NR-511 Differential Diagnosis & Primary Care Practicum All quiz/exam questions 1. A maximum of 20 alternative hours can be used as part of the 125-hour practicum requirement for each clinical course--> T/F - False- Can u
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NR-511 Differential Diagnosis & Primary Care Practicum All quiz/exam questions 1. A maximum of 20 alternative hours can be used as part of the 125-hour practicum requirement for each clinical course--> T/F - False- Can use only 15 2. You are required to submit at least 4 SOAP notes from your practicum site for this class A. True B. False 3. Which of the following is (are) true regarding SOAP notes? A. SOAP notes are a way to document an interaction between a patient and provider B. SOAP notes become part of the patient's permanent medical record C. SOAP notes can serve as a means of communication between health care professionals D. All of the above 4. Students are required to submit one written SOAP note from the clinical setting, which can be a copy of the notes that the student entered in the EMR A. True B. False 5. Which of the following should be considered when ordering a test? A. Cost B. Convenience C. Sensitivity D. All of the above 6. Which one of the following students is not meeting practicum expectations? A. Brianna has a phone in her lab coat, the ringer and notification settings are muted B. Taylor wears a below the knee-length skirt on a designated casual Friday C. Hannah texts a friend during "down-time" in-between patients D. Hailey has her Chamberlain student ID on and visible at all times. 7. Which one of the following is NOT considered subjective data? A. Headache B. Visual acuity C. Ear Pain D. Nausea 8. Shawn Gethi is scheduled for an acute visit for a skin lesion. After looking at his lesion, he pulls out a long list of things he wants to discuss. You are 30 minutes behind on your schedule and you only have 15 minutes for his appointment. Which of the following is the BEST response for the patient? A. I see you have a list of concerns and I want to discuss them but my schedule with only allow for a few items today. Let’s look at them together and identify the 3 most important items for you to discuss today, and then we can make a plan to address the remaining concerns for another visit B. What would you like to talk about C. I don't have time for this today. 9. Which of the following is not an approved "alternative hours" category A. Telephone management B. EMR training C. Lab review D. Prescription Refills 10. Edwin Muchiri is seen if your office with complaints of a sore throat x2 days. Which body system would not be included in the history and physical for the problem focused visit? A. Skin B. Neurological C. Eyes, ears, nose and throat D. Respiratory 11. A student "forgets" to document the pediatric encounters for NR511. The student successfully passed the course and is now in NR601. Because the student passed the course, it is okay to go back and update the clinical log to reflect the missed documentation encounters? A. True B. False 12. There are six core clinical courses in this FNP program A. True B. False 13. A well-rounded clinical experience should include roughly 10% of pediatric and woman’s health patients, each of the total number of patients seen by the end of your rotation A. True B. False 14. A family practice office for all five of your clinical rotations will guarantee that you will gain the required pediatric exposure A. True B. False 15. Observation or shadowing the preceptor should be counted as part of the student’s clinical hours A. True B. False 16. A student sees 550 patients for the entire practicum experience. Of these visits, the student sees the following number of patients according to the age group. This is an example of a well-rounded clinical experience: 2 children less than a year old, one child 1-4 years, three children 5-11 years old, five children 12-17 years old, 10 adults 18-39 years old and 529 adults greater than age 40 A. True B. False 17. Students may be held from an anticipated clinical site if faculty determines that the student has not seen enough patients of low, medium, high or very high complexity A. True B. False 18. A student may follow a provider who does hospital rounds on their patients for a max of _____________ A. 15% of their total hours for the term B. 20% of their total hours for the term C. 25% of their total hours for the term D. 30% of their total hours for the term 19. Sally’s preceptor, Dr. Bones, is unexpectedly ill. His nurse practitioner offers to allow the student to work with her for the day. Dr. Bones is the only preceptor on file with the student’s practicum coordinator for that class. Because it is only one day, the student can rotate with the substitute provider as long the student notifies the course instructor A. True B. False 20. Health literacy can be described as the degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make an appropriate healthcare decision A. True B. False 21. The history of present illness (HPI) should attempt to explain the chief complaint A. True B. False 22. Medical billing is the process of communicating with payers about which procedures were preformed and why A. True B. False 23. ICD-10 codes are shorthand for the patient's diagnosis A. True B. False 24. The components of the E&M code include the place of service, the type of service and the patient’s gender A. True B. False 25. Suzie Q was a patient of yours in 2010. She moved to Florida and briefly returns to reestablish care at your office. For billing and coding purposes, Suzy Q considered a new or established patient? A. New B. Established 26. Tommy wants to be seen for a sore throat today. You look at his chart and notice that the last time he was seen in your office was in 2012 by your partner. Is tommy considered new or established patient? A. New B. Established 27. The complexity of a 99202-office visit is higher than that of a 99204 A. True B. False 28. Three components that determine risk based on E&M codes are _________________ A. history, medications and co-morbidities B. Physical exam, history and medical decision making C. Medical decision making, co-morbities and history D. History, physical and medications 29. Three elements needed to determine the level of complexity of a visit include risk, data and ___________ A. diagnosis B. severity of illness C. time of day D. history and physical 30. Receiving an immunization is considered what kind of prevention? A. Primary B. Secondary C. Tertiary 31. Receiving a pap smear is considered what kind of prevention? A. Primary B. Secondary C. Tertiary 32. Receiving a bronchodilator for asthma is considered what kind of prevention? A. Primary B. Secondary C. Tertiary 33. Dyspnea is one of the more common complaints in primary care that can be caused by diverse health problems. In the majority of cases, dyspnea is a result of cardiac or pulmonary decompensation. Which etiology is not associated with cardiac or pulmonary decompensation? A. spinal cord lesions affecting the innervation to the diaphragm B. congestive heart failure C. interstitial lung disease D. pneumonia 34. Dyspnea can be classified into flow or volume disorders, and the underlying cause can be from an intra-thorax or extra-thorax problem. Which of the following is a flow extra-thorax problem? A. Diphtheria B. Asthma C Epiglottis D. A & C 35. The following are all essential in gathering your history of a patient with a chief complaint of dyspnea, except ___________. A. timing of dyspnea B. Ordering diagnostic test C. Onset and timing of episode of dyspnea D. Acute, chronic or recurrent symptoms 36. Which of the following is not a test that can be used in the evaluation of the patient who is dyspneic? A. Sleep apnea or sleep hypoxia testing B. Rhinoscopy, laryngoscopy or bronchoscopy C. Arterial Blood Gas D. None of the above 37. Foods that have been shown in clinical trials to be associated with the development of acne are ________ A. greasy foods B. Chocolate C. Caffeine D. Dairy 38. Every patient with acne needs to use a good cleanser with a retinoid or benzoyl peroxide A. True B. False 39. Treatment of moderate acne may include the use of topical and oral antibiotic with a retinoid A. True B. False 40. Patients should be referred to a dermatologist for treatment of acne with Accutane A. True B. False 41. Acute bacterial prostatitis is most common in men, ages 30 to 50 years of age and who are sexually active A. True B. False 42. When performing a DRE, you will note a warm, tense, swollen, boggy, and very tender prostate with _____ prostatitis. A. Acute B. Chronic C. Nonbacterial D. Acute and non-chronic nonbacterial 43. Current CDC guidelines recommend which class of medications to treat Acute Bacterial Prostatitis for 14 to 28 days? A. Macrolides B. Fluoroquinolones C. Penicillin’s D. Cephalosporins 44. A negative Prehn sign indicates epididymitis? True False 45. For the patient diagnosed with epididymitis, the recommended treatment is: A. Ceftriaxone 250mg IM x 1 B. Azithromycin 1gm po x 1 C. Bactrim DS 1 BID po x 7d D. A & B 46. An example of an obstructive voiding complaint with BPH is post-void dribbling. True False 47. Alpha-1a blockers provide some relief for BPH symptoms by relaxing the smooth muscle around the neck of the bladder. True False 48. Your 7-year-old patient arrives to clinic complaining of pain in bilateral knees and is diagnosed with Osgood-Schlatter disease. You notice that the patient has a BMI that no longer plots on the CDC BMI graph. What anticipatory guidance will you give the parents of this child? A. Diet and nutrition advice alone B. Diet and nutrition advice along with monthly weight checks C. Diet and nutrition advice, lab testing, motivational interviewing with a 24-hour diet recall along with monthly weight checks D. Referral to pediatric endocrinology 49. Your adult patient has a BMI of 50.1 along with HTN, diabetes and dyslipidemia. What would be the best recommended avenue of weight loss for this patient? A. Diet and exercise alone B. Diet and exercise along with a referral to bariatric management C. Monthly weight checks with the primary care clinician 50. Testicular torsion is an urological emergency and will lead to ischemic necrosis within six hours if not corrected True False 51. Diagnosis of testicular torsion is based on the history and physical findings; in other words, the clinical findings. True False 52. Transillumination of the scrotum will cause the scrotum to appear light pink, yellow, or red in the patient with a hydrocele. True False 53. The hallmark characteristic of a varicocele is the sensation that the testes feels like a bag of rocks secondary to venous engorgement. True False 54. Testicular cancer occurs primarily in men over the age of 50. True False 55. To make a definitive diagnosis of testicular cancer, the patient will need an ultrasound of the lump found in the patient's testicle True False 56. Treatment for testicular cancer is determined by the TNMS staging system. True False 57. The patient should be taught to perform a self-testicular exam during a warm bath/shower because the warmth relaxes the scrotum making the exam easier. True False 58. Chronic pain affects the mood/psychological status and lasts longer than 3 months in duration True False 59. Non-articular disorders are described as either focal or widespread. True False 60. The four cardinal signs of joint inflammation are erythema, warmth, pain, and bruising. True False 61. How many joints are involved in a polyarticular disorder? 1 2 3 4 or more 62. Quervain's tenosynovitis can be confirmed with which of the following maneuvers? Phalen's test Tinel's test Finkelstein test Varus test 63. A useful maneuver test to confirm a cervical spine sprain/pain is: Spurling's Test Patrick's Test Obrien's Test Neer's Test 64. Acute low back pain does not warrant radiographic imaging unless there is evidence of neurological dysfunction. True False 65. The preferred imaging to determine the degree of spinal canal narrowing and facet arthroplasty resulting in nerve impingement is what? X-ray Magnetic resonance imaging Ultrasound Computed tomography 66. Which of the following is not a maneuver test to assess for lumbosacral pain? Straight leg raise Gaenslen's Hawkins Faber 67. auda equina syndrome should prompt a yellow flag for the provider. True False 68. To determine whether the patient has normal thyroid function, the initial test should be _____. thyroglobulin antibodies thyroperoxidase antibodies TSH with reflex to FT4 TT3 69. Your patient is symptomatic with complains of fatigue, weight gain, constipation, and hair loss. The patient's labs return with a TSH of 7 and a normal FT4. Without considering a patient's weight (she refuses to get on the scale today), what dose of medication would you chose based on the lab values? Synthroid 75 mcg Synthroid 50 mcg Synthroid 25 mcg I would not medicate this patient. 70. A 70-year-old patient presents with a complaint of difficulty swallowing, tachycardia, sweating, and unintentional weight loss. Upon physical exam, the patient is found to have an enlarged thyroid that has an abnormal contour. Without any further testing, what diagnosis would you say is the most likely? Overt hypothyroidism Hashimoto's thyroiditis Subclinical hyperthyroidism Nodular goiter 71. Maddie has a history of asthma that is classified as mild, intermittent asthma. She comes to the office today with wheezing which is not improving with her inhaler. Which would be the best ICD-10 code to apply with only the information given? A. Severe persistent asthma (J45.5) B. Mild intermittent asthma with acute exacerbation (J45.21) C. Unspecified asthma with acute exacerbation (J45.901) D. Other asthma (J45.998) 72. Morbidity refers to the number of people who have died from a particular disease T/F - False 73. The number of new cases of a particular disease in a population at a given time is known as: A. Prevalence B. Risk C. Incidence D. Morbidity 74. Seat belt use is considered _________________ prevention: A. Primary B. Secondary C. Tertiary D. Unnecessary 75. Systemic reviews of randomized clinical trial studies are considered Level __________ evidence A. 1 B. 2 C. 3 D. 4 76. Sporadic outbreaks occur when there are occasional cases of an event unrelated in space or time T/F - True 77. The level of Evaluation & Management (E&M) coding for new and established patients is based on documentation that is provided in the patient's medical record. T/F - True 78. Which one of the following do NOT meet the requirements of this program? A. MS degree with board certification as an Adult Nurse Practitioner (ANP) B. DNP degree with board certification as an Acute Care Nurse Practitioner (ACNP) C. Graduate degree with board certification as a Physician’s Assistant (PA-C) D. Current, unencumbered state license as MD, NP or PA 79. The History of Present Illness (HPI) is a detailed breakdown of the ____________ and its documented as ____________: A. Review of Systems, PMH B. Past medical history, SOAP C. Chief complaint, Review of systems D. Chief complaint, OLDCARTS 80. What are the three main components of determining the E & M code? A. History, physical, diagnosis B. History, physical, medical decision making C. Risk, data, diagnosis D. Diagnosis, age of patient, complexity of visit 81. Which one of the following preceptors would not meet the FNP program requirements? A. Board Certified Adult-Gerontology Nurse Practitioner working in a primary care setting with 2 years’ experience in an Advanced Practice Role B. Board Certified Pediatric nurse practitioner working in a pediatric primary care setting with 6 months experience in an Advanced Practice role C. Physician board certified in internal medicine, working in a primary care setting with 1 year experience 82. Nursing research should be utilized by: A. nurses at the bedside B. Advanced practice nurses C. Nurse researchers D. Nurses at all levels of practice 83. Subjective information is what the patient reports, complains of, or tells you in response to your questions. T/F - 84. Evidence from well-designed case-control and cohort studies are considered which Level of evidence in research design? A. 1 B. 2 C. 3 D. 4 85. Experience is a necessary component in exercising clinical judgement A. True B. False 86. The Resource-Based Relative Value Scale (RBRVS) is used by centers for Medicare and Medicaid Services (CMS) to set reimbursement rates which are designed to reflect the costs needed to provide services. Which of the following is NOT one of the components in determining set reimbursement rates for provider services A. Professional liability and malpractice expenses B. The providers work or medical expertise C. The patient's insurance coverage D. The practice overhead expense 87. HIV infection in young adults aged 21-24 years was 0.1% in the United States in 2004 is an example of ______________ A. Prevalence B. Morbidity C. Incidence D. Mortality 88. Which of the following is NOT a secondary prevention measure? A. Testosterone replacement B. Testicular self-exams C. Bone density test D. Perform digital rectal exam (DRE) 89. Having a family practice site for all 5 practicum courses guarantees that you will have a well-rounded clinical experience to all ages and conditions A. True B. False 90. Chloe complains of acute pain in her right ear. Her exam reveals a normal exam on the left. The right external ear is non-erythemic and non-tender. The EAC is free of debris or obstruction without redness. The TM is visible, bright red and bulging with cloudy fluid. Which is the best ICD-10 code for your findings? A. Acute superlative otitis media with spontaneous rupture of ear drum, right ear (H66.011) B. Acute superlative otitis media with spontaneous rupture of ear drum, left ear (H66.012) C. Acute superlative otitis media without spontaneous rupture of ear drum, right ear (H66.001) 91. Episodic visits are also known as problem focused visits A. True B. False 92. Reimbursement policy changes by insurance carriers over the years have resulted in a reduction of healthcare spending A. True B. False 93. Which of the following is NOT a requirement when developing a practice guideline? A. literature review of EBM B. Rating of the available evidence C. The panel of experts must all be physicians D. Panel members should be chosen based on the focus of the guideline 94. Which of the following statement(s) is (are) true? A. Clinical logs are not legal documents B. You may make an amendment to your NR511 clinical logs when you are in NR601 C. Clinical logs must demonstrate a well-rounded clinical experience by graduation D. All of the above 95. Aaron Rogers presents to your clinic in the off-season with a painful, red and swollen left calf. Without any other further information given, which one of the following is a reasonable differential to investigate further? A. Cellulitis B. Deep venous thrombosis C. Acute musculoskeletal injury D. All of the above 96. Which statement is true? A. The differential diagnosis is the final diagnosis determined for the visit B. A problem list is a list of possible diagnosis for the patient C. A differential is a list of plausible diagnoses that fit the presentation and findings of a patient D. The differential is ranked inn order from least likely to most likely 97. Your patient presents with sore throat x2 days. You suspect that he may have strep pharyngitis because his best friend had it last week. You do not have a rapid antigen in the office, so you could send a throat swab for culture. Which ICD-10 code should you use on the lab requisition A. Rule out strep pharyngitis (no code) B. Streptococcal pharyngitis (J02.0) C. Chronic pharyngitis (J31.2) D. acute pharyngitis, unspecified (J02.9) 98. Which of the following is required when documenting a clinical experience in your student clinical encounter log? A. E&M visit code (99202 etc) B. Date of service C. Age D All of the above 99. Which statement(s) is true regarding documentation of your clinical encounter? A. using the correct codes in y our clinical log is especially important because it provides evidence of the population of patients that you have seen B. When faculty reviews your logs, we will be looking for both preventative and complaint office visit codes across all age groups C. If I do not see a sufficient amount of a certain population, such as pediatric patients or complex visits, I may be required to find a different practicum site D. All of the above 100. Alternative activities can be used toward your clinical requirements. Which of the following should NOT be documented as an "alternative activity" A. Telephone and/or electronic message communication with patients B. Authorizing prescription refill requests C. Tele-visit or e-visit 101. Malaria in the Southern hemisphere (Africa) is considered to be a (an) _______________ disease A. Sporadic B. Endemic C. Pandemic D. None of the above 102. Point of care strategy involves: A. Having readily available evidence-based resources B. Asking a clinical question C. Applying the findings to the individual patient D. All of the above 103. Which of the following is NOT true regarding ICD-10 codes? A. The codes communicate the complexity of the visit B. The codes communicate the patient's diagnosis C. All insurance carriers use the codes D. Codes are used to support the services provided at a visit 104. HIPPA legislation is important to the daily management of the practitioner practice setting. Precautions should be used to protect patient electronic personal information at all times. Which of the following is an appropriate precautionary measure? A. Use of computer privacy screens B. Taping a list of passwords to the back of your keyboard C. Forwarding lab results to your personal email account or server D. Storing patient documentation in an unlocked file cabinet
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