away on it's own; severe cases may benefit from azithromycin What is the most common cause of traveler's diarrhea? - answer-e coli What bacteria is responsible for causing cat scratch disease? - answer-bartonella henselae What are the 4 different components of tetralogy of fallot? - answer-overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a ventricular septal defect What does the murmur auscultated in tetralogy of fallot sound like? - answer-systolic murmur best heard at the left upper sternal border What does the murmur auscultated in a ventricular septal defect sound like? - answer-systolic murmur best heard at the left lower sternal border Where is the aorta best auscultated? - answer-at the second ICS to to the right of the sternum Where is the pulmonary artery best auscultated? - answer-at the second ICS to the left of the sternum What is a scotoma? - answer-a blind spot or aura that obstructs part of your vision Is presbyopia nearsightedness or farsightedness? - answer-farsightedness meaning it can be harder to see things up close, such as reading a newspaper and may need to hold it farther away or use reading glasses Is myopia nearsightedness or farsightedness? - answer-nearsightedness meaning it is hard to see things far away Do cataracts cause myopia or presbyopia? - answer-myopia; meaning nearsightedness and they make things blurry that are farther away which is why driving at night becomes difficult What is the USPSTF's recommendation on scoliosis screening for adolescents? - answer-insufficient When should adolescent girls be screened for scoliosis? - answer-as early as 10 years old and then again at age 12 When should adolescent boys be screening for scoliosis? - answer-between age 12-13 What is Auspitz sign? - answer-the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques A positive Auspitz sign is indicative of what? - answer-psoriasis When are pregnant women screening for gestational diabetes? - answer-week 24-28 What is round ligament pain? - answer-a deep, sharp, stabbing or stretching sensation that begins or worsens with movement and can be unilateral or bilateral. This is a normal and benign part of pregnancy What are the components of the fetal biophysical profile? - answer-nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? - answer-via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? - answer-in the third trimester, often after week 28-32 What is a normal kick count in pregnancy? - answer-at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? - answer-28-40 pounds How much weight should a normal weight woman gain in pregnancy? - answer-25-35 pounds How much weight should an overweight woman gain in pregnancy? - answer-15-25 pounds How much weight should an obese woman gain in pregnancy? - answer-11-20 pounds Underweight and normal weight woman should be gaining how much weight per week in their second and third trimesters? - answer-1 pound Overweight and obese women should be gaining how much weight per week in their second and third trimesters? - answer-0.5 pounds Erikson stage from 18 months to 3 years - answer-autonomy vs shame and doubt Erikson stage from 3-5 years - answer-initiative vs guilt Erikson stage from 5-13 years - answer-industry vs inferiority Erikson stage from 13-21 years - answer-identity vs role confusion Erikson stage from 21-39 years - answer-intimacy vs isolation Erikson stage from 40-65 years - answer-generativity vs stagnation Erikson stage for 65 and older - answer-ego integrity vs despair Macrobid/nitrofurantoin is contraindicated in which patients? - answer-those with renal insufficiency Treatment options for complicated UTI - answer-cipro or levo x 5-7 days Treatment options for uncomplicated UTI - answer-bactrim x 3 days, macrobid x 5 days, fosfamycin 1g one time dose Olecranon bursitis is pain in which region of the elbow? - answer-the posterior elbow; will also have swelling and warmth Lateral epicondylitis manifests as what type of elbow pain? - answer-weak grip and pain with gripping, pain with rotation of the wrist and forearm The medical term for golfer's elbow - answer-medial epicondylitis How does the pain in lateral vs. medial epicondylitis differ? - answer-lateral epicondylitis is worse with supination of the hand and medial epicondylitis is worse with pronation of the hand involves tapping a finger along the problem nerve - answer-tinel sign asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists - answer-phalen sign Which nerve runs on the side of the thumb - answer-median nerve Which nerve runs on the side of the pinky finger - answer-ulnar nerve What is ankylosing spondylitis? - answer-an inflammatory condition affecting the spine causing chronic back pain and stiffness that improves with exercise and enthesitis What is the treatment for ankylosing spondylitis? - answer-refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? - answer-chronic pain in the proximal joints (shoulders and hips) bilaterally with stiffness lasting for more than 45 minutes What is the recommended treatment for polymyalgia rheumatica? - answer-PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? - answer-fish, meat, poultry, eggs, and dairy products, also fortified breakfast cereals and fortified nutritional yeasts What is the gold standard for the diagnosis of herpes? - answer-nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? - answer-treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? - answer-chronic htn is present before 20 weeks gestation or 12 weeks after delivery; gestational hypertension is after 20 weeks gestation Which is the recommended diagnostic when a patient has a breast lump? - answer-if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? - answer-urge incontinence What is the recommended treatment for urge incontinence? - answer-anticholinergics like oxybutynin What is the recommended treatment for stress incontinence? - answer-alpha agonists like sudafed, TCAs What is the recommended treatment for BPH? - answer-alpha blockers like terazosin, doxazosin, tamsulosin Alcohol and marijuana worsen which type of incontinence? - answer-urge Which SSRI is safest in pregnancy? Which poses the most risk? - answer-sertraline; paroxetine Infants born to women who smoke are at increased risk for what? - answer-low birth weight and preterm delivery What is the best marker of an acute MI? - answer-troponin When do troponins peak after a MI? - answer-12 hours When should an infant be able to display a conjugate gaze (track you all the way across the room)? - answer-6 months Diphenhydramine has properties and is contraindicated in which patient populations? - answer-anticholinergic; elderly and those with glaucoma The medical term for flat feet - answer-pes planus How does plantar fasciitis usually present? - answer-as pain in the morning with resolution after several steps, but as it worsens the patient will start to complain of heel pain throughout the day and with walking Scope of practice for NPs is not influenced by which entity? - answer-a court of law Used to establish a designated level of professional competence - answer-licensure Treatment of subclinical hypothyroidism is generally not indicated unless the TSH is . - answer-greater than 10 In the presence of an elevated serum TSH, what is the next step in management? - answer-repeat TSH plus free T4 Patients with a history of UC or Crohn's should have a colonoscopy how often? - answer-every 1-5 years due to the increased risk of colorectal cancer What is the first line treatment for community acquired atypical pneumonia? - answer-macrolides such azithromycin. If the pt cannot take a macrolide, then they can do levofloxacin or doxycycline What is metatarsus adductus? - answer-the medical term for in-toeing What is true regarding older adults who are overweight? - answer-mortality in older adults related to overweight states declines over time How do we manage rubella immunity in pregnant women? - answer-we screen all pregnant women with a rubella titer. If they had a protective rubella titer in a previous pregnancy, then they do not need to be checked again. If they are found to not be immune when pregnant, then she should be vaccinated AFTER delivery How is permethrin applied to the skin for scabies? - answer-a one time application to all skin below the neck and then left on for 8-12 hours is sufficient After exposure to HIV, when will the patient seroconvert and become positive? - answer-3 months Is age less than 18 years a risk factor for an ectopic pregnancy? - answer-no; but personal history of PID, an IUD, previous ectopic pregnancy, previous tubal surgery, pathology, or ligation all are risk factors What is Tanner stage 5 of breast development in females? - answer-projection of the nipple only What are two common classes of drugs that interact with grapefruit juice? - answer-statins and CCBs Ankle inversion is a common complaint from a patient with what? - answer-a lateral ankle sprain How can we best diagnose coarctation of the aorta? - answer-by comparing the upper and lower extremity blood pressures What is the most important risk factor for developing breast cancer in women of average risk? - answer- age hey - answer-stopped at top of page 7 What is the recommended treatment for blepharitis? - answer-erythromycin 1cm ribbon 5x daily for 7 days What is the recommended treatment for severe anorexia with delusions? - answer-2nd atypical antipsychotics What lab values need to be monitored in a patient on Tizanidine? - answer-LFTs and BP at baseline and 1 month after the max dose is achieved (can cause hepatotoxicity and hypotension) What class of drug is dabigatran (pradaxa)? - answer-direct thrombin inhibitor The most effective treatments for acne related to increased sebum production are what? - answer-oral contraceptives and isotretinoin Oral contraceptive regimen in which both the estrogen and progesterone concentrations vary throughout the cycle - answer-quadriphasic Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle - answer-monophasic Oral contraceptive regimen in which in the estrogen dose remains the same for the first 21 days of the cycle, while progestin is lower in the first half and higher in the second half - answer-biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies - answer-triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? - answer- treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? - answer-tetracyclines depress prothrombin activity, same as warfarin, so we need to decrease the warfarin to avoid an increase in INR and significant bleeding What is the herbal, valerian root often used for? - answer-insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? - answer-BPH HMO and PPOs are called what? - answer-managed care plans TCAs can cause what worsened problem in a patient with BPH? - answer-urinary retention Signs of a ruptured ovarian cyst - answer-nausea, vomiting, shoulder pain, fever Growing pains often start in what age group? - answer-3-5 What antibiotics are considered safe in pregnancy? - answer-beta lactams (cephalosporins, amox, augmentin), nitrofurantoin, vancomycin, metronidazole, clindamycin, and fosfomycin an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. It occurs when a viral infection, such as an upper respiratory infection, moves to and settles in the hip joint. - answer-transient synovitis HCTZ can cause , whereas ACEI can cause - answer-hypokalemia; hyperkalemia Hyperparathyroidism can cause what? - answer-hypercalcemia and thus, osteoporosis PID should improve after of the antibiotic course. - answer-3 days A loss of the central sulcus of the prostate on DRE is a sign of what? - answer-BPH A woman who gets the MMR vaccine should wait at least before getting pregnant. - answer-4 weeks What is a major cause of cleft palate and lip? - answer-smoking during pregnancy What is Auspitz sign? - answer-the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques Treatment of choice for pyelonephritis - answer-ciprofloxacin When should pediatrics be screened for hyperlipidemia? - answer-between 9 and 11 years old What is the tell-tale symptom of endometriosis? - answer-progressive dysmenorrhea What is treatment for first-line endometriosis? - answer-cyclic OCPs and NSAIDs How is endometriosis diagnosed? - answer-via transvaginal ultrasound What are risk factors for the development of cervical cancer? - answer-HIV, immunocompromised, low socioeconomic status, smoking, hispanic, DES daughters, long term contraceptive use What does the D in melanoma stand for? - answer-greater than 6mm in diameter or 1/4 of an inch Boutonniere deformities are indicative of what disease? - answer-rheumatoid arthritis What are the potassium sparing diuretics? - answer-spironolactone, triamterene, amiloride, eplenerone What class of diuretic is bumetanide? - answer-a loop diuretic, same as lasix What is Chovstek's sign? - answer-a contraction of ipsilateral facial muscles subsequent to percussion over the facial nerve, indicative of hypocalcemia What is Trousseau's sign? - answer-a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer cuff, indicative of hypocalcemia Calcium is in an inverse relationship with what electrolyte? - answer-phosphorous When you see the trigger word "christmas tree", what rash should you consider? - answer-pityriasis rosea What is the recommended treatment for pityriasis rosea? - answer-nothing; it is a viral rash and can last up to two months before clearing on it's own Causing harm or damage - answer-deleterious How do you calculate ideal body weight for men? - answer-start at 106 pounds and then add 6 for every inch above 5 feet How is lichen sclerosus treated? - answer-topical steroids, topical calcineuronin inhibitors to suppress the immune system, topical or oral retinoids, phototherapy What is the tell-tale sign of malignant hypertension? - answer-retinopathy and blurred vision; characterized by a diastolic BP of greater than 130 What is the difference between a Parkinsonian tremor and an essential tremor? - answer-a Parkinson tremor is also known as a resting tremor and is seen at rest, may look like pill-rolling. an essential tremor is bilateral, symmetric and seen when the hands are doing something What can worsen and improve an essential tremor? - answer-worsened by stress or fatigue, improved by alcohol What is first-line treatment for trigeminal neuralgia? - answer-carbamazepine (tegretol) or amtriptyline Are Parkinsonian tremors unilateral or bilateral at first? - answer-unilateral Where is the TMJ best palpated? - answer-anterior to the tragus Antibiotic of choice for dog or cat bite - answer-augmentin Antibiotic of choice for mastitis - answer-keflex Antibiotic of choice for chronic bacterial prostatitis - answer-bactrim plus cipro or levo What is the earliest sign of diabetic nephropathy on labwork? - answer-microalbuminuria in the urine Recommended treatment for verruca (warts) - answer-topical salicylic acid daily x 12 weeks Perineal pain is indicative of what in males? - answer-prostatitis Gestational diabetes screening occurs between what weeks gestation? - answer-24-48 When you ask the patient to take a deep breath in and then palpate over the RUQ abdomen. Positive when pain is elicited. This is a sign of . - answer-Murphy's sign; cholecystitis What are names of LABA medications? - answer-salmeterol What is encopresis in children? - answer-stool incontinence after the age of being toilet trained The medical term for being cross-eyed - answer-strabismus What is atopic dermatitis? - answer-eczema Tests used to diagnose developmental hip dysplasia - answer-Barlow and Ortolani maneuvers What is the female athlete triad? - answer-disordered eating, amenorrhea, osteoporosis How do patients with aortic regurgitation typically present? - answer-they will have a long asymptomatic period followed by exercise intolerance, then dyspnea at rest. The left ventricle eventually fails unless the aortic valve is replaced. What does the rash of fifth disease (a viral exanthem) look like? - answer-maculopapular rash that blanches easily and may be accompanied by joint aches What cardiac abnormalities are expected to be heard on auscultation of a pregnant patient? - answer-a venous hum murmur and an S3 When a headache accompanies a stroke, is this most often hemorrhagic or ischemic? - answer- hemorrhagic AV nicking is most commonly seen on retinal exam of which chronic condition? - answer-hypertension Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs? - answer- weight gain When does otitis media with effusion usually occur? - answer-either before or after an episode of acute otitis media. This effusion is not infected fluid but it is considered a breeding ground for bacteria. This should not be treated with antibiotics. The medical term for jock itch - answer-tinea cruris Tinea cruris "jock itch" is a common infection and should be treated with what? - answer- fungal; OTC antifungal cream What are teaching points for males to avoid contracting tinea cruris? - answer-dry off after swimming and don't stay in a wet bathing suit Tinea cruris can affect the inner thighs but never what else? - answer-the penis or scrotum On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? - answer- cocci and rods On microscopic exam, what is most likely to be seen in the presence of a candidal infection? - answer- yeasts What are dermatophytes? - answer-fungi On microscopic exam, what is most likely to be seen in the presence of a dermatophytic (fungal) infection? - answer-hyphae that are long, thin, and branching (such as in the case of tinea pedis, tinea cruris, and tinea corporis) The medical term for ringworm - answer-tinea corporis What is the most common cause of viral pneumonia in peds? - answer-RSV Viral pneumonia is the most common type of pneumonia in children of what ages? - answer-6 months to 5 years What is the simplest way to screen for nutritional adequacy in older adults? - answer-measure their weight How are scabies treated? - answer-via permethrin and good hygiene What are common side effects of NSAIDs? - answer-renal impairment, acute renal failure, gastritis What is the most common cause of pernicious anemias? - answer-vitamin B12 deficiency How should oral iron supplements be taken? - answer-on an empty stomach with something acidic and high in calcium such as orange juice What happens to a womans vital signs when she is in her second trimester of pregnancy? - answer-her blood pressure decreases What is the most common cause of acute pharyngitis in children? - answer-respiratory viruses A depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response? - answer-8-12 weeks If the number of bacteria on a urinalysis are greater than , this is indicative of a UTI. - answer-100,000 What are signs of a ruptured TM other than the obviously ruptured TM? - answer-muffled hearing and bright red blood in the canal Osgood Schlatter disease produces pain where? - answer-in the knees Growing pains usually occur when? - answer-at nighttime Children with complaints of midbone pain should be worked for what MNM differential? - answer-acute lymphocytic leukemia NSAIDs should be used in caution with what patient population? - answer-anyone with hypertension because they cause sodium retention and increase blood pressure What is the most common cause of secondary dysmenorrhea? - answer-endometriosis; symptoms include spotting in between periods, cervical stenosis or displacement, nodular or tender uterosacral ligaments When should AAA screening be performed via US? - answer-once for all males age 65-75 who have ever smoked What is responsible for the transmission of poison ivy? - answer-the oils from the plant itself. So the only way someone can pass it on to another person is if they still have oil from the plant on their skin (like if they haven't bathed). Note that the fluid inside the blisters is not contagious Actinic keratosis is a precursor for what? - answer-squamos cell carcinoma What is papilledema? - answer-swelling of the optic nerve and disc secondary to increased ICP. Often co- occurring with a headache Is sexual activity safe during pregnancy? - answer-it can expose someone to STDs and it can also stimulate preterm labor due to stimulation of the lower uterine segment and release of oxtocin A report of "knee locking" is a classic complaint of what? - answer-a meniscal tear Can a pregnant woman be on levothyroxine during pregnancy? - answer-yes, she should continue it and have TSH checked monthly because she may need a higher dose as thyroid hormone needs increase during pregnancy What characterizes mild persistent asthma? - answer-asthma where symptoms occur more than twice weekly People who do not have a spleen (asplenic) are at a greater risk of what? - answer-more susceptible to bacterial infections What 2 things put someone at the highest risk of developing pancreatitis? - answer-gallstones and alcohol abuse. Hypertriglyceridemia can also cause it. What are the RF for GI bleeding? - answer-age 75 or older, warfarin use, daily NSAID use, chronic steroid use, PMHx of GI bleed When two or more RF for a GI bleed are present, we should not start a patient on aspirin without what? - answer-a daily PPI What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy? - answer-nitrofurantoin Athletic amenorrhea increases one's risk of developing what? - answer-osteoporosis; this is because there is a loss of body fat and body fat is what produces estrogen so estrogen levels decline An intervention being performed to prevent the occurrence of the same event happening again is an example of prevention. Give an example. - answer-secondary; taking a daily aspirin to prevent another stroke after already having one What is Strattera (atomoxetine) used for? - answer-ADHD; side effect includes increased BP and HR so monitor closely What is the drug Danazol and what is it used for? - answer-an androgen used in the treatment of endometriosis and fibrocystic breast disease Danazol, an androgen, has what potential side effects? - answer-edema, hirsutism, hair loss, vocal changes The Mirena (Levonorgestrol) IUD stays in for how long? - answer-5 years What is the most common reason for persistent gonorrhea infections? - answer-failure of the patient to abstain from unprotected sexual intercourse What class of drug is theophylline? What does it do? - answer-methylxanthine; it's a bronchodilator Beta blockers are contraindicated in which cardiovascular condition? - answer-variant (prinzmetal) angina bc they may induce coronary vasospasm from unopposed alpha receptor activity What class of drug is Ropinirole (requip) and what is it used for? - answer-dopamine agonist; restless leg syndrome Seborrheic dermatitis is basically the same thing as what? - answer-eczema of the scalp The flow of air coming in and out of the lungs in one inhalation and one exhalation - answer-peak expiratory flow What does an incentive spirometer measure? - answer-peak expiratory flow What happens in the luteal phase of the menstrual cycle? - answer-LH and FSH decrease, the ruptured follicle closes after an egg has been released and forms the corpus luteum, which produces progesterone. Estrogen and progesterone remain high and it is those two things that cause the lining of the uterus to thicken further in preparation for fertilization What is a sign of the initial appearance of measurable histamines in a patient with allergic rhinitis? - answer-sneezing The bacteria responsible for syphilis is called what? - answer-treponema pallidum The STI, chancroid, is caused by what responsible bacteria? - answer-haemophilus ducreyi What is the most common cause of septic arthritis? - answer-staph aureus The STI, mycoplasma genitalium, is unique in what way? - answer-it lacks a cell wall and has a terminal tip-like structure which allows it to attach to and enter other cells. It then modulates the host's immune response What are the 3 secondary causes of type 2 diabetes? - answer-prolonged physical or emotional stress, pregnancy, drugs such as steroids and hormonal contraceptives How does hyperinsulinemia in PCOS work? - answer-insulin resistance occurs in all places except for the ovary which remains sensitive to insulin. This insulin upregulates androgen production. Which drug classes are responsible for causing urinary retention? - answer-antihistamines, TCAs, antispasmodics, bronchodilators, antipsychotics, carbidopa levodopa A 75 year old patient is experiencing progressive confusion and memory deterioration. Which condition mimics dementia that this patient should be tested for? - answer-neurosyphilis Which hormones in late pregnancy can block insulin and cause gestational diabetes? - answer-cortisol, estrogen, and placental lactogen Target shaped skin lesions as a result of a hypersensitivity reaction to certain infections and drugs - answer-erythema multiforme An abnormal growth of squamos epithelium in the middle ear and mastoid - answer-cholesteatoma The cremasteric reflex is assessed in infants for what purpose? - answer-to assess for retractile testicles; this occurs when the reflex is too strong and it pulls the testicle out of the body and into the groin; this is normal and should go away by puberty Patient populations who may present atypically when having a MI include who? - answer-diabetics, females, elderly A disorder that results in the destruction of platelets due to an autoimmune response - answer- idiopathic thrombocytopenia purpura Pelvic inflammatory disease is most commonly caused by what? - answer-chlamydia and gonorrhea A protruding abdominal mass after bending over, lifting, or coughing, and is painful with coughing, is often what in adults? - answer-inguinal hernia Hiatal hernias cause what type of symptoms? - answer-GERD What is the name of an immature female gamete? - answer-oocyte The fused ovum and sperm once fertilization has occurred - answer-zygote What are conditions that are often co-occurring with alopecia areata? - answer-atopic dermatitis, vitiligo, thyroid disease, collagen-vascular diseases, Down syndrome The medical term for eczema - answer-atopic dermatitis The leading cause of death in infants under the age of 1 - answer-sudden unexplained infant death How is varicella zoster transmitted? - answer-via the respiratory tract The presence of pruritic papules, macules, and vesicles in various stages of healing - answer-varicella zoster What is presbycusis? - answer-age related hearing loss Age is the most common cause of presbycusis, but what other conditions may play a role in quickening the onset of this? - answer-white, infections, smoking, hypertenson, diabetes, vascular disease, immune disorders, hormonal factors The fascia layer of the male anatomy that the anterior 2/3s of the testicle resides in - answer-tunica vaginalis A subtype of strabismus that describes an inward turning of the eye - answer-esotropia The abducens nerve (CN VI) is responsible for what? - answer-lateral movement of the eye outward The trochlear nerve is responsible for what extraocular movement? - answer-down and inward movement Are the sickling of RBCS in sickle cell anemia reversible? - answer-initially, yes they are reversible with oxygenation. But repeated episodes cause the cells to become irreversibly sickled. When the brain is exposed to something rewarding, it responds by increasing the release of what? - answer-dopamine Where are T cells produced? - answer-in the thymus Where are B cells produced? - answer-in the bone marrow What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)? - answer-T3 and T4 are overproduced which leads to increased production of epinephrine and severe hypermetabolism What causes a reduction in the number of RBCs in pregnancy? - answer-iron deficiency anemia due to blood volume expansion and a decrease in hemoglobin levels so the iron stores are depleted because they are needed to be used for the expanded blood volume When should the ductus arteriosus close in an infant? - answer-within the first 1-2 days of birth The minimum arterial pressure exerted during relaxation and dilation of the ventricles - answer-diastole Lyme disease is caused by what spirochete present on ticks? - answer-borrelia burgdorfei What are the potential sequelae of strep pharyngitis? - answer-acute glomerulonephritis, peritonsillar abscess, toxic shock disease, rheumatic heart disease (although rare) The medical term for pubic lice aka crabs - answer-phthirus pubis Petechiae noted on the cervix during a pelvic exam is a sign of what disease process? - answer- trichomoniasis; also called "strawberry cervix" What is the difference between a folliculitis and a furuncle? - answer-folliculitis is an inflammation of the follice whereas a furuncle is an abscess that results from folliculitis Urea is eliminated by the kidneys, but where does it come from originally? - answer-from the liver as a byproduct of protein metabolism What are the 5 primary structures of the immune system? - answer-lymph nodes, thymus, tonsils, spleen, bone marrow Bacteria most commonly responsible for pyelonephritis - answer-e coli What causes back pain in pregnancy? - answer-curvature of the lumbosacral vertebrae What is dacrocystitis? - answer-inflammation of the nasolacrimal duct due to duct obstruction or infection What are potential causes of blepharitis? - answer-bacterial infection, dry eyes, rosacea What are s/s of croup? - answer-hoarseness, cough, inspiratory stridor, possible respiratory distress due to narrowing of the larynx Women who become pregnant later in life have an increased risk of what? - answer-breast cancer What are things women can do to decrease their risk of breast cancer? - answer-regular physical activity, breastfeeding Does an increase or decrease in blood pH affect the rate and degree of sickling in sickle cell anemia? - answer-a decrease in blood pH increases the rate What is the difference between Prinzmetals and stable (classic angina)? - answer-Prinzmetals may occur randomly and while at rest, whereas stable angina is usually only with physical activity Why may infection of the palatine tonsils become serious very quickly? - answer-the area is composed of loose connective tissue What are cutaneous xanthomas? - answer-localized lipid deposits caused by elevated lipids or LDL Uterine prolpase is caused by stretching of the uterine - answer-ligaments What causes bacterial vaginosis? - answer-a decrease in lactobacillus species within the vagina Where is acanthosis nigricans most likely to occur? - answer-axillae, neck, groin What causes subjective tinnitus? - answer-abnormal neuronal activity HIV produces cellular immunity deficiency by depleting what? - answer-helper T cells What is the function of B cells in the immune system? - answer-development of antibodies When does the male fetus begin to produce testosterone and how? - answer-around 9 weeks gestation due to the Leydig cells What is the pathophys of Addison's disease? - answer-causes decreased or absent aldosterone levels resulting in increased excretion of sodium and water by the kidneys, and hyperkalemia What is the most serious complication of Addison's disease? - answer-acute adrenal insufficiency or adrenal crisis What are the 4 heart defects of Tetralogy of Fallot? - answer-VSD, right ventricular hypertrophy, overriding aorta, pulmonary stenosis What are the s/s of Kawasaki disease? - answer-think CREAM; conjunctivitis, rash, erythema of hands and soles of feet, adenopathy (cervical), mucous membranes (strawberry tongue) International travelers to endemic areas are at a risk for what form of hepatitis? - answer-hepatitis A because it can be transmitted through contaminated food or drink Adrenarche is the early presence of pubic hair in girls aged - answer-5-8 years old A condition that presents with symptomatic limb ischemia upon exertion is termed: - answer- atherosclerotic peripheral arterial disease The largest salivary gland is the parotid gland, and where does it drain to? - answer-Stensen's duct which has an opening on the buccal mucosa opposite the second molar The varus stress test assesses for a tear in which part of the lower extremities? - answer-lateral meniscus The valgus stress test assesses for a tear in which part of the lower extremities? - answer-medical meniscus To evaluate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen where? - answer-about midway betwee the umbilicus and symphysis pubis while elevating the cervix and uterus with the other hand A feeling of constantly needing to pass stool - answer-tenesmus Severe constipation resulting from intestinal obstruction - answer-obstipation What does the vaginal discharge associated with trich look like? - answer-profuse, yellowish green that is malodorous What does the discharge associated with bacterial vaginosis look like? - answer-gray or white, thin, malodorous (fishy) and not profuse The nurse practitioner instructs the patient to place on hand behind his back and touch his shoulder blade. This shoulder movement elicits what? - answer-internal rotation How do we test for flexion and extension of the shoulder? - answer-extension is asking the patient to move their arm behind themself. Flexion is asking the patient to move their arm in front of the body Symptoms related to Shaken Baby Syndrome are due to what? - answer-uncontrollable cerebral edema and hypoxia What are the symptoms of Shaken Baby Syndrome? - answer-blindness, inability to perform previously learned milestones, flaccid muscle tone Koplik's spots are indicative of what disease? - answer-measles (rubeola) The medical term for measles - answer-rubeola What do Koplik's spots of measles look like? - answer-small white specks that resemble grains of salt on a red background Round or oval shaped lesions surrounded by erythematous mucosa found anywhere on the oral mucosa - answer-aphthous ulcers Excessive or prolonged menstrual flow occurring at regular intervals - answer-menorrhagia Intermenstrual bleeding (aka spotting in between periods) - answer-metrorrhagia Polymenorrhea is when there are fewer than between periods - answer-21 days Oligomenorrhea is when there are more than between periods; or only 4-9 menstrual cycles per year - answer-35 days Retraction of the nipple and areola are suggestive of what? - answer-an underlying breast mass; this is never considered normal What is the straight leg raise test? - answer-used to evaluate for sciatica; the NP raises the straight leg while flexing the hip and then dorsiflexes the foot. Positive if pain is elicited. What is Tinel's sign? - answer-positive for carpal tunnel; the NP taps over the median nerve and is positive if n/t is felt What is Phalen's sign? - answer-positive for carpal tunnel; patient holds their wrists together to form right angles for 60 seconds and is positive if n/t is felt Test used to identify de Quervain's tenosynovitis - answer-Finkelsteins test Test of thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation - answer-Finkelsteins test What does the murmur associated with mitral regurg sound like? - answer-pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla When auscultating the apex of the heart in a child older than 7, the bell of the stethoscope should be placed where? - answer-fifth intercostal space to the left of the midclavicular line; if younger than 7, it is best heard at the third or fourth intercostal space What is the main sign of Kaposi's sarcoma? - answer-raised or flat deep purple lesions in the mouth Where do lesions of Kaposi's sarcoma usually manifest? - answer-in the mouth, GI tract, or lungs A patient is experiencing a dull achy pain in the epigastric area with eating. This type of pain is consistent with what? - answer-a gastric ulcer Which segments of the spine control the plantar reflexes? - answer-lumbar 5 and sacral 1 A softening of the skin at the angles of the mouth which may be due to nutritional deficiency - answer- angular cheilitis Angular cheilitis can be caused by what? - answer-nutritional deficiency What causes actinic cheilitis? - answer-excessive exposure to sunlight; most often affects the lower lip Intention tremors appear with movement and worsen when? - answer-as the target gets closer Nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event - answer-vasovagal syncope Which conditions are known to cause polyuria? - answer-lithium toxicity, uncontrolled diabetes, disorders of the posterior pituitary and hypothalamus (hypogonadism), and hypokalemic nephropathy Breath sounds heard over the periphery of the lung fields are what? - answer-vesicular; they are quiet and wispy What do bronchovesicular breath sounds sound like? - answer-full inspiratory phase with a shortened and quieter expiratory phase Thenar atrophy suggests what? - answer-a median nerve disorder Does the ulnar nerve innervate the pinky or the thumb? - answer-pinky The pregnant woman who has a BMI of less than 18.5 should gain how many pounds in pregnancy? - answer-28-40 pounds The pregnant woman who has a BMI of 18.5-24.9 (normal) should gain how many pounds in pregnancy? - answer-25-35 pounds The pregnant woman who has a BMI of 25-29.9 (overweight) should gain how many pounds in pregnancy? - answer-15-25 pounds The pregnant woman with a BMI over 30 should gain how many pounds in pregnancy? - answer-11-20 pounds A BMI of less than is considered underweight - answer-18.5 The term used to refer to skin that is peeling - answer-exfoliation What will a basal cell carcinoma on the eyelid look like? - answer-papule with an ulcerated center, most often on the lower lid and medial canthus What is Rovsing's sign? - answer-positive for appendicitis; palpation on the LLQ elicits pain in the RLQ What causes plantar warts? - answer-human papillomavirus; usually occur on the sole of the foot In second degree uterine prolapse, where is the cervix located? - answer-at the introitus In third degree uterine prolapse, where is the cervix located? - answer-both the cervix and vagina are outside the introitus The anterior cervical lymph node chain is located where? - answer-anterior and superficial to the sternocleidomastoid muscle How do we diagnose a migraine headache? - answer-if 3 of the 5 POUND symptoms are present: pulsatile or throbbing, one day duration or 4-72 hours if left untreated, unilateral, nausea or vomiting, disabiling or intense causing interruption of daily activity What causes the S4 sound? - answer-the atrium forcefully contracting against a stiffened ventricle During the vaginal exam of a pregnant woman in her first trimester, an adnexal mass with tenderness is palpated. This is consistent with what? - answer-an ectopic pregnancy Stridor indicates a partial or complete obstruction of the and is best heard where? - answer- larynx; neck When assessing an african american person, black, dusky mucous membranes are related to what - answer-cyanosis Persistent, sharp, and knife-like chest pain is indicative of what? - answer-pericarditis or pleuritic chest pain Thin, pencil-like stool can be associated with what? - answer-a lesion in the sigmoid colon An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive of what? - answer-tracheobronchitis The shiny, pink area located around the cervical os is known as what? - answer-squamos epithelium Tenderness of the posterior medial malleolus may be a sign of what? - answer-tibial tendinitis When performing a rectal exam on a female, a hard nodular rectal "shelf" is palpable at the tip of the examiner's finger. What is this suggestive of? - answer-metastatic tissue in the rectouterine pouch Which of these instructions should a nurse include in the teaching plan for a client who had removal of a cataract in the left eye? a. "Forcefully cough and take deep breaths every two hours to keep your airway clear." b. "Perform the prescribed eye exercises each day to strengthen your eye muscles." c. "Rinse your eyes with saline each morning to prevent postoperative infection." d. "Take the prescribed stool softener to avoid increasing intraocular pressure." - answer-d. "Take the prescribed stool softener to avoid increasing intraocular pressure." a. flushed skin and thirst. b. irritability and hunger. c. sweating and jitteriness. d. lethargy and tremors. - answer-a. flushed skin and thirst. A client has shortness of breath when lying down and usually assumes an upright or sitting position in order to breathe more comfortably. A nurse should document this observation as: a. dyspnea. b. bradypnea. c. orthopnea. d. apnea. - answer-c. orthopnea. Which of these menus, if chosen by a parent of a child who has celiac disease, would indicate to a nurse that the parent understands the teaching about a gluten-free diet? a. Broiled steak, baked potato, and spinach. b. Pork chop, egg noodles, and green peas. c. Fried chicken, white roll, and mixed vegetables. d. Baked macaroni with cheddar cheese and corn. - answer-a. Broiled steak, baked potato, and spinach. Which of these nursing measures is the priority for a child who has hemophilia and who sustains a leg injury? a. Ensuring adequate hydration for the child. b. Soaking the child's injured leg in warm water. c. Administering the missing factor VIII to the child. d. Transfusing one unit of whole blood to the child. - answer-c. Administering the missing factor VIII to the child. Which of these laboratory test results is more important for a nurse to assess for a client who reports chest pain? a. WBC count. b. PTT level. c. Troponin level. d. Hemoglobin. - answer-c. Troponin level. A nurse should explain to a primigravida that urine tests will be done at each prenatal visit throughout the pregnancy to measure: a. specific gravity and pregnancy hormones. b. culture and white blood cell count. c. glucose and protein. d. bacteria and red blood cell count. - answer-c. glucose and protein. Which of these manifestations should a nurse expect to observe in a client who is diagnosed with paranoid schizophrenia? a. Regression. b. Suspiciousness. c. Catatonia. d. Hyperactivity. - answer-b. Suspiciousness. Which of these assessments is the priority for a client who is admitted with recurrent depression? a. Previous episodes of depression. b. Compliance with prescribed medications. c. Presence of a suicide plan. d. Problems with communication. - answer-c. Presence of a suicide plan. Which of these changes in the assessment data of a child who has congestive heart failure should a nurse recognize as indicative of a therapeutic response to prescribed medication therapy? a. Increased weight. b. Increased urine output. c. Increased respiratory rate. d. Increased heart size. - answer-b. Increased urine output. A client who has a history of asthma develops an acute asthma attack. Which of these questions should a nurse ask when assessing the etiology of this attack? a. "Have you eaten any new foods recently?" b. "How many hours did you sleep last night?" c. "Are you exercising every day?" d. "Have you reduced your fluid intake recently?" - answer-a. "Have you eaten any new foods recently?" Which of these foods should a nurse suggest that a client who is diagnosed with iron-deficiency anemia choose for dinner? a. Cooked dry beans, green leafy vegetables, and dried fruits. b. Raw cabbage, tomato juice, and cantaloupe. c. Fresh fish, peanut butter, and oatmeal. d. Cheddar cheese, enriched bread, and yellow vegetables. - answer-a. Cooked dry beans, green leafy vegetables, and dried fruits. A child is brought to the clinical for serum lead screening because of ingestion of lead-based paint. Which of these manifestations, if present in the child, would indicate early signs of lead toxicity? a. Convulsive seizures. b. Behavior changes. c. Bleeding tendencies. d. Low-grade fever. - answer-b. Behavior changes.