APEA PREDICTOR EXAM TESTBANK 2024/ APEA PREDICTOR EXAM WITH 900+ QUESTIONS WITH CORRECT, Exams of Nursing

Download APEA PREDICTOR EXAM TESTBANK 2024/ APEA PREDICTOR EXAM WITH 900+ QUESTIONS WITH CORRECT and more Exams Nursing in PDF only on Docsity! APEA PREDICTOR EXAM TESTBANK 2024/ APEA PREDICTOR EXAM WITH 900+ QUESTIONS WITH CORRECT VERIFIED AND DETAILED ANSWERS WITH RATIONALES/A+ GRADE/LATEST 2024-2025 What is the most common cause of Cushing's syndrome? - ANSWER-Administration of a glucocorticoid or ACTH. RATIONALE: Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to: - ANSWER-Elevate her legs periodically. RATIONALE: The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed. A 25-yo female patient presents for a routine well-women exam. On physical exam, the NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph node enlargement. What is the most likely diagnosis? – ANSWER- Itraductal papilloma. RATIONALE: Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain. According to the ANA, the role of the NP who provides primary health care is the: - ANSWER-Direct nursing care role. RATIONALE: The NP with a traditional nursing care role is a primary health care provider. Increasing numbers of nurse practitioners are assuming indirect roles such as educator, administrator, researcher, and consultant. An 8-mo male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma, but say " he has always bruised easily" The most likely diagnosis is: - ANSWER-A type of hemophilia. RATIONALE:Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times. The nurse practitioner is following a child with juvemile rheumatoid arthritis (JRA) who has been previously diagnosed and is being managed for the disease by a pediatric rheumatologist. The mother asks for information about the child's long-term prognosis. The appropriate reply is that: - ANSWER-most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. RATIONALE: Although the active disease does not continue into adulthood, the What are the primary bacteria in dog bites? - ANSWER-staph, strep, and pasteurella What is the gold standard treatment of giant cell arteritis? - ANSWER-oral steroids and potential artery biopsy by rheum Cranial Nerve VIII – ANSWER-Acoustic (Hearing and balance) Cranial nerve IX - ANSWER-Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI – ANSWER-Spinal Accessory (upper trapezius) Deep tendon reflex – ANSWER-Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7 Stroke risk scale – ANSWER-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 - ANSWER-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 – ANSWER-D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension – ANSWER-B. Pregnancy-induced hypertension (pre- eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria. The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes – ANSWER-B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough Atenolol is a beta blocker. It should be avoided in pateints with asthma or other bronchospastic conditions. These patients often require beta stimulation, not beta 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: - ANSWER-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: - ANSWER-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? - ANSWER-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? - ANSWER- Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? - ANSWER-Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? - ANSWER-Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? - ANSWER-6 weeks. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: - ANSWER-testicular self-examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: - ANSWER-a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring 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? - ANSWER- 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? - ANSWER-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. A 38 year old patient is being treated the by the NP for heavy vaginal bleeding secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks gestational size, her hematocrit is 28%, and she has not responded to hormonal therapy. Which of the following would be the most appropriate intervention at this time? - ANSWER-Obtain a gynecological consultation Gynecological consultation is recommended for a patient with a uterus greater that 12 weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy with failure to respond to hormonal therapy. What maternal situation is considered an absolute contraindication to breastfeeding? - ANSWER-Early HIV detection There are few absolute contraindications to breastfeeding. HIV infection and IV drug abuse are 2 contraindications. A 21 yo college student presents to the sudent health center with copious, markedly purulent discharge from her left eye. The nurse practitioner should suspect: - ANSWER- gonococcal conjunctivitis. A purulent and copious discharge should alert the nurse practitioner to the likely possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic treatment and immediate referral to an opthalmologist for evaluation. Babies should begin oral iron supplementation: - ANSWER-4-6 months of age. Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6 months of life. Earlier supplementation may be m=necessary for premature infants, infants who are breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior to 1 year of age. Which item is NOT implicated in erectile dysfunction (ED)? - ANSWER-Urinary tract infection (UTI) Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many medications can cause ED, particularly the antihypertensives (Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED. Expected spriometry readings when the patient has chronic emphysema include: - ANSWER-Increased total lung capacity (TLC). Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis. Physical exam findings consistent with emphysema include all of the following EXCEPT: - ANSWER-pallor and cyanosis of the mucosa and nailbeds. Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are minished and cough is weak and ineffective. Which laboratory test is useful in the diagnosis of spontaneous abortion? - ANSWER- Serial quantitative beta-huma chorionic gonadotropin levels. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT: - ANSWER-one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? - ANSWER-Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? - ANSWER- Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: - ANSWER-alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to driving under the influence of alcohol are the leading cause of death in the 15-24 year old age group. A patient with moderate persistent asthma will probably be most effectively managed with daily: - ANSWER-inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen. A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT: - ANSWER- Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face. What is the recommended treatment for cat scratch disease? - ANSWER-usually self- limiting and presents with lymphadenopathy that goes away on it's own; severe cases may benefit from azithromycin What is the most common cause of traveler's diarrhea? - ANSWER-e coli What bacteria is responsible for causing cat scratch disease? - ANSWER-bartonella A positive Auspitz sign is indicative of what? - ANSWER-psoriasis When are pregnant women screening for gestational diabetes? - ANSWER-week 24-28 What is round ligament pain? - ANSWER-a deep, sharp, stabbing or stretching sensation that begins or worsens with movement and can be unilateral or bilateral. This is a normal and benign part of pregnancy What are the components of the fetal biophysical profile? - ANSWER-nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? - ANSWER-via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? - ANSWER-in the third trimester, often after week 28-32 What is a normal kick count in pregnancy? - ANSWER-at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? - ANSWER-28-40 pounds How much weight should a normal weight woman gain in pregnancy? - ANSWER-25-35 pounds How much weight should an overweight woman gain in pregnancy? - ANSWER-15-25 pounds How much weight should an obese woman gain in pregnancy? - ANSWER-11-20 pounds Underweight and normal weight woman should be gaining how much weight per week in their second and third trimesters? - ANSWER-1 pound Overweight and obese women should be gaining how much weight per week in their second and third trimesters? - ANSWER-0.5 pounds What is the biggest risk associated with scabies? - ANSWER-secondary infection due to itching What do scabies look like on the skin? - ANSWER-red papular bumps that have s shaped burrows on them; may have fluid coming from them Sickle cell anemia is what type of anemia? - ANSWER-normocytic How is sickle cell anemia diagnosed? - ANSWER-hemoglobin electrophoresis Which age group is rheumatic fever most common in? - ANSWER-children ages 5-15 What are the major symptoms of rheumatic fever? - ANSWER-carditis, arthritis, chorea, erythema marginatum (rash), subcutaneous nodules What are the minor symptoms of rheumatic fever? - ANSWER-fever, elevated ESR, prolonged PR interval How do we treat rheumatic fever? - ANSWER-refer to the hospital What is chorea? - ANSWER-abnormal involuntary movements What are the main s/s of rubeiola (measles) - ANSWER-Koplick spots + the 3 c's - cough, coryza, conjunctivitis GABHS infection puts individuals at the highest risk of developing what sequelae? - ANSWER-peritonsillar abscess, glomerulonephritis, rheumatic fever Erikson stage from 21-39 years - ANSWER-intimacy vs isolation Erikson stage from 40-65 years - ANSWER-generativity vs stagnation Erikson stage for 65 and older - ANSWER-ego integrity vs despair Macrobid/nitrofurantoin is contraindicated in which patients? - ANSWER-those with renal insufficiency Treatment options for complicated UTI - ANSWER-cipro or levo x 5-7 days Treatment options for uncomplicated UTI - ANSWER-bactrim x 3 days, macrobid x 5 days, fosfamycin 1g one time dose Olecranon bursitis is pain in which region of the elbow? - ANSWER-the posterior elbow; will also have swelling and warmth Lateral epicondylitis manifests as what type of elbow pain? - ANSWER-weak grip and pain with gripping, pain with rotation of the wrist and forearm The medical term for golfer's elbow - ANSWER-medial epicondylitis How does the pain in lateral vs. medial epicondylitis differ? - ANSWER-lateral epicondylitis is worse with supination of the hand and medial epicondylitis is worse with pronation of the hand involves tapping a finger along the problem nerve - ANSWER-tinel sign asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists - ANSWER-phalen sign Which nerve runs on the side of the thumb - ANSWER-median nerve Which nerve runs on the side of the pinky finger - ANSWER-ulnar nerve What is ankylosing spondylitis? - ANSWER-an inflammatory condition affecting the spine causing chronic back pain and stiffness that improves with exercise and enthesitis What is the treatment for ankylosing spondylitis? - ANSWER-refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? - ANSWER-chronic pain in the proximal joints (shoulders and hips) bilaterally with stiffness lasting for more than 45 minutes What is the recommended treatment for polymyalgia rheumatica? - ANSWER-PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? - ANSWER-fish, meat, poultry, eggs, and dairy products, also fortified breakfast cereals and fortified nutritional yeasts What is the gold standard for the diagnosis of herpes? - ANSWER-nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? - ANSWER-treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? - ANSWER- chronic htn is present before 20 weeks gestation or 12 weeks after delivery; gestational hypertension is after 20 weeks gestation Which is the recommended diagnostic when a patient has a breast lump? - ANSWER-if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? - ANSWER-urge incontinence What are ECG changes you may see on a patient with hyperkalemia? - ANSWER- peaked T waves A U wave present on EKG is thought to represent what? - ANSWER-repolarization of the purkinje fibers What is considered legal blindness? - ANSWER-20/200 or worse What is the pain of temporal arteritis like? - ANSWER-new onset headache, jaw pain with chewing Are nexplanon and norplant (levonorgestrol) combined contraceptives or progesterone only? - ANSWER-progesterone only Breastfeeding women cannot have which type of anti-contraceptive? - ANSWER- anything with estrogen in it; this includes things like cocps What is the treatment of choice for community acquired, uncomplicated pneumonia? - ANSWER-amoxicillin Vitamin B12 deficiency anemia is a type of anemia. - ANSWER- 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? - ANSWER-4 weeks The most common cause of atypical pneumonia in adults - ANSWER-mycoplasma pneumoniae An herbal supplement thought to help BPH - ANSWER-saw palmetto A male patient presents to your clinic with a lump in his breast. How should we work this up? - ANSWER-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? - ANSWER-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? - ANSWER-48 hours When should kids be treated for hypertension? - ANSWER-if they also have diabetes, are symptomatic, have hypertension > 95th percentile, or when end organ damage is present ACEIs can cause what electrolyte abnormality? - ANSWER-hyperkalemia A positive "drop arm" test is a sign of what? - ANSWER-torn rotator cuff The medical term for spoon shaped nails - ANSWER-koilonychia Koilonychia is a sign of what? - ANSWER-iron deficiency anemia How is influenza diagnosed? - ANSWER-a nasal swab What finding would be most likely to differentiate gout from septic arthritis? - ANSWER- fever would be indicative of septic arthritis Diphenhydramine has properties and is contraindicated in which patient populations? - ANSWER-anticholinergic; elderly and those with glaucoma statins and CCBs Ankle inversion is a common complaint from a patient with what? - ANSWER-a lateral ankle sprain How can we best diagnose coarctation of the aorta? - ANSWER-by comparing the upper and lower extremity blood pressures What is the most important risk factor for developing breast cancer in women of average risk? - ANSWER-age hey - ANSWER-stopped at top of page 7 What is the recommended treatment for blepharitis? - ANSWER-erythromycin 1cm ribbon 5x daily for 7 days What is the recommended treatment for severe anorexia with delusions? - ANSWER- 2nd atypical antipsychotics What lab values need to be monitored in a patient on Tizanidine? - ANSWER-LFTs and BP at baseline and 1 month after the max dose is achieved (can cause hepatotoxicity and hypotension) What class of drug is dabigatran (pradaxa)? - ANSWER-direct thrombin inhibitor The most effective treatments for acne related to increased sebum production are what? - ANSWER-oral contraceptives and isotretinoin Oral contraceptive regimen in which both the estrogen and progesterone concentrations vary throughout the cycle - ANSWER-quadriphasic Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle - ANSWER-monophasic Oral contraceptive regimen in which in the estrogen dose remains the same for the first 21 days of the cycle, while progestin is lower in the first half and higher in the second half - ANSWER-biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies - ANSWER-triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? - ANSWER-treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? - ANSWER-tetracyclines depress prothrombin activity, same as warfarin, so we need to decrease the warfarin to avoid an increase in INR and significant bleeding What is the herbal, valerian root often used for? - ANSWER-insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? - ANSWER-BPH What is the herbal, black kohosh, often used for? - ANSWER-symptoms of menopause - hot flashes What is the herbal, St. John's wart, often used for? - ANSWER-depression What are the intrauterine transplacental infections that can be passed from mother to infant? - ANSWER-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 - ANSWER-augmentin; doxy if there is a penicillin allergy Obese women should gain how much weight during pregnancy? - ANSWER-11-20 pounds What are the 4 components of Tetralogy of Fallot? - ANSWER-VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy What does the murmur of Tet of Fallot sound like? - ANSWER-harsh systolic murmur at the left upper sternal border What is a tet spell? - ANSWER-when the child turns blue during crying or feeding How do we treat thrush in infants? - ANSWER-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? - ANSWER-managed care plans TCAs can cause what worsened problem in a patient with BPH? - ANSWER-urinary retention Signs of a ruptured ovarian cyst - ANSWER-nausea, vomiting, shoulder pain, fever Growing pains often start in what age group? - ANSWER-3-5 What antibiotics are considered safe in pregnancy? - ANSWER-beta lactams (cephalosporins, amox, augmentin), nitrofurantoin, vancomycin, metronidazole, clindamycin, and fosfomycin an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. It occurs when a viral infection, such as an upper respiratory infection, moves to and settles in the hip joint. - ANSWER-transient synovitis hypokalemia; hyperkalemia Hyperparathyroidism can cause what? - ANSWER-hypercalcemia and thus, osteoporosis PID should improve after of the antibiotic course. - ANSWER-3 days A loss of the central sulcus of the prostate on DRE is a sign of what? - ANSWER-BPH A woman who gets the MMR vaccine should wait at least before getting pregnant. - ANSWER-4 weeks What is a major cause of cleft palate and lip? - ANSWER-smoking during pregnancy HCTZ can cause , whereas ACEI can cause - ANSWER- What is Auspitz sign? - ANSWER-the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques Treatment of choice for pyelonephritis - ANSWER-ciprofloxacin When should pediatrics be screened for hyperlipidemia? - ANSWER-between 9 and 11 years old What is the tell-tale symptom of endometriosis? - ANSWER-progressive dysmenorrhea What is treatment for first-line endometriosis? - ANSWER-cyclic OCPs and NSAIDs How is endometriosis diagnosed? - ANSWER-via transvaginal ultrasound What are risk factors for the development of cervical cancer? - ANSWER-HIV, immunocompromised, low socioeconomic status, smoking, hispanic, DES daughters, long term contraceptive use Who should be screened for HIV? - ANSWER-everyone at least once from age 13-64 if low risk, and then more frequently if high risk Should patients undergo gonorrhea testing to confirm a cure after receiving treatment? - ANSWER-only if they had pharyngeal gonorrhea, not vaginal or anal Tanner stage 1 female breast developmental - ANSWER-prepubertal Tanner stage 2 female breast development - ANSWER-thelarche; the breasts bud as a small mound and the areola increases in diameter Tanner stage 3 female breast development - ANSWER-the areola, breast, and nipple grow together in one mount Tanner stage 4 female breast development - ANSWER-the areola and nipple separate from the breast to form a secondary mound Tanner stage 5 female breast development - ANSWER-mature nipples project only Tanner stage 1 male genital development - ANSWER-prepubertal Tanner stage 2 male genital development - ANSWER-testicles and scrotum enlarge Tanner stage 3 male genital development - ANSWER-testicles continue to enlarge and the penis lengthens Tanner stage 4 male genital development - ANSWER-penis lengthens, testicles enlarge, and the scrotum darkens Tanner stage 5 male genital development - ANSWER-mature Antibiotic of choice for lyme disease - ANSWER-doxycycline Antibiotic of choice for cellulitis - ANSWER-keflex or cefdinir Antibiotic of choice for chlamydia - ANSWER-azithromycin Antibiotic of choice for syphilis - ANSWER-penicillin G Antibiotic of choice for bacterial vaginosis - ANSWER-flagyl Antibiotic of choice for trichomoniasis - ANSWER-flagyl Antibiotic of choice for acute prostatitis - ANSWER-cipro (or ceftriaxone if STI related) Antibiotic of choice for PID - ANSWER-ceftriaxone and doxycycline Antibiotic of choice for pyelonephritis - ANSWER-cephalexin or bactrim Antibiotic of choice for MRSA - ANSWER-bactrim, clindamycin, doxycycline Antibiotic of choice for dog or cat bite - ANSWER-augmentin Antibiotic of choice for mastitis - ANSWER-keflex Antibiotic of choice for chronic bacterial prostatitis - ANSWER-bactrim plus cipro or levo What is the earliest sign of diabetic nephropathy on labwork? - ANSWER- microalbuminuria in the urine Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs? - ANSWER-weight gain When does otitis media with effusion usually occur? - ANSWER-either before or after an episode of acute otitis media. This effusion is not infected fluid but it is considered a breeding ground for bacteria. This should not be treated with antibiotics. The medical term for jock itch - ANSWER-tinea cruris what? - ANSWER-fungal; OTC antifungal cream What are teaching points for males to avoid contracting tinea cruris? - ANSWER-dry off after swimming and don't stay in a wet bathing suit Tinea cruris can affect the inner thighs but never what else? - ANSWER-the penis or scrotum On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? - ANSWER-cocci and rods On microscopic exam, what is most likely to be seen in the presence of a candidal infection? - ANSWER-yeasts Tinea cruris "jock itch" is a common infection and should be treated with What are dermatophytes? - ANSWER-fungi On microscopic exam, what is most likely to be seen in the presence of a dermatophytic (fungal) infection? - ANSWER-hyphae that are long, thin, and branching (such as in the case of tinea pedis, tinea cruris, and tinea corporis) The medical term for ringworm - ANSWER-tinea corporis What is the most common cause of viral pneumonia in peds? - ANSWER-RSV Viral pneumonia is the most common type of pneumonia in children of what ages? - ANSWER-6 months to 5 years What is the simplest way to screen for nutritional adequacy in older adults? - ANSWER- measure their weight How are scabies treated? - ANSWER-via permethrin and good hygiene What are common side effects of NSAIDs? - ANSWER-renal impairment, acute renal failure, gastritis What is the most common cause of pernicious anemias? - ANSWER-vitamin B12 deficiency How should oral iron supplements be taken? - ANSWER-on an empty stomach with something acidic and high in calcium such as orange juice Group A strep pharyngitis can be accompanied by what symptoms other than the classic Centor criteria? - ANSWER-abdominal pain, nausea, and vomiting A stool specimen that is positive for WBCs is a sign of what? - ANSWER-a viral or bacterial infection The only type of incontinence that would not benefit from pelvic floor therapy is what? - ANSWER-overflow incontinence What do the skin manifestations of a penicillin allergy look like? - ANSWER-hives pregnancy? - ANSWER-her blood pressure decreases What is the most common cause of acute pharyngitis in children? - ANSWER- respiratory viruses A depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response? - ANSWER-8-12 weeks is indicative of a UTI. - ANSWER-100,000 What are signs of a ruptured TM other than the obviously ruptured TM? - ANSWER- muffled hearing and bright red blood in the canal Osgood Schlatter disease produces pain where? - ANSWER-in the knees Growing pains usually occur when? - ANSWER-at nighttime Children with complaints of midbone pain should be worked for what MNM differential? - ANSWER-acute lymphocytic leukemia If the number of bacteria on a urinalysis are greater than , this NSAIDs should be used in caution with what patient population? - ANSWER-anyone with hypertension because they cause sodium retention and increase blood pressure What is the most common cause of secondary dysmenorrhea? - ANSWER- endometriosis; symptoms include spotting in between periods, cervical stenosis or displacement, nodular or tender uterosacral ligaments When should AAA screening be performed via US? - ANSWER-once for all males age 65-75 who have ever smoked What is responsible for the transmission of poison ivy? - ANSWER-the oils from the plant itself. So the only way someone can pass it on to another person is if they still have oil from the plant on their skin (like if they haven't bathed). Note that the fluid inside the blisters is not contagious Actinic keratosis is a precursor for what? - ANSWER-squamos cell carcinoma What is papilledema? - ANSWER-swelling of the optic nerve and disc secondary to increased ICP. Often co-occurring with a headache Is sexual activity safe during pregnancy? - ANSWER-it can expose someone to STDs and it can also stimulate preterm labor due to stimulation of the lower uterine segment and release of oxtocin A report of "knee locking" is a classic complaint of what? - ANSWER-a meniscal tear Can a pregnant woman be on levothyroxine during pregnancy? - ANSWER-yes, she should continue it and have TSH checked monthly because she may need a higher dose as thyroid hormone needs increase during pregnancy What characterizes mild persistent asthma? - ANSWER-asthma where symptoms occur more than twice weekly People who do not have a spleen (asplenic) are at a greater risk of what? - ANSWER- more susceptible to bacterial infections What 2 things put someone at the highest risk of developing pancreatitis? - ANSWER- gallstones and alcohol abuse. Hypertriglyceridemia can also cause it. What are the RF for GI bleeding? - ANSWER-age 75 or older, warfarin use, daily NSAID use, chronic steroid use, PMHx of GI bleed When two or more RF for a GI bleed are present, we should not start a patient on aspirin without what? - ANSWER-a daily PPI What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy? - ANSWER-nitrofurantoin What helps prevent infection by maintaining the acidic environment of the ear canal? - ANSWER-cerumen Mortality associated with Kawasaki disease is most likely related to what? - ANSWER- coronary artery aneurysm What is Kawasaki disease? - ANSWER-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? - ANSWER-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? - ANSWER-parainfluenza virus What are the two subsets of impetigo? - ANSWER-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? - ANSWER-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 - ANSWER-seizures What is HELLP syndrome in pregnancy? - ANSWER-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? - ANSWER-endothelial dysfunction Patients with acute coronary syndrome typically have plaque erosion caused by what? - ANSWER-accumulation of hyaluronan and neutrophils Which diagnostic study is most helpful for differentiating Alzheimer's disease from dementia with Lewy bodies? - ANSWER-PET scan ADHD is a risk factor for both depression and what else? - ANSWER-substance abuse Epididymitis with orchitis is commonly related to what? - ANSWER-genitourinary infections Mycoplasma genitalium is most commonly associated with which disease presentation in men? - ANSWER-urethritis, especially if persistent or recurrent C. trachomatis stands for what common type of bacteria infection? - ANSWER- chlamydia Chlamydia passed from a mother to a newborn can result in which problems for the newborn? - ANSWER-conjunctivitis and pneumonia In a patient with patent ductus arteriosus, where is the murmur best heard? - ANSWER- localized at the left clavicle and is both systolic and diastolic What is the ductus arteriosus? - ANSWER-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? - ANSWER- diabetes, obesity, arthritis, cancer, Alzheimers Seborrheic dermatitis is basically the same thing as what? - ANSWER-eczema of the scalp The flow of air coming in and out of the lungs in one inhalation and one exhalation - ANSWER-peak expiratory flow What does an incentive spirometer measure? - ANSWER-peak expiratory flow Patient populations who may present atypically when having a MI include who? - ANSWER-diabetics, females, elderly A disorder that results in the destruction of platelets due to an autoimmune response - ANSWER-idiopathic thrombocytopenia purpura Pelvic inflammatory disease is most commonly caused by what? - ANSWER-chlamydia and gonorrhea A protruding abdominal mass after bending over, lifting, or coughing, and is painful with coughing, is often what in adults? - ANSWER-inguinal hernia Hiatal hernias cause what type of symptoms? - ANSWER-GERD What is the name of an immature female gamete? - ANSWER-oocyte The fused ovum and sperm once fertilization has occurred - ANSWER-zygote What are conditions that are often co-occurring with alopecia areata? - ANSWER-atopic dermatitis, vitiligo, thyroid disease, collagen-vascular diseases, Down syndrome The medical term for eczema - ANSWER-atopic dermatitis The leading cause of death in infants under the age of 1 - ANSWER-sudden unexplained infant death How is varicella zoster transmitted? - ANSWER-via the respiratory tract The presence of pruritic papules, macules, and vesicles in various stages of healing - ANSWER-varicella zoster What is presbycusis? - ANSWER-age related hearing loss Age is the most common cause of presbycusis, but what other conditions may play a role in quickening the onset of this? - ANSWER-white, infections, smoking, hypertenson, diabetes, vascular disease, immune disorders, hormonal factors The fascia layer of the male anatomy that the anterior 2/3s of the testicle resides in - ANSWER-tunica vaginalis A subtype of strabismus that describes an inward turning of the eye - ANSWER- esotropia The abducens nerve (CN VI) is responsible for what? - ANSWER-lateral movement of the eye outward The trochlear nerve is responsible for what extraocular movement? - ANSWER-down and inward movement Why is primary open-angle glaucoma considered a chronic glaucoma? - ANSWER- there is a SLOW rise in intraocular pressure A benign epidermal tumor that is a well-demarcated, coin-like, pigmented lesion with a stuck on appearance - ANSWER-seborrheic keratosis The most common precancerous skin lesion that results from years of repeated sun exposure - ANSWER-actinic keratosis What happens during the follicular phase of the menstrual cycle? - ANSWER-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 - ANSWER-tinea capitis Bacterial invasion of the renal parenchyma - ANSWER-pyelonephritis When can you hear the murmur associated with mitral valve stenosis? - ANSWER- diastole only What EKG changes may be present during episodes of angina? - ANSWER-transient ST elevation, T wave changes such as inversions, ST depressionals, Q waves Children and teens present with depression most commonly how? - ANSWER-irritability Are the sickling of RBCS in sickle cell anemia reversible? - ANSWER-initially, yes they are reversible with oxygenation. But repeated episodes cause the cells to become irreversibly sickled. When the brain is exposed to something rewarding, it responds by increasing the release of what? - ANSWER-dopamine Where are T cells produced? - ANSWER-in the thymus Where are B cells produced? - ANSWER-in the bone marrow What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)? - ANSWER-T3 and T4 are overproduced which leads to increased production of epinephrine and severe hypermetabolism What causes a reduction in the number of RBCs in pregnancy? - ANSWER-iron deficiency anemia due to blood volume expansion and a decrease in hemoglobin levels so the iron stores are depleted because they are needed to be used for the expanded blood volume When should the ductus arteriosus close in an infant? - ANSWER-within the first 1-2 days of birth The minimum arterial pressure exerted during relaxation and dilation of the ventricles - ANSWER-diastole Lyme disease is caused by what spirochete present on ticks? - ANSWER-borrelia burgdorfei What are the potential sequelae of strep pharyngitis? - ANSWER-acute glomerulonephritis, peritonsillar abscess, toxic shock disease, rheumatic heart disease (although rare) The medical term for pubic lice aka crabs - ANSWER-phthirus pubis Petechiae noted on the cervix during a pelvic exam is a sign of what disease process? - ANSWER-trichomoniasis; also called "strawberry cervix" What is the difference between a folliculitis and a furuncle? - ANSWER-folliculitis is an inflammation of the follice whereas a furuncle is an abscess that results from folliculitis Urea is eliminated by the kidneys, but where does it come from originally? - ANSWER- from the liver as a byproduct of protein metabolism What are the 5 primary structures of the immune system? - ANSWER-lymph nodes, thymus, tonsils, spleen, bone marrow Bacteria most commonly responsible for pyelonephritis - ANSWER-e coli What causes back pain in pregnancy? - ANSWER-curvature of the lumbosacral vertebrae What is dacrocystitis? - ANSWER-inflammation of the nasolacrimal duct due to duct obstruction or infection What are potential causes of blepharitis? - ANSWER-bacterial infection, dry eyes, rosacea What are s/s of croup? - ANSWER-hoarseness, cough, inspiratory stridor, possible respiratory distress due to narrowing of the larynx What are the s/s of Kawasaki disease? - ANSWER-think CREAM; conjunctivitis, rash, erythema of hands and soles of feet, adenopathy (cervical), mucous membranes (strawberry tongue) A palpable softening of the cervical isthmus during pregnancy - ANSWER-Hegar's sign A bluish tint to the vagina and cervix due to increased vascularity during pregnancy - ANSWER-Chadwick's sign What is Paget's disease? - ANSWER-where there is abnormal bone destruction or growth of bone. It is also a malignant disease of the breast. Does Meniere's disease result in hearing loss? - ANSWER-yes, gradual but progressive sensorineural hearing loss What is another term for chronic bladder pain syndrome? - ANSWER-interstitial cystitis What classifies someone as having "prediabetes"? - ANSWER-hgba1c between 5.7 and 6.4 What classifies someone as having diabetes? - ANSWER-hgba1c 6.5 or greater A reduction in vision in one or both eyes causing loss of binocular vision - ANSWER- amblyopia What is Brudzinski's sign? - ANSWER-the patient lies supine and the NP flexes the patients neck forward. If both hips and knees flex at the same time, this is indicative of meningitis A child presents with erythematous papules and vesicles, that are weeping, oozing, and crusty. They are located all over the forehead, wrists, elbows, and backs of knees. What is this most likely to be? - ANSWER-atopic dermatitis In older adults, what is an audible S3 sound usually a sign of? - ANSWER-left ventricular hypertrophy from heart failure, or cardiomyopathy How is cervical radiculopathy different from cervical myelopathy? - ANSWER-in radiculopathy, there is nerve root compression that results in burning pain and n/t in the neck and one arm. In myelopathy, there is pain with bilateral weakness and n/t in both the upper and lower extremities Other than scratching the medial aspect of the thigh, how else can we elicit the cremasteric reflex in a child? - ANSWER-have them sit cross legged and blow into a balloon. This will increase intraabdominal pressure and stimulate the reflex. What is the Lachman's test and what does it identify? - ANSWER-used to assess for ACL tear; the knee is held passively at 30 degrees flexed and then one hand stabilizes the femur while the other applies a gentle anterior force to the proximal tibia. If it moves beyond it's normal ROM, there may be an ACL tear When should the testicles fully descend into the scrotum by in an infant? - ANSWER-6 months of age. If not descended by this time, then refer to Urology at 6 months although surgical correction (orchipexy) may not be performed until 1 year What is another name for the moro reflex? - ANSWER-the startle reflex; both arms should extend outwards when this is positive If a moro reflex in an infant is only positive in one arm, then what do you need to consider? - ANSWER-examine the clavicle for a potential fracture Which model is used to designate risk factors for melanoma? - ANSWER-think HARMM; history, age, regular dermatologist absent, mole changing, male gender What is a sign of an ankle fracture on physical exam? - ANSWER-point tenderness over the posterior malleolus with an inability to bear weight after 4 or more steps What is an acoustic neuroma? - ANSWER-something pressing, likely a tumor, on the acoustic nerve that results in dizziness, loss of balance, facial numbness, hearing loss, and tinnitus The axillary lymph nodes drain lymphatic fluid from where? - ANSWER-breast, upper abdomen, upper back, pectoral region, and upper limbs What are the symptoms of Shaken Baby Syndrome? - ANSWER-blindness, inability to perform previously learned milestones, flaccid muscle tone Koplik's spots are indicative of what disease? - ANSWER-measles (rubeola) The medical term for measles - ANSWER-rubeola What do Koplik's spots of measles look like? - ANSWER-small white specks that resemble grains of salt on a red background Round or oval shaped lesions surrounded by erythematous mucosa found anywhere on the oral mucosa - ANSWER-aphthous ulcers Excessive or prolonged menstrual flow occurring at regular intervals - ANSWER- menorrhagia Intermenstrual bleeding (aka spotting in between periods) - ANSWER-metrorrhagia Polymenorrhea is when there are fewer than between periods - ANSWER-21 days Oligomenorrhea is when there are more than between periods; or only 4-9 menstrual cycles per year - ANSWER-35 days Retraction of the nipple and areola are suggestive of what? - ANSWER-an underlying breast mass; this is never considered normal What is the straight leg raise test? - ANSWER-used to evaluate for sciatica; the NP raises the straight leg while flexing the hip and then dorsiflexes the foot. Positive if pain is elicited. What is Tinel's sign? - ANSWER-positive for carpal tunnel; the NP taps over the median nerve and is positive if n/t is felt What is Phalen's sign? - ANSWER-positive for carpal tunnel; patient holds their wrists together to form right angles for 60 seconds and is positive if n/t is felt Test used to identify de Quervain's tenosynovitis - ANSWER-Finkelsteins test Test of thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation - ANSWER-Finkelsteins test What does the murmur associated with mitral regurg sound like? - ANSWER- pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla When auscultating the apex of the heart in a child older than 7, the bell of the stethoscope should be placed where? - ANSWER-fifth intercostal space to the left of the midclavicular line; if younger than 7, it is best heard at the third or fourth intercostal space What is the main sign of Kaposi's sarcoma? - ANSWER-raised or flat deep purple lesions in the mouth Where do lesions of Kaposi's sarcoma usually manifest? - ANSWER-in the mouth, GI tract, or lungs A patient is experiencing a dull achy pain in the epigastric area with eating. This type of pain is consistent with what? - ANSWER-a gastric ulcer How is the pain of a gastric ulcer vs. a duodenal ulcer different? - ANSWER-the pain is worsened with eating with a gastric ulcer but improved with eating in a duodenal ulcer What are s/s of glaucoma? - ANSWER-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? - ANSWER-instrumental activities of daily living An inability to extend the knee is a sign of what? - ANSWER-a partial or complete patellar tendon tear Where is the best place to locate the twelfth rib? - ANSWER-between the spine and lateral chest What is biliary colic? - ANSWER-pain in the epigastric region or RUQ that radiates to the right scapula or shoulder; indicative of cholecystitis Costochondritis occurs when there is inflammation of the cartilage where? - ANSWER- that connects the ribs to the sternum What aggravates costochondritis? - ANSWER-movement of the chest, trunk, and arms Which segments of the spine control the plantar reflexes? - ANSWER-lumbar 5 and sacral 1 A softening of the skin at the angles of the mouth which may be due to nutritional deficiency - ANSWER-angular cheilitis Angular cheilitis can be caused by what? - ANSWER-nutritional deficiency What causes actinic cheilitis? - ANSWER-excessive exposure to sunlight; most often affects the lower lip Intention tremors appear with movement and worsen when? - ANSWER-as the target gets closer Nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event - ANSWER- vasovagal syncope Which conditions are known to cause polyuria? - ANSWER-lithium toxicity, uncontrolled diabetes, disorders of the posterior pituitary and hypothalamus (hypogonadism), and hypokalemic nephropathy Breath sounds heard over the periphery of the lung fields are what? - ANSWER- vesicular; they are quiet and wispy What do bronchovesicular breath sounds sound like? - ANSWER-full inspiratory phase with a shortened and quieter expiratory phase Thenar atrophy suggests what? - ANSWER-a median nerve disorder Does the ulnar nerve innervate the pinky or the thumb? - ANSWER-pinky The pregnant woman who has a BMI of less than 18.5 should gain how many pounds in pregnancy? - ANSWER-28-40 pounds The pregnant woman who has a BMI of 18.5-24.9 (normal) should gain how many pounds in pregnancy? - ANSWER-25-35 pounds The pregnant woman who has a BMI of 25-29.9 (overweight) should gain how many pounds in pregnancy? - ANSWER-15-25 pounds The pregnant woman with a BMI over 30 should gain how many pounds in pregnancy? - ANSWER-11-20 pounds A BMI of less than is considered underweight - ANSWER-18.5 The term used to refer to skin that is peeling - ANSWER-exfoliation What will a basal cell carcinoma on the eyelid look like? - ANSWER-papule with an ulcerated center, most often on the lower lid and medial canthus What is Rovsing's sign? - ANSWER-positive for appendicitis; palpation on the LLQ elicits pain in the RLQ What causes plantar warts? - ANSWER-human papillomavirus; usually occur on the sole of the foot had removal of a cataract in the left eye? a. "Forcefully cough and take deep breaths every two hours to keep your airway clear." b. "Perform the prescribed eye exercises each day to strengthen your eye muscles." c. "Rinse your eyes with saline each morning to prevent postoperative infection." d. "Take the prescribed stool softener to avoid increasing intraocular pressure." - ANSWER-d. "Take the prescribed stool softener to avoid increasing intraocular pressure." A 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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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." - ANSWER-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. - ANSWER-d. Beefburger with cheese.