APEA Predictor Np Test Exam Questions and Answers 2024, Exams of Nursing

Download APEA Predictor Np Test Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 APEA Predictor Np Test Exam Questions and Answers 2024 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. 2 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: 5 A nurse determines that the therapeutic effectiveness of magnesium sulfate (MgSO4) for client who has preeclampsia is achieved when there is increased: a. urinary output. b. blood pressure. c. respiratory rate. d. uterine movement. ✓ urinary output. Which of these assessments is the initial priority of a client who is one-hour postoperative after an exploratory laparotomy? a. The appearance of the client's surgical incision. b. The client's level consciousness. c. The adequacy of the client's respiratory function. d. The client's fluid and electrolyte status. ✓ c. The adequacy of the client's respiratory function. Which of these client reports should a nurse recognize as suggestive of hypothyroidism? a. "My hands shake whenever I reach for anything." b. "I feel cold and tired all the time." c. "I sweat whenever I walk more than one block." d. "My head aches each evening." ✓ b. "I feel cold and tired all the time." A nurse is monitoring a client who is taking acetylsalicylic acid (Aspirin) 975 mg daily for adverse effects, which include: 6 a. loss of joint mobility. b. increased serum calcium levels. c. increasing heart failure. d. occult blood in the stools. ✓ d. occult blood in the stools. Which of these rationales explains the purpose of nasogastric tube with suction for a client who had abdominal surgery? a. Prevention of gastric decompression. b. Removal of secretions from the stomach. c. Provision of postoperative nutrition. d. Promotion of abdominal distention. ✓ b. Removal of secretions from the stomach. A 75-year-old client who is newly admitted to a long-term care facility has all these nursing diagnoses. Which one is the priority? a. Risk of injury. b. Anxiety. c. Sleep pattern disturbance. d. Chronic. ✓ Risk of injury. A 12-month-old child is playing with the father. Which of these behaviors indicates that the child is demonstrating object permanence? a. The child transfers a toy to the other hand when given another one. b. The child returns a block to the same spot on the table. c. The child looks for a toy that the father has hidden under the table. 7 d. The child recognizes that a ball of clay is the same when flattened out. ✓ c. The child looks for a toy that the father has hidden under the table. 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. 10 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 We have an expert-written solution to this problem! 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 11 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 12 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 15 What is primary amenorrhea? when the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics Secondary amenorrhea is a lack of menses after of not having a period; but you have had one before 3 months What do we need to do first when a patient comes in with secondary amenorrhea? rule out pregnancy Anorexia can put you at risk for what? osteoporosis, amenorrhea, cardiac damage Amenorrhea is considered a risk factor for what? osteoporosis What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? they get their period back If a pregnant woman has syphilis, what should we do? treat it with penicillin while she is pregnant because there is risk for spontaneous abortion 16 What is the causative organism of mastitis? staph What is the first line treatment for mastitis? keflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is one of the biggest risk factors for cervical cancer? numerous sexual partners Preeclampsia most commonly shows up at what time in pregnancy? around week 20 How do we treat UTIs in a pregnant woman? can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? about 10 days before menses What can be a sequelae of an ectopic pregnancy? pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) 17 What is the Coomb's test and when is this completed? test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? IUD We have an expert-written solution to this problem! The vaginal ring for contraception must be taken out how often? every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? increase the progesterone How do we treat temporal arteritis? steroids 20 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 21 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 22 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 25 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 How is the pain of trigeminal neuralgia vs temporal arteritis different? in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? 26 adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta molar pregnancy What bacteria is the leading cause of urethritis? neisseria gonorrhea What is the most common cause of hypercortisolism? excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? 5 years old; penicillin 27 We have an expert-written solution to this problem! When can cervical cancer screening stop if no abnormal screening history is present? age 65 We have an expert-written solution to this problem! When should breast cancer screening begin and end with a biannual mammogram? age 50-74 When should colorectal cancer screening stop? age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? age 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? LSIL If a patient has LSIL with a negative HPV test, what would you do? 30 2 year old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed manipulation, the best indication of successful treatment is that: A. Swelling dissipates immediately B. Pulse and sensation are restored C. The child quickly begins to use the affected arm D. A click is felt while the child is extending and rotating the arm C. The child quickly begins to use the affected arm. Which of the following would be an appropriate alternative to erythromycin therapy in an 18 year old patient with Mycoplasma pneumoniae infection? A. Azithromycin (Zithromax) B. Cephalexin (Keflex) C. Amoxicillin 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 31 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 32 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 35 (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. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? A. Palpate structures around the shoulder B. Obtain an MRI to evaluate the shoulder C. Order an Xray of the shoulder D. Request an EMG A. Palpate the structures around the shoulder 36 A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual development. Her physical exam in completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? A. Ovarian dysgenesis B. Dysmenorrhea C. Primary amenorrhea D. Secondary amenorrhea C. Primary amenorrhea An 18-month old child presents with a bulging, immobile tympanic membrane; T-103F(39.4C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: A. Obtain an EKG B. Obtain an Echocardiogram C. Reevaluate the patient in 10 days D. Refer the patient to a cardiologist C. Reevaluate the patient in 10 days Which of the following is NOT an indication of preeclampsia? A. visual disturbances B. Glucosuria C. Edema of the face and hands D. Headaches B. Glucosuria Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? 37 A. Olopatadine (Patanol) B. Cromolyn opthalmic (Crolom) C. Timolol (Timoptic) D. Gentamycin Opthalmic (Genoptic) D. Gentamycin Opthalmic (Genoptic) An 88 year old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? A. Seizure B. Right-sided Stroke C. Left-sided stroke D. Trans ischemic attack C. Left-sided Stroke A nurse pracitioner is evaluating a 40 year old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat chest x-ray is normal. Which of the following tests should the nurse practitioner perform next? A. Spirometry B. MRI C. Contrast venography D. Helical CT pulmonary angiography D. Helical CT pulmonary angiography A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid 40 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 41 C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales D. Red, sharply defined plaques with silvery scales We have an expert-written solution to this problem! 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 42 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. We have an expert-written solution to this problem! 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 45 Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms D. absence of residual symptoms A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields B. In the center of the visual fields. Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck A. Electric-shock-like unilateral facial pain A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: 46 A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion C. Heart failure An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize A. Lateralize to the left. A 38-yo male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A. Testicluar cancer B. Testicular torsion C. Appendicitis D. Epididymitis B. Testicular Torsion Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen 47 B. Anticholinergic drugs C. Systemic steroids D. Exercise A. Oxygen A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with alot of burning. The patient has not resumed sexual activity and has menstrated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? A. Urine pregnancy test B. Microscopic exam of urine C. Herpes simplex virus culture D. Repeat chlamydia test. B. Microscopic exam of urine. 14 year old patient who fell on a outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on xray. The most likely working diagnosis is: A. upper arm sprain B. lateral epicondylitis C. Radial head fracture D. Olecranon bursitis C. Radial head fracture. Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? A. Urinalysis and urine culture 50 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 We have an expert-written solution to this problem! 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 51 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 We have an expert-written solution to this problem! 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. 52 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: 55 Oburator Sign right hypogastric pain constitiutes a positive obturator sign. Ask patient to flex right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. Positive Murphy's sign indicates Acute Cholecystitis. Right upper Quadrant What test is used to assess peripheral arterial disease (PAD)? ankle-brachial index. Heberdens nodes Found at the distal interphalangeal joint (DIP). Seen in osteoarthritis. Finkelstein's Test If positive, Indicates de Quervain's tenosynovitis. Grasp the thumb against the palm and then move the wrist toward the midline in the ulnar deviation Carpal Tunnel maneuvers Tinnel's and Phalen's Evaluation of a meniscal tear using McMurray Sign and a locking on full knee extension 56 Abduction (Valgus) stress test Evaluate for Medial Collateral Ligament (MCL) injury Adduction (Varus) Stress test Evaluate for lateral collateral ligament (LCL) injury Evaluation of Anterior Cruciate Ligament (ACL) injury Anterior Drawer sign and Lachman test Evaluating Posterior Cruciate Ligament (PCL) injury Posterior drawer sign Cranial Nerve I Smell (1 nose) Cranial Nerve II Vision (2 eyes) Cranial nerve III, IV, VI Eye movement 57 Cranial Nerve V,VII,X,XII Voice and speech 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 60 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 At what level of prevention would you classify for lung cancer? A. Primary prevention B. Secondary prevention 61 C. Tertiary prevention D. Primordial prevention D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention. A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation A. Peripheral vision What is the most common cause of Cushing's syndrome? Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to: Elevate her legs periodically. The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed. We have an expert-written solution to this problem! 62 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? Itraductal papilloma. Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain. According to the ANA, the role of the NP who provides primary health care is the: Direct nursing care role. 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: A type of hemophilia. Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times. We have an expert-written solution to this problem! 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: most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. Although the active disease does not continue into adulthood, the contractures, growth retardation, bone deformities, and visual impairment associated with JRA may lead to lifelong functional impairments. A comprehensive treatment program involving physical therapy, occupational therapy, nutrition, education, and regular opthalmologic care can limit residual functional limitations. 65 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. We have an expert-written solution to this problem! 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. We have an expert-written solution to this problem! A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? 66 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. We have an expert-written solution to this problem! 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. 67 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. We have an expert-written solution to this problem! 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. 70 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: 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: 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? Serial quantitative beta-huma chorionic gonadotropin levels. Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing spontaneous abortion. The levels progressively decline. The most acceoted recommendation regarding skin cancer prevention is: avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women >65 years, those 71 with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis. We have an expert-written solution to this problem! The diagnosis of Meniere's disease is based on: The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease. The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia. We have an expert-written solution to this problem! An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight? 135 lbs 72 The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age. We have an expert-written solution to this problem! The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is: Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. We have an expert-written solution to this problem! 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) 75 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? 76 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 77 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 80 GABHS infection puts individuals at the highest risk of developing what sequelae? peritonsillar abscess, glomerulonephritis, rheumatic fever What is the diagnostic criteria for acute rheumatic fever? 2 major criteria OR 1 major + 2 minor criteria PLUS evidence of a recent strep infection When can a breastfeeding mother breast feed again after drinking alcohol? wait 2-3 hours per drink consumed before breastfeeding again Can a mother take methadone while pregnant and breastfeeding? yes Does subsequent mean before or after? after What is the recommended treatment for Kawasaki disease? refer to the ED, will likely need IVIG and high dose aspirin What are the s/s of Kawasaki disease? fever + CREAM (conjunctivitis, rash, erythema of palms and soles, adenopathy cervical, mucous membranes) 81 Kawasaki disease is caused by what? an acute vasculitis of the small and medium blood vessels What is the main difference between Kawasaki disease and scarlet fever? KD has conjunctivitis and scarlet fever does not The rash associated with acute rheumatic fever erythema marginatum The rash associated with parvovirus aka slapped cheek aka fifth disease erythema infectiosum What does erythema marginatum of rheumatic fever look like? erythematous with a central clearing, not itchy The medical term for tennis elbow lateral epicondylitis What is the leading cause of death in anorexia? suicide 82 Erikson stage from birth to 18 months trust vs mistrust Erikson stage from 18 months to 3 years autonomy vs shame and doubt Erikson stage from 3-5 years initiative vs guilt Erikson stage from 5-13 years industry vs inferiority Erikson stage from 13-21 years identity vs role confusion Erikson stage from 21-39 years intimacy vs isolation Erikson stage from 40-65 years generativity vs stagnation Erikson stage for 65 and older 85 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. 86 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 87 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? 90 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 Koilonychia is a sign of what? iron deficiency anemia How is influenza diagnosed? a nasal swab What finding would be most likely to differentiate gout from septic arthritis? 91 fever would be indicative of septic arthritis Diphenhydramine has properties and is contraindicated in which patient populations? anticholinergic; elderly and those with glaucoma The medical term for flat feet pes planus How does plantar fasciitis usually present? as pain in the morning with resolution after several steps, but as it worsens the patient will start to complain of heel pain throughout the day and with walking Scope of practice for NPs is not influenced by which entity? a court of law Used to establish a designated level of professional competence licensure Treatment of subclinical hypothyroidism is generally not indicated unless the TSH is . greater than 10 In the presence of an elevated serum TSH, what is the next step in management? 92 repeat TSH plus free T4 Patients with a history of UC or Crohn's should have a colonoscopy how often? every 1-5 years due to the increased risk of colorectal cancer What is the first line treatment for community acquired atypical pneumonia? macrolides such azithromycin. If the pt cannot take a macrolide, then they can do levofloxacin or doxycycline What is metatarsus adductus? the medical term for in-toeing What is true regarding older adults who are overweight? mortality in older adults related to overweight states declines over time How do we manage rubella immunity in pregnant women? we screen all pregnant women with a rubella titer. If they had a protective rubella titer in a previous pregnancy, then they do not need to be checked again. If they are found to not be immune when pregnant, then she should be vaccinated AFTER delivery How is permethrin applied to the skin for scabies? a one time application to all skin below the neck and then left on for 8-12 hours is sufficient 95 Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle 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 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 96 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? 97 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?