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Fitzgerald Review 2 updated correctly answered
- Which of the following is not an expected finding for a patient with Meniere's disease? A positive Romberg test An abnormal Rinne test Lateralization during the Weber test Hearing loss: An abnormal Rinne test An abnormal Rinne test. The Weber and Rinne tests are physical examination techniques to assess for the presence of a conductive and/or sensorineural hearing loss and findings can be suggestive of Meniere's disease. In Meniere's disease, the Weber test shows lateralization to the unattected ear. The Rinne test is usually normal (i.e., air conductance exceeds bone conductance). The Romberg test is positive, with the patient showing diflculty staying balanced when standing with eyes closed.
- The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman who reports a progressive worsening of her hearing in both ears. The NP removes a large amount of cerumen from the patient's ears with stated resolution of her hearing problem. Her hearing loss was likely of what nature? Sensory Sensorineural Conductive Neural: Conductive Conductive. In this situation, the hearing loss was due to obstruction with cerumen in the external ear
2 / 120 canal. Another common reason for conductive hearing loss includes middle ear ettusion. Sensorineural loss is the most common form of progressive, high-frequency hearing loss due to presbycusis or aging. Sensorineural hearing loss can have many causes and results in the gradual loss of sound receptors and nerve endings. Conductive hearing loss is usually temporary while sensorineural hearing loss is permanent.
- A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet therapy with low-dose aspirin and clopidogrel. He complains about intermittent headaches and says his friend mentioned about the use of feverfew. You caution the patient that feverfew can be associated with: Hypertension. Increased bleeding risk. QTc prolongation. Ventricular arrhythmia.: Increased bleeding risk. Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family and the supplement is derived from the leaves of the plant. Feverfew is used for migraine and other types of headaches, as well as dizziness, rheumatoid arthritis, fever, and abdominal pain, among other conditions. Its mechanisms of action include inhibiting platelet aggregation, exhibiting anti-prostaglandin ettects, and decreasing serotonin release. Due to its antiplatelet ettect, there is an increased risk of bleeding with use of feverfew and should be used with caution or avoided altogether with concomitant antiplatelet therapy, such as aspirin and/or clopidogrel.
- The most important component of the initial assessment of an asthma exacerbation includes a(n): SaO2. Objective measurement of lung function. Chest X-ray. Arterial blood gases.: Objective measurement of lung function.
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- A 27-year-old woman presents complaining of pain on her upper thighs related to spilled hot coffee on her lap. Physical examination reveals a burn site that is red, dry and blanches briefly with pressure but without blisters. The NP categorizes this burn as: First degree. Second degree. Third degree. Fourth degree.: First degree. First degree. A first degree burn is a superficial burn that attects only the epidermis. The appearance of first degree burns is a burn site that is red, painful, dry, and without blisters. A second degree burn can involve the upper layers of papillary dermis (superficial partial thickness) or deeper layers of the dermis (deep partial thickness). These burns appear red, blistered, and can be swollen. A third degree burn can involve the dermis and underlying fat and can appear white or charred.
- You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit his blood pressure is 185/110 mm Hg but does not report any symptoms. Auscultation will likely reveal: S3 heart sound heard during early diastole S3 heart sound heard during late diastole S4 heart sound heard during early diastole S4 heart sound heard during late diastole: S4 heart sound heard during late diastole S4 heart sound heard during late diastole. The S4 sound is the sound heard when a stitt, non- compliant ventricular wall is being subjected to a sudden increase in pressure that occurs during atrial contraction. At the end of diastole, the atria contracts, ejecting its final contents into the ventricle just before the mitral valve closes. A stitt, non-compliant ventricle vibrates in response to this pressure and creates the end-diastolic sound known as an S4. The S4 sound is a marker of poor diastolic function
5 / 120 and is most often found in poorly-controlled hypertension or recurrent myocardial ischemia. The S4 heart sound that results from poor hypertension control usually resolves once the blood pressure has been well controlled for a few weeks.
- The NP sees a 48-year-old woman for an initial visit at the clinic. She con-fesses that she was diagnosed with hypertension 8 years ago but has not had any healthcare visit or taken any antihypertensive medications since that time. During her evaluation, signs of hypertension target organ damage can include any of the following except: Aortic murmur. Proteinuria. Elevated AST and ALT. Arterioventricular nicking of the retina.: Elevated AST and ALT. Elevated AST and ALT. Long-standing poorly-controlled hypertension can lead to target organ damage. Low-grade hypertensive retinopathy will not lead to visual changes but can be detected by the narrowing of arteriolar branches and severe local constriction. Damage to the kidney is detected by persistent proteinuria, while left ventricular hypertrophy is detected by the presence of an aortic murmur upon auscultation. Elevated AST and ALT are indications of liver damage, which is not a typical consequence of prolonged hypertension.
7 / 120 coronary artery. NSTE-ACS is less serious and involves non-transmural myocardial infarction and subtotal occlusion of the vessel.
- All of the following are risk factors for death from asthma except:
8 / 120 Rural residence. Low economic status. Greater than 3 emergency department (ED) visits for asthma. Use of more than 2 canisters of short-acting beta2-agonist (SABA) per month.- : Rural residence. The National Heart, Lung, and Blood Institutes (NHLBI) Expert Panel Report (EPR) 4 has identified a variety of risk factors for asthma-related death such as low economic status, > emergency department visits, and use of >2 canisters of SABA per month. However, urban residence is actually a risk factor whereas patients who live in rural environments are at lower risk of asthma- related death.
- Symptoms characteristic of poorly-controlled asthma can include all of the following except: A recurrent spasmodic cough that is worse at night and with exertion Recurrent shortness of breath and chest tightness A congested cough that is worse during the day. Wheezing with and without respiratory infections.: A congested cough that is worse during the day. Poorly-controlled asthma is most classically characterized by recurrent shortness of breath, chest tightness, and by dittuse, bilateral expiratory wheezes as a consequence of bronchoconstriction with or without coincident infection. Exacerbations are triggered by those circumstances that place an increased workload on the airways, such as exertion. Since endogenous glucocorticoid release is diurnal and reaches its nadir at night, inflammatory conditions often exacerbate at night. A congested cough that is worse during the day is not characteristic of asthma and suggests an infectious process.
- Which clinical scenario is most consistent with Legionella pneumonia? A 56-year-old heating and cooling repair person with a dry cough and abdom-inal pain A 78-year-old retired firefighter recovering from influenza with thick yellow sputum and abscess noted on chest X-ray A 24-year-old with severe sore throat, hoarseness, and a hacking cough
10 / 120 is contracted through aerosolized water vapor. The retired firefighter recovering from influenza with thick sputum and abscess more likely has activated a colonized organism, such as S. aureus. The hoarseness and hacking cough are more consistent with viral or atypical pathogen infection. Fever, chills, and rusty sputum are more typical of S. pneumoniae infection.
- When evaluating a patient with lumbar radiculopathy, "red flags" for a potentially serious underlying etiology include all of the following except: History of recent trauma. Unexplained weight loss. Radiation of pain to buttocks. Bladder dysfunction.: Radiation of pain to buttocks. Low back pain is most often a consequence of muscle strain or nerve irritation/impingement. However, certain red flags can indicate a potentially serious underlying cause that would require immediate evaluation. History of recent trauma can indicate the presence of a fracture. Constitutional symptoms such as unexplained weight loss or fever can indicate a possible tumor or infection. When the patient develops coincident loss of bowel and bladder control, this suggests acute compression of the nerve roots at the end of the spinal cord (cauda equina syndrome).
- Identify which of the following individuals is most consistent with a presen-tation of rheumatoid arthritis? A 67-year-old with bilateral knee pain that is alleviated with NSAIDs A 54-year-old with bilateral joint stiffness that is worst in the mornings and who is ANA positive A 34-year-old experiencing heel pain 2 weeks following an episode of acute bacterial diarrhea A 56-year-old with recurrent sharp pain in the large toe, typically occurring after eating a large quantity of meat: A 54-year-old with bilateral joint stittness that is worst in the mornings and who is ANA positive. Rheumatoid arthritis is an autoinflammatory disease that causes chronic systemic inflammation, including the synovial membranes of joints. Clinical signs and symptoms include slowly progressive malaise, weight loss and joint stittness. Stittness is symmetrical and worst on arising. The ANA test is used to help in the
11 / 120 diagnosis of rheumatoid arthritis. The individual with bilateral knee pain alleviated with NSAIDs is likely caused by osteoarthritis, while the individual with knee pain following a bacterial diarrheal episode is likely caused by reactive
13 / 120 symptoms must be present for a diagnosis. Among the more common of these additional symptoms is insomnia, which in depression most commonly presents
14 / 120 as diflculty staying asleep or early morning awakening (EMA). Diflculty falling asleep is possible but less likely. Recurring headaches and gastrointestinal complaints are not common characteristics of depression.
- For an individual with type 2 diabetes mellitus, urine microalbumin levels should be checked annually to help identify: Chronic kidney disease. Drug-induced hepatotoxicity. Congestive heart failure Hypotension.: Chronic kidney disease. Albumin is a protein that is normally found in serum. However, a certain level of albumin in urine can be an indication of kidney disease or kidney damage. Microalbuminuria is defined as the presence of 30 to 300 mg albumin in a 24-hour urine collection.
- A rise in serum creatinine is indicative of: Decreased glomerular filtration rate. Early renal damage. Volume expansion. Impaired renal perfusion.: Decreased glomerular filtration rate. Creatinine is the end-product of protein metabolism and is excreted by the kidney. If the serum creatinine rises, this means that renal excretion is decreased. This can occur for a variety of reasons, many of which are reversible, and does not necessarily imply renal damage or impaired perfusion. Creatinine clearance is influenced by glomerular filtration rate (GFR). The GFR describes the flow rate of filtered fluid through the kidney, whereas clearance occurs via glomerular filtration. If GFR falls, then creatinine clearance is less eflcient and resulting serum creatinine will be elevated, so while the two values are not identical, creatinine clearance is a reasonable approximation of GFR. The normal range for GFR is 90?120 mL/min/1.73 m2.
- You see a 22-year-old college student who reports a fainting episode after playing a pick-up basketball game. Upon examination, you note a midsystolic murmur that gets louder with standing. This could represent a(n): Aortic stenosis. Physiologic murmur.
16 / 120 in the standing position implies that the murmur is blunted by fluid and exaggerated with less volume. This implies a non-volume related murmur, and when it occurs in a young patient it is possible that the murmur is created by hypertrophic myocardium. The patient should have additional diagnostic testing including an echocardiography to help with establishing the diagnosis of hypertrophic cardiomyopathy.
- The S4 sound heard in a 59-year-old with poorly-controlled hypertension occurs during: Early systole. Late systole. Early diastole. Late diastole.: Late diastole. The S4 sound is the sound heard when a stitt, non-compliant ventricular wall is being subjected to a sudden increase in pressure that occurs during atrial contraction. At the end of diastole, the atrium contracts, ejecting its final contents into the ventricle just before the mitral valve closes. A stitt, non-compliant ventricle vibrates in response to this pressure and creates the end-diastolic sound known as an S4. The S4 sound is a marker of poor diastolic function that is most often found in poorly-controlled hypertension or recurrent myocardial ischemia.
- The S3 sound found in an individual with heart failure is heard during: Early systole. Late systole. Late diastole. Early diastole.: Early diastole. The S3 sound is the sound that a weak ventricular wall makes in response to passive filling from the atria. Less commonly, the S3 sound occurs in a normal heart that is subject to higher than normal volumes of passive filling. In either event, the sound occurs during passive filling, which happens early in diastole immediately upon opening of the mitral valve. The S
17 / 120 sound is a marker of ventricular overload and/or systolic dysfunction and can be used to help diagnose heart failure in the presence of other findings such as dyspnea, tachycardia, or crackles.
- Common symptoms of uncomplicated cystitis in a 28-year-old woman can include all of the following except: Dysuria. Gross hematuria.
19 / 120 Sexual contact. Cooked seafood.: Fecal contaminated water. Hepatitis A is transferred via the oral-fecal route, and is most commonly transmitted via fecal contaminated water and raw or undercooked seafood. Properly cooked seafood is
20 / 120 generally safe as heat denatures the virus. Because hepatitis A is not parenterally transmitted, there is no risk in sharing injection drug equipment or in sexual contact; those practices increase risk for hepatitis B and C.
- A 43-year-old woman with BMI of 32 kg/m2 presents with a 12-hour history of fever, acute epigastric pain, and a positive Murphy's sign. The most likely diagnosis is: Hepatoma. Chronic cholelithiasis. Acute cholecystitis. Acute viral hepatitis.: Acute cholecystitis. Right upper quadrant palpation that produces pain and a sharp intake of breath is known as the Murphy's sign. This is highly characteristic of acute cholecystitis, and when there is coincident fever and pain, a diagnosis of acute cholecystitis should be pursued via right upper quadrant abdominal ultrasound.
- The most common cause of hypothyroidism is as a result of: Radioactive iodine exposure. Thyroid neoplasia. Primary pituitary failure. Autoimmune thyroiditis.: Autoimmune thyroiditis. Autoimmune thyroiditis is a condition in which the body produces thyroid peroxidase antibodies that contribute to chronic thyroid inflammation and eventual thyroid failure. As a result, the thyroid gland does not produce thyroxine, and the patient becomes clinically hypothyroid. This is the most common cause of hypothyroidism in parts of the world, such as North America, where iodine deficiency is not a problem.
- A 62-year-old man is experiencing an exacerbation of heart failure and starts high dose loop diuretic therapy with clinical effect. Recognizing the risk of hypokalemia, the NP is wary of all of the following signs and symptoms except: Muscle weakness. Nausea and
