APEA Pre-Predictor Test Questions and Answers with Rationales 2024/2025 \A+ Graded, Exams of Community Health

Download APEA Pre-Predictor Test Questions and Answers with Rationales 2024/2025 \A+ Graded and more Exams Community Health in PDF only on Docsity! APEA Pre-Predictor Test Questions and Answers with Rationales 2024/2025 \A+ Graded Cranial Nerve VIII - Acoustic (Hearing and balance) Cranial nerve IX - Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI - Spinal Accessory (upper trapezius) Deep tendon reflex - Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7 Stroke risk scale - CHADS2 C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines - A. First Molars 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 - 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 - 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 - 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 - 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. - 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 - 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 - B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2 receptors (bronchial and vascular) are blocked. Beta blockers, specifically atenolol, are beneficial post-myocardial infarction because they have demonstrated a reduction in morbidity and mortality. All of the following interventions with pediatric patients are appropriate EXCEPT: - Pre- medicate the patient prior to all painful interventions. Pre-medication is not warranted prior to all painful interventions. For example, premedication is not warranted prior to routine immunizations but it certainly is prior to suturing. Pain management should be an integral part of patient management. Infants with veliac disease (gluten eneteropathy) are at risk for multiple complications. The most urgen complication of this disease is: - Intususseption or volvulus. Intuseusseption and volvulus are surgical emergencies. Delay releasing the invaginated or "telescoped" bowel (intususseption), or releasing the twisted bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis, and/or sepsis, and fatality. There is also a high rate of intususseption and volvulus among infants with cistic fibrosis. Which activities are NOT characteristic of preschool children? - Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed- wetting is not unusual. The use of a security item such as a blanket is common. 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? - 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? - 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 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? - 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? - 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: - 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: - 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? - 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? - 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: - 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? - 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? - 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. - A sterile in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate between bladder, kidney, or prostate site infection. The sequence for obtaining specimens when prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3. voided post-prostate massage urine. A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the nurse practitioner advise her to do to minimize her risk of pregnancy? - Double today's dose and tomorrow's dose and use a barrier method for the rest of the month. If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled and a barrier method recommended for the remainder of the cycle. A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum specimen is collected and sent for culture and sensitivity. What action should the nurse practitioner take today? - Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days. Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and 60 years of age or younger, recommend erythromycin or another macrolide like Biaxin. Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended for Legionella species. 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: - 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? - 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? - 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: - 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: - 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. 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: - 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? - 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? - e coli What bacteria is responsible for causing cat scratch disease? - bartonella henselae What are the 4 different components of tetralogy of fallot? - overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a ventricular septal defect What does the murmur auscultated in tetralogy of fallot sound like? - systolic murmur best heard at the left upper sternal border What does the murmur auscultated in a ventricular septal defect sound like? - systolic murmur best heard at the left lower sternal border Where is the aorta best auscultated? - at the second ICS to to the right of the sternum Where is the pulmonary artery best auscultated? - at the second ICS to the left of the sternum What is a scotoma? - a blind spot or aura that obstructs part of your vision Is presbyopia nearsightedness or farsightedness? - 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? - nearsightedness meaning it is hard to see things far away Do cataracts cause myopia or presbyopia? - 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? - insufficient When should adolescent girls be screened for scoliosis? - as early as 10 years old and then again at age 12 When should adolescent boys be screening for scoliosis? - between age 12-13 What is Auspitz sign? - 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? - psoriasis When are pregnant women screening for gestational diabetes? - week 24-28 What is round ligament pain? - 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? - nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? - via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? - in the third trimester, often after week 28-32 What is a normal kick count in pregnancy? - at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? - 28-40 pounds How much weight should a normal weight woman gain in pregnancy? - 25-35 pounds Treatment options for uncomplicated UTI - bactrim x 3 days, macrobid x 5 days, fosfamycin 1g one time dose Olecranon bursitis is pain in which region of the elbow? - the posterior elbow; will also have swelling and warmth Lateral epicondylitis manifests as what type of elbow pain? - weak grip and pain with gripping, pain with rotation of the wrist and forearm The medical term for golfer's elbow - medial epicondylitis How does the pain in lateral vs. medial epicondylitis differ? - 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 - tinel sign asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists - phalen sign Which nerve runs on the side of the thumb - median nerve Which nerve runs on the side of the pinky finger - ulnar nerve What is ankylosing spondylitis? - 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? - refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? - 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? - PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? - 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? - nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? - treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? - 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? - if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? - urge incontinence What is the recommended treatment for urge incontinence? - anticholinergics like oxybutynin What is the recommended treatment for stress incontinence? - alpha agonists like sudafed, TCAs What is the recommended treatment for BPH? - alpha blockers like terazosin, doxazosin, tamsulosin Alcohol and marijuana worsen which type of incontinence? - urge Which SSRI is safest in pregnancy? Which poses the most risk? - sertraline; paroxetine Infants born to women who smoke are at increased risk for what? - low birth weight and preterm delivery What is the best marker of an acute MI? - troponin When do troponins peak after a MI? - 12 hours When should an infant be able to display a conjugate gaze (track you all the way across the room)? - 6 months Which medication is approved in Peds for the prevention of febrile seizures? - diazepam Folic acid is which vitamin? - vitamin B9 What is the dosage preferred for folic acid deficiency? - 1-5mg daily Dosage of folic acid in pregnancy to prevent neural tube defects - 400mcg daily What are ECG changes you may see on a patient with hypokalemia? - tachyarrhythmas, ST depression, prolonged QT, and U wave present What are ECG changes you may see on a patient with hyperkalemia? - peaked T waves A U wave present on EKG is thought to represent what? - repolarization of the purkinje fibers What is considered legal blindness? - 20/200 or worse What is the pain of temporal arteritis like? - new onset headache, jaw pain with chewing Are nexplanon and norplant (levonorgestrol) combined contraceptives or progesterone only? - progesterone only Breastfeeding women cannot have which type of anti-contraceptive? - anything with estrogen in it; this includes things like cocps What is the treatment of choice for community acquired, uncomplicated pneumonia? - amoxicillin Vitamin B12 deficiency anemia is a type of ____________ anemia. - pernicious; macrocytic Prostate infection or inflammation can cause a sharp rise in PSA values. When should this value go back down to normal levels and be checked after an acute infection? - 4 weeks The most common cause of atypical pneumonia in adults - mycoplasma pneumoniae An herbal supplement thought to help BPH - saw palmetto A male patient presents to your clinic with a lump in his breast. How should we work this up? - clinical breast exam, mammogram, AND ultrasound If a patient with strep comes back after 48 hours with no improvement on antibiotics, what should you then prescribe? - a penicillin or cephalosporin with beta lactamase coverage How long must a tick be attached to the skin in order for Lyme disease to be transferred? - 48 hours When should kids be treated for hypertension? - if they also have diabetes, are symptomatic, have hypertension > 95th percentile, or when end organ damage is present ACEIs can cause what electrolyte abnormality? - hyperkalemia A positive "drop arm" test is a sign of what? - torn rotator cuff The medical term for spoon shaped nails - koilonychia 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 - biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies - triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? - treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? - 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? - insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? - BPH What is the herbal, black kohosh, often used for? - symptoms of menopause - hot flashes What is the herbal, St. John's wart, often used for? - depression What are the intrauterine transplacental infections that can be passed from mother to infant? - think TORCH; toxoplasmosis, Other (syphilis, varicella zoster, parvovirus) Rubella, Cytomegalovirus and Herpes simplex, as well as tuberculosis. Note that chlamydia is NOT transplacental, but rather transvaginal during childbirth The antibiotic of choice for a dog bite - augmentin; doxy if there is a penicillin allergy Obese women should gain how much weight during pregnancy? - 11-20 pounds Overweight women should gain how much weight during pregnancy? - 15-25 pounds Normal weight people should gain how much weight during pregnancy? - 25-35 pounds Underweight people should gain how much weight during pregnancy? - 28-40 pounds Pregnant women should increase their daily caloric intake by how many calories per day? - 300 Immunizations are considered to be what level of prevention? - primary Children can start to ride a tricycle around age _____ - 3 A gray or white ring present around the peripheral iris - arcus senilis What causes arcus senilis? - it is a normal, benign condition with aging, but can also occur in younger people as a result of high cholesterol and triglycerides How is a diagnosis of neuroblastoma confirmed? - via serum catecholamine testing and a biopsy Are saturated or unsaturated fatty acids better for you? - unsaturated Which patient populations are thalassemias most common in? - mediterranean countries (greece and turkey), asia, africa Is Meniere's disease most often unilateral or bilateral? - unilateral What type of hearing loss occurs in Meniere's disease? - sensorineural Dix Hallpike maneuver is the standard clinical test for _______ - BPPV How do we test cerebellar function? - rapid alternating movements, finger to nose test, balance (romberg), gait The first sign of puberty in girls - thelarche (breast budding) When the uterine lining grows in to the uterine muscle wall - adenomyosis; this is often asymptomatic and may result in heavier periods What are the 4 components of Tetralogy of Fallot? - VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy What does the murmur of Tet of Fallot sound like? - harsh systolic murmur at the left upper sternal border What is a tet spell? - when the child turns blue during crying or feeding How do we treat thrush in infants? - application of nystatin to inside of the mouth, sterilize all pacifiers and bottle nipples; a topical antifungal may be applied to the nipples HMO and PPOs are called what? - managed care plans TCAs can cause what worsened problem in a patient with BPH? - urinary retention Signs of a ruptured ovarian cyst - nausea, vomiting, shoulder pain, fever Growing pains often start in what age group? - 3-5 What antibiotics are considered safe in pregnancy? - 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. - transient synovitis HCTZ can cause _________, whereas ACEI can cause _________ - hypokalemia; hyperkalemia Hyperparathyroidism can cause what? - hypercalcemia and thus, osteoporosis PID should improve after ____ of the antibiotic course. - 3 days A loss of the central sulcus of the prostate on DRE is a sign of what? - BPH A woman who gets the MMR vaccine should wait at least __________ before getting pregnant. - 4 weeks What is a major cause of cleft palate and lip? - smoking during pregnancy What is Auspitz sign? - 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 - ciprofloxacin When should pediatrics be screened for hyperlipidemia? - between 9 and 11 years old What is the tell-tale symptom of endometriosis? - progressive dysmenorrhea What is treatment for first-line endometriosis? - cyclic OCPs and NSAIDs How is endometriosis diagnosed? - via transvaginal ultrasound What are risk factors for the development of cervical cancer? - HIV, immunocompromised, low socioeconomic status, smoking, hispanic, DES daughters, long term contraceptive use What does the D in melanoma stand for? - greater than 6mm in diameter or 1/4 of an inch Boutonniere deformities are indicative of what disease? - rheumatoid arthritis Antibiotic of choice for chlamydia - azithromycin Antibiotic of choice for syphilis - penicillin G Antibiotic of choice for bacterial vaginosis - flagyl Antibiotic of choice for trichomoniasis - flagyl Antibiotic of choice for acute prostatitis - cipro (or ceftriaxone if STI related) Antibiotic of choice for PID - ceftriaxone and doxycycline Antibiotic of choice for pyelonephritis - cephalexin or bactrim Antibiotic of choice for MRSA - bactrim, clindamycin, doxycycline Antibiotic of choice for dog or cat bite - augmentin Antibiotic of choice for mastitis - keflex Antibiotic of choice for chronic bacterial prostatitis - bactrim plus cipro or levo What is the earliest sign of diabetic nephropathy on labwork? - microalbuminuria in the urine Recommended treatment for verruca (warts) - topical salicylic acid daily x 12 weeks Perineal pain is indicative of what in males? - prostatitis Gestational diabetes screening occurs between what weeks gestation? - 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 ___________. - Murphy's sign; cholecystitis What are names of LABA medications? - salmeterol What is encopresis in children? - stool incontinence after the age of being toilet trained The medical term for being cross-eyed - strabismus What is atopic dermatitis? - eczema Tests used to diagnose developmental hip dysplasia - Barlow and Ortolani maneuvers What is the female athlete triad? - disordered eating, amenorrhea, osteoporosis How do patients with aortic regurgitation typically present? - 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? - 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? - a venous hum murmur and an S3 When a headache accompanies a stroke, is this most often hemorrhagic or ischemic? - hemorrhagic AV nicking is most commonly seen on retinal exam of which chronic condition? - hypertension Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs? - weight gain When does otitis media with effusion usually occur? - 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 - tinea cruris Tinea cruris "jock itch" is a common __________ infection and should be treated with what? - fungal; OTC antifungal cream What are teaching points for males to avoid contracting tinea cruris? - dry off after swimming and don't stay in a wet bathing suit Tinea cruris can affect the inner thighs but never what else? - the penis or scrotum On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? - cocci and rods On microscopic exam, what is most likely to be seen in the presence of a candidal infection? - yeasts What are dermatophytes? - fungi On microscopic exam, what is most likely to be seen in the presence of a dermatophytic (fungal) infection? - 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 - tinea corporis What is the most common cause of viral pneumonia in peds? - RSV Viral pneumonia is the most common type of pneumonia in children of what ages? - 6 months to 5 years What is the simplest way to screen for nutritional adequacy in older adults? - measure their weight How are scabies treated? - via permethrin and good hygiene What are common side effects of NSAIDs? - renal impairment, acute renal failure, gastritis What is the most common cause of pernicious anemias? - vitamin B12 deficiency How should oral iron supplements be taken? - on an empty stomach with something acidic and high in calcium such as orange juice Group A strep pharyngitis can be accompanied by what symptoms other than the classic Centor criteria? - abdominal pain, nausea, and vomiting A stool specimen that is positive for WBCs is a sign of what? - a viral or bacterial infection The only type of incontinence that would not benefit from pelvic floor therapy is what? - overflow incontinence What do the skin manifestations of a penicillin allergy look like? - hives What are symptoms that someone will experience as soon as they are started on a SSRI and when will this resolve? - headache, nausea, insomnia, restlessness, agitation; will resolve in 2 weeks What causes the dry cough in people taking an ACEI? - the buildup of bradykinin which is usually degraded by ACE ACEI induced coughs usually begin how soon after starting the medication? - within 2 weeks COPD is often associated with what sequelae? - anxiety and depression When should an antiviral be started in a patient with shingles? - within 72 hours of the onset of symptoms What characterizes mild persistent asthma? - asthma where symptoms occur more than twice weekly People who do not have a spleen (asplenic) are at a greater risk of what? - more susceptible to bacterial infections What 2 things put someone at the highest risk of developing pancreatitis? - gallstones and alcohol abuse. Hypertriglyceridemia can also cause it. What are the RF for GI bleeding? - 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? - a daily PPI What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy? - nitrofurantoin Athletic amenorrhea increases one's risk of developing what? - 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. - secondary; taking a daily aspirin to prevent another stroke after already having one What is Strattera (atomoxetine) used for? - ADHD; side effect includes increased BP and HR so monitor closely What is the drug Danazol and what is it used for? - an androgen used in the treatment of endometriosis and fibrocystic breast disease Danazol, an androgen, has what potential side effects? - edema, hirsutism, hair loss, vocal changes The Mirena (Levonorgestrol) IUD stays in for how long? - 5 years What is the most common reason for persistent gonorrhea infections? - failure of the patient to abstain from unprotected sexual intercourse What class of drug is theophylline? What does it do? - methylxanthine; it's a bronchodilator Beta blockers are contraindicated in which cardiovascular condition? - 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? - dopamine agonist; restless leg syndrome Are males or females more likely to commit suicide? - males How do depression vs. anxiety differ in the way that they affect sleep? - anxiety usually causes people to have problems falling asleep whereas depression causes early morning wakening What is the most common cause of pneumonia in all ages? - strep pneumo What is the most common cause of hemorrhagic stroke? - hypertension What helps prevent infection by maintaining the acidic environment of the ear canal? - cerumen Mortality associated with Kawasaki disease is most likely related to what? - coronary artery aneurysm What is Kawasaki disease? - an acute febrile illness of early childhood characterized by vasculitis of the medium sized arteries, most noticeable in the coronary vessels Serial echos must be performed in a patient with Kawasaki disease in order to rule out coronary artery aneurysms. When should these occur? - at the time of diagnosis, 1-2 weeks after onset of illness, 5-6 weeks after onset of illness What is the most common cause of croup? - parainfluenza virus What are the two subsets of impetigo? - bullous (fluid filled) or nonbullous (honey crusts) Which protein is an important mediator of the inflammatory response and serves as a messenger at the site of antigen (allergen) invasion? - cytokines; they are released by mast cells in response to an invading antigen and recruit leukocytes and eosinophils Paroxysmal events associated with abnormal electrical discharges of neurons in the brain - seizures What is HELLP syndrome in pregnancy? - stands for hemolysis, elevated liver enzymes, and low platelets; is characterized by thrombocytopenia, hemolytic anemia, and liver dysfunction HELLP syndrome in pregnancy is due to what? - endothelial dysfunction Patients with acute coronary syndrome typically have plaque erosion caused by what? - accumulation of hyaluronan and neutrophils Which diagnostic study is most helpful for differentiating Alzheimer's disease from dementia with Lewy bodies? - PET scan ADHD is a risk factor for both depression and what else? - substance abuse Epididymitis with orchitis is commonly related to what? - genitourinary infections Mycoplasma genitalium is most commonly associated with which disease presentation in men? - urethritis, especially if persistent or recurrent C. trachomatis stands for what common type of bacteria infection? - chlamydia Chlamydia passed from a mother to a newborn can result in which problems for the newborn? - conjunctivitis and pneumonia In a patient with patent ductus arteriosus, where is the murmur best heard? - localized at the left clavicle and is both systolic and diastolic What is the ductus arteriosus? - provides the fetus with a pathway from the pulmonary artery to the aorta in utero in order to skip the lungs What are examples of some conditions that have multifactorial inheritance? - diabetes, obesity, arthritis, cancer, Alzheimers Seborrheic dermatitis is basically the same thing as what? - eczema of the scalp The flow of air coming in and out of the lungs in one inhalation and one exhalation - peak expiratory flow What does an incentive spirometer measure? - peak expiratory flow What happens in the luteal phase of the menstrual cycle? - 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? - sneezing The bacteria responsible for syphilis is called what? - treponema pallidum The STI, chancroid, is caused by what responsible bacteria? - haemophilus ducreyi What happens during the follicular phase of the menstrual cycle? - FSH and LH increase which stimulate the production of estrogen. Ultimately, it is estrogen that prepares the uterus for ovum fertilization A superficial dermatophyte/fungal infection of the skin of the scalp, eyebrows, and eyelashes - tinea capitis Bacterial invasion of the renal parenchyma - pyelonephritis What is phimosis vs. paraphimosis? - phimosis is tightening of the foreskin over the glans that prevents retraction; paraphimosis is when you can retract the foreskin but you can't pull it back up What is a common characteristic of a person with Graves disease? - ophthalmopathy causing lymphocytes to infiltrate the extraocular muscle, resulting in paralysis of EOMs, involvement of the optic nerve, and corneal ulcers Which phase of the menstrual cycle begins with a surge in LH and FSH? - ovulatory phase What is the pathophys of HIV? - causes destruction of the CD4 T cells resulting in eventual immune suppression Cells within the epidermis that are primarily responsible for protecting the skin from UV rays in sunlight - melanocytes Body lice primarily live where? - on bedding and clothing, not people Body lice are vectors for which diseases? - epidemic typhus, trench fever, relapsing fever Fifth disease is spread via how? - respiratory droplets What are other names of fifth disease? - parvovirus, slapped cheek disease What is the life span of lice? - 30 days The hypersensitivity and pain crescendo experienced in conjunction with a migraine is thought to be related to the release of what? - substance P; a neurotransmitter which functions as the pain transmitter of the dorsal horn and is responsible for causing nausea, vomiting, stress, and anxiety Where is the location of the tricuspid valve? - separates the right atrium and ventricle What does a tricuspid regurgitation murmur sound like? - best heard at the left sternal border, on both systole and diastole. Increases with inspiration When can you hear the murmur associated with pulmonic stenosis? - mid-late systolic murmur When can you hear the murmur associated with aortic regurg? - diastole only When can you hear the murmur associated with mitral valve stenosis? - diastole only What EKG changes may be present during episodes of angina? - transient ST elevation, T wave changes such as inversions, ST depressionals, Q waves Children and teens present with depression most commonly how? - irritability Are the sickling of RBCS in sickle cell anemia reversible? - 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? - dopamine Where are T cells produced? - in the thymus Where are B cells produced? - in the bone marrow What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)? - 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? - 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? - within the first 1-2 days of birth The minimum arterial pressure exerted during relaxation and dilation of the ventricles - diastole Lyme disease is caused by what spirochete present on ticks? - borrelia burgdorfei What are the potential sequelae of strep pharyngitis? - acute glomerulonephritis, peritonsillar abscess, toxic shock disease, rheumatic heart disease (although rare) The medical term for pubic lice aka crabs - phthirus pubis Petechiae noted on the cervix during a pelvic exam is a sign of what disease process? - trichomoniasis; also called "strawberry cervix" What is the difference between a folliculitis and a furuncle? - 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? - from the liver as a byproduct of protein metabolism What are the 5 primary structures of the immune system? - lymph nodes, thymus, tonsils, spleen, bone marrow Bacteria most commonly responsible for pyelonephritis - e coli What causes back pain in pregnancy? - curvature of the lumbosacral vertebrae What is dacrocystitis? - inflammation of the nasolacrimal duct due to duct obstruction or infection What are potential causes of blepharitis? - bacterial infection, dry eyes, rosacea What are s/s of croup? - 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? - breast cancer What are things women can do to decrease their risk of breast cancer? - regular physical activity, breastfeeding Does an increase or decrease in blood pH affect the rate and degree of sickling in sickle cell anemia? - a decrease in blood pH increases the rate What is the difference between Prinzmetals and stable (classic angina)? - 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? - the area is composed of loose connective tissue What are cutaneous xanthomas? - localized lipid deposits caused by elevated lipids or LDL Uterine prolpase is caused by stretching of the uterine ____________ - ligaments What causes bacterial vaginosis? - a decrease in lactobacillus species within the vagina Where is acanthosis nigricans most likely to occur? - axillae, neck, groin Adrenarche is the early presence of pubic hair in girls aged __________ - 5-8 years old A condition that presents with symptomatic limb ischemia upon exertion is termed: - atherosclerotic peripheral arterial disease The largest salivary gland is the parotid gland, and where does it drain to? - 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? - lateral meniscus The valgus stress test assesses for a tear in which part of the lower extremities? - 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? - 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 - tenesmus Severe constipation resulting from intestinal obstruction - obstipation What does the vaginal discharge associated with trich look like? - profuse, yellowish green that is malodorous What does the discharge associated with bacterial vaginosis look like? - 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? - internal rotation How do we test for flexion and extension of the shoulder? - 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? - uncontrollable cerebral edema and hypoxia What are the symptoms of Shaken Baby Syndrome? - blindness, inability to perform previously learned milestones, flaccid muscle tone Koplik's spots are indicative of what disease? - measles (rubeola) The medical term for measles - rubeola What do Koplik's spots of measles look like? - 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 - aphthous ulcers Excessive or prolonged menstrual flow occurring at regular intervals - menorrhagia Intermenstrual bleeding (aka spotting in between periods) - metrorrhagia Polymenorrhea is when there are fewer than ________ between periods - 21 days Oligomenorrhea is when there are more than _______ between periods; or only 4-9 menstrual cycles per year - 35 days Retraction of the nipple and areola are suggestive of what? - an underlying breast mass; this is never considered normal What is the straight leg raise test? - 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? - positive for carpal tunnel; the NP taps over the median nerve and is positive if n/t is felt What is Phalen's sign? - 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 - 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 - Finkelsteins test What does the murmur associated with mitral regurg sound like? - 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? - 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? - raised or flat deep purple lesions in the mouth Where do lesions of Kaposi's sarcoma usually manifest? - 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? - a gastric ulcer How is the pain of a gastric ulcer vs. a duodenal ulcer different? - the pain is worsened with eating with a gastric ulcer but improved with eating in a duodenal ulcer What are s/s of glaucoma? - loss of peripheral vision, halos around lights, difficulty focusing on near objects Higher level functioning, such as using the telephone, doing laundry, taking medicine, etc. are considered to be called what? - instrumental activities of daily living An inability to extend the knee is a sign of what? - a partial or complete patellar tendon tear Which part of the spine controls the ankle DTRs? - sacral nerve 1 Which part of the spine controls the knee DTRs? - lumbar nerves 2, 3, 4 Which part of the spine controls the biceps DTRs? - cervical nerves 5 and 6 Which part of the spine controls the triceps DTRs? - cervical nerves 6 and 7 What are s/s of carpal tunnel syndrome? - dropping objects, unable to twist lids off of jars, aching at the wrist or forearm, numbness of the first 3 digits of the hand Which movement indicates a nuchal rigidity sign when working a patient up for meningitis? - neck stiffness and resistance when flexing the neck forward What is Kernig's sign? - flex the patients leg at both the hip and the knee, then straighten the knee. Pain and resistance to extension of the knee are positive for meningitis. A patient who is unable to touch his left scapula with his right hand likely has what? - a rotator cuff tear A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for what? - cardiovascular disease, stroke, renal disease The ethmoidal sinuses are located where? - between the eyes Where do the sphenoid sinuses lie? - just behind the ethmoid sinuses Where do the maxillary sinuses lie? - around the nasal cavity During the vaginal exam of a pregnant woman in her first trimester, an adnexal mass with tenderness is palpated. This is consistent with what? - an ectopic pregnancy Stridor indicates a partial or complete obstruction of the _________ and is best heard where? - larynx; neck When assessing an african american person, black, dusky mucous membranes are related to what - cyanosis Persistent, sharp, and knife-like chest pain is indicative of what? - pericarditis or pleuritic chest pain Thin, pencil-like stool can be associated with what? - 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? - tracheobronchitis The shiny, pink area located around the cervical os is known as what? - squamos epithelium Tenderness of the posterior medial malleolus may be a sign of what? - 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? - 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." - d. "Take the prescribed stool softener to avoid increasing intraocular pressure." A client vomits during a continuous nasogastric tube feeding. A nurse should stop the feeding and take which of these actions? a. Suction the nasogastric tube. b. Flush the tube with 30 mL of sterile water. c. Remove the nasogastric tube. d. Check the residual volume. - d. Check the residual volume. Which of these actions best demonstrates cultural sensitivity by a nurse? a. The nurse talks in a slow-paced speech. b. The nurse asks clients about their beliefs and practices toward pregnancy. c. The nurse uses charts and diagrams when teaching pregnant clients. d. The nurse can speak several different languages. - b. The nurse asks clients about their beliefs and practices toward pregnancy. Which of these manifestations should a nurse expect to observe in a 3-month-old infant who is diagnosed with dehydration? a. Hyperreflexia. b. Tachycardia. c. Bradypnea. d. Agitation. - b. Tachycardia. When assessing a client's risk of developing nosocomial infection, a nurse plans to determine potential entry portals, which include: a. the urinary meatus. b. vomitus. c. contaminated water. d. sexual intercourse. - a. the urinary meatus. A client who is on the inpatient psychiatric unit has a history of violence. Which of these actions should a nurse take if the client is agitated? a. Encourage the client to verbalize feelings. b. Lock the client in a secluded room. c. Ask the other clients to give feedback regarding the client's behavior. d. Ignore the client's inappropriate behavior. - a. Encourage the client to verbalize feelings. Which of these measures should a nurse include when planning care for a school-aged child during a sickle cell crisis episode? a. Monitoring for signs of bleeding. b. Providing pain relief. c. Administering cool sponge baths to reduce fevers. d. Offering a high calorie diet. - b. Providing pain relief. Which of these instructions should a nurse include in the plan of care for a 32-week gestation client who had an amniocentesis today? a. "Drink at least six glasses of fluids during the next six hours after the test." b. "Call the clinic if you experience any abdominal cramps." c. "Don't be concerned if you have some vaginal spotting in the next 12 hours." d. "When you get home, stay on bed-rest for the next 48 hours." - b. "Call the clinic if you experience any abdominal cramps." An adolescent has a nursing diagnosis of fatigue related to inadequate intake of iron- rich foods. Selection of which of these lunches by the client indicates a correct understanding of foods high in iron content? a. Peanut butter and jam sandwich. b. Chicken nuggets with rice. c. Tuna salad sandwich. d. Beefburger with cheese. - d. Beefburger with cheese. A client has been admitted with acute pancreatitis. Which of these laboratory test results supports this diagnosis? a. Elevated serum potassium level. b. Elevated serum amylase level. c. Elevated serum sodium level. d. Elevated serum creatinine level. - b. Elevated serum amylase level. Which of these manifestations, if assessed in a client who is two-hours postoperative after abdominal surgery, should a nurse report immediately? a. Vomiting and a pulse rate of 106/minute. b. Respiratory rate of 12/minute and urine dribbling. c. Blood pressure of 100/60 mm Hg and wound discomfort. d. Urine output of 100 mL/hr and flushed skin. - a. Vomiting and a pulse rate of 106/minute. Which of these observations of a student nurse's behavior while interacting with a client who is crying indicates a correct understanding of therapeutic communication? a. The student maintains continuous eye contact with the client. b. The student places one arm around the client's shoulder? c. The student sits quietly next to the client. d. The student leaves the room to provide privacy for the client. - c. The student sits quietly next to the client. Which of these actions should a nurse take initially if a client who is diagnosed with diabetes mellitus develops tremors and ataxia? a. Measure the client's blood sugar level. b. Administer a concentrated form glucose to the client. c. Administer a prn dose of insulin. d. Measure the client's urine for ketones. - a. Measure the client's blood sugar level. An elderly client is at increased risk of developing drug toxicity to prescribed medications due to declining hepatic and renal functioning. Which of these strategies should a nurse plan to decrease this risk? a. Increasing the time interval between medication doses. b. Limiting the client's oral fluid intake. c. Administering the medications with meals. d. Encouraging the client to void every three to four hours. - a. Increasing the time interval between medication doses. A client has persistent paranoid delusions that the food on the unit is poisoned. Which of these measures should a nurse include in the client's care plan? a. Explaining that staff does not poison clients. b. Focusing on how the hospital staff helps clients. c. Allowing the client to eat food from sealed containers. An elderly client who is receiving a blood transfusion develops a rapid bounding pulse and an elevated blood pressure. Which of these actions should a nurse take? a. Add a 5% dextrose solution to the line. b. Raise the head of the bed. c. Stop the transfusion. d. Measure the client's temperature. - c. Stop the transfusion. When caring for a client who has hepatitis B, a nurse should wear: a. gloves when administering oral medications to the client. b. a gown when changing the client's position. c. gloves when removing the intravenous cannula. d. a gown when emptying the client's used bath water. - c. gloves when removing the intravenous cannula. Which of these outcome criteria is appropriate for a client who has a nursing diagnosis of ineffective airway clearance? a. Absence of wheezing throughout the lung fields. b. Clear lung sounds on auscultation. c. Pulse oximetry level of 80%. d. Frequent coughing throughout the day. - b. Clear lung sounds on auscultation. A doctor prescribes liquid oral iron medication for a 4-year-old child. Which of these questions should a nurse ask the child's mother to determine if the medication is being administered correctly? a. "Are you using a straw to administer the medicine?" b. "Has your child been urinating more frequently?" c. "Have you increased your child's milk intake each day?" d. "Is there a change in the color of your child's skin?" - a. "Are you using a straw to administer the medicine?" Which of these assessment findings, if present in a 4-month-old infant who has severe diarrhea, should a nurse recognize as suggestive that the infant is dehydrated? a. Bulging anterior fontanel. b. Pulse rate of 120/minute. c. Decreased urine output. d. Cyanosis of the mucus membrane. - c. Decreased urine output. Which of these instructions should be included in the teaching plan for the parents of a 10-month-old infant who is admitted to the hospital for failure to thrive? a. Advise the mother to make sure the infant drinks the entire bottle at each feeding. b. Encourage the mother to feed the infant slowly in a quiet environment. c. Teach the mother to position the infant on the abdomen following feedings. d. Instruct the mother to play actively with the infant during bottle feedings. - b. Encourage the mother to feed the infant slowly in a quiet environment. When a newborn is 48 hours old, a nurse notes that the child is jaundiced. The nurse should recognize which of these conditions as a probable cause of the newborn's jaundice? a. Dehydration. b. Liver immaturity. c. ABO incompatibility. d. Gallbladder immaturity. - b. Liver immaturity. Which of these items should a nurse removed from the food tray of a client who is on a sodium-restricted diet? a. Packet of a salt substitute. b. Grapefruit juice. c. Container of jelly. d. Ketchup. - d. Ketchup. Which of these statements, if made by a client who had a total hip replacement, would indicate a correct understanding of the postoperative instructions? a. "I will stoop carefully to pick up items from the floor." b. "I will use a raised toilet seat in the bathroom." c. "I will bend forward when tying my shoes." d. "I will put my leg through the full range of motion each day." - b. "I will use a raised toilet seat in the bathroom." Which of these measures should a nurse include when planning care for an 88-year-old client who is admitted to the hospital with pneumonia? a. Restricting visitors to the client's immediate family members. b. Limiting the client care activities to no more than five minutes each. c. Allowing the client to perform self-care as tolerated. d. Providing the client with a non-stimulating environment. - c. Allowing the client to perform self-care as tolerated. A client, who is newly diagnosed with cancer says to anurse, "I suppose I need to complete all unfinished business as soon as possible." Which of these responses is appropriate? a. "Yes, you should do this immediately. b. "Don't you think you should stay focused on your treatment for now? c. "Exactly what things are you talking about?" d. "It sounds like you are concerned with your diagnosis." - d. "It sounds like you are concerned with your diagnosis." Which of these interventions should plan for a child who is receiving chelation therapy for lead poisoning? a. Keeping an accurate record of intake and output. b. Instituting measures to prevent skeletal fractures. c. Maintaining isolation precautions. d. Maintaining strict bed rest. - a. Keeping an accurate record of intake and output. A nurse obtains these vital signs on an adult client. Which finding should the nurse follow-up first? a. Heart rate, 60/minute and regular. b. Respiration, 30/minute and deep. c. Temperature, 97.1 °F (36.2 °C) d. Blood pressure, 136/86 mm Hg - b. Respiration, 30/minute and deep. When determining the duration of a uterine contraction, a nurse should measure the contraction from the: a. beginning of one contraction to the end of that contraction. b. end of one contraction to the beginning of the next contraction. c. beginning of one contraction to the beginning of the next contraction. d. strongest point of one contraction to the strongest point of the next contraction. - a. beginning of one contraction to the end of that contraction. A nurse should recognize which of these signs is a probably sign of pregnancy? a. Frequency of urination. b. Positive pregnancy test. c. Nausea in the morning. d. Abdominal distention. - b. Positive pregnancy test. All of these clients are on bed rest. Which one is the most at risk to develop skin breakdown? a. An 82-year-old client who bathes once a week. b. An 83-year-old client who applies powder after drying the skin. c. An 84-year-old client who has been NPO for four days. d. An 85-year-old client who has coronary artery disease. - c. An 84-year-old client who has been NPO for four days. A client diagnosed with type 1 diabetes mellitus has a glycosylated hemoglobin A1c of 4.2%. A nurse should interpret this to mean that the client has: a. had a period of sustained hyperglycemia. b. been non-compliant with home management. c. been in relatively good diabetic control. d. eaten a high carbohydrate snack just prior to testing. - c. been in relatively good diabetic control. A nurse is caring for a client with burns and in reverse isolation. Which measures should the nurse include? a. Wearing disposable gloves when chaging the dressings. b. Having the client wear goggles when staff is in the room. c. Wearing a gown, mask, and gloves when providing care to the client. d. Disposing of the client's soiled laundry in a red bag. - c. Wearing a gown, mask, and gloves when providing care to the client. a. Risk for aspiration. b. Ineffective protection. c. Risk for deficient fluid volume. d. Altered tissue perfusion. - c. Risk for deficient fluid volume. 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. - a. Broiled steak, baked potato, and spinach. Which of these statements, if made by a nurse, is non-therapeutic because it disregards a client's feelings and concerns? a. "You appear anxious and tense." b. "Everything will be okay." c. "I notice you're biting your nails." d. "I'm not sure I understand what you're saying." - b. "Everything will be okay." A client tells a nurse, "I am so scared about the interview tomorrow. I just know I will say the wrong thing and not get the job." Which of these responses, if made by the nurse, will create a communication barrier? a. "Would you like to practice the interview?" b. "Have you thought about some possible questions that may be asked in the interview?" c. "Tell me more about your concerns." d. "You need to relax, and everything will be fine." - d. "You need to relax, and everything will be fine." A young healthy adult, who has been exercising in hot weather, has fatigue, loss of appetite, and lightheadedness. Which of these assessments should a nurse make? a. Determine the client's preferred diet. b. Measure the client's body temperature. c. Auscultate the lungs. d. Ascertain the client's typical sleep pattern. - b. Measure the client's body temperature. 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. - c. Administering the missing factor VIII to the child. Which of these outcomes should a nurse focus on for a client who had a bronchoscopy two hours ago? a. Preventing hemorrhage. b. Preventing pneumonia. c. Preventing aspiration. d. Preventing dehydration. - c. Preventing aspiration. A client who had a coronary artery bypass graft four days ago suddenly develops sinus tachycardia and reports shortness of breath and dizziness. Which of these interpretations and actions should a nurse take? a. This is an expected occurrence following bypass surgery; continue to monitor the client. b. This indicates normalization of the blood pressure; hold all anti-hypertensive medications. c. This may be an early sign of heart failure; notify the physician. d. This indicates hypoxia; administer oxygen at 5/L per minute. - c. This may be an early sign of heart failure; notify the physician. Which of these lunch selections, if made by a client who has congestive heart failure, should a nurse recognize as indicative of a need for additional instructions? a. Cottage cheese with fresh fruit salad, whole wheat bread, and herbal tea. b. Baked chicken with brown rice, mixed green salad, and iced coffee. c. Egg salad sandwich with mayonnaise, pickles, and seltzer water. d. Beef tenderloin, carrots, mashed potatoes, and a baked apple. - c. Egg salad sandwich with mayonnaise, pickles, and seltzer water. Which of the statements if made by a client who is take furosemide (Lasix), supports a nursing diagnosis of knowledge deficit? a. "This medication will increase the amount and frequency of my urination." b. "This medication must be taken, even on days when I fell well." c. "I will need to add more salt to my diet because this medication will increase its excretion." d. "I should change my position slowly to avoid dizziness related to this medication." - c. "I will need to add more salt to my diet because this medication will increase its excretion." Which of these statements, if made by a client who has chronic obstructive pulmonary disease, indicates improvement? a. "I hope to attend my grandson's graduation next month." b. "I can now walk one more block than I could last month." c. "I take several quick breaths when I begin to cough." d. "I do my breathing exercises in the evening after I eat dinner." - b. "I can now walk one more block than I could last month." An 8-month-old infant is admitted to the hospital because of failure to thrive. Which of these actions should a nurse plan? a. Limit the parents' interactions with the infant. b. Consistently assign the care of the infant to the same staff. c. Rotate assignments so that all staff can evaluate the infant. d. Limit the infant's activity until the cause of the problem is identified. - b. Consistently assign the care of the infant to the same staff. Which of these actions should a nurse include to enhance the effectiveness of client teaching sessions? a. Include all content in one session so as not to overwhelm the client. b. Initially demonstrate and explain the procedure to the client. c. Avoid repetition of content. d. Include all clients on the unit in the sessions. - b. Initially demonstrate and explain the procedure to the client. 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. - 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. - 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. - b. Suspiciousness. Which of these measures should an emergency room nurse include when speaking with a family experiencing the loss of an infant from Sudden Infant Death Syndrome (SIDS)? a. Explaining to the parents how SIDS could have been predicted. b. Discouraging the parents from viewing the infant's body. c. Encouraging the parents to take the opportunity to say goodbye. d. Interviewing the parents in-depth about the circumstances of the infants death. - c. Encouraging the parents to take the opportunity to say goodbye. Which of these assessments is the priority for a client who is admitted with recurrent depression? a. Previous episodes of depression. A nurse plans to assess a client's recent memory. Which of these questions should the nurse include? a. "Who is your closest friend?" b. "What was the name of the school you attended?" c. "What day were you admitted to the unit?" d. "What did you have for breakfast?" - d. "What did you have for breakfast?" A client who has a breast tumor says to a nurse, "I am so anxious. Why did I have to get sick now?" Which of these responses, if made by the nurse, is therapeutic? a. "You will need to find someone to talk over your fears on a regular basis." b. "What do you think is making you feel so anxious now?" c. "Are you aware that there are newer, more effective treatments for breast cancer?" d. "Tell me more about your concerns." - d. "Tell me more about your concerns." Which of these actions, if taken by a nurse who is transferring a client from the bed to the chair, is correct? a. The bed is raised to a comfortable working height for the nurse. b. The wheelchair is placed perpendicular to the bed. c. The nurse stands behind the client during the transfer. d. The nurse supports the client in an upright standing position for a few moments. - d. The nurse supports the client in an upright standing position for a few moments. A nurse should assist a pregnant client who is in the first trimester to achieve the developmental task of this stage of pregnancy, which is: a. accepting the fact that she is pregnant. b. accepting the fact that the fetus is a separate being. c. accepting that she will soon deliver the child. d. accepting that her body image has changed. - a. accepting the fact that she is pregnant. When interacting with a client who is paranoid, a nurse should: a. use touch to place the client at ease. b. maintain a caring facial expression. c. stand close to the client. d. maintain a professional attitude towards the client. - d. maintain a professional attitude towards the client. Which of these tasks is appropriate for a nurse to delegate to a nursing assistant in an acute care unit? a. Feeding a client who was admitted with a stroke yesterday. b. Ambulating a client who was admitted with a myocardial infarction yesterday. c. Measure the blood pressure of a client who was admitted with an asthma attack yesterday. d. Suctioning the tracheostomy that was performed on a client yesterday. - c. Measure the blood pressure of a client who was admitted with an asthma attack yesterday. Which of these techniques should a nurse plan to use with a client who is delusional? a. Explore the delusion so the client will know it is false. b. Explain clearly why the client's belief is incorrect. c. Focus on reality-based topics. d. Avoid speaking with the client when he/she is delusional. - c. Focus on reality-based topics. Which of the following manifestations should a nurse recognize as suggestive of right- sided heart failure? a. Cool extremities and frothy sputum. b. Jugular vein distention and pedal edema. c. Orthopnea and frequent cough at night. d. Weight loss and lower calf pains. - b. Jugular vein distention and pedal edema. Which of these statements, if made by a nursing student prior to a sterile dressing change, is correct? a. "I understand that if objects touch other objects on the sterile field they are considered contaminated." b. "I understand that sterile objects that are below my waist are considered contaminated." c. "I understand that all objects in the sterile field must be dry." d. "I understand that contaminated objects can be used if rinsed with an antimicrobial solution." - b. "I understand that sterile objects that are below my waist are considered contaminated." A nurse reviews a client's prenatal record and notes that the client's last menstrual period (LMP) was on September 18th. Using the Naegele's rule, the nurse should calculate that the client's expected date of delivery (EDD) will be: a. May 11th. b. May 25th. c. June 11th. d. June 25th. - d. June 25th. Which of these instructions should a nurse give to a client who has venous insufficiency regarding the use of elastic stockings (TEDs)? a. "Bunch the TEDs up and pull them on like socks." b. "Lower the TEDs to your ankles if your legs ache." c. "Keep the TEDs on at all times." d. "Put the TEDs on before you get up in the morning." - d. "Put the TEDs on before you get up in the morning." A nurse assesses a client who is scheduled for a total abdominal hysterectomy at 10:00 A.M. WHich of the factors should the nurse recognize as most likely to influence the outcome of the surgery? a. The client has voided two times since 5:00 A.M. b. The client is not able to demonstrate leg exercises because of osteoarthritis. c. The client takes one acetylsalicylic acid (baby Aspirin) daily. d. The client reports mouth dryness. - c. The client takes one acetysalicylic acid (baby Aspirin) daily. A client's urine output is 500 mL in 24 hours. Which of these actions should a nurse take? a. Report the findings to the physician. b. Obtain an order for a diuretic. c. Encourage the client to limit fluid intake. d. Record the finding and continue to monitor the client. - a. Report the findings to the physician. A nurse should question an order for a potassium chloride intravenous infusion for which of these clients? a. A client who has hypoxia. b. A client who is obese. c. A client who has anuria. d. A client who is congested. - c. A client who has anuria. A 22-year-old college student has a heart rate that is 48/minute and regular during a routine physical examination. Which of these questions should a nurse consider when analyzing this heart rate? a. Is this student an athlete? b. Does this student smoke? c. How much alcohol does this student drink? d. Is this student feeling anxious? - a. Is this student an athlete? Which of the following clients should a nurse recognize is most likely to develop diabetic ketoacidosis? a. A 23-year-old who has type 1 diabetes mellitus and is being treated for a tooth abscess. b. A 31-year-old gestational diabetic who has occasional bout of nausea. c. A 55-year-old who has type 2 diabetes mellitus and is adjusting well to the lifestyle changes. d. A 72-year-old who has type 2 diabetes mellitus and is managed with diet and exercise. - a. A 23-year-old who has type 1 diabetes mellitus and is being treated for a tooth abscess. Which of these postoperative complications in the first hour after surgery requires immediate intervention? a. Serous draining on the dressing. b. Swelling of an extremity under a cast. c. Vomiting. d. Dehiscence of a wound. - d. Dehiscence of a wound. d. Using the same cuff to measure the blood pressures of all the clients on the unit. - c. Placing the Foley catheter drainage bag on the bed while transferring the client. A nurse is preparing a client for a vaginal examination. Which of these statements should the nurse make? a. "Go into the bathroom and empty your bladder." b. "Cleanse your perineal area with betadine solution." c. "Hold your breath while the speculum remains in place." d. "Push down as the doctor inserts the speculum." - a. "Go into the bathroom and empty your bladder." A licensed practical nurse (LPN) is assigned to care for all of these clients. Which client should the nurse assess first? a. A 25-year-old client who is terminally ill with metastatic testicular cancer. b. A 37-year-old client who has second-degree burns on both feet. c. A 49-year-old client who has an acute myocardial infarction related to cocaine ingestion. d. A 68-year-old client who is bed bound related to severe Parkinson's disease. - c. A 49-year-old client who has an acute myocardial infarction related to cocaine ingestion. Which of these preventative measures should a nurse manager in a long-term care facility plan to institute to decrease clients' risks for falls? a. Monitoring clients frequently for evidence of activity intolerance. b. Placing all client personal items in the bedside drawers. c. Raising the side rails for all clients who have memory impairment. d. Maintaining all client beds in the highest position. - a. Monitoring clients frequently for evidence of activity intolerance. Which of these assessment findings, if present in a primigravida, indicates that the client is experiencing true labor? a. The pains are felt in the lower abdomen, back, and groin. b. The Braxton-Hicks contractions have become stronger and more frequent. c. There is an increased amount of white mucus discharge. d. There is a progressive increase in effacement and cervical dilatation. - d. There is a progressive increase in effacement and cervical dilatation. A client is admitted for opiate detoxification for the fifth time. Which of these statements, if made by a staff member, indicates a biased view of the client? a. "I feel so frustrated when clients are re-admitted." b. "Addicts relapse because they don't try hard enough." c. "I think this client needs to consider long-term placement after detoxification." d. "The team really needs to discuss this client's treatment plan." - b. "Addicts relapse because they don't try hard enough." Which of these women, each of whom is in labor, should a nurse recognize as in need of immediate attention? a. A woman who is having contractions every 6 to 8 minutes of mild to moderate intensity. b. A woman who is receiving oxytocin augmentation and who has contractions lasting 60 to 70 seconds. c. A woman who is in the active phase of labor and who insists she needs to use the bedpan to have a bowel movement. d. A woman whose uterine contractions frequency is every two to give minutes. - c. A woman who is in the active phase of labor and who insists she needs to use the bedpan to have a bowel movement. A nurse has received a report on these assigned clients. Which client should the nurse follow-up first? a. A client, admitted with acute diverticulitis, who has a white blood cell count (WBC) of 10,000 mm3. b. A client, admitted with acute pancreatitis, who has a fasting serum glucose of 130 mg/dL today, and had a reading of 160 mg/dL yesterday. c. A client, admitted with hepatitis, who has jaundice and tea-colored urine. d. A client who is currently receiving cancer chemotherapy and who has a white blood cell count of 500 mm3 today. - d. A client who is currently receiving cancer chemotherapy and who has a white blood cell count of 500 mm3 today. Which of these statements, if made by a client who is taking a diuretic, should a nurse recognize as indicative of the need for additional instructions? a. "I take all of my medications at bedtime so I don't forget them." b. "I eat one or two bananas every day." c. "I weigh myself every day in the morning." d. "I will call my doctor if I have muscle weakness." - a. "I take all of my medications at bedtime so I don't forget them." A nurse is monitoring a client who had a cystoscopy six hours ago. The nurse should inform the physician of which these manifestations? a. The client has pink-tinged urine. b. The client reports burning on urination. c. The client's white blood cell count is 15,000 mm3. d. The client appears drowsy. - c. The client's white blood cell count is 15,000 mm3. Which of these actions should a nurse perform prior to a client's scheduled hemodialysis? a. Administer prophylactic antibiotics. b. Weigh the client. c. Give the client normal saline solution to drink. d. Measure the urine specific gravity. - b. Weigh the client. Which of these behaviors, if taken by a staff nurse on a psychiatric unit, indicates a correct understanding of therapeutic techniques? a. A nurse smiles when speaking with clients who are manic. b. A nurse uses touch to communicate concern with a depressed client. c. A nurse sets consistent limits with manipulative clients. d. A nurse shares own anxiety reduction techniques with a client who has panic attacks. - c. A nurse sets consistent limits with manipulative clients. A client has been in bed for the past three days. Which of these measures should a nurse include before assisting the client out of bed? a. Having the client drink a glass of water. b. Raising the head of the bed. c. Flexing the client's knees. d. Assessing the lung sounds. - b. Raising the head of the bed. A client who has insulin-dependent diabetes mellitus asks a nurse, "What should I do when I feel nervous, sweaty, and hungry?" The nurse should give the client which of these instructions? a. "Lie down and rest." b. "Eat a carbohydrate snack." c. "Take your prn dose of insulin." d. "Add a slice of bread to your next meal." - b. "Eat a carbohydrate snack." Which of these tasks should a licensed practical nurse (LPN) delegate to a nursing assistant? a. Checking the 11 A.M. blood sugar for a client who has ketoacidosis. b. Measuring the pulse oximetry level for a client who has status asthmaticus. c. AMbulating a client who had a hip replacement three days ago. d. Changing the dressing for a client who had wound debridement last week. - c. AMbulating a client who had a hip replacement three days ago. A 36-week-pregnant woman awakens to find she is having profuse, red vaginal bleeding. A nurse should prepare the woman to have an immediate sonogram to determine the: a. location of the placenta. b. uterine response to labor. c. the fetus's current weight. d. condition of the uterine vascular bed. - a. location of the placenta. A nurse is planning to interview a client who speaks limited English. Which of these strategies should the nurse include? a. Smile frequently during the interview interview to reduce the client's anxiety. b. Observe the client for indicators of confusion or not understanding questions. c. Maintain constant eye contact throughout the interview. d. Keep the interview short to decrease the client's fatigue. - b. Observe the client for indicators of confusion or not understanding questions. A nurse should recognize that a client's selection of which of these foods demonstrates a correct understanding of a high-fiber diet for colon cancer prevention? a. Corn muffin. b. Bran flakes. c. Raising muffin. d. Green salad. - b. Bran flakes. Which of these discharge instructions should a nurse include for a client who has a ruptured tympanic membrane that occurred during a fall? a. "No showers or washing of the hair for the next month." b. "Avoid yawning or holding your head down." c. "Do not allow any water to enter the ear until healing is confirmed by direct visualization." d. "Avoid swallowing and coughing until your ear has healed." - c. "Do not allow any water to enter the ear until healing is confirmed by direct visualization." Which of these nursing measures is appropriate for a client who has recurrent renal calculi? a. Weighing the client daily before breakfast. b. Measuring the blood pressure every four hours. c. Encouraging a daily intake of three liters of fluids. d. Testing the urine for protein each shift. - c. Encouraging a daily intake of three liters of fluids. When auscultating the lungs of a woman who is admitted for severe pregnancy-induced hypertension, a nurse notes the presence of crackles and moist respirations. These assessment findings most likely indicate which of these complications? a. A convulsion is imminent. b. Pulmonary edema has developed. c. Bilateral lobar pneumonia is present. d. Respiratory failure is evident. - b. Pulmonary edema has developed. A licensed practical nurse (LPN) is assigned to care for all of these clients. Which client should the nurse assess first? a. A client who is eight-hours postoperative after a hip replacement. b. A client who is drowsy after falling out a third story window. c. A client who is four hours post-colonoscopy and polyp removal. d. A client who is dysphasic after a transient ischemic attack. - b. A client who is drowsy after falling out a third story window. Which of these clients is at the highest risk of developing osteoporosis? a. An obese African-American adolescent who does not exercise. b. A pregnant Asian client who is a vegetarian. c. A middle-aged Native-American male who is quadriplegic. d. A thin, elderly Caucasian female who lives alone. - d. A thin, elderly Caucasian female who lives alone. A nurse is obtaining the health history of a client who is admitted for surgical repair of an inguinal hernia. Which of these factors should the nurse recognize as having the greatest impact on the outcome of the surgery? a. The client takes several acetylsalicylic acid (Aspirin) tablets daily for knee pain. b. The client drinks one glass of beer every evening with dinner. c. The client had a knee replacement six months prior to this admission. d. The client is allergic to all penicillin-type antibiotics. - a. The client takes several acetylsalicylic acid (Aspirin) tablets daily for knee pain. A nurse should recognize that a client who has chronic obstructive pulmonary disease (COPD), needs additional instructions if the client makes which of these statements? a. "I will try to take slow, deep breaths when I feel short of breath." b. "I will use the albuterol (Proventil) nebulizer before I eat. c. "I will drink most of my fluids between meals." d. "I will turn up the oxygen flow rate if I have difficulty breathing." - d. "I will turn up the oxygen flow rate if I have difficulty breathing." A woman is treated in the emergency room for a broken arm and multiple facial bruises caused by her spouse. Which of these statements, if made by a nurse, is therapeutic? a. "You should leave this relationship now or you will be sorry." b. "Are you aware that women who remain in abusive relationships eventually are killed?" c. "This type of abuse typically recurs after a period of remorse by the abuser." d. "Can you think of what you did to cause this abuse?" - c. "This type of abuse typically recurs after a period of remorse by the abuser." What is the biggest side effect of colchicine? - diarrhea How would you describe the appearance of molluscum contagiosum? - papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? - no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? - week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - week 28 At what week of pregnancy is the fundus just below the xiphoid process? - week 34 Increased sweat production is a sign of what endocrine disorder? - hyperthyroidism What is Paget's disease? - there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures How do we treat Paget's diseease? - bisphosphonates How should pregnant women wear their seatbelt? - with the shoulder strap like a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? - parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations? - primary When should patients begin antiretroviral therapy for HIV infection? - as soon as it is detected, even if in the acute phase What are the first generation antihistamines? - diphenhydramine (benadryl) and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis? - rash on hands and feet, lymphadenopathy, fever What is the recommended treatment for chronic bacterial prostatitis? - a fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis? - cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? - clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area If a patient has GABHS but has an allergy to penicillins, what is the second line option? - first generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - in those who are on any type of nitrate or triptan because it could result in hypotension What class of drug is sildenafil (viagra)? - a PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG If a patient is on birth control and they miss one pill, what should they do? - double up If a patient is on birth control and they miss two pills, what should they do? - 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? - 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. - mammogram; ultrasound When do we screen for group B strep in pregnancy? - weeks 35-37 When do we perform alpha fetoprotein screening in pregnancy? - 15-20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - spina bifida and anencephaly What is placenta previa? - when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? - in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? - a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - placenta previa What is the recommended treatment for polymyalgia rheumatica? - steroids Patients with SLE are going to have what abnormal labwork? - elevated ESR and CRP How do we treat lupus flares? - steroids What are common sequelae of fibromyalgia? - insomnia and depression What is a great treatment option for fibromyalgia? - amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression How is fibromyalgia diagnosed? - when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? - when the femoral head of the hip is out of place What is the trendelenburg sign and when is it positive? - when the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What is the main characteristic of a slipped capital femoral epiphysis? - walking with a limp SCFE is most common in which patient population? - adolescents What is legg-calve-perthe disease? - avascular necrosis of the femoral head due to a lack of blood supply Legg-calve-perthes disease is most common in which patient population? - young children What is the radiographic study of choice for the knee? - MRI What is the radiographic study of choice for the back? - x ray What is bursitis? - a fluid collection in the bursa of a joint How is bursitis treated? - a needle to instill intraarticular steroids and then pull off fluid Bursitis can be a __________ issue - recurrent The medical term for knock knees - genu valgum The medical term for bow legs - genu varum What is myasthenia gravis? - an autoimmune disorder that causes muscle weakness of the voluntary muscles Genu valgum is caused by a problem with what? - the medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - the lateral collateral ligament What are shin splints? - a medial tibial syndrome caused by overuse of the muscles How do we treat shin splints? - rest and avoidance of exercise until the pain resolves What is the tell-tale difference between a herniated disc and sciatica? - sciatica feels better when you stand, a herniated disc feels better when you sit down When will spinal or lumbar stenosis feel better? - when the patient sits down What is Korsakoff syndrome? - a deficiency in thiamine and folate caused by alcoholism What changes to the vagina occur with aging? - dryness, loss of rugae, less pubic hair What is a navicular fracture? - 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? - osteoarthritis; rheumatoid arthritis What is Morton's neuroma? - 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? - via a positive Muddler's or squeeze test causing pain What is the hook test? - used to assess for a bicep tendon issue How do we treat any rotator cuff injuries? - wear a sling to stabilize the arm and refer to ortho How long do migraine headaches last? - 4-72 hours How can we abort cluster headaches? - calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? - cluster headaches What does the apprehension test assess for? - used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? - 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? - carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - steroids and anti-virals D. Clindamycin (Cleocin) - A. Azithromycin A 10-month old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papuls with an erythematous base on the buccal mucosa. What does this suggest? A. Scarlet fever B. Rubella C. Erythema infectiosum D. Measles - D. Measles Office Spriometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: A. Oxygen saturation B. Whether airway obstruction is from pulmonary fibrosis C. Chronic carbon dioxide retention D. Whether a patient has reversible airway obstruction - D. Whether a patient has reversible airway obstruction An 18yr old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? A. Amoxicillin-Clavulanate (Augmentin) B. Ceftriaxone (Rocephin) C. Levofloxacin (Levaquin) D. Erythromycin - A. Amoxicillin-Clavulanate (Augmentin) 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 - 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 - 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. - 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. - 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 - 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 - 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) - 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 - 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 - 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 - D. Providing reassurance The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex - 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) - D. Paroxetine (Paxil) A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A. throat culture B. sputum culture C. Mantoux (PPD) skin test D. Cold agglutinin test - B. Sputum culture A 25-year old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated with movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. 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) - 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 - 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 - 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. - 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 - 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 - 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 - 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 B. Cortisol deficiency C. the Somogyi effect D. pawn phenomenon - C. the Somogyi effect An 18 yo college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some hearb" she bought at a health food store for migrains and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? A. Ephedra B. Echinacea C. Feverfew D. Ginko Biloba - C. Feverfew Which of the following GI changes in associated with normal aging? A. Decreased production of gastric acid B. Decreased incidence of gallstones C. Increased salivation D. Increased esophageal emptying - A. Decreased production of gastric acid. A 32 year old patient reports a 6-month history of intermittant symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Gouty arthritis D. Reiter's syndrome - A. Rheumatoid Arthritis An 85 year old patient related that on the way to an annual physical exam, the patient suffered a sudden loss of vision in the right eye characterized by a "bunch of lights" and a feeling that " a curtain came down" The most likely diagnosis is: A. Vitreal hemorrhage B. Optic nerve lesion C. Central retinal nerve occlusion D. Retinal Detachment - D. Retinal detachment Assessment findings that would support a diagnosis of mitral regurgitation include: A. atrial fibrillation with summation gallop B. Loud, high-pitched pansystolic murmur C. Diastolic murmur with split S1 D. Early diastolic murmur with an S3 wave. - B. Loud, high-pitched pansystolic murmur During an employment physical exam of a 21-year old female, bruising around the areola on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: A. Current social relatonships B. History of present or past traumas C. Mental health status D. Socioeconomic status. - D. Socioeconomic status. According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a vlaue equal to or greater than: A. 100 mg/dl B. 126 mg/dl C. 140 mg/dl D. 180 mg/dl - B. 126 mg/dl A nurse practitioner orders pulmonary rehabilitation for a 75 yo patient with COPD. Expected outcomes of this program include all the following EXCEPT: A. enhanced quality of life B. Increased lung capacity C. Decreased in-patient hospitalizations D. Improved exercise capacity - B. Increased lung capacity 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 Which of the following is the most serious outcome of Barrett's esophagus? A. Esophageal adenocarcinoma B. Biliary atresia C. Liver hemangioma D. Esophageal varices - A. Esophageal adenocarcinoma A 4-yo girl with a history of recurrent urinary tract infections returns for follow-up after diagnosis of the most recent infection. During the physical exam, the 4 yo tells the nurse practitioner that her brother (age 9) lies on top of her and rubs his penis in her pubic area. After completing the physical exam, the nurse practitioner must: A. Discuss the child's report with the mother B. Report suspicion's to the appropriate child protective services agency C. Refer the case to a physician D. Suggest psychological counseling. - B. Report suspicions to the appropriate child protective services agency. A 20 yo male presents with a 1 month history of a " bump on my testicle" He reports being sexually active, frequent episodes of unprotected intercourse with multiple partners. Which condition should be suspected? A. Cancer of the testicles B. Torsion of the testicles C. Acute epididymitis D. Gonorrhea - A. Cancer of the testicles Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? A. Calcium channel blockers B. Thiazide diuretics C. Potassium-sparing diuretics D. Angiotensin-converting enzyme (ACE) inhibitors. - D. ACE inhibitors A 70 yo male presents with parathesia of the lower extremities. On exam, the patient appears pale and shows a decreased vibratory sense. Lab tests reveal elevated indirect bilirubin; Hct=30%; Mean corpuscular volume(MCV)=120 (norm 87-103). The most likely diagnosis is: A. pernicious anemia B. Anemia of chronic disease C. folic acid deficiency D. Iron deficiency anemia - A. Pernicious anemia Which of the following findings is typically a sign of acute appendicitis? A. Positive Murphy's sign B. Rebound tenderness at McBurney's point C. A negative Rovsing's sign D. Positive Prehn's sign - Rebound tenderness at McBurney's point Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? A. Pain worse in supine position; focal neurological signs B. Hyperreflexia; personality changes C. Acute onset; increasing pain over hours to days D. Pupillary constriction; stupor - A. Pain worse in supine position; focal neurological signs A 65 yo female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical exam, there is pain on ROM, with no weakness noted. Lab studies show a low hemoglobin and elevated SED rate. Which of the following is the most likely diagnosis? A. Polymyositis B. Osteoarthrits C. Polymyagia Rheumatica D. Fibromyalgia - Polymyalgia Rheumatica 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 - 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) - 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 - 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 - 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) - 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 - 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 - 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 - 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 - A. Scalp A common rule to follow when prescribing many medications for the elderly is to: - 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: - the meaning of a common proverb