NR511 Week 8 Final Exam., Exams of Nursing

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Erythema iinfectiosum i(fifth

idisease)

HERALDiPATCH"

Pityriasis irosea

NR511 MIDTERM REVIEW

• Actinic keratosis: pre-cancerous lesion. The main assessment technique is iINSPECTION, which

will show as flesh colored, hard and sand paper like.

▪ TX: cryotherapy

o Risk factor: sun exposure, can progress to squamous cell carcinoma

o Referrer pt to dermatology to prevent progression

• Fungal skin infection: assess rash and satellite lesions.

o DX: based on clinical presentation, most common is candida albicans

o Tx: antifungal cream, pills, keep area as dry as possible. The fungus likes moisture and poor

air circulation

o At risk: opportunistic, pts who are immunocompromised, older and younger pts, diabetics,

and antibiotic therapy.

o Refer patient if there's no improvement

• Common types of fungal infections:

o Tinea vesicolor: flat to slightly elevated brown papules and plaques that scale when they

are rubbed along with areas of hypopigmentation, pruritic, most commonly found on trunk

and shoulders.

o Balanitis: candidiasis in the glands of the penis

o Tinea corporis: annual lesions with scaly borders and central clearing on the trunk

o Tinea pedis: athlete's foot, and between toes

o Tinea cruis: jock-itch groin

• Bacterial skin infections: warm, red, painful w/o sharply demarcated border

o Cellulitis: is a spreading infection of the epidermis and sub-cut tissue that usually begins after

a break in the skin.

o Folliculitis: bacterial infection of the hair follicle, papules are characteristics of folliculitis

• Viral skin infections

o erythematous, warm rash, gives the appearance

of slapped cheeks. Sore throat, slight fever, upset stomach, headache, fatigue, and

itching. Resolves on its own.

o Varicella rash: contagious 48 hours before the onset of the vesicular rash, during the

rash formation and during the several days it takes the vesicles to dry up.

Characteristics rash appears 2-3 weeks after exposure.

o Warts: caused by the human papillomavirus, most warts recur despite treatment. Contrary

to popular opinion, warts do not have roots, the underside of a wart is smooth and round.

Abrading the skin can spread the virus, vigorous rubbing, shaving, and nail biting can do

the same.

• Skin inflammations:

o

lesion. This "

chest or

back.

: common, self-limiting, usually asymptomatic eruption with a distinct initial

, which appears suddenly and without symptoms, usually is on the

▪ Secondary lesions appear 1-2 wks later while the herald patch remains.

▪ The collarette scaling is another classic symptom of pityriasis rosea.

▪ The lesions usually resolve suddenly in 4-12wks w/o scarring.

▪ Outbreaks are known to occur in close quarters like military barracks or dormitories.

o Hives: look at the location of the rash, the first step is to determine the need for

epinephrine. Look for respiratory symptoms, SOB, hoarseness, look at location. If the rash

is on the neck, face- admin epinephrine.

o Cholinergic urticaria: hives or wheals that are pruritic and occur on the trunk and

arms following exercise, anxiety, elevated body temp. hot bath and showers.

▪ Hx taking about when the rash started is important for dx

Atopicitriad:iASTHMA,iECZEMA,iALLERGICiRHINITIS

AtopiciDermatitis:

Minoxidil(Rogaine)ivasodilatoriandimayistimulateivertexihairigrowth.

iHEARING iLOSS, iTINNITUS, iAND iVERTIGO.

Meniere'sidisease: itheitriadiofisymptomsiassociatediwithiMeniere'sidisease:iPROGRESSIVE

o Contact dermatitis: poison ivy: a form of contact dermatitis, it is not contagious and it

cannot be spread from one area of the body to another by touching it. Type of SPORE

reaction.

▪ Another type is Latex sensitivity

o Keratosis pilaris: mild pruritic and looks like GOOSEFLESH, the rash appears as small,

pinpoint, follicular papules on a mildly erythematous base. It is a benign conditions that

resolves by adulthood.

o consider ALLERGY!!

▪

• Hair loss

▪ RAST may be done to ID the antigen-specific mast cell activation or to quantify levels

of antigen-specific IgE. RAST is usually available to PCPs, where as scratch testing is

usually done by allergists.

▪ RAST results requires specialized knowledge, and should be used as general

atopic screening tool.

o Alopecia areata: systemic cause of alopecia, nonscarring hair loss of rapid onset, the pattern

of which is most commonly sharply defined round or oval patches.

o Trichotilomania: non-scarring, non-systemic causes of alopecia include trauma, bacterial

or local fungal infections, and radiation to the head.

o

• Parasitic skin infections

o Pediculosis: (LICE!!) client education is important in the tx of pediculosis b/c pts should be

informed that itching may cause for up to a week after successful tx b/c of the slow

resolutionof the inflammatory reaction caused by the lice infestation.

• Ear disorders

o Otitis externa: classic sign of acute otitis externa is tenderness on traction of the pinna

and/or pain on applying pressure over the tragus. There is typically an erythematous ear

canal, and usually a hx of recent swimming.

▪ Using ear drops made of a solution of equal parts alcohol and vinegar in ea. Ear after

swimming is effective in drying the ear canal and maintaining an acidic environment,

therefore preventing a favorable medium for the growth of bacteria, the cause of

swimmer's ears.

o Acute otitis media: ear infection that is dx by otoscopic examination. The tympanic

membrane will appear red and bulging with or w/o visible effusion.

▪ Light reflex is usually diminished or absent, and mobility id decreased

NOT INCREASED!!

▪ The external auditory canal is red and erythematous

▪ Tx of choice: amoxicillin 80-90mg/kg/day in children in daycare

▪ Note: it is important to note that if a child w/ O.M. with effusion has a change in

hearing threshold greater than 25 dB and has notable speech and language

delays,

more aggressive tx is indicated. It is important that theprovider evaluates the child's

developmental milestone in speech and language. Abnormal findings warrant a

referral.

o

• Hearing loss

o Sensorineural loss: come from exposure to loud noises, inner ear infections,

tumors, congenital, and familial disorders, and aging.

▪ Sensorineural loss comes from exposure to tumors such as acoustic

neuromas, Meniere's disease, medications, trauma, and certain disease.

o Conductive hearing loss: presbycusis- the conductive hearing loss- bone conduction is

greater than air conduction, so the patient will report the bone conduction sound longer

than the air conduction.

ihallmarkicharacteristics iofiHSV- 1 ior iHSV- 2 iconjunctivitis.

Skinivesiclesi(ifipresent)iandicornealiinfectioniwithiai"dendrite"iappearanceiare

Preauricularilymphinodeiswellingianditendernessiisihallmarkiforiviraliconjunctivitis

▪ Serous otitis media can result in conductive hearing loss.

o The Weber test- a vibrating tuning fork is placed on the top of the head mid center from

the patient's ears.

▪ In the normal pt: the tuning fork sound is head equally loud on both ears

▪ In abnormal pt: the tuning fork is heard LOUDER in the BAD ear.

• Eye disorders

o Conjunctivitis- viral or bacterial: the causative organism of viral conjunctivitis ad adenovirus.

It can be present w/ or w/o cold symptoms. Pts complain of itchy, watery, red eyes and may

have clear to no discharge.

▪

▪

▪ Education: teach pts to put drops in and advise to avoid touching the tip of the

bottle to any conjunctival or skin surface.

• Women should be told to throw away all eye makeup products due to

contamination and to start with new products when the infection

clears.

• Likewise, disposable contact lens wearers will need to discard the

contacts, refrain from wearing any during tx, and start with a new pair

when clinical

symptoms have resolved.

• Bacterial conjunctivitis is very contagious so the pt should stay home from

work or school until 24 hours of antibiotic tx or as soon as

clinicalimprovement

(decreased redness and d/c) is noted.

o Blepharitis: inflammation around the eyelid margins, that is caused by staphylococcal

injection at the lash base and dysfunctional Meibomian glands.

o Subconjunctival hemorrhage: bright red blood in a sharply defined area surrounded by

normal- appearing conjunctive indicates subconjunctival hemorrhage.

▪ Risk factors: blood thinners, DM2, HTN, Valsalva type maneuvers.

▪ The condition is self-limiting and resolves on its own

▪ Patient w/ visual changes or with more extensive hemorrhage should be referred to

an ophthalmologist or ER.

o Corneal abrasion: aka as an eye scratch- DX: fluorescein stain is done to detect abrasion

or foreign body objects in the cornea.

• ENT

o Sinusitis: invasive complications such as infection of an adjacent cranial structure

(mastoiditis, meningitis, etc) require referral to a specialist.

▪ With Ethmoid sinus problems: the pain is felt behind the eye and high on the nose

▪ Maxillary sinus: the largest of the paranasal sinuses and is the most commonly

affected sinus. There is usually pain and pressure over the cheek. The inability to

transilluminate thecavity usually indicates a cavity filled with purulent material.

• Discolored nasal drainage, as well as poor response to decongestants, may

also indicate sinusitis.

▪ If the patient has a URI for at least 7 days, the presence of 2 or more of the

following signs/symptoms:

• Colored nasal drainage

• Poorresponse to decongestants

• Facial or sinus pain (aggravated by postural change)

• Headache

▪ Viruses may produce all ofthe clinicalmanifestations described, however, patients

who meet the 7-day criteria are more likely to have bacterial rather than a viral URI.

o Mononucleosis: fatigue, sore throat, low grade fever, nasal and throat mild erythema

▪ Edematous, enlarged tonsils bilaterally, with erythema of thepharyngeal wall

and tonsillar exudates.

▪

▪ This presentation could be viral pharyngitis, however with posterior

cervical lymphadenitis, you should suspect mononucleosis.

o Epiglottitis: a symptom cluster of severe throat pain with difficulty swallowing, copious oral

secretions, respiratory difficulty, stridor, and fever but without pharyngeal erythema or

coughiis indicative of epiglottitis.

▪ A pediatric pt w/ acute epiglottitis, a number of symptoms can indicate the airway

obstruction is imminent: STRIDOR, RESTLESSNESS, NASAL FLARING, USE OF

ACCESSORY MUSCLE OF RESPIRATION

o Tonsillitis: tonsil grading is important: grade 3- indicates that the tonsils are touching the uvula.

▪ Tonsils are enlarged to 2,3, or 4 indicate acute infection.

o Laryngitis: most cases of acute laryngitis are due to viruses with H. influenza. Viral illnesses

are best treated with supportive care. Antibiotics are ineffective and increase the risk of

antibiotic resistance.

o Peritonsillar Abscess: peritonsillar cellulitis and abscess are acute pharyngeal infections

most common among adolescents and young adults.

▪ Infection is virtually always unilateral and is located btw the tonsil and the

superior pharyngeal constriction muscle.

▪ S/S: gradual onset of severe unilateral sorethroat, odynophagia, fever, otalgia, and

asymmetric cervical adenopathy. Trismus, similar to lock jaw or "hot potato"

voice

(speaking as if a hot object was in the mouth), is common. A toxic appearance (e.g.

poor or absent eye contact, failure to recognize parents, irritability, inability to be

consoledor distracted, drooling, severe halitosis, tonsillar erythema, and exudates

can also be observed.

▪ S/S cont: in pt's peritonsillar abscess, there is more of a discrete bulge, with

deviation of the soft palate and uvula. Patients should be referred to the ED

immediately as

maintaining airway patency and preventing sepsis is of concern.

o Candidiasis: painless, white, slightly raises patches on the pt's mouth, AKA thrush

o Oral Cancer: 90% of oral cancers are squamous cell carcinoma (SCC) and is seen typically on

the lip or lateral part of the toungue, usually as a lesion that is white, red, or mixed white

and red.

▪ Characterized by painless, firm lesions with indurated borders.

o Rhinitis (Hay Fever): allergic rhinitis results from immunoglobulin E(IgE)-mediated

type I hypersensitivity to airborne irritants affecting eyes, nose, sinuses, throat, and

bronchi.

▪ The s/s are allergic rhinitis are similar to those of viral rhinitis but usually persist

and are seasonal in nature. When assessing the nasal mucosa, you will observe

that the

turbinates are usually pale or violaceous because of venous engorgement.

• GI DISORDERS

o Appendicitis: constant periumbilical pain shifting to the right lower quadrant,

vomiting following the pain, a small volume of diarrhea.

▪ Fecalith: most common cause: stone made of feces typically found in the

colon

▪ No systemic symptoms: headaches/ malaise/ myalgia

▪ A mild elevation of WBC count w/ early left shift, and WBCs or RBCs in the

urine indications of appendicitis.

▪

urine may have EBCs or RBCs if the bladder is irritated and ketonuria if there

is prolonged vomiting.

▪ Obtur

ator

sign:

elicit

ed

when

, with

the

patie

nt's

right

TheiWBCicountibecomesihighionlyiwithigangreneioriperforationiofithe

iappendix.

Inflamediposterior icervicalilymphinodes

i

hip and knee flexed. The

The

examiner slowly rotatesthe right leginternally, which stretches

theobturatormuscle.Pain over the right lower quadrant is considered a positive sign.

o Inflammatory bowel disease: Chron disease shows transmural inflammation, granulomas,

focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa,

the inflammation extends deeper into the intestinal wall.

▪ Chron's disease can involve all or any layer of the bowel wall and any portion of the

GI tract from the mouth to the anus.

▪ Any portion of the GI tract can be affected by 80% of pts have small

bowel involvement.

▪ In advance disease, perianal lesions, fistulas, strictures, and obstructions are

common in CD.

▪ Folic acid and serum levels of most vitamins, including A, B complex, C, and the fat-

soluble vitamins, are decreased in CD as a result of malabsorption. Liver enzymes

are

increases.

▪ Ulcerative colitis is a disease only of the colon. While it is not the first tx of choise,

total colectomy is tx option that can completely resolve this problem.

▪ In ulcerative colitis, the mucosal surface of the colon is inflamed. This ultimately results

in friability, erosions, and bleeding. It most often occurs in the rectosigmoid areas but

can involve the entire colon.

▪ In CD, patients with UC are more at risk for colon perforation and should be

followed closely by surgeon.

o GERD: Symptoms occur at night w/ regurgitation, heartburn is classic for GERD (mild to

severe). Dysphagia is frequently a prominent symptom of GERD.

▪ It is usually associated with other symptoms, including regurgitation, water

brash (reflex salivation) sour taste in the mouth in the morning, odynophagia,

blenching,

coughing, hoarseness, or wheezing, usually at night.

▪ It a patient has been tx w/ diet modifications and 6wks of omeprazole

w/o improvement of symptoms, the next step is an endoscopy.

▪ A biopsy can be done and sent for H pylori at that time.

▪ Diverticular disease has been shown to be significantly increased with a low fiber

diet and diet that is high in fat and red meats. Obesity is associated with a higher

risk for diverticular disease.

▪ Clients w/ GERD should be instructed to avoid coffee, alcohol, chocolate,

peppermint, and spicy foods. Eat smaller meals, smoking cessation, remain upright

for 2 hours after

meals, elevate the head of the 6-8 inches in blockers and refrain from eating for 3

hours before going to bed.

o IBS: Tx: anti-diarrheals (Lomotil), laxatives, antispasmodics (Bentyl), tricyclic

antidepressants, SSRIs (prozac), and medications to increase the intestinal fluid secretion

and improve fecal transit (Linzess) are all used to treat IBS.

o Acute diverticulitis: pts may have it with bleeding not associated with pain or

discomfort. When diverticula become inflamed, there are usual s/s of infection: fever,

chills, and tachycardia. Patients typically present with localized pain and tenderness in

the LLQ of the abdomen with associated anorexia, nausea and vomiting.

▪ CT scan w/ contrast may sometimes be done to r/o if the GN etiology such as ovarian

cyst of tumor as well as bowel pathology such as abdominal abscess.

o Gastroenteritis: BOTULISM: GI illness associated with descending neurological s/s such

as double vision after eating canned food.

▪ Traveler's diarrhea: E coli is the most common pathogen responsible for

traveler's diarrhea.

o Peptic Ulcer Disease: associated w/ H. pylori infection. TX: amoxicillin, clarithromycin,

and omeprazole for 2 weeks.

• Primary care basics:

o Data collection: subjective

o Documentation: OLDCART best reflects HPI

o APN business essentials:

▪ Determining the level of complexity of a visit: risk data and dx

▪ CPT codes: recognized universally and can be used to track healthcare data

▪ MEDICARE PART A: covershospital services only.

▪ MEDICARE PART B: covers provider and outpatient services.

▪ Third party payers: the term indemnity insurer refers to an insurance that pays for

the medical care of the insured but does not provide that care.

vi accine) bi y ithis iorganization iare ibased ion ia igrading iscale. iSome iof ithe iguidelines istate ithat ithey idon’t ihave NR 511 Week 1 practice questions

1. Which of the following initiatives does not fall under the National Prevention Strategy?
   • Diabetes iManagement. iReference iPagei 29
   • Tobacco Free Living
   • Healthy Eating
   • Mental and Emotional Wellbeing
2. All of the following statements about the US Preventive Services Task Force (USPSTF) are true except?
   • All iof ithe irecommendations imade iby ithe iUSPSTFiare istrong irecommendations. i(The irecommendations imade iscientific idata itoisupport ian iinformed irecommendation.) iReference iPage i31-
   • This is a private sector group without government ties.
   • This group makes recommendations about preventive medicine.
   • All of the USPSTF recommendations are considered mandatory in primary care.
3. What type of reaction following an immunization is considered serious and requires reevaluation?
   • Temperatureigreater ithani103˚F. i(Highifever iis ia ireason itoireevaluate ia ipatient ifollowing ia ivaccine. iReference iPage i 33
   • Fatigue
   • Temperature of 100.2˚F.
   • Erythema and soreness at the injection site.
4. Herbert, a 69-year-old man, comes to your office complaining of nocturia. On questioning Herbert, you find that for the past 3 months he has been getting up at least 5 times a night to void. He came in to seek help today because of his wife’s insistence that he be checked out. When you perform the digital rectal exam, you find that his prostate protrudes3 to 4 cm into the rectum. What grade would you assign to Herbert’s prostate enlargement?
   • Grade 1 (Grade 1 enlargement is a protrusion of 1 to 2 cm.)
   • Grade 2 (Grade 2 enlargement is a protrusion of 2 to 3 cm)
   • Grade i 3 i(The idegree iof iprostate ienlargement iis ibased ion ithe iamount iof iprojection iof ithe iprostate iinto ithe irectum. iThe inormal iprostate iprotrudes iless ithan i 1 icm iintoithe irectum.iAigrade i 3 ienlargement iis i 3 ito i 4 icm. iinto the irectum) iReference iPage i 748
   • Grade 4 (Grade 4 enlargement is a protrusion of greater than 4 cm)
5. Which of the following individuals should get the shingles (herpes zoster) vaccine?
   • Jerry, who has a mild upper respiratory tract infection and is allergic to neomycin (Allergy to neomycin is a contraindication to receiving the shingles vaccine)
   • Tim, who has been on prolonged use of high-dose steroids for his chronic obstructive pulmonary disease (COPD). (Prolonged use of high-dose steroids is a contraindication to receiving the shingles vaccine)
   • Joan, whose husband recently had shingles and who is trying to get pregnant (Women should not get pregnant until 4 weeks after receiving the vaccination)
   • Joe, iwhoihas ia istressful ijobi(Joe, iwho ihas ia istressful ijob, iis ia icandidate ifor ithe ishingles i(herpes izoster)
6. As a primary care provider, which of the following topics is not typically important for adults aged 20 to 40?
   • Focusing ion iincreasing ilifespan. i(This iis itypically iimportant ito ipatients igreater ithan i 65 iyears iold)
   • Career development.
   • Self-image.
   • Family relationships.
7. Which of the following statements defines health literacy?
   • The ilevel itoiwhichia ipatient ican iunderstand, igainiaccess ito, iand imake iproper imedical idecisions.
   • The ability of a patient to read health pamphlets.
   • The extent to which a patient can travel to see a medical provider.
   • The ability of a patient to write in the language of the health practitioner.

hi istory iof ipresent iand iACEiinhibitor. iOther iclinicians ifeel ithat iher iA1Ciindicatesithat ishe ihas ibeen ia idiabetic ifor iprobably i 10 iyears

8. Between ages 7 and 18, both boys and girls are immunized against the following diseases:
   • Tetanus, idiphtheria, ipertussis, imeningitis, iandihuman ipapillomavirus.
   • Tetanus, diphtheria, pertussis, and rotavirus. (The rotavirus vaccine is given prior to age 7)
   • Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and hepatitis A. (The hepatitis A vaccine isgiven prior to age 7)
   • Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and hepatitis C. (There is no known vaccine for Hep C yet)
9. The OLD CARTS (onset, location, duration, character, aggravating/alleviating factors, radiation, timing, severity) mnemonic is best used in which part of your chart note?
   • Historyiof ipresent iillness i(TheiOLDiCARTSimnemonic iisibest iuseditoidescribe ithe ipatient’s isymptoms iinithe
   • Plan.
   • Diagnosis.
   • Physical exam.
10. Eileen, a 42-year-old woman, comes to your office with a chief complaint of fatigue, weight loss, and blurred vision. Eileen has a past medical history that is negative for any chronic medical problems. You obtain a fasting chemistry panel, lipid profile, complete blood count (CBC), and hemoglobin A1c (HbA1c). The results of the blood work show Eileen’s blood sugar elevated at 356 mg/dL, total cholesterol elevated at 255, high-density lipoprotein (HDL) cholesterol low at 28, low-density lipoprotein (LDL) cholesterol elevated at 167, triglycerides 333, and HbA1c 12. On questioning Eileen further, you discover that both her grandmothers had adult-onset diabetes mellitus. You diagnose type 2 diabetes mellitus. Your treatment plan should include a cholesterol-lowering agent, an agent that lowers blood sugar, and which other class of medication?
    • Angiotensin-converting ienzyme i(ACE) iinhibitor i( Studies ihave ishown ithe iuse iofiACEiinhibitors iiniclients iwithidiabetes, iwith ior iwithout ihypertension, ihas slowed ithe iprogression iof inephropathy. iYou imust imonitor ithe iclient’s icreatinine iand ipotassium ilevels iroutinely. iIf ithe iclient’s irenal ifunction idoes idecrease, ielevated ipotassium ilevels imay ioccur. iSome iclinicians idisagree ionithis iapproach iand irecommend iwaiting iuntil imicroalbuminuria iis ipresent ibefore iinitiating ian iwouldibenefit ifrom ithis iapproach)
    • Diuretic.
    • Weight loss medication (Diet and weight loss are fundamental components of diabetes management)
    • Beta blocker.
11. Margaret, age 29, is of medium build and 5 ft 4 in tall. You estimate that she should weigh about:
    • 105 lb.
    • 110 lb.
    • 120 ilb i(To iestimate ia iclient’s iideal iweight, iuse ithe ifollowing iformula: iFor iwomen iolder ithan iage i25, iallow i 100 ilbifor ithe ifirst i 5 ift, ithen iadd i 5 ilbifor ieach iinchithereafter. iFor imen, iallowi 106 ilbifor ithe ifirst i 5 ift, ithen iadd 6 ilbifor ieachiinchithereafter. iMultiply ithe inumber iby i110% ifor ia iclient iwithia ilargeiframe iand i90% ifor ia iclient iwith ia ismall iframe)
    • 130 lb.
12. Susie, age 5, comes to the clinic for a well-child visit. She has not been in since she was 2. Her immunizations areiup to date. What immunizations would you give her today?
    • None; wait until she is 6 years old to give her her booster shots (Susie is due for diphtheria, tetanus, and pertussis (DTaP); inactivated polio vaccine (IPV); and measles, mumps, and rubella (MMR) between the ages of 4 and 6. There is no need to wait until she is 6 years old)
    • Diphtheria, tetanus, and pertussis (DTaP); Haemophilus influenzae type B (Hib); and measles, mumps, and rubella (MMR) ( Susie is due for inactivated polio vaccine (IPV), in addition to DTaP and MMR. She is not due for Hib)
    • Diphtheria, tetanus, and pertussis (DTaP) and inactivated polio vaccine (IPV) (Susie is due for measles, mumps, and rubella (MMR), in addition to DTaP and IPV)
    • Diphtheria, itetanus, iand ipertussis i(DTaP); iinactivated ipolio ivaccine i(IPV); iand imeasles, imumps, iand irubella i(MMR) i(Because iSusie ihas inot ibeen iinifor iseveral iyears, ione icannot iassume ishe iwill icome iininext iyear ito iget

iherirecent ifall, iso ithis iinformation ibelongs ihere) ti emporal iarteritis. iHowever, icolor iduplex iultrasonography i(a icombination iof iultrasonography iand ithe isame itheirbi reasts imonthly, ia iweekiafter itheir iperiod.iAfter imenopause, iwomen ishould iexamine itheir ibreasts iat ithe the iimmunizations ithat iare idue ibetween ithe iages iof i 4 iand i6; itherefore, ithis iopportunity ito igive iher ineeded iimmunizations icannot ibeimissed. iBetweenitheiagesiof i 4 iandi6, ia ichildiis idueifor iDTaP, iIPV, iandiMMR, iif iall iother iimmunizations iare iup itoidate)

13. Mimi, age 52, asks why she should perform a monthly breast self-examination (BSE) when she has her mammograms on schedule. You respond:
    • “If you are faithful about your annual exams and mammograms, that is enough.” (All women older than age20 should examine their breasts monthly)
    • “More breast abnormalities are picked up by mammograms than by clinical exams or BSE.” ( More than 90% of all breast abnormalities are first detected by self-examination_
    • “More ithan i90% iof iall ibreast iabnormalities iare ifirst idetected iby iself-examination.” i(More ithan i90% iof iall ibreast iabnormalities iare ifirst idetected iby iself-examination. iAll iwomen iolder ithan iage i 20 ishould iexamine time ieach imonth. iThere iis isome icontroversy. iMost iwomen iperform iBSE iincorrectly, ithus imaking ithe isignificance iof ia ipositive ifinding iquestionable. iBreastcancer.org irecommends ia iBSEibe iperformedias ia imammogram imay imiss ia itumor)
    • “Self-examinations need to be performed only every other month.” ( All women older than age 20 should examine their breasts monthly)
14. Marian’s husband, Stu, age 72, has temporal arteritis. She tells you that his physician wants to perform a biopsy of the temporal artery. She asks if there is a less invasive diagnostic test. What test do you tell her is less invasive?
    • Computed tomography (CT) scan (A CT scan and magnetic resonance imaging (MRI) are done to detect neurological damage from hemorrhage, tumor, cyst, edema, or myocardial infarction. These tests may also identify displacement of the brain structures by expanding lesions. However, not all lesions can be detected by CT scan or MRI)
    • Magnetic resonance imaging (MRI) (A computed tomography (CT) scan and MRI are done to detect neurological damage from hemorrhage, tumor, cyst, edema, or myocardial infarction. These tests may also identify displacement of the brain structures by expanding lesions. However, not all lesions can be detected by CT scan or MRI)
    • Electroencephalogram (EEG) (An EEG is used to evaluate the electrical activity of the brain. It can identify seizure activity as well as certain infectious and metabolic conditions)
    • Color iduplex iultrasonography i(Aibiopsy iof ithe itemporal iartery iis iusually irequired itoiconfirm ithe idiagnosis iof ivelocity ideterminations iof iaiDoppler isystem) ihas ibeen ishown itoiexamine ievenismall ivessels, isuch ias ithe superficial itemporal iartery, iandishowia ihaloiaroundithe iinflamed iarteries iwhen itemporal iarteritis iis ipresent. Ti^ herefore,^ iit^ iis^ ia^ imuch^ iless^ iinvasive^ iprocedure^ ithan
15. Which of the following refers to an aspect of a patient’s health that can be changed or affected by a health intervention?
    • Modifiable iriskifactor i(Aimodifiable irisk ifactor iis ianiaspect iof ia ipatient’s ihealthithat ican ibe ichanged ior affected iby ia ihealth iintervention)
    • Nonmodifiable risk factor (A nonmodifiable risk factor is something in a patient’s health profile that cannot be changed)
    • Adjustable risk factor (This term does not exist in medicine)
    • Changeable risk factor (This term does not exist in medicine)
16. An 81-year-old patient presents for a physical. She recently had a fall and now has problems walking up her stairs. The only restroom in the house is on the second floor. She also has a flight of stairs outside her house she has to navigate in order to reach street level, and this is difficult for her. Where does this information belong in your chart note?
    • Functional ihealth ipatterns i(The ipatient iis ihavingitrouble iwith iher inormal iroutineiand idaily ilife idueito
    • Review of systems (This section is for patient symptoms, not functional home circumstances)
    • Plan (While you can address these problems in the plan, this is not the place to make note of them)

• Assessment (You can list her immobility as a diagnosis, but this area of the note would not be the place to note these findings)

iof iidentity iintegrationiand iself-disclosure. iThe iprocess iof idiscoveringiand irevealingione’sisexual iyour ifeet idaily ifor iany ilesions; iand iapply ilotion ito iany idry iareas.” inicotine, iit iZyban, idaysiafter istarting iChantix i(Chantix ihas ibeen ishown ito ibe imore ieffective iin ihelping ismokers iquit ithan iup iin ithe ibody. iquit idate ito istop ithe ievening).iChantix ishould ibe itaken iwith ia ifull iglass iof iwater iafter ieating. iThe iclient ishould ichoose ia ievening);iday i 8 ito ithe iend iof itreatment, ione i1-mg itablet itwice iper iday i(once iin ithe imorning iand ionce iin i0.5-mg imakesqi uitting iso ihard. iThe irecommended idosing ischedule ifor iChantix iis ias ifollows: iday i 1 ito iday i 3 , ione idiscontinue ithe imosticommon iside ieffect iis inausea i(30%), ibut ithis iis iusually inot isevere ienough ito imake ithe iclient ian iandi(4) iidentity iintegration iand iself-disclosure. iIf ithe iultimate icosts iof iself-disclosure iare ifelt ito ibe itoo ihigh, ia 4 i - step iprocess: i( 1 ) iawareness iof ihomosexual ifeelings, i( 2 ) itesting iand iexploration, i( 3 ) iidentity iacceptance,

17. Telehealth has shown a drastic increase in utilization by patients in which of the following fields of medicine?
    • Psychologyiandipsychiatry.
    • Pediatrics.
    • Primary care.
    • Dermatology.
18. Mark, a 56-year-old man, comes to your practice seeking help quitting smoking. You prescribe varenicline (Chantix), a prescription medication, to aid with his attempt. What instructions do you give Mark regarding how to stopsmoking with Chantix?
    • Start the Chantix today according to the dosing schedule and then quit smoking after the 12-week medicationischedule (Following the 12-week medication schedule after quitting minimizes the effect of nicotine withdrawal because Chantix works on the same receptors as nicotine)
    • Start ithe iChantixitoday iaccording ito ithe idosingischedule iandithenipick ia idate ito istop ismoking iabout i 7 another inonnicotine iprescription imedicine ifor ismoking icessation. iWhile iChantixicontains ino works ion ithe isame ireceptors ias inicotine. iIt’s ithe iaddiction ito ithe inicotine iinhaled ifrom ismoking ithat itablet iper iday; iday i 4 ito iday i7, ione i0.5-mgitablet itwice ia iday i(once iinithe imorning iand ionce iinithe ismoking. iChantix ishouldibe itaken ifor i 7 idays ibefore ithe iquit idate. iThis ilets iChantix ibuild Smoking ishould icease ion ithe iquit iday, iand iChantix ishould ibe icontinued ifor iup ito i 12 iweeks. iIf ithe iclient ihas inot icompletely iquit ismoking iby i 12 iweeks, ianother i 12 iweeks imay ihelpithe iclient istay icigarette-free. iThe medication)
    • Pick a date to stop smoking and start Chantix that day according to the dosing schedule (Taking Chantix for 7days before the quit date allows it to build up in the body)
    • Start Chantix today, take it twice a day for 2 weeks, and then stop smoking (Chantix should be initiated with one tab once a day. It should be taken for 7 days prior to the quit date)
19. Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs ofinfection on his feet. What health teaching should Joseph receive today regarding the care of his feet?
    • “Wash your feet with cold water only.” (Joseph should wash his feet with warm, soapy water)
    • “See a podiatrist every two years, inspect your own feet monthly, and apply lotion to your feet daily.” (Diabetic clients should see a podiatrist yearly)
    • “Go to a spa and have a pedicure monthly.” (Joseph should rely on licensed health professionals for the care of his feet)
    • “See ia ipodiatrist iyearly; iwashiyour ifeet idaily iwithiwarm, isoapy iwater iand itowel idryibetween itheitoes; iinspect recommends icareful iinspection iof ia idiabetic iclient’s ifeet ifor icorns, icalluses, iand iopen ilesions ito iprevent ifurther ideterioration iinto idiabetic ifoot iulcers. iJoseph ishouldiwash ihis ifeet idailyiwithiwarm, isoapyiwater iand then itowel idry ithem, iespecially ibetween ithe itoes, ito iprevent ifungal iinfections. iDiabetic iclients ishould isee ia ipodiatrist iyearly. iEncourage ipatients itoiuse ia imirror itoiinspect ithe ibottom iof itheir ifeet)
20. Marvin is a gay man who is ready to “come out.” What is the last step in the process of coming out?
    • Testing and exploration (Testing and exploration is the second of 4 steps)
    • Identity acceptance (Identity acceptance is the third of 4 steps)
    • Identity iintegration iandiself-disclosure i(The ilast istepiinithe iprocess iof ia igayiman ior ilesbian icoming iout iis ithat can ioccur iat ianyiage iand iis iknown ias i“comingiout.” iStage itheories ifor icoming iout ihave ibeen isummarized ias iindividual imay ibecome isocially iisolated ior ideny igay ior ilesbian iidentity)
    • Awareness of homosexual feelings (Awareness is the first of 4 steps)
21. A lab value that is commonly decreased in older adults is:

• Creatinine iclearance i(The icreatinine iclearance ivalue iis icommonly idecreased iiniolder iadults ibecause iof iimpaired irenal ifunction)

iwouldsi how ithe ipercentage iof iany iblockage, ibut iat iage i 82 iwith ino isymptoms, ithis iis inot inecessary) itreatments ireduce ithe irisk iof iCVA iin iclients iwith iasymptomatic icarotid ibruits. iA icarotid iultrasound

• Serum cholesterol (this is typically increased in older adults)
• Serum triglycerides (This is typically increased in older adults)
• Blood urea nitrogen (This is typically increased in older adults)

22. Martha, age 82, has an asymptomatic carotid bruit on the left side. What do you recommend?

• Acetylsalicylic acid, or aspirin (ASA), therapy (Starting an asymptomatic older woman on ASA therapy may produce more problems, such as skin bruising or gastrointestinal bleeding)
• Coumadin therapy (There is insufficient data to support Coumadin therapy for clients with asymptomatic carotid bruits)
• Surgery (There is insufficient data to support surgery for clients with asymptomatic carotid bruits)
• No itreatment iat ithis itime i(Clients iwithiasymptomatic icarotidibruits ihave ia i2% iincidence iof icerebrovascular accident i(CVA), ialsoiknown ias istroke ior ibrainiattack, iper iyear.iAlthough iacetylsalicylic iacid, ior iaspirin (ASA), ianticoagulants, iand isurgery iare ifrequently iordered, ithere iare inot isufficient idata ito iprove ithat ithese

23. Which of the following is not a modifiable risk factor?

• Weight.
• Stress level.
• Race.
• Physical activity level.

24. Which of the following is not one of the generalized patterns of nursing care included in the Circle of Caringimodel?

• Intelligence.
• Patience.
• Advocacy.
• Courage.

25. Which of the following statements does not belong in the past medical history portion of your chart note?

• Your ipatient ihad ilabiwork iat itheir ilast iappointment ithat iwas inegative i(This ibelongs iinithe ihistory iof ipresent illness ior idiagnostic itests iportion iof iyour inote)
• Your patient had a cholecystectomy 3 years prior
• Your patient’s father passed away from lung cancer.
• Your patient has an allergy to penicillin.

26. You have a patient who presents with ankle pain. Which of the following facts or observations does not belong in the physical exam portion of your note?

• The ipatient’s ipainistarted iafter ia ifall ioff ihis iskateboardi(This ibelongs iinitheihistory iof ipresent iillness)
• The patient has a normal pulse and normal sensation of the foot.
• The patient has edema in his ankle.
• The patient has limited motion of his ankle.

27. Harry is taking his entire family to Central America and is wondering about protection against bites from malaria- causing mosquitoes. What advice do you give him?

• Use an insect repellent with diethyltoluamide (DEET) for the entire family, applying it sparingly to small children (DEET is not recommended for application to the hands or faces of young children)
• Make sure the family is in well-screened or indoor areas from dusk to dawn ( This preventive measure is recommended in combination with an insect repellent)
• Use ian iinsect irepellent iwith idiethyltoluamide i(DEET) ifor iadults iand ipermethrin ifor ichildren, iand istay iinside ifrom idusk ito idawn i(Insect irepellents iwith ihighiconcentrations i(greater ithani35%) iof iDEETiare ieffective iin preventing imosquitoibites; ihowever, iDEETiis inot irecommended ifor iapplication itoithe ihands ior ifaces iof iyoung ci^ hildren.^ iPermethrin^ iis^ ieffective^ ias^ ia^ iscabicide^ i(at^ i^5 %)^ iand^ ias^ ia^ ipediculicide^ i(at^ i^1 %).^ iIt^ iis^ ivery ilow^ iefifectiveconcentration^ iat^ ia iagainst imalaria-carrying imosquitoes iandiis isafe ifor iall iages. iOther ipreventive imeasures

ithisicase, iJulia iwas ieating i 3 ig, ior i 27 ical, iof ifat i(9 ical iper igram iof ifat itimes i 3 ig iof ifat iequals i 27 ical). pi erson iwith itype i 2 idiabetes imellitus ishould ihave ian iHbA1c i of i 6 .5 ior iless iand ian iFBS iless ithan i 130. include iremaining iin iwell-screened ior iindoor iareasifrom iduskitoidawn, iusing imosquitoinets, iandiwearing ci^ lothing^ ithat^ icovers^ imost^ iof^ ithe

• Stay inside from dusk to dawn, and use an insect repellent with permethrin (Permethrin is recommended for young children. DEET is most effective for preventing mosquito bites)

28. Mary, a 70-year-old woman with diabetes, is at your office for her 3-month diabetic checkup. Mary’s list of medications includes metformin (Glucophage XR) 1000 mg daily, an angiotensin-converting enzyme (ACE) inhibitor daily, and 1 baby aspirin (ASA) daily. Mary’s blood work showed a fasting blood sugar (FBS) of 112 and glycosylatedhemoglobin^ (HbA1c)^ of^ 6.5.^ You^ tell^ Mary^ that her^ blood^ work^ shows:

• That iher idiabetes iis iunder igood icontrol iand ishe ishould iremain ionithe isame imedications i(For ioptimal icontrol, ia the iclient’s ilabiresults ifall iinithose icategories, ishe iis iunder igoodicontrol iandiher imedications ishouldistay ithe isame)
• That her diabetes is controlled and she needs to have her medications decreased.
• That her diabetes is not controlled and her medications need to be increased.
• That her diabetes has resolved and she no longer needs any medication.

29. Sandy, a 68-year-old woman, presents to your office for screening for osteoporosis. She states that her grandmother and mother both lost inches in their old age. She has been postmenopausal for the past 15 years and never took any hormone replacement medications. She is Caucasian, weighs 108 lb, and is 5 ft 1 in tall on today’s measurement. Whendo women lose the greatest amount of bone density?

• During adolescence (Bone density increases during adolescence until peak bone density occurs (about age 20).
• The first year of menopause (Women lose the greatest amount of bone density in the first decade after menopause)
• The ifirst i 10 iyears iafter imenopause i(Bone iloss ibegins iat ia irate iof i0.5% ia iyear iinia iwoman’s imiddle itoilate until ideath. iThis ipatient ishould ibe iencouraged itoidoiweight-bearing iexercises iand ihave ian iadequate icalcium intake iof i 1000 ito i 1500 img/d, iwith isufficient iamounts iof ivitamin iD)
• Bone loss occurs continuously at the same rate from menopause to death (Bone loss occurs at different rates from menopause until death)

30. If a screening test used on 100 individuals known to be free of breast cancer identified 80 individuals who did nothave breast cancer while missing 20 of the individuals, the specificity would be:

• 80% i(Specificity imeasures ia iscreening itest’s iability ito irecognize iindividuals iwho iare inondiseased ior ithose iwith inegative ireactions i(true inegatives). iIt ican ibe irepresented ibyia iratioiof itestedinegatives ito ithe itotal inumber of iknown, ior itrue, inegatives. iIn ithis icase, ithe inumber iof inegatives ithat ithe itest irecognized iwas i80, iwith ithe itotal inumber iof iknown, ior itrue, inegatives ibeingi100. iTherefore, i 80 iout iof i 100 i(80/100) iequals ia ispecificity iofi80%
• 60%.
• 40%.
• 20%.

31. Julia, age 18, asks you how many calories of fat she is eating when 1 serving has 3 g of fat. You tell her:

• 12 cal.
• 18 cal.
• 27 ical i(Aigramiof ifat icontains i 9 ical, iwhereas ia igramiof ieither icarbohydrates ior iproteins icontains i 4 ical. iIn
• 30 cal. i40s.iThe irate ithen iincreases iup ito i7% ia iyear ifor ithe ifirst idecade iafter imenopause. iThis iincrease iin ithe irate iof iboneiloss iis idirectlyirelated itoia idecrease iinia iwoman’s iestrogen. iBone iloss ithenidecreases ito i0.5% itoi1% iyear ia

32. In relation to writing a patient encounter note, the acronym SOAP stands for which of the following words?

hi elps ispread ithese iimportantiaspect iof iclinical ipractice iand inot iused isolely iif iit iis iconvenient ifor ithe ipractitioner)

• Subjective, iobjective, iassessment, iplan.
• Symptoms, objective, assessment, pills.
• Subjective, outward findings, assessment, plan.
• Symptoms, objective, assessment, plan.

33. Which of the following demonstrates a subjective finding?

• Pain ilevel.
• Pulse rate.
• Eye color.
• Extremity edema.

34. Which of the following statements about health promotion is false?

• Health ipromotion iis ia ibenefit ito iadditoiyour ipractice iif iyouihave itime i(Healthipromotion iis ian
• Health promotion helps to prevent diseases (This is included in the scope of health promotion)
• Health promotion includes early screening to detect diseases (This is included in the scope of health promotion)
• Health promotion includes helping to restore health after a patient has had an illness (This is included in thesi cope of health promotion)

35. What intervention would not be included in the definition of secondary prevention?

• Sexually transmitted infection (STI) testing
• Preventive mammography.
• Testicular self-examination.
• Routine iimmunizations i(This iis iprimary)

34. As a nurse practitioner, which of the following would not be an example of primary health promotion?

• Posting ihealthiarticles ioniyour isocial imedia iaccount.
• Speaking to patients at each visit about strategies for maintaining/attaining a healthy life.
• Lecturing at local community centers about diabetes.
• Organizing a 5K running event for the patients in your practice.

35. Which of the following patients is health literate?

• Ai62-year-oldifemale iwhoispeaks ithe ilanguage iof iher iprovider, ihas iMedicare ifor iinsurance, iand ican idrive i(This ipatient ihas iaccess itoitransportation iandihealth iinsurance iand ihas ithe iabilityitoicommunicate iwith iheriprovider)
• A 70-year-old patient with dementia (This patient cannot make his or her own medical decisions)
• A 22-year-old migrant worker who only speaks Spanish (This patient may have difficulty understanding aprovider in the United States and therefore may not be able to heed medical advice)
• A 45-year-old college graduate with no health insurance (This person can be seen only at an emergencydepartment or if they have the ability to pay; their ability to obtain medical care is not guaranteed)

36. The study of the way diseases are spread through groups and what causes and helps spread these diseases is called?

• Epidemiology i(Epidemiology iis ithe istudy iof ithe iway idiseases iare ispread ithrough igroups iand iwhat icauses iand
• Pathology (Pathology is the study of diseased tissues and cells)
• Physiology (Physiology is the study of the physiological processes of the body)
• Kinesiology (Kinesiology is the study of body movement)

37. Documentation in your patient’s chart is important for all the following reasons except?

• Documentation iis ionly iimportant ifor irecording iyour iside iof ithe ivisit iso iyou ican ireduce iyour iliability iin ithe ievent iof ia ilawsuit i(While ianiaccurate irecord iwill ihelpitoidocument iyour ioffice ivisit iandicould iserve ias ia ilegalidocument^ iin^ ia^ ilawsuit,^ iit^ iis^ inot^ ithe^ ionly^ ireason^ idocumentation^ iis
• Documentation allows you to communicate your findings to another provider.
• Documentation allows you to remember the office visit so you can best treat the patient in the future.

bi one imass iyet. iIt ihas ibeen iproven ithat iaerobic iexercise iincreases ibone imass) ai cids. iThis itriggers ia iseries iof ireactions. iWith ithe iincreased icortisol, iglucose iproduction ifrom iamino ii njection isite i( 13 %– 20 % iin iadults, i 3 %–9% iin ri eceiving iyour ilast ivaccine, isome iproviders iwill igo iahead iand igive iyou ia

• Documentation allows you to create a record of the visit and record your patient’s findings and treatment plans.

38. How often should you receive a Tdap booster when no injury history is present?

• Everyi 10 iyearsi(Youineed ithisivaccine ieveryi 10 iyears. iIf iyouisuffer ianiinjury ibetween i 5 iandi 10 iyears iafter
• After 18 you don’t need a booster unless you have a laceration.
• Every 20 years.
• Every 5 years.

39. How do you respond when Jill, age 42, asks you how long she should work out each week?

• Exercise for at least 30 minutes every day.
• Exercise a total of 2 hours per week.
• Exercise for at least 20 minutes 3 or more days per week.
• Exercise ifor iat ileast i 30 iminutes i 5 idays iper iweeki( TheiAmerican iCollege iof iSports iMedicine i(ACSM) irecommends i 3 itoi 5 idays iper iweek ifor imost icardiovascular exercise iprograms. iFor icardiovascular ibenefits, iaim ifor i 20 ito i 60 iminutes iin iyour itarget iheart irate izone, iapart ifrom ithe iwarm-upiand icool-down iperiods.iACSM’s ioverall irecommendation iis ifor imost iadults ito iengageiiniat li^ east^ i^150 iminutes^ iof^ imoderate-intensity^ iexercise^ ieach^ iweek.^ iIf^ iyou^ iencourage^ ipatients^ ito^ iexercise^ imost iof ithe iweek, ithey imight imake ithis igoal)

40. Sandra, a 27-year-old nurse, states that she does not want to get the hepatitis B virus vaccine because of its adverse effects. You tell her that the most common adverse effect is:

• Fatigue (This mild, transient systemic adverse effect occurs in 11% to 17% of adults and 8% to 18% of children)
• Headache (This mild, transient systemic adverse effect occurs in 11% to 17% of adults and 8% to 18% of children)
• Pain iat ithe iinjectionisite i(The imost icommon iadverse ireaction itoithe ihepatitis iB ivirus ivaccine iis ipain iat ithe
• Elevated temperature (This mild, transient systemic adverse effect occurs in 1% to 6% of all injections)

41. You are sharing with your client the idea that he needs to get some counseling to deal with his severe stress because it is affecting his physiological condition. Which of the following hormonal changes occurs during severe stress?

• A decrease in catecholamines (During severe stress, as glucagon release increases, catecholamine levels increase. The insulin to glucagon ratio decreases, glycogen breakdown increases, and glucose production fromamino acids increases)
• An iincrease iin icortisol i(During isevereistress, ithe icortisol ilevel iincreases, iallowingimobilization iof ifreeifatty iincreases)
• A decrease in antidiuretic hormone (The release of antidiuretic hormone also increases during stressfuliperiods, increasing the retention of water)
• A decrease in aldosterone (The level of aldosterone increases, leading to the increased retention of sodium)

42. Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you giveito Emily?

• Drink all the soda you like—it has no effect on your bone density (Soda drinking has been shown to decrease bone mass)
• It has not been proved that smoking affects bone loss (Smoking has been shown to decrease bone mass)
• Replace estrogen when you reach menopause (Estrogen replacement therapy is no longer recommended forbone health; it is recommended only for short-term use to alleviate vasomotor symptoms of menopause)
• Performiaerobic iexercise iat ileast i 3 itimes ia iweek i(Emily iis ionly i 26 iyears ioldiandihas inot ireached iher ipeak

43. Harvey, age 55, comes to the office with a blood pressure (BP) of 144/96 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the examination, it remains 144/96. Whatshould your next action be?

ci hanged ior iaffected iby ia ihealth ci onsider iit iextremely hi ypertension iis iinstituted i(unless ithe iBP iis iextremely ielevated), inonpharmacological imethods iwould ibe ifor itryinonpharmacological imethods iand imonitor ihis iblood ipressure iat ihomeiand ithen ireturn iin i 1 ito i 2 iweeks iathi ome iand icall ithe ihealth icare iprovider iif iit iexceeds ithe iparameters idiscussed. iIn ithis icase, iHarvey ishould

• Start him on an angiotensin-converting enzyme (ACE) inhibitor (If Harvey’s diastolic pressure is still 96 mm Hg after 2 weeks, a diuretic or an ACE inhibitor would be indicated)
• Start him on a diuretic
• Have him monitor his blood pressure at home (Harvey should try nonpharmacological methods to lower his blood pressure and should monitor his blood pressure at home)
• Tryinonpharmacological imethods iandihave ihimimonitor ihis iblood ipressure iat ihome i(Before idrugitherapyifor ichanges), isuchias isalt irestriction, iweight ireduction, ibiofeedback, iand iexercise, ishould ibe iconsidered. Aggressive itreatment iof iall iclients iaged i 18 ito i 59 iwith ia isystolic ipressure igreater ithan i 140 imm iHg iand/or ia idiastolic ipressure igreater ithani 90 imm iHg iis iessential. iThe iclient ishould imonitor ihis ior iher iblood ipressure ifollow-up. iIf ihis idiastolic ipressure iis istill i 96 imm iHg iafter i 2 iweeks, ia idiuretic ior ian iACE iinhibitor indicated)

44. For which patient would you administer the human papillomavirus (HPV) vaccination?

• Susie, age 7 (The HPV vaccination is not recommended for females under the age of 9)
• Janice, iage i17, iwho ihad ia ibaby i 6 imonths iago iand iis ibreastfeeding i(Women iwho iare ilactating ior iimmunocompromised iare ieligible itoireceiveithe ivaccine. iIt iis ialso irecommended ifor ifemales iaged i 9 ito i 25 years, iregardless iof iwhether ithey ihave ihad isex iyet iand ieven iif ithe iwomen ialready ihave ia ihistory iof igenitaliwarts,^ ia^ ipositive^ iHPVitest,^ ior^ ian^ iabnormal^ iPap^ itest)
• Alice, age 18, who is allergic to yeast (A contraindication to the HPV vaccine is a history of immediate hypersensitivity to yeast)
• Jill, age 25, who is pregnant (HPV vaccination is not recommended for use in women who are pregnant)

45. Which of the following is not a subjective finding?

• Headache.
• Respiratory irate i(This iis ianiobjective iphysical iexamifinding ithat icanibe imeasured)
• Shortness of breath.
• Ankle pain.

46. Which of the following doesn’t fall under the umbrella of health promotion as a nurse practitioner?

• Information iabout ionline idating i(This idoesn’t ipromote ithe ihealth iof iyour ipatient, ialthough ihe ior ishe imay
• Exercise programs.
• Immunizations.
• Nutrition support.

47. Which of the following refers to an aspect of a patient’s health that cannot be changed or affected by a health intervention?

• Modifiable risk factor.
• Nonmodifiable irisk ifactor i(Ainonmodifiable irisk ifactor iis ian iaspect iof ia ipatient’s ihealth ithat icannot ibe
• Adjustable risk factor.
• Changeable risk factor.

48. A nurse practitioner is practicing based on the rule-based actions he was taught in school and doesn’t understandwhen/where those rules may be inappropriate. Which following statement best describes this skill level?

• Novice.
• Advanced beginner.
• Proficient.
• Expert.

49. Mildred, an independent 92-year-old woman, is moving into her daughter’s home. Her daughter comes to see you seeking information to help keep her mother from falling. Which of the following interventions would you suggest sheido to help prevent Mildred from falling?

• Install an intercom system in Mildred’s bedroom.
• Limit the time Mildred is home alone.

ihaveihypertrophic fi rom ihypertrophic icardiomyopathy imay ibeigreatly ireduced iwith ia ithorough icardiac ihistory iand iexamination. Ti erazosin iis ibegun iat i 1 img iat ibedtime iinitially iand ithen ititrated iupward ito i 10 ii s ian ialpha-1 iadrenergic iblocker. iIt iis inot ia ipreventive idrug, ibut iit idoes irelax ismooth imuscle iin ithe ieasily itoiallow iMildred iher iindependence ibut iprovide ia isafe ienvironment iby iremovingiloose irugs ithat ishe icould ifamily ioccurirapidly ior islowly iover ithe icourse iof iseveral iyears, iknowing iwhat istage ia ifamily imember iis iin ihelps

• Hire an aide to assist Mildred 24 hours a day.
• Remove iall iloose irugs ifrom ifloors iand iinstall ihand igrasps iin ibathtubs iand inear itoilets i(The icorrect ianswer iis trip iover iandiinstalling ihandrails iby ithe itoilet iand iin ithe ibathtub. iThe irails iwill iprovide isupport ifor iher ias ishe igoes ifrom ia isitting ito ia istanding iposition)

50. Dennis, age 62, has benign prostatic hyperplasia (BPH). He tells you that he voids at least 4 times per night and thathe has read about a preventive drug called terazosin hydrochloride (Hytrin) that might help him. What do you tell him?

• “It’s inot ia ipreventive idrug, ibut iit irelaxes ismoothimuscle iinithe iprostate iandibladder ineck i(Terazosin i(Hytrin) and ibladder ineckiandiallows icomplete iemptyingiof ithe ibladder, irelieving ifrequent inocturnal iurination.
• “It changes the pH of the urine and prevents infections caused by urinary stasis.” (Alpha-1 adrenergic blockers do not affect the pH of the urine. They relax smooth muscle in the prostate and bladder neck)
• “It relaxes the urethra.” (The urethra is not directly involved in BPH)
• “It shrinks the prostate tissue.” (Finasteride (Proscar), a 5-alpha-reductase inhibitor, decreases the volume of the prostate within about 3 months. At 12 months, it reaches its peak effectiveness. Finasteride is given at 5 mg daily for at least 6 months; then the client is reevaluated)

51. Jan’s mother has Alzheimer disease (AD). Jan tells you that her mother’s recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, “Is this as bad as it gets?” You tell her that her mother is in which stage of the disease?

• Stage 1 (Stage 1 of AD is the onset, which is insidious. Spontaneity, energy, and initiative are decreased; slowness is increased; word finding is difficult; the person angers more easily; and familiarity is sought and preferred)
• Stage 2 (In stage 2, supervision with detailed activities, such as banking, is needed; speech and understanding are much slower; and the train of thought is lost)
• Stage i 3 i(Families iof ipersons iwith iADineed ito iknow ithat iADiis ia iprogressive idisorder iof ithe ibrain, iaffecting imemory, ithought, iandilanguage.iAlthough ithe iprogression iof ithe istages iis iindividual, iand ichanges imay members iin iplanning iand iknowing iwhat ito iexpect. iIn istage i3, ipersonality ichange iis imarked iand idepression imay ioccur. iDirections imust ibe ispecific iandirepeatedifor isafety, irecent imemory iisipoor, idisorientation ioccurs ei^ asily,^ ipeople^ iare^ iincorrectly^ iidentified,^ iand^ ithe^ iperson^ imay^ ibe
• Stage 4 (In stage 4, apathy is noticeable, memory is poor or absent, urinary incontinence is present, individuals are not recognized, and the person should not be alone)

52. When performing a sports physical exam on Kevin, a healthy 16-year-old boy, which question in the history is important to ask Kevin or his guardian?

• Did ianyoneiiniyour ifamily iever ihave isudden icardiac ideath? i(The iriskiof isudden ideathiduring isports iactivities If ia ichild ihas ia irelative iwho idied iof isudden icardiac idisease ibefore iage i55, ithat ichild icould ipossibly
• Does anyone in your family have elevated cholesterol levels?
• Did you ever have any injury requiring stitches?
• Does anyone in your family have a history of asthma?

53. The Agency for Healthcare Research and Quality (AHRQ) was established to:

• Mandate treatment protocols
• Dictate health care policy based on voluminous research.
• Promote ievidence-based ipractice i(The iAHRQ iwas iestablished ito ipromote ievidence-based ipractice iand idevelopidatabases ifor iresearch iand iclinical iguidelines. iTheiAHRQiroutinely ipublishes ireviews iof istudies ion clinical iproblems iwithisummaries iof itreatment iprotocols iandieffectiveness)
• Develop cost-effective interventions.

54. You have seen a client who has tested positive for syphilis. You have treated the client; tested the client for other potential sexually transmitted diseases, including human immunodeficiency virus (HIV); counseled the client about safe sexual practices; and scheduled the client to return at 3 and 6 months for repeat serologic testing. The tests at thoseitimes demonstrated that no further syphilis was present. Should you have taken any other action?

• No, you have treated the client appropriately (You must report the case to the local health authorities)

ni ecessary, iand ifailure ito idisclose inecessary iinformation ito ipatients iare iall iexamples iof inegligence) ri andomized icontrolled itrial i(RCT). iCase ireports, idescriptive istudies, iand icorrelational istudies ti he icase iof isyphilis ito ithe ilocal ihealth iauthorities. iSyphilis iis ieasily itreated iand icontrollable iif iits iif ia ibeeniachieved ithus ifar ican ibe ian ieffective istrategy.iYou iwant ito ileave ithe iprocess iwithipositive ifeelings ieven

• Yes, iyouimust ireport ithe icase itoithe ilocal ihealthiauthorities i(The ipractitioner iis ialsoiresponsible ifor ireporting ireported)
• Yes, you need to notify all sexual contacts (All sexual partners of the client should be contacted; however, it is the health department that has the trained staff who will investigate contacts and follow up)
• Yes, you must follow up on the client’s HIV status (It is not necessary to retest the client’s HIV status unless there is a new clinical reason on subsequent visits)

55. Which of the following is the best method for evaluating the efficacy of a new clinical intervention?

• A case report.
• A descriptive study.
• Airandomized icontrolled itrial i(The ibest imethod ifor ievaluating ithe iefficacy iof ia inewiclinical iintervention iis ia methodological iapproaches ithat iare iless ireliable iin iestablishing icausal irelationships, iand ithus ithe iattribution iof ai^ n^ ieffect^ ito^ ithe^ inew^ iclinical^ iintervention^ iwould^ ibe^ iless^ iclear.^ iThe^ ieffect^ imight^ ibe^ iattributable^ ito iconfounding ivariables)
• A correlational study.

56. Negligence is the predominant legal theory of malpractice liability. Negligence includes:

• Failure itoigive inecessary icare i(Failure itoigiveinecessary icare, ifailure ito ifollowiup, ifailure ito irefer iwhen
• Failure to discharge.
• Failure to share information with family.
• Failure to provide shelter and food.

57. While counseling Mr. Brown, a patient newly diagnosed with diabetes, the advanced practice registered nurse (APRN) hands him a pamphlet on foot care. She notices that he puts it away, saying he will read it later. What mightithis behavior indicate?

• Being overly dependent on others.
• Having ia ilowiliteracy ilevel i(The iNational iAssessment iof iAdult iLiteracy ireported ithat i 1 iout iof ievery i 3 iAmericans ilacks ithe iliteracy ineeded ito iunderstand ihealthicare iproviders iand iis iembarrassed itoiadmit iit. iOne sign iof ilack iof iliteracyiis iputting iaside iwritten iinformation)
• Having a high level of motivation.
• Memorization of the information that is being taught.

58. If conflict arises during a job negotiation, you should consider:

• Separating ithe iissue ifrom ithe iperson i(Always iseparate ithe iissue ifrom ithe iperson. iIt iis iabout iachieving ia imutually isatisfyingioutcome—a iwin-winisituation. iClarifying imisconceptions iandifocusing ioniwhat ihas workiagreement iis inot iachieved)
• Always standing your ground.
• Getting a legal opinion.
• Basing your actions on the contract a friend of yours has secured in a local practice.

59. There are advantages to owning your own practice. However, there are also barriers to the ability to do this. These barriers include which of the following?

• Getting iandikeeping ia icollaborating iphysician, iif irequired iby ilaw; igettingionimanaged icare ipanels; iandigetting rivileges iat ihospitals ( Barriers ito iindependent ipractice iinclude igetting ion imanaged icare ipanels; igetting iand ikeeping ia icollaborating iphysician, iif imandated iin ithe istate iwhere ione iis ipracticing; igetting ireferrals ifrom ihospital iemergency irooms; igetting iprivileges iat ihospitals; iand ilackingilegal iauthority iin ithe istate iof ipractice itoiadmit ito inursingihomes, ito oi^ rder^ ihome^ icare^ iservices,^ iand/or^ ito^ idirect^ ihospice