Chamberlain College of Nursing - NR 511 Final exam |NR511 final part 2_Fall 2020 (solution).

Chamberlain College of Nursing - NR 511NR 511 final part 2. Male GU 14-2 Benign prostatic hypertrophy is a common fi nding as men age. Classically, this condition may begin with diffi culty initiating the urinary strea ...

Chamberlain College of Nursing - NR 511NR 511 final part 2. Male GU 14-2 Benign prostatic hypertrophy is a common fi nding as men age. Classically, this condition may begin with diffi culty initiating the urinary stream, hesitancy, urgency, postvoid dribbling, urinary frequency, nocturia, urinary retention, sensation of a full bladder immediately after voiding, and incontinence. These preceding symptoms would also cause the nurse practitioner to consider what other condition as a differential diagnosis? A. Epididymitis B. Testicular cancer C. Cancer of the prostate D. Balanitis 14-4 The main principle of management for prostatitis is to treat the patient on an outpatient basis if he is afebrile. All of the following antibiotics are recommended in the pharmacologic treatment in men with bacterial prostatitis except A. penicillin. B. nitrofurantoin (Macrobid). 14-18 Milton, a 72- year- old unmarried, sexually active white man, presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although the nurse practitioner suspects benign prostatic hypertrophy, what else should the differential diagnosis list include? A. Antihistamine use B. Urethral stricture C. Detrusor hyperrefl exia D. Renal calculi 14-20 A bladder tumor antigen test may be positive with A. testicular torsion. B. the use of steroids for bodybuilding. C. scrotal trauma. D. symptomatic sexually transmitted disease. 14-21 The action of a 5- alpha- reductase inhibitor in the treatment of benign prostatic hypertrophy is to A. relax the smooth muscle of the prostatic capsule. B. reduce action of androgens in the prostate. 14-27 In deciding whether to treat 63- year- old Morrison, who has benign prostatic hypertrophy, the nurse practitioner uses the American Urological Association (AUA) scale. No treatment is indicated if the AUA score is A. 36 or higher. B. 20 to 35. C. 8 to 19. D. 7 or lower. 14-30 What is the most common prostatitis syndrome found in males of any age? A. Nonbacterial prostatitis B. Prostatodynia C. Acute bacterial prostatitis D. Chronic bacterial prostatitis 14-35 What is the medical terminology for infl ammation of the glans and prepuce? A. Balanitis. B. Balanoposthitis. C. Phimosis. D. Paraphimosis. 14-40 Harvey is complaining of stress urinary incontinence. To assess the autonomic arch innervating the bladder, the nurse practitioner should test the A. inguinal refl ex. B. neuronal refl ex. C. bulbocavernous refl ex. D. meatal resistance. 14-44 The most accurate diagnostic tool for prostate cancer is A. a digital rectal examination. B. a prostate- specifi c antigen test. C. a transrectal ultrasound examination. D. a needle biopsy. 14-57 Cryptorchidism is a risk factor for A. cancer of the prostate. B. testicular cancer. C. bladder cancer. D. a benign testicular tumor. 14-59 Which of the following can cause phimosis? A. Paraphimosis B. Smegma C. Adhesions from infection D. Priapism 14-60 A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for cardiovascular disease and coagulopathy. Which of the following medications would be contraindicated? A. Topical testosterone (Androgel) B. Sildenafi l (Viagra) C. Alprostadil (Caverjet) D. Subcutaneous pellet testost 14-61 A patient’s chief complaint is heaviness in the scrotum. The nurse practitioner assesses swelling of the testes, along with warm scrotal skin. What differential diagnosis is most probable? A. Cryptorchidism B. Orchitis C. Testicular torsion D. Epididymitis 14-65 Most lesions of the penis are nontender and painless. Which of the following conditions begins with a tender, painful lesion? A. Syphilitic chancre B. Genital herpes 14-70 Which of the following medications is known to cause nocturia? A. Sympathomimetic agents B. Phenothiazines C. Androgens D. Alpha- adrenergic agents 14-72 Harris, age 68, is complaining of crooked, painful erections. He has palpable, nontender, hard plaques just beneath the skin of his penis. Based on the chief complaint and assessment, what is the most likely differential diagnosis? A. Carcinoma of the penis B. Genital herpes C. Syphilitic chancre D. Peyronie’s disease 14-74 Morris, age 52, is in a new relationship and is not sure whether his erectile dysfunction is caused by stress about his performance or is organic. What simple test could you suggest to determine if he has the ability to have an erection? A. Nocturnal penile tumescence and rigidity test urethral opening is on the dorsal side of the glans. This is referred to as A. hypospadias. B. Peyronie’s disease. C. priapism. D. epispadias. 14-80 A patient is being followed by the nurse practitioner for disease progression or remission after treatment for testicular cancer. Which of the following biochemical markers would be ordered and analyzed? A. Human chorionic gonadotropin (hCG) B. Alpha- fetoprotein (AFP) C. Lactate dehydrogenase (LDH) D. All of the above 14-87 Which sexually transmitted diseases are cofactors for HIV transmission? A. Syphilis and chlamydia B. Herpes and chlamydia C. Chancroid and genital herpes D. Chancroid and gonorrhea 14-89 A patient’s chief complaint is blood in the urine. The nurse practitioner knows that the most common cause of gross hematuria in the male population is A. a bladder infection. B. benign prostatic hypertrophy. C. bladder tumor. D. prostatitis. 14-90 Sidney, age 72, presents to the clinic with complaints of a weak urine stream, hesitancy, and painful ejaculation. On digital rectal examination, you note that his prostate is boggy. The most common cause of his symptoms is A. acute bacterial prostatitis. B. chronic bacterial prostatitis. C. chronic nonbacterial prostatitis with chronic pelvic pain syndrome. D. noninfl ammatory prostatitis. 14-98 Lower urinary tract symptoms (LUTS) in males can present as a constellation of storage or voiding symptoms. Storage symptoms include A. hesitancy and poor fl ow. B. intermittency and post- void dribble. C. straining and dysuria. D. urgency and nocturia. 14-102 The most common type of hernia in the male population is a(n) A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. umbilical hernia. 14-104 The nurse practitioner has just treated a patient’s condylomata acuminata with podophyllum in benzoin. What instructions should be given to him as part of patient teaching? A. “Refrain from sexual relations for 48 hours.” B. “Don’t take a shower until tomorrow morning.” C. “Wash the medication off within 1 to 2 hours.” D. “Go into the bathroom now and wash the medication off.” 14-105 Transillumination of fl uid in the scrotum may be seen with A. a varicocele. B. a hydrocele. C. te 14-106 Low- grade, localized prostate cancer can be treated successfully with A. radical prostatectomy or radiation. B. chemotherapy. C. cryosurgery (freezing) of a small part of the gland. D. watchful waiting. sticular torsion. D. testicular cancer. 14-108 You are referring a 73- year- old client for management of his prostate cancer with hormonal therapy. It is understood that goserelin acetate (Zoladex) acts as a method of androgen ablation by A. blocking the release of follicle- stimulating hormone (FSH) and luteinizing hormone (LH). B. blocking 5- alpha- reductase, which converts testosterone into dihydrotestosterone. C. inhibiting the binding of testosterone to the cancer cells. D. inhibiting the progression of cancer cells through the cell cycle. Chap 16 16-1 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 fl exion causing external hip rotation. Based on the above scenario, the nurse practitioner should suspect A. a left meniscal tear. B. a left anterior cruciate ligament (ACL) tear. C. a slipped capital femoral epiphysis (SCFE). D. Osgood-Schlatter disease. 16-4 Treatment of choice for polymyalgia rheumatica (PMR) is A. acetaminophen or NSAIDs. B. low- dose steroids. C. tricyclic antidepressants. D. antibiotics.’ 16-5 Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct? A. Integumentary effects include swelling, erythema, and warmth at the involved site. B. There is a low- grade fever with intermittent chills. C. Musculoskeletal effects include tenderness of the entire leg. D. Cardiovascular effects include bradycardia. 16-12 If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured using A. Phalen’s test. B. skeletometry. C. the Thomas test. D. a goniometer. 16-14 Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age- related change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis 16-23 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 confi ned 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 16-24 To aid in the diagnosis of meniscus damage, which test should a nurse practitioner perform? A. The bulge test B. The Lachman test C. The drawer test D. Apley’s compression test 16-25 Mickey, age 18, is on a chemotherapeutic antibiotic for a musculoskeletal neoplasm. Which drug do you think he is taking? A. Cyclophosphamide (Cytoxan) B. Doxorubicin (Adriamycin) C. Methotrexate (Rheumatrex) D. Cisplatin (Platinol) 16-26 Stan, age 34, fractured his femur when his horse tripped over a jump. With this type of injury, you know that Stan is at risk for fat emboli. Early assessment fi ndings for this complication include A. fever, tachycardia, rapid respirations, and neurological manifestations. B. neurological manifestations, temperature elevation, bradycardia, and pallor. C. hostility; combativeness; substernal pain; and a weak, thready pulse. D. lethargy, hypothermia, paresthesia, and absent peripheral pulses. 16-27 Upon assessment, the nurse practitioner notes unilateral back pain that had an acute onset and increases when standing and bending. A straight- leg test is negative. The most likely differential diagnosis is A. herniated nucleus pulposus. B. muscle strain. C. osteoarthritis. D. spondylolisthesis 16-33 The nurse practitioner has just completed a work- up on Michael, age 13, and confi rmed Osgood-Schlatter disease. The initial management would be to A. refer to orthopedics for early surgical correction. B. recommend physical therapy for quadricepstrengthening 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. 16-35 You are assessing Jamal, 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. 16-36 Carol, age 62, has swollen, bony proximal interphalangeal joints. The nurse practitioner describes these as A. Heberden’s nodes. B. Bouchard’s nodes. C. Osler’s nodes. D. Murphy’s nodes.. 16-37 Sean, a factory line worker, has osteoarthritis of the right hand. According to the American College of Rheumatology (ACR), the guidelines for pharmacological treatment include A. acetaminophen, tramadol, and intra- articular corticosteroid injections. B. oral NSAIDs, Tramadol, and articular corticosteroid injections. C. acetaminophen, topical capsaicin, and topical NSAIDs. D. topical capsaicin, topical NSAIDs, and oral NSAIDs. 16-40 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. 16-45 Joan, age 76, has been given a diagnosis of osteoporosis confi rmed with a dual- energy x- ray absorptiometry (DEXA) scan. The nurse practitioner has educated her about the importance of increasing calcium and vitamin D in her diet and starting a low- impact, weight- bearing exercise program. The nurse practitioner is also going to start the patient on medial management. Joan asks about a drug called a “SERM” that she has heard has been shown in studies to prevent vertebral fractures. Which of the following pharmacological therapies for osteoporosis is classifi ed as a selective estrogen receptor modulator (SERM)? A. Alendronate (Fosamax) B. Risedronate (Actonel) C. Salmon calcitonin D. Raloxifene (Evista) 16-52 Which of the following statements is true regarding vertebrae? A. All people have only 24 vertebrae (cervical, thoracic, and lumbar). B. Due to differences in race or gender, select groups may have 23 or 25 vertebrae (cervical, thoracic, and lumbar). C. It is common to have fewer than 23 vertebrae (cervical, thoracic, and lumbar). D. It is common to have more than 2 tests are ordered, the nurse practitioner completes a physical examination and makes a differential 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 16-55 Mrs. Matthews, age 71, 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 16-56 Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple “mechanical” backache and order A. bedrest for 2 days. B. muscle relaxants. C. her to continue activities as the pain permits. D. back- strengthening exercises. 16-58 Which of the following is true regarding scoliosis? A. Functional scoliosis is fl exible; it is apparent with standing and disappears with forward bending. B. Functional scoliosis is fi xed; the curvature shows both on standing and bending forward. C. Structural scoliosis is fi xed; the curvature shows both on standing and bending forward. D. Functional scoliosis is permanent, whereas structural scoliosis can result from outside infl uences such as leg length discrepancy or muscle spasms.. 16-65 In analyzing synovial fl uid, a yellow- green color may indicate which of the following? A. Trauma B. Gout C. A bacterial infection D. Rheumatoid arthritis 16-66 When teaching Alice, age 77, 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. 16-67 June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back and muscles without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely differential diagnosis? A. Ankylosing spondylitis B. Musculoskeletal strain C. Spondylolisthesis D. Herniated disk 16-69 Ankylosis is defi ned as A. muscle shortening. B. joint stiffness. C. malposition of a joint. D. dislocation of a joint. 16-71 Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest with her elbow fl exed. Based on the specifi c location of her pain, you suspect a radial head fracture. The best initial strategy to assess for radial head fracture would be A. to palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle. 16-75 Jim, age 64, has rheumatoid arthritis (RA). Which of the following drugs would be of the least benefi t? A. Disease- modifying antirheumatic drugs (DMARDs) B. Acetaminophen (Tylenol) C. NSAIDs D. Glucocorticoids 16-76 To diagnose fi bromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender point sites, which would include the A. occiput, low cervical, trapezius, and supraspinatus. 16-77 The nurse practitioner is trying to distinguish between an articular and nonarticular musculoskeletal complaint of a 26- year- old patient complaining of pain in the elbow area. Which of the following would characterize nonarticular bursitis? A. Deep or diffuse pain B. Limited ROM on active and passive movement C. Point or focal tenderness D. Swelling and instability 16-83 Ethan, age 10, jumps off a 2- foot wall, twisting his foot and ankle upon landing. His ankle x- ray demonstrates a fracture of the distal tibia over the articular surface into the epiphysis and physis. Based on the Salter-Harris classifi cation for growth plate injuries, you know this is a A. Salter-Harris II. B. Salter-Harris III. 16-90 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 rheumatic. 16-91 Which test is used to diagnose an Achilles’ tendon rupture? A. The Boutonniere test B. The Lachman test C. The Thompson test 16-92 How can you differentiate between a ganglion cyst and a neoplasm? A. A neoplasm is more painful. B. Ganglia transilluminate.. 16-96 What is the name of the test used to assess for nerve- root compression? A. The Apley scratch test B. The drop arm test C. Finkelstein’s test D. Spurling’s maneuver 16-97 A 55- year- old patient is able to complete ROM against gravity with some resistance. The nurse practitioner would assign which of the following numerical grades to this manual muscle testing description? A. 5 B. 4 16-100 What is the type of joint that is freely movable, such as the shoulder joint, called? A. The synarthrosis joint B. The amphiarthrosis joint C. The diarthrosis joint 16-101 Daniel, age 45, is of northern European ancestry and has a dysfunctional and disfi guring condition affecting the palmar tissue between the skin of the distal palm and fourth and fi fth fi ngers. What do you suspect? A. Hallux valgus B. de Quervain’s tenosynovitis C. Dupuytren’s contracture 16-111 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 16-114 Which of the following tests assesses the patency of the radial and ulnar arteries? A. Allen test 16-119 Which test assesses for thoracic outlet syndrome by having the client abduct his or her arms 90 degrees externally rotated with the elbows fl exed 90 degrees and then having the client open and close his or her hands for 3 minutes? A. The Neer test B. Speed’s test C. Hawkins test D. The Roos test Chap 17 17-8 If a client has hepatitis, abdominal pain in the right upper quadrant is a result of what pathophysiological basis? A. Reduced prothrombin synthesis by injured hepatic cells B. Bile salt accumulation C. Release of pyrogens D. Stretching of Glisson’s capsule 17-9 How long after the acute illness of hepatitis A do immunoglobulin M anti–hepatitis A virus titers disappear? A. 1 week B. 3 to 6 months C. 1 year D. 2 years 17-10 Which of the following individuals would not be a candidate for a thiazolidinedione such as pioglitazone (Actos)? A. A client with a history of hyperuricemia B. A client with asthma C. A client with heart failure D. A client with a sulfa allergy 17-12 Which of the following statements is true about insulin lispro (Humalog)? A. It works faster than regular insulin because its amino acid composition has been slightly modifi ed. 17-24 Which of the following medications can increase uric acid and lead to an acute gouty attack? A. HCTZ B. Beta blockers C. Calcium channel blocker D. ACE inhibitors 17-26 Which of the following steps will not prevent or slow the progression of diabetic nephropathy? A. Control of blood pressure B. Use of ACE inhibitors C. Smoking cessation D. Use of beta adrenergic antagonists 17-28 A fetus with intrauterine growth retardation (IUGR) is prone to hypoglycemia at birth because of A. an imbalance in insulin-glucagon secretion resulting from hyperinsulinemia from islet cell hyperplasia. B. few carbon stores in the form of glycogen and body fat. C. an inborn error of metabolism: glycogen storage disease. D. a complication of birth asphyxia. 17-33 ACE inhibitors are given to clients with diabetes who have A. an elevated glycohemoglobin level. B. insulin sensitivity. C. persistent albuminuria. 17-35 Which hormone is secreted by the adrenal cortex? A. Thyroid-stimulating hormone B. Growth hormone C. Follicle-stimulating hormone D. Aldosterone 17-38 Marie, age 50, has type 1 diabetes and checks her blood glucose level several times every day. Her blood glucose level ranges from 250 to 280 mg/dL in the morning and is usually about 140 at lunch, about 120 at dinner, and about 100 at bedtime. In the morning she takes 30 units of neutral protamine Hagedorn (NPH) insulin and 4 units of regular insulin, and before dinner she takes 18 units of NPH insulin and 4 units of regular insulin. Although she has had her insulin dosage adjusted several times in the past month, it has had no effect on her high morning blood glucose level. What is your next course of action? A. Increase the evening NPH insulin dosage by two more units. B. Have her check her blood glucose level between 2 a.m. and 4 a.m. for the next several days. 17-41 Pathological changes that occur with diabetic neuropathies include A. a thinning of the walls of the blood vessels that supply nerves. B. the formation and accumulation of amino glycosyl within the Schwann cells, which impairs nerve conduction. C. demyelinization of the Schwann cells, which results in slowed nerve conduction. 17-48 Marty has pheochromocytoma. You instruct him to A. void in small amounts. 17-50 Jeffrey, age 17, has gynecomastia. You should also assess him for A. obesity. B. endocrine abnormalities. C. testicular cancer. 17-61 Sara, age, 40, has diabetes and is now experiencing anhidrosis on the hands and feet, increased sweating on the face and trunk, dysphagia, anorexia, and heartburn. Which complication of diabetes do you suspect? A. Macrocirculation changes B. Microcirculation changes C. Peripheral neuropathies D. Autonomic neuropathies 17-64 Sandy, age 63, is being treated for chronic hypocalcemia. When her serum calcium level returns to normal, you assess her urinary calcium level and note that it is greater than 250 mg in a 24-hour sample. This indicates that A. her vitamin D dosage should be increased. B. her vitamin D dosage should be decreased. 17-67 Which of the following hormones is secreted by the posterior pituitary gland? A. Antidiuretic hormone (ADH)3 17-68 Jennifer has DM and is injecting 30 units of Novolin 70/30 with breakfast and 18 units at bedtime. She is complaining that she woke up once in the middle of the night with palpitations and sweating. Based on this information, what do you recommend ? A. Decrease the a.m. dose of 70/30. B. Decrease the p.m. dose of 70/30. C. Eat a snack before going to bed. D. Change the time of the nighttime insulin injection. 17-70 Leah, age 70, has had diabetes for many years. When teaching her about foot care, you want to stress A. that her calluses will protect her from infection. B. the need to assess the bottom of her feet carefully after walking barefoot. C. that painless ulceration might occur and feet should be examined with a mirror. 17-75 Pancreatitis has been associated with which of the following antidiabetic drugs ? A. Glipizide (Glucotrol) B. Metformin (Glucophage) C. Insulin glargine (Lantus) D. Exenatide (Byetta) 17-80 You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has A. elevated serum phosphate levels. 17-82 A client with diabetes on a sulfonylurea and metformin with an HbA1c of 6.5% is complaining of episodes of low blood sugar. Which of the following changes would be the most appropriate? A. Decrease the dosage of the metformin B. Discontinue the metformin C. Increase carbohydrate intake D. Decrease the dosage of the sulfonylurea. 17-83 Morton has type 2 diabetes. His treatment, which includes diet, exercise, and three oral antidiabetic agents at maximum dose, is insuffi cient to achieve acceptable glycemic control. Your next course of action is to A. give the patient a sliding scale with mealtime coverage with regular insulin. B. add a dosage of long-acting insulin at bedtime to the regimen. 17-89 Why is parathyroid hormone secretion increased during pregnancy? A. To meet the increased stress demands on the mother B. To meet the increased requirements for calcium and vitamin D for fetal skeletal growth. 17-93 Morris has had type 1 diabetes for 10 years. Several recent urinalysis reports have shown microalbuminuria. Your next step would be to A. order a 24-hour urinalysis. B. start him on an angiotensin-converting enzyme (ACE) inhibitor. 17-94 Jason, age 14, appears with tender discoid breast tissue enlargement (2–3 cm in diameter) beneath the areola. Your next action would be to A. perform watchful waiting for 1 year. 17-96 Presence of Trousseau’s sign is often preceded by A. a spasm of the facial muscle. B. muscle cramps in the legs and feet. 17-97 Mindy is scheduled to have an oral glucose tolerance test. For 3 days before the test, she is instructed to discontinue many of her medications. Which one is it safe to continue taking? A. Vitamin C B. Aspirin C. Calcium 17-99 Jay has had diabetes for 10 years. He recently had a physical and was told he has some evidence of renal nephropathy. What is the fi rst manifestation of this renal dysfunction? A. Microalbuminuria0 17-100 Polydipsia occurs in diabetes as a result of a high serum glucose level, which A. interferes with the release of antidiuretic hormones. B. has an osmotic effect on fl uids and eventually triggers the thirst mechanism for compensation. 17-102 Sadie, age 40, has just been given a diagnosis of Graves’ disease. She has recently lost 25 lb, has palpitations, is very irritable, feels very warm, and has a noticeable bulge on her neck. The most likely cause of her increased thyroid function is A. hyperplasia of the thyroid. B. an anterior pituitary tumor. C. a thyroid carcinoma. D. an autoimmune response. 17-106 The following is a self-monitoring blood glucose (SMBG) log on a client receiving 20 units Novolin 70/30 in the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m.: 90, 98, 112, 100. Predinner: 140, 150, 105, 144. What changes would you make? A. Increase the p.m. insulin B. Increase the a.m. insulinD. Increase the a.m. and p.m. insulin. 17-107 The most common worldwide cause of hypothyroidism is A. an autoimmune process. B. Hashimoto’s thyroiditis. C. iodine defi ciency. 17-109 A client with diabetes presents with a medication list that includes lisinopril and losartan. Which of the following statements is true regarding this combination? A. Additional blood pressure and renal benefi t is gained using an ACE inhibitor and ARB. B. This combination will lead to excessive lowering of the potassium. C. This was probably a provider error or patient misunderstanding.. 17-113 Clients with diabetes and neuropathy require special foot care because most ulcers begin at the site of A. an ingrown toenail. B. a previous sore. C. a mole. D. a callus. 17-114 Sandra, age 28, has secondary obesity. Which of the following may have caused this? A. An intake of more calories than are expended B. Polycystic ovary disease C. Her antihypertensive medications D. Her sedentary lifestyle Chap 18 18-1 Mrs. Jameson complains of unilateral blurry vision and partial blindness in the left eye. On physical examination, you fi nd decreased peripheral vision on her left side. Funduscopic examination reveals cotton-wool spots. Your most likely diagnosis is A. cryptococcosis. B. toxoplasmosis. C. cytomegalovirus infection. 18-2 Sickle cell anemia affects African Americans. Approximately 1 in 400 African Americans in the United States has sickle cell disease (SCD). Advances in treatment have been made, but life expectancy is still limited. The mean survival time for men with the disease is approximately A. 24 years. B. 34 years. C. 42 years. 18-4 Your client George, age 60, presents with pruritus and complains of lymphadenopathy in his neck. He also complains of night sweats and has noticed a low-grade fever. He has not lost any weight and otherwise feels well. He is widowed and has been dating a new woman recently. On physical exam, you fi nd enlarged supraclavicular nodes. You suspect A. lung cancer. B. Hodgkin’s lymphoma. 18-7 Samantha is being given platelets because of acute leukemia. One “pack” of platelets should raise her count by how much? A. 2,000 to 4,000 mm 3 B. 5,000 to 8,000 mm 3 18-9 Robin has HIV and is having a problem with massive diarrhea. You suspect the cause is A. cryptococcosis. B. toxoplasmosis. C. cryptosporidiosis. 18-10 Julia asks how smoking increases the risk for folic acid defi ciency. You respond that smoking A. causes small-vessel disease and constricts all vessels that transport essential nutrients. B. decreases vitamin C absorption. 18-12 Your client, Ms. Jones, has an elevated platelet count. You suspect A. systemic lupus erythematosus. B. infectious mononucleosis. C. disseminated intravascular coagulation (DIC). D. splenectomy. 18-14 One major approach to cancer prevention is A. colonoscopy. B. new drug trials. C. Pap smears for women of all ages. D. host modifi cation. 18-17 Your client Jeannie, age 64, comes to you complaining of tinnitus and lightheadedness without loss of consciousness. On physical exam, you note splenomegaly. To sort out your differential diagnosis, you order an alkaline phosphatase and vitamin B 12 level because you are ruling out a diagnosis of A. liver cancer. B. pancreatic cancer. C. mononucleosis. D. polycythemia vera. 18-24 Screening infants for anemia should occur at what age? A. 6 months B. No screening is recommended C. 9 months 18-26 Julie’s brother has chronic lymphatic leukemia. She overheard that he was in stage IV and asks what this means. According to the Rai classifi - cation system, stage IV is a stage A. at which the lymphocytes are greater than 10,000 mm 3 . B. with an absolute lymphocytosis, in which the client may live 7 to 10 years or more. C. of thrombocytopenia, in which the life expectancy may be only 2 years. 18-31 The three most common signs and symptoms of primary HIV infection are A. weight loss, pharyngitis, and fatigue. B. fever, fatigue, and pharyngitis. 18-34 A client with HIV has a fever of unknown origin (FUO). Which of the following is a possible cause of an FUO in a client with HIV? A. Drug fever 18-37 Caroline, an older adult, is homeless and has iron-defi ciency anemia. She smokes and drinks when she can and has a stomach ulcer. Which of the following is not one of her risk factors of irondefi ciency anemia? A. Smoking 18-40 Mrs. Bartley, age 58, presents with complaints of unsteady gait and numbness and tingling in her fi ngers. Her laboratory values show increased MCV, normal MCHC, and normal hemoglobin. Which of the following laboratory test results would you also expect? A. Decreased B 12 , normal folate, and increased reticulocyte count B. Normal B 12 , decreased folate, and decreased red cell distribution width C. Decreased B 12 , normal folate, and decreased reticulocyte count 18-42 Which of the following is a benign neoplasm? A. Leiomyoma 18-43 Prophylaxis for the fi rst episode of Pneumocystis jiroveci pneumonia in an adult or adolescent client infected with HIV is A. isoniazid (Nydrazid) 300 mg PO and pyridoxine (vitamin B-6 [Beesix]) 50 mg PO daily for 12 days. B. clarithromycin (Biaxin) 500 mg PO twice daily for 2 weeks. C. rifampin (Rimactane) 600 mg PO daily for 12 months. D. trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim) DS 1 tablet PO daily for 10 days. 18-48 The test in which a small, radioactive tracer dose of cyanocobalamin is given by mouth and then a 24-hour urine sample is collected and assayed for radioactivity is the A. Coombs’ test. B. oligonucleotide probe test. C. spherocytic test. D. Schilling test. 18-50 Multiple myeloma is a plasma cell malignancy in which the bone marrow is replaced and there is bone destruction and paraprotein formation. Myeloma is a disease of older adults overall (median age at presentation is 65 years). Common presenting symptoms include A. nausea and vomiting and chronic cough. B. fatigue and splenomegaly. C. lower back pain and hypercalcemia. 18-53 Which of the following white blood cell types is elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders? A. Neutrophils B. Eosinophils 18-54 Which hypersensitivity reaction results in a skin test that is erythematous with edema within 3 to 8 hours? A. Anaphylactic reaction B. Cytotoxic reaction C. Immune complex–mediated reaction 18-55 Under which of the following circumstances is the reticulocyte count elevated? A. Aplastic anemia B. Iron-defi ciency anemia C. Poisoning D. Acute blood loss 18-60 Which tumor marker may detect a tumor of the ovary or testis? A. Alpha fetoprotein 18-61 Jill has just been given a diagnosis of HIV infection and has a normal initial Pap test. When do the Centers for Disease Control and Prevention (CDC) guidelines state that she should have a repeat Pap test? A. In 3 months B. In 6 months 18-63 A platelet count less than 150,000/mm 3 may indicate A. possible hemorrhage. B. hypersplenism. 18-64 Thalassemia is caused by A. blood loss. B. impaired production of all blood-forming elements. C. increased destruction of red blood cells 18-65 You are examining Joseph, age 9 months, and note a palpable right supraclavicular node. You know that this fi nding is suspicious for A. candidiasis. B. cryptococcosis. C. lymphoma of the mediastinum.. 18-69 Which bone tumor arises from cartilage and is usually located in the pelvis, femur, proximal humerus, or ribs? A. Osteosarcoma B. Chondrosarcoma 18-72 Antibodies (inhibitors) directed against factor VIII can arise spontaneously in a number of situations. These include A. clients who have mitral regurgitation. B. as sequelae to a strep infection. C. clients on antibiotics. D. women who are several weeks postpartum after a normal labor and delivery. 18-75 Maurice is an intravenous drug abuser with chronic hepatitis B (HBV). The development of which other type of hepatitis poses the greatest risk to a client with HBV? A. Hepatitis A B. Hepatitis C C. Hepatitis D 18-76 The placement of a high dose of radioactive material directly into a malignant tumor and giving a lower dose to the normal tissues is referred to as A. radiotherapy. B. teletherapy. C. brachytherapy0. 18-77 Prostate cancer is associated with which of the following viruses? A. Herpes simplex virus types 1 and 2 B. Human herpes virus 6 C. Human cytomegalovirus 18-82 Barbara, age 27, had her spleen removed after an automobile accident. You are seeing her in the offi ce for the fi rst time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond? A. “Your red blood cell production will be slowed.” B. “Your lymphatic system may have diffi culty transporting lymph fl uid to the blood vessels.” C. “You’ll have diffi culty storing the nutritional agents needed to make red blood cells.” D. “You may have diffi culty salvaging iron from old red blood cells for reuse.” 18-85 Skip, age 4, is brought to the offi ce by his mother. His symptoms are pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, and hepatosplenomegaly. You refer him to a specialist. Which of the following tests do you expect the specialist to perform to confi rm a diagnosis? A. An enzyme-linked immunosorbent assay B. A monospot test C. A prothrombin time, partial thromboplastin time, bleeding time, complete blood count, and peripheral smear D. A bone marrow smear 18-86 Lorie, age 29, appears with the following signs: pale conjunctiva and nailbeds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? A. Vitamin B 12 defi ciency B. Folate defi ciency C. Iron-defi ciency anemia. 18-91 Mandy, age 18, has infectious mononucleosis. What might you expect her blood work to refl ect? A. Thrombocytopenia and elevated transaminase 18-92 Select a statement that is true about the erythrocyte sedimentation rate (ESR). A. It is a very specifi c indicator of infl ammation. B. A rise in the ESR is a normal part of aging. 18-99 What is the earliest visual sign of oral and pharyngeal squamous cell carcinomas? A. Leukoplakia B. Mucosal erythroplasia. 18-101 In teaching your client about the American Cancer Society’s CAUTION model that identifi es signs of many cancers, you teach her that the N stands for A. night sweats. B. nagging cough. 18-102 Which is the best serum test to perform to spot an iron-defi ciency anemia early, before it progresses to full-blown anemia? A. Hemoglobin B. Hematocrit C. Ferritin 18-103 What is the mechanism of action of steroid hormones in cancer chemotherapy? A. They interfere with DNA or RNA synthesis. B. They interfere with DNA replication by attacking DNA synthesis throughout the cell cycle. C. They inhibit protein synthesis. D. They alter the host environment for cell growth.. 18-104 Which of the following indicates that Jim, a 32-year-old client with AIDS, has oropharyngeal candidiasis? A. Small vesicles B. Fissured, white, thickened patches C. Removable white plaques 18-106 Sam is being worked up for pancreatic cancer. He states that the doctor wants to put a “scope” in and inject dye into his ducts. He wants to know more about this. What procedure is he referring to? A. Percutaneous transhepatic cholangiography B. An endoscopic retrograde cholangiopancreatography. 18-110 Some pharmacological adjuncts to analgesics in clients with uncontrolled cancer pain include A. anticonvulsants and tricyclic antidepressants. B. anticonvulsants, tricyclic antidepressants, and corticosteroids.