Download D118: OA Study Guide (Complete) 100% VERIFIED ANSWERS 2024/2025 CORRECT and more Exams Nursing in PDF only on Docsity! D118: OA Study Guide (Complete) 100% VERIFIED ANSWERS 2024/2025 CORRECT An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, the APRN is interviewing individual patients as well as conducting focused group sessions with multiple patients. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive ANS: B Qualitative research relies on data obtained by the researcher from first-hand observation, interviews, questionnaires (on which participants write descriptively), focus groups, participant observation, recordings made in natural settings, documents, case studies, and artifacts. An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, a group of individuals with Type 2 diabetes are divided into two randomized groups. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive ANS: C In an experimental research study, the participants in both the treatment and control groups are randomly assigned. An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, a group of individuals with Type 2 diabetes are divided into two non-randomized groups. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive ANS: A A quasi-experimental design does not randomly assign participants to treatment or control groups for comparison. An advanced practice registered nurse (APRN) is gathering data for an ongoing research project. In the project, the APRN is focusing on identifying the characteristics that makeup a population of patients with Type 2 diabetes. Which type of research design is being used by the APRN? a. Quasi-experimental b. Qualitative c. Experimental d. Descriptive ANS: D Descriptive Research is used to describe characteristics of a population or phenomenon being studied. It does not answer questions about how/when/why the characteristics occurred. Rather it addresses the "what" question (what are the characteristics of the population or situation being studied?). What is the purpose of Level I research? a. To define characteristics of interest of groups of patients Which is the most appropriate research design for a Level III research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials ANS: B The experimental design is the most appropriate design for a Level III study. Epidemiological studies are appropriate for level II studies. Qualitative designs are useful for Level I studies. Randomized clinical trials are used for Level IV studies. Which is the most appropriate research design for a Level IV research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials ANS: D Randomized clinical trials are used for Level IV studies. What is the purpose of clinical research trials in the spectrum of translational research? a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the preclinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage. What is a goal of the Healthy People initiative? a. To increase a patient's quality of life b. To create physical environments that promote proper health c. To achieve health equality by eliminating disparities d. To provide free health care to those unable to pay for care e. To promote healthy behaviors across all life stages ANS: C Overarching goals of the Healthy People initiative are to increase quality and length of life, free of preventable disease, disability, injury, and premature death; to achieve health equality by eliminating disparities; to create social and physical environments that promote proper health; and to promote increased quality of life, healthy development, and healthy behaviors across all life stages, all goals consistent with the definition of wellness. Free health care is not a stated goal of the initiative. The Healthy People 2020 contains new topics and objectives that correlate with emerging technologies and data that were not present in the Healthy People 2010 initiative. Which objective was newly added to the 2020 document? a. Nutrition and weight b. Mental health c. Global health d. Substance abuse ANS: C Global Health A 35-year-old patient is being seen in the primary care clinic for a routine assessment. The patient had her last pap smear in conjunction with an HPV screening three years before and has no abnormal gynecological signs or symptoms. The advanced practice registered nurse (APRN) performs a physical assessment with a clinical breast exam and then provides information about recommended health screenings. Which USPTF recommendations should the APRN share with this patient? a. "We should do a chlamydia screening today." b. "We need to do a pap smear in two years." c. "We need to schedule a mammogram this month." d. "We should do a HPV screening next year." ANS: B "We need to do a pap smear in 2 years" HPV and Pap smear done together every 5 years A woman who has had routine Pap tests all her adult life has an abnormal Pap. What will the provider tell her about this result? a. Colposcopy with biopsy is necessary b. She may have vaginal cancer c. She most likely has early cervical cancer d. The result most likely indicates HPV infection ANS: A The Pap test is a screen and should be followed by colposcopy with biopsy. Women who have had Pap tests routinely are less likely to have cervical cancer. b. Immunized with all recommended childhood vaccines to prevent serious disease c. Some vaccines are contraindicated in those with T-cell involvement only d. The child may need more vaccine boosters than other children ANS: C Children with T-cell disorders should not receive live-virus vaccines, but children with humoral deficiency may be given the vaccine. Vaccines are important to help prevent disease and children with immunodeficiency should receive any vaccines that are safe for them. Not all vaccines are recommended, since live-virus vaccines can cause disease in certain children A patient asks the advanced practice registered nurse (APRN) if there are any contraindications to receiving the influenza vaccine other than an egg allergy. Which other precaution must be taken when administering this vaccine? a. A history of thrombocytopenia within six weeks of previous flu vaccine b. A history of Guillain-Barré syndrome within six weeks of previous flu vaccine c. A history of exposure to influenza A within the past six weeks d. A history of illness with or without fever after previous flu vaccine ANS: B A history of Guillain-Barre Syndrome within 6 weeks of previous flu vaccine Guillain-Barre syndrome attacks own immune system (neurologic), weakening motor function throughout the body. Risk of causing Guillain-Barre when administering flu shot A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? a. Administer LAIV influenza vaccine b. Begin treatment with an antiviral medication c. Observe for improvement or worsening for 24 hours d. Perform a nasal swab for RT-PCR assay ANS: D Samples to isolate the virus should be collected within 12 to 36 hours of onset of illness and this should be performed to confirm the disease. Administration of the LAIV influenza vaccine will not prevent symptoms in this patient, is not recommended in persons over 59 years of age, and is contraindicated when also giving antiviral medications. Antiviral drugs should be started within 48 hours of onset of illness and may be started empirically while waiting on cultures because this patient is higher risk than younger patients. Because identification of the virus and effectiveness of treatment are time-limited, it is not correct to watch and wait for symptoms to worsen. The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent? a. The infant should be given prophylactic antiviral medications. b. The infant should have an influenza vaccine now with a booster in 1 month. c. The infant should have the live attenuated influenza vaccine (LAIV). d. The infant should not but family and all close contacts should be vaccinated. ANS: D Infants are not given influenza vaccine until age 6 months. To protect infants younger than 6 months, it is important for other family members and close contacts to be vaccinated. LAIV is approved for use in children over age 2 years. Antiviral prophylaxis is not recommended. A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccines? a. Country-specific guidelines are provided by individual embassies. b. Malaria vaccine is the most important vaccine for worldwide travel. c. Requirements should be reviewed at least 4 to 6 weeks prior to travel. d. There are at least five required vaccines for entry into certain countries ANS: C Patients seeking immunizations prior to international travel should have these reviewed at least 4 to 6 weeks prior so that antibody responses and completion of vaccine series may occur. Country- specific guidelines may be found on the CDC website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines that are required. A 51-year-old male is being seen in the primary care clinic for a routine assessment. The patient has not been seen in the clinic for a number of years. The advanced practice registered nurse assesses the patient and notes physical assessment and VS findings to be WNL. Which additional screening should the APRN recommend? a. Prostate screening b. Osteoporosis screening c. Colorectal screening d. Abdominal aortic aneurysm screening c. Colorectal screening Q10 YEARS starting at age 50 A primary care provider is providing care for a postsurgical client who recently immigrated to the United States and speaks English only marginally. What intervention will provide the most effective means of communicating postdischarge information to the client? a. Postpone discharge until the client is fully recovered from the surgery. d. Understanding of and ability to discuss healthcare concerns ANS: A The "Newest Vital Sign" tests asks patients to look at information on an ice cream container label and answer questions that evaluate ability to calculate caloric data and to grasp general knowledge about food allergies. It does not test understanding of technology or directly measure reading comprehension. It does not assess oral communication. The "Ask Me 3" tool teaches patients to ask three primary questions about their health care and management. A female patient who is from the Middle East schedules an appointment in a primary care office. What will clinic personnel do to provide culturally responsive care when meeting this patient for the first time? a. Ensure that she is seen by a female provider. b. Include a male family member in discussions about health care. c. Inquire about the patient's beliefs about health and treatment. d. Research middle eastern cultural beliefs about health care. ANS: C It is important not to make assumptions about beliefs and practices associated with health care and to ask the patient about these. While certain practices are common in some cultural and ethnic groups, assuming that all members of those groups follow those norms is not culturally responsive. A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is always out of breath and has no more energy. His only medications are bronchodilators, which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left chest. What is the most likely cause of this physical finding? A. Asthma B. Pneumonia C. Emphysema D. Pneumothorax ANS: B Egophony is an increased resonance of voice sounds when a medical professional auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is enhanced transmission of high-frequency noise across the fluid. Similarly, bronchophony and whispered pectoriloquy can be used to assess the lungs. A patient presents with a cough and fever. The provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient's pneumonia? a. A virus b. Mycoplasma c. S. pneumoniae d. Tuberculosis ANS: B Atypical pneumonias, such as those caused by mycoplasma, often present with headache and sore throat and will have larger areas of infiltrate on chest radiograph. Viral pneumonias show more diffuse radiographic findings. S. pneumonia will have high fever and cough and distinct areas of infiltration. A young, previously healthy adult clinic patient reports symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? a. A B-lactam antibiotic plus a fluoroquinolone b. A respiratory fluoroquinolone antibiotic c. Empirical treatment with a macrolide antibiotic d. Hospitalization for intravenous antibiotics ANS: C This patient likely has community-acquired pneumonia. The patient has typical symptoms and, even though the chest radiograph is normal, will require outpatient treatment. For community-acquired pneumonia in a previously healthy individual, treatment with a macrolide antibiotic is the recommended first-line therapy. B-lactam plus fluoroquinolone therapy is used for patients in the ICU. Respiratory fluoroquinolones are used for patients with underlying disorders who develop pneumonia. Hospitalization is not necessary. A patient was initially treated as an outpatient for pneumonia and then after 2 weeks was hospitalized after no improvement was evident. The patient continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient? a. Administration of the pneumonia vaccine b. Increasing the dose of the antibiotics c. Open lung biopsy d. Performing diagnostic bronchoscopy ANS: D Patients who do not respond to antibiotic therapy may have opportunistic fungal or other infections, bronchogenic carcinoma, or other diseases. Bronchoscopy can exclude or confirm these. The pneumonia vaccine is preventative for pneumococcal causes and will not help this patient. Increasing the dose of the antibiotics is not recommended. Open lung biopsy may be performed if a bronchoscopy is inconclusive. A pregnant woman tests positive for human immunodeficiency virus (HIV-1) infection. What will the provider recommend? a. Consideration of termination of the pregnancy b. No treatment and caesarian section for delivery The scenario is indicative of diarrhea due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm. The diarrhea is of chronic nature and watery. The diagnosis is based on finding acid fast oocysts in stool and also by antigen detection. With declining CD4+ counts opportunistic infections become common. Histoplasmosis usually presents with CD4+ counts usually between 100-200 cubic mm and fever, cough, dyspnea are the predominant symptoms. Giardiasis has no specific association with AIDs and presents usually with fatty diarrhea, not watery. Candida Albicans causes esophagitis at cell counts lower than 100 per cubic mm which explains the features of epigastric pain and dysphagia but has no associations with diarrhea. A patient reports chronic nasal obstruction and recurrent epistaxis. Which type of nasal mass is likely? a. Inverted papilloma b. Nasal polyp c. Paranasal lymphoma d. Squamous cell carcinoma ANS: A Inverted papillomas are benign tumors of the nasal mucosa and are highly vascular with frequent bleeding. Nasal polyps typically do not bleed and are associated with allergies. Paranasal lymphoma and squamous cell carcinoma are not initially associated with bleeding. A patient reports chronic nasal obstruction and difficulty distinguishing smells. The provider examines the nares with a nasal speculum and observes several grape-like lesions in both nostrils. What is the likely cause of this patient's symptoms? a. Chronic sinusitis b. Nasal polyps c. Squamous cell carcinoma d. Vascular benign tumor ANS: B Polyps cause obstruction and olfactory dysfunction and appear as grape-like lesions on the nasal mucosa. Most malignant neoplasms are asymptomatic until late in the course. Chronic sinusitis characteristically produces inflammation and purulent discharge. A provider examines a patient who has chronic nasal obstruction, respiratory tract symptoms, and generalized malaise. An examination of the nasal mucosa reveals ulceration of the nasal septum. What is the most important action when caring for this patient? a. Administering prednisone b. Obtaining a chest radiograph c. Performing laboratory tests d. Referring to a specialist ANS: D This patient has symptoms of granulomatosis with polyangiitis (GPA) and should be referred as soon as the disease is suspected. The other actions will be taken, but referral is the most important. A 58-year-old man presented to the hospital with right-sided decreased hearing for two years. His wife mentions he has started snoring recently. He has been a smoker for the last 25 years and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which key anatomical area is the pathology most likely to be situated in? A. Right Middle Meatus B. The roof of the nasal cavity C. Right vallecula D. Postnasal space ANS: D In a patient with recent-onset unilateral hearing loss and nasal obstruction with a social history of smoking one must rule out a nasopharyngeal pathology most likely a malignancy. • Any mass in the nasopharynx can obstruct the medial ends of the eustachian tube leading to problems with the ears. • Nasopharyngeal cancer can arise from the fossa of Rosenmüller, which lies behind the eustachian tubes on either side. So a clear look at this area with a nasendoscopy in high-risk patients with unilateral middle ear effusion is mandatory. • Malignancies in the other anatomical areas mentioned are obviously possible, but will not cause unilateral middle ear effusion with conductive hearing loss. A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient? a. Dialysis only b. Immunosuppressant therapy c. Kidney transplantation d. Palliative care ANS: C Patients with SLE who develop renal failure may require dialysis and then kidney transplantation; most who undergo transplant do relatively well because of the immunosuppression given to prevent graft rejection. Immunosuppressant therapy is given for graft rejection and does not treat end-stage renal failure. Palliative care is not the only option for this patient. A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure. After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in reducing immunity. What is the next preferred step to avoid rejection? A. Prescribe tacrolimus B. Increase the dose of cyclosporine C. Prescribe amoxicillin D. Prescribe paracetamol ANS: A Tacrolimus is efficient more than ten folds when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored cautiously as an increase in its blood concentration could cause many complications like kidney failure. • Cyclosporine, tacrolimus, and pimecrolimus are called calcineurin inhibitors because they inhibit the enzyme "calcineurin" that is responsible for T-cell activation. • Tacrolimus is used as an adjuvant to other immunosuppressive drugs to avoid organ rejection. differential diagnoses? a. Apply antihistamine eye drops daily b. Use Ketorolac (Acuvail) 0.5% eye drops four times a day c. Use artificial tears as needed for irritation d. Irrigate the eye with Epinastine (Elestat) 0.05% daily ANS: C Use artificial tears as-needed for irritation A 62-year-old patient is seen by an advanced practice registered nurse (APRN) for intermittent buzzing in the ears. The patient has no history of exposure to loud noises at work but does have a history of attending many loud rock concerts. Otoscopic inspection reveals no excess cerumen and normal tympanic membranes. Audiology testing reveals mild hearing loss bilaterally. The patient denies dizziness and has no known allergies. Review of medications includes low-dose aspirin, multivitamin, calcium supplement, and over-the-counter Ibuprofen prn for back and hip pain related to arthritis. Which treatment should the APRN recommend for this patient? a. Refer to physical therapy for canalith repositioning b. Prescribe use of an antihistamine c. Replace NSAID with a Cox2 inhibitor d. Order application of carbamide dioxide daily ANS: C Replace NSAID with a COX2 inhibitor A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? a. Acute otitis externa b. Acute otitis media c. Chronic otitis externa d. Otitis media with effusion ANS: A This patient's symptoms are classic for acute otitis externa. Chronic otitis externa more commonly presents with itching. Acute otitis media is accompanied by fever and tympanic membrane inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness but not pain. A patient presents to the clinic complaining of fullness in his right ear with decreased hearing. He denies pain or fever. What condition does the FNP suspect? a. Otitis externa b. Ruptured eardrum c. Otitis media with effusion d. Acute sinusitis ANS: C OME presents with fluid and inflammation in the middle ear WITHOUT evidence of signs and symptoms of acute infection. A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly inflamed, and the tympanic membrane is not involved. Which medication will be ordered? a. Cipro HC b. Fluconazole c. Neomycin d. Vinegar and alcohol ANS: A In the absence of a culture, the provider should choose a medication that is effective against both P. aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for inflammation. Fluconazole is an oral antifungal medication used when fungal infection is present. Neomycin alone does not cover these organisms. Vinegar and alcohol are used to treat mild fungal infections. A patient's assessment confirms the patient has otalgia, a fever of 38.8°C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action? a. Perform a tympanogram on the right ear. b. Recommend symptomatic treatment for fever and pain. c. Remove the cerumen and visualize the tympanic membrane. d. Treat empirically with amoxicillin 80 to 90 mg/kg/day. ANS: C The AAP 2013 guidelines strongly recommend visualization of the tympanic membrane to accurately diagnose otitis media and not to treat based on symptoms alone. The practitioner should attempt to remove the cerumen to visualize the tympanic membrane. A tympanogram cannot be performed when cerumen is blocking the canal. Because the child may have an acute ear infection, antibiotics may be necessary. A young, previously healthy adult clinic patient reports symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? a. A B-lactam antibiotic plus a fluoroquinolone b. A respiratory fluoroquinolone antibiotic c. Nasal packing d. Petrolatum ointment ANS: C Nasal packing is used if bleeding continues after initial measures. Chemical cautery and electrocautery are used only if the site of bleeding is visualized. Petrolatum ointment is applied once the bleeding is stopped. A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient? a. Apply firm, continuous pressure to the nostrils. b. Assess airway safety and vital signs. c. Clear the blood with suction to identify site of bleeding. d. Have the patient sit up straight and tilt the head forward. ANS: B Bilateral epistaxis into the pharynx is more indicative of a posterior bleed which is more likely to be severe. The most important intervention is to ensure airway safety and determine stability of vital signs. Other measures are taken as needed. A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms? a. Allergic pharyngitis b. Group A streptococcus c. Infectious mononucleosis d. Viral pharyngitis ANS: D Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by URI symptoms of cough and runny nose. Allergic pharyngitis usually also causes dryness. GAS causes high fever, cervical adenopathy, and marked erythema with exudate. Infectious mononucleosis will cause an exudate along with cervical adenopathy. A patient presents with sore throat, a temperature of 38.5°C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient's symptoms? a. Order an anti-streptolysin O (ASO) titer. b. Perform a rapid antigen detection test (RADT). c. Prescribe empirical penicillin. d. Refer to an otolaryngologist. ANS: B The RADT is performed initially to determine whether Group A Beta-hemolytic Streptococcus (GAS) is present. The ASO titer is not used during initial diagnostic screening. Penicillin should not be given empirically. A referral to a specialist is not required for GAS infection. A 34-year-old male with no significant past medical history. He lives at home with his wife and two children, ages 6 and 10. No known drug allergies. He presents to an urgent care clinic with a 2-day history of fever and sore throat. On exam, he is noted to have dry mucous membranes, enlarged lymph nodes, and a sore throat with exudative patches on the tonsils. The patient's Rapid Antigen Detection Tests resulted positive for Group A Strep. Which of the following is the most appropriate treatment for this patient? a. Vancomycin15 mg/kg IV q 12 hours b. Clindamycin 450 mg TID c. Azithromycin 500 mg x1, 250 mg days 2-5 d. Amoxicillin 500 mg BID ANS: D viral etiologies do not require medication therapy -1st line= penicillin or amoxicillin penicillin V: child 250mg BID or TID x 10 days; adult 250mg TID or QID OR 500mg BID x 10 days amoxicillin: 50mg/kg once daily (max 1000mg) OR 25mg/kg BID (max 500mg) x 10 days *benzathine penicillin G 600000 units IM for pts<27kg x 1 dose; 1.2 million units IM for pts>27kg x 1 dose -penicillin allergy: 1st gen ceph, clinda, macrolide A patient reports bilateral burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient's eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely? a. Allergic b. Bacterial c. Chemical d. Viral ANS: A Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema. Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI. A patient who has symptoms of a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated? a. Antihistamine-vasoconstrictor drops b. Artificial tears and cool compresses c. Topical antibiotic eye drops d. Topical corticosteroid drops ANS: B Viral conjunctivitis accompanies upper respiratory tract infections and is generally self-limited, lasting A 65-year-old female patient presents to the clinic complaining of abdominal pain,n/v, distention, &constipation for the past few days. The FNP auscultates high-pitched (aka "tinkling") bowel sounds. What condition does the FNP suspect? a. Viral Gastroenteritis b. IBS c. Bowel obstruction d. Food poisoning ANS: C Symptoms of intestinal obstruction are: Severe pain in your belly. Severe cramping sensations in your belly. Throwing up. Feelings of fullness or swelling in your belly. Loud sounds from your belly. Feeling gassy, but being unable to pass gas. Constipation (being unable to pass stool) A patient diagnosed with chronic constipation uses polyethylene glycol and reports increased abdominal discomfort with nausea and vomiting. What is the initial action by the provider? a. Increase the dose of polyethylene glycol b. Obtain radiographic abdominal studies c. Perform a stool culture and occult blood d. Refer to a specialist for colonoscopy ANS: B Patients with abdominal pain, nausea, and vomiting should have radiologic studies to exclude obstruction, ileus, megacolon, or volvulus. If those are ruled out, increasing the laxative may be warranted. Stool culture is indicated if the parasite ascariasis is suspected. Referral for colonoscopy is needed if alarm symptoms for neoplasm are present. A patient with a previous history of liver disease is diagnosed with a bile duct obstruction. Which procedure will be prescribed for this patient? a. Chemical dissolution of the gallstone b. Lithotripsy c. Open cholecystectomy d. Laparoscopic cholecystectomy ANS: C Patients with possible liver disease should have open cholecystectomy. The other procedures are contraindicated. Chemical dissolution is not reliable and may take some time. An adult patient presents to the clinic complaining of upper to mid-abdominal pain that has been occurring off and on for two months. The pain is the right upper abdominal area that comes and goes but is increased after eating spicy food. The advanced practice registered nurse (APRN) notes the vital signs are within normal limits, and the abdomen is soft with active bowel sounds. Palpation reveals tenderness in RUQ and a positive Murphy's sign. ECG and CXR are negative. Alkaline phosphatase and total bilirubin are within normal limits. Which diagnosis should the APRN suspect? a. Acute gastroenteritis b. Pancreatitis c. Acute cholecystitis d. Diverticulitis ANS: C Acute cholecystitis Murphy's sign is gallbladder Which diagnostic test will the provider safely order for a 30-year-old woman reporting right upper quadrant abdominal pain, nausea, and vomiting? a. Abdominal computed tomography (CT) with contrast b. Abdominal ultrasound c. Magnetic resonance imaging (MRI) of the abdomen d. Plain abdominal radiographs ANS: B Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided. A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient's symptoms? a. Empirical treatment with antibiotics b. Hospitalization for emergent treatment c. Prescribing ursodeoxycholic acid d. Supportive care with close follow-up ANS: B This patient has symptoms of acute acalculous cholecystitis and is critically ill. Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones. A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the significance of this finding? a. Compression of the common bile duct b. b. Presence of a pancreatic pseudocyst c. Retroperitoneal hemorrhage d. Severe acute pancreatitis with peritonitis ANS: D Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is present with compression of the common bile duct. Palpation of a mass suggests the presence of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal hemorrhage. Which is the most common cause of pancreatitis in the United States? ANS: C The patient does not have Lyme disease, so no therapy is needed. The appropriate Western blot bands are required to qualify as a positive result. No positive or reactive bands means a negative result. In addition, the complaints of a cold are not consistent with more common symptoms of Lyme infection The family nurse practitioner has just diagnosed a 27-year-old with Lyme disease. What is the appropriate management? a. Bactrim 400 mg b.i.d. for 14- 21 days b. Amoxicillin 100 mg t.i.d. for 10 days c. Doxycycline 100 mg b.i.d. for 14- 21 days d. Keflex 500 mg q.i.d. for 14 days ANS: C A patient presents to the clinic with complaints of itching and flaking to bilateral feet. The NP observes that there is a characteristic macerated appearance between the toes. The NP diagnoses the patient with which of the following? a. Tinea pedis b. Onychomycosis c. Tinea versicolor d. Seborrheic dermatitis ANS: A The macerated appearance between the toes is consistent with a tinea infection and is commonly called "athlete's foot." A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice-daily ketoconazole cream prescribed by the provider. What will the provider order for this patient? a. Burrow's solution soaks once daily b. Oral corticosteroids c. Oral itraconazole (Sporanox) d. Selenium sulfide shampoo 2.5% as a daily rinse ANS: C Itraconazole is effective for moderate to severe symptoms and is an alternative for those who do not wish to use topical treatment. Burrow's solution and selenium shampoo rinses are not indicated. Oral corticosteroids are usually not given. A client presents to the healthcare provider's office with cellulitis on the lower leg. Other than the inflammation of the leg, the client has no other symptoms. To determine the causative organism, the nurse anticipates an order for which test? a. WBC count b. Drainage culture c. RBC count d. Blood culture ANS: B A patient who has never had an outbreak of oral lesions reports a burning sensation on the oral mucosa and then develops multiple painful round vesicles at the site. A Tzanck culture confirms HSV-1 infection. What will the provider tell the patient about this condition? a. Antiviral medications are curative for oral herpes. b. The initial episode is usually the most severe. c. There are no specific triggers for this type of herpesvirus. d. Transmission to others occurs only when lesions are present. ANS: B In herpes virus outbreaks, the initial episode is generally the most severe. Antiviral medications may prevent outbreaks, but do not cure the disease. HSV-1 has several specific triggers. Transmission to others may occur even when lesions are not present. A patient who has had lesions for several days is diagnosed with primary herpes labialis and asks about using a topical medication. What will the provider tell this patient? a. Oral antivirals are necessary to treat this type of herpes. b. Preparations containing salicylic acid are most helpful. c. Topical medications can have an impact on pain and discomfort. d. Topical medications will significantly shorten the healing time. ANS: C Topical medications may alleviate discomfort, but do not shorten healing time. Oral antivirals may help shorten healing, but are not necessary as treatment, since the disease is usually self-limiting. Salicylic acid should not be used because it can erode the skin. A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes. What will the primary care provider recommend as first-line treatment? a. Acyclovir b. Famciclovir c. Topical medications d. Valacyclovir ANS: A All three oral antiviral medications help reduce the number of occurrences and the frequency of asymptomatic shedding. Famciclovir and valacyclovir are more costly and no more effective, so should not be first-line therapy. Topical medications are not useful with recurrent, frequent genital herpes. a. Anterior drawer test b. Posterior drawer test c. Valgus stress on knee joint d. Varus stress on knee joint ANS: A The anterior drawer test, in which the examiner pulls the tibia forward while the knee is flexed, is used to assess anterior cruciate ligament laxity. The posterior drawer test is used to determine posterior cruciate ligament laxity. The valgus stress test assesses the medial collateral ligament (MCL) laxity and the varus stress test assesses the lateral collateral ligament (LCL) laxity. John is a 16 year old boy who presents to the emergency room after hurting his knee in a football game. He describes twisting his knee and then not being able extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be the most appropriate to assess for the presence of a meniscal tear? a. Valgus stress test b. Lachman test c. McMurray circumduction test d. Varus stress test ANS: C A patient diagnosed with diabetes has symptoms consistent with renal stones. Which type of stone is most likely in this patient? a. Citrate b. Cysteine c. Oxalate d. Uric acid ANS: D Uric acid stones are more prevalent in diabetics. Citrate, cysteine, and oxalate are less common in all patients. The family nurse practitioner is taking a history of a patient who has been diagnosed with renal calculi. What information in the history would the family nurse practitioner identify as a precipitating factor in the development of renal calculi? a. Drinking 6-8 oz of milk daily b. History of fractured femur and prolonged bed rest c. Increased incidence of UTI's over the past 3 years d. High intake of citrus fruits and high fiber carbohydrates ANS: B Long-term bed-rest-induced renal stone formation was found to be induced by increased urinary calcium and subsequent crystal formation of calcium oxalate and calcium phosphate. Exercise during bed rest for the prevention of bone mineral loss and contracture might increase the risk of renal stone formation. A 25-year-old female comes to the outpatient clinic complaining of suprapubic pressure and burning with urination for the past two days. She denies having any chills but states that she may have had a fever yesterday. The next step will be: a. Obtain a urine dipstick. b. Get a urine culture and sensitivity. c. Ask about previous infections. d. Refer the patient to a urologist. ANS: C The next step in assessing/treating this patient will depend on whether or not this urinary tract infection is recurrent or a first occurrence. A 25-year-old female comes to the outpatient clinic complaining of suprapubic pressure and burning with urination for the past two days. She denies having any chills but states that she may have had a fever yesterday. Upon further questioning, the patient denies any previous infections. The next step will be: a. Obtain a urine dipstick. b. Get a urine culture and sensitivity. c. Ascertain any drug allergies. d. Refer the patient to a urologist. ANS: B In an uncomplicated or non-recurring urinary tract infection, a urinalysis (dipstick or microscopic) can adequately identify urinary tract infections. A urine culture and sensitivity should be performed in the following cases: (1) any patient with a first febrile infection; (2) a recurrent infection with or without fever (more than one per year); (3) a urinary calculi; and (4) a congenital defect Which of the following groups should asymptomatic bacteremia be treated? a. Patients with diabetes mellitus b. Patients with spinal cord injuries c. Patients with indwelling catheters d. Pregnant women ANS: D Pregnant women are at an increased risk of asymptomatic bacteriuria becoming acute cystitis and/or acute pyelonephritis, and the maternal and obstetric risk associated with pyelonephritis are great. However, the Infectious Disease Society of America does not recommend that the remaining groups in the list undergo treatment of asymptomatic bacteriuria. A 52-year-old male patient presents to the office following a brief hospitalization for pyelonephritis. He is currently on the second day of a 7-day course of antibiotic. Patient education includes which of the following? a. If you develop dysuria, increase PO fluids for two days. b. Continue your antibiotic until you are asymptomatic a. A course of systemic corticosteroids. b. Bed rest for 3-5 days c. avoidance of contact sports for 3-5 days d. Increased clear fluids ANS: D Increased fluids are an important supportive measure during the acute phase of IM. Increased activity levels increase the possibility of splenic rupture, and sports should be avoided for at least 4-6 weeks. Systemic corticosteroids are only used with complicated cases because they can affect cell- mediated immune response and may increase the risk of secondary bacterial infection. A patient injures an ankle while playing soccer and reports rolling the foot inward while falling with immediate pain and swelling of the lateral part of the joint. The patient is able to bear weight and denies hearing an audible sound at the time of injury. What does this history indicate? a. Likely ankle sprain with a possible fracture b. Mild ankle injury without fracture c. Mild soft tissue injury only d. Serious ankle injury with certain fracture ANS: A Immediate swelling of the joint raises the index of suspicion for a fracture or a substantial amount of joint involvement. Without radiographs, none of these possibilities can be confirmed. Which of the following elements on PE would indicate the possibility of ankle fx and should be evaluated by x-ray? a. ability to bear wt on affected ankle b. tenderness over medial malleolus c. swelling of affected ankle d. bruising of affected ankle ANS: B If your ankle hurts or is tender to the touch directly over your ankle bone, you probably have a fracture. If the pain is in the soft part of your ankle, it's more likely a sprain. What is the first line tx for mild chronic shoulder pain caused by osteoarthritis? a. injection of steroids with lidocaine b. hydrocodone c. acetaminophen d. oral corticosteroids ANS: C A 45-year-old patient reports a recent onset of unilateral shoulder pain which is described as diffuse and is associated with weakness of the shoulder but no loss of passive range of motion. What does the provider suspect as the cause of these symptoms? a. Acromioclavicular joint disease b. Cervical radicular pain c. Glenohumeral arthritis d. Rotator cuff injury ANS: D Rotator cuff injury is usually characterized by diffuse pain, weakness of the joint, but no change in range of motion. Acromioclavicular joint disease is associated with anterior-superior shoulder pain. Glenohumeral arthritis has similar symptoms, but with loss of range of motion. Cervical radicular pain is characterized by pain distal to the elbow. Which of the following imaging modalities should be used to assess for rotator cuff tear? a. Anteroposterior x-ray of the shoulder b. MRI of the shoulder without contrast c. CT scan of the shoulder with contrast d. Axillary x-ray of the shoulder ANS: B MRI provides useful information about tear dimension, tear depth, tendon retraction, which can influence treatment decision. In addition, MRI also provides information about tendon retraction, muscle atrophy, fatty degeneration and coracoacromial impingement, which may have important prognostic implications A patient diagnosed with acute renal colic is experiencing nausea and vomiting. A urinalysis reveals hematuria but is otherwise normal. A radiographic exam shows several radiopaque stones in the ureter which are less than 1 mm in diameter. What will the primary provider do initially to manage this patient? a. Obtain a consultation with a urology specialist b. Order a narcotic pain medication and increased oral fluids c. Prescribe desmopressin and a corticosteroid medication d. Prescribe nifedipine and hospitalize for intravenous antibiotics ANS: B Stones that are less than 1 mm in diameter will usually pass spontaneously. The provider should counsel the patient to increase fluid intake and should prescribe adequate pain medication. A consultation is not necessary unless initial measures fail. Desmopressin and corticosteroids have not been shown to be effective. Nifedipine and IV fluids may be used as a secondary option. An adult develops a chronic cough with episodes of wheezing and shortness of breath. The primary care provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? a. Allergy testing b. Methacholine challenge test ANS: A About 10% of patients taking ACE inhibitors will develop chronic cough. COPD, GERD, and psychogenic causes are possible, but given this patient's cardiovascular history, the possibility of ACE inhibitor-induced cough should be investigated initially. A young adult patient develops a cough persisting longer than 2 months. The provider prescribes pulmonary function tests and a chest radiograph, which are normal. The patient denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough? a. 24-hour esophageal pH monitoring b. Methacholine challenge test c. Sputum culture d. Tuberculosis testing ANS: B Chronic cough without other symptoms may indicate asthma. If PFTs are normal, a methacholine challenge test may be performed. 24-hour esophageal pH monitoring is sometimes performed to evaluate for GERD, but this patient does not have abdominal symptoms and this test is usually not performed because it is inconvenient. Sputum culture is not indicated. TB is less likely. Which statement below regarding chronic cough is true? A. A postinfectious cough, by definition, lasts no longer than 8 weeks; B. Chest radiographs are abnormal in postinfectious cough C. Intervention is usually required for the postinfectious cough to resolve D. All of the above ANS: A Rationale: A postinfectious cough, by definition, lasts no longer than 8 weeks; chest radiograph findings are normal, and the cough eventually resolves, generally without intervention. A sudden onset of cough in the supine position with an associated sour taste in the mouth suggests: A. esophageal reflux B. upper airway cough syndrome C. a virus or common cold D. none of the above E. viral syndrome or the common cold ANS: A A sudden onset of cough in the supine position with an associated sour taste in the mouth suggests esophageal reflux. A cough that lasts for 3 consecutive months for more than 2 consecutive years is indicative of: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold ANS: D A cough that lasts for 3 consecutive months for more than 2 consecutive years is indicative of chronic bronchitis. A cough associated with constant throat clearing and thick mucus production, especially on rising from bed, is consistent with: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold ANS: B A cough associated with constant throat clearing and thick mucus production, especially on rising from bed, is consistent with upper airway cough and sinusitis. A cough associated with rhinorrhea or sneezing may be: A. esophageal reflux B. upper airway cough and sinusitis C. Psychogenic cough D. Chronic Bronchitis E. viral syndrome or the common cold ANS: E A cough associated with rhinorrhea or sneezing may be a viral syndrome or the common cold. A cough associated with rhinorrhea that recurs annually at the same time of year is: A. Allergic rhinitis B. Use of lisinopril C. Psychogenic cough D. Asthma ANS: A A cough with rhinorrhea recurs annually at the same time of year, allergic rhinitis is possible. A patient diagnosed with asthma has been prescribed three bronchodilator treatments but continues to experience wheezing and shortness of breath. The health care provider caring for the patient notes an oxygen saturation of 90% on room air. What action is indicated? a. Administer oxygen and continue to monitor the patient. b. Contact the respiratory therapist to administer another treatment. c. Notify the patient's physician immediately. ANS: D Intermittent productive cough associated with wheezing is most probably asthma. Which symptom in a patient diagnosed with asthma indicates severe bronchospasm? a. Breathlessness with minimal activity or eating b. Pausing to breathe while attempting to talk c. Repetitive, spasmodic coughing at night d. Wheezing after exposure to a trigger ANS: B Inability to speak a full sentence without pausing to breathe indicates severe bronchospasm. Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs of bronchospasm and do not necessarily indicate severe bronchospasm. A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient? a. Administer three more nebulizer treatments and reassess. b. Admit to the hospital with specialist consultation. c. Give epinephrine injections and monitor response. d. Prescribe an oral corticosteroid medication. ANS: B Patients having an asthma exacerbation should be referred if they fail to improve after three nebulizer treatments or three epinephrine injections, have a peak flow less than 70% and a pulse oximetry reading less than 90% on room air. Giving more nebulizer treatments or administering epinephrine is not indicated. The patient will most likely be given IV corticosteroids; oral corticosteroids would be given if the patient is managed as an outpatient. An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? a. Allergy testing b. Methacholine challenge test c. Peak expiratory flow rate (PEFR) d. Spirometry ANS: D Spirometry is recommended at the time of initial assessment to confirm the diagnosis of asthma. Allergy testing is performed only if allergies are a possible trigger. The methacholine challenge test is performed if spirometry is inconclusive. PEFR is generally used to monitor asthma symptoms. A patient diagnosed with asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? a. Administering two more doses of albuterol b. Coming to the clinic for evaluation c. Going to the emergency department (ED) d. Taking an oral corticosteroid ANS: A The patient is experiencing an asthma exacerbation and should follow the asthma action plan (AAP) which recommends three doses of albuterol before reassessing. The peak flow is above 70%, so ED admission is not indicated. The patient may be instructed to come to the clinic for oxygen saturation and spirometry evaluation after administering the albuterol. An oral corticosteroid may be prescribed if the patient will be treated as an outpatient after following the AAP. Which physical examination finding is typical in in a patient with cough from COPD? A. Inspiratory wheezes B. Fine crackles C. Course rhonchi D. Expiratory wheeze ANS: D Which test is most diagnostic for chronic obstructive pulmonary disease (COPD)? a. COPD Assessment Test b. Forced expiratory time maneuver c. Lung radiograph d. Spirometry for FVC and FEV1 ANS: D Spirometry testing is the gold standard for the diagnosis and assessment of COPD because it is reproducible and objective. The forced expiratory time maneuver is easy to perform in a clinic setting and is a good screening to indicate a need for confirmatory spirometry. Lung radiographs are non- specific but may indicate hyperexpansion of the lungs. The COPD assessment test helps measure health status impairment in persons already diagnosed with COPD. A patient diagnosed with chronic obstructive pulmonary disease reports daily symptoms of dyspnea and cough. Which medication will the primary health care provider prescribe? a. Ipratropium bromide b. Pirbuterol acetate c. Salmeterol xinafoate d. Theophylline A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? a. Immediate referral to a thoracic surgeon b. Ordering computerized tomography (CT) angiography c. Scheduling a magnetic resonance imaging (MRI) to evaluate for aortic disease d. Ultrasound of the mass to determine size (US) ANS: D This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by US. Immediate referral is not necessary. MRI and CT diagnostic tests are ordered before surgery to evaluate the characteristics of the aneurysm. What is the recommended treatment for a 70-year-old male patient with an aortic aneurysm measuring 5.0 cm, poorly-controlled hypertension, and decompensated heart failure? Endovascular stent grafting of the aneurysm b. Immediate open surgical repair of the aneurysm c. No intervention is necessary for this patient d. Serial ultrasonographic surveillance (US) of the aneurysm ANS: D Serial US surveillance of the aneurysm. Patient's aneurysm is less than 5.5cm, so repair is not necessary at this time. Serial US of the aneurysm is necessary to continue to evaluate its size A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action? a. Order a CBC, type and crossmatch, electrolytes, and renal function tests. b. Perform an ultrasound examination to evaluate the cause. c. Schedule the patient for an aortic angiogram. d. Transfer the patient to the emergency department for a surgical consult. ANS: D This patient has symptoms and physical findings consistent with a ruptured aortic aneurysm and should have an immediate surgical consult. Ordering other tests is not necessary by the primary provider. A healthy 20-year-old patient reports having had 1 or 2 episodes of syncope without loss of consciousness. Which is the most likely type of syncope in this patient? a. Cardiac b. Neurogenic c. Orthostatic hypotension d. Reflex syncope ANS: D Neurally mediated or reflex syncope is the most common cause of syncope and is primarily seen in young adults. Cardiac, neurogenic, and orthostatic syncope are generally seen in older adults. An elderly patient reports experiencing syncope each morning when getting out of bed. Which assessment will the health care provider perform first to evaluate this patient's symptoms? a. Cardiac enzyme levels b. Electroencephalogram c. Fasting blood glucose d. Orthostatic blood pressures ANS: D Orthostatic blood pressure should be measured first since this patient reports problems associated with rising from a supine position. The other tests are performed as part of the diagnostic workup only if indicated by associated symptoms or suspected causes. A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia, and does not take any medications. What will the primary care provider do next to evaluate this patient? a. Assess serum cortisol levels b. Continue to monitor blood pressure at each health maintenance visit c. Order urinalysis, CBC, BUN, and creatinine d. Refer to a specialist for a sleep study ANS: C This patient has prehypertension levels and should be evaluated. UA, CBC, BUN, and creatinine help to evaluate renal function and are in the initial workup. Serum cortisol levels are performed if pheochromocytoma is suspected, which would cause a headache. The patient does not have to snore, so a sleep study is not indicated at this time. It is not correct to continue to monitor without assessing possible causes of early hypertension. An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? a. Add a beta blocker to the patient's regimen. b. Admit to the hospital for evaluation and treatment. c. Increase the dose of the thiazide medication. d. Prescribe a calcium channel blocker. Patients with cauda equina syndrome, which causes spinal stenosis, will often not get relief until they sit down for a period of time. Buerger's disease involves both the upper and lower extremities. Diabetic neuropathy may mask pain. PAD involves these symptoms that stop with rest. A patient is diagnosed with peripheral arterial disease (PAD) and elects not to have angioplasty after an angiogram reveals partial obstruction in the patient's lower extremity arteries. What will the primary care provider recommend to help with relief of symptoms in this patient? a. Daily aspirin therapy to prevent clotting b. Statin therapy with clopidogrel c. Walking slowly for 15 to 20 minutes twice daily d. Walking to the point of pain each day ANS: D Studies have demonstrated that an exercise program involving walking to the point of pain is as effective as angioplasty. Medications are useful to prevent the progression of plaque formation and to prevent myocardial infarction (MI). A patient experiences a sharp pain just under the sternum with swallowing. This is more commonly associated with which condition? a. Hiatal hernia b. Infectious esophagitis c. Peptic stricture d. Schatzki ring ANS: B A sharp, substernal pain with swallowing is most commonly associated with infectious esophagitis. Esophageal strictures are highly correlated with hiatal hernia and patients with stricture will report a feeling of food becoming stuck. A Schatzki ring and peptic stricture are types of strictures. A patient has a recent episode of vomiting and describes the vomitus as containing mostly gastric juice. What does this symptom suggest? a. Bile duct obstruction b. Gastritis c. Peptic ulcer d. Small bowel obstruction ANS: C The vomitus with peptic ulcer disease contains mostly gastric juice. Bile duct obstruction will result in bilious vomitus. Gastritis vomitus contains blood and will have a coffee-ground appearance. Small bowel obstruction produces vomitus that is feculent. What is the best treatment for H. pylori-related peptic ulcer disease? PPI and clarithromycin for 14 days Documented improved effectiveness over other regimens in treating H. pylori-related peptic ulcer disease A 50-year-old, previously healthy patient has developed chronic gastritis. What is the most likely cause of this condition, assuming the patient is from the United States? a. H. pylori infection b. NSAID use c. Parasite infestation d. Viral gastroenteritis ANS: A H. pylori accounts for most cases such as gastritis, duodenal ulcers, and gastric ulcers. NSAID use is an important cause, but not likely in a previously healthy individual. Parasites are the leading cause worldwide, but not in the United States. Viral gastroenteritis usually does not cause chronic gastritis and usually has lower GI symptoms. A patient has both occasional "coffee ground" emesis and melena stools. What is the most probably source of bleeding in this patient? a. Hepatic b. Lower gastrointestinal (GI) tract c. Rectal d. Upper gastrointestinal (GI) tract ANS: D Coffee ground emesis is usually old blood from an upper GI source and melena is black, shiny, foul- smelling as a result of blood degradation and is usually upper GI in origin. Lower GI and rectal bleeding will cause bright red blood in stools. Hepatic bleeding usually does not affect the GI tract. A patient reports lower abdominal cramping and occasional blood in stools. The provider suspects inflammatory bowel disease. Which test will the provider order to determine whether the patient has ulcerative colitis (UC) or Crohn's disease (CD)? a. Barium enema b. Colonoscopy c. Genetic testing d. Small bowel series ANS: B Colonoscopy is useful in differentiating UC from CD. Barium enema has limited use in diagnosis, but is used to detect distension, strictures, tumors, fistulas, or obstructions. Genetic testing may be helpful in the future with further advances. Small bowel series are used infrequently to determine small bowel involvement. A patient is diagnosed with mild to moderate ulcerative colitis. Which medication will be prescribed initially to establish remission? a. Azathioprine b. Budesonide A 50 year old male patient presents to the clinic complaining of fever, nausea, vomiting, rapid onset of abd. pain that radiates to the midback, and epigastric area or upper abdomen, anorexia. He also reports that the Pain is often relieved by leaning forward. What diagnosis does the FNP consider based on these symptoms? a. Myocardial Infarction b. Pancreatitis c. Choleycystitis d. Stroke ANS: B A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the significance of this finding? a. Compression of the common bile duct b. Presence of a pancreatic pseudocyst c. Retroperitoneal hemorrhage d. Severe acute pancreatitis with peritonitis ANS: D Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is present with compression of the common bile duct. Palpation of a mass suggests the presence of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal hemorrhage. The provider suspects that a patient has chronic pancreatitis. Which diagnostic tests will be most helpful to confirm this diagnosis? a. Blood glucose and fecal fat b. Complete blood count (CBC) c. Liver function tests (LFTs) d. Serum amylase and lipase levels ANS: A Patients with pancreatic insufficiency will have elevated blood glucose levels and steatorrhea. The CBC, LFTs, and serum amylase and lipase are typically normal with chronic pancreatitis. A patient recovering from chronic alcohol abuse reports nausea, vomiting, diarrhea, and abdominal discomfort. A physical examination is negative for jaundice or ascites. What will the provider do initially? a. Obtain a bilirubin level and prothrombin time b. Order a complete blood count and liver function tests c. Reassure the patient that this is likely a viral gastroenteritis d. Refer the patient to a specialist for evaluation and treatment ANS: B Patients with alcoholic hepatitis may present initially with signs of gastroenteritis. Based on the history, even without jaundice and ascites, the provider should order a CBC and LFTs. Bilirubin and PT levels are performed when a diagnosis is made to determine prognosis and course of the disease. Reassuring the patient without confirmation of disease is not recommended. Referral is made if hepatitis is diagnosed. An advanced practice registered nurse (APRN) is assessing a patient who has been diagnosed with hepatitis. The patient has been treated at home and had liver function tests (LFTs) completed upon diagnosis. The APRN notes that repeat LFTs remain elevated after several weeks. Which action should the APRN recommend for this patient? a. Parenteral vitamin B therapy b. Schedule an oral glucose tolerance test c. Long-term antiviral therapy d. Referral for a liver biopsy Referral for a liver biopsy A patient is diagnosed with fibrotic liver disease; a liver biopsy shows micronodular cirrhosis. What is the most common cause of this form of cirrhosis? a. Alcoholism b. Hepatitis C c. Hepatocellular carcinoma d. Right-sided heart failure ANS: A Micronodular cirrhosis is often associated with alcoholic liver disease. Viral causes and carcinoma usually cause macronodular cirrhosis. Right-sided heart failure occurs with many other causes as part of the disease development. A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding? a. Electrocardiography b. Gallbladder ultrasonography c. Mammography d. Polysomnography ANS: D Women with a neck circumference greater than 16 cm have an increased risk of obstructive sleep apnea and should have polysomnography to assess for this complication. The other tests may be necessary for obese patients but are not specific to this finding. A patient presents to the clinic with left ankle pain after rolling their ankle when trying to kick a ball during a soccer game. Upon examination, the advanced practice registered nurse (APRN) notes pain with movement and swelling. The patient is diagnosed with a minor left ankle sprain. Which treatment should the APRN prescribe first for this patient? a. Air cast b. Elastic wrap c. Physical therapy d. Plaster casting exercise. Although patients experience pain, damage to tissues does not occur. Exercise may be painful but does not cause damage. Medications help alleviate some, but not all symptoms. What treatment management might the FNP consider for a fibromyalgia patient that is not having pain control with NSAID therapy? a. gabapentin b. opioids c. physical therapy d. cognitive behavioral therapy ANS: A Pharm: can help reduce pain Go slow and gradually build up - we want to make them comfortable with as little amount of pain medications as possible Eat a good, healthful diet can help - but no good evidence on herbs/supplements Severe pain: duloxetine, pregabalin, gabapentin, tramadol Severe sleep problems: low dose amitriptyline, cyclobenzaprine, pregabalin at night No opioids! These make the patient worse, because they develop hyperalgesia and have to constantly increase the dose - easily to abuse these A postmenopausal female patient has a blood test that reveals hyperuricemia, although the patient has no symptoms of gout. What will the provider do initially? a. Ask the patient about medications and medical history b. Begin therapy with colchicine and an NSAID c. Recommend a low-purine, alcohol-restricted diet d. Treat for gout prophylactically to prevent a flare ANS: A Patients without symptoms of gout but with hyperuricemia do not need treatment, since most of these patients will never have a gout flare. It is important, however, to determine the cause of this finding and correct it if possible, since it is a risk factor for gout. Certain medications and medical conditions can predispose patients to gout. Colchicine and NSAIDs are used to treat symptoms of gout. Dietary changes are not necessary and are difficult to follow. Prophylaxis for the prevention of flares is for patients who have gout and who are between flares. A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment? a. Administration of intraarticular corticosteroid b. Discontinuing ULT while treating the flare c. Oral colchicine for 5 days d. Therapy with NSAIDs begun with in 24 hours ANS: A Intra-articular steroids are practical and beneficial when only one or two joints are involved and are safe for patients who cannot use NSAIDs or colchicine. NSIADs are contraindicated in patients with renal disease and colchicine should not be used in those with low glomerular filtration rates. It is not necessary to discontinue urate-lowering therapy during an acute attack. A patient experiences a second gouty flare and the provider decides to begin urate-lowering therapy (ULT). How should this be prescribed? a. Begin with a high-loading dose and gradually decrease. b. Start ULT during the current flare for best results. c. Start ULT in 5 weeks along with an anti-inflammatory drug. d. ULT should be suspended during future gouty flares. ANS: C Beginning therapy with a urate-lowering drug during an acute flare will prolong the flare. Typically, ULT is begun 5 to 6 weeks after a flare and should be given with an anti-inflammatory drug, since the initial period of ULT administration is associated with flares. ULT dosing should start low and gradually increase. It is not recommended to stop ULT during future flares, but to treat those flares while continuing the ULT A patient is following up with the advanced practice registered nurse (APRN) for large, painless nodules over the metacarpophalangeal joints. The patient has a history of three prior gout attacks and takes Allopurinol (Aloprim). Which referral should the APRN make for this patient? a. Rheumatology b. Neurology c. Orthopedics d. Physical therapy ANS: A Rheumatology A patient presents with a tender, red, swollen knee. you r/o septic arthritis and dx gout by confirming: a. an elevated WBC b. hyperuricemia c. a significant response to a dose of ceftriaxone (Rocephin) d. a positive antinuclear antibody test ANS: B A patient presents to an advanced practice registered nurse (APRN). Symptoms include generalized stiffness with painful, tender, and swollen joints. These symptoms started two months before and involved bilateral upper and lower limbs. Which diagnostic studies should the APRN order for this patient? ANS: A Septic arthritis is usually painful both with movement and at rest and is accompanied by swelling and erythema. Fever is not always present. The other causes of arthritis are not painful at rest. B.W. is a 34-year-old male who complains that his left knee has been painful for three days and is getting progressively worse. He describes the pain as throbbing and rates the pain as a 7/10. ROS is positive for fever. He denies fatigue, weight loss, and rash. PMH is unremarkable. He denies past GI or GU infection. Surgical history includes previous arthroscopic surgery to left knee two years ago. Social history includes smoking 2 packs/day. On exam, the left knee is erythematous, warm and edematous. Which diagnosis is most probable? a. septic arthritis b. fibromyalgia c. reactive arthritis d. SLE ANS: A A patient has marked swelling of a shoulder joint with erythema and severe pain. The provider suspects a bacterial cause. Which culture will be most helpful to determine the cause of these symptoms? a. Blood culture b. Synovial fluid culture c. Urethral culture d. Urine culture ANS: B Synovial fluid culture is the most important exam for diagnosis of septic arthritis. Blood culture may be positive in only 10% of cases. Urethral culture is performed if gonococcal arthritis is suspected. Urine culture is not helpful. The primary care provider is assessing a 45-year-old postmenopausal woman who has a family history of osteoporosis. Which test will be most useful to screen for this disease in this patient? a. Biochemical markers of bone resorption and bone formation b. Bone densitometry of the hip and posteroanterior lumbar spine c. Plain radiographs of the hips and lumbar and thoracic spine d. Serum calcium and serum 25-hydroxyvitamin D ANS: B Postmenopausal women are candidates for bone densitometry to assess for osteopenia and osteoporosis. Biochemical markers are generally ordered by specialists; their role in primary care is uncertain. Plain radiographs are used to determine fracture. Serum calcium and vitamin D levels are useful in the general population as a preventive measure. A patient is diagnosed with osteoporosis. What is the recommended treatment once the diagnosis is made? a. Bisphosphonate therapy b. Calcium and vitamin D c. Estrogen replacement d. Yoga and weight-bearing exercises ANS: A Bisphosphonates are FDA-approved treatment for osteoporosis and will help improve bone density and reduce the risk of fractures. Calcium and vitamin D may help prevent osteoporosis but must be taken from an early age. Estrogen replacement is used to prevent osteoporosis. Yoga and exercise help with balance and muscle strength to help prevent falls. A 50-year-old woman reports pain in one knee upon awakening each morning that goes away later in the morning. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the provider tell this patient? a. A magnetic resonance imaging study is necessary for diagnosis b. That the lack of findings indicates no disease process c. To take acetaminophen 1 gram three times daily for pain d. To use a cyclooxygenase 2-selective NSAIDs to reduce inflammation ANS: C Acetaminophen is the mainstay for initial treatment of osteoarthritis. Radiologic findings are often negative in the early stages of the disease. There are no serologic markers for OA. A COX-2-selective inhibitor has cardiovascular side effects and should not be used unless necessary. These agents are used more for pain than for inflammation. A 45-year-old patient has mild osteoarthritis in both knees and asks about nonpharmacologic therapies. What will the provider recommend? a. Aerobic exercise b. Glucosamine with chondroitin c. Therapeutic magnets or copper bracelets d. Using a cane or walker ANS: A Aerobic exercise helps with cardiovascular conditioning and weight reduction as well as improved range of motion, decreased pain, and strengthening of supporting structures. Randomized controlled studies have failed to demonstrate significant pain relief with glucosamine. Therapeutic magnets and copper have not been proven to be effective. A young patient with mild symptoms will not need assistive devices and should focus on conditioning. A patient has been given a diagnosis of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. you have educated her about the importance of increasing calcium and vitamin D in her diet and starting a low impact wt bearing exercise program. you are also going to start her on medical management. J. ask you about a drug called a "SERM" that she has heard a. NSAIDS b. Corticosteroids c. bisphosphonates d. Calcitonin ANS: C A patient has Paget's disease of the bone. it was dx as a result of routine blood work during his annual physical, which showed an increased serum alkaline phosphate level. you know that the most serious complication of Paget's disease is: a. osteosarcoma b. nerve compression c. fracture d. bone pain ANS: A A soccer player is brought to the emergency department after twisting an ankle during a game. An examination of the affected joint reveals ecchymosis and edema of the ankle and limited joint laxity along with pain on weight-bearing, although movement with pain is intact. Which grade sprain is likely? a. Grade I b. Grade II c. Grade III d. Grade IV ANS: B This patient probably has a grade II sprain, which involves incomplete tear of a ligament with some functional impairment, ecchymosis, and pain with weight-bearing. A grade I sprain causes only pain and edema. A grade III sprain is a full or complete tear of the ligament with loss of ligament integrity. A grade IV sprain results in severe weakness with loss of function. A patient presents today with another muscle strain from one of her many sports activities. you think that she was probably never taught about health promotion and maintenance regarding physical activity. what information do you include in your teaching? a. after an activity, if any part hurts, apply ice for 20 minutes b. you must first get in shape with a rigorous schedule of wt training and then you can participate in any activity once you are physically fit c. after any strenuous activity, you must completely rest your muscles before beginning your next activity d. stretching and warm-up exercises are an important part of any exercise routine ANS: D A patient with a history of frostbite presents to an advanced practice registered nurse (APRN) with three fingers that are white in color and numb. The patient's vital signs are normal, and the pain is rated as a zero. While the APRN examines the patient, the fingers change to blue and then to red. Which recommendation should the APRN make for this patient? a. Begin Pseudoephedrine (Sudafed) b. Limit exposure to cold temperatures c. Limit exposure to warm temperatures d. Begin Atenolol (Tenormin) ANS: B Limit exposure to cold temperatures A 75-year-old patient is referred to the endocrinologist's office with complaints of increasing weakness in the arms and legs over the past several months. The patient also reports losing interest in activities that were previously enjoyed and slowing weight gain. Upon examination, the advanced practice registered nurse (APRN) noted multiple bruises on the arms and legs, thin skin, and a slightly protruding abdomen coinciding with the weight gain. Which diagnostic study should the APRN order for this patient? a. BNP b. ACTH c. Lipid panel d. Uric acid ANS: B ACTH A 55-year-old patient presents to the advanced practice registered nurse (APRN) about increasing headaches over the course of the past several months. The patient has been taking over-the- counter (OTC) medications to relieve the headaches, but the headaches are becoming more severe and the OTCs are not working. The patient also reports profuse sweating even without physical activity, increasing weakness, and shakiness of the hands. Upon examination, the APRN notes the patient's blood pressure is 152/94. Which condition should the APRN assess for this patient? a. Hashimoto b. Gout c. Pheochromocytoma d. Diabetes ANS: C Pheochromocytoma A patient with a history of multiple sclerosis presents to an advanced practice registered nurse (APRN) in the emergency department with complaints of urinary hesitancy, urgency, and frequent incontinence. Which treatment regimen should the APRN prescribe for this patient? a. Channel blockers b. Alpha-blockers c. H2 blockers d. Beta-blockers ANS: B Alpha-blockers c. Prescribe a trial of an antidepressant medication. d. Recommend a trial of a cholinesterase inhibitor drug. ANS: C Elderly patients with depression who do not have other signs of AD may be given a trial of antidepressant medications initially in order to evaluate these symptoms. Brain imaging studies are not indicated initially. Genetic testing is not indicated. Once the degree of depression is determined and if other symptoms appear, an anticholinesterase inhibitor may be ordered. Which of the following is least likely associated with dementia: a. mental status returns to pre-illness baseline b. insidious onset over months to years c. no perceptual disturbance are noted until later in the disease d. progressive loss of intellectual function ANS: A Which type of dementia is characterized by: Gradual onset with moderate progression. Cognitive symptoms include memory, visuospatial, hallucinations, and fluctuations. Motor symptoms are typically Parkinson's like a. lewey body dementia b. acute delirium c. Alzheimer's dementia d. vascular dementia ANS: A Which type of headaches are described as typically familial, often unilateral throbbing, common to have nausea/vomiting, associated with photo and phono sensitivity, visual changes - 5% visual changes, flashing lights, strange odors or paresthesias a. cluster b. migraine with aura c. tension d. sinus ANS: B A patient reports recurrent headaches occurring 1 or 2 times per month that generally occur with weather changes or when sleep patterns are disrupted. They are described as severe, with throbbing on one side of the head and sometimes accompanied by nausea. What is the recommended abortive treatment for this type of headache? a. Gabapentin b. Propranolol c. Ergotamine tartrate d. Topiramate ANS: C This patient describes migraine headache without aura and has fewer than 4 per month. An abortive medication, such as ergotamine tartrate, is recommended. The other medications are preventive medications and are used for patients having more than 4 per month. The wife of the client diagnosed with meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse Practitioner? a. "There is bleeding into his brain causing irritation of the meninges." b. "A virus has infected the brain, causing inflammation." c. "This is a bacterial infection of the meninges, causing inflammation." d. "This is an inflammation of the brain parenchyma caused by a mosquito bite." ANS: C Meningitis is an infection of the meninges, causing inflammation. Most cases of community- acquired, new-onset meningitis are bacterial. The spouse of a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) asks about long- term care. What will the provider include when teaching the family about this disease? a. Bowel and bladder function will eventually be lost. b. Positive-pressure ventilation can prolong life. c. Preventing malnutrition is a key element in care. d. The nerves affecting sensation will die initially. ANS: C Prevention of malnutrition may improve both the quality and length of life. Bowel and bladder function and sensation remain intact. Positive-pressure ventilation helps to relieve sleep disturbance. A patient presents with numbness and paralysis in the legs, upper body, and face. Which of the following is a possible differential diagnosis? a. myasthenia gravis b. Guillain-Barre syndrome c. CVA d. Parkinson's disease ANS: B GB is An autoimmune disease in which the peripheral nerves become inflamed. Results in numbness and paralysis in the legs, upper body, and face. Level of independence depends on extent of paralysis. Which diagnostic test helps confirm a diagnosis of Guillain-Barré syndrome (GBS) in a patient who is developing muscle weakness and paresthesias? a. Lumbar puncture