6531 NRNP Combined Midterm and Final

Review | Actual 2025 Latest set |

Questions and verified Answers
A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be
used to identify the need to initiate cardiopulmonary resuscitation (CPR)?

Evaluation of peripheral perfusion and level of consciousness

Obtaining a history of previous myocardial infarction
Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - ANSW-Assessment of gasping breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension
reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is
the recommended action for this patient?

Increase the dose of the thiazide medication

Add a beta blocker to the patient's regimen
Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - ANSW-Admit to the hospital for evaluation and treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these
symptoms?
Atrial fibrillation
Anemia
Extrasystole
Paroxysmal attacks - ANSW-Atrial fibrillation
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border.
The provider determines that the murmur decreases in intensity when the patient changes from
standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the
provider suspect for this murmur?
Aortic stenosis
Tricuspid regurgitation
Hypertrophic cardiomyopathy
Mitral valve prolapse - ANSW-Hypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours
away. What is the initial treatment for this patient?
Give the patient an oral beta blocker
Transfer to the PCI-capable institution
Administer heparin
Initiate fibrinolytic treatment - ANSW-Initiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease
are those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - ANSW-previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for
30 minutes or more. What the does provider suspect as the cause for these symptoms?
Buerger's disease
Cauda equina syndrome
Diabetic neuropathy
Peripheral arterial disease - ANSW-Cauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.)
Oral contraceptives
Isometic excercises
NSAIDS
Sleep apnea
Increased salt intake - ANSW-Oral contraceptives
NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the
provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest
pain, syncope, or palpitations. What will the provider do?
Reassure the patient that these findings are expected
Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - ANSW-Consult with cardiology to
determine appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider
notes a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease
Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - ANSW-US of the mass to determine size
A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours
away. What is the initial treatment for this patient?
Give the patient an oral beta blocker
Initiate fibrinolytic treatment
Administer heparin
Transfer to the PCI-capable institution - ANSW-Initiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches,
palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the
provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - ANSW-Order urinalysis, CBC, BUN and creatinine
A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial
obstruction in lower extremity arteries. What will the provider recommend to help with relief of
symptoms in this patient?
Statin therapy with clopidogrel
Walking to the point of pain each day
Daily aspirin therapy to prevent clotting
Walking slowly for 15 to 20 minutes twice daily - ANSW-Walking to the point of pain each day
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart
rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down
Evaluate the patient's orthostatic vital signs
Reassure the patient that the symptoms are non-cardiac in origin - ANSW-Evaluate the patient's
orthostatic vital signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital
setting because most victims have which arrhythmia?
Atrial flutter
Ventricular fibrillation
Atrial fibrillation
Ventricular tachycardia - ANSW-Ventricular fibrillation
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a
heart rate of 225 beats per minute. The provider notifies transport to take the child to the child
emergency department. What initial intervention may be attempted in the clinic?
Administration of intravenous adenosine
Using a vagal maneuver or carotid massage
Providing a loading dose of digoxin
Giving a beta blocker - ANSW-Using a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that apply.)
Using a ratio of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - ANSW-Using a ratio of 2 rescue breaths to
30 compressions
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The
provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next
action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist
Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - ANSW-Give the patient a beta blocker medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled
hypertension, and decompensated heart failure. What is the recommendation for treatment for this
patient?
No intervention is necessary for this patient
Immediate open surgical repair of the aneurysm
Endovascular stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - ANSW-Serial ultrasonographic surveillance of the
aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with
a diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - ANSW-Inappropriate
secretion of PTH along with hypercalcemia
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time.
What initial diagnostic test will the provider order in the clinic at this visit?
Hemoglobin A1C
Random serum glucose
C-peptide level
Thyroid studies - ANSW-Hemoglobin A1C
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3-4)
0.2 uIU/L
4.2 uIU/L
0.4 uIU/L
2.4 uIU/L - ANSW-0.2 uIU/L
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following
laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is
negative. What is the initial treatment for this patient?
Radioiodine therapy
Surgical resection of the thyroid gland
Beta blocker medications
Thionamide therapy - ANSW-Beta blocker medications
A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above
normal without signs of nephrolithiasis. What is the recommended treatment for this patient?
Avoidance of weight bearing exercises
Annual monitoring of calcium, creatinine, and bone density
Decreasing calcium and Vitamin D intake until values normal
Parathyroidectomy - ANSW-Annual monitoring of calcium, creatinine, and bone density
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for
potential malignancy, which test is performed?
Serum calcitonin
Radionucleotide imaging
Serum TSH level
Thyroid ultrasound - ANSW-Thyroid ultrasound
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with
a diagnosis of primary hyperparathyroidism?
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Appropriately increased PTH and low or normal serum calcium - ANSW-Inappropriate secretion of PTH
along with hypercalcemia
What is important about increased PAI-1 levels in patients with metabolic syndrome?
They cause increased insulin resistance.
They predispose patients to dyslipidemia.
They lower the risk of hypertension.
They increase the risk of arterial thrombosis. - ANSW-They increase the risk of arterial thrombosis.
A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action
by the primary care provider is indicated for management of this patient?
Consulting with a nephrologist
Prescribing an antihypertensive medication
Referring to an ophthalmologist
Limiting protein intake - ANSW-Consulting with a nephrologist
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated
TSH and decreased T3 and T4 levels. What will the provider tell this patient?
She will need lifelong medication.
A thyroidectomy will be necessary.
This condition may be transient.
She should be referred to an endocrinologist. - ANSW-This condition may be transient.
Which findings are symptoms of hyperparathyroidism? (Select all that apply.)
Cognitive impairment
Left ventricular hypertrophy
Renal calculi
Perioral paresthesias
Chvostek's sign - ANSW-Cognitive impairment
Left ventricular hypertrophy
Renal calculi
Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels?
Aspirin
Niacin
Atorvastatin
Metformin - ANSW-Metformin
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The
provider notes that the patient appears confused and irritable and is sweating and shaking. What
intervention will the provider expect to perform once the point of care blood glucose level is known?
Giving a rapid-acting carbohydrate
Performing a hemoglobin A1C
Dipstick urinalysis for ketones
Injection of rapid-acting insulin - ANSW-Giving a rapid-acting carbohydrate
A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral
diabetes medications. When explaining this change in therapy, the provider will tell the patient:
that strict diet and exercise measures may be relaxed with insulin therapy.
it is necessary because the patient cannot comply with the previous regimen.
this is because of the natural progression of the disease.
the use of insulin therapy may be temporary. - ANSW-this is because of the natural progression of the
disease.
A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
Bronchodilator treatment
Mucokinetic agents
Antitussive medication
Antibiotic therapy - ANSW-Antitussive medication
A young adult patient without a previous history of lung disease has an increased respiratory rate and
reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no
signs of increased respiratory effort. Which diagnostic test will the provider perform initially?
Chest radiograph
Complete blood count
Computerized tomography
Spirometry - ANSW-Complete blood count
A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of
breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly
after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the
provider recommend?
Administering two more doses of albuterol
Taking an oral corticosteroid
Coming to the clinic for evaluation
Going to the emergency department - ANSW-Administering two more doses of albuterol
The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the
infant may have an influenza vaccine. What will the provider tell this patient?
The infant should have an influenza vaccine now with a booster in 1 month
The infant should be given prophylactic antiviral medications
The rest of the family and all close contacts should have the influenza vaccine
The infant should have the live attenuated influenza vaccine (LAIV) - ANSW-The rest of the family and all
close contacts should have the influenza vaccine
A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has
been previously healthy and does not smoke or work around pollutants or irritants. What will the
provider suspect as the most likely cause of this patient's symptoms?
Thromboembolism
Infection
Malignancy
Lung abscess - ANSW-Infection
An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air.
The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider
order to help manage this patient's dyspnea?
Opioid medications
Anxiolytic drugs
Supplemental oxygen
Breathing exercises - ANSW-Breathing exercises
A patient reports shortness of breath with activity and exhibits increased work of breathing with
prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this
patient?
Arterial blood gases
ventilation/perfusion scan
Spirometry
Blood cultures - ANSW-Spirometry
A patient with hemoptysis and no other symptoms has a normal chest radiograph, CT, and fiberoptic
bronch studies. What is the next action in managing this patient?
Observation
Refer to specialist
Surgical intervention
Prophylactic ABX - ANSW-Observation
Which clinical sign is especially worrisome in a patient with a pulmonary embolism?
TachycardiaAsw
Dyspnea
Hypotension
Abnormal lung sounds - ANSW-Hypotension
A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal
reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient
reports improvement in symptoms. What is the next action in treating this patient?
Schedule an upper endoscopy
Continue the proton pump inhibitor
Refer the patient to a gastroenterologist
Order esophageal pH monitoring - ANSW-PPI
A patient comes to an emergency department with chest pain. The patient describes the pain is sharp
and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner
determines that the pain is worse after eating. The patient reports getting relief after taking a friend's
nitroglycerin during one episode. What is the most likely cause of this chest pain?
Pleural pain
Cardiac pain
Aortic dissection pain
Esophageal pain - ANSW-Esophageal pain
A patient who has a central line develops respiratory compromise. What is the initial intervention for this
patient?
Obtaining cultures and starting antibiotics
Lung ultrasonography to determine the cause
Prompt removal of the central line
Rapid assessment and resuscitation - ANSW-Rapid assessment and resuscitation
A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with
cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest
radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the
most likely cause of this patient's pneumonia?
S. pneumonia
A virus
Mycoplasma
Tuberculosis - ANSW-Mycoplasma
A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting.
A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum
that increases with pressure. What will the provider do next?
Recommend an NSAID
Prescribe an antibiotic
Refer to a cardiologist
Order a chest radiograph - ANSW-Recommend an NSAID
A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks
after no improvement continues to show no improvement after several antibiotic regimens have been
attempted. What is the next step in managing this patient?
Increasing the dose of the antibiotics
Open lung biopsy
Performing diagnostic bronchoscopy
Administration of the pneumonia vaccine - ANSW-Performing a diagnostic broncho
A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and
cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is
unable to expectorate sputum. Which treatment is recommended for this patient?
A respiratory fluoroquinolone antibiotic
Empiric treatment with a macrolide antibiotic
Hospitalization for intravenous antibiotics
A B-lactam antibiotic plus a fluoroquinolone - ANSW-Empiric treatment with a macrolide antibiotic
Which are causes of pleural effusions? (Select all that apply.)
Bronchiectasis
Breast Cancer
Dehydration
Congestive Heart failure
Allergies - ANSW-Bronchiectasis
Breast Cancer
Congestive Heart failure
An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a
runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What
is recommended for this patient?
Pertussis vaccine booster
Azithromycin daily for 5 days
Isolation if paroxysmal cough develops
Symptomatic care only - ANSW-Azithromycin daily for 5 days
Which method of treatment is used for traumatic pneumothorax?
Placement of a small-bore catheter
Observation for spontaneous resolution
Needle aspiration of the pneumothorax
Tube thoracostomy - ANSW-Tube thoracostomy
An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider
performs chest radiography and other tests and rules out infection, upper respiratory, and
gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma
as the cause of these symptoms?
Spirometry
Allergy Testing
Methacholine Challenge test
Peak expiratory flow rate - ANSW-Spirometry
A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help
reduce the duration of symptoms in this patient?
Trimethoprim-sulfamethoxazole
Clindamycin
Azithromycin
Oseltamivir - ANSW-Oseltamivir
A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest
pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic
test will confirm the presence of a pulmonary embolism?

D-dimer
CT angiography
Arterial blood gases
Electrocardiogram - ANSW-CT angiography
A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the
clinic the following day with fever and watery, red eyes. What will the provider do initially?

Perform a nasal swab for RT-PCR assay

Administer LAIV influenza vaccine
Observe for improvement or worsening for 24 hours
Begin treatment with an antiviral medication - ANSW-Perform a nasal swab for RT-PCR assay
A patient complains of shortness of breath when in a recumbent position and reports coughing and pain
associated with inspiration. The provider notes distended neck veins during the exam. What is the likely
cause of these findings?

Pulmonary infection
Congestive heart failure
Pulmonary embolus
Hepatic disease - ANSW-CHF
A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking
an antiviral medication. The next day, the patient reports increased fever and cough without respiratory
distress. The patient's lungs are clear and oxygen saturations are 97% on room air. What will the provider
recommend?

Symptomatic treatment with close follow up in clinic

Referral to a specialist for evaluation and treatment
Admission to the hospital for treatment of complications
Empiric antibiotics to treat a possible secondary infection - ANSW-Symptomatic treatment with close
follow up in clinic
A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer
treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak
flow assessment is 70%. What is the next step in treating this patient?
Administer three more nebulizer treatments and reassess
Give epinephrine injections and monitor response
Admit to the hospital with specialist consultation
Prescribe an oral corticosteroid medication - ANSW-Admit to the hospital with specialist consultation
A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms
of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe.
Which diagnostic test is indicated?
Coagulation studies
Computerized tomography
Fiberoptic bronchoscopy
Needle biopsy - ANSW-Computerized tomography
A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest
pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic
test will confirm the presence of a pulmonary embolism?
CT angiography
D-dimer
Arterial blood gases
Electrocardiogram - ANSW-CT angiography
A patient develops a pulmonary embolism after surgery and shows signs of right-sided heart failure.
Which drug will be administered to this patient?
Low molecular heparin
Warfarin
Tissue plasminogen activator
Unfractionated heparin - ANSW-TPA
A patient develops a dry, nonproductive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
Antibiotic therapy
Bronchodilator treatment
Mucokinetic agents
Antitussive medication - ANSW-antitussive
A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single
laceration away from the iris that involves the anterior but not the posterior segment. What is the
prognosis for this injury? - ANSW-Because the posterior segment is not involved, the prognosis is good
A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy
appearance to the conjunctivae, along with clear, watery discharge. The patient's eyelids are thickened
and discolored. There are no other symptoms. Which type of conjunctivitis is most likely?
Allergic
Bacterial
Chemical
viral - ANSW-Allergic
A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5
mm in size between the patient's pupils. What does this finding indicate?
Probable benign, physiologic anisocoria
A relative afferent pupillary defect
Likely underlying neurological abnormality
Indication of a difference in intraocular pressure - ANSW-Probable benign, physiologic anisocoria
Which patients should be referred immediately to an ophthalmologist after eye injury and initial
treatment? (Select all that apply.)
A patient who was sprayed by lawn chemicals
A patient with irrigation secondary to wood dust
A patient who works in a metal fabrication shop
A patient with a full-thickness corneal laceration
A patient with a corneal abrasion - ANSW-A patient who was sprayed by lawn chemicals
A patient who works in a metal fabrication shop
A patient with a full-thickness corneal laceration
A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The
examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most
likely treatment for this condition?
Prescribe ophthalmic antibiotic drops
Reassure the patient that this will resolve
Refer to an ophthalmologist
Order lubricating drops or ointments - ANSW-Reassure the patient that this will resolve
A child has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination,
the provider notes clear conjunctivae and no discharge. What is the recommended treatment?
Warm compress and massage of the lesion
Surgical incision and drainage
Referral to ophthalmologist
Systemic antibiotics - ANSW-Warm compress and massage of the lesion
An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one
eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which
initial treatment will the provider recommend?
Warm compress
Nasolacrimal duct probing
Systemic antibiotics
Antibiotic eye drops - ANSW-Warm compress
During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the
significance of this finding?
Ocular disease requiring referral
Potential infection in the "red" eye
Normal physiologic variant
Potential vision loss in one eye - ANSW-Ocular disease requiring referral
A child sustains an ocular injury in which a shard of glass from a bottle penetrated into the eye wall. The
emergency department provider notes that the shard has remained in the eye. Which best describes this
type of injury?
Intraocular foreign body
Penetrating eye injury
Ruptured globe injury
Perforating eye injury - ANSW-Intraocular foreign body
A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming
to a head. Which treatment will be useful initially?
Incision and drainage
Topical antibiotic ointment
Lacrimal bypass surgery
Eyelid scrubs with baby shampoo - ANSW-I&D
A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On
examination, the lesion appears warm and erythematous. The provider knows that this is likely to be
which type of lesion?
Blepharitis
Chalazion
meibomian
Hordeolum - ANSW-Hordeolum
A patient who has an inflamed pterygia lesion has been using loteprednol topical steroid drops for 7
days. The patient shows no improvement in symptoms. What is the next course of action?
Prescribe a systemic corticosteroid
Consult with an opthamologist
Refer the patient to the emergency department
Continue the medication for 7 more days - ANSW-Consult with an opthamologist
A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while
sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye.
On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the
practitioner's next step?
Application of topical fluorescein dye
Administration of antibiotic eye drops
Irrigation of the eye with normal saline
Instillation of cyclopegic eye drops - ANSW-Application of topical fluorescein dye
A patient who has a cold develops conjunctivitis. The provider notes erythema of one eye with profuse,
watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is
indicated?
Artificial tears and cool compresses
Topical antibiotic eye drops
Antihistamine-vasoconstrictor drops
Topical corticosteroid drops - ANSW-Artificial tears and cool compresses
A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o'clock position of the
right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion.
What will the provider tell the patient about this lesion?
UVB eye protection is especially important
Artificial tear drops are contraindicated
Spontaneous bleeding is likely
Visine may be used for symptomatic relief - ANSW-UVB eye protection is especially important
A patient reports has been using artificial tears for comfort because of burning and itching in both eyes,
but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins
with clear conjunctivae. What is the recommended treatment?
Compresses, lid scrubs, and antibiotic ointment - ANSW-Compresses, lid scrubs, and antibiotic ointment
A patient with allergic conjunctivitis who has been using a topical antihistamine-vasoconstrictor
medication reports worsening symptoms. What is the provider's next step in managing this patient's
symptoms?
Consider prescribing a topical mast cell stabilizer
Prescribe a non-sedating oral antihistamine
Refer the patient to an ophthalmologist for further care
Determine the duration of treatment with this medication - ANSW-Determine the duration of treatment
with this medication
A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the
tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this
patient?
Refer the patient to an otolaryngologist
Prescribe antibiotic ear drops
Insert a wick into the ear canal
Irrigate the ear canal to remove the discharge - ANSW-Prescribe antibiotic ear drops
Which symptoms in children are evaluated using a parent-reported scoring system to determine the
severity of pain in children with otitis media? (Select all that apply.)
Tugging on ears
Difficulty sleeping
Poor hearing
Level of cooperation
Appetite - ANSW-Tugging on ears
Difficulty sleeping
Appetite
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain
when manipulating the external ear structures. What is the likely diagnosis?
Otitis media with effusion
Acute otitis externa
Acute otitis media
Chronic otitis externa - ANSW-Acute otitis externa
A patient has nasal congestion, fever, purulent nasal discharge, headache, and facial pain and begins
treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the
patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next
course of action for this patient?
A trial of azithromycin
A CT scan of the paranasal sinuses
A second course of amoxicillin-clavulanate
A referral to an otolaryngologist - ANSW-A second course of amoxicillin-clavulanate
A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup. The
provider notes that the patient has dry skin in the ear canal. Which preparation is FDA approved for this
use?
Mineral oil
Liquid docusate sodium
Carbamide peroxide
Hydrogen peroxide - ANSW-Carbamide peroxide
A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic
exam and notes a dark brown mass in the lower portion of the external canal blocking the patient's
tympanic membrane. What is the initial action?
Irrigate the canal with normal saline
Ask the patient about previous problems with that ear
Use a curette to attempt to dislodge the mass
Prescribe a ceruminolytic agent for that ear - ANSW-Ask the patient about previous problems with that
ear
A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient
loss of consciousness. A healthcare provider at the game notes bleeding from the child's nose and
displacement of the septum. What is the most important intervention at this time?
Immobilize the child's head and call 911
Apply ice to the injured site to prevent airway occlusion
Turn the child's head to the side to prevent aspiration of blood
Place nasal packing in both nares to stop the bleeding - ANSW-Immobilize the child's head and call 911
A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and
grasses. What is the first-line treatment for this patient?
Intranasal steroids
Oral antihistamines
Antihistamine spray
Intranasal cromolyn - ANSW-Intranasal steroids
Surgery to reduce the nasal fracture
A patient has been taking amoxicillin for treatment of a dental abscess. In a follow-up visit, the provider
notes edema of the eyelids and conjunctivae. What is the next action?
Hospitalize the patient for an endodontist consultation
Suggest using warm compresses to the eyes for comfort
Recommend follow up with a dentist in 2-3 days
Prescribe amoxicillin clavulanate for 10-14 days - ANSW-Hospitalize the patient for an endodontist
consultation
A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor
vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal
septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal
septum. Which action is necessary at this time?
Urgent drainage of the mass
CT scan of facial structures
Ice packs to reduce facial swelling
Surgery to reduce the nasal fracture - ANSW-Urgent drainage of the mass
A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1
ACO. What is part of this designation?
Standards for minimum cash reserves
Care coordination for chronic diseases
Strict requirements for financial reporting
Bonuses based on achievement of benchmarks - ANSW-Bonuses based on achievement of benchmarks
A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy.
What will the provider do next to manage this patient's symptoms?
Refer to to an otolaryngologist
Prescribe empiric penicillin
Perform a rapid antigen detection test
Order an antistreptolysin O titer - ANSW-Perform a rapid antigen detection test
A patient has gingival inflammation with several areas of ulceration and a small amount of purulent
discharge. What is required to diagnose this condition?
Culture and sensitivity
Microscopic exam of oral scrapings
Tzanck smear
Physical examination - ANSW-Physical examination
An alert, irritable 12-month-old child is brought to the emergency department by a parent who reports
that the child fell into a coffee table. The child has epistaxis, periorbital ecchymosis, and nasal edema.
Nares are patent and the examiner palpates instability and point tenderness of the nasal septum. The
orbital structures appear intact. What is an urgent action for this patient? - ANSW-Involvement of social
services
Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial
antibiotic therapy?
A 36 month old with fever of 38C, mild otalgia, and red, non- bulging ™
A 6 month old with fever of 39.2C, poor sleep and appetite and bulging ™
A 5 year old with fever of 38.0 C, severe otalgia, and red, bulging ™
A 4 year old, afebrile child with bilateral otorrhea - ANSW-A 36 month old with fever of 38C, mild otalgia,
and red, non- bulging ™
Which are potential complications of chronic or recurrent sinusitis?
Orbital infection
Osteomyelitis
Meningitis - ANSW-Orbital infection
Osteomyelitis
Meningitis
A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which
measure may help with symptomatic relief for patients with underlying allergic rhinitis?
Intranasal steroids
Topical decongestants
Oral mucolytics
Saline solution rinses - ANSW-Intranasal steroids
A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and
edema of the surrounding tissues w/o discharge. Which is the initial course of action by the provider? -
ANSW-Prescribe Amoxicillin, refer to dentist in 2-3 days
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent
with the diagnosis? - ANSW-Spontaneous horizontal nystagmus
Which physical examination finding suggests viral rather than bacterial parotitis?
Clear discharge from Stensen's duct
Unilateral edema of parotid glands
Gradual reduction in saliva production
Enlargement and pain of affected glands - ANSW-Clear discharge from Stensen's duct
A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to
further evaluate the cause of this finding?
Pure tone audiogram
Impedance audiometry
Tympanogram
Speech reception test - ANSW-Tympanogram
A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be
performed to evaluate this condition? (Select all that apply.)
BUN and creatinine
CBC with platelets
PT/INR
PT and PTT
Liver function tests - ANSW-CBC with platelets
PT/INR
PT and PTT
Which assessments of care providers are performed as part of the Value Based Purchasing initiative?
(Select all that apply.)
Appraising costs per case of care for Medicare patients
Requiring advanced IT standards and minimum cash reserves
Evaluating available evidence to guide clinical care guidelines
Monitoring mortality rates of all patients with pneumonia
Assessing patients' satisfaction with hospital care - ANSW-Appraising costs per case of care for Medicare
patients
Monitoring mortality rates of all patients with pneumonia
Assessing patients' satisfaction with hospital care
A patient who has acute suppurative parotitis has been taking amoxicillin- clavulanate for 4 days without
improvement in symptoms. The provider will order an antibiotic for Methicillin resistant S. aureus. Which
other measure may be helpful?
Topical corticosteroid
Discouraging chewing gum
Cool compresses
Surgical drainage - ANSW-Surgical drainage
Which symptoms may occur with vestibular neuritis? (Select all that apply.)
Hearing loss
Fever
N/V
Disequilibrium
Tinnitus - ANSW-Hearing loss
Fever
N/V
Disequilibrium
Tinnitus
An adult patient is seen in clinic with fever, sore throat, and dysphagia. Which diagnostic test will the
provider order to confirm a diagnosis of epiglottitis?
Lateral neck film
Blood cultures
Fiberoptic nasopharyngoscopy
Complete blood count - ANSW-Fiberoptic nasopharyngoscopy
A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly
inflamed and the tympanic membrane is not involved. Which medication will be ordered?
Cipro HC
Neomycin
Vinegar and alcohol
Fluconazole - ANSW-Cipro HC
A patient is in the emergency department with unilateral epistaxis that continues to bleed after 15
minutes of pressure on the anterior septum and application of a topical nasal decongestant. The
provider is unable to visualize the site of the bleeding. What is the next measure for this patient?
Nasal Packing
Electrocautery
Chemical cautery
Petrolatum ointment - ANSW-Nasal Packing
A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider
notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these
symptoms?
Herpes simplex virus
Bacterial infection
Candida albicans
Human papilloma virus - ANSW-Herpes simplex virus
A primary care provider notes painless, hard lesions on a patient's external ears that expel a white
crystalline substance when pressed. What diagnostic test is indicated?
Uric acid chemical profile
Rheumatoid factor
Endocrine studies
Biopsy of the lesions - ANSW-Uric acid chemical profile
A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial
intervention for this patient?
Clear the blood with suction to identify site of bleeding
Have the patient sit up straight and tilt the head forward
Apply firm, continuous pressure to the nostrils
Assess airway safety and vital signs - ANSW-Assess airway safety and vital signs
A pediatric patient has otalgia, fever of 38.8° C, and a recent history of upper respiratory examination.
The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of
cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the
correct action?
Treat empirically with amoxicillin 80-90 mg/kg/day
Remove the cerumen and visualize the tympanic membrane
Recommend symptomatic treatment for fever and pain
Perform a tympanogram on the right ear - ANSW-Remove the cerumen and visualize the tympanic
membrane
A school age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year. The
child's parent asks the provider if the child needs a tonsillectomy. What will the provider tell this parent?
If there is one more episode in the next 6 months, a tonsillectomy is necessary
Current recommendations do not support tonsillectomy for this child.
The child should have radiographic studies to evaluate the need for tonsillectomy
Tonsillectomy is recommended based on this child's history - ANSW-Current recommendations do not
support tonsillectomy for this child.
An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to
prevent complications?
Dexamethasone
Chloramphenicol
Metronidazole
Clindamycin - ANSW-Dexamethasone
The provider sees a child with a history of high fever and sore throat. When entering the exam room, the
provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the
initial action for this patient?
Obtain an immediate consultation with an otolaryngologist
Administer empiric intravenous antibiotics and steroids
Have the child lie down and administer high-flow, humidified oxygen
Perform a thorough examination of the oropharynx - ANSW-Obtain an immediate consultation with an
otolaryngologist
Which are risk factors for developing otitis externa? (Select all that apply.)
Cooler, low-humidity environments
Exposure to someone with otitis externa
Having underlying diabetes mellitus
Vigorous external canal hygiene
Use of earplugs and hearing aids - ANSW-Difficulty sleeping
Tugging on ears
Appetite
An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul smelling
breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the
primary care provider do?
Refer the patient to an otolaryngologist
Prescribe empiric oral antibiotics
Evaluate for possible epiglottitis
Perform a rapid strep and throat culture - ANSW-Refer the patient to an otolaryngologist
What was an important finding of the Advisory Board survey of 2014 about primary care preferences of
patients?
Costs of ambulatory care
Associations with area hospitals
The ratio of providers to patients
Ease of access to care - ANSW-ease of access to care
Which are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.)
High blood pressure
Diabetes
Smoking
GERD
Liver disease - ANSW-HTN, diabetes, smoking
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild
erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most
likely cause of these symptoms?
Infectious mononucleosis
Group A streptococcus
Allergic pharyngitis
Viral pharyngitis - ANSW-Viral pharyngitis
A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal
secretions. The provider notes puffiness around the eyes. The patient's vital signs are normal. What is
the most likely diagnosis for this patient?
Acute sinusitis
Viral rhinitis
Chronic sinusitis
Allergic rhinitis - ANSW-allergic rhinitis
A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated
tympanic membrane. What is the recommended treatment?
Refer the patient to an otolaryngologist for evaluation - ANSW-refer
A patient is diagnosed with peritonsillar abscess and will be hospitalized for intravenous antibiotics.
What additional treatment will be required?
Needle aspiration of the abscess - ANSW-needle aspiration
During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of
one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion?
Immediate surgery is recommended
This is most likely malignant
A biopsy should be performed
It is benign and will not need intervention - ANSW-A biopsy should be performed
To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid
Service have implemented which policy?
Reduction of payments for patients readmitted within 30 days after discharge
Mandates for communication among primary caregivers and hospitalists
Penalties for failure to perform medication reconciliations at time of discharge
Requirements for written discharge instructions for patients and caregivers - ANSW-Reduction of
payments for patients readmitted within 30 days after discharge
What are factors associated with acute suppurative parotitis? (Select all that apply.)
DM
Allergies
Hypervolemia
Radiotherapy
Anticholinergic medications - ANSW-DM, Radiotherapy, anticholingrics
Which approaches are among those recommended by the Agency for Healthcare Research and Quality
to improve health literacy in patients? (Select all that apply.)
Supplementing teaching with visual aids
Highlighting no more than 7 key points
Empowering patients and families
Giving written handouts for all teaching
Repeating the instructions - ANSW-supplement, empower, repeating
A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without
improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus.
Which other measure may be helpful?
Cool compresses
Topical corticosteroids
Surgical drainage
Discouraging chewing gum - ANSW-surgical drainage
A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and
edema of the surrounding tissues without discharge. Which is the initial course of action by the
provider?
Refer to an oral surgeon for emergency surgery
Perform an incision and drainage of the edematous tissue
Recommend oral antiseptic rinses and follow up in one week
Prescribe amoxicillin and refer to a dentist in 2-3 days - ANSW-Prescribe amoxicillin and refer to a dentist
in 2-3 days
The most common cancer found on the auricle is: - ANSW-Basal Cell Carcinoma
Which of the following medication classes should be avoided in patients with acute or chronic bronchitis
because it will contribute to ventilation-perfusion mismatch in the patient?
Xanthines

Antihistimines

Steroids

Anticholinergics - ANSW-Antihistamines
A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright
red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner
proceed?
Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet.

Order a topical hemorrhoid cream along with a stool softener.

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy. - ANSW-Refer the patient for a barium enema and
sigmoidoscopy.
Which of the following patient characteristics are associated with chronic bronchitis?
Overweight, cyanosis, and normal or slightly increased respiratory rate

Underweight, pink skin, and increased respiratory rate

Overweight, pink skin, and normal or slightly increased respiratory rate

Normal weight, cyanosis, and greatly increased respiratory rate - ANSW-Overweight, cyanosis, and
normal or slightly increased respiratory rate
A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia
rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications
include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po
daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and
possibly an abscess. The most appropriate diagnostic test for this patient at this time is:
CBC/diff

Erythrocyte sedimentation rate

Abdominal ultrasound

CT scan - ANSW-CT scan

A patient reports "something flew in my eye" about an hour ago while he was splitting logs. If there were
a foreign body in his eye, the nurse practitioner would expect to find all except:
Purulent drainage

Tearing

Photophobia

A positive fluorescein stain - ANSW-Purulent drainage

A 21 year old college student presents to the student health center with copious, markedly purulent
discharge from her left eye. The nurse practitioner student should suspect:
Viral conjunctivitis

Common pink eye

Gonococcal conjunctivitis

Allergic conjunctivitis - ANSW-Gonococcal conjunctivitis

A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles
consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning,
and itching. The nurse practitioner should suspect:
A common case of shingles and prescribe an analgesic and an antiviral agent

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

Herpes zoster and consider that this patient may be immunocompromised

A recurrence of chickenpox and treat the patient's symptoms - ANSW-Herpes zoster and consider that
this patient may be immunocompromised
Which type of lung cancer has the poorest prognosis?
Adenocarcinoma

Epidermoid carcinoma

Small cell carcinoma

Large cell carcinoma - ANSW-Small cell carcinoma

An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she
has even had fecal incontinence one time. She describes loose stools 3-4 times a day for several weeks
and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:
Acute diarrhea

Chronic diarrhea

Irritable bowel

Functional bowel disease - ANSW-Chronic diarrhea

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly
distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?
An allergic reaction

Relapsing polychondritis
Lymphocytoma cutis

Systemic lupus erythematosus - ANSW-Systemic lupus erythematosus

Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the
following disease processes?
Chronic sinusitis

Acute bronchitis

Bacterial pneumonia

Acute exacerbation of chronic bronchitis - ANSW-Acute bronchitis

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her
exacerbations affect her activities and they occur at least twice weekly and may last for days. She is
affected more than once weekly during the night with an exacerbation. Which category of asthma
severity is Lisa in?
Mild intermittent

Mild persistent

Moderate persistent - ANSW-Moderate persistent

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known
allergies diagnosed with group A B-hemolytic strep?
Penicillin V 500 milligrams PO every 8 hours for 10 days

Ampicillin 250 milligrams PO twice a day for 10 days

Clarithromycin 500 milligrams po daily for 7 days

None of the above - ANSW-Penicillin V 500 milligrams PO every 8 hours for 10 days
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation.
She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of
these problems?
Congestive heart failure

Varicose veins

Deep vein thrombosis

Arterial insufficiency - ANSW-Varicose veins
Which statement below is correct about pertussis?

It is also called whooping cough

It begins with symptoms like strep throat

It lasts about 3 weeks

It occurs most commonly in toddlers and young children - ANSW-It is also called whooping cough
Which of the following is the most important diagnosis to rule out in the adult patient with acute
bronchitis?
Pneumonia

Asthma

Sinusitis

Pertussis - ANSW-Pneumonia
A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender
palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the
suspected condition?
Diverticulosis

Diverticula

Diverticulitis

Diverticulum - ANSW-Diverticulitis
Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she
noticed a rash with erythematous papules in that site. What do you suspect?
Varicella

Herpes zoster

Syphilis
Rubella - ANSW-Herpes zoster
A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most
common cause of pancreatitis is:
Alcohol

Gallstones

Medications

Pregnancy - ANSW-Gallstones
When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse
practitioner action?
Order abdominal x-rays

Order an abdominal ultrasound

Refer the patient to a surgeon for evaluation

Prescribe pain medication - ANSW-Order an abdominal ultrasound

A false-positive result with the fecal occult blood test can result from:
ingestion of large amounts of vitamin C

a high dietary intake of rare cooked beef

a colonic neoplasm that is not bleeding

stool that has been stored before testing - ANSW-a high dietary intake of rare cooked beef
A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical
findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain
suspects a tumor in the small intestine. The best diagnostic test for this patient is:
Colonoscopy

Small bowel follow-through

Barium enema

CT abdomen - ANSW-Small bowel follow-through

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The
echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings
are consistent with:
Mitral regurgitation

Systolic heart failure

Cardiac myxoma

Diastolic heart failure - ANSW-Systolic heart failure

Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication
that she should be hospitalized?
Multilobar involvement on chest x-ray with the inability to take oral medications

Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home

Sputum and gram positive organisms

A complete blood count showing leukocytosis - ANSW-Multilobar involvement on chest x-ray with the
inability to take oral medications
A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:
"It is the most common cause of death in patients with skin cancer."

"It can be cured with surgical excision or radiation therapy."

"It is a slow growing skin cancer that rarely undergoes malignant changes."

"It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks." - ANSW-"It can be cured with
surgical excision or radiation therapy."
Expected spirometry readings when the patient has chronic emphysema include:
Decreased residual volume (RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

Increased total lung capacity (TLC) - ANSW-Increased total lung capacity (TLC)
An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner
recognizes the differential diagnosis for this patient's dysphagia is:
Esophageal cancer

Chest pain

GERD

A and C

All of the above - ANSW-A and C

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her
back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner
suspect?
Squamous cell carcinoma

Malignant melanoma

A common nevus

Basal cell carcinoma - ANSW-Malignant melanoma

Which of the following is not a goal of treatment for the patient with cystic fibrosis?
Prevent intestinal obstruction

Provide adequate nutrition

Promote clearance of secretions

Replace water-soluble vitamins - ANSW-Replace water-soluble vitamins

The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of
the following areas is a common site for melanomas in African-Americans and other dark-skinned
individuals?
Scalp

Nails

Feet
B and C

All of the above - ANSW-B and C

An adult presents with tinea corporis. Which item below is a risk factor for its development?
Topical steroid use

Topical antibiotic use

A recent laceration

Cold climates - ANSW-Topical steroid use

A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps,
and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting
medication for diarrhea. What is the most appropriate response?
Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24
hours.

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte
replacement instruction.

Order stool cultures. - ANSW-Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and
symptom management.
Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria.
What do you order?
Aspirin

NSAIDs

Opioids

Antihistamines - ANSW-Antihistamines
Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation
is:
Peripheral edema

Weight gain
Shortness of breath

Nocturnal dyspnea - ANSW-Weight gain

A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and
palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate
to prescribe?
Ibuprofen

Erythromycin

Amoxicillin

Acetaminophen - ANSW-Amoxicillin
A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The
problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question
asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis
obliterans?
"Are you wearing your usual shoes?"

"Do you also have chest pain when you have leg pain?"

"Is your leg pain relieved by rest?"

"Do you ever have the same pain in the other leg?" - ANSW-"Is your leg pain relieved by rest?"
Which of the following statements about malignant melanomas is true?
They usually occur in older adult males

The patient has no family history of melanoma

They are common in blacks

The prognosis is directly related to the thickness of the lesion - ANSW-The prognosis is directly related to
the thickness of the lesion
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her
and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema.
What do you suspect?
Asthma

Nocturnal allergies
Valvular disease

Heart failure - ANSW-Heart Failure

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a
young adult without any comorbid conditions?
Erythromycin

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin - ANSW-Clarithromycin (Biaxin)

Which of the following dermatologic vehicles are the most effective in absorbing moisture and
decreasing friction?
Powders

Gels

Creams

Lotion - ANSW-Powders
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She
admits to having been a "sun worshiper." The nurse practitioner suspects actinic keratosis. This lesion is a
precursor to:
Squamous cell carcinoma

Basal cell carcinoma

Malignant melanoma

Acne vulgaris - ANSW-Squamous cell carcinoma

An elderly patient is being seen in the clinic for complaint of "weak spells" relieved by sitting or lying
down. How should the nurse practitioner proceed with the physical examination?
Assist the patient to a standing position and take her blood pressure.

Assess the patient's cranial nerves.

Compare the patient's blood pressure lying first, then sitting, and then standing.

Compare the amplitude of the patient's radial and pedal pulses. - ANSW-Compare the patient's blood
pressure lying first, then sitting, and then standing.
What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for
surgery?
Ursodiol

Ibuprofen

Prednisone

Surgery is the only answer - ANSW-Ursodiol

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right
auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely
causative organism for this patient's problem is:
Staphylococcus aureus

Group A beta hemolytic streptococcus

Haemophilus influenza

Pseudomonas aeruginosa - ANSW-Pseudomonas aeruginosa

Which of the following is not a symptom of irritable bowel syndrome?
Painful diarrhea

Painful constipation

Cramping and abdominal pain

Weight loss - ANSW-Weight loss

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to
the right. What additional history is needed?
Any recent trauma

Difficulty swallowing

Stiffness in the right shoulder

Change in sleeping habits - ANSW-Any recent trauma
Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the
following drugs has the potential to cause the development of bronchial asthma and inhibit
gluconeogenesis?
ACE Inhibitor

Beta Blocker

Calcium channel blocker

Diuretic - ANSW-Beta Blocker

The differential diagnosis for a patient complaining of a sore throat includes which of the following?
Gonococcal infection

Thrush

Leukoplakia

B only

A, B, and C - ANSW-A, B, and C

A patient presents to the primary care provider complaining of a rash on his right forehead that started
yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash
that extends over the patient's right eye to his upper right forehead. Based on the history and
examination, the most likely cause of this patient's symptoms is:
Rhus dermatitis

Ophthalmic zoster

Chemosis

Optic neuritis - ANSW-Ophthalmic zoster

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver
function studies. The patient's aminotransferase (ALT) is elevated. What laboratory test(s) should be
ordered?
Serologic markers for hepatitis

Serum bilirubin
Serum cholesterol with HDL and LDL

A liver biopsy - ANSW-Serologic markers for hepatitis

A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report
generalized muscle aches. The nurse practitioner should suspect:
A drug interaction

Hepatic dysfunction

Hypersensitivity to lovastatin

Rhabdomyolysis - ANSW-Rhabdomyolysis
Treatment of acute vertigo includes:
Bedrest and an antihistamine

Fluids and a decongestant

A sedative and decongestant

Rest and a low sodium diet - ANSW-Bedrest and an antihistamine

Treatment of H.pylori includes which of the following?
Proton pump inhibitor

Antibiotic therapy

Bismuth subsalicylate

A and B

A, B, and C - ANSW-A, B, and C

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly
since last night. Carl reports that his vision is "like looking through a veil." He also sees floaters and
flashing lights but is not having any pain. What do you suspect?
Cataracts

Glaucoma
Retinal detachment

Iritis - ANSW-Retinal detachment

In order to decrease deaths from lung cancer:
All smokers should be screened annually

All patients should be screened annually

Only high risk patients should be screened routinely

Patients should be counseled to quit smoking - ANSW-Patients should be counseled to quit smoking
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for
hypercholesterolemia?
Every 5 years

Every 2 years

Every year

Whenever blood work is done - ANSW-Every 5 years

Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as
the antihypertensive medication?
Mort is black

Mort also has congestive heart failure

Mort has benign prostatic hyperplasia

Mort has frequent migraine headaches - ANSW-Mort has benign prostatic hyperplasia
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery
white scale on the extensor aspect of his elbows and knees. What do you suspect?
Actinic keratosis

Eczema

Psoriasis

Seborrheic dermatitis - ANSW-Psoriasis

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension.
Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At
today's visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to
control Harriet's blood pressure?
Increase her Lisinopril to 20mg daily

Add a thiazide diuretic to the Lisinopril 5mg daily

Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker

Discontinue the Lisinopril and start a diuretic - ANSW-Add a thiazide diuretic to the Lisinopril 5mg daily
An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral
regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs
elective replacement of his aortic valve. When he comes into the office you discover that he has 10
remaining teeth in poor repair. Your recommendation would be to:
defer any further dental work until his valve replacement is completed

instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed.

suggest he consult with his oral surgeon about having all the teeth removed at once and receiving
appropriate antibiotic prophylaxis

coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done
at the same time to reduce the risk of anesthetic complications. - ANSW-suggest he consult with his oral
surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis
Appropriate therapy for peptic ulcer disease (PUD) is:
Primarily by eradication of infection

Based on etiology

Aimed at diminishing prostaglandin synthesis

Dependent on cessation of NSAID use - ANSW-Based on etiology

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes
medications, what would you prescribe today during her routine office visit?
A calcium channel blocker

A beta blocker
An ACE Inhibitor

No hypertension medication - ANSW-An ACE Inhibitor

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS).
The CMS has developed guidelines for Evaluation and Management coding, which all providers are
expected to follow when coding patient visits for reimbursement. Which of the following is an important
consideration regarding billing practices?
It is important to "undercode" so that one does not get charged with Medicare fraud

The practice of "overcoding" is essential in this age of decreasing reimbursements

Failing to bill for billable services will lead to unnecessarily low revenues

Time spent with the patient is a very important determinant of billing - ANSW-Failing to bill for billable
services will lead to unnecessarily low revenues
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?
Viral conjunctivitis

Glaucoma

Corneal abrasion

Retinoblastoma - ANSW-Retinoblastoma
Harvey has had Meniere's disease for several years. He has some hearing loss but now has persistent
vertigo. What treatment might be instituted to relieve the vertigo?
Pharmacological therapy

A labyrinthectomy

A vestibular neurectomy

Wearing an earplug in the ear with the most hearing loss - ANSW-A vestibular neurectomy
Which of the following is not a risk factor for coronary arterial insufficiency?
Hyperhomocysteinemia

Smoking

Genetic factors
Alcohol ingestion - ANSW-Alcohol ingestion
An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes
that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the
nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and
surrounding skin. Which of the following is the most likely cause of this patient's symptoms?
Allergic conjunctivitis

Bacterial conjunctivitis

Gonococcal conjunctivitis

Viral conjunctivitis - ANSW-Allergic conjunctivitis

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective
in keeping him symptom-free?
A long-acting bronchodilator

An inhaled corticosteroid and cromolyn

Theophylline and a short acting bronchodilator

A bronchodilator PRN and an inhaled corticosteroid - ANSW-A bronchodilator PRN and an inhaled
corticosteroid
Acute rheumatic fever is an inflammatory disease which can follow infection with:
Group A Streptococcus

Staphlococcus areus

B-hemolytic Streptococcus

Streptococcus pyogenes - ANSW-Group A Streptococcus

A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral
aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week
which "is better." His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is
to:
Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days

Order mandibular x-rays and question the patient about physical abuse
Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic

Initiate a parenteral antibiotic and consider hospital admission - ANSW-Initiate a parenteral antibiotic
and consider hospital admission
If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:
Iritis

Allergic conjunctivitis

Viral conjunctivitis

Bacterial conjunctivitis - ANSW-Iritis

The National Cholesterol Education Program's Adult Treatment Panel III recommends that the goal for
low density lipoproteins in high risk patients be less than:
160 mg/dL

130 mg/dL

100 mg/dL

70 mg/dL - ANSW-100 mg/dL

A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on
life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he
was "fine" as long as he took the medication. The most appropriate next step is:
Referral for surgical intervention such as a partial or complete fundoplication

Dependent upon how sever the practitioner believes the condition

To repeat the 8 week course of drug therapy while continuing lifestyle modifications

Investigation with endoscopy, manometry, and/or pH testing - ANSW-Investigation with endoscopy,

manometry, and/or pH testing
Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?
Under 3 years of age

Preschool children

6 to 12 years of age
Adolescents - ANSW-6 to 12 years of age
The most appropriate treatment for a child with mild croup is:
A bronchodilator

An antibiotic

A decongestant

A cool mist vaporizer - ANSW-A cool mist vaporizer

A child complains that his "throat hurts" with swallowing. His voice is very "throaty" and he is
hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is
deviated to the left. What is the most likely diagnosis?
Peritonsillar abscess

Thyroiditis

Mononucleosis

Epiglottitis - ANSW-Peritonsillar abscess

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point
about this medication?
It is not effective during an acute asthma attack.

It may take 2 to 3 days to begin working.

This drug works within 10 minutes.

This drug may be used by patients 6 years and older. - ANSW-It is not effective during an acute asthma
attack.
Which intervention listed below is safe for long term use by an adult with constipation?
Bulk-forming agents

Stool softeners

Laxatives

Osmotic agents - ANSW-Bulk-forming agents

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
Apply a topical antibiotic and warm compresses.

Apply cool compresses and avoid touching the hordeolum.

Use an oral antibiotic and eye flushes.

Apply light palpation to facilitate drainage. - ANSW-Apply a topical antibiotic and warm compresses.
Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following
meds ordered for allergic rhinitis would be most appropriate?
An antihistamine intranasal spray

A decongestant nasal spray

Ipratropium

Omalizumab - ANSW-A decongestant nasal spray

What is the Gold standard for the diagnosis of asthma?
Patient's perception of clogged airways

Validated quality-of-life questionnaires

Bronchoscopy

Spirometry - ANSW-Spirometry
A patient complains of "an aggravating cough for the past 6 weeks." There is no physiological cause for
the cough. Which medication is most likely causing the cough?
Methyldopa

Enalapril

Amlodipine

Hydrochlorothiazide - ANSW-Enalapril
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably
caused by:
Herpes simplex
Aphthous ulcers

Candidiasis

Oral cancer - ANSW-Candidiasis

Risk factors for acute otitis media (AOM) include all of the following except:
Household cigarette smoke

Group daycare attendance

Sibling history of acute otitis media

African-American ethnicity - ANSW-African-American ethnicity

Which of the following can result from chronic inflammation of a meibomian gland?
A chalazion

Uveitis

Keratitis

A pterygium - ANSW-A chalazion

What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement
from Medicare?
You must initiate the plan of care for the patient

The physician must be on-site and engaged in patient care

You must be employed as an independent contractor

You must be the main health care provider who sees the patient - ANSW-The physician must be on-site
and engaged in patient care
Of the following choices, the least likely cause of cough is:
Asthma

Gastroesophageal reflux

Acute pharyngitis
Allergic rhinitis - ANSW-Acute pharyngitis
The most common correlate(s) with chronic bronchitis and emphysema is(are):
Familial and genetic factors

Cigarette smoking

Air pollution

Occupational environment - ANSW-Cigarette smoking

Which choice below is least effective for alleviating symptoms of the common cold?
Antihistamines

Oral decongestants

Topical decongestants

Antipyretics - ANSW-Antihistamines
When teaching a patient with hypertension about restricting sodium, you would include which of the
following instructions?
Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond
blood pressure control

Sodium restriction can cause serious adverse effects

A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable

Seventy-five of sodium intake is derived from processed foods - ANSW-Seventy-five of sodium intake is
derived from processed foods
Which of the following heart murmurs warrants the greatest concern?
Systolic murmur

Venous hum murmur

Diastolic murmur

Flow murmur - ANSW-Diastolic murmur

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate
matter along the upper eyelid. The patient complains of a sensation that "there is something in my eye."
What is the diagnosis and how should it be treated?
Hordeolum; treat with a topical antibiotic and warm compress

Conjunctivitis; treat with topical antibiotic and warm compresses

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

Chalazion; refer to an ophthalmologist for incision and drainage - ANSW-Blepharitis; treat with warm
compresses and gentle debridement with a cotton swab
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour.
The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes
are consistent with which myocardial infarction territory?
Inferior wall

Anterior wall

Apical wall

Lateral wall - ANSW-Inferior wall

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is
without bulging or inflammation. The least likely diagnosis for this patient is:
Acute otitis media (AOM)

Otitis media with effusion

Mucoid otitis media

Serous otitis media - ANSW-Acute otitis media (AOM)

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is
a ventral hernia, also known as:
inguinal hernia

epigastric hernia

umbilical hernia

incisional hernia - ANSW-epigastric hernia

A 58-year-old man is diagnosed with Barrett's esophagus after an endoscopy. He has no known allergies.
Which of the following medications is MOST appropriate to treat this patient's disorder?
Omeprazole

Ranitidine

An antacid

None of the above - ANSW-Omeprazole

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent
reinfarction, the most important behavior change that he can make is to:
Quit smoking

Maintain aggressive hypertension therapy

Stick to a low-fat, low-sodium diet

Continue with his exercise program - ANSW-Quit smoking

Risk factors for acute arterial insufficiency include which of the following?
Recent myocardial infarction

Atrial fibrillation

Atherosclerosis

All of the above - ANSW-All of the above

Impetigo and folliculitis are usually successfully treated with:
Systemic antibiotics

Topical antibiotics

Topical steroid creams

Cleansing and debridement - ANSW-Topical antibiotics

Which of the following drugs used for
parkinsonism mimics dopamine?
A. Anticholinergics
B. Levodopa (l-dopa)
C. Bromocriptine
D. Tolcapone - ANSW-Answer C
Bromocriptine and pergolide mimic dopamine.
The other mechanisms of antiparkinsonian
treatments are as follows: anticholinergics restore
acetylcholine-dopamine balance; levodopa restores
striatal dopamine; and tolcapone and entacapone
reduce systemic degradation of oral dopamine
Current pharmacological therapy for
relapsing-remitting multiple sclerosis involves
A. high-dose steroids.
B. baclofen (Lioresal) or diazepam (Valium).
C. interferon B (Betaseron).
D. benzodiazepines. - ANSW-Answer C
Interferon B (Betaseron) is used for the treatment of
multiple sclerosis because it decreases the frequency of
exacerbations in clients with the relapsing-remitting
type of multiple sclerosis. Before the early 1990s, highdose
steroids were used for acute exacerbations, and
baclofen (Lioresal) or diazepam (Valium) was used for
excessive spasticity and spasms. Benzodiazepines are
ordered in a small dosage for anxiety.
Marian, age 39, has multiple sclerosis (MS).
She tells you that she heard that the majority of
people with MS have the chronic-relapsing type of
disease and that she has nothing to live for. How do
you respond?
A. " The majority of people have this response to MS."
B. " There are many different clinical courses of MS,
and the chronic-relapsing type is only one of
them. "
C. " The chronic-relapsing type of MS is in the
minority. "
D. " There is an even chance that you have this type." - ANSW-Answer B
It is expected that Marian might be depressed
because of her multiple sclerosis (MS). Focusing
more on what she has " going for her " rather than
the type of MS she has should be the first response
The use of tricyclic antidepressants in the
elderly increases the risk of
A. suicide.
B. cardiac arrhythmias.
C. reactive depression.
D. shortness of breath. - ANSW-Answer B
A study by the Heart and Lung Institute of the
National Institute of Health in the mid-1980s
showed that class 1 antiarrhythmic drugs given to
patients with ventricular arrhythmias following
myocardial infarction, instead of preventing deaths,
actually increased the number of patients dying.
Some providers have successfully induced
remission in clients with multiple sclerosis by
using adrenocorticotropic hormone therapy or other
pharmacological therapy along with
A. chelation therapy.
B. plasmapheresis.
C. bone marrow transplantation.
D. intravenous lipids. - ANSW-Answer B
Plasmapheresis, or plasma exchange, when used
with adrenocorticotropic hormone therapy or other
pharmacological therapy, has successfully induced
remission in some clients with multiple sclerosis
Which appropriate test for the initial
assessment of Alzheimer ' s disease provides
performance ratings on 10 complex, higher-order
activities?
A. MMSE
B. CAGE questionnaire
C. FAQ
D. Holmes and Rahe Social Readjustment
Scale - ANSW-Answer C
The FAQ (Functional Activities Questionnaire)
is a measure of functional activities. There are 10
complex, higher-order activities that are appropriate
for the initial assessment of Alzheimer ' s disease
Which medication should be avoided
in clients with Alzheimer ' s disease who have
concurrent vascular dementia or vascular risk
factors?
A. Acetycholinesterase inhibitors like donepezil
(Aricept)
B. N -methyl-d-aspartate (NMDA) receptor
antagonists
C. Anxiolytics like bupirone (Buspar)
D. Atypical antipsychotics like risperidone (Risperdal) - ANSW-Answer D
Atypical antipsychotics such as risperidone should
be avoided in clients with Alzheimer ' s disease who
also have vascular risk factors because they may
increase the risk of stroke
Deficiency of which nutritional source
usually presents with an insidious onset of
paresthesias of the hands and feet that are
usually painful?
A. Thiamine
B. Vitamin B 12
C. Folic acid
D. Vitamin K - ANSW-Answer B
Deficiency of vitamin B 12 usually presents with
an insidious onset of paresthesias of the hands
and feet that are usually painful
Barbara, age 36, presents with episodic
attacks of severe vertigo, usually with associated
ear fullness. Her attacks usually last several
hours and she feels well before and after the
attacks. To what might you attribute these
symptoms?
A. M é ni è re ' s disease
B. Vestibular neuronitis
C. Benign paroxysmal positional vertigo
D. Otosclerosis - ANSW-Answer A
A client with M é ni è re ' s disease presents with
episodic attacks of severe vertigo, usually with
associated ear fullness or hearing loss
Herbert, age 58, has just been diagnosed
with Bell ' s palsy. He is understandably upset and has
questions about the prognosis. Your response should be
A. " Although most of the symptoms will disappear,
some will remain but can usually be camouflaged
by altering your hairstyle or growing a beard or
mustache. "
B. " Unfortunately, there is no cure, but you have a
mild case. "
C. " The condition is self-limiting, and most likely
complete recovery will occur. "
D. " With suppressive drug therapy, you can
minimize the symptoms. " - ANSW-Answer C
The peripheral facial palsy of Bell ' s palsy is selflimiting,
and complete recovery usually occurs in
several weeks or months in the majority of cases
In teaching a client with multiple sclerosis,
the provider should emphasize all of the following
points except
A. taking a daily hot shower to relax.
B. exercising to maintain mobility.
C. getting plenty of rest.
D. seeking psychological and emotional support. - ANSW-Answer A
Hot showers may exacerbate the symptoms of
multiple sclerosis. For the same reason, fevers should
be controlled
Which of the following objective data are
associated with significantly better long-term
outcomes in children born with open spina bifida?
A. A higher APGAR score
B. Presence of Babinski ' s reflex
C. Perineal sensation
D. A higher score on the Glasgow Coma Scale - ANSW-Answer C
In infants with open spina bifida, the presence of
perineal sensation is associated with significantly
better long-term outcomes
Diane, age 35, presents with weakness and
numbness of the left arm, diplopia, and some bowel
and bladder changes for the past week. She states
that the same thing happened last year and lasted for
several weeks. What diagnosis is a strong possibility?
A. Multiple sclerosis
B. Subdural hematoma
C. Pituitary tumor
D. Myasthenia gravis - ANSW-Answer A
The diagnosis of multiple sclerosis (MS) is often
difficult given the large variety of symptoms, but
it is a strong possibility in this case. Generally, it
occurs in clients ages 20 - 40.
Which of the following conditions is most
responsible for developmental delays in children?
A. Cerebral palsy
B. Fetal alcohol syndrome
C. Down syndrome
D. Meningomyelocele - ANSW-Answer B
Fetal alcohol syndrome is most often responsible for
developmental delays in children. In descending
order, the others are cerebral palsy, Down syndrome,
and meningomyelocele.
Clients with senile dementia of the
Alzheimer ' s type often die of
A. pneumonia.
B. suicide.
C. pressure sores.
D. malnutrition. - ANSW-Answer A
Clients with senile dementia of the Alzheimer ' s type
(SDAT) commonly die of pneumonia (the most
common cause of death of clients with Alzheimer ' s
disease).
Which of the following screening
instruments is quick and easy to use and has a high
level of diagnostic accuracy to detect alcohol abuse?
A. The CAGE questionnaire
B. The HEAT instrument
C. The DRINK tool
D. MMSE - ANSW-Answer A
The CAGE instrument is a widely used
questionnaire that has a high degree of accuracy for
identifying clients who abuse alcohol. CAGE is an
acronym for four questions: the C stands for " Have
you ever felt you should c ut down on drinking? " ; the
A for " Have people a nnoyed you by criticizing your
drinking " ; the G for " Have you felt bad or g uilty
about your drinking " ; and the E for " Have you had
a drink first thing in the morning (an " e ye opener " )
to steady your nerves or to get rid of a hangover? "
What is the first symptom seen in the
majority of clients with Parkinson ' s disease?
A. Rigidity
B. Bradykinesia
C. Rest tremor
D. Flexed posture - ANSW-Answer C
Although rigidity, bradykinesia, and flexed posture
are associated with Parkinson ' s disease, rest tremor
is usually the first symptom seen
Lynne, age 72, presents for the first time
with her daughter. Her daughter describes some
recent disturbing facts about her mother. How can
you differentiate between depression and dementia?
A. You might be able to pinpoint the onset of
dementia, but the onset of depression is difficult
to identify.
B. A depressed person has wide mood swings,
whereas a person with dementia demonstrates
apathetic behavior.
C. The person with dementia tries to hide problems
concerning his or her memory, whereas the
person with depression complains about memory.
D. The person with dementia has a poor self-image,
whereas the person with depression does not have
a change in self-image. - ANSW-Answer C
To help differentiate between depression and
dementia, keep in mind that the person with
dementia tries to hide problems concerning memory,
whereas the person with depression complains
about memory and discusses the fact that there is a
problem with memory
Grace, age 82, has Alzheimer ' s disease.
Her daughter states that she is agitated, has time
disorientation, and wanders during the afternoon
and evening hours. How do you describe this
behavior?
A. Alzheimer ' s dementia
B. Sundowning
C. Deficits of the Alzheimer ' s type
D. Senile dementia - ANSW-Answer B
Sundowning is a common behavioral change in
clients with Alzheimer ' s disease. It is characterized
by increased agitation, time disorientation, and
wandering behaviors during the afternoon and
evening hours.
Which of the following antiepileptic drugs
are associated with spina bifida?
A. Dilantin
B. Lamictal
C. Depakote
D. Keppra - ANSW-Answer C
Mothers who have taken Depakote during
pregnancy have given birth to babies with spina
bifida. Safer medications during pregnancy include
Keppra and Lamictal, but they are still considered
pregnancy-risk category C.
What is the main overall goal of therapy for
the client with Parkinson ' s disease?
A. To halt the progression of the disease
B. To keep the client functioning independently as
long as possible
C. To control the symptoms of the disease
D. To ease the depression associated with the disease - ANSW-Answer B
The main overall goal of therapy for the client with
Parkinson ' s disease is to keep the client functioning
independently as long as possible
Which of the following interventions
can significantly slow the decline in performing
activities of daily living (ADLs) in clients with
Alzheimer ' s disease living in a nursing home?
A. A simple exercise program
B. Ginkgo biloba
C. Doing crossword puzzles
D. Improving nutritional state - ANSW-Answer A
A simple exercise program, 1 hour twice a week,
has been shown to significantly slow the decline in performing ADLs in persons living in a nursing
home
Diana, 55, complains of ear pain, right
facial weakness, and loss of taste. What diagnosis
would you consider?
A. Lyme disease
B. Stroke
C. Ear infection
D. Brain tumor - ANSW-Answer A
Some Lyme disease cases involve the nervous system,
causing paralysis of facial muscles, pain in the ear,
and loss of taste due to swelling of the auricular
nerve
Which of the following symptoms related to
memory indicates depression rather than delirium
or dementia in the older adult?
A. Inability to concentrate, with psychomotor
agitation or retardation
B. Impaired memory, especially of recent events
C. Inability to learn new material
D. Difficulty with long-term memory - ANSW-Answer A
The prevalence of depression (5% - 10%) does not
change with age, but depression is often overlooked in the older adult. The diagnosis requires a
depressed mood for 2 straight weeks and at least
four of the following eight signs (which can be
remembered using the mnemonic SIG E CAPS [like
prescribing energy caps]): S for sleep disturbance,
I for lack of interest, G for feelings of guilt, E for
decreased energy, C for decreased concentration, A
for decreased appetite, P for psychomotor agitation
or retardation, and S for suicidal ideation.
Sally, age 52, presents with a rapidly
progressive weakness of her legs that is moving
up the trunk. She also has absent reflexes and no
sensory change. What do you suspect?
A. Peripheral neuropathy
B. Guillain-Barr é syndrome
C. Myasthenia gravis
D. Radiculopathy - ANSW-Answer B
The diagnosis of Guillain-Barr é syndrome is
confirmed by a rapidly progressive weakness, usually
in an ascending pattern from the legs up to the
trunk and then to the arms and face.
You assess for cogwheel rigidity in
Sophia, age 76. What is cogwheel rigidity a
manifestation of?
A. Alzheimer ' s disease
B. Parkinson ' s disease
C. Brain attack
D. Degenerative joint disease - ANSW-Answer B
Clients with Parkinson ' s disease may exhibit
" cogwheel rigidity, " a condition in which there is an
increased resistance in muscle tone when the nurse
practitioner moves the client ' s neck, trunk, or limbs.
The muscle is stiff and difficult to move.
Which peripheral nervous system disorder
usually follows a viral respiratory or gastrointestinal
infection?
A. Cytomegalovirus
B. Herpes zoster
C. Guillain-Barr é syndrome
D. Trigeminal neuralgia - ANSW-Answer C
Guillain-Barr é syndrome (GBS) is an acute
demyelinating disorder. It is a peripheral
nervous system disorder that usually follows a
viral respiratory or gastrointestinal infection
What are the two most common causes of
dementia in older adults?
A. Polypharmacy and nutritional disorders
B. Alzheimer ' s disease and vascular disorders
C. Metabolic disorders and space-occupying lesions
D. Infections affecting the brain and polypharmacy - ANSW-Answer B
The two most common causes of dementia in
older adults are dementia of the Alzheimer type
(Alzheimer ' s disease) and vascular disorders
such as hypertension, atherosclerosis, vasculitis,
embolic disease, and cardiac disease
Which of the following tests is highly
specific and fairly sensitive for myasthenia gravis?
A. Electromyography nerve conduction tests
B. Magnetic resonance imaging scan of the brain
and brainstem
C. Serum acetylcholine receptor antibody level
D. Lumbar puncture - ANSW-Answer C
Of clients with generalized myasthenia gravis,
80% - 90% have antibodies to acetylcholine
receptors
Which type of urinary incontinence results
from Parkinson ' s disease and multiple sclerosis?
A. Overflow incontinence
B. Stress incontinence
C. Urge incontinence
D. Functional incontinence - ANSW-Answer C
There are five types of urinary incontinence:
overflow, stress, urge, and functional, which are
considered established causes of incontinence, and
transient or potentially reversible causes of urinary
incontinence
Which of the following conditions includes
weakness, muscle atrophy, muscle fasciculations, mixed
hyper- and hyporeflexia, and spares the ocular muscles?
A. Parkinson ' s
B. Alzheimer ' s
C. Multiple sclerosis
D. Amyotrophic lateral sclerosis - ANSW-Answer D
Which type of tremor is goal directed,
more prominent with willful action, and may
be located in proximal as well as distal
extremities?
A. Cerebellar
B. Physiological
C. Parkinsonian
D. Essential - ANSW-Answer A
A thymectomy is usually recommended in
the early treatment of which disease?
A. Parkinson ' s disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Huntington ' s chorea - ANSW-Answer C
A thymectomy is performed in approximately
75% of clients with myasthenia gravis because
of dysplasia of the thymus gland
What is the main overall goal of therapy for
the client with Parkinson ' s disease?
A. To halt the progression of the disease
B. To keep the client functioning independently as
long as possible
C. To control the symptoms of the disease
D. To ease the depression associated with the disease - ANSW-Answer B
The main overall goal of therapy for the client with
Parkinson ' s disease is to keep the client functioning
independently as long as possible
Maura, age 36, has just been given a
diagnosis of Bell ' s palsy and asks you about her
chances for a complete recovery. How do you respond?
A. " Don ' t worry; I ' m sure you ' ll have a complete
recovery. "
B. " You have about a 50-50 chance of complete
recovery; otherwise, you may have some minor
problems. "
C. " About 80% of clients have a complete recovery
within 2 months. "
D. " Although you won ' t recover completely, the
residual effects are minor. " - ANSW-Answer C
A classic symptom of carpal tunnel syndrome
is acroparesthesia, which is
A. the relief of tingling and numbness of the fingers
by shaking or rubbing the hands.
B. awaking at night with numbness and burning
pain in the fingers.
C. wrist pain with repetitive motions.
D. pain on percussion of the median nerve. - ANSW-Answer B
Jennifer, age 36, has systemic lupus
erythematosus. She exhibits erythematous raised
patches with adherent keratotic scaling and
follicular plugging. This is characteristic of
A. a malar rash.
B. a discoid rash.
C. photosensitivity.
D. an oral ulcer. - ANSW-Answer B
Ben, age 72, is complaining of insomnia and
asks your advice. You recommend that he
A. take alprazolam (Xanax) at bedtime.
B. go for a walk before bedtime.
C. eat a large meal before bedtime for relaxation.
D. refrain from napping during the day. - ANSW-Answer D
What is the most common cause of
progressive dementia in persons older than 55?
A. Alzheimer ' s disease
B. Vascular disease
C. Huntington ' s disease
D. Parkinson ' s disease - ANSW-Answer A
Which of the following exercises would you
recommend as being the best for your client with
osteoporosis?
A. Swimming
B. Walking
C. Chair aerobics
D. The client should avoid any exercise that might
cause an injury. - ANSW-Answer B
Sandy, age 9, has seizures with brief,
jerking contractions of her arms, legs, and trunk.
Which seizure type is this?
A. Myoclonic
B. Clonic
C. Tonic
D. Tonic-clonic - ANSW-Answer A
Which of the following symptoms is typical
in fibromyalgia?
A. Widespread pain at multiple sites
B. Sleeping deeply for greater than 8 hours
C. Afternoon fatigue
D. Difficulty with fine motor tasks - ANSW-Answer A
You suspect that Marcia has an eating
disorder because she is 5 ft 6 in. tall, weighs 110 lbs,
and seems disgusted with herself when you weigh
her. During your examination, you suspect bulimia
rather than anorexia because of her
A. sensitivity to cold.
B. hair loss.
C. swollen salivary glands.
D. statement regarding irregular menstruation. - ANSW-Answer C
Mavis, age 76, comes to the office with a
unilateral throbbing headache in the periorbital
region. She states that the pain has been gradually
increasing over the past several hours and when
she went out into the cold weather, the pain was
extremely bad. What do you suspect?
A. Trigeminal neuralgia
B. A migraine
C. Giant-cell arteritis
D. A transient ischemic attack - ANSW-Answer C
The system that is affected in about 75%
of all clients with systemic lupus erythematosus
and has one of the most serious systemic sequelae,
leading to significant morbidity and mortality,
is the
A. renal system.
B. cardiovascular system.
C. neuromuscular system.
D. integumentary system. - ANSW-Answer A
Joan, age 24, has chronic fatigue
syndrome. She is so frustrated with her family
and friends thinking that it is all in her head that
she tells you that she has actually thought about
suicide. Knowing which of the following would be
most helpful in assessing Joan ' s suicidal risk?
A. If there is a history of suicide in the family
B. If Joan lives alone
C. If Joan uses any alcohol or recreational drugs
D. If Joan has developed a plan for the suicide - ANSW-Answer D
Delirium in the older adult typically presents
with which of the following behaviors?
A. Agitation and wandering behavior
B. Acute change in mental status and apathy,
lack of response to stimuli
C. Agitation and restlessness
D. Absence of purpose and apathy - ANSW-Answer C
Jeremy, age 18, comes in for a visit.
His left arm is in a cast, and he tells you that
he has a comminuted fracture of his humerus.
This means that
A. the bone is crushed.
B. bony fragments are in many places.
C. bone breaks cleanly but does not penetrate the
skin.
D. broken ends of the bone protrude through the
soft tissues and skin. - ANSW-Answer B
John, age 18, has a seizure disorder.
He has been taking a combination of phenytoin
(Dilantin) and phenobarbital (Luminal) to treat
his seizures. He reports a new rash. You know
that
A. the phenobarbital should be discontinued.
B. the phenytoin should be discontinued.
C. either of these drugs could cause a rash.
D. you must begin John on an entirely new drug
regimen. - ANSW-Answer C
Rose, age 66, comes in with an intractable
headache accompanied by weakness, difficulty
chewing, and visual changes. You note some
swelling and tenderness on her left forehead.
What do you suspect?
A. A migraine headache
B. Temporal arteritis
C. A cluster headache
D. A cerebral aneurysm - ANSW-Answer B
Mrs. Moore brings her 3-year-old son to
your primary care office for evaluation. She is very
upset and reports that, after eating dinner last
evening, her son seemed to lose consciousness for
a brief period. She states that he was sitting up
but that his head drooped and he did not respond
to calls from her. She could not recall exactly
how long this episode lasted but reports that he
returned to normal as the evening progressed and
is also acting normally today. You suspect that the
child had a(n)
A. absence seizure.
B. tonic-clonic seizure.
C. myoclonic seizure.
D. atonic seizure. - ANSW-Answer A
Abnormal bony growths on the distal and
proximal interphalangeal joints are associated with
A. rheumatoid arthritis.
B. osteoarthritis.
C. scleroderma.
D. Lyme disease. - ANSW-Answer B
When diagnosing seizures in a child,
despite an appropriate work-up, the etiology
remains undetermined 50% of the time. Differential
diagnoses for seizure disorders in a child include
which of the following?
A. Autism
B. Benign paroxysmal vertigo
C. Drug reaction
D. Labyrinthitis - ANSW-Answer D
When your teenage client Shane asks you
about what to do for his knee, which is sprained
from playing ice hockey, you tell him to use
A. heat for 30 minutes every hour for the first
48 hours.
B. ice for 20 minutes and then remove for
30 - 45 minutes for the first 48 hours.
C. alternately heat for 15 minutes followed by ice
for 20 minutes for the first 72 hours.
D. ice for 40 minutes followed by heat for
20 minutes for the first 24 hours. - ANSW-Answer B
Delirium is often acute and reversible.
Reversible causes of delirium include
A. depression, deafness, and use of nitrates.
B. psychosis, vitamin B 12 deficiency, and migraine
headache.
C. sepsis, syphilis, and use of warfarin (Coumadin).
D. subdural hematoma, depression, and use of
anticholinergics. - ANSW-Answer D
Abnormal bony growths on the proximal
interphalangeal joints are referred to as
A. Heberden ' s nodes.
B. Bouchard ' s nodes.
C. subcutaneous nodules.
D. tophi. - ANSW-Answer B
One of the major criteria for diagnosing
chronic fatigue syndrome is
A. generalized headaches.
B. unexplained, generalized muscle weakness.
C. sleep disturbance.
D. fatigue for more than 6 months. - ANSW-Answer D
Fatigue for more than 6 months and absence of other
clinical conditions that may explain such fatigue are
the two major criteria the client must demonstrate
to be diagnosed with chronic fatigue syndrome
Anorexia nervosa is a steady, intentional loss
of weight with maintenance of that weight at an
extremely unhealthy low level. Which statement
is true regarding anorexia nervosa?
A. The poor eating habits result in diarrhea.
B. It may cause tachycardia.
C. It may occur from prepubescence into the
early 30s.
D. It may cause excessive bleeding during menses. - ANSW-Answer C
Anorexia nervosa may occur from prepubescence
into the early 30s and occurs most commonly from
early to late adolescence
The CAGE screening test for alcoholism is
suggestive of the disease if two of the responses are
positive. What does the E in CAGE stand for?
A. Every day
B. Eye opener
C. Energy
D. Ego - ANSW-Answer B
The E stands for eye opener, or the need for a drink
early in the day
Jan's mother has Alzheimer's disease.
She 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?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4 - ANSW-Answer C
Families of persons with Alzheimer's disease (AD)
need to know that AD is a progressive disorder of
the brain affecting memory, thought, and language.
A 68-year-old woman presents to your office
for screening for osteoporosis. Sandy states that her
grandmother and mother both lost inches in their
old age. Sandy 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. When do
women lose the greatest amount of bone density?
A. During adolescence
B. The first year of menopause
C. The first 10 years after menopause
D. Bone loss occurs continuously at the same rate
from menopause to death. - ANSW-Answer C
Bone loss begins at a rate of 0.5% a year in a
woman's middle to late 40s. When menopause
occurs, the rate increases up to 7% a year for the
first decade after menopause
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 give to Emily?
A. Drink all the soda you like—it has no effect on
your bone density.
B. It has not been proved that smoking affects
bone loss.
C. Replace estrogen when you reach menopause.
D. Perform aerobic exercise at least three times
a week. - ANSW-Answer D
Emily is only 26 years old and has not reached her
peak bone mass yet. It has been proven that aerobic
exercise increases bone mass. Smoking and soda
drinking both have been shown to decrease bone
mass.
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?
A. Computed tomography (CT) scan
B. Magnetic resonance imaging (MRI)
C. Electroencephalogram (EEG)
D. Color duplex ultrasonography - ANSW-Answer D
A biopsy of the temporal artery is usually required
to confirm the diagnosis of temporal arteritis.
Which of the following criteria is not
diagnostic for a child with attention deficithyperactivity
disorder (ADHD)?
A. The child frequently blurts out the answer to a
question before the question is finished.
B. The child has difficulty following directions.
C. The child talks very little but is very restless.
D. The child often engages in physically dangerous
activities. - ANSW-Answer C
Diagnostic criteria for the child with ADHD include
frequently blurting out answers before a question is
finished, difficulty following directions, engaging
in physically dangerous activities (often without
thinking of the consequences of actions), tending
to talk excessively, and often interrupting others.
Which statement about gender disparities
and suicide is true?
A. Women take their own lives more often than
men.
B. Men attempt suicide more often than women.
C. Suicide rates for males are highest among those
aged 75 and older.
D. Poisoning is the most common method of suicide
for both sexes. - ANSW-Answer C
Suicide rates for males are highest among those aged
75 and older. Suicide rates for females are highest
among those aged 45-54
Which of the following is a major risk
factor associated with osteoporosis and fragility
fractures?
A. Body weight less than 127 lb
B. Alcohol intake greater than 2 drinks/day
C. Estrogen deficiency occurring before 45 years
of age
D. Low physical activity - ANSW-Answer A
Many major risk factors are associated with
osteoporosis and fragility fractures. The major risk
factors are body weight less than 127 lb, personal
history of fracture as an adult, history of fracture in
a first-degree relative, oral corticosteroid therapy of
longer than 3 months, and current smoking
Postmenopausal women who are not on
hormone replacement therapy need how much
calcium per day to help prevent osteoporosis?
A. 1,000 mg
B. 1,200 mg
C. 1,500 mg
D. 1,800 mg - ANSW-Answer C
Postmenopausal women who are not taking
hormone replacement therapy need 1,500 mg of
calcium a day to help prevent osteoporosis. Because
treatment for osteoporosis is limited, prevention is
necessary to reduce the occurrence
Karen, who is postmenopausal, is taking
1,500 mg of calcium but does not understand why
she also needs to take vitamin D. You tell her that
A. a deficiency of vitamin D results in an inadequate
mineralization of bone matrix.
B. all vitamins need to be supplemented.
C. vitamin D increases intestinal absorption of
dietary calcium and mobilizes calcium from the
bone.
D. vitamin D binds with calcium to allow active
transport into the cells. - ANSW-Answer C
Advise clients taking calcium supplements that they
also need to take vitamin D because vitamin D raises
serum calcium levels by increasing the intestinal
absorption of dietary calcium and mobilizing calcium
from the bone.
Sandy, age 49, presents with loss of anal
sphincter tone, impaired micturition, incontinence,
and progressive loss of strength in the legs. You suspect
cauda equina syndrome. What is your next action?
A. Order physical therapy.
B. Order a lumbar/sacral x-ray.
C. Order extensive lab work.
D. Refer to a neurosurgeon. - ANSW-Answer D
A prompt referral to a neurosurgeon is required when
a diagnosis of cauda equina syndrome is suspected
Colchicine may be used to terminate an
acute attack of gouty arthritis, as well as to prevent
recurrent episodes. The mechanism of action is to
A. interrupt the cycle of urate crystal deposition and
inflammatory response.
B. increase serum uric acid levels.
C. potentiate the excretion of uric acid.
D. inhibit the tubular reabsorption of urate,
promoting the excretion of uric acid. - ANSW-Answer A
The mechanism of action of colchicine is to
interrupt the cycle of urate crystal deposition and
inflammatory response
James, age 17, has been complaining
of a painful knob below his right knee that has
prevented him from actively participating in
sports. He has recently been given a diagnosis of
Osgood-Schlatter disease and asks you about his
treatment options. You tell him that the initial
treatment is
A. relative rest; he could benefit from hamstring
stretching, heel cord stretching, and quadriceps
stretching exercises.
B. immobilization; a long-leg knee immobilizer is
recommended.
C. surgical intervention; removal of the bony
fragments is necessary.
D. bedrest for 1 week. - ANSW-Answer A
Osgood-Schlatter disease is an overuse injury
that results from excessive tension and pull of the
patellar tendon on the tibial tuberosity.
Mrs. Matthews has rheumatoid arthritis.
On reviewing an x-ray of her hip, you notice that
there is a marked absence of articular cartilage.
What mechanism is responsible for this?
A. Antigen-antibody formation
B. Lymphocyte response
C. Immune complex formation
D. Lysosomal degradation - ANSW-Answer D
Lysosomal degradation results when leukocytes
produce lysosomal enzymes that destroy articular
cartilage in rheumatoid arthritis
Mr. McKinsey was recently given a
diagnosis of degenerative joint disease. Which
assessment test would you use to check for effusion
on his knee?
A. Thomas test
B. Tinel ' s sign
C. Bulge test
D. Phalen ' s test - ANSW-Answer C
The bulge test assesses for an effusion of the knee. If
effusion is present, a bulge will appear to the sides of
or below the patella when the practitioner compresses
the area above the patella. The Thomas test is used to
assess for hip problems. Both Tinel ' s sign and Phalen ' s
test assess for carpal tunnel syndrome
Cass, age 67, tells you that she has been
diagnosed with a condition that causes sudden
flares of pain, swelling, and redness of the joints
in her toes. She cannot remember the name of the
diagnosis but she knows that it is caused by urate
crystals that " get stuck in the joint and cause pain. " Joan is on hydrochlorothiazide (HCTZ) for
management of her hypertension. You suspect a
diagnosis of
A. septic arthritis.
B. gout.
C. rheumatoid arthritis.
D. Charcot neuro-osteoarthropathy. - ANSW-Answer B
Gout is a disorder that involves abnormal
metabolism of uric acid and results in hyperuricemia
Marsha, age 34, presents with
symptoms resembling both fibromyalgia and
chronic fatigue syndrome, which have many
similarities. Which of the following is more
characteristic of fibromyalgia than of chronic
fatigue syndrome?
A. Musculoskeletal pain
B. Difficulty sleeping
C. Depression
D. Fatigue - ANSW-Answer A
Musculoskeletal pain is not characteristic of chronic
fatigue syndrome; rather, it is characteristic of
fibromyalgia.
Jim, age 64, has rheumatoid arthritis
(RA). Which of the following drugs would be of the
least benefit?
A. Disease-modifying antirheumatic drugs
(DMARDs)
B. Acetaminophen (Tylenol)
C. NSAIDs
D. Glucocorticoids - ANSW-Answer B
The client with rheumatoid arthritis (RA) benefits
from DMARDs, NSAIDs, and steroids because
they all treat the disease of RA as well as the pain.
You have just completed a work-up on
Michael, age 13, and confirmed Osgood-Schlatter
disease. You should
A. refer to orthopedics for early surgical correction.
B. recommend physical therapy for quadricepsstrengthening
exercises.
C. advise him to temporarily discontinue all sports
activities until his growth plates have completely
fused.
D. tell Michael that he can resume his usual
activities immediately without concern and
should begin aggressive exercises to increase
muscle bulk and strength. - ANSW-Answer B
Osgood-Schlatter is usually a benign, self-limited
knee condition in adolescent boys and girls.
Treatment consists of ice, analgesics, NSAIDs, and
temporary avoidance of pain-producing activities
Janine, age 69, has a class III case
of rheumatoid arthritis. According to the
American Rheumatism Association, her
function would be
A. adequate for normal activities despite a handicap
of discomfort or limited motion of one or more
joints.
B. largely or wholly incapacitated, bedridden, or
confined to a wheelchair permitting little or no
self-care.
C. completely able to carry on all usual duties
without handicaps.
D. adequate to perform only few or none of the
duties of usual occupation or self-care. - ANSW-Answer D
The American Rheumatism Association has
identified functional classes I - IV depending on the
client ' s ability to accomplish activities of daily living
Ginny, age 48, has rheumatoid arthritis
and gets achy and stiff after sitting through a long
movie. This is referred to as
A. longevity stiffness.
B. gelling.
C. intermittent arthritis.
D. molding. - ANSW-Answer B
Gelling refers to the achiness and stiffness that
occur in clients with rheumatoid arthritis after a
period of inactivity
A 13-year-old obese (BMI greater than 95%)
boy reports low-grade left knee pain for the
past 2 months. He denies antecedent trauma
but admits to frequent " horseplay " with his
friends. The pain has progressively worsened,
and he is now unable to bear weight at all on
his left leg. His current complaints include
left groin, thigh, and medial knee pain and
tenderness. His examination demonstrates
negative drawer, Lachman, and McMurray
tests; left hip with decreased internal rotation
and abduction; and knee flexion causing
external hip rotation. Based on the above
scenario, you suspect
A. left meniscal tear.
B. left anterior cruciate ligament (ACL) tear.
C. slipped capital femoral epiphysis (SCFE).
D. Osgood-Schlatter disease. - ANSW-Answer C
Slipped capital femoral epiphysis (SCFE) is a
displacement of the femoral head relative to the
femoral neck that occurs through the physis (growth
plate) of the femur
You are assessing Mike, age 16, after a
football injury to his right knee. You elicit a positive
anterior/posterior drawer sign. This test indicates
an injury to the
A. lateral meniscus.
B. cruciate ligament.
C. medial meniscus.
D. collateral ligament. - ANSW-Answer B
A positive anterior or posterior drawer sign indicates
an injury to the anterior or posterior cruciate
ligaments, respectively. The drawer test, or Lachman
test, are both utilized to assess for cruciate ligament
injury.
When wrist and finger extension causes
pain over the extensor carpi radialis brevis
tendon, the extensor carpi radialis longus tendon, and the extensor digitorum communis,
you would suspect
A. tennis elbow.
B. golfer ' s elbow.
C. de Quervain ' s disease.
D. intersection syndrome. - ANSW-Answer A
With tennis elbow, wrist and finger extension causes
pain over the extensor carpi radialis brevis tendon,
the extensor carpi radialis longus tendon, and the
extensor digitorum communis
When you elicit a painful Finkelstein ' s
sign, you are testing for
A. carpal tunnel syndrome.
B. bursitis of the shoulder.
C. de Quervain ' s tenosynovitis.
D. tennis elbow. - ANSW-Answer C
Pain elicited when the Finkelstein ' s test is performed
indicates de Quervain ' s tenosynovitis at the base of
the thumb.
Alexander, age 18, sprained his ankle
playing ice hockey. He is confused as to whether to
apply heat or cold. What do you tell him?
A. " Use continuous heat for the first 12 hours,
then use heat or cold to your own
preference. "
B. " Use continuous cold for the first 12 hours, then
use heat or cold to your own preference. "
C. " Apply cold for 20 minutes, then take it off for
30 - 45 minutes; repeat for the first 24 - 48 hours
while awake. "
D. " Alternate between cold and heat for 20 minutes
each for the first 24 - 48 hours. " - ANSW-Answer C
Tell a client who has sprained his ankle to apply
cold for 20 minutes, then take it off for 30 - 45
minutes, and repeat that procedure for the first
24 - 48 hours while awake
In analyzing synovial fluid, a yellow-green
color may indicate which of the following?
A. Trauma
B. Gout
C. A bacterial infection
D. Rheumatoid arthritis - ANSW-Answer D
Synovial fluid that is turbid and yellow-green on
analysis indicates an inflammation, such as one that
occurs in rheumatoid arthritis
To diagnose fibromyalgia, there must be
tenderness on digital palpation in at least 11 of 18
(nine pairs) tender-point sites, which would include
A. the occiput, low cervical, trapezius, and supraspinatus.
B. the proximal interphalangeal (PIP),
metacarpophalangeal (MCP) joints of the hands,
and the metatarsophalangeal (MTP) and PIP
joints of the foot.
C. the facet joints of the cervical, thoracic, and
lumbar spine.
D. the radial and ulnar styloids and the medial and
lateral malleoli. - ANSW-Answer A
To diagnose fibromyalgia, there must be tenderness
on digital palpation in at least 11 of 18 (nine
pairs) tender-point sites, including the occiput,
low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and
knee
Trevor, age 4, has an apparent hypertrophy
of the calf muscles, which seem doughy on
palpation. His mother is concerned because Trevor
is unable to raise himself from the floor without
bracing his knees with his hands. What do you
suspect?
A. Duchenne muscular dystrophy
B. Cerebral palsy
C. Legg-Calv é -Perthes disease
D. Multiple sclerosis - ANSW-Answer A
Duchenne muscular dystrophy, inherited in a sexlinked
recessive pattern, afflicts boys, with the onset
usually occurring around ages 3 - 5. The inability
of the child to raise himself without supporting
his knees because of weakness beginning primarily
in the calf muscles, quadriceps, and hip extensor
muscles is characteristic.
Sandra, a computer programmer, has
just been given a new diagnosis of carpal tunnel
syndrome. Your next step is to
A. refer her to a hand surgeon.
B. take a more complete history.
C. try neutral position wrist splinting and order an
oral NSAID.
D. order a nerve conduction study such as an
electromyography (EMG). - ANSW-Answer C
For the client who has just been given a diagnosis
of carpal tunnel syndrome, your next step is to
try neutral position wrist splinting and order
an oral NSAID
Carol, age 62, has swollen, bony
proximal interphalangeal joints. You describe
these as
A. Heberden ' s nodes.
B. Bouchard ' s nodes.
C. Osler ' s nodes.
D. Murphy ' s nodes. - ANSW-Answer B
Swollen, bony proximal interphalangeal joints are
Bouchard ' s nodes. Bony enlargements of the distal
interphalangeal joints are Heberden ' s nodes
Jennifer says that she has heard that
caffeine can cause osteoporosis and asks you why.
How do you respond?
A. " Caffeine has no effect on osteoporosis. "
B. " A high caffeine intake has a diuretic effect
that may cause calcium to be excreted more
rapidly. "
C. " Caffeine affects bone metabolism by altering
intestinal absorption of calcium and assimilation
of calcium into the bone matrix. "
D. " Caffeine increases bone resorption. " - ANSW-Answer B
The effect of caffeine in causing osteoporosis is
controversial, but it is postulated to result from
caffeine ' s diuretic effect that causes calcium to be
excreted more rapidly
You suspect adolescent idiopathic scoliosis
in Victoria, age 15, who is in her growth spurt. You
perform the Adams forward-bending test and note a
right-sided rib hump. What is this indicative of?
A. Right lumbar shifting
B. Right thoracic curvature
C. Right truncal shift
D. Spondylolysis - ANSW-Answer B
When you have a client bend forward to assess the
spine (the Adams forward-bending test) and you
note a right-sided rib hump, this is indicative of a
right thoracic curve
Joan, age 76, has been give a diagnoses
of osteoporosis confirmed with a dual-energy x-ray
absorptiometry (DEXA) scan. You have educated
her about the importance of increasing calcium and
vitamin D in her diet and starting a low impact
weight bearing exercise program. You are also going
to start her on medial management. Joan asks you
about a drug called a " SERM " that she has heard
has been shown in studies to prevent vertebral
factures. Which of the following pharmacological
therapies for osteoporosis is classified as a selective
estrogen receptor modulator (SERM)?
A. Alendronate
B. Risedronate
C. Salmon calcitonin
D. Raloxifene - ANSW-Answer D
Raloxifene is a selective estrogen receptor
modulator. Intranasal salmon calcitonin has
been shown effective for pain management of
osteoporotic fracture, but data on fracture incidence
with this treatment is not available
Lillian, age 70, was told that she has
osteoporosis. When she asks you what this is, you
respond that osteoporosis
A. develops when loss of bone matrix (resorption)
occurs more rapidly than new bone growth
(deposition).
B. is a degenerative joint disease characterized by
degeneration and loss of articular cartilage in
synovial joints.
C. is a chronic, systemic inflammatory disorder
characterized by persistent synovitis of multiple
joints.
D. is a metabolic bone disorder characterized by
inadequate mineralization of bone matrix. - ANSW-Answer A
Osteoporosis develops when bone resorption occurs
more rapidly than bone deposition. Osteoarthritis
is a degenerative joint disease characterized by
degeneration and loss of articular cartilage in
synovial joints
A Baker ' s cyst is
A. an inflammation of the bursa.
B. a form of tendinitis.
C. the buildup of synovial fluid behind the knee.
D. the result of a " swollen " ligament. - ANSW-Answer C
A Baker ' s cyst, also called popliteal cyst, is the
buildup of synovial fluid behind the knee. It usually
results from inflammation resulting from knee
arthritis or a cartilage (especially meniscal) tear and
consists of local pain, inability to extend the knee,
and symptoms related to compression of surrounding
structures
When teaching Alice, age 67, to use a
cane because of osteoarthritis of her left knee, an
important point to stress is to tell her to
A. carry the cane in the ipsilateral hand.
B. advance the cane with the ipsilateral leg.
C. make sure that the cane length equals the height
of the iliac crest.
D. use the cane to aid in joint protection and
safety. - ANSW-Answer B
When teaching clients about using a cane, tell them
to advance the cane with the ipsilateral (affected)
leg. The cane should be carried in the contralateral
hand and the cane length should equal the height of
the greater trochanter
Which of the following is true regarding
scoliosis?
A. Functional scoliosis is flexible; it is apparent with
standing and disappears with forward bending.
B. Functional scoliosis is fixed; the curvature shows
both on standing and bending forward.
C. Structural scoliosis is fixed; the curvature shows
both on standing and bending forward.
D. Functional scoliosis is permanent, whereas
structural scoliosis can result from outside
influences such as leg length discrepancy or
muscle spasms. - ANSW-Answer A
Scoliosis is a curve in the spine. It is prominent
beginning between ages 8 and 10 years through
adolescence and is more common in females than in
males. Functional scoliosis is flexible; it is apparent
with standing and disappears with forward bending
Jessie, age 49, states that she thinks she
has rheumatoid arthritis. Before any diagnostic tests
are ordered, you complete a physical examination
and make a tentative diagnosis of osteoarthritis
rather than rheumatoid arthritis. Which clinical
manifestation ruled out rheumatoid arthritis?
A. Fatigue
B. Affected joints are swollen, cool, and bony hard
on palpation
C. Decreased range of motion
D. Stiffness - ANSW-Answer B
In osteoarthritis, the affected joints are swollen,
cool, and bony hard on palpation. With rheumatoid
arthritis, the affected joints appear red, hot, and
swollen and are boggy and tender on palpation
In assessing an infant for developmental
dysplasia of the hip (DDH), the practitioner places
the infant supine, flexes the knees by holding the
thumbs on the inner midthighs, with fingers outside
on the hips touching the greater trochanters,
stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external
rotation feels smooth with no sound present, there
is no hip dislocation. This is
A. the Allis test.
B. Lasègue ' s sign.
C. the McMurray test.
D. Ortolani maneuver. - ANSW-Answer D
In performing Ortolani ' s maneuver to assess for
developmental dysplasia of the hip (formerly referred
to as congenital hip dislocation), the practitioner
places the infant supine, flexes the knees, places
thumbs on the medial proximal thighs and fingers on
the greater trochanters, and stabilizes one thigh while
the other thigh is gently abducted
You are caring for a patient that has
a history of psoriasis and now is showing signs
of musculoskeletal signs and symptoms with
joint involvement. Seropositivity provides a
definitive diagnosis of psoriatic arthritis (PsA).
Your initial treatment choice for management
of the patient is
A. disease-modifying antirheumatic drugs
(DMARDs).
B. NSAIDs.
C. tumor necrosis factor - alpha inhibitors (TNF- α
inhibitors).
D. uricosuric. - ANSW-Answer B
NSAIDs are the first-line treatment for
musculoskeletal signs and symptoms with joint
involvement. DMARDs such as methotrexate are
used for early-stage treatment of active disease with
structural damage and inflammation
What disorder affects older individuals,
particularly women, and is characterized by pain and
stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as
malaise, weight loss, sweats, and low-grade fever?
A. Fibromyalgia syndrome
B. Myofascial somatic dysfunction
C. Polymyalgia rheumatica
D. Reiter ' s syndrome - ANSW-Answer C
Myalgias in the cervical spine and shoulder and
hip girdle with polymyalgia rheumatica (PMR)
can be profound and are commonly accompanied
by systemic symptoms. Arthralgias may also occur
which are similar to those found in patients with
rheumatoid arthritis. Fibromyalgia also occurs
more commonly in women but is associated with
a more chronic widespread musculoskeletal pain
and trigger points.
You are considering a diagnosis of
calcium pyrophosphate dihydrate (CPPD) crystal
deposition disease or pseudogout in a 72-yearold
man who presents with complaints of pain
and stiffness in his wrists and knees. The most
useful diagnostic test to assist you in making this
diagnosis would be
A. synovial-fluid analysis and x-ray.
B. bacterial culture.
C. bone scan and MRI.
D. anticitrullinated protein antibody (ACPA) test
and RA factor. - ANSW-Answer A
CPPD disease (pseudogout) may appear clinically
similar to gouty arthritis however, in CPPD crystals
form in the cartilage and lead to inflammation.
Bone mineral density (BMD) testing
is recommended by the National Osteoporosis
Foundation for which of the following client
populations to assess whether they are at high risk
for osteoporosis?
A. All women age 65 and older regardless of risk
factors
B. All men age 65 and older regardless of risk factors
C. All women in their 30s for baseline
D. All women of menopausal age - ANSW-Answer A
The National Osteoporosis Foundation
recommendations indicate that bone mineral
density (BMD) testing should be performed on all
women age 65 and older regardless of risk factors,
on postmenopausal women under age 65 with risk factors, on women of menopausal age with
risk factors, and on individuals who present with
fractures after age 50 to confirm underlying disease
and severity.
The most widely accepted screening tool
for psoriatic arthritis (PsA) is the
A. ACR (American College of Rheumatology)
Criteria
B. CASPAR (Classification of Psoriatic Arthritis)
Criteria
C. Psoriasis Area and Severity Index
D. Rome Criteria - ANSW-Answer B
The CASPAR Criteria is the most widely accepted
tool and has a 91.4% sensitivity and 98.7%
specificity rate. It assigns points from five categories:
current psoriasis, personal history of psoriasis, family
history of psoriasis; typical psoriatic nail dystrophy;
negative rheumatoid factor; current dactylitis or
history of dactylitis; and radiographic evidence of
juxta-articular new bone formation.
Management of fibromyalgia would include
A. giving psychotropic drugs, such as amitriptyline
(Elavil), in a low dose at bedtime.
B. instructing clients to keep as busy as possible to
keep their minds off the symptoms.
C. using high doses of NSAIDs.
D. avoiding exercise. - ANSW-Answer A
Management of fibromyalgia includes giving
tricyclic antidepressants such as amitriptyline
(Elavil) in a low dose at bedtime
Which of the following is a modifiable risk
factor for osteoporosis?
A. Low alcohol intake
B. Low caffeine intake
C. Smoking
D. Excessive exercise - ANSW-Answer C
Modifiable risk factors for osteoporosis include
smoking, high caffeine intake, high alcohol intake,
sedentary lifestyle, calcium deficiency, and estrogen
deficiency
When Maxwell, age 12, slid into
home plate while playing baseball, he injured
his ankle. You are trying to differentiate
between a sprain and a strain. You know that
a sprain
A. is an injury to the ligaments that attach to bones
in a joint.
B. is an injury to the tendons that attach to the
muscles in a joint.
C. is an injury resulting in extensive tears of the
muscles.
D. does not result in joint instability. - ANSW-Answer A
A sprain is defined as an injury to the ligaments that
connect bone to bone in a joint that results from a
twisting motion and may cause joint instability
Which of the following can assist in the
diagnosis of myasthenia gravis?
A. Repetitive nerve stimulation
B. The presence of cogwheel rigidity
C. Chvostek ' s sign
D. Trousseau ' s sign - ANSW-Answer A
Repetitive nerve stimulation (RNS) is the
most frequently used electrodiagnostic test for
myasthenia gravis
Anne Marie states that she has a
maternal history of rheumatoid disease but that she
has never been affected. Today she presents with
complaints of dryness of the eyes and mouth. What
do you suspect?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Sj ö gren ' s syndrome
D. Rosacea - ANSW-Answer C
Sj ö gren ' s syndrome, which affects the salivary and
lacrimal glands, causes clients to have dry eyes
and mouths. It is an inflammatory disease of the
exocrine glands and may be an isolated entity or
may be associated with other rheumatic disease,
such as rheumatoid arthritis (RA) or systemic lupus
erythematosus (SLE).
Alan, age 46, presents with a tender,
red, swollen knee. You rule out septic arthritis and
diagnose gout by confirming
A. an elevated WBC.
B. hyperuricemia.
C. a significant response to a dose of ceftriaxone
(Rocephin).
D. a positive antinuclear antibody test. - ANSW-Answer B
To diagnose gout, there should be a negative joint
culture and hyperuricemia. A septic joint would
likely cause an elevated white blood count (WBC)
and a positive bacterial joint culture
Martin, age 58, presents with urethritis,
conjunctivitis, and asymmetric joint stiffness,
primarily in the knees, ankles, and feet. Which
condition do you suspect?
A. Syphilis
B. Gonorrhea
C. HIV
D. Reactive arthritis - ANSW-Answer D
Reactive arthritis (formerly Reiter ' s syndrome)
is arthritis of the lower extremities and is more
common in white men. Associated symptoms
include the classic triad of conjunctivitis,
nongonococcal urethritis, and arthritis
Hilda, age 73, presents with a complaint
of low back pain. Red flags in her history of a minor
fall, having osteopenia, and prolonged steroid use for
systemic lupus erythematosus suggest the possibility
of which of the following serious underlying
conditions as the cause of her low back pain?
A. Cancer
B. Cauda equina syndrome
C. Neurological compromise
D. Spinal fracture - ANSW-Answer D
The red flags for spinal fracture include major
trauma or a direct blow the back in adults, a minor
fall or heavy lifting in a potentially osteoporotic or
elderly person, prolonged steroid use, and age over
70.
Mary, age 72, has severe osteoarthritis
of her right knee. She obtains much relief from
corticosteroid injections. When she asks you how
often she can have them, how do you respond?
A. Only once a year in the same joint
B. No more than twice a year in the same joint
C. No more than three to four times a year in the
same joint
D. No more than five to six times a year in the same
joint - ANSW-Answer C
Intra-articular corticosteroid injections provide
much needed pain relief in weight-bearing joints of
clients with osteoarthritis; however, they should be
limited to no more than three to four in the same
joint per year because of potential damage to the
cartilage if given more frequently
Which of the following statements
concerning developmental dysplasia of the hip
(DDH) is correct?
A. It is often associated with being the firstborn
female child.
B. It results from an orthopedic malformation in utero.
C. It has no genetic predisposition.
D. It is more common in males. - ANSW-Answer A
Developmental dysplasia of the hip (DDH),
previously referred to as congenital hip dislocation,
occurs in approximately 1% of live births and
is more common in females than males
Anna, age 42, is pregnant and was just
given a diagnosis of carpal tunnel syndrome.
She is worried that this will affect her in caring
for the baby. What do you tell her?
A. " Don ' t worry, we ' ll find a brace that is very
malleable. "
B. " After childbirth, your carpal tunnel syndrome
may resolve. "
C. " If we do surgery now, you ' ll be recovered by the
time the baby arrives. "
D. " You should prepare yourself for the probability of
being unable to care for your baby. " - ANSW-Answer B
Pregnant women have an increased incidence of
carpal tunnel syndrome (CTS) but often have
their carpal tunnel syndrome resolve after delivery.
How can you differentiate between a
ganglion cyst and a neoplasm?
A. A neoplasm is more painful.
B. Ganglia transilluminate.
C. Ganglia cause more swelling.
D. A neoplasm may fluctuate in size. - ANSW-Answer B
Ganglia can be distinguished from neoplasms
by their ability to transilluminate. Large ganglia
and neoplasms may both restrict joint motion
Emily, age 21, presents today with
another muscle strain from one of her many sports
activities. You think that she was probably never
taught about health promotion and maintenance
regarding physical activity. What information do
you include in your teaching?
A. " After an activity, if any part hurts, apply ice for
20 minutes. "
B. " You must first get in shape with a rigorous schedule
of weight training and then you can participate in
any activity once you are physically fit. "
C. " After any strenuous activity, you must
completely rest your muscles before beginning
your next activity. "
D. " Stretching and warm-up exercises are an
important part of any exercise routine. " - ANSW-Answer D
Health promotion and maintenance information
regarding physical activity that should be included
in client teaching includes reminding the client that
stretching and warm-up exercises are an important
part of any exercise routine
Black men have a relatively low incidence
of osteoporosis because they have
A. increased bone resorption.
B. a higher bone mass.
C. wide and thick long bones.
D. decreased bone deposition. - ANSW-Answer B
Black men have a relatively low incidence of
osteoporosis because they have higher levels of
bone mass and are protected by the bone-resorptive
effects of parathyroid hormone
Which individuals does the U.S. Preventive
Services Task Force (USPSTF) recommend
screening for depression?
A. Adults who are experiencing gender issues
B. Adults who have already tried unsuccessfully
to commit suicide
C. All adults
D. If a provider suspects depression, the individual
should be referred to a specialist rather than
screening in the primary care office - ANSW-Answer C
The USPSTF recommends screening all adults for
depression in practices that have systems in place to
assure accurate diagnosis, effective treatment, and
adequate follow-up
Pregnant women should know that folic acid
can help to prevent neural tube defects. For folic
acid to be most effective, women should take it
A. before becoming pregnant.
B. during the second trimester.
C. during the third trimester.
D. soon after a positive pregnancy test. - ANSW-Answer A
Folic acid should be taken before getting pregnant
and during the first few weeks of pregnancy, often
before a woman may even know she is pregnant.
Marta asks you how pregnancy will affect
her rheumatoid arthritis. You respond,
A. "There is a one-third rule: One-third get better, onethird
remain the same, and one-third get worse."
B. "Pregnancy will have no effect on your
rheumatoid arthritis."
C. "Seventy-five percent of women experience
remission of the disease during pregnancy."
D. "It is advised that you don't get pregnant with
this condition." - ANSW-Answer C
For women with rheumatoid arthritis, 75% will
experience remission of their disease during
pregnancy.
In an infant, when you flex the hips and
knees at a 90° angle and attempt to slip the femur
heads onto the posterior tips of the acetabulums
by lateral pressure of the thumbs and by rocking
the knees medially with the knuckles of the index
fingers, you are testing for normal hip movement.
This test or maneuver is known as
A. Ortolani's maneuver.
B. Barlow's test.
C. Spock's test.
D. Moro maneuver. - ANSW-Answer B
Flexing the hips and knees at a 90° angle in an
infant and attempting to slip the femur heads onto
the posterior tip of the acetabulums by lateral
pressure of the thumbs and by rocking the knees
medially with the knuckles of the index fingers is
known as Barlow's test.
Diane is the mother of a child diagnosed
with autism. After the clinician recommends the
seasonal flu vaccine for the family, Diane asks,
"Does the flu vaccine contain thimerosal"? The
clinician knows that
A. the nasal spray does not contain thimerosal.
B. multidose vials do not contain thimerosal.
C. all flu vaccine vials do not contain thimerosal.
D. trace amounts of thimerosal are found in singledose
units. - ANSW-Answer A
Seasonal influenza vaccine is produced in large
quantities for annual immunization campaigns
Shana shares concerns about her unborn
child. She states, "My sister's child is diagnosed
with autism." The clinician knows the following to
be true about autism spectrum disorder (ASD):
A. There is no genetic predisposition to autism.
B. Females are four times more likely to have an
ASD than males.
C. About 20%-30% of children with an ASD
develop epilepsy by the time they reach
adulthood.
D. Mental retardation occurs in all cases. - ANSW-Answer C
About 20%-30% of children with an autism
spectrum disorder (ASD) develop epilepsy by the
time they reach adulthood. Males are four times
more likely to have ASD than females
Bob, age 49, is complaining of recurrent,
intrusive dreams since returning from his Marine
combat training. You suspect
A. depersonalization.
B. schizophrenia.
C. post-traumatic stress disorder.
D. anxiety. - ANSW-Answer C
Although Bob is experiencing anxiety with
his unpleasant dreams, they are a component
of post-traumatic stress disorder (PTSD).
Dan, age 82, recently lost his wife to breast
cancer. He presents with weight loss, fatigue, and
difficulty sleeping. What should your first response be?
A. " Do you have a history of thyroid problems in
your family? "
B. " Do you think a sleeping pill might help you sleep
at night? "
C. " Things might look up if you added nutritional
supplements to your diet. "
D. " Have you thought of suicide? " - ANSW-Answer D
Direct confrontation should be used when suspecting
depression and the possibility of suicide. Fatigue,
loss of weight, and insomnia, in combination with
the client ' s history of the death of his spouse, should
point in the direction of depression with a suicidal
potential.
If you suspect that your client abuses
alcohol, the most appropriate action would be to
A. confront the client.
B. obtain further confirmatory information.
C. consult with family members.
D. suggest Alcoholics Anonymous (AA). - ANSW-Answer A
If you suspect that your client abuses alcohol, the
most appropriate action would be to confront the
client.
The use of tricyclic antidepressants in the
elderly increases the risk of
A. suicide.
B. cardiac arrhythmias.
C. reactive depression.
D. shortness of breath. - ANSW-Answer B
A study by the Heart and Lung Institute of the
National Institute of Health in the mid-1980s
showed that class 1 antiarrhythmic drugs given to
patients with ventricular arrhythmias following
myocardial infarction, instead of preventing deaths,
actually increased the number of patients dying
In the depressed client, antidepressants are
most effective in alleviating
A. suicidal feelings.
B. interpersonal problems.
C. sleep disturbances.
D. anxiety disorders. - ANSW-Answer C
In the depressed client, antidepressants are
most effective in alleviating sleep and appetite
disturbances. Psychotherapy is most effective in
dealing with suicidal feelings and interpersonal
problems.
Jim, age 45, has two small children.
He states that his wife made him come to this
appointment because she thinks he has been
impossible to live with lately. He admits to being
stressed and depressed because he is working
two jobs, and he says he sometimes takes his
stress out on his family. About twice a week he
complains of palpitations along with nervous
energy. What is the most important question
to ask him at this time?
A. " How is your wife handling stress? "
B. " Have you thought about committing suicide? "
C. " Do you and your wife spend time alone together? "
D. " Tell me more about what you think is causing
this. " - ANSW-Answer B
Although all the questions are important, suicidal
ideation is an emergency situation, and if it is
present, the client needs immediate admission,
preferably to a psychiatric hospital
What is the medication of choice for
obsessive-compulsive disorders?
A. Alprazolam (Xanax)
B. Carbamazepine (Tegretol)
C. Clomipramine (Anafranil)
D. Buspirone (Buspar) - ANSW-Answer C
The medication of choice for obsessive-compulsive
disorders is clomipramine (Anafranil), a tricyclic
antidepressant. It seems to have a much better effect
than alprazolam (Xanax), an antianxiety agent;
carbamazepine (Tegretol), an anticonvulsant; or
buspirone (Buspar), a nonbenzodiazepine anxiolytic.
Which of the following objective data are
associated with significantly better long-term
outcomes in children born with open spina bifida?
A. A higher APGAR score
B. Presence of Babinski ' s reflex
C. Perineal sensation
D. A higher score on the Glasgow Coma Scale - ANSW-Answer C
In infants with open spina bifida, the presence of
perineal sensation is associated with significantly
better long-term outcomes
Karen Ann, age 52, has four children and
a very stressful job. After you perform her physical,
which was normal, she tells you she has insomnia.
You make several suggestions for lifestyle changes
that might assist in promoting helpful sleep. You
know she misunderstands when she states which of
the following?
A. " I ' ll wind down before bedtime by taking a warm
bath or by reading for 10 minutes. "
B. " I ' ll try some valerian extract from the health
food store. "
C. " I ' ll exercise in the evening to tire myself out
before bed. "
D. " I won ' t read or watch television while in bed. " - ANSW-Answer C
Suggestions for making lifestyle changes that might
assist a client in promoting helpful sleep include
advising the client to wind down before bedtime by
taking a warm bath or by reading for 10 minutes, to
try some valerian extract (obtainable from a health
food store), and not to read or watch television
while in bed.
Mary, age 82, appears without an
appointment. She is complaining of a new,
unilateral headache; fever; and muscle aches.
She denies any precipitating event. On further
examination, you note that her erythrocyte
sedimentation rate is over 100 mm/min. What do
you suspect?
A. Temporal arteritis
B. Meningitis
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage - ANSW-Answer A
Temporal arteritis, also called giant cell arteritis,
presents as a systemic illness with generalized
symptoms such as fever, myalgia, arthralgia, anemia, and elevated liver function tests.
Julie, age 15, is 5 ft tall and weighs 85 lb.
You suspect anorexia and know that the best initial
approach is to
A. discuss proper nutrition.
B. tell Julie what she should weigh for her height
and suggest a balanced diet.
C. speak to her parents before going any further.
D. confront Julie with the fact that you suspect an
eating disorder. - ANSW-Answer D
If you suspect anorexia, the best initial approach
is to confront Julie with the fact that you suspect
an eating disorder
Obsessive-compulsive disorder symptoms
usually occur
A. before age 15.
B. during midlife crises.
C. during late adolescence and early adulthood.
D. in later life. - ANSW-Answer A
Obsessive-compulsive disorder symptoms usually
occur before age 15. Young people in their early
teens with obsessive-compulsive disorder are
inflexible, lack spontaneity, are ambivalent, and
are in a constant state of conflict while harboring
hostile feelings
Jim, a 45-year-old postal worker, presents
for the first time with a sudden onset of intense
apprehension, fear, dyspnea, palpitations, and a
choking sensation. What is your initial diagnosis?
A. Anxiety
B. Panic attack
C. Depression
D. Agoraphobia - ANSW-Answer B
A panic attack is characterized by its episodic
nature. It is manifested by the sudden onset of
intense apprehension, fear, or terror and the
abrupt development of some of the following
symptoms: dyspnea, palpitations, chest pain or
discomfort, choking or smothering sensations,
dizziness, a feeling of being detached, diaphoresis,
trembling, and nausea.
June, age 79, comes to your office with
a recent onset of depression. She is taking several
medications. Which medication is safe for her
to take because depression is not one of the side
effects?
A. Antiparkinsonian agents
B. Hormones
C. Cholesterol-lowering agents
D. Antihypertensive agents - ANSW-Answer C
The diagnosis of depression in an older adult
is especially difficult when a medical illness is
present
Mark, age 29, tells you that he has thought
about suicide. Which should you say next?
A. " How long have you felt this way? "
B. " Tell me more about it. "
C. " Do you have a plan? "
D. " Have you told anyone else? " - ANSW-Answer C
A client ' s intent or commitment to the act of suicide
by means of a plan suggests a high risk of actually
committing the act
Which of the following interventions
can significantly slow the decline in performing
activities of daily living (ADLs) in clients with
Alzheimer ' s disease living in a nursing home?
A. A simple exercise program
B. Ginkgo biloba
C. Doing crossword puzzles
D. Improving nutritional state - ANSW-Answer A
A simple exercise program, 1 hour twice a week,
has been shown to significantly slow the decline in performing ADLs in persons living in a nursing
home
Which statement is accurate regarding a
client who is at highest risk for an eating disorder?
A. The client is male
B. The client is usually 25 - 35 years of age
C. The client has low self-esteem
D. The client has a bipolar personality - ANSW-Answer C
Clients with eating disorders tend to have low selfesteem.
Other factors that appear to increase the
risk for an eating disorder include female gender,
young age, perfectionist personality, family history
of eating disorders, attempts to diet, depression, and
living in cultures in which thinness is a standard of
beauty.
Marie, age 17, was raped when she was
13. She is now experiencing sleeping problems,
flashbacks, and depression. What is your initial
diagnosis?
A. Depression
B. Panic disorder
C. Anxiety
D. Post-traumatic stress disorder - ANSW-Answer D
Clients with post-traumatic stress disorder (PTSD)
have experienced some severe catastrophic event (in
this case, rape) and reexperience the event by having
recurrent, often intrusive images of the trauma and
recurrent dreams or nightmares of the event.
What is the most sensitive diagnostic test
for identifying an alcoholic client?
A. Aspartate transaminase (AST, also called serum
glutamic-oxaloacetic transaminase [SGOT])
B. Mean corpuscular volume
C. Alkaline phosphatase
D. γ -glutamyltransferase (GGT) - ANSW-Answer D
The most sensitive diagnostic test for identifying an
alcoholic client is the γ -glutamyltransferase (GGT)
test. GGT is an enzyme produced in the liver after
consumption of five or more drinks daily.
The persistent and irrational fear of a
specific object, activity, or situation that results
in a compelling desire to avoid the dreaded object,
activity, or situation is defined as
A. depression.
B. obsession-compulsion.
C. agoraphobia.
D. phobia. - ANSW-Answer D
A phobia is the persistent and irrational fear of a
specific object, activity, or situation that results in
the compelling desire to avoid the dreaded object,
activity, or situation
Which of the following is characteristic of a
manic episode?
A. Weight loss or gain
B. Insomnia or hypersomnia
C. Diminished ability to think or concentrate
D. Grandiose delusions - ANSW-Answer D
Grandiose delusions are exaggerated beliefs of
one ' s importance or identity, one of the criteria for
a manic episode
Major depression occurs most often in
which of the following conditions?
A. Parkinson ' s disease
B. Alzheimer ' s disease
C. Myocardial infarction
D. Stroke - ANSW-Answer D
Sixty percent of clients suffer major depression
during their first year after a stroke. Other depressive
symptoms, as well as major depression, may also
occur, although usually less often, with thyroid
disorders, Parkinson ' s disease, heart disease, and
dementia.
Jenna has been diagnosed with a
generalized anxiety disorder (GAD). You know that
she may experience which of the following?
A. She may be worried or anxious about having a
panic attack.
B. She may be worried about being separated or
about being away from home or close relatives.
C. She may have been excessively anxious and
worried on most days for more than 6 months.
D. She may have multiple physical complaints or
believe she has a physical illness. - ANSW-Answer C
According to DSM-IV, the diagnostic manual from
the American Psychiatric Association (APA),
generalized anxiety disorder (GAD) is present
if excessive anxiety and worry (apprehensive
expectation) occurs more days than not for
6 months about a number of events or activities
such as work or school performance, if the client
finds it difficult to control the worry, and if three
or more of the following six symptoms are present:
restlessness, fatigability, difficulty in concentration,
irritability, muscle tension, and sleep disturbances.
Sharon, age 29, is pregnant for the first time. She complains of nasal stuffiness and occasional epistaxis.
What do you do?
A. Order lab tests, such as a CBC with differential, hemoglobin and hematocrit
B. Prescribe an antihistamine
C. You do nothing except for client teaching
D. Refer the client to an ear, nose and throat specialist - ANSW-C. You do nothing except for client
teaching
- Can occur with pregnancy because of increased vascularization in the upper respiratory tract
David, age 32, states that he thinks he has an ear infection because he just flew back from a business trip
and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
A. Prescribe nasal steroids and oral decongestants
B. Prescribe antibiotic eardrops
C. Prescribe systemic eardrops
D. Refer David to an ear, nose, and throat specialist - ANSW-A. Prescribe nasal steroids and oral
decongestants
A sexual history of oral-genital contact in a client presenting with pharyngitis is significant when which of
the following organisms is suspected?
A. Escherichia coli
B. Haemophilus influenzae
C. Neisseria gonorrhoeae
D. Streptococcus pneumoniae - ANSW-C. Neisseria gonorrhoeae
- Neisseria gonorrhoeae pharyngitis is a common sexually transmitted disease
The most common cause of sensoineural hearing loss is
A. Trauma
B. Tympanic membrane sclerosis and scarring
C. Otosclerosis
D. Presbycusis - ANSW-D. Presbycusis
How do you describe the cervical lymphadenopathy associated with asymptomatic HIV infection?
A. Movable, discrete, soft, and nontender lymph nodes
B. Enlarged, warm, tender, firm, but freely movable lymph nodes
C. Hard, unilateral, nontender, and fixed lymph nodes
D. Firm but not hard, nontender, and mobile lymph nodes - ANSW-D. Firm but not hard, nontender, and
mobile lymph nodes
You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergeny room.
Which of the following symptoms would indicate that an airway obstruction is imminent?
A. Reddened face
B. Screaming
C. Grabbing her throat
D. Stridor - ANSW-D. Stridor
Purulent matter in the anterior chamber of the eye is called
A. Hyphema
B. Hypopyon
C. Anisocoria
D. Pterygium - ANSW-B. Hypopyon
A 42 year old stockbroker comes to your office for evaluation of a pulsating headache over the left
temporal region and he rates the pain as an 8 on a scale of 1-10. The pain has been constant for the past
several hours and is accompanied by nausea and sensitivity to light. He has had frequent headaches for
many years but not as severe and they are usually relieved by over the counter medicines. He is unclear
as to a precipitating event but notes that he has had visual disturbances before each headache and has
been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this
type of headaache?
A. Tension
B. Migraine
C. Cluster
D. Temporal arteritis - ANSW-B. Migraine
The trachea deviates toward the affected side in all of the following except
A. Aortic aneurysm
B. Unilateral thyroid lobe enlargement
C. Large atelectasis
D. Pneumothorax - ANSW-C. Large atelectasis
Matthew, age 52, has allergic rhinitis and would like some medicine to relieve his symptoms. He is taking
cimetidine (Tagamet) for gastroesophageal reflux disease. Which medication would you not order?
A. A first-generation antihistamine
B. A second-generation antihistamine
C. A decongestant
D. A topical nasal corticosteroid - ANSW-B. A second-generation antihistamine
Jessica, an 8 year old third grader is broght to the office by her grandmother, who is the child's
babysitter. She has complained of fever and sore throat for the past 2 days. Five other children in her
class have been sick with sore throats. She denies difficulty swallowing and has been drinking fluids but
has no appetite. ROS reveals that she has clear nasal drainage, hoarseness, and nonproductive cough.
She denies vomiting but has had mild diarrhea. On examination she has a temperature of 101.5 F, 3+
erythematous tonsils, and palpable, tender cervical lymph nodes. Based on these findings, what is the
most likely diagnosis?
A. Mono
B. Sinusitis
C. Strep pharyingitis
D. Viral pharyngitis - ANSW-D. Viral pharyngitis
Marcia, age 4, is brought into the office by her mother. She has a sore throat, difficulty swallowing,
copious oral secretions, respiratory difficulty, stridor, and a temperature of 102 F but no pharyngeal
erythema or cough. What do you suspect?
A. Epiglottitis
B. Group A beta-hemolytic streptococcal infection pharyngitis
C. Tonsillitis
D. Diphtheria - ANSW-A. Epiglottitis
You note a completely split uvula in Noi, a 42 year old Asian. What is your next course of action?
A. Do nothing
B. Refer Noi to a specialist
C. Perform a throat culture
D. Order a CBC - ANSW-A. Do nothing
Claude, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle
glaucoma. While performing a new client history and physical, you note that he is taking other
medications. Which medication would you be most concerned about?
A. Apsirin therapy as prophylaxis for heart attack
B. Ranitidine (Zantac) for gastroesophageal reflux disease
C. Alprazolam (Xanax), an anxiolytic for anxiety
D. Atenolol (Tenormin), a beta blocker for high blood pressure - ANSW-D. Atenolol (Tenormin), a beta
blocker for high blood pressure
Harry, age 69, has had Meniere's disease for several years. He has some hearing loss but now has
persistent vertigo. What treatment might be instituted to relieve the vertigo?
A. A labyrinthectomy
B. Pharmacological therapy
C. A vestibular neurectomy
D. Wearing an earplug in the ear with the most hearing loss - ANSW-C. A vestibular neurectomy
A 65 year old man presents complaining of left sided deep, throbbing headache along with mild fatigue.
On examination the client has a tender, tortuous temporal artery. You suspect temporal arteritis. How do
you confirm your diagnosis?
A. MRI fo the head
B. Erythrocyte sedimentation rate (ESR)
C. EEG
D. Otoscopy - ANSW-B. Erythrocyte sedimentation rate (ESR)
Marty has a hordeolum in his right eye. You suspect that the offending organism is
A. Herpes simplex virus
B. Staphylococcus
C. Candida albicans
D. Escherichia coli - ANSW-B. Staphylococcus
The most common offending allergens causing allergic rhinitis are
A. Pollens of grasses, trees and weeds
B. Fungi
C. Animal allergens
D. Food sensitivity - ANSW-A. Pollens of grasses, trees, and weeds
Cydney, age 7, is complaining that she feels as though something is stuck in her ear. What action is
contraindicated?
A. Inspecting the ear canal with an otoscope
B. Using a small suction device to try to remove the object
C. Flushing the ear with water
D. Instilling several drops of mineral oil in the ear - ANSW-C. Flushing the ear with water
June, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthus. She is
concerned that they may be cancerous skin lesions. You tell her they are probably
A. Xanthelasmas
B. Pingueculae
C. The result of arcus senilis
D. Actinic keratoses - ANSW-A. Xanthelasmas
Mavis is 70 years old and wonders if she can donate her corneas when she dies. How do you respond?
A. "As long as you don't have any chronic illness, you corneas may be harvested."
B. "They will use corneas only from persons younger than age 65."
C. "What makes you feel like you are dying?"
D. "Don't think about such terrible things now." - ANSW-B. "They will use corneas only from persons
younger than age 65."
Manny, age 16, was hit in the eye with a baseball. He developed pain in the eye, decreased visual acuity,
and injection of the globe. You confirm the diagnosis of hyphema by finding blood in the anterior
chamber. What treatment would you recommend while Manny is waiting to see the ophthalmologist?
A. Apply bilateral eye patches
B. Have Manny lie flat
C. Refer him to an ophthalmologist within a week
D. Make sure Manny is able to be awakened every 30 minutes - ANSW-A. Apply bilateral eye patches
Judy, age 67, complains of a sudden onset of impaired vision, severe eye pain, vomiting, and a headache.
You diagnose the following condition and refer for urgent treatment
A. Cataracts
B. Macular degeneration
C. Presbyopia
D. Acute glaucoma - ANSW-D. Acute glaucoma
Which of the following refractive errors in vision is a result of the natural loss of accomodative capacity
with age?
A. Presbyopia
B. Hyperopia
C. Myopia
D. Astigmatism - ANSW-A. Presbyopia
The leading cause of blindness in persons age 20-60 in the United States is
A. Macular degeneration
B. Glaucoma
C. Diabetic retinopathy
D. Trauma - ANSW-C. Diabetic retinopathy
A 62 year old obese woman comes in today complaining of difficulty swallowing for the past 3 weeks.
She states that "some foods get stuck" and she has been having "heartburn" at night when she lies
down, especially if she has had a heavy meal. Occasionally she will awake at night coughing. She denies
weight gain and/or weight loss, vomiting, or change in bowel movements. She does not drink or smoke.
There is no pertinent family history or findings on review of systems (ROS). Physical examination is
normal with no abdominal tenderness, and the stool is OB negative. What is the most likely diagnosis?
A. Esophageal varices
B. Esophageal cancer
C. Gastroesophageal reflux disease (GERD)
D. Peptic ulcer disease - ANSW-C. Gastroesophageal reflux disease (GERD)
Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What
do you suspect?
A. Acute otitis media
B. Chronic otitis media
C. External otitis
D. Temporomandibular joint syndrome - ANSW-C. External otitis
Barbara, age 72, states that she was told she had atrophic macular degeneration and asks you if there is
any treatment. How do you respond?
A. "No, but 5 years from the time of the first symptoms, the process usually stops."
B. "Yes, there is a surgical procedure that will cure this."
C. "If we start medications now, they may prevent any further damage."
D. "Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can
help you adjust to the visual loss." - ANSW-D. "Unfortunately, there is no effective treatment, but I can
refer you to a rehabilitation agency that can help you adjust to the visual loss."
Natasha, age 4, has amblyopia. How do you respond when her mother asks about treatment?
A. "We'll wait until she's 7 years old before starting treatment."
B. "Treatment needs to be started now. We'll cover her 'bad' eye."
C. "Treatment needs to be started now. We'll cover her 'good' eye."
D. "No treatment is necessary. She'll outgrow this." - ANSW-C. "Treatment needs to be started now. We'll
cover her 'good' eye."
When Judith, age 15, asks you to explain the 20/50 vision in her right eye, you respond
A. "You can see at 20ft with your left eye what the normal person can see at 50ft."
B. "You can see at 20ft with your right eye what the normal person can see at 50ft."
C. "You can see at 50ft with your right eye what the normal person can see at 20ft."
D. "You can see at 50ft with the left eye what the normal person can see at 20ft." - ANSW-B. "You can see
at 20ft with your right eye what the normal person can see at 50ft."
- If vision is greater than 20/30, refer the client to an ophthalmologist or optometrist
Risk factors for oral cancers include
A. A family history, poor dental habits, and use of alcohol
B. Obesity, sedentary lifestyle, and chewing tobacco
C. A history of diabetes, smoking, and a high fat intake
D. Smokine, use of alcohol, and chewing tobacco - ANSW-D. Smoking, use of alcohol, and chewing
tobacco
When you are assessing the internal structure of the eye, absence of a red reflex may indicate
A. A cataract or a hemorrhage into the vitreous humor
B. Acute iritis
C. Nothing, this is a normal finding in older adults
D. Diabetes or long-standing hypertension - ANSW-A. A cataract or a hemorrhage into the vitreous
humor
The immediate goal of myringotomy and tube placement in a child with recurrent episodes of totis
media is to
A. Prevent future infections
B. Have an open access to the middle ear for irrigation and instillation of antibiotics
C. Allow removal of suppurative or mucoid material
D. Relieve pain - ANSW-C. Allow removal of suppurative or mucoid material
A 22 year old client who plays in a rock band complains that he finds it difficult to understand his fellow
musicians at the end of a night of performing, a problem that is compounded by the noisy environment
of the "club." These symptoms are most characteristic of which of the following?
A. Sensorineural loss
B. Conductive loss
C. Tinnitus
D. Vertigo - ANSW-A. Sensorineural loss
With a chronic allergy, a client's nasal mucosa appear
A. Swollen and red
B. Swollen, boggy, pale and gray
C. Hard, pale, and inflamed
D. Bright pink and inflamed - ANSW-B. Swollen, boggy, pale and gray
When a practitioner places a vibrating tuning fork in the midline of a client's skull and asks if the tone
sounds the same in both ears or is better in one, the examiner is performing
A. The Rinne test
B. The Weber test
C. The caloric test
D. A hearing acuity test - ANSW-B. The Weber test
How should Tommy, age 2 1/2, have his vision screened?
A. Using a Snellen letter chart
B. Using the Allen test
C. Using a Snellen E chart
D. Using a Rosebaum chart - ANSW-B. Using the Allen test
What therapy has proved beneficial for long-term symptom relief of tinnitus?
A. Aspirin
B. Lidocaine
C. Cognitive behavioral therapy
D. Corticosporin otic gtts PRN - ANSW-C. Cognitive behavioral therapy
Jill presents with symptoms of hay fever and you assess the nasal mucosa of her turbinates to be pale.
What diagnosis do you suspect?
A. Allergic rhinitis
B. Viral rhinitis
C. Nasal polyps
D. Nasal vestibulitis from folliculitis - ANSW-A. Allergic rhinitis
Which method can be safely used to remove cerumen in a 12 month old child's ear?
A. A size 2 ear curette
B. Irrigation using hot water from a 3cc syringe
C. A commercial jet tooth cleaner
D. Cerumen should not be removed from a child this young - ANSW-C. A commercial jet tooth cleaner
- Only if no suspicion of perforated tympanic membrane
Mark, age 18, has a persistent sore throat, fever, and malaise not relieved with penicillin therapy. What
do you order next?
A. A throat culture
B. A monospot test
C. A rapid antigen test
D. A Thayer-Martin plate test - ANSW-B. A monospot test
You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains
of pain behind her eye. Which sinuses are affected?
A. Maxillary
B. Ethmoid
C. Frontal
D. Sphenoid - ANSW-B. Ethmoid
- Maxillary sinus pain is over the cheek and into the upper teeth
- Frontal sinus pain is over the lower forehead
- Sphenoid sinus pain is in the occiput, vertex, or middle of the head
In older adults, the most common cause of decreased visual functioning is
A. Cataract formation
B. Glaucoma
C. Macular degeneration
D. Arcus senilis - ANSW-A. Cataract formation
Greg, age 72, is brought to the office by his son, who states that his father has been unable to see clearly
since last night. Greg reports that his vision is "like looking through a veil." He also sees floaters and
flashing lights but is not having eye pain. What do you suspect?
A. Cataracts
B. Glaucoma
C. Retinal detachment
D. Iritis - ANSW-C. Retinal detachment
Maggie, a 56 year old woman, comes to the office requesting a test for thyroid disease. She has had
some weight gain since menopause and she read on the internet that all women should have a thyroid
test. Based on the recommendations from the U.S. Preventive Service Task Force, which one of the
following statements should be considered in this woman's care?
A. All adults should be screened for thyroid disease
B. Evidence is insufficient for or against routine screening for thyroid disease in asymptomatic adults
C. All adults older than 50 should be screened for thyroid disease
D. All perimenopausal women should be screened for thyroid disease - ANSW-B. Evidence is insufficient
for or against routine screening for thyroid disease in asymptomatic adults
A child's head circumference is routinely measured at each well-child visit until age
A. 12 months
B. 18 months
C. 2 years
D. 5 years - ANSW-C. 2 years
In a young child, unilateral purulent rhinitis is most often caused by
A. A foreign body
B. A viral infection
C. A bacterial infection
D. An allergic reaction - ANSW-A. A foreign body
A child's central visual acuity is 20/30 by age
A. 18 months
B. 2 years
C. 3 years
D. 4 years - ANSW-C. 3 years
Sara, age 29, states that she has painless, white, slightly raised patches in her mouth. They are probably
caused by
A. Herpes simplex
B. Aphthous ulcers
C. Candidiasis
D. Oral cancer - ANSW-C. Candidiasis
How do you test for near vision?
A. By using the Snellen eye chart
B. By using the Rosenbaum chart
C. By asking the client to read from a magazine or newspaper
D. By testing the cardinal fields - ANSW-B. By using the Rosenbaum chart
- Hold it about 12-14 inches from the client's eyes.
Mandy was given a diagnosis of flu 2 days ago and wants to start on the "new flu medicine" right away.
What do you tell her?
A. "The medication is effective only if started within the first 48 hours after the symptoms begin."
B. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week."
C. "The medicine has not proven its effectiveness."
D. "I'll start you on zanamivir today. It may shorten the course of the disease and perhaps lessen the
severity of your symptoms." - ANSW-D. "I'll start you on zanamivir today. It may shorten the course of
the disease and perhaps lessen the severity of your symptoms."
What condition occurs in almost all persons beginning around age 42-46?
A. Arcus senilis
B. Presbyopia
C. Cataracts
D. Glaucoma - ANSW-B. Presbyopia
Sara, age 92, presents with dry eyes, redness, and a scratchy feeling. You note that this is one of the most
common disorders, particularly in older women, and diagnose this as
A. Viral conjunctivitis
B. Keratoconjunctivitis sicca
C. Allergic eye disease
D. Corneal ulcer - ANSW-B. Keratoconjunctivitis sicca
When you are assessing the corneal light reflex, an abnormal finding indicates
A. Possible use of eye medications
B. A neurological problem
C. Improper alignment of the eyes
D. Strabismus - ANSW-C. Improper alignment of the eyes
- It is noted when the reflections of the light are on different sites on the eyes
While doing a face, head, and neck examination, you note that the palpebral fissures are abnormally
narrow. What are you examining?
A. Nasolabial folds
B. The openings between the margins of the upper and lower eyelids
C. The thyroid gland in relation to the trachea
D. The distance between the trigeminal nerve branches - ANSW-B. The opening between the margins of
the upper and lower eyelids
Signs and symptoms of acute angle-closure glaucoma include
A. Painless redness of the eyes
B. Loss of peripheral vision
C. Translucent corneas
D. Halos around lights - ANSW-D. Halos around lights
Clonazepam (Klonopin) is occasionally ordered for temporal mandibular joint (TMJ) disease. Which of
the following statements applies to this medicine?
A. It is ordered for inflammatory pain
B. It is ordered for neuropathic pain
C. It is ordered for a short course of therapy for 1-2 weeks only
D. It is ordered for muscle relaxation - ANSW-C. It is ordered for a short course of therapy for 1-2 weeks
only
The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is
A. A cataract
B. Retinoblastoma
C. Persistent hyperplastic primary vitreous
D. Retinal detachment - ANSW-A. A cataract
- Some infants require no treatment, however, surgery may be performed
Your neighbor calls you because her son, age 9, fell on the sidewalk while playing outside and a tooth fell
out. She wants to know what she should put the tooth in to transport it to the dentist. You tell her that
the best solution to put it in is
A. Salt water
B. Saliva
C. Milk
D. Water - ANSW-C. Milk
If a client presents with a deep, aching, red eye and there is no discharge, you should suspect
A. Bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Iritis - ANSW-D. Iritis
Marnie, who has asthma, has been told that she has nasal polyps. What do you tell her about them?
A. Nasal polyps are usually precancerous
B. Nasal polyps are benign growths
C. The majority of nasal polyps are neoplastic
D. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with
asthma - ANSW-B. Nasal polyps are benign growths
A smooth tongue may indicate
A. A normal finding
B. Alcohol abuse
C. A vitamin deficiency
D. Nicotine addiction - ANSW-C. A vitamin deficiency
Henry is having difficulty getting rid of a corneal infection. He asks you why. How do you respond?
A. "We can't determine the causative agent."
B. "Antibiotics have difficulty getting to that area."
C. "Because the infection was painless, it was not treated early enough."
D. "Because the cornea doesn't have a blood supply, an infection can't be fought off as usual." - ANSW-D.
"Because the cornea doesn't have a blood supply, an infection can't be fought off as usual."
Jill states that her 5 year old daughter continually grinds her teeth at night. You document this as
A. Temporal mandibular joint malocclusion
B. Bruxism
C. A psychosis
D. An oropharyngeal lesion - ANSW-B. Bruxism
The first-line antibiotic therapy for an adult with no known allergies and suspected group A beta-
hemolytic streptococcal pharyngitis is
A. Penicillin
B. Erythromycin (E-Mycin)
C. Azithromycin (Zithromax)
D. Cephalexin (Keflex) - ANSW-A. Penicillin
The antibiotic of choice for beta-lactamase coverage of otitis media is
A. Amoxicillin (Amoxil)
B. Amoxicillin and potassium clavulanate (Augmentin)
C. Azithromycin (Zithromax)
D. Prednisone (Deltasone) - ANSW-B. Amoxicillin and potassium clavulanate (Augmentin)
Microtia refers to the size of the
A. Ears
B. Skull
C. Pupils
D. Eyes - ANSW-A. Ears
Ty, age 68, has a hearing problem. He tells you he is ready for a drastic solution to the problem because
he likes to play bingo but cannot hear the calls. What can you do for him?
A. Refer him to a hearing aid specialist
B. Refer him for further testing
C. Perform a gross hearing test in the office, then repeat in 6 months to determine if there is any further
loss
D. Nothing. Tell him that a gradual hearing loss is to be expected with aging - ANSW-B. Refer him to
further testing
Which cranial nerve (CN) is affected in sensorineural or perceptive hearing loss?
A. CN II
B. CN IV
C. CN VIII
D. CN XI - ANSW-C. CN VIII
Samantha, age 12, appears with ear pain. When you begin to assess her ear, you tug on her normal
appearing auricle, eliciting severe pain. This leads you to suspect
A. Otitis media
B. Otitis media with effusion
C. Otitis externa
D. Primary otalgia - ANSW-C. Otitis externa
When you examine the tympanic membrane, which of these structures is visible?
A. Stapes
B. Cochlea
C. Pars flaccida
D. Round window - ANSW-C. Pars flaccida
Which fo the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes?
A. Trigeminal neuralgia
B. TMJ
C. Goiter
D. Preauricular adenitis - ANSW-A. Trigeminal neuralgia
When assessing Lenore, age 59, who has a sore throat, you note that she has a positive history of
diabetes and rheumatic fever. These facts increase the likelihood that which of the following agents
caused her sore throat?
A. Neisseria gonorrhoeae
B. Epstein-Barr virus
C. Haemophilus influenzae
D. Group A beta-hemolytic streptococcus - ANSW-D. Group A beta-hemolytic streptococcus
Tara was born with a cleft lip and palate. When should treatment begin for this condition?
A. Immediately after birth
B. At age 3 months
C. At age 6 months
D. When Tara is ready to drink from a cup - ANSW-A. Immediately after birth
Which manifestation is noted with carbon monoxide poisoning?
A. Circumoral pallor of the lips
B. Cherry-red lips
C. Cyanosis of the lips
D. Pale, pink lips - ANSW-B. Cherry-red lips
Regular ocular pressure testing is indicated for older adults taking
A. High-dose inhaled glucocorticoids
B. NSAIDs
C. Angiotensin converting enzyme (ACE) inhibitors
D. Insulin - ANSW-A. High-dose inhaled glucocorticoids
John, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is
true?
A. The offending organism is bacteria and should be treated with antibiotics
B. Convalescence is usually only a few days and John should be back to normal in a week.
C. Mono is rarely contagious
D. John should avoid contact sports and heavy lifting. - ANSW-D. John should avoid contact sports and
heavy lifting
Your client is unable to differentiate between sharp and dull stimulation on both sides of her face. You
suspect
A. Bell's palsy
B. A lesion affecting the trigeminal nerve
C. A stroke
D. Shingles - ANSW-B. A lesion affecting the trigeminal nerve
Mycostatin (Nystatin) is ordered for Michael, who has an oral fungal infection. What instructions do you
give Michael for taking the medication?
A. "Don't swallow the medication because it's irritating to the gastric mucosa."
B. "Take the medication with meals so that it's better absorbed."
C. "Swish and swallow the medication."
D. "Apply the medication only to the lesions." - ANSW-C. "Swish and swallow the medication."
Which assessment test is a gross measurement of peripheral vision?
A. The cover test
B. The corneal light reflex test
C. The confrontation test
D. The Snellen eye chart test - ANSW-C. The confrontation test
- It compares the client's peripheral vision with the practitioner's, assuming that the practitioner has
normal peripheral vision.
Marian, age 79, is at a higher risk than a middle-aged client for developing an eye infection because of
which age-related change?
A. Increased eyestrain
B. Loss of subcutaneous tissue
C. Change in pupil size
D. A decrease in tear production - ANSW-D. A decrease in tear production
Sam, age 4, is brought into the clinic by his father. His tympanic membrane is perforated from otitis
media. His father asks about repair of the eardrum. How do you respond?
A. "The eardrum, in most cases, heals within several weeks."
B. "We need to schedule Sam for a surgical repair."
C. "He must absolutely stay out of water for 3-6 months."
D. "If the eardrum is not healed in several months, it can be surgically repaired." - ANSW-A. "The
eardrum, in most cases, heals within several weeks."
Sylvia has glaucoma and has started taking a medication that acts as a diuretic to reduce the intraocular
pressure. Which medication is she taking?
A. A carbonic anhydrase inhibitor
B. A beta-adrenergic receptor blocker
C. A miotic
D. A mydriatic - ANSW-A. A carbonic anhydrase inhibitor
Tee, age 64, presents with a sore throat. Your assessment reveals tonsillar exudate, anterior cervical
adenopathy, presence of a fever, and absence of a cough. There is a high probability of which causative
agent?
A. Haemophilus influenzae
B. Group A beta-hemolytic streptococcus
C. Epstein-Barr virus
D. Rhinovirus - ANSW-B. Group A beta-hemolytic streptococcus
- When the four symptoms present as a cluster, there is a high probability that the infection is caused by
group A beta-hemolytic streptococcus
Monique brings her 4 week old infant into the office because she noticed small, yellow-white, glistening
bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer.
You diagnose these bumps as
A. Bednar's aphthae
B. Epstein's pearls
C. Buccal tumors
D. Exostosis - ANSW-B. Epstein's pearls
Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a
subconjunctival hemorrhage. Your next step is to
A. Refer him to an ophthalmologist
B. Order antibiotics
C. Do nothing other than provide reassurance
D. Consult with you collaborating physician - ANSW-C. Do nothing other than provide reassurance
Clients with allergic conjunctivitis have which type of discharge?
A. Purulent
B. Serous or clear
C. Stringy and white
D. Profuse mucoid or mucopurulent - ANSW-C. Stringy and white
Which of the following signs of thyroid dysfunction is a sign of hyperthyroidism?
A. Slow pulse
B. Decreased systolic BP
C. Exophthalmos
D. Dry, coarse, cool skin - ANSW-C. Exopthalmus
What is the easiest way to differentiate between otitis externa and otitis media?
A. With otitis media, tender swelling is usually visible
B. With otitis media, there is usually bilateral pain in the ears
C. With otitis media, there is usually tenderness on palpation over the mastoid process
D. With otitis externa, movement or pressure on the pinna is extremely painful - ANSW-D. With otitis
externa, movement or pressure on the pinna is extremely painful
Mattie says she has heard that it is not good to let a baby go to bed with a bottle. She says that she has
always done this with her other children and wonders why it is not recommended. How do you respond?
A. "A bottle in the baby's mouth forces the baby to breathe through the nose. If the nose is clogged, the
baby will not get enough oxygen."
B. "A nipple, when placed in the mouth for long periods of time, can cause toothe displacement."
C. "Normal mouth bacteria act on the sugar in the bottle contents to form acids, which will break down
the tooth enamel and destroy the teeth even before they come in."
D. "This encourages the baby to continually want to drink at night. When the child is older, it will become
a habit, and the child will end up wearing diapers into the preschool years." - ANSW-C. "Normal mouth
bacteria act on sugar in the bottle contents to form acids, which will break down the tooth enamel and
destroy the teeth even before they come in."
Darren, age 26, has AIDS and presents with a painful tongue covered with what looks like creamy-white,
curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue
depressor, which assists you in making which of the following diagnoses?
A. Leukoplakia
B. Lichen planus
C. Oral candidiasis
D. Oral cancer - ANSW-C. Oral candidiasis
Mavis has persistent pruritus of the external auditory canal. External otitis and dermatological conditions
such as seborrheic dermatitis and psoriasis have been ruled out. What can you advise her to do?
A. Use a cotton tipped applicatory daily to remove all moisture and potential bacteria
B. Wash daily with soap and water
C. Apply mineral oil to counteract dryness
D. Avoid topical corticosteroids - ANSW-C. Apply mineral oil to counteract dryness
An 80 year old woman comes in today with complaints of a rash on the left side of her face that is
blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she
remembers being very tired and feeling feverish for a week before the rash appeared. On examination
the rash follows the trigeminal nerve on the left and she has some scleral injection and tearing. You
suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you
explain to her that she needs
A. Antibiotics
B. A biopsy of the rash
C. Immediate hospitalization
D. Ophthalmological consultation - ANSW-D. Ophthalmological consultation
How would you grade tonsils that touch the uvula?
A. Grade 1+
B. Grade 2+
C. Grade 3+
D. Grade 4+ - ANSW-C. Grade 3+
What significant finding(s) in a child with otitis media with effusion would prompt more aggressive
treatment?
A. There is a change in the child's hearing threshold to less than or equal to 20 decibels (dB)
B. The child becomes a fussy eater
C. The child's speech and language skills seem slightly delayed
D. Persistent rhinitis is present - ANSW-A. There is a change in the child's hearing threshold to less than
or equal to 20 decibels (dB)
A client come in complaining of 1 week of pain in the posterior neck with difficulty turning the head to
the right. What additional history is needed?
A. Recent trauma
B. Difficulty swallowing
C. Stiffness in the right shoulder
D. Changes in sleeping habits - ANSW-A. Recent trauma
The most frequent cause of laryngeal obstruction in an adult is
A. A piece of meat
B. A tumor
C. Mucosal swelling from an allergic reaction
D. Inhalation of a carcinogen - ANSW-A. A piece of meat
A client complain of frequent bouts of severe, intense, disabling left sided facial pain accompanied by
excessive left eye lacrimation (tearing) and worsening anxiety. The pain wakes him at night and he has
even contemplated harming himself during these episodes due to the intensity and unrelenting nature
of the pain. What kind of headache is he describing?
A. Classic migraine
B. Tension headache
C. Sinus headache
D. Cluster headache - ANSW-D. Cluster headache
Which is the most common localized infection of one of the glands of the eyelids?
A. Hordeolum
B. Chalazion
C. Bacterial conjunctivitis
D. Herpes simplex - ANSW-A. Hordeolum
Maury, age 52, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and
redness around the iris. What is your initial diagnosis?
A. Conjunctivitis
B. Iritis
C. Subconjunctival hemorrhage
D. Acute glaucoma - ANSW-B. Iritis
How do you respond when Diane, age 29, asks why she gets sores on her lips every time she sits out in
the sun for an extended period of time?
A. "You are allergic to the sun and must wear sunblock on your lips."
B. "Your lips are dry to begin with and you must keep them moist at all times."
C. "You have herpes simplex that recurs with sunlight exposure."
D. "You're probably allergic to your lip balm." - ANSW-C. "You have herpes simplex that recurs with
sunlight exposure."
The normal ratio of the artery-to-vein width in the retina as viewed through the ophthalmoscope is
A. 2:3
B. 3:2
C. 1:3
D. 3:1 - ANSW-A. 2:3
Which of the following symptom(s) is (are) most indicative of mononucleosis (Epstein-Barr virus)?
A. Rapid onset of anterior cervical adenopathy, fatigue, malaise, and headache
B. Gradual onset of fatigue, posterior cervical adenopathy, fever and sore throat
C. Gradual and seasonal onset of pharyngeal erythema
D. Rapid onset of cough, congestion and headache - ANSW-B. Gradual onset of fatigue, posterior cervical
adenopathy, fever and sore throat
Joy, age 36, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general
malaise and misery. Her temperature is 102 F. You diagnose influenza (flu). What is your next course of
action?
A. Order amoxicillin (Amoxil) 500mg every 12 hours for 7 days
B. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive
C. Order a complete blood count
D. Consult with your collaborating physician - ANSW-B. Prescribe rest, fluids, acetaminophen (Tylenol),
and possibly a decongestant and an antitussive
Nathan, age 19, is a college swimmer. He frequently gets swimmer's ear and asks if there is anything he
can do to help prevent it other than wearing ear plugs, which don't really work for him. What do you
suggest?
A. Use a cotton-tipped applicator to dry the ears after swimming
B. Use eardrops made of a solution of equal parts of alcohol and vinegar in each ear after swimming
C. Use a hair dryer on the highest setting to dry the ears
D. Tell Nathan he must change his sport - ANSW-B. Use eardrops made of a solution of equal parts of
alcohol and vinegar in each ear after swimming
You observe a mother showing her infant a toy. You note that the infant can fixate on, briefly follow, and
then reach for the toy. You suspect the infant is
A. 2 months old
B. 4 months old
C. 6 months old
D. 8 months old - ANSW-B. 4 months old
A common cause of conductive hearing loss in adults age 20-40 is
A. Trauma
B. Otitis media
C. Presbycusis
D. Otosclerosis - ANSW-D. Otosclerosis
Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You
cannot transilluminate the sinuses. You suspect which common sinus to be affected?
A. Maxillary sinus
B. Ethmoid sinus
C. Temporal sinus
D. Frontal sinus - ANSW-A. Maxillary sinus
Which manifestation of the buccal mucosa is present in a client with mumps?
A. Pink, smooth, moist appearance with some patchy hyperpigmentation
B. Dappled brown patches
C. The orifice of Stensen's duct appearing red
D. Koplik's spots - ANSW-C. The orifice of Stensen's duct appearing red
Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look
"sunken in." What do you suspect?
A. Hypothyroidism
B. Normal age-related changes
C. Cushing's syndrome
D. A detached retina - ANSW-B. Normal age-related changes
Leah, 4 months old, has both eyes turning inward. What is this called?
A. Pseudostrabismus
B. Strabismus
C. Esotropia
D. Exotropia - ANSW-C. Esotropia
When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, this
indicates
A. Conductive deafness
B. Perceptive deafness
C. A normal finding
D. Nerve damage - ANSW-C. A normal finding
Jim, age 49, comes to the office with a rapid-onset complete paralysis of one-half of his face. He is
unable to raise his eyebrow, close his eye, whistle, or show his teeth. You suspect a lower motor neuron
lesion resulting in cranial nerve VII paralysis. What is your working diagnosis?
A. Cerebrovascular accident
B. Trigeminal neuralgia
C. Bell's Palsy
D. Tic douloureux - ANSW-C. Bell's Palsy
Acute otitis media is diagnosed when there is
A. Fluid in the middle ear without signs or symptoms of an ear infection
B. A diagnosis of three or more episodes of otitis media within 1 year
C. Fluid in the middle ear accompanied by otalgia and fever
D. Fluid within the middle ear for at least 3 months - ANSW-C. Fluid in the middle ear accompanied by
otalgia and fever
Mattie, age 64, presents with blurred vision in one eye and states that it felt like "a curtain came down
over my eye." She doesn't have any pain or redness. What do you suspect?
A. Retinal detachment
B. Acute angle-closure glaucoma
C. Open-anlge glaucoma
D. Cataract - ANSW-A. Retinal detachment
Shelley, age 47, is complaining of red eye. You are trying to decide between a diagnosis of conjunctivitis
and iritis. One distinguishing characteristic between the two is
A. Eye discomfort
B. Slow progression
C. A ciliary flush
D. No change in or slightly blurred vision - ANSW-C. A ciliary flush
Thiazide diuretics are usually well tolerated and a good choice for the initial drug therapy for the
treatment of hypertension in adults. Which statement below is UNTRUE about the advantages of using
thiazide diuretics with adult patients: - ANSW-orthostatic hypotension is a common side effect of
thiazide diuretics
General guidelines for managing adults with HTN may include all of the following steps EXCEPT - ANSW-
In patients with isolated systolic hypertension, the goal of treatment is to lower the systolic pressure by
40 mm Hg.
In treating diabetic patients with hypertension, which class of anti-hypertensive agent is considered the
preferred first-line therapy: - ANSW-ACE inhibitors/ARB's
Mrs. Edna M., a 67-year old female presents in your office for an annual physical. During your
examination, you detect a right carotid bruit. What is the first step you would take in diagnosing/treating
Mrs. M.: - ANSW-Order a carotid ultrasound and start on aspirin.
Which of the following is NOT associated with leg ulcers caused by venous insufficiency - ANSW-Deep
ulcers with well-circumscribed borders
Mr. H is a 32-year old male who presents for a job-related physical. Cholesterol screening reveals serum
LDL of 190mg/dl. The appropriate action would be: - ANSW-Implement diet and lifestyle changes and re-
assess in 3-6 months
Symptomatic abdominal aortic aneurysms (AAA) generally imply impending rupture. Which of the
following symptoms should alert you to impending AAA rupture: - ANSW-Subjective feeling of a second
heart beat
Mr. Turner visits your office with complaints of clear, watery nasal discharge; frequent coughing to clear
throat; sneezing and itchy eyes for several days. On examination, you detect pale, boggy mucous
membranes and conjunctival injection. The remainder of the physical examination is unremarkable. The
most likely diagnosis is: - ANSW-Allergic rhinitis
Acute bacterial conjunctivitis is generally treated with which of the following as a first-line therapy -
ANSW-Broad-spectrum antibiotic drops
Acute bacterial sinusitis should be treated with broad-spectrum antibiotics for: - ANSW-10-14 days
A painful red ear in a diabetic is presumed to be which of the following until proven otherwise - ANSW-
Malignant otitis
Which of the following is a diagnostic finding in hypertensive retinopathy - ANSW-A-V nicking, copper or
silver wiring, cotton-wool patches, hard exudates, flame-shaped hemorrhages, retinal edema, arterial
macro-aneurysms
Dot & blot hemorrhages, microaneurysms, hard exudates, cotton-wool patches, venous bleeding, and
intraretinal microvascular abnormalities are seen in: - ANSW-diabetic retinopathy
What is the most immediate life threatening complication of severe epiglottitis? - ANSW-airway
occlusion
Which of the following objective findings is generally not associated with acute frontal sinusitis? - ANSW-
pain with movement of pinna
Which of the following is generally considered the "first-line" empiric drug of choice for treating acute
sinusitis in an adult with no known allergies: - ANSW-amoxicillin
Initial treatment of bacterial sinusitis does not include which of the following: - ANSW-antihistamines
A patient comes to the clinic complaining of acute pain and loss of vision in the right eye. The
adult/gerontology nurse practitioner informs the patient that these symptoms require: - ANSW-
immediate referral to an ophthalmologist
Treatment of bacterial sinusitis may include all of the following EXCEPT: - ANSW-broad-spectrum
antibiotics for 5-7 days
Movement of the auricle will usually elicit pain with: - ANSW-External otitis
In autosomal dominant inheritance, the abnormality or abnormalities usually: - ANSW-appear in every
generation
Down's syndrome is an example of a: - ANSW-chromosomal disorder
Your patient presents with URI symptoms consistent with viral infection. What is the most appropriate
course of treatment: - ANSW-suggest increasing fluids, rest and symptomatic treatment
Loss of peripheral visual fields is an indication of: - ANSW-Glaucoma
The "common cold" is caused by: - ANSW-Rhinoviruses
Macular degeneration is manifested by: - ANSW-Loss of central vision
Dependent rubor is a physical finding associated with - ANSW-Arteriosclerotic occlusive disease
Lillian is a 28 year old white female presenting for an annual wellness exam. Her blood pressure is
139/85, BMI =30, and FBG on recent lab assessment was 98. Her blood pressure at last year's exam was
135/79, and her BMI was 28. There is a family history of type 2 diabetes. What is Lillian's diagnosis? -
ANSW-Pre-hypertension
Nathan, age 19, is a college sophomore. He frequently gets swimmer's ear and asks if there is anything
he can do to help prevent it other than wearing earplugs, which don't really work for him. What do you
suggest? - ANSW-Use eardrops made of equal parts of alcohol and vinegar in each ear after swimming.
Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You
cannot transilluminate the sinuses. You suspect which common sinus to be infected? - ANSW-Maxillary
The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an
important point to discuss with this patient about taking such supplements? - ANSW-Many supplements
lack clear clinical evidence of efficacy
A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this patient,
what is the best initial action? - ANSW-Gather and record a three-generation pedigree
Which medication is associated with weight gain? - ANSW-Antidepressants
A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On
examination, the lesion appears warm and erythematous. The provider knows that this is likely to be
which type of lesion? - ANSW-Hordeolum
A patient reports has been using artificial tears for comfort because of burning and itching in both eyes,
but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins
with clear conjunctivae. What is the recommended treatment? - ANSW-Compresses, lid scrubs, and
antibiotic ointment
A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while
sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye.
On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the
practitioner's next step? - ANSW-Application of topical fluorescein dye
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea
and vomiting. What is part of the initial diagnostic workup for this patient? - ANSW-Audiogram and MRI
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain
when manipulating the external ear structures. What is the likely diagnosis? - ANSW-Acute otitis externa
A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the
tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this
patient? - ANSW-Prescribe antibiotic ear drops
Which physical examination finding suggests viral rather than bacterial parotitis? - ANSW-Clear discharge
from Stensen's duct
An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul-smelling
breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the
primary care provider do? - ANSW-Refer the patient to an otolaryngologist
An asymptomatic 63-year-old female has a low-density lipoprotein level of 135 mg/dL. Which test is
beneficial to assess this patient's coronary artery disease risk? - ANSW-C-reactive protein
Which risk assessment for coronary artery disease is recommended for all female patients? - ANSW-
Framingham risk score
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider
notes a pulsatile abdominal mass. What is the initial action? - ANSW-Stat ultrasound of the mass to
determine size
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled
hypertension, and decompensated heart failure. What is the recommendation for treatment for this
patient? - ANSW-Serial ultrasonographic surveillance of the aneurysm
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these
symptoms? - ANSW-Atrial fibrillation
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart
rate of 70 beats per minutes. What will the provider do next? - ANSW-Evaluate the patient's orthostatic
vital signs
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The
provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next
action? - ANSW-Give the patient a beta blocker medication
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches,
palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the
provider do next to evaluate this patient? - ANSW-Order urinalysis, CBC, BUN, and creatinine
Which is not a cause of secondary hypertension? - ANSW-Increased salt intake
An elderly female without prior history of cardiovascular disease reports lower leg soreness and fatigue
when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses
bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on
these symptoms? - ANSW-Doppler ankle, arm index
A patient is diagnosed with PAD and elects not to have angioplasty after an angiogram reveals partial
obstruction in lower extremity arteries. What will the provider recommend to help with relief of
symptoms in this patient? - ANSW-Walking to the point of pain each day
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border.
The provider determines that the murmur decreases in intensity when the patient changes from
standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the
provider suspect for this murmur? - ANSW-Hypertrophic cardiomyopathy
Aortic stenosis can be a contributing cause of coronary artery disease. Which of the following heart
sounds is suggestive of aortic stenosis? - ANSW-A systolic murmur loudest at the second intercostal
space, right sternal border
The presence of angina, syncope, and heart failure in a patient with an aortic valve murmur should raise
the suspicion of: - ANSW-Aortic stenosis
All of the following are typically associated with stable angina EXCEPT: - ANSW-chest pain at rest or with
minimal exertion
In a patient presenting with oral candidiasis in the absence of diabetes or recent antibiotic use, which of
the following should be suspected: - ANSW-immunosuppresion
A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the
provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest
pain, syncope, or palpitations. What will the provider do? - ANSW-Consult with the cardiologist to
determine appropriate diagnostic tests
A patient develops acute diarrhea and then comes to clinic two weeks later reporting profuse watery,
bloody diarrheal stools 6 to 8 times daily. The provider notes a toxic appearance with moderate
dehydration. Which test is indicated to diagnose this cause?

Stool collection for 24-hour stool pH

Qualitative and quantitative fecal fat
C. difficile toxin
Wright stain of stool for white blood cells - ANSW-C. difficile toxin
A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal
area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider
orders a
colonoscopy to further evaluate this patient. What is the treatment for this patient's symptoms?

Referral for possible surgical intervention

A high-fiber diet and increased fluid intake
Daily laxatives to prevent straining with stools
Infiltration of a local anesthetic into the hemorrhoid - ANSW-A high-fiber diet and increased fluid intake
A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea,
and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable
cause of these findings?

Acute acalculous cholecystitis

Infectious cholecystitis
Common bile duct obstruction
Chronic cholelithiasis - ANSW-Common bile duct obstruction
An 83 year old is diagnosed with diverticulitis. The most common complaint is

Rectal bleeding
Bloating and crampiness
Left lower quadrant pain
Frequent belching and flatulence - ANSW-Left lower quadrant pain
A patient's CBC demonstrated anemia. Which diagnosis is likely based on this patient's laboratory
values?
MCV 74.1 fL (normal 80-95)
MCH 24 pg (normal 27-31)
MCHC 33% (normal 32-69)
RDW 12% (normal 11-14.5)

iron deficiency anemia

anemia of chronic disease
vitamin B12 deficiency anemia
thalassemia - ANSW-thalassemia
A patient has fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound
is negative for gallstones. Which action is necessary to treat this patient's symptoms?

Hospitalization for emergent treatment

Empiric treatment with antibiotics
Supportive care with close follow-up
Prescribing ursodeoxycholic acid - ANSW-Hospitalization for emergent treatment
A patient has both occasional "coffee ground" emesis and melena stools. What is the most probably
source of bleeding in this patient?

Upper GI
Hepatic
Lower GI
Rectal - ANSW-Upper GI
An adult patient has intermittent, crampy abdominal pain with vomiting. The provider notes marked
abdominal distention and hyperactive bowel sounds. What will the provider do initially?

Prescribe an antiemetic and recommend a clear liquid diet for 24 hours

Obtain upright and supine radiologic views of the abdomen
Schedule the patient for a barium swallow and enema
Admit the patient to the hospital for consultation with a surgeon - ANSW-Obtain upright and supine
radiologic views of the abdomen
What choice below is most commonly associated with pancreatitis?

Appendicitis and renal stones

Hypertriglyceridemia and cholecystitis
Gallstones and alcohol abuse
Viral infection and cholecystitis - ANSW-Gallstones and alcohol abuse
What medication may be used to treat GERD if a patient has tried over the counter ranitidine without
benefit?

Prescription strength ranitidine

Calcium carbonate
Prescription strength ranitidine
Pantoprazole - ANSW-Pantoprazole
A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which diagnostic
test will the provider order?

Abdominal ultrasound
MRI of the abdomen
Abdominal CT with contrast
Plain abdominal radiographs - ANSW-Abdominal ultrasound
Which medications may increase the prevalence of GERD? (Select all that apply.)

Calcium antagonists
Aspirin
Oral contraceptives
Hormone replacements
Benzodiazepines - ANSW-Calcium antagonists
Aspirin
Benzodiazepines
What is the best treatment for H. pylori-related peptic ulcer disease?

H2RA, bismuth, metronidazole, and tetracycline for 10 to 14 days

PPI, amoxicillin, and clarithromycin for 10 days
PPI and clarithromycin for 14 days
H2RA and clarithromycin for 14 days - ANSW-PPI and clarithromycin for 14 days
An 8-month-old girl is brought by her grandmother to see the nurse practitioner because of intermittent,
random episodes of vomiting, abdominal bloating, currant jelly stools, and irritability with poor appetite.
The infant is stranding in the 10th percentile on the growth chart and appears lethargic. During the
abdominal exam, a sausage like mass is palpated on the right side of the abdomen. The infant's
presentation is highly suggestive of which condition?

Lactose intolerance
Intussusception
Inflammatory bowel disease
Irritable bowel syndrome - ANSW-Intussusception

The classic triad of intussusception is currant jelly stools, a sausage like mass, and pain. A sausage-
shaped abdominal mass may be palpated on the right side of the abdomen.
A patient is in the clinic with a 36 hrs history of diarrhea and moderate dehydration. Interventions should
include:

IV rehydration
Oral rehydration with gatorade or tea
Resumption of usual fluid intake
Oral rehydration with an electrolyte replenishment solution - ANSW-Oral rehydration with an electrolyte
replenishment solution
All of the following are true statements about diverticula except:

Most diverticula in the colon are infected with gram negative bacteria
Supplementing with fiber, such as psyllium (Metamucil), is recommended
Diverticula are located in the colon
A low fiber diet is associated with the condition - ANSW-Most diverticula in the colon are infected with
gram negative bacteria
A patient has a history of diverticular disease and asks what can be done to minimize acute symptoms.
What will the practitioner recommend to this
patient?

Taking an anticholinergic medication

Consuming a diet high in fiber
Avoiding saturated fats and red meat
Using bran to replace high-fiber foods - ANSW-Consuming a diet high in fiber
A patient has a recent episode of vomiting and describes the vomitus as containing mostly gastric juice.
What does this symptom suggest?

Small bowel obstruction

Gastritis
Peptic ulcer
Bile duct obstruction - ANSW-Peptic ulcer
A patient present with abdominal pain and has the following laboratory
findings. Would does this mean?
HBsAg positive
anti-HBc positive
IgM Anti-HBc positive
anti-HBs negative

He has immunity to hepatitis B

More data is needed
He has no immunity to hepatitis B
He has acute hepatitis B - ANSW-He has acute hepatitis B

A positive hepatitis B surface antigen and a positive IgM means that

this patient has acute hepatitis B. The first serological marker to be
positive is the surface antigen. It can become positive as soon as 3-4
weeks after exposure to hepatitis B. Positive IgM indicates acute
infection.
A patient who has been taking an NSAID for osteoarthritis pain has newly diagnosed peptic ulcer disease.
What is the initial step in treating this patient?

Discontinue the NSAID

Order prostaglandin therapy
Prescribe a proton pump inhibitor
Recommend an H2 receptor antagonist - ANSW-Discontinue the NSAID
Which is the most common cause of pancreatitis in the United States?

Hyperlipidemia
Ethyl alcohol
Trauma
Gallstones - ANSW-Gallstones
Most patient who have an acute hepatitis B infection:

Have varied clinical presentations

Are acutely ill
Are females
Develop subsequent cirrhosis - ANSW-Have varied clinical presentations
Which description is more typical of a patient with acute cholecystitis?

The patient is ill appearing and febrile

The elderly patient is more likely to exhibit Murphy's sign
The patient rolls from side to side on the exam table
Most are asymptomatic until a stone blocks the bile duct - ANSW-The patient is ill appearing and febrile

A patient with acute cholecystitis usually c/o abd pain in upper right quadrant or epigastric pain. Many
also have nausea. The patient lies still on the exam table as this condition is associated with peritoneal
inflammation that is worse with movement. Elderly are less likely to exhibit Murphy's sign.
Asymptomatic patients have cholelithiasis.
A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile,
painful mass between the xiphoid process and
the umbilicus. What is the initial action?

Schedule the patient for an aortic angiogram

Perform an ultrasound examination to evaluate the cause
Transfer the patient to the emergency department for a surgical consult
Order a CBC, type and crossmatch, electrolytes, and renal function tests - ANSW-Transfer the patient to
the emergency department for a surgical consult
A patient has intermittent left-sided lower abdominal pain and fever associated with bloating and
constipation alternating with diarrhea. The provider suspects acute diverticulitis. Which tests will the
provider order? (Select all that apply.)
Stool for occult blood
CT scan of abdomen and pelvis
Rigid sigmoidoscopy
Plain abdominal radiographs
Barium enema examination - ANSW-Stool for occult blood
CT scan of abdomen and pelvis
Extreme tenderness and involuntary guarding at McBurney's point is a significant finding for possible:

Acute gastroenteritis
Acute appendicitis
Acute diverticulitis
Acute cholecystitis - ANSW-Acute appendicitis
A 24 year old female with pain and tenderness in the right lower abdominal quadrant. Pelvic exam and
UA are normal. WBC is elevated. Urine pregnancy test is negative. What is part of the differential
diagnosis?

UTI
Pelvic inflammatory disease
Ectopic pregnancy
Appendicitis - ANSW-Appendicitis
Which factors increase the risk of renal stones? (Select all that apply.)

Excess antacid use

Vitamin D excess
Strenuous exercise
Snow skiing
Surgical menopause - ANSW-Excess antacid use
Strenuous exercise
Surgical menopause
A pregnant woman at 30 weeks gestation has proteinuria. What will the
provider do next?

Reassure her that this normal at this stage of pregnancy

Evaluate her blood pressure
Monitor serum glucose for gestational diabetes
Perform a 24-hour urine collection - ANSW-Evaluate her blood pressure
A patient who has diabetes has symptoms consistent with renal stones.
Which type of stone is most likely in this patient?

Uric acid
Citrate
Oxalate
Cysteine - ANSW-Uric acid
A 50-year-old male patient reports that he has a sensation of scrotal
heaviness. He reports that the sensation is worse at the end of the day. He denies pain. What is likely
etiology of these symptoms?

Strangulated hernia
Inguinal hernia
Epididymitis
Hydrocele - ANSW-Inguinal hernia

Inguinal hernias are common in males. typical symptom reported by

man with an inguinal hernia is scrotal heaviness, especially at the end
of the day. If pain is severe, it may indicated strangulated hernia.
This is a medical emergency. Epididymitis can produce scrotal pain,
not usually heaviness. Hydrocele results in fluid in the scrotum.
A female patient who is 45-year-old states that she is having urinary
frequency. She describes episodes of "having to go right now" and not being
able to wait. Her urinalysis results are within normal limits. What this part of
the differential?

Stress incontinence
Asymptomatic bacteriuria
Lupus
Diabetes - ANSW-Diabetes

Patients with diabetes can present with polyuria. In assessment of

patient's risk factors should be done with strong consideration even to
checking glucose level. Other possible diagnoses include urge
incontinence and vaginitis. A urinalysis would show bacteriuria.
A 3-month-old male infant has edema and painless swelling of the scrotum.
On physical examination, the provider is able to transilluminate the scrotum.
What will the provider recommend?

A short course of empiric antibiotic therapy

Observation and reassurance that spontaneous resolution may occur
A Doppler ultrasound to evaluate the scrotal structures
Immediate referral to a genitourinary surgeon for repair - ANSW-Observation and reassurance that
spontaneous resolution may occur
An asymptomatic pregnant woman has a positive leukocyte esterase and
positive nitrites on a urine dipstick screening. What will the provider do next?

Admit to the hospital

Obtain a urine culture
Prescribe trimethoprim-sulfamethoxazole
Order a renal ultrasound - ANSW-Obtain a urine culture
A patient has acute renal colic, nausea, and vomiting and a urinalysis reveals
hematuria, but is otherwise normal. A radiographic exam shows several
radiopaque stones in the ureter which are less than 1 mm in diameter. What
will the primary provider do initially to manage this patient?

Order a narcotic pain medication and increased oral fluids

Obtain a consultation with a urology specialist
Prescribe desmopressin and a corticosteroid medication
Prescribe nifedipine and hospitalize for intravenous antibiotics - ANSW-Order a narcotic pain medication
and increased oral fluids
17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood
vessels that feel like "a bag of worms" are noted underneath the scrotal skin. The testicle is not swollen
or reddened. The most likely diagnosis is:

Testicular torsion
Varicocele
Chronic orchitis
Chronic epididymitis - ANSW-Varicocele

Palpation of varicose veins, described as "a bag of worms", is a

classic symptom of varicocele.
The daughter of an elderly, confused female patient reports that her mother is having urinary
incontinence several times each day. What will the provider do initially?
Perform a bladder scan to determine distention and retention
Tell the daughter that this is expected given her mother's age and confusion
Obtain a urine sample for urinalysis and possible culture
Order serum creatinine and blood urea nitrogen tests - ANSW-Obtain a urine sample for urinalysis and
possible culture
An adolescent male reports severe pain in one testicle. The examiner notes
edema and erythema of the scrotum on that side with a swollen, tender
spermatic cord and absence of the cremasteric reflex. What is the most
important intervention?

Immediate referral to the emergency department

Doppler ultrasound to assess testicular blood flow
Prescribing anti-infective agents to treat the infection
Transillumination to assess for a "blue dot" sign - ANSW-Immediate referral to the emergency
department
A 20-year-old male has epididymitis. His most common complaint will be:

Scrotal pain
Burning with urination
Penile discharge
Testicular pain - ANSW-Scrotal pain

The most common complaint for epididymitis is scrotal pain. Usually

develops over a period of days. Burning with urination is possible if
the underlying cause is a urinary tract infection. However, this is more
common in older males. Testicular pain is not a common complaint
with epididymitis. Penile discharge may occur with gonorrhea or
Chlamydia infections.
A 16-year-old female patient is being treated for her first UTI. She had an
allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be
contraindicated?

Trimethoprim-sulfamethoxazole
Cephalexin
Nitrofurantoin
Ampicillin - ANSW-Trimethoprim-sulfamethoxazole
A young adult male reports a gradual onset 3/10 dull pain in the right scrotum
and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a
bag of worms on the proximal spermatic
cord. What is an important next step in managing this patient?

Consideration of underlying causes of this finding

Referral to an emergency department for surgical consultation
Reassurance that this is benign and may resolve spontaneously
Anti-infective therapy with ceftriaxone or doxycycline - ANSW-Consideration of underlying causes of this
finding
A 30-year-old male patient has a positive leukocyte esterase and nitrites on a
random urine dipstick during a well patient exam. What type of urinary tract
infection does this represent?

Unresolved
Uncomplicated
Isolation
Complicated - ANSW-Complicated
An older male patient reports gross hematuria but denies flank pain and
fever. What will the provider do to manage this patient?

Obtain a urine culture

Monitor blood pressure closely
Refer for cystoscopy and imaging
Perform a 24-hour urine collection - ANSW-Refer for cystoscopy and imaging
A male patient complaints of dysuria. His urinalysis is positive for nitrates, leukocytes, and bacteria. What
medication should be given and for how
many days?

Ciprofloxacin for 3 days

Nitrofurantoin for 14 days
Doxycycline for 7 days
Trimethoprim-sulfamethoxazole for 7-10 days - ANSW-Trimethoprim-sulfamethoxazole for 7-10 days
A patient's recent blood work indicates acute kidney injury. You know that acute kidney injury can be
caused from:

Heart failure exacerbation

GERD
Increase in metoprolol dose
atrial fibrillation - ANSW-Heart failure exacerbation

Heart failure exacerbation and cause decreased perfusion to the

kidneys, leading to acute kidney injury. Changes in medications or
nephrotoxic can cause acute kidney injury, metoprolol is not one of
them. While patients with atrial fibrillation can have decreased
cardiac output, it is often compensated to preserve renal perfusion
The provider is evaluating a patient for potential causes of urinary
incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the
interpretation of this result?

The patient may have overflow incontinence.

The patient probably has a UTI.
This represents incomplete emptying.
This a normal result. - ANSW-This a normal result.
A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract infection.
After treatment for the UTI, what testing is indicated for this patient?

Voiding cystourethrogram
24-hour urine collection to evaluate for glomerulonephritis
No testing if hematuria is resolved
Bladder scan - ANSW-No testing if hematuria is resolved
A physically independent 75 year old was diagnosed with mild cognitive impairment 6 months ago. She
resides in an assisted living facility. she is in clinic today for scheduled visit. Her adult daughter reports
that about 2 weeks ago her mother had an episode of urinary incontinence, but no episode since then.
She is found to have asymptomatic bacteriuria. How should this be managed?

Repeat the urinalysis in 7 days

Repeat the urinalysis in 4 weeks
Treat her today with one dose of an antibiotic
Monitor her for symptoms of urinary tract infection - ANSW-Monitor her for symptoms of urinary tract
infection

Approximately 30-50% of older females living in institutions have

asymptomatic bacteriuria. No data support treatment of patients to prevent future problems or
complications. In fact, asymptomatic bacteriuria is not usually treated unless the patient is pregnant,
immunocompromised, or is undergoing a urinary procedure.
A pregnant patient has asymptomatic bacteriuria. What is the likely pathogen?
Escherichia coli
Staph aureus
Klebsiella
No pathogen - ANSW-Escherichia coli

Of pregnant patient with asymptomatic bacteriuria should be treated with antibiotics because she is at
high risk of developing pyelonephritis and/or preterm labor. The most common pathogen is Escherichia
coli.
The provider is counseling a patient who has stress incontinence about ways to minimize accidents.
What will the provider suggest initially?

Voiding every 2 hours during the day

Referral to a physical therapist
Increasing fluid intake to dilute the urine
Taking pseudoephedrine daily - ANSW-Voiding every 2 hours during the day
A patient with urolithiasis is more likely to:

Demonstrate RBC casts

Have chills and fevers
Be of male gender
Have frequent UTIs - ANSW-Be of male gender

Males are more likely than females to have urolithiasis. There is no

increased incidence of stone formation among patients with frequent UTIs. Patients with your
urolithiasis may exhibit fever and chills of infection if associated with a very large stone, but this is not
the usual case. RBC casts are formed in the renal tubules, this generally indicates glomerular injury, not
urolithiasis.
A pregnant patient is found to have a urinary tract infection. What is the appropriate course of action?

Prescribe nitrofurantoin
Prescribe ciprofloxacin
Prescribe TMP/SMX
Prescribe no antibiotics - ANSW-Prescribe nitrofurantoin

Nitrofurantoin is considered probably safer to use during pregnancy. It provides coverage for most
common UTI pathogens. TMP/SMX is a full of acid antagonist and may be associated with increased risk
of congenital malformation. Ciprofloxacin is not to be used first line for any simple UTI, and may not be
safe during pregnancy. In some occasions it could still be given if benefits outweigh risks.
An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the
scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What
is the most important intervention?

Prescribing anti-infective agents to treat the infection

Immediate referral to the emergency department
Transillumination to assess for a "blue dot" sign
Doppler ultrasound to assess testicular blood flow - ANSW-Immediate referral to the emergency
department
If cervical stenosis is met when performing IUD insertions, which of the following should be used to
overcome resistance?

12 - 15 cm
3 - 6 cm
9 - 12 cm
6 - 9 cm - ANSW-6 - 9 cm
A 45 year old diabetic female presents with c/o vaginal itching and discharge that began after douching
post-menstruation approximately one week ago. Upon exam, you find thick, white discharge with a curd-
like consistency and erythema generally in the vuvlvogavinal region. Under a wet mount you see the
following below (budding, branching hyphae). Which of the following is an appropriate treatment for this
patient?

No treatment needed
Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1
Diflucan (Fluconazole) 150mg PO x 1
Flagyl (Metronidazole) 500mg PO BID x 7 days - ANSW-Diflucan (Fluconazole) 150mg PO x 1
What is included in your treatment plan for #4?

Flagyl (Metronidazole) 2g PO x 1 of patient only and no report to the county

Rocephin (Ceftriaxone) 250mg IM with partner treatment and report to the county
Flagyl (Metronidazole) 2g PO x 1 with partner treatment and report to the county
Rocephin (Ceftriaxone) 250mg IM of patient only and no report to the county - ANSW-Flagyl
(Metronidazole) 2g PO x 1 with partner treatment and report to the county
Syphilis may present as:

Discharge
Painful lesions
Dysuria
A rash - ANSW-A rash
Secondary syphilis can present as a rash, more commonly on the
palms of the hands or soles of the feet. Lesions are usually painless. It usually does not produce
significant dysuria or discharge.
A 19-year-old student who is on prescription combined oral contraceptive pills is being seen for lower GI
pain. The nurse practitioner has obtained a Pap smear and is about to perform the bimanual exam. She
gently remove the plastic speculum from the vagina. While the NP is performing the bimanual vaginal
exam, the patient complaints of slight discomfort during palpation of the ovaries. Which with the
following is a true statement?

The fallopian tubes and ovaries are not sensitive to light or deep palpation
The ovaries are sensitive to deep palpation but they should not be painful.
The uterus and ovaries are not important organs of reproduction
The uterus and ovaries are both sensitive to any Palpation - ANSW-The ovaries are sensitive to deep
palpation but they should not be painful.

Unilateral adnexal pain accompanied by cervical motion tenderness and purulent endocervical discharge
suggestive of PID
When seen on a wet mount like the following, clue cells would indicate the treatment by which of the
following?

Flagyl (Metronidazole) 500mg PO BID x 7 days

Diflucan (Fluconazole) 150mg PO x 1
Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1
No treatment needed - ANSW-Flagyl (Metronidazole) 500mg PO BID x 7 days
A 54-year-old female presents with small to moderate amount of vaginal bleeding of recent onset. She
has been postmenopausal for approximately 2 years. With diagnosis is least likely?

Endometrial carcinoma
Ovarian cancer
Endometrial hyperplasia
Uterine polyps - ANSW-Ovarian cancer

Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others.
Postmenopausal bleeding is an uncommon presentation of ovarian cancer, but can present this way.
Other pathologies are usually evaluated before considering ovarian pathology.
Clue cells are found in patients who have:

Pneumonia
Leukemia
Epidermal fungal infections
Bacterial vaginosis - ANSW-Bacterial vaginosis

Clue cells are hallmark sign of bacterial vaginosis and can be seen in a microscopic exam.
A 40 year old female patient returns to your clinic to review her pap smear results from the previous
week. You tell her the test is abnormal with "atypical squamous cells of undetermined significance and
HPV positive". What is the
appropriate next step of the following?

Repeat cytology immediately

Repeat cytology in 1 year
Perform or refer out for colposcopy
Repeat cytology in 2-4 months - ANSW-Perform or refer out for colposcopy
A 65 year old female presents with c/o vaginal soreness and dysuria that has been intermittent for
several years. She notes the pain is worse after intercourse with her husband of 30 years, with whom is
in an monogamous relationship. She denies vaginal discharge and has not had a pap smear
since her total hysterectomy ten years ago. She currently only takes a multivitamin. Your wet mount
reveals few lactobacilli and increased parabasal cells. What is your likely diagnosis?

Trichomonas vaginalis
Vaginal candidiasis
Atrophic vulvovaginitis
Bacterial Vaginosis - ANSW-Atrophic vulvovaginitis
An initial pharmacological approach to the patient was diagnosed with primary dysmenorrhea could be:

NSAIDs prior to the onset of menses

NSAIDs at the time symptoms begin or onset of menses
Combination of acetaminophen and NSAIDs
Acetaminophen - ANSW-NSAIDs at the time symptoms begin or onset of menses

Pain associated with dysmenorrhea is likely due to prostaglandins. NSAIDs are prostaglandin synthesis
inhibitors. They are usually started at the onset of menses or onset of symptoms and continued for 2-3
days depending on symptom pattern. There is no demonstrated increase in efficacy when
acetaminophen is added or given alone.
A 26-year-old female patient has been diagnosed with gonorrhea. However should she be managed?

Ceftriaxone and azithromycin

Cefixime and azithromycin
Ceftriaxone only
Penicillin G - ANSW-Ceftriaxone and azithromycin

Usual treatment for gonorrhea/Chlamydia includes ceftriaxone 250 mg IM in conjunction with 1 g

azithromycin by mouth.
A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as
pelvic inflammatory disease?

Abnormal CMP
Temperature greater than 101°F
Hematuria
Presence of hyphae - ANSW-Temperature greater than 101°F

Symptoms of PAD include elevated temperature, abnormal cervical or vaginal discharge, presence of
abundant WBC, elevated sedimentation rate or C-reactive protein. The CDC recommends empiric
treatment of PID if lower abdominal pain or pelvic pain is present concurrently with cervical motion
tenderness or uterine/adnexal tenderness
A 27-year-old asymptomatic male presents with generalized
lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following
choices, what tests should be performed?

HIV test
Comprehensive metabolic panel
Lymph node biopsy
RPR - ANSW-HIV test

Asymptomatic HIV infections often have persistent generalized lymphadenopathy.

What is your treatment for Atrophic Vulvovaginitis?

Diflucan (Fluconazole) 150mg PO x 1

Flagyl (Metronidazole) 2g PO x 1
Premarin cream 0.5g PV 1-3 x wk
Clindamycin 2% 5g applicator PV x 7 days - ANSW-Premarin cream 0.5g PV 1-3 x wk
You suspect that the patient you are seeing as HIV. which with the following is a sensitive screening test
for human immunodeficiency virus?

HIV antibody test

ELISA test
Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen
Western blot test - ANSW-Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen

The CDC recommends screening for combination antigen/antibody near as 8 with PT 24 antigen.
Previously the ELISA was used as a screening test, and a Western blot was a confirmatory test. However
they tested only for HIV antibody. The CDC recommends testing everyone between the ages of 13-64
years for HIV at least once as part of a routine health care. If risk factors are present, the patient should
be tested for HIV annually. For sexually active gay and bisexual man, the CDC recommends more
frequent testing, perhaps every
3-6 months.
After an IUD is placed, the threads should be cut so approximately ______ are visible. This should then
be _________.

6 cm; measured and documented in the chart.

3 cm; measured and forgotten about.
3 cm; measured and documented in the chart.
6 cm; measured and forgotten about. - ANSW-6 cm; measured and documented in the chart.
The uterus should sound to ______ cm when measuring for Mirena IUD insertion to allow for the arms
to open and proper alignment to occur.

6 cm; measured and documented in the chart.

6 cm; measured and forgotten about.
3 cm; measured and documented in the chart.
3 cm; measured and forgotten about. - ANSW-3 cm; measured and documented in the chart.
A sexually active adolescent male has a warty growth on the shaft of his
penis. It is painless. This is likely:

Trichomonas
Syphilis
HPV
Herpes - ANSW-HPV

This is not a clinical presentation of trichomonas because this

produces a discharge. Syphilis produces a painless lesion that
presents as an ulceration with a hard edge and clean yellow base.
Herpes produces lesions but are usually painful. HPV produces warty
growths as described above.
A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulvall
itching and discharge. He is asymptomatic. How should they be treated?
They both should be treated with azithromycin and doxycycline
They both should receive metronidazole
She should be treated with ceftriaxone, he should receive ciprofloxacin
She should receive metronidazole, he does not need treatment - ANSW-They both should receive
metronidazole

Metronidazole is the drug of choice to treat male in females for

Trichomonas. Even though he is asymptomatic, he should receive
treatment. Neither partner should resume sexual intercourse until
both have been treated and usually 5-7 days after.
Chancroid considered a cofactor for transmission of:

Trichomonas
Chlamydia
Gonorrhea
HIV - ANSW-HIV

Chancroid is an STD. It is spread by sexual contact or by contacting

pus from an infected lesion. The ulcers usually. Painful and then, but
usually not painful in women. It is a cofactor in the transmission of
HIV.
An initial pharmacological approach to the patient was diagnosed with primary
dysmenorrhea could be:

NSAIDs
Tramadol
Acetaminophen
Combination of acetaminophen and NSAIDs - ANSW-NSAIDs
A 25-year-old female presents with lower abdominal pain. Which finding would indicate
the etiology as pelvic inflammatory disease?

Abnormal CMP
Hematuria
Temperature greater than 101°F
Presence of hyphae - ANSW-Temperature greater than 101°F
A 21-year-old college student has recently been informed that he has HPV infection on the shaft of his
penis. With the following methods can be used to visualize subclinical HPV lesions on the penile skin?
Perform a KOH exam
Order a serum herpes virus titer
Scrape out some of the affected skin and send it to culture and sensitivity
Apply acetic acid to the penile shaft to look for acetowhite changes - ANSW-Apply acetic acid to the
penile shaft to look for acetowhite changes

Lesions of HPV infection will turn white with application of acetic acid.
Routine use of this procedure to detect mucosal changes due to HPV
is not recommended because results do not influence clinical
management (per CDC).
50-year-old male comes to in see the nurse practitioner for evaluation. He complains of fever, chills,
pelvic pain, dysuria. He should be diagnosed with:

Urinary tract infection

Acute bacterial prostatitis
Nonbacterial prostatitis
Chronic bacterial prostatitis - ANSW-Acute bacterial prostatitis

Acute bacterial prostatitis should always be considered first in male

patient to present with these symptoms. Chronic bacterial prostatitis
presents with a more subtle presentation. UTIs far less common in
men than women and is usually associated with anal intercourse or
being uncircumcised. Nonbacterial prostatitis presents like chronic
prostatitis except urine and prostate secretion cultures are negative.
In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the
public health department. The patient asks the NP not to reported because her husband works in the
public health department.
How show this be managed by the NP?

Report it to the public health department as required by law

Report it to the public health department but don't divulge all the details
Tell the patient that it will not be reported, but report it anyways
Respect the patient's right privacy and not report it - ANSW-Report it to the public health department as
required by law

If state law requires it, it should be reported. Patient names or other

identifying data are not part of the reporting process, so the patient
should not worry about being identified and associated with this
finding.
A 31-year-old female patient presents with fatigue, fever, worsening unilateral low back pain for the past
5 days. Her pain is 5 out of 10 on the pain scale which has been unresponsive to ibuprofen. she denies
abdominal pain, but
is anorexic and nauseous. She denies vaginal discharge. Urinalysis demonstrates hematuria, the
presence of WBC casts, leukocytes, nitrates.
Which should be included in differential diagnosis?

UTI
Pelvic inflammatory disease
Renal stones
Pyelonephritis - ANSW-Pyelonephritis

The patient's complaint of unilateral low back pain is likely secondary

to pyelonephritis. The presence of WBC casts in the urine strongly
suggest a renal origin for pyuria. A patient who presents with this
scenario has to be considered to have pyelonephritis until proven
otherwise. Most women with PID have bilateral abdominal
tenderness, usually in the lower quadrants. Purulent vaginal
discharge and fever also common.
The mother of a 3-day-old newborn reports that her infant nurses every 3-4 hours during the day and
sleeps 6 hours at night. What will the provider recommend?

Pumping her breasts to maintain her milk supply so that baby will have extra milk later after the initial
newborn period.
Ensuring that her infant nurses for 15 to 20 minutes each time on one breast only, switching to the other
breast at the next feeding
Awakening the baby every 3-4 hours to nurse if the baby is not gaining weight
Continuing this schedule until the baby is 6 months old, then the interval between feedings can be
increased - ANSW-Awakening the baby every 3-4 hours to nurse if the baby is not gaining weight
A mother who has been breastfeeding her infant for several weeks develops a fever x 24 hours, malaise,
breast erythema, and breast tenderness. What will the provider recommend?

Ice packs and increased frequency of nursing

Cessation of nursing and antibiotics initiated that covers S. aureus
Increased frequency of nursing and antibiotics initiated that covers S. aureus
Ice packs and cessation of nursing with breast pumping initiated - ANSW-Increased frequency of nursing
and antibiotics initiated that covers S. aureus
A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial
screening exam reveals a blood pressure of 140/90, she is asymptomatic. And a fasting blood glucose of
128 mg/dL. What will the practitioner do?

Monitor blood pressure and fasting blood glucose closely. Do 2 hr GTT (glucose tolerance test) early,
before 24 weeks.
Initiate insulin therapy
Refer the patient to a high-risk pregnancy specialist
Prescribe an antihypertensive medication - ANSW-Monitor blood pressure and fasting blood glucose
closely. Do 2 hr GTT (glucose tolerance test) early, before 24 weeks.
A pregnant patient is found to have positive leukocytes and positive nitrates in her urine. She is
asymptomatic. What medication should be given?

Trimethoprim-sulfamethoxazole
Doxycycline
Pyridium
Nitrofurantoin - ANSW-Nitrofurantoin

Patient's urinalysis indicates UTI. Nitrofurantoin would be a good

choice to treat patient, it is generally considered safe during
pregnancy. Doxycycline is not considered safe during pregnancy.
Which with the following is contraindicated in the care of a pregnant woman with placenta previa?

Echocardiogram
Pelvic ultrasound
Intravaginal ultrasound
Abdominal ultrasound - ANSW-Intravaginal ultrasound

No type of vaginal exam should be performed and the patient

diagnosed with placenta previa. Intravaginal ultrasound and pelvic
exams are contraindicated
A woman who is taking oral contraceptive pills (OCPs) to prevent pregnancy calls the provider to report
forgetting to take the pills for 4 days. She has not had sexual intercourse during that time. What will the
provider recommend?

Use a morning after pill today and resume the OCPs now
Stop the OCP, use an alternative method, and resume OCPs at the next cycle
Resume the pills and use a backup method the remainder of the cycle
Take 2 pills daily for 4 days and use an alternative method for 4 days - ANSW-Resume the pills and use a
backup method the remainder of the cycle
A young primigravida reports to you that she is starting to feel the baby's movement in her uterus. This is
considered to be rechecked the following?

Positive sign
Presumptive signs
Possible sign
Probable sign - ANSW-Presumptive signs

Presumptive signs or sensations that are felt by the mother, but they
could also be caused by other conditions. They are some of the
earliest symptoms of pregnancy, such as nausea, fatigue, breast
tenderness, amenorrhea, and quickening.
A 24-year-old patient presents to clinic with intermittent nausea and vomiting for the past 5 days. She
feels fine otherwise. She is afebrile. Her vital signs are within normal limits. What should the nurse
practitioner ordered initially?

Electrolytes and qualitative beta hCG

Metabolic panel and potassium level
CBC and urine for ketones
Electrolytes and quantitative beta hCG - ANSW-Electrolytes and qualitative beta hCG

Pregnancy must be ruled out for this patient. The other concern is her
electrolyte status, especially her potassium level as it tends to drop
with vomiting
A woman comes into clinic due to migraines with aura, but also requests oral contraceptives to prevent
pregnancy. Which type of contraceptive will the provider recommend?

Contraceptive implant
Progestin-only contraception
Combination oral contraceptive
Transdermal combination product - ANSW-Progestin-only contraception
14-year-old girl with amenorrhea was tested for pregnancy and has a positive result. The patient tells a
nurse practitioner that she is seriously considering terminating the pregnancy. She tells the NP that she
wants to be referred to a Planned Parenthood clinic. The NP's personal believes in religious beliefs are
pro-life. Which with the following is the best action for the NP?

NP should excuse herself from the case

NP should tell the patient about her personal believes and advise her against getting an abortion
NP should advise patient that a peer who is working with NP can help answer the patient's questions
more thoroughly
NP should refer patient to an obstetrician - ANSW-NP should advise patient that a peer who is working
with NP can help answer the patient's questions more thoroughly

In general, discussing personal beliefs are considered unprofessional behavior. respecting the patient's
right to choose is an example of supporting patient of autonomy
A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered
at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks
gestation. How will this be recorded as her G/TPAL in her electronic medical record?

G4P:1213
G4P:2113
G4P:1113
G5P:1213 - ANSW-G4P:1113

G/TPAL
T = refers to term births, after 37 wks gestation
P = refers to premature births
A = refers to abortions (refers to the total # of spontaneous or induced abortions or miscarriages, except
ectopic pregnancies, prior to 20
wks. If a fetus is aborted after 20 wks, spontaneously or electively,
then it is counted as a premature birth and P will increase but L will
not.
L = refers to living children
A 3-day-old, full-term female infant who is breastfeeding develops some jaundice. The transcutaneous
bilirubin(TcB) reading in the office is in the intermediate risk zone. What will the provider tell the
mother?

To use a breast pump to increase her milk supply and increase baby to breast
and return to clinic within 5 days for reassessment
To supplement feedings with extra water and return to clinic within 5 days for reassessment
To switch to formula and return to clinic within 5 days for reassessment
To decrease the frequency of breastfeeding and return to clinic within 5 days for reassessment - ANSW-
To use a breast pump to increase her milk supply and increase baby to breast
and return to clinic within 5 days for reassessment
A 30-year-old woman complains of having had no period for the last 12 weeks. She is sexually active and
her partner has been using condoms inconsistently. The patient has had history of irregular menstrual
cycles and
severe dysmenorrhea. The urine pregnancy test result is positive. Which of the following is true
statement regarding this pregnancy?

Hegar's sign is present during this period of pregnancy

Quickening starts during this period
The fundus of the uterus should be at the level of the symphysis pubis
The cervix should be dilated about half an inch at this time of gestation - ANSW-The fundus of the uterus
should be at the level of the symphysis pubis
Hegar's sign is considered a:

Presumptive sinus pregnancy

Problem in pregnancy
Probable sign of pregnancy
Positive sign of pregnancy - ANSW-Probable sign of pregnancy

Hegar's sign is a softening of the lower portion of the uterus and is considered a probable sign of
pregnancy.
A female calls the provider to report having unprotected sexual intercourse approximately 4 days prior.
Which regimen will the provider recommend?

Ulipristal Acetate twice daily for 3 days

Plan B One Step twice daily for 5 days
Ulipristal Acetate taken one time
Plan B One Step daily for 5 days - ANSW-Ulipristal Acetate taken one time
A female patient is coming to your clinic complaining of nausea. You go to urine pregnancy test and it is
negative. however the patient still thinks she is pregnant. You know that since she has been
contemplating pregnancy, she should initiate folic acid..

Now
At the diagnosis of pregnancy
In the third trimester
In the second trimester - ANSW-Now

Folic acid has been found to significantly decrease the incidence of neural tube defects. It should be
supplemented at a dosage of 0.4 mg daily for all women of childbearing age before becoming pregnant.
The classic presentation of placenta previa is:
Painless vaginal bleeding after the 20th week
Painful bleeding in the third trimester
Painless bleeding in the first trimester
Painful vaginal bleeding before the 30th week - ANSW-Painless vaginal bleeding after the 20th week

Painless vaginal bleeding is associated with placenta prevue if occurs after the 20th week. Bleeding is
likely at this time because the
lower uterine segment develops and uterine contractions occur. At this time, the cervix dilates and
effaces. Placenta can become detached and bleeding can occur.
The classic symptoms of ectopic pregnancy are:

Abdominal pain, vaginal discharge, fever

Amenorrhea, vaginal discharge, Abdominal pain
Abdominal pain, nausea, vaginal bleeding
Shoulder pain, bleeding, menorrhea - ANSW-Amenorrhea, vaginal discharge, Abdominal pain

The majority reports these symptoms with the follow %: 99% Abdominal pain, Amenorrhea 74%, vaginal
bleeding 55%.
Hyperemesis gravidarum is:

Morning sickness
Indicative of multiple gestations
Persistent, intractable vomiting during pregnancy
Always associated with hydatiform mole - ANSW-Persistent, intractable vomiting during pregnancy

Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. A
common definition used to define hyperemesis gravidarum is persistent vomiting that produces a weight
loss exceeding 5% of prepregnancy body weight.
A 44-year-old female who is undergoing treatment for infertility complains of not having had a menstrual
period for a few months. The night before, she started spotting and is now having cramp-like pains in her
pelvic area. Her blood pressure is 160/80, pulse 110, she is afebrile. Her labs revealed mild anemia, mild
leukocytosis. On exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is
dilated to 3 cm. Which of the following is most likely?

Acute pelvic inflammatory disease

Incomplete abortion
Inevitable abortion
Threatened abortion - ANSW-Inevitable abortion
Inevitable abortion is defined and vaginal bleeding with pain, cervical dilation and/or cervical
effacement. threatened abortion is defined as vaginal bleeding with absent or minimal pain and closed
cervix. Incomplete abortion involves moderate or diffuse bleeding with the passage of tissue and painful
uterine cramping or contractions.
When prescribing medications to an 80-year-old patient, the provider will

Consult the Beers list to help identify potentially problematic drugs.

Ensure that the patient does not take more than five concurrent medications.
Begin with higher doses and decrease according to the patient's response.
Review all patient medications at the annual health maintenance visit - ANSW-Consult the Beers list to
help identify potentially problematic drugs.
An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She appears
somewhat confused, according to her daughter, who is concerned that she is developing dementia. The
provider learns that the woman still drives, volunteers at the local hospital, and attends a book club with
several friends once a month. What is the initial step in evaluating this patient?

Obtain a CBC, serum electrolytes, BUN, and glucose

Referring the patient to a neurologist for evaluation for AD
Ordering a CBC, serum ferritin, and TIBC
Referring the patient to a dietician for nutritional evaluation - ANSW-Obtain a CBC, serum electrolytes,
BUN, and glucose
Which of the following would be usual in a patient with biliary colic?

Positive Murphy's sign

Pain in upper abdomen in response to eating fatty foods
Presence of gallstones on imaging study
Presence of gallstones and unpredictable abdominal pain - ANSW-Pain in upper abdomen in response to
eating fatty foods

Biliary colic refers to discomfort produced by contraction of the gallbladder, which often occurs in
response to eating.
A patient who has a history of diverticular disease has left-sided pain and reports seeing blood in the
stool. What is an important intervention for these
symptoms?

Ordering a CBC and stool for occult blood

Referring the patient for a lower endoscopy
Prescribing an antispasmodic medication
Reminding the patient to eat a high-fiber diet - ANSW-Referring the patient for a lower endoscopy
A patient has nausea associated with chemotherapy. Which agent will be prescribed?

Meclizine
Scopolamine
Ondansetron
Diphenhydramine - ANSW-Ondansetron
Most patients who has acute hepatitis A infection:

Have a self limiting illness

Develop fulminant disease
Become acutely ill
Develop subsequent cirrhosis - ANSW-Have a self limiting illness
A female patient with the complaint of dysuria has a urine specimen that is positive for leukocytes and
nitrates. There is blood in the specimen. The most appropriate diagnosis is:

UTI or chlamydia
Urinary tract infection
UTI with hematuria
Asymptomatic bacteriuria
No answer text provided. - ANSW-UTI with hematuria

The presence of leukocytes and nitrates in the urine indicates likely

infection in the bladder, and more likely from a gram-negative
pathogen such as Escherichia coli. The presence of blood is common
when patient's has a UTI. A diagnosis of chlamydia cannot be made
based on the symptoms and urinalysis results.
If cervical stenosis is met when performing IUD insertions, which of the following should be used to
overcome resistance?

12 - 15 cm
6 - 9 cm
9 - 12 cm
3 - 6 cm - ANSW-6 - 9 cm
A pregnant patient complains of urinary frequency and dysuria. Her urinalysis is positive for nitrates,
leukocyte esterase, and bacteria. Will course of action is most appropriate?

Prescribe an antibiotic only

Order a urine culture only
Order urine culture and begin antibiotics
Repeated the urinalysis - ANSW-Order urine culture and begin antibiotics

The findings of the urinalysis along with symptoms of dysuria are

consistent with UTI. Empiric antibiotic should be initiated and culture
ordered. Pregnant female start high risk of developing pyelonephritis
if UTI is left untreated.
Which medications are useful in treating both obsessive-compulsive disorder and PTSD? (Select all that
apply.)

Benzodiazepines
Buspirone
Selective serotonin reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitors
Tricyclic antidepressants - ANSW-Selective serotonin reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitors
Tricyclic antidepressants
A patient reports symptoms of restlessness, fatigue, and difficulty
concentrating. The provider determines that these symptoms occur in relation to many events and
concerns. What other things will the provider question this patient about?

Headaches and bowel habits

Ability to manage social situations
Occupational performance
Body image and eating habits - ANSW-Headaches and bowel habits
A patient is coming to the clinic complaining of feeling depressed. You know that a typical symptom of
depression is:

Snoring
Difficulty falling asleep
Early morning wakening
Keeping late-night hours reading - ANSW-Early morning wakening

Sleeping difficulty is a common complaint among patients with

depression. Patients with difficulty falling asleep or often anxious.
Frequent wakening and early morning wakening are complaints by
many patients with depression.
A 38-year-old patient diagnosed with bipolar disease has taken lithium for many months. His mood has
stabilized. He was told to report frequent urination while taking lithium. What might be the underlying
cause of his frequent urination?

Blood sugar elevation

Diabetes insipidus
Urinary tract infection
Elevated lithium level - ANSW-Diabetes insipidus

The most common side effect of lithium therapy is nephrogenic

diabetes insipidus. Polyuria and polydipsia secondary to nephrogenic
diabetes insipidus occur in about 20% of patients who take lithium.
A patient is coming in to see you at your urgent care with vague symptoms. You note that she has been
at your urgent care multiple times over the last several weeks complaining of vague symptoms. You note
that she seems to respond poorly to medical treatment that has been given to her. What should be
considered when obtaining a history from her?

Physical abuse or depression

Anemia or depression
Hepatitis or HIV
Depression or HIV - ANSW-Physical abuse or depression

Patient's who have been victims of violence or more likely to utilize

health care and to have a poor response to treatment. If the patient is
suspected to have been a victim of violence, they should also be
screened for anxiety, depression, and PTSD.
A college student is brought to the emergency department by a roommate who is concerned about
symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and
blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects
withdrawal from which substance?

Opioids
Cocaine
Alcohol
LSD - ANSW-Opioids
A patientwith acute anxiety will experience the fastest relief of symptoms when he is treated with?

A benzodiazepine
A TCA
An SSRI
A beta blocker - ANSW-A benzodiazepine
A 86-year-old male reports feeling anhedonia for the last month. What should be part of the nurse
practitioner's initial assessment?

Mania
Suicidal ideation
Libido
Depression - ANSW-Suicidal ideation

Anhedonia is the loss of pleasure interest in things that have always

brought pleasure or interest. It is a red flag for depression. Screening
for depression is necessary, however, suicidal ideation should be the
priority assessment.
A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake inhibitor
medication. Six weeks later, the patient reports little relief from symptoms. What will the provider do
next to manage this patient?

Change the medication to buspirone

Discontinue the medication
Refer to a mental health provider
Increase the medication dose - ANSW-Refer to a mental health provider
CNS stimulants cause increase alertness, excitation, and sometime
euphoria. Stimulant drugs include the following:

Naloxone, Benzodiazepines and Alcohol

Benzodiazepines, Cocaine and Amphetamines
Cocaine, Amphetamine and Ecstasy
Ectasy, Cocaine and Alcohol - ANSW-Cocaine, Amphetamine and Ecstasy
You are seeing a new 10 year old patient in your primary care clinic. You believe the patient has
symptoms congruent with bipolar disorder. However, you also know that the usual age of onset of
symptoms with bipolar disorder is:

Childhood
Third decade
Adolescence
Between 15 and 30 years old - ANSW-Between 15 and 30 years old
The usual age of onset of bipolar disease symptoms as between 15-
30 years old. Onset of symptoms almost never occurs in patients
older than 65 or younger than 15 years old.
A patient is coming in to your urgent care and notes that he has been on edge lately and needs help. You
read in his chart that he is bipolar. The patient states that he recently purchased at $10,000 grand piano.
He does not play the piano. This behavior is typical during:

Hypomania
Depression
Mania
Psychosis - ANSW-Mania
4 days ago, 79-year-old female lost her husband of 55 years. She presents today with her daughter
because she believes that she is "going crazy." She reports that she often hears her husbands voice
though she realizes that he has died. She has not slept well since his death and hasn't been eating much.
She has taken her usual medications for hypertension, osteoporosis, osteoarthritis, and hypothyroidism.
She has no history of psychiatric illness. Should the NP manage this?

Tell her that this is a normal response and will resolve

Prescribe a benzodiazepine for relief of anxiety
Encourage her daughter to consider assisted living placement
Prescribe an antidepressant and follow-up in one to 2 weeks - ANSW-Tell her that this is a normal
response and will resolve

This imagined hearing or seeing of the deceased person is referred to

as "searching behavior" and is not indicative of a psychiatric illness. It
is a common response after the death of a lot of the 1, especially after
55 years of marriage. This patient and her daughter should be
educated regarding the stages of grief and a variable length of each
of those stages.
A patient with an eating disorder might exhibit evidence of:

Thyroid disease
Sexual abuse
Anxiety disorders
Sleep disorders - ANSW-Anxiety disorders

In patients with eating disorders, it is common to identify affective

disorders, anxiety disorders, or substance abuse issues. Obsessivecompulsive
disorder is also commonly observed. There is no
evidence of patients with eating disorders exhibit a higher incidence of
sleep disorders, or had been sexually abused. Thyroid disease
should always be assessed in patients with eating disorders, but this
does not represent the reason for weight loss when eating disorder is
present.
A 29-year-old postpartum female reports that she is having difficulty with concentration, sleep, and has
feelings of guilt. She states that she feels sad most of the time. The symptoms have been present since
the birth of her baby about one month ago. She can be diagnosed with:

Dysthymia
Hypothyroidism
Postpartum depression
Minor depressive disorder - ANSW-Postpartum depression

Post partum depression is diagnosed with depression begins within

the first month after delivery.
Which class of antidepressants is first line to treat obsessive compulsive disorder?

SNRI
TCA
MAOI
SSRI - ANSW-SSRI
You are seeing a patient and considering serotonin syndrome as a potential differential diagnosis. The
patient is taking an SSRI. Which of the other medications the patient is taking may cause serotonin
syndrome?

Pravastatin
Dextromethorphan
Niacin
Loratadine - ANSW-Dextromethorphan

Necessary rind dextromethorphan can cause serotonin syndrome. This is a potentially life threatening
condition.