NURS740 Final Exam Questions with Answers, Exams of Nursing

Download NURS740 Final Exam Questions with Answers and more Exams Nursing in PDF only on Docsity! 1 / 59 NURS740 Final Exam Questions with Answers 1.Sandra is 70 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit? A. Acute lymphoblastic leukemia (ALL) B. Acute myelogenous leukemia (AML) C. Chronic myelogenous leukemia (CML) D. Chronic lymphocytic leukemia (CLL): D. Chronic lymphocytic leukemia (CLL) 2.Which type of bone marrow transplant is obtained from an identical twin? A. Xenograft B. Autologous C. Allogeneic D. Syngeneic: D. Syngeneic 3.During treatment for anaphylaxis, which site is used for the initial injection of epinephrine? A. Antecubital vein B. Abdomen C. Upper lateral thigh D. Deltoid: C. Upper lateral thigh 4.After the initial treatment for anaphylaxis, which medication should be added to prevent late-phase anaphylactic reactions? A. Albuterol B. Diphenhydramine C. H2 blocker D. Corticosteroid: D. Corticosteroid 2 / 59 5.When analyzing synovial fluid, if it has 10,000 white blood cells/mcL with 80% polymorphonuclear neutrophils (PMNs), it may be indicative of which of the following conditions? A. None, this is a normal result B. Scleroderma C. Rheumatoid arthritis D. Sickle cell disease: C. Rheumatoid arthritis 6.Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist? A. Methotrexate (Rheumatrex) B. Etanercept (Enbrel) C. Rituximab (Rituxan) D. Anakinra (Kineret): A. Methotrexate (Rheumatrex) 7.Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate? A. PEP treatment regimens contain two antiretroviral medications. B. PEP should be started within 72 hours of exposure. C. PEP follow-up requires renal function tests at 6 weeks after beginning PEP. D. PEP will prevent potential hepatitis C infection, if present.: B. PEP should be started within 72 hours of exposure. 8.For which patient would the clinician recommend annual HIV testing? A. One who is in a mutually monogamous relationship that engages in anal sex B. One who is a migrant worker C. One who is diagnosed with viral hepatitis D. One who is pregnant with second child from another male: C. One who is 5 / 59 following? A. Epstein-Barr virus B. Acute HIV infection C. Guillain-Barré D. Hepatitis: A. Epstein-Barr virus 18.Which condition is the most common cause of generalized musculoskele- tal pain in women ages 20 to 55? A. Chronic fatigue syndrome B. Anemia C. Fibromyalgia syndrome D. Sports-related injuries: C. Fibromyalgia syndrome 19.After returning from visiting his grandchildren in Connecticut, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. Which disease should the clinician be considering? A. Rubella B. Lyme disease C. Fibromyalgia syndrome D. Shingles: B. Lyme disease 20.Dryness of the eyes and mouth is typical of which condition? A. Sjögren's syndrome B. Allergic reaction C. Hypothyroidism D. Sideroblastic anemia: A. Sjögren's syndrome 6 / 59 21.Exposure to ultraviolet (UV)-B and UV-A rays is a triggering factor for acute exacerbations of which condition? A. Rheumatoid arthritis B. Gout C. Systemic lupus erythematosus D. Sjögren's syndrome: C. Systemic lupus erythematosus 22.What is the current goal of treatment for a patient with HIV infection? A. Viral suppression to undetectable levels B. Compete eradication of the virus C. Limit contact with uninfected individuals D.Total abstinence: A. Viral suppression to undetectable levels 23.Which test should the clinician use to initially screen for HIV? A. Western blot B. Enzyme-linked immunosorbent assay C. HIV-1/2 antigen/antibody combination immunoassay D. Nucleic acid amplification testing: C. HIV-1/2 antigen/antibody combination immunoassay 24.Which lab test would the clinician order to monitor for a significant side effect from tenofovir disoproxil fumarate? A. Urine protein B. Allele genetic testing C. Sodium level D. Hemoglobin: A. Urine protein 25.Which drug category of antiretroviral (ARV) therapy is generally effective in crossing the blood-brain barrier and may be useful in managing HIV-asso- ciated dementia? 7 / 59 A. Nucleoside reverse transcriptase inhibitors B. Protease inhibitors C. Integrase inhibitors D. Nonnucleoside reverse transcriptase inhibitors: D. Nonnucleoside reverse transcriptase inhibitors 26.Spontaneous bruising may be seen with platelet counts below what level? A. 100,000 cells/mL B. 75,000 cells/mL C. 50,000 cells/mL D. 30,000 cells/mL: D. 30,000 cells/mL 27.Which type of fatigue may improve with exercise after awakening? A. Functional B. Acute C. Persistent D. Anemia associated: A. Functional 28.Which assessment finding presents with early rheumatoid disease? A. Pain and swelling in both small and large peripheral joints B. Rigid joints with diminished range of motion C. Joint swelling and immobility on rising D. A cardiac rub with pulmonary friction rub: C. Joint swelling and immobility on rising 29.Which test is diagnostic of RA? A. Rheumatoid factor B. Erythrocyte sedimentation rate 10 / 59 C. Tuberculosis D. Pancreatitis: D. Pancreatitis 39.Which type of hypersensitivity reaction should the clinician suspect in a patient who has an elevated IgE level? A. 1 B. 2 C. 3 D. 4: A. 1 40.In which area would the clinician evaluate a tender point in a patient with suspected fibromyalgia syndrome (FMS)? A. Fifth rib B. Trapezius C. Maxillary D. Midforearm: B. Trapezius 41.A patient has CFS. Which strategy should the clinician consider to manage this patient? A. Bedrest B. High-impact exercise C. Thermal biofeedback D. Cognitive-behavioral therapy: D. Cognitive-behavioral therapy 42.Which classic rash should the clinician assess for in a patient with SLE? A. Butterfly B. Bulls-eye C. Ringworm 11 / 59 D. "Slapped" cheeks: A. Butterfly 43.Which blood cell is excessively elevated in a person who has poly- cythemia? A. Platelets B. Neutrophils C. Red blood cells D. All types of blood cells: C. Red blood cells 44.Which treatment would the clinician recommend for a patient who has relative polycythemia? A. Rehydration B. Antihistamines C. Weekly phlebotomies D. Referral to hematologist: A. Rehydration 45.Which behavior would the clinician advise the patient with sickle cell anemia to avoid? A. Becoming overhydrated B. Taking folic acid supplements C. Becoming physically overtaxed D.Taking rest periods during the day: C. Becoming physically overtaxed 46.The clinician must differentiate chronic vitamin B12 deficiency anemia from folate deficiency anemia. Which action should the clinician take? A. Obtain a complete blood count B. Assess for peripheral neuropathy C. Inspect for smooth surface on tongue 12 / 59 D. Determine the size of the red blood cell: B. Assess for peripheral neuropathy 47.Which finding from the bone marrow aspiration is typical in a patient with CML? A. Schistocytes B. Howell-Jolly bodies C. Hemoglobin S gene D. Philadelphia chromosome: D. Philadelphia chromosome 48.How long would the clinician inform the patient to rest after onset of infectious mononucleosis? A. 4 days B. 10 days C. 2 weeks D. 4 weeks: D. 4 weeks 49.A patient presents with symptoms of infectious mononucleosis. Which lab chemistry test should the clinician order? A. Viral load B. Hemoglobin A1c C. Western blot assay D. Heterophile antibody test: D. Heterophile antibody test 50.The advance practice registered nurse (APRN) is providing a community health program for the prevention of Lyme disease. Which information should be included? A. Safe sex practices B. Hiking precautions C. Smoking cessation D.Vaccination schedules: B. Hiking precautions 51.1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause? 15 / 59 Which type of impetigo is this? A. Bullous impetigo B. Staphylococcal scalded skin syndrome (SSSS) C. Nonbullous impetigo D. Ecthyma: D. Ecthyma 60.10. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria? A. Staphylococcus aureus B. Clostridium perfringens C. S. pyogenes D. Streptococcus: B. Clostridium perfringens 61.11. When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? A. A piece of hair or a thread B. Hyphae C. Leukocytes D. Spores: B. Hyphae 62.12. What should be the initial management for a new wart? A. Tretinoin cream B. Liquid nitrogen cryotherapy C. Salicylic acid D.Watchful waiting: D. Watchful waiting 63.13. Stacy has a verruca plana and she is using tretinoin cream. Which of the following is true? A. It should be applied at bedtime over the entire area that is affected. B. It should be applied twice daily for 1 week. 16 / 59 C. It is not normal to have a fine scaling when using this medication. D. It is not normal to have erythema when using this medication.: A. It should be applied at bedtime over the entire area that is affected. 64.14. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers? A. Necrotizing fasciitis B. Periorbital cellulitis C. Erysipelas D. "Flesh-eating" cellulitis: C. Erysipelas 65.15. Mandy presents with a cauliflower-like wart on her anogenital region. You suspect it was sexually transmitted and discuss that: A. HPV 16 and 18 usually cause anogenital warts. B. Penetrative intercourse is necessary to transmit anogenital warts. C. Anogenital warts are transmitted genital to genital. D. OTC home-based cryotherapy is a good choice for treatment.: C. Anogenital warts are transmitted genital to genital. 66.16. Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him. Which would be a good choice? A. Betamethasone dipropionate 0.05% B. Hydrocortisone base 2.5% C. Halcinonide 0.1% D. Desonide 0.05%: B. Hydrocortisone base 2.5% 67.17. Harvey has a rubbery, smooth, round mass on his chest that is com- pressible and has a soft-to-very-firm texture. What do you diagnose this as? A. A lipoma 17 / 59 B. A nevus C. A skin tag D. A possible adenoma: A. A lipoma 68.18. Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using snip excision? A. Do not use lidocaine as it may potentiate bleeding. B. Pinch the skin taut together C. Use gel foam to control bleeding D.This should be performed by a dermatologist only.: C. use gel foam to control bleeding. 69.19. The "B" in the ABCDEs of assessing skin cancer represents: A. Biopsy B. Best practice C. Boundary D. Border irregularity: D. Border irregularity 70.20. Gary has been diagnosed with HSV-2 genital herpes and is wondering what to expect. Which of the following is a credible teaching point? A. HSV-1 genital herpes occurs more frequently than HSV-2 genital herpes. B. The HSV lesions will never occur near the initial infection site. C. Burning and tingling at the site of initial infection can signal recurrence. D. Each recurrent HSV infection will be worse than the initial infection.: C. Burning and tingling at the site of initial infection can signal recurrence. 71.21. Eighty percent of men have noticeable hair loss by what age? A. 35 B. 50 20 / 59 increased levels of estrogen and progesterone 80.30. A patient presents with xerosis. What do you tell the patient about this condition? A. Daily hot baths can help to soothe the skin. B. Using a strong deodorant can improve the condition. C. It can be a side effect of depigmentation creams. D. It is uncommon in the elderly: C. It can be a side effect of depigmentation creams. 81.31. Which medication used for scabies is safe for children 2 months and older? A. Permethrin cream B. Lindane C. Crotaminton lotion and cream D. Ivermectin: A. Permethrin cream 82.32. Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis? A. Keratosis pilaris B. Dennie's sign C. Keratoconus D. Pityriasis alba: B. Dennie's sign 83.33. Which of the following statements about performing cryosurgery for actinic keratosis is true? A. It is better to slightly overfreeze the area, so you only have to do it once. B. Using liquid nitrogen, freeze each lesion for at least 30 seconds. C. Every lesion should be biopsied after using liquid nitrogen. 21 / 59 D.The "freeze balls" should be approximately one-and-a-half times as wide as they are deep.: D. The "freeze balls" should be approximately one-and-a-half times as wide as they are deep. 84.34. Gerald presents with a very dark color on his right pinkie finger. What is the health-care provider's next care step? A. Referral to a dermatologist for a nail biopsy B. Watchful waiting C. Discussing that the condition is benign and the patient can ignore it D. Follow up in 2 weeks to see if there is any change: A. Referral to a dermatol- ogist for a nail biopsy 85.35. Which statement regarding necrotizing fasciitis is true? A. The hallmark of this infection is its slow and steady progression B. Once the border of the infection is "established," it does not spread. C. This is a medical emergency and gangrene can develop. D.The lesion is most dangerous, because it is painless.: C. This is a medical emergency and gangrene can develop. 86.36. When staging a malignant melanoma using Clark's levels, which level extends into the papillary dermis? A. Level I B. Level II C. Level III D. Level IV: C. Level III 87.37. Which of these patients is most likely to have acne and resultant scarring? A. 15-year-old Caucasian male B. 17-year-old Hispanic female 22 / 59 C. 20-year-old Asian female D. 21-year-old African American male: B. 17-year-old Hispanic female 88.38. A 20-year-old Hispanic male presents with multiple noninflammatory comedones on his chest and back with four small papules on his right upper arm. Which diagnosis is accurate? A. Mild acne B. Moderate acne C. Severe acne D. Nodulocystic acne: A. Mild acne 89.A 40-year-old woman presents with inflammatory papules on her face, facial flushing when she drinks a glass of wine, telangiecstasis, and dry eyes. 25 / 59 A. Systemic antibiotics B. Cold compress to the site C. Incision and drainage D.Watchful waiting: C. Incision and drainage 97. 47. Jack is complaining of an extremely pruritic lesion that is round to a half circle in his genital area. Which of the following is the most likely diagnosis? A. Tinea cruris B. Tinea pedis C. Tinea versicolor D.Tinea manuum: A. Tinea cruris 98.48. Which of the following is true of scabies? A. Scabies is more common in the Caucasian population. B. Scabies is transmitted through blood. C. Scabies is not associated with hygiene. D. Scabies is transmitted through close personal contact.: D. Scabies is trans- mitted through close personal contact. 99.49. Which of the following is true of pediculosis? A. Pruritus occurs before the sensitivity to the head louse. B. Patients can be symptomatic or cause few symptoms in the first 2 weeks following exposure. C. In a patient's first infection, they will develop symptoms within 24 to 48 hours. D. It is transmitted through droplets.: B. Patients can be symptomatic or cause few symptoms in the first 2 weeks following exposure. 26 / 59 100. 50. How might a rash appear on a patient with a darker skin tone? A. Dark brown B. Light pink C. Bright red D. Deep purple: A. Dark brown 101. 51. What of the following is the most common appearance of Paget's disease? A. Poorly defined, red, raised plaque on one nipple B. Scattered white papules on the nipples bilaterally C. Oval-shaped, erythematous scaling plaque with sharp margins on one nipple D. Raised, silvery-white patches on the nipples bilaterally: C. Oval-shaped, erythematous scaling plaque with sharp margins on one nipple 102. 1. Which of the following is a correct recommendation of when to begin prostate screening? A. Men with no symptoms of prostate cancer and who are in good health should start screening at age 60. B. Asian American men should start screening at age 45. C. Men who have had a brother diagnosed with prostate cancer before the age of 65 should start screening at 45. D. Caucasian men should start screening at age 55.: C. Men who have had a brother diagnosed with prostate cancer before the age of 65 should start screening at 45. 103. 2. A 63-year-old man is seen with a chief complaint of nocturia. Which of the following is the most common sign of a prostatic problems in men with nocturia? A. Psychogenic nocturia B. Urethral polyp 27 / 59 C. Irritative posterior urethral lesion D. Benign prostatic hypertrophy: D. Benign prostatic hypertrophy 104. 3. A 76-year-old man is seen in the office for complaints of urinary tract infection (UTI). The clinician should explore which of these causes of UTI in men? A. Urethral polyps B. Epididymitis C. Selective serotonin reuptake inhibitor (SSRI) medication D. Prostatodynia: B. Epididymitis 105. 4. A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? A. Refer to urologist immediately B. Obtain a computed tomography (CT) scan C. Instruct the patient to elevate the scrotum D. Prescribe ibuprofen: A. Refer to urologist immediately 106. 5. An 82-year-old man is seen in the primary-care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? A. Prostatodynia B. Lupus disease C. Trichomoniasis infection D. Fungal infection: D. Fungal infection 107. 6. Which of the following would be an appropriate treatment for a patient with mild benign prostatic hyperplasia (BPH)? A. Referral to urologist for surgery 30 / 59 A. Urinary tract infection B. Prostatitis C. Erectile dysfunction D. Peyronie's disease: B. Prostatitis 116. A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate. He is not a long-distance runner. Which of the following would lead you to a diagnosis of prostatodynia versus prostatitis? A. Long-distance runners are more likely to have prostatodynia than prostati- tis. B. Prostatodynia presents with signs and symptoms of prostatitis, but without inflammation. C. Prostatodynia usually has a bacterial origin, whereas prostatitis has a relation to internal urethral sphincter problems. D. Patients with prostatodynia usually have a history of recurrent UTIs, where- as patients with prostatitis do not.: B. Prostatodynia presents with signs and symptoms of prostatitis, but without inflammation. 117. A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism? A. Escherichia coli B. Staphylococcus aureus C. Chlamydia trachomatis D. Pseudomonas aeruginosa: C. Chlamydia trachomatis 118. Carl is a 24-year-old male who presents with scrotal pain that radiates to his 31 / 59 flank. It manifested 3 hours ago. He also complains of pain at the tip of his penis, cloudy urine, and urethral discharge. Which of the following conditions is most likely? A. Testicular torsion B. Epididymitis C. Prostatodynia D. Prostatitis: B. Epididymitis 119. Which test is used to confirm a diagnosis of epididymitis? A. Urinalysis B. Gram stain of urethral discharge C. Complete blood cell count with differential D. Ultrasound of the scrotum: D. Ultrasound of the scrotum 120. Treatment for epididymitis includes which of the following? A. Warm sitz baths B. Scrotal elevation C. Masturbation D. Heat application: B. Scrotal elevation 121. Which of the following data is indicative of testicular torsion? A. Absent cremasteric reflex B. Pain relieved on testicular elevation C. Testicle very low in the scrotum D. Swollen scrotum with "red dot sign": A. Absent cremasteric reflex 122. A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find? 32 / 59 A. The scrotum will be dark. B. The scrotum will appear light pink or yellow. C. The scrotum will appear milky white. D.The internal structures will be clearly visible.: B. The scrotum will appear light pink or yellow. 123. During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious? A. A nodular and unusually firm gland B. A smooth gland C. A tender gland D. A boggy gland: A. A nodular and unusually firm gland 124. A patient presents complaining of pain and enlarged testes that feel like "a bag of worms." Which diagnosis should the provider most likely assess for? A. Prostate cancer B. Varicocele C. Hydrocele D.Testicular cancer: B. Varicocele 125. Which of the following is a complementary therapy for BPH? A. Red raspberry leaf tea B. Saw palmetto C. Black cohosh D.Vitamin A: B. Saw palmetto 126. A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which understanding of the Jewett rating system? A. The cancer involves the seminal vesicles. B. There is metastatic disease to regional lymph nodes. 35 / 59 good to me." C. "You mentioned on your intake form that you do not feel safe in your home. Why is that?" D. "You've been dating your boyfriend for three months, but you haven't had an STI screening yet? That's not safe.": C. "You mentioned on your intake form that you do not feel safe in your home. Why is that?" 133. Which of these patients needs a cervical cancer screening? A. Lisa, a 45-year-old patient who has atypical squamous cells of uncertain significance (ASCUS) and a human papillomavirus (HPV) positive Pap 1 month ago B. April, a 26-year-old patient who had a negative Pap with negative HPV 1 year ago C. Sondra, a 66-year-old patient who had a negative Pap with negative HPV 11 years, 6 years, and 1 year ago D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago: D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago 134. Which of the following is true of the IUD (intrauterine device)? A. The IUD is 95% effective at preventing pregnancy. B. The IUD has an inhibitory effect on sperm capacitation. C. The IUD can only be inserted at menses. D.The IUD can only be inserted in women with multiparity.: B. The IUD has an inhibitory effect on sperm capacitation. 135. Alice has been diagnosed with breast cancer. Its TNM staging is T2, N1, M0. She would like to know what this means. Which statement made by the clinician is accurate? A. "Your tumor is 4 cm, has metastasized to a moveable lymph node, but has not metastasized to another location." B. "Your tumor is 5.5 cm and has not metastasized to lymph nodes or any- where 36 / 59 else." C. "Your tumor is 1.5 cm, has metastasized to a moveable lymph node, but has not metastasized to another location." D. "Your tumor is 3 cm, has metastasized to a moveable lymph node, and has only metastasized to supraclavicular lymph nodes.": A. "Your tumor is 4 cm, has metastasized to a moveable lymph node, but has not metastasized to another location." 136. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? A. Human papillomavirus B. Endometrial hyperplasia C. Vaginismus D. Polycystic ovarian syndrome: A. Human papillomavirus 137. A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? A. Ceftriaxone B. Doxycycline C. Acyclovir D. Metronidazole: A. Ceftriaxone 138. A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? 37 / 59 A. Gonorrhea B. HPV C. Chlamydia D.Trichomoniasis: C. Chlamydia 139. A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? A. Trichomonas B. Bacterial vaginosis C. HPV D. Herpes simplex virus: B. Bacterial vaginosis 140. Which of the following medications is the treatment of choice for Tri- chomonas? A. Metronidazole B. Ceftriaxone C. Diflucan D. Doxycycline: A. Metronidazole 141. A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? A. "It is probably just a cyst because that is the most common breast mass." B. "We will order a mammogram and ultrasound to help establish a diagnosis." C. "We will go ahead and schedule you for a biopsy because that is the only way to know for sure." D. "Because your lump is painful, it is most likely not cancer.": B. "We will order a mammogram and ultrasound to help establish a diagnosis." 40 / 59 get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes? A. Pelvic inflammatory disease B. Oral contraceptive use for 15 years C. Early menarche D. Diet high in soy protein: A. Pelvic inflammatory disease 150. When assessing a woman for infertility, which of the following tests should be done first? A. Hysterosalpingogram B. Magnetic resonance imaging (MRI) C. Analysis of partner's sperm D. Estrogen level: C. Analysis of partner's sperm 151. A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause? A. "Are you sexually active?" B. "How long have you been underweight?" C. "Was your mother pregnant with you when she was of advanced maternal age?" D. "Have you noticed any changes in your moods lately?": B. "How long have you been underweight?" 152. What is the most common cause of secondary amenorrhea? A. Pregnancy B. Pituitary dysfunction C. Inadequate estrogen levels D. Genetic disorders: A. Pregnancy 41 / 59 153. A 22-year-old woman is diagnosed with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient's symptoms? A. At least 4 cups of green tea daily B. Regular exercise C. Take vitamin A supplements D. Eat a diet high in iron: B. Regular exercise 154. A 25-year-old woman is seen in the clinic complaining of painful menstru- ation. Which of the following pelvic pathologies is the most common cause of secondary dysmenorrhea? A. Pelvic inflammatory disease B. Endometriosis C. Sexually transmitted infections D. Ovarian cyst: B. Endometriosis 155. A 26-year-old woman tells the clinician that she has endometriosis, be- cause she has frequent pelvic pain. The clinician also should consider which of these differential diagnoses? A. Diverticulitis B. Cholelithiasis C. Kidney stones D. Ovarian cysts: D. Ovarian cysts 156. Which of the following would be appropriate treatment for a woman with mild endometriosis? A. Oral contraceptives B. Leuprolide acetate injections 42 / 59 C. Nafarelin nasal spray D. Hysterectomy: A. Oral contraceptives 157. A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the fol- lowing diagnoses? A. Postmenopausal syndrome B. Infertility C. Mittelschmerz D. Polyp: D. Polyp 158. A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnos- tic tests should the clinician order first? A. Transvaginal ultrasound B. Endometrial biopsy C. MRI D. Abdominal computed tomography scan: A. Transvaginal ultrasound 159. Dorothy is a 45-year-old female who complains of a mass in her left breast, dull nipple pain, tenderness of the left nipple, and pasty left nipple discharge. Which of the following conditions should the clinician be most suspicious for? A. Intraductal papilloma B. Hamartomas C. Duct ectasia D. Fibroadenoma: C. Duct ectasia 160. A 45-year-old woman is seen because of irregular menstrual periods. Her 45 / 59 167. 2. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of mo- tion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: A. Articular B. Inflammatory C. Nonarticular D. Noninflammatory: A. Articular 168. 3. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain? A. Decreased C-reactive protein B. Hyperalbuminemia C. Morning stiffness D.Weight gain: C. Morning stiffness 169. 4. Which of the following statements concerning the musculoskeletal examinations is true? A.The uninvolved side should be examined initially and then compared to the involved side. B. The part of the body that is causing the patient pain should be examined first. C. When possible, the patient should not be asked to perform active ROM exercises to avoid causing pain. D. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.: A. The uninvolved side should be examined initially and then compared to the involved side. 170. 5. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM but cannot move it 46 / 59 above gravity. Which numeric grade of muscle strength would you give this patient? A. 1 B. 2 C. 3 D. 4: B. 2 171. 6. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's history supports this diagnosis? A. History of hypertension B. Her affected shoulder is also her dominant arm C. Her history of type 1 diabetes D. Her work as a secretary predisposes her to repetitive motions: C. Her history of type 1 diabetes 172. 7. Jennifer is an 18-year-old woman who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation? A. Anterior dislocations are not painful, and ROM is normal. B. There is a risk of neurovascular and neurosensory trauma, so the clinician should 47 / 59 check for distal pulses. C. X-rays are the only diagnostic testing appropriate to assess a dislocation. D. Most traumatic dislocations are posterior.: B. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses. 173. 8. Fred has been diagnosed with a trigger finger of the ring finer. Which of the following management strategies is appropriate? A. Surgical removal of the tendon sheath B. NSAIDs C. Local anesthetic injection into the tendon sheath D. Splinting: C. Local anesthetic injection into the tendon sheath 174. 9. Mrs. Anderson is a 35-year-old woman who has been recently diag- nosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? A. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. B. People with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. C. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. D. Carpal tunnel syndrome only occurs in the presence of a hormonal im- balance.: B.People with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. 50 / 59 more than a 3-month period is an indication for surgical intervention. 180. 15. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to 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 most appropriate to assess for the presence of a meniscal tear? A. Valgus stress test B. McMurray circumduction test C. Lachman test D.Varus stress test: B. McMurray circumduction test 181. 16. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as: A. Apprehension sign B. Bulge sign C. Thumb sign D. Lachman sign: A. Apprehension sign 182. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane's description of her injury. Which of the following clues in Diane's examination or history would alert the clinician to the need for obtaining radiographs? 51 / 59 A. Ability to bear weight immediately after the injury B. Development of minor ankle swelling after the injury C. Slight bruising over the injury site 2 days after injury D. Crepitation with palpation or movement of the ankle: D. Crepitation with palpation or movement of the ankle 183. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthri- tis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician? A. "Complementary therapies should be considered only if surgical interven- tions are not successful." B. "I am unfamiliar with the available complementary therapies for osteoarthri- tis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition." C. "I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai chi, are being studied for use in the treatment of osteoarthritis and acupuncture can be used and is safe and well tolerated." D. "It would be crazy to use complementary therapies to treat such a serious condition.": C. "I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai chi, are being studied for use in the treatment of osteoarthritis and acupuncture can be used and is safe and well tolerated." 184. 19. Chris is a 28-year-old male who complains of lower back pain that began 3 days ago. The pain is worse when he stands or bends, and it is somewhat relieved 52 / 59 when he sits. The clinician performs the straight-leg raise test and it is negative. Plain film x-ray is positive. Which diagnosis is most likely? A. Osteoarthritis B. Spinal stenosis C. Scoliosis D. Muscle strain: D. Muscle strain 185. 20. A clinician has performed a synovial fluid analysis and the results are as follows: visual analysis: turbid and yellow, viscosity: decreased, 52,000 white blood cells (WBCs) per mm3, polymorphonuclear leukocytes (PMNs): 75%, protein: 5 g/dL. Which of the following conditions could this result be attributed to? A. Rheumatoid arthritis B. Osteoarthritis C. Gout D. Septic arthritis: D. Septic arthritis 186. 21. Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways? A. By increasing the erosive activity of osteoclasts B. By promoting osteoclastogenesis C. By inhibiting osteoclast apoptosis D. By increasing the activity of osteoblasts: D. By increasing the activity of osteoblasts 187. 22. Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis? A. Bone alkaline phosphatase levels 55 / 59 myalgia can be fibromyalgia. 192. 27. One of the most frequent presenting sings/symptoms of osteoporosis is: A. Goiter B. Abnormal serum calcium C. Elevated urine biochemical markers D. Bony fracture: D. Bony fracture 193. 28. Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening 1 week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is: A. Ecchymosis, edema, and erythema over the lateral epicondyle B. Pain at the elbow that radiates into the forearm and pain and weakness with gripping objects C. Inability to supinate and pronate the arm D. Inability to flex or extend the elbow against resistance: B. Pain at the elbow that radiates into the forearm and pain and weakness with gripping objects 194. 29. A clinician is examining a vertebral fracture, and the examination and diagnostic findings have shown a compression of the anterior column that includes both endplates. What type and subtype are these? A. Compression fracture, type A B. Burst fracture, type B C. Seat-belt type injury, level two D. Fracture-dislocation, shear: A. Compression fracture, type A 195. 30. Which of the following would lead the clinician to suspect a tumor when paired with low back pain? 56 / 59 A. Minor trauma with sneezing in elderly with osteoporosis B. History of spinal procedure C. Sudden loss of bowel or bladder function D. Unintended weight loss > 10% of body weight in 6 months: D. Unintended weight loss > 10% of body weight in 6 months 196. 31. A 70-year-old female fell 2 weeks ago and developed immediate pain in her left elbow on the lateral epicondyle. She thought she just bruised it, but is now worried because it has not improved. She has used Tylenol and ice at home, and that has helped slightly. During your examination, you find she has moderate swelling and ecchymosis, but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do? A. Make an immediate referral for an orthopedic surgical evaluation without further assessment. B. Tell her that it takes time for these bruises to improve, so she should be patient C. Prescribe a splint for her left wrist and begin corticosteroid injections. D. Send her to the emergency room for reduction of this obvious wrist frac- ture: C. Prescribe a splint for her left wrist and begin corticosteroid injections. 197. 32. Debbie is a 43-year-old female being evaluated for a wrist injury. The clinician is assessing for median nerve compression by having Debbie maintain forced flexion of her wrist for 1 minute with the dorsal surface of each hand pressed together. Which of these tests did the clinician just perform? A. Allen's test B. Phalen's test C. Tinel's sign 57 / 59 D. Finkelstein's test: B. Phalen's test 198. 33. In which of these athletes is posterior impingement syndrome most commonly seen? A. Cross country runner B. Swimmer C. Soccer player D. Ballet dancer: D. Ballet dancer 199. The clinician is assessing Sally's diffuse hip pain. How should the clini- cian begin the examination? A. Begin the range-of-motion examination with an assessment of the motion that causes pain. B. Physical examination of the hip must first assess its position at rest. C.The patient should move the hip prior to radiographic studies to determine whether they are necessary. D. Flexion and extension of the affected hips' extremity should only be per- formed with the knee straight.: B. Physical examination of the hip must first assess its position at rest. 200. 35. Felice is a 66-year-old female who complains that walking and pro- longed standing causes pain and weakness in her legs and buttocks. She expresses that she has short-term relief when she leans on the shopping cart. When she sleeps on her back, she sometimes wakes up in the night in pain. Which of the following diagnoses is most likely? A. Multiple sclerosis B. Herniated lumbar disc C. Lumbar spinal stenosis D. Cervical spondylosis: C. Lumbar spinal stenosis 201. Which of the following is a risk factor for overuse syndrome with ten-