A 65-year-old woman presents for a follow-up examination after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her hypertension is now adequately controlled with medicat
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A 65-year-old woman presents for a follow-up examination after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse practitioner should start the patient on:
1.bile acid sequestrant.
2. a statin drug.
3. a cholesterol absorption inhibitor.
4. low-dose aspirin. - ANSWER A statin drug
The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is:
1. azathioprine (AZA).
2. belimumab (Benlysta).
3. ibuprofen (Advil).
4. cyclophosphamide (Cytoxan). - ANSWER ibuprofen (advil)
The most common sign of cervical cancer is:
1. postcoital bleeding.
2. strong odor from vaginal discharge.
3. itching in the vaginal area.
4. molluscum contagiosum. - ANSWER postcoital bleeding
The nurse practitioner prescribes amitriptyline (Elavil) for a patient with neuropathic pain secondary to diabetes mellitus. On follow-up, the patient complains of urine retention and dry mouth. The practitioner would:
1. discontinue amitriptyline and begin ibuprofen (Motrin).
2. refer to physical therapy.
3. start methocarbamol (Robaxin).
4. discontinue amitriptyline and begin gabapentin (Neurontin). - ANSWER discontinue amitriptyline and begin gabapentin (neurontin)
A 17-year-old male with rheumatoid arthritis is being treated with an NSAID and omeprazole (Prilosec). The patient complains of headache, abdominal pain, and gas. These symptoms are most likely:
1. associated with the omeprazole.
2. related to the underlying condition.
3. the result of the NSAID.
4. caused by viral gastroenteritis. - ANSWER associated with the omeprazole
The medication of choice for the initial treatment of juvenile rheumatoid arthritis is:
1. acetaminophen.
2. prednisone.
3. aspirin.
4. ibuprofen. - ANSWER ibuprofen
A 12-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and:
1. white blood cell levels.
2. fecal occult blood test.
3. hemoglobin levels.
4. urine dipsticks. - ANSWER hemoglobin levels
A 90-year-old female is brought to the clinic by her neighbor. She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner's pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next?
1. Report the case to the proper authorities.
2. Tell the neighbor to check on the woman daily and report back.
3. Document the data and report the information to risk management.
4. Call the patient's family and inquire about the concerns. - ANSWER report the case to proper authorities
In most cases, the first manifestation of Alzheimer's disease is:
1. impaired judgment.
2. decrease in short-term memory.
3. disorientation in time and place.
4. decrease in long-term memory. - ANSWER decrease in short-term memory
The optimal treatment for latent tuberculosis is:
1. rifampin (Rifadin) for 5 months.
2. isoniazid (Nydrazid) for 9 months.
3. pyrazinamide for 6 months.
4. ethambutol for 6 months. - ANSWER osioniazid (nydrazid) for 9 months
Unilateral spontaneous serous or serosanguineous discharge from a single duct of a breast is most often caused by:
1. intraductal papilloma.
2. mucinous breast lesions.
3. Paget's disease.
4. ductal carcinoma in situ. - ANSWER intraductal papilloma
A young child with asthma presents for follow-up evaluation. After numerous changes in medications and doses, the parents report that the child continues to have difficulty with coughing, especially during the night. Which of the following conditions would be the most likely cause of the continued asthma symptoms?
1. Vocal cord dysfunction
2. Cystic fibrosis
3. Gastroesophageal reflux
4. Allergic rhinitis - ANSWER gastroesophageal reflux
A pregnant woman with known HIV infection can reduce the risk of perinatal transmission through zidovudine (Retrovir) therapy. Based on current research, optimal therapy is to start daily dosing:
1. post amniocentesis.
2. after 14 weeks of gestation.
3. if premature rupture of membranes occurs.
4. if maternal viral loads are greater than 10,000. - ANSWER after 14 weeks gestation
T-wave inversion with a normal ST segment on a 12-lead EKG may represent:
1. acute coronary ischemia.
2. right ventricular hypertrophy.
3. atrial hypertrophy.
4. hyperkalemia. - ANSWER acute coronary ischemia
The 16-year-old mother of a 2-month-old presents the infant, reporting that the child is very irritable and does not feed well. During physical examination, the child's head drops back and the child exhibits sudden flexing of the extremities. As the flexing stops, the child cries uncontrollably. Funduscopic examination reveals retinal hemorrhages. Which of the following diagnostic tests should be ordered?
1. Skull X-rays
2. MRI
3. CT scan
4. Pet scan - ANSWER CT scan
The most important diagnostic factor in evaluating angina pectoris is the patient's:
1. King of Heart's monitor.
2. physical examination.
3. history.
4. echocardiogram. - ANSWER history
There are three reasons for latex allergies. Which of the following does NOT cause the problem?
1. Immediate hypersensitivity
2. Irritant contact of dermatitis
3. Cytotoxic hypersensitivity
4. Immune complex reaction - ANSWER cytotoxic hypersensitivity
A patient on warfarin (Coumadin) therapy for recurrent deep vein thrombosis (DVT) is about to have lumbar spinal fusion surgery. The patient's warfarin is put on hold starting 5 days prior to the surgery and subcutaneous Lovenox has been ordered for DVT prophylaxis until the resumption of the warfarin. The nurse practitioner knows that the patient's postoperative warfarin dose should be restarted based on the:
1. value of her morning Prothrombin time.
2. loading dose of 10 mg, plus the previous warfarin dose.
3. baseline PT and INR values.
4. target INR of 2. - ANSWER caseline PT and INR values
An 87-year-old patient presents with round, pruritic plaques and small vesicles on the lower legs. The most likely diagnosis is:
1. allergic contact dermatitis.
2. plaque psoriasis.
3. cutaneous T-cell lymphoma.
4. nummular eczema - ANSWER nummular eczema
A 3-year-old presents with a 2-day history of acute diarrhea with a total of 8 watery stools without blood or mucus, and 2 episodes of vomiting in the past 48 hours. Assessment reveals no current antibiotic therapy, dehydration <5%, soft abdomen with hyperactive bowel sounds, no masses or organomegaly; other physical findings are normal. Which of the following is the most appropriate management plan?
1. Stool culture; Immodium AD liquid.
2. No laboratory workup; instruct parents on signs and symptoms of dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell-O, and soup.
3. Start diet of clear liquids, advancing to bananas, rice cereal, Jell-O, and soup over next 72 hours; Imodium AD liquid, 1 mg/sml
4. Stool for ova and parasites; advise parents of likely sources of Giardia; prescribe furazolidone (Furoxone) - ANSWER No laboratory workup; instruct parents on signs and symptoms of dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell-O, and soup.
A mother presents her 12-month-old child with concern because the child does not yet say "mama" or "dada." The mother reports that in the first months of life, the child loved listening to music and being talked to. The past medical history is negative for ear infections. The nurse practitioner should:
1. evaluate for hearing loss.
2. refer to speech therapy.
3. re-evaluate in 3 months.
4. check for cerumen impaction. - ANSWER evaluate for hearing loss
The most common side effect of the oral ribavirin used in the treatment of hepatitis C is:
1. hemolytic anemia.
2. weight loss.
3. depression.
4. hypothyroidism. - ANSWER hemolytic anemia
An 86-year-old patient presents with pinguecula, a yellow triangular degenerative tissue thickening of the bulbar conjunctiva. This condition is:
1. cured by eye drops.
2. a genetic process.
3. a malignant growth.
4. a solar-induced lesion - ANSWER a solar-induced lesion
During a well-child examination of an 18-month-old, premature tooth decay and inflamed gums, particularly of the maxillary incisors, are noted. The approach to this problem includes:
1. referring the child to a dentist, assessing for bottle feeding and fluoride in local water.
2. teaching the mother to brush the child's teeth, encouraging vitamin supplements.
3. recommending fluoride mouthwash and toothpaste, suggesting celery sticks for snacks.
4. providing fluoride treatment, teaching dental hygiene, and eating foods high in calcium. - ANSWER referring the child to a dentist, assessing for bottle feeding and fluoride in local water
Which of the following is typically observed in the GI system upon stimulation of the parasympathetic nervous system?
1. No overall effect
2. Increased sphincter tone
3. Increased peristalsis
4. Decreased secretions - ANSWER increased peristalsis
Type 2 diabetes mellitus is characterized by which of the following?
1. Decreased production of exogenous glucagon-like peptide
2. Autoimmune beta-cell destruction
3. Relative deficiency of dipeptidyl peptidase-4
4. Decreased reabsorption of sodium-glucose transporters - ANSWER decreased reabsorption of sodium-glucose transporters
In pulmonary function testing, forced vital capacity represents the:
1. maximum volume of air that can be forcefully exhaled after maximum inspiration.
2. total volume of air that is exhaled after normal inspiration.
3. total volume of air that the lungs can hold, minus the expiratory reserve volume.
4. volume of air that can be forcefully exhaled in 1 second. - ANSWER maximum volume of air that can be forcefully exhaled after maximum inspiration
An adult male presents as first patient of the day after awaking about 5:00 AM with indigestion and chest pressure. On checking his pulse, he found no change from previous measurements. He states that, while waiting for the nurse practitioner to arrive, he began to feel a little clammy. A 12-lead EKG records the following patterns. On the basis of these EKG readings, the diagnosis is:
1. anterior-septal acute myocardial infarction.
2. lateral acute myocardial infarction.
3. inferior acute myocardial infarction.
4. anterior acute myocardial infarction. - ANSWER inferior acute myocardial infarction
During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to the back. The patient also reports several episodes of nausea and vomiting, a low-grade temperature, and a history of excessive drinking. Physical examination reveals a distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase, amylase, and serum lipase. The most likely diagnosis is:
1. alcoholic liver disease.
2. acute mesenteric ischemia.
3. viral hepatitis.
4. acute pancreatitis. - ANSWER acute pancreatitis
An otherwise healthy adult female presents complaining of vaginal burning and itching during urination. She has a social history of two sexual partners. She denies fever or vaginal discharge, but has noted a lesion on one labium. The nurse practitioner should order all of the following EXCEPT:
1. wet mount and potassium hydroxide.
2. dark-field microscopy of fluid from the lesion.
3. nucleic acid amplification testing for gonorrhea.
4. serology for Haemophilus ducreyi. - ANSWER dark-field microscopy of fluid from lesion
A 3-year-old female has been diagnosed with bacterial meningitis. She attends preschool daily at a local church day care program. The day before her diagnosis, she ate lunch with her mother at a local restaurant. For which contact(s) would chemoprophylaxis with rifampin be recommended?
1. Preschool contacts in the past 7 days
2. A friend of the patient's sister who visited after school yesterday
3. The checkout employee at the grocery store yesterday
4. Diners at the restaurant during lunch the day the patient ate there - ANSWER preschool contacts in past 7 days
Congenital dysplasia of the hip:
1. more commonly affects both hips.
2. occurs more commonly in females.
3. is correctable at any age.
4. typically self-corrects by 12 weeks of age. - ANSWER more commonly affects both hips
Anticholinergic agents such as ipratropium (Atrovent) and tiotropium (Spiriva) are used in COPD primarily to:
1. induce bronchodilation.
2. decrease airway inflammation.
3. expand the lung fields.
4. treat hypoxemia. - ANSWER induce bronchodilation
The clinical presentation of placenta previa that develops during the third trimester includes:
1. intermittent dark-red spotting.
2. occult bleeding with abdominal or back pain.
3. sudden onset of painless and profuse bleeding.
4. painless occult bleeding that becomes visible upon onset of labor. - ANSWER sudden onset of painless and profuse bleeding
A 27-year-old male patient, who works as a janitor, presents with a 6-month history of an intermittent rash on his hands. History reveals itching and occasional burning. Examination reveals irregularly-distributed scaly maculopapular erythematous patches extending from the dorsum of the hand several inches up the forearms, and dry palms with no nail involvement. The most likely diagnosis is:
1. contact dermatitis.
2. scabies infestation.
3. psoriasis.
4. eczema. - ANSWER contact dermatitis
Anorexia nervosa occurs most commonly in which of the following?
1. Painters
2. Only children
3. High-level athletes
4. Individuals from large families - ANSWER high level athletes
A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause?
1. Decreased bowel muscle tone
2. Increased bile secretion
3. Increased absorption of calcium
4. Decreased pancreatic secretions - ANSWER decreased bowel muscle tone
A patient reports to your office, having been struck on the right cheek with a baseball bat. On examination, you notice tenderness and swelling over the cheek. The patient is unable to gaze laterally with his left eye, and he complains of double vision when he attempts to do so. This is most likely associated with:
1. retinal hemorrhage.
2. orbital rim fracture.
3. subarachnoid hemorrhage.
4. periorbital cellulitis. - ANSWER orbital rim fractures
A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin (EryPed oral suspension) 3 weeks ago. What is the most appropriate next intervention?
1. Treat with amoxicillin for 10 days.
2. Obtain culture for all household members.
3. Treat with azithromycin (Zithromax) for 10 days.
4. Intramuscular Penicillin. - ANSWER treat with amoxicillin for 10 days
A 16-year-old female adolescent is brought to the nurse practitioner's office by her mother, who is concerned about her daughter's recent weight loss. History reveals that the daughter was consistently in the 50th percentile for weight, but is now in the 10th percentile. The mother states that she is concerned that her daughter is purging herself after meals since she often goes to the restroom after eating and remains there for a long period of time. The daughter denies any self-induced vomiting, starvation or excessive activity. She does state that she jogs five miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment?
1. Electrolytes, fasting blood sugar
2. Creatine phosphokinase, follicle-stimulating hormone (FSH)
3. Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis
4. Electrolytes, FSH, stool for occult blood - ANSWER electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis
An adult female who is homeless presents for an initial obstetric visit at 34 weeks of pregnancy. She is diagnosed with Chlamydia trachomatis infection. What complication will her newborn be most at risk?
1. Conjunctivitis
2. Hearing loss
3. Pneumonitis
4. Meningitis - ANSWER conjunctivitis
A 2-year-old male presents for reevaluation. Two days ago, he had four episodes of vomiting and six diarrheal stools. On physical examination today, his vital signs reveal P = 120 and capillary refill of 3 seconds. The patient's eyes are sunken and his extremities are mottled and cool to the touch. The treatment plan would include:
1. start oral electrolyte mixture every hour.
2. hospitalization for IV fluid replacement.
3. giving the child loperamide for each diarrheal stool.
4. catheterizing the child to obtain accurate urine output. - ANSWER hospitalization for IV fluid replacement
A nurse practitioner places a 76-year-old patient on nifedipine (Procardia) 10 mg t.i.d. for angina. The patient is unable to remember to take the medication at the scheduled times. The practitioner should:
1. discontinue the issue with the patient's daughter.
2. change the dose to extended release 30 mg daily.
3. reinforce the importance of taking the medication.
4. increase the dosage to 20 mg b.i.d. - ANSWER change the dose to extended release 30mg daily
A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal area. Which diagnostic procedure would confirm a diagnosis of pinworm infestation?
1. The patch test
2. Examination of bed linens
3. Examination of transparent tape sample from perianal skin
4. Blood tests for anemia and eosinophilia - ANSWER examination of transparent tape sample from perianal skin
Which of the following microorganisms are most frequently associated with acute bacterial rhino-sinusitis?
1. Staphylococcus aureus and Mycoplasma pneumonia
2. Staphylococcus aureus and Methicillin Resistant Staph aureus
3. Streptococcus pneumoniae and Haemophilus influenzae
4. Streptococcus pneumoniae and Pseudomonas aeruginosa - ANSWER strep pneumo and haemophilus influenzae
A child is being treated with methylphenidate (Ritalin) for attention-deficit disorder. The following are all side effects of Ritalin EXCEPT:
1. muscle cramps
2. mild irritability.
3. increased heart rate.
4. slight increase in growth velocity. - ANSWER slight increase in growth velocity
A geriatric female presents for her annual examination. She has been on antihypertensive medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse practitioner is concerned about the patient's cardiac health risks, due her to weight and her waist circumference. According to the AHA guidelines, which of the following goals is expected for this patient?
1. Physical activity for 60 minutes daily, for a minimum of 6 days a week
2. Physical activity for 30 minutes daily, 7 days a week
3. Physical activity for 30 minutes daily, for a minimum of 5 days a week
4. Physical activity for 60 minutes daily, 7 days a week - ANSWER physical activity for 30 minutes daily, for a minimum of 5 days a week
The management of COPD in the elderly is best guided by:
1. spirometry.
2. arterial blood gases.
3. radiologic imaging.
4. symptomatology. - ANSWER symptomatology
A young, athletic adult presents with shoulder pain and inability to raise the arm above the shoulder. The most likely diagnosis is:
1. frozen shoulder syndrome.
2. cervical radiculopathy.
3. rotator cuff tear.
4. polymyositis. - ANSWER rotator cuff tear
A 50-year-old male presents with bruises and abrasions on the left leg and forearm, claiming to have had a number of minor accidents at home and at work. The patient reports general feelings of depression, forgetfulness, and, despite the fact that he is regularly employed, a mounting collection of unpaid and overdue bills. In taking the patient's history, a significant pattern of parental alcohol abuse, stroke, TIA, and MI emerges. During questioning to elicit a more thorough diagnosis, the patient becomes hostile and leaves the clinic without further treatment. The most likely explanation for this behavior is:
1. Alzheimer's disease.
2. chronic alcoholism.
3. cancer.
4. carotid artery stenosis. - ANSWER chronic alcoholism
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