Mosby Comprehensive Exam 3 Questions/Answers (2) (Latest Update)

Mosby_Comprehensive_Exam_3_-_Answers (2) 1. Which finding is consistent with pathology suggestive of endometriosis? A. Nodules along the cul de sac B. Inguinal lymphadenopathy C. Positive Chandelier’s sig ...

Mosby_Comprehensive_Exam_3_-_Answers (2) 1. Which finding is consistent with pathology suggestive of endometriosis? A. Nodules along the cul de sac B. Inguinal lymphadenopathy C. Positive Chandelier’s sign D. Multiple nabothian cysts The implants from endometriosis often contribute to nodules that are palpable along the cul de sac or within the uterosacral space (Schuiling Likis, 2005). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 2. Which objective finding is consistent with a diagnosis of fibromyalgia? A. Visible swelling at all major joints bilaterally B. Demonstrable weakness of all 4 extremities C. Elicitation of pain in 11 of 18 tender points D. Decreased joint mobility and laxity in elbows and knees Elicitation of pain in 11 of 18 identifiable tender points helps in diagnosing fibromyalgia. The defined points are both above and below the waist and on both sides of the body (American College of Rheumatology, 1990). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 3. Which finding in a patient fails to suggest cystitis? A. Urinary frequency in a college-age woman B. Hematuria in a middle-aged man C. Suprapubic tenderness in a teenage girl D. Dysuria in a 7-year-old All symptoms except hematuria in a middle-aged man. Hematuria is not a common finding in men; however, cystitis in women may present with hematuria (Fihn, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 4. Which finding is not usually associated with breast cancer? A. Rubbery and well-circumscribed tender lump B. Peau d’orange dimpling of the skin over the breast C. Unilateral retracted and deviated nipple D. Eczema-like scaling over one areola and nipple The rubbery well-circumscribed lump is more likely a finding of fibrocystic breast changes than of malignancy. Other options are suggestive of cancer (Seidel, 2003). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 5. Which factor in the history of a college male does not increase his risk of HPV? A. Use of perineal talcum powder B. Smoking C. Multiple sexual partners D. Bisexuality Increased chances of contracting HPV occur with individuals who are immunocompromised, smoke, are pregnant, have other STIs, use oral contraceptives, have multiple sex partners, are younger in age, or are of an ethnic minority (CDC, 2002). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 6. Which of the following is the best example of case finding? A. Cervical cancer discovered on Pap smear in a middle-aged woman B. Hypertension in a man who presented with a rash on his hands C. Lung metastasis on chest x-ray of a patient with a known brain cancer D. Hyperlipidemia during a cholesterol screening at a local high school Case finding is a type of secondary prevention. Health problems found in asymptomatic individuals or in those who present for a totally different health concern such as in this scenario are good examples of case finding (Kutty et al, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 7. A mother is worried that her teenage daughter has anemia. Which of the following historical data would lend support to that concern? A. The daughter has tan/gray-colored skin. B. Her daughter studies late at night, so she sleeps approximately 6 hours a night. C. The daughter has a ruddy appearance. D. She chews ice all the time. Pica may alert the provider to the presence of anemia (Blackwell, 2001). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 8. An NP is reviewing the chart of a new patient before his visit. He has a diagnosis of BPH, and a review of the current medication list shows a significant number of drugs. Which drug, if on the list, would aggravate his prostate condition? A. Lisinopril B. Diphenhydramine (Benadryl) C. Atenolol (Tenormin) D. Oral buspirone (Buspar) Atenolol is an anticholinergic drug that has the potential to aggravate prostatic hypertrophy by causing additional difficulty with voiding (Tierney, 2006). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 9. Which objective exam finding is anticipated in a woman with polycystic ovary disease? A. Prominent iliac spines B. Hirsutism with male pattern baldness C. Large pendulous breasts D. Small labia and clitoris Hirsutism with male pattern baldness is typical of women with PCOS. Acne, obesity, and amenorrhea also are common features (Sherif, 2006). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 10. On a scale of 1+ to 4+, which deep tendon reflex score is appropriate for a finding of clonus in a patient? A. 2+ B. 4+ C. 3+ D. 1+ A 1+ score indicates a sluggish or diminished reflex; 2+ indicates an active or expected response; 3+ indicates a more-brisk response than expected—slightly hyperactive; and a 4+ indicates a brisk, hyperactive response with intermittent or transient clonus (Seidel, 2006). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 11. Which of the following questions is not included in the CAGE test? A. Have you ever had to have a drink first thing in the morning to steady your nerves? B. Have you ever had more than 6 drinks at one time? C. Have you ever felt guilty about your drinking? D. Have you ever felt you should cut down on your drinking? The CAGE has a high degree of accuracy for identifying patients with alcohol abuse. CAGE stands for Cut down, Annoyed by criticizing, Guilty or Eye opener (Allen, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 12. Which of these occupations/hobbies are at least risk for carpal tunnel syndrome? A. Swimmers, opera singers, salesman B. Meat cutters, jackhammer users, hairdressers C. Bowlers, knitters, musicians D. Checkout clerks, seamstresses, typists Occupations/hobbies with repetitive forceful motions are at risk for CTS. It is not a known problem in swimmers (Kidd et al, 2003). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 13. A 3-year-old comes to the clinic with a 24-hour history of vomiting, diarrhea, fever (103°F), and severe abdominal tenderness. What should the NP do first? A. Conduct a complete history and physical examination before making a diagnosis. B. Take a complete dietary history, looking especially for other family members who might have eaten the same contaminated foods. C. Send a stool culture for ova, parasites, and enteric pathogens. D. Reassure the mother that this is gastroenteritis and that it should be self-limiting. More information is needed, including both historical information and a physical examination, before a diagnosis can be made (Richardson, 2006). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 14. Which of the following would cause the NP to order a cardiology workup for a 37-year-old male patient who wishes to start exercising? A. Sudden cardiac death of father at age 41 B. Smoking 1 ppd for 18 years C. Family history of heart failure D. History of hypertension A family history of sudden cardiac death should alert the practitioner to look further into the causes of these conditions in the patient’s family members. Familial cardiomyopathy may be responsible for as much as 30% of unexplained heart failure. Many times family members may not have been diagnosed, and the only indication of a problem is sudden cardiac death. Family history of early coronary artery disease places the patient at increased risk of development of CAD. CAD is the leading cause of heart failure (Hunt et al, 2005). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 15. By what age has the posterior fontanel usually closed? A. 8 months B. 6 months C. 1 year D. 2 months The posterior fontanel closes by age 2 months; it may be difficult to palpate even before closure (Wilson, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 16. A 72-year-old man who works part time at a service station comes in with complaints of visual changes. Specifically he describes “the colors seem to be fading, everything is blurred and dark, and straight lines appear to be bending over.” The patient is accurately describing what condition? A. Diabetic retinopathy B. Senile cataracts C. Glaucoma D. Macular degeneration The man in this question has described common symptoms of macular degeneration, which predominantly affects central vision (Vander and Gault, 2002). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 17. Which is not a diagnostic test used to assess for carpal tunnel syndrome? A. Phalen’s maneuver B. Rapid alternating movements C. Grip and pinch test D. Two-point discrimination Phalen’s maneuver, Tinel’s sign, grip and pinch test, and two-point discrimination are diagnostic maneuvers for CTS. Rapid alternating movements are not used as a typical diagnostic maneuver for CTS (Fox, 2000). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 18. On eye exam, an NP notes narrowing and blockage of the vein at the point an arteriole crosses. What is the significance of this finding? A. It indicates the need for better diabetes management in the patient. B. It is indicative of a small embolus in the arteriole. C. It indicates the need for evaluation of hypertension in the patient. D. It indicates increased ocular pressure typical of glaucoma. This is descriptive of AV nicking, a sign suggestive of hypertensive changes in the eye (Seidel, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 19. A patient comes to the office with complaints of wheezing. What associated history would best support a diagnosis of asthma? A. Recurrent otitis media B. Smokers in the home C. Other family members with asthma D. Older brother with seasonal allergies Atopy is the strongest predisposing factor associated with the development of asthma along with the family history of asthma. Irritants and illnesses can serve as triggers for allergy attacks. A family history of allergies is not as much a support for the diagnosis as are the symptoms of the patient herself (Kidd et al, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 20. Functional assessment is most important during the examination of a(n): A. Older adult B. Newborn C. Adolescent D. Toddler Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual’s independent functional capacity. Attention should be given to self-care activities and instrumental activities (Seidel, 2006). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 21. Which of the following regarding pain and the elderly is true? A. Pain is an expected part of aging. B. The elderly usually experience higher levels of pain. C. Pain may be a symptom of age-related illness. D. The elderly require more-aggressive pain management. The incidence of disease becomes more common as we age, and frequently pain may be a symptom of disease (McCafferty, 2002). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 22. Which comorbidity is often seen with epididymitis? A. Prostatitis B. Hydrocele C. Varicocele D. Testicular cancer When epididymitis is associated with gram-negative rods as a cause, prostatitis is often a comorbidity. Other conditions are not (Tierney, 2006). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 23. Which of the following would be the best way to ask about a sensitive subject? A. “How much alcohol do you drink?” B. “Many teenagers go to parties where alcohol is served; what about you?” C. “Do your parents allow you to drink alcohol at home?” D. “You don’t use alcohol, do you?” Asking sensitive questions in the third person is recommended as a technique for adolescents. The other questions are not the best techniques to use when obtaining information from teens (Levenberg, 1998). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 24. Which of the following symptoms is not a sign of an acute stroke? A. Difficulty seeing in one or both eyes B. Severe headache C. Sudden numbness D. Tenderness of the scalp All symptoms except tenderness of the scalp are symptoms that may indicate a CVA. Tenderness of the scalp is more indicative of temporal arteritis (Kidd et al, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 25. Which objective finding is most specific for the diagnosis of Lyme disease? A. Erythematous macular lesion with central clearing B. Fatigue C. Adenopathy and pharyngitis D. Yellow discharge present on the eyelids Fatigue, discharge on the eyelids, adenopathy, and pharyngitis are nonspecific symptoms of numerous disease processes; erythema migrans is most specific for Lyme disease (DePietropaolo et al, 2005). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 26. While performing an abdominal examination for reported abdominal pain, you note a pause in inspiration. The patient reports increased pain. You would note this as which of the following? A. A positive psoas sign B. Evidence of malingering C. A negative McBurney’s sign D. A positive Murphy’s sign A positive Murphy’s sign is described as a pause on inspiration caused by pain over the gallbladder. Phalen’s maneuver is related to carpal tunnel syndrome. McBurney’s point is located over the left lower quadrant and is related to appendicitis (Robinson, 2000). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 27. Cardiac findings associated with heart failure include the following except: A. Presence of an S3 B. Laterally displaced PMI C. Murmur of mitral regurgitation D. A split S1 An S3 gallop indicates volume overload. Mitral regurgitation results because of the geometric changes in the valve itself caused by the cardiac dilation that also causes the laterally displaced PMI. A split S1 is a normal finding (Hunt et al, 2005). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 28. A 17-year-old girl was playing flag football. When running down the field she attempted to remove the flag from another player. When the player cut away from her, she made a quick stop and rotated her body to the right in an effort to reach the flag. Immediately she felt pain in her left knee, heard a pop, and fell to the ground. She attempted to get up but was not able to support weight on the leg. Which test would you expect to be positive at this point? A. Lachman B. Varus stress C. McMurray D. Valgus stress The mechanism of injury for this patient is consistent with an ACL knee injury—that of sudden deceleration and twisting. Half of ACL injuries are accompanied by a pop at the time of injury (Shahady, Paull, and Jeoboam, 2005). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 29. Which of the following is one of the limitations of the mini-mental state examination (MMSE)? A. Its tendency to overestimate the severity of dementia B. Its long length C. Its ability to assess multiple cognitive functions D. Its inability to assess for early signs of dementia The MMSE is brief and assesses multiple cognitive functions but is generally unable to detect early signs of dementia as well as being unable to evaluate aspects of executive functioning (Resnick and Galik, 2006). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 30. An NP student asks how to tell retinal vessels apart. An experienced preceptor would give this response: A. Veins are darker and narrower than arteries. B. Veins are lighter colored and wider than arteries. C. Veins are lighter colored and narrower than arteries. D. Veins are darker and wider than arteries. A fundoscopic examination of the eye reveals the following about retinal vessels: veins are darker and wider than arteries (Seidel, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 31. A pregnant woman remembers that her last normal menstrual period began on Valentine’s Day (February 14). This means that her expected date of delivery is: A. May 21 B. November 21 C. May 7 D. November 7 Naegele’s rule is used to calculate the expected date of delivery. The rule is: subtract 3 months from the date the last menstrual period began and add 7 days. This would make the patient’s due date November 21 (Loudermilk and Perry, 2004). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 32. Which factor in a child’s history places him at greatest risk for the visual problems of amblyopia? A. Rubella B. Strabismus C. Injury from foreign body D. Congenital cataracts A child with a history of strabismus is most likely to be affected by amblyopia than are children with other findings in their histories (Seidel, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: B Your Response: A 33. In a patient with COPD, the ratio of anteroposterior diameter to lateral diameter is: A. 1.0 B. 1.6:2.0 C. 0.7:0.75 D. 1.20:1.25 In a barrel chest, an increase in the chest anteroposterior diameter leads to an increase in thoracic ratio (anteroposterior to transverse diameters) of 1.0, so that the chest is equally as wide as it is thick (Seidel, 2006). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 34. A commonly found objective finding in a patient with multiple sclerosis is: A. Apraxia B. Aphasia C. Stuttering D. Asymmetrical weakness Common findings on examination for multiple sclerosis include decreased motor strength in the legs (Robinson, 2000). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 35. To perform the Rinne test, where do you first place the tuning fork? A. Mastoid bone B. In front of the ear C. Forehead D. Top of the head The fork is initially placed against the mastoid bone for the Rinne test, which is a test for sensorineural loss (Seidel, 2006). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 36. Which of the following would be the expected assessment finding for a patient with gout? A. Pain at MTP joint of great toe, with lateral deviation of the great toe B. Reddish brown, hairless lower extremities C. Pale, cold foot with diminished pulses D. Inflamed, tender, swollen left great toe Characteristics of an acute gouty attack include an inflamed, tender, swollen left great toe. There is usually extensive swelling and erythema of the toe, and the whole foot is tender. Reddish brown discoloration of the foot is characteristic of venous insufficiency; and a pale, cold foot is seen with decreased arterial circulation. Pain at the MTP joint with lateral deviation is a bunion (Kidd, Robinson, and Kish, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: D Your Response: A 37. Which of the following findings is consistent with target-organ damage in hypertension? A. Left ventricular hypertrophy B. DTR 5+ C. Edema of extremities D. Thyromegaly Target-organ damage resulting from poor or no control of blood pressure can include left ventricular hypertrophy, angina, previous myocardial infarction, heart failure, cerebrovascular accident, neuropathy, peripheral artery disease, retinopathy, and arteriovenous nicking (Kidd et al, 2003). *Assessment Category Points Earned: 1/1 Correct Answer: A Your Response: A 38. Which of the following patients needs immediate assessment for hypothyroidism? A. New mother of 5-day-old twins who has been tearful since childbirth B. Male who has been on Synthroid for 2 years with good symptom control C. Newly retired woman who is having recent-onset difficulties with memory D. Adult teacher who has developed a fine tremor in his hands A new mother of 5-day-old twins is likely experiencing normal postpartum blues; a tremor would be a more likely finding in hyperthyroidism rather than hypothyroidism. Older women are a risk for hypothyroidism, in which difficulty with memory is common. Good symptom control on Synthoid would not justify referral (Kutty et al, 2003). *Assessment Category Points Earned: 0/1 Correct Answer: C Your Response: A 39. A mother is concerned that her child is not as developmentally advanced as her other children have been. In addition, she has noted that the child seems to “bounce off the walls when walking” and has a broad mouth with persistent smile. These characteristics are seen in: A. Autism B. Angelman syndrome C. Fragile X syndrome D. Down syndrome The biggest clue that there is something wrong with a child is the parent’s report of concern. Angelman syndrome presents with ataxic gait and broad mouth with persistent smile (Rapin, 2002). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 40. A 48-year-old woman whose mother experienced premature menopause asks the NP if the emotional instability and hot flashes she is experiencing might be related to menopause. Which test would provide a definitive diagnosis of menopause for this woman? A. Follicle-stimulating hormone (FSH) level B. Estrogen maturation index C. Luteinizing hormone (LH) level D. Serum estrogen level Menopause can be definitely diagnosed by an increase in the FSH level (Hackley et al, 2006). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 41. Which of the following symptoms are seen in a patient with primary HIV? A. Fever, generalized malaise, headache B. Esophageal candidiasis C. Kaposi’s sarcoma D. Wheezing and shortness of breath Primary HIV is identified by a flu-like presentation: fever, malaise, headache, or rash (CDC, 2003). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 42. In an adult who presents with severe sore throat and a muffled voice and appears toxic, which of the following diagnoses must be ruled out first? A. Strep throat B. Mononucleosis C. Tonsillitis D. Epiglottitis It is imperative that emergency life-support equipment be available during the physical examination of a patient with suspected epiglottitis; this diagnosis must be ruled out first before the pharynx is examined with a tongue blade. Since children have been immunized for H. influenza, more cases are being seen in adults (Zoorob and Campbell, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 43. A 5-year-old boy is seen for his preschool physical examination and is noted to have cool lower extremities with weak pulses and hypertension (blood pressure 164/92 mm Hg). Initial tests to examine for possible coarctation of the aorta include all the following except: A. ECG B. Chest radiograph C. GXT D. Four-extremity blood pressures Coarctation of the aorta essentially can be diagnosed with simple tests that can be performed in the office, such as four-extremity blood pressures to examine for significant blood pressure discrepancies between the upper and lower extremities. ECG and chest radiograph add evidence of left-sided heart failure with this obstructive lesion. GXT is not appropriate unless there is evidence of myocardial ischemia (Kidd et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 44. What is the rationale for the NP on why Epstein-Barr is not tested when making the diagnosis of chronic fatigue? A. “That’s a good idea. I’ll order the test immediately.” B. “I’ll consult my collaborative physician and see if she believes an Epstein-Barr titer is warranted in your case.” C. “The Epstein-Barr titer is no longer available.” D. “In the past, the medical community believed that Epstein-Barr virus caused chronic fatigue, but more recent research has proved otherwise.” Epstein-Barr virus, which was once considered a causative agent in CSF, is no longer considered such, and a titer is no longer warranted for diagnosis (Craig et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 45. In addition to either loss of interest in activities or depressed mood, how many symptoms must be present for 2 weeks to meet the diagnostic criteria for depression? A. Any number; depressed mood is the most critical B. Two or more C. One, but the symptom must be severe D. Five The DSM IV criteria for depression require at least five of the following: weight loss or gain, insomnia or hypersomnia, psychomotor agitation, feelings of worthlessness, decreased ability to concentrate, recurrent thoughts of death, fatigue, or loss of energy (DSM IV, 2000). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 46. What type of testing situation occurs when a rapid strep test is negative and the patient actually has the condition? A. High specificity B. High sensitivity C. Low specificity D. Low sensitivity This situation describes a test designed to test patients who are positive for the disease. At this time the test was not able to detect a true positive; therefore the test had a low sensitivity (Seidel, 2006). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 47. A college student has had a hepatitis titer run before beginning a clinical rotation. Which of the following hepatitis serology is consistent with someone who has had the hepatitis B series? A. Negative HBsAG, +anti-HBs, negative anti-HBc, negative IgM B. +HBsAG, negative anti HBs, negative IgM C. Negative HBsAG, +anti-HBs, +anti-HBc, positive IgG D. +HBsAG, negative anti-HBc, +anti-HBc, negative IgM Only the antibody to the HB surface antigen (HBsAG) would be positive in someone who has had the vaccine series and not the illness (Kidd et al, 2003). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 48. Which clinical finding indicates a complication of impetigo? A. Generalized edema B. Ventricular arrhythmias C. Declining hearing acuity D. Inspiratory wheezing Edema is indicative of post-streptococcal glomerulonephritis, a complication of impetigo. Other findings are not associated (Fitzpatrick et al, 2001). *Diagnosis/ Dermatology Category Points Earned: 1/1 Correct Answer: A Your Response: A 49. How long does morning stiffness in RA last? A. 30 to 60 minutes or longer B. Less than 30 minutes C. An indefinite period D. Throughout the day RA typically has a history of morning stiffness lasting 30 to 60 minutes or even longer, whereas with OA, morning stiffness lasts 15 to 30 minutes (Rindfleish et al, 2005). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 50. Which of the following EKG patterns is consistent with an anterior MI? A. Prolonged P-R interval B. Changes in leads I, aVL (lateral) and V1 through V6 (anterior V1-V4, V5, and V6 lateral) C. Changes in leads II, III, and aVF (inferior) and I, aVL, V5, and V6 D. No visible P waves Changes in II, III, and aVF, aVL, V5, and V6 are seen with an inferior MI. Changes in the V leads indicate an anterior MI. A prolonged P-R interval indicates a first-degree block. No visible P waves may indicate atrial fibrillation or complete heart block (Mosby, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 51. Which of the following diagnostic methods is least appropriate for the patient with suspected Alzheimer’s disease? A. Performing simple screening tests B. Asking the patient if he/she has suffered from memory loss recently C. Routinely screening patients over 65 for symptoms of memory loss and functional impairment D. Asking friends and family about cognitive and functional performance The diagnosis of a patient with AD is made with input from friends and family (Alzheimer’s Disease Organization, 2006). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 52. It is important to differentiate between IBS and organic abdominal pain. Which of the following is characteristic of structural abdominal pain? A. Pain accompanied by bloating B. Pain that radiates to the back C. The patient must experience a detrimental effect in terms of physical or mental health D. Pain accompanied by diarrhea Pain that awakens the patient from sleep is more likely organic in nature. IBS abdominal pain does not wake the patient from sleep. All the other descriptions are characteristic of IBS (Rogers, 2000). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 53. You suspect physical abuse in a patient who has many different minor injuries at different stages of healing. She seems very stressed. Which approach by the NP is most likely to elicit information to either support or negate this diagnosis? A. “Are you in a relationship in which you feel unsafe?” B. “Do you want to tell me anything while we are in private?” C. “Wow, you have lots of bruises and scratches today.” D. “Do you and your partner get along?” The most therapeutic manner for eliciting information to diagnose intimate partner violence is to question the individual about her perceptions of safety within the existing (sometimes former) relationship (Walling, 2002). *Diagnosis/Violence Category Points Earned: 1/1 Correct Answer: A Your Response: A 54. The presence of a fishy odor after potassium hydroxide is dropped on a wet mount slide containing vaginal mucus suggests: A. Candidiasis B. Bacterial vaginosis C. Trichomoniasis D. Gonorrhea A positive “whiff test” suggests bacterial vaginosis (Seidel, 2006). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 55. A 32-year-old woman presents with a 2-month history of bloody nipple discharge from her right nipple. Palpation indicates a small, soft lump just beneath the right areola. These findings support a diagnosis of: A. Intraductal papilloma B. Breast cancer C. Fat necrosis D. Fibrocystic changes Intraductal papilloma is a benign tumor of the epithelium found in the major lactiferous ducts and usually attached to the duct wall. It is seen in women in their 30s and 40s and involves bloody nipple discharge. Treatment is referral (Hackley et al, 2006). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 56. An FNP is checking the eyes of an 18-month-old child and notes leukocoria, a white pupil that fails to reflect light. This finding raises the index of suspicion of: A. Retrobulbar neuritis B. Retinoblastoma C. Ophthalmia neonatorum D. Congenital glaucoma Retinoblastoma is the most common ocular tumor in infancy. Unfortunately, it is diagnosed only when the disease is in an advanced phase and the prognosis is decidedly unfavorable. Patients treated early, in the first stage of the disease, can be cured with surgical and radiation treatment. For patients who are already in an advanced stage, the risk of metastasis is high. Often a white pupil that does not reflect the light (leukocoria) is an early identification. Older children may squint or have eye pain (Vander and Gault, 2002). *Diagnosis/Eye Category Points Earned: 0/1 Correct Answer: B Your Response: A 57. The NP prescribes orlistat (Xenical) for a patient who is morbidly obese. They carefully examine together common side effects and the dietary changes to minimize difficulty. Which food if eaten by the patient will exacerbate the major side effect of Xenical? A. French-fried potatoes B. Blueberry yogurt with sprinkles C. Broccoli and cheese sauce D. Apples and pears with peelings Orlistat’s side effects include steatorrhea, flatus, fecal incontinence, abdominal bloating, and oily spotting. Consuming fatty foods causes a greater problem with the side effects. These side effects cause many to stop the medication (Berke and Morden, 2000). *Diagnosis/Nutrition Category Points Earned: 1/1 Correct Answer: A Your Response: A 58. In a bioterrorism simulation, a simulated victim presents with a sign noting these symptoms: high fever, muscle aching, and abdominal pain. A note says that the patient has a rash on the face and extremities including the palms and soles and on the mucosa. It is a maculopapular then vesicular rash in a synchronous pattern with firm lesions. Smallpox is the suspected agent of terror. What diagnostic test would confirm this diagnosis? A. DNA probe B. Biopsy of lesions C. Peripheral blood smear D. Electron microscopy of contents of vesicles confirmed by the public health department Only the electron microscopic evaluation of vesicular contents can diagnose smallpox. This will be a role of the public health department in the event of a bioterror attack (Fortmeier-Saucier, 2004). *Diagnosis/Violence Category Points Earned: 0/1 Correct Answer: D Your Response: A 59. A patient has been asked to identify items in the grocery store that start with the letter “s.” The patient has been able to identify five items in 60 seconds. This test indicates what? A. This finding indicates an abstraction deficit. B. This finding indicates a deficit in executive function. C. This is a normal finding. D. This finding indicates a deficit in recent memory. The ability to identify items or animals that all begin with the same letter is a good indicator of executive function. Generally most individuals are able to name 20 to 25 items in 60 seconds. A patient who is not able to identify that many needs more in-depth assessment (Resnick and Galik, 2006). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 60. A patient complains about having too much cerumen in his ear. Which of the following is true concerning cerumen? A. It provides an ideal medium for bacterial growth. B. Excess cerumen is a symptom of ear problems. C. Cotton-tipped applicators should be used on a regular basis to clean out cerumen. D. Only if the cerumen is impacted does it create a problem. Only if the cerumen is impacted and completely occludes the canal is cerumen a problem. Cerumen is bactericidal and fungicidal. It does not indicate any underlying ear problems. The ear canal should be cleaned with only a washcloth and fingertip. Cotton-tipped applicators can contribute to impaction in the ear canal (Kidd et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 61. A college senior presents to the health clinic and anxiously informs the NP that he has just learned that a coed with whom he had sex has genital herpes. He has asked to be tested for that diagnosis. What response by the NP is best? A. Swab the urethra to obtain a viral culture. B. Draw blood for an RPR. C. Perform a Tzanck smear. D. Explain that diagnostic testing can only be done when lesions are present. Diagnosis with a Tzanck smear is appropriate when there are vesicles that can be unroofed. Viral culture for diagnosing herpes demands vesicular fluid. Reliable testing is not available in the absence of lesions (Fitzpatrick et al, 2001). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 62. A male patient has a history of cryptorchidism. This places him at risk for which diagnosis? A. Frequent UTI B. Testicular cancer C. Prostatitis D. Priapism An undescended testicle (cryptorchidism) places males at risk for infertility and for testicular cancer (Dambro, 2003). *Diagnosis/Male Reproductive Category Points Earned: 0/1 Correct Answer: B Your Response: A 63. According to the Prochaska model of behavioral intervention, a person who wants to begin an exercise program but has not made a specific plan to do so is in which stage? A. Contemplation B. Action C. Maintenance D. Precontemplation A person in the contemplation stage is considering a change in the next 6 months but does not really know how to proceed. A person in the preparation stage is going to begin in the next 30 days, while a person in the action phase is actually making the change. Maintenance is a stage in which someone has committed to the change and needs to continue with the new plan (Kidd et al, 2003). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 64. Which of the following statements best describes the pathophysiologic findings of gout? A. Gout is most commonly a result of increased uric acid production. B. The onset of gout is caused by a gradual change in uric acid levels. C. The lower temperature of the toe causes precipitation of uric acid crystals. D. Secondary gout is a hereditary chronic disorder. Uric acid is soluble in serum at body temperature, but at lower temperatures, uric acid precipitates into a joint. Only 10% of gout is caused by overproduction of uric acid. Onset of gout symptoms is caused by a rapid change in uric acid levels. Secondary gout is caused by an acquired disease and is not hereditary (Siva, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 65. A 55-year-old house painter has had a constant dull ache in his right shoulder for 3 weeks. It worsens when he elevates his arm, and he cannot raise the arm above his head. The pain radiates to his neck and wakes him at night. He has no history of numbness in his right arm or hand. He has no history of acute trauma. His medications include atorvastatin, metformin, and ASA. What is your presumptive diagnosis at this point? A. Statin-induced myositis B. C5-C6 nerve root compression C. Rotator cuff impingement syndrome D. Acromioclavicular joint arthritis This man has rotator cuff impingement. These problems make up 60% of the problems seen in the primary care setting; the patient who complains of this is usually >40 years of age. The pain worsens at night and with elevation of the arm. The pain is usually localized on the superior lateral portion of the shoulder. Compression of C5 usually includes numbness in the hands. Statin-induced myositis is unlikely because it usually affects more than one muscle group (Shahady, Paull, and Smith, 2005). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 66. Which of the following is true about deep venous thrombosis? A. It can easily be diagnosed by physical findings. B. It causes hypocoagulability. C. It may not be clinically apparent. D. It is unusual in people older than 85 years. The physical signs for diagnosing DVT may not be apparent. Hypocoagulability may cause bleeding, not clotting (Kidd et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: C Your Response: A 67. A 60-year-old neighbor of yours confides in you that on a recent airline flight she experienced an episode of urinary incontinence. The flight was delayed by bad weather and the plane’s lavatories remained closed. She had become uncomfortable before landing and wet herself before she could make it off the plane and to a restroom. It has not happened again. You recognize that this is a classic description of: A. Functional incontinence B. Urge incontinence C. Bladder outlet obstruction D. Stress incontinence This isolated incidence of functional incontinence occurred when the bladder became overly full and timely voiding was not possible. More typically, it is associated with difficulty getting to the toilet because of cognitive or mobility issues. Unless there are additional episodes, no follow-up is necessary and the woman can be reassured (Gray, 2005). *Diagnosis/Genitourinary Category Points Earned: 1/1 Correct Answer: A Your Response: A 68. A 65-year-old woman complains of feeling depressed. She would like a prescription to make her feel better. Her husband died 6 months ago. The NP knows that: A. Major depression must be considered. B. Diagnostic tests will not be needed. C. Anxiety is a probable diagnosis. D. Her problem is a normal grief reaction but will require surveillance. Although this patient may be experiencing a normal grief reaction, the possibility of major depression must be ruled out (Kidd et al, 2003). *Diagnosis Category Points Earned: 1/1 Correct Answer: A Your Response: A 69. A 37-year-old male presents with complaints of malaise and a swollen red eyelid on the right; he thinks he has had a slight fever as well. Exam by the FNP reveals the following: proptosis on the right lid which is edematous and reddened. There is restricted intraocular movement on the right. Which diagnosis is suspect? A. Acute iritis B. Uveitis C. Orbital cellulitis D. Blepharitis Uveitis is an inflammation of the the uvea, the layer between the sclera and the retina, which includes the iris, ciliary body, and the choroid. Acute iritis is also known as anterior uveitis. Blepharitis is a bacterial inflammation of the lash follicles at the eyelid margins. Orbital cellulitis, a serious inflammation that requires immediate referral, is the suspect diagnosis here (Vander & Gault, 2002). *Diagnosis/Eye Category Points Earned: 0/1 Correct Answer: C Your Response: A 70. A 26-year-old young woman has come in to be seen because her partner has been diagnosed with gonorrhea. In addition to testing for gonorrhea and chlamydia, the NP should: A. Recommend the HPV vaccine. B. Test for syphilis. C. Test for hepatitis C serology. D. Recommend the hepatitis B vaccine series. The HBV vaccine does not contain a live virus; it is recommended for adults who are at high risk. Since this patient has been exposed to an STD, she is considered high risk and should get the vaccine to prevent the occurrence of hepatitis B (Kidd et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: D Your Response: A 71. A man has a 6-month history of fatigue, a 20-lb weight gain, and muscle weakness. The NP notes the following on exam: hypertension, edematous legs, reddened face, truncal obesity, supraclavicular fullness, and striae. Which diagnostic test is indicated, given these findings? A. Dexamethasone suppression test B. Random cortisol levels C. Adrenal CT D. MRI of pituitary The most probable diagnosis for this patient is Cushing’s syndrome. He will be referred to an endocrinologist for treatment, but a dexamethasone suppression test is an anticipated diagnostic test (Kutty et al, 2003). *Diagnosis/Endocrine Category Points Earned: 1/1 Correct Answer: A Your Response: A 72. Which of the following is the most sensitive marker for myocardial necrosis? A. C-reactive protein B. Troponins T and I C. Myoglobin D. Total creatine kinase (CK) Troponin is a contractile protein that is not found in serum; it is released only when myocardial necrosis occurs (Kidd et al, 2003). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 73. Which of the following findings is inconsistent with a diagnosis of cancer of the vulva? A. Area of leukoplakia on left labia majora B. History of pessary use C. History of genital warts D. Local itching Local itching, leukoplakia, and a history of infection related to HPV are elements consistent with a diagnosis of cancer of the vulva. Pessary use is not a factor in this malignancy (Canavan and Cohen, 2002). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 74. Which of the following is considered to be a defining factor in substance dependence? A. Metabolic activity affected by drug use B. Tolerence C. Overwhelming feelings of pleasure D. Continued use despite adverse physical effects Substance dependence requires the development of tolerance leading to withdrawal symptoms. Substance abuse is defined in terms of the social consequences of substance use (National Institute on Drug Abuse, 2000). *Diagnosis Category Points Earned: 0/1 Correct Answer: B Your Response: A 75. Visual acuity testing of a young man hoping to enter the military service indicates 20/40 vision. The FNP correctly interprets these findings to the patient as: A. “Your vision is just as it should be for someone your age.” B. “You are able to see at 20 feet what the normal eye sees at 40 feet.” C. “You are able to see from 40 feet what the normal eye sees at 20 feet.” D. “You are able to see normally in your right eye but 40 feet in your left eye.” Visual acuity is documented in a fraction where the numerator is consistent (20 feet), noting the distance of 20 feet from the chart required for measurement. The denominator represents the distance at which the 20-foot line is read. The larger the denominator, the worse the visual acuity (Seidel et al, 2003). *Plan/Eye Category Points Earned: 0/1 Correct Answer: B Your Response: A 76. The FNPs in a large clinic decide they want to portray their clinical site as being particularly supportive of women experiencing intimate partner abuse. They believe this environment will encourage disclosure. Which aspect of the plan is least appropriate to meeting this goal? A. Wearing large lapel pins that read “Men Who Hit Don’t Deserve Women!” B. Putting posters on the clinic walls that reflect this as a “safe space for those in unsafe relationships” C. Placing information about shelters, hotlines, safety plans, and exit strategies in female-only bathrooms in plain brown wrappers D. Beginning to do universal screening for violence for all female patients Universal screening, posters that reflect the clinic as a safe space for disclosure, and information in places accessible to the patients (not partners) are helpful strategies. The large lapel pins are judgmental (Kidd et al, 2003). *Plan/Violence Category Points Earned: 1/1 Correct Answer: A Your Response: A 77. A 7-year-old girl is experiencing scalp alopecia. Lesions are noted in the scalp, and there are broken hair shafts. What action is recommended? A. Suggestion for counseling for an anxiety disorder B. Performance of a TSH level C. Referral to a pediatric allergist immediately D. Prescription for topical griseofulvin for 6 weeks This case describes tinea capitis, which is appropriately treated with topical griseofulvin ointment for 6 weeks (Fitzpatrick et al, 2001). *Plan/Dermatology Category Points Earned: 0/1 Correct Answer: D Your Response: A 78. A victim of assault had lye thrown into his face. What initial action by the FNP in a nearby clinic would be best? A. Quickly check pH. B. Check visual acuity with the Snellen chart. C. Refer the patient to a hospital ER. D. Begin copious irrigation with saline or Ringer’s lactate for 30 minutes. Alkalies such as lye, cement, and plaster penetrate deeply and may cause severe burns. The initial action is to check pH. Copious irrigation is begun and continued by using saline or lactated Ringer’s for 30 minutes. Irrigation is not discontinued as long as the pH is >7.0 The patient will need to be seen in an ER but not until the pH of the burned eye is lowered (Vander and Gault, 2002). *Plan/Eye Category Points Earned: 1/1 Correct Answer: A Your Response: A 79. During her prenatal care, Nan’s rubella titer is found to be 1:16. This finding can be interpreted by the FNP as: A. An obvious laboratory error B. Evidence of immunity C. Need for a rubella immunization D. Highly suspicious of rubella Immunity to rubella is denoted by a rubella titer >1:8 (Loudermilk and Perry, 2004). *Plan Category Points Earned: 0/1 Correct Answer: B Your Response: A 80. The FNP diagnoses mild rosacea in a middle-aged man. What is the drug of choice for initial treatment? A. Erythromycin ointment B. Penicillin C. Metronidazole aqueous gel D. Nizoral Metronidazole aqueous gel (MetroGel) is an appropriate choice for initial treatment of mild rosacea or after oral antibiotics such as tetracycline, doxycycline, or minocycline. Clindamyacin (Cleocin) lotion is sometimes used, and isotretinoin (Accutane) is sometimes used for refractory cases (Ferri, 2002). *Plan/Dermatology Category Points Earned: 0/1 Correct Answer: C Your Response: A 81. A 21-year-old with type 1 diabetes since age 8 presents for a routine visit. He checks his glucose levels QID and takes NPH 15 units and Lispro 5 units before breakfast and supper. He has recently started waking around 2 AM with a hypoglycemic reaction. Hemoglobin A1c is 6.8%. What treatment approach is most appropriate? A. Increase the bedtime snack. B. Continue Lispro before supper but move the NPH dose to bedtime. C. Decrease the pre-breakfast NPH dose to 12 units. D. Reduce the pre-supper NPH dose to 12 units. The regimen for this young man mixes quick-acting and intermediate-acting insulins. His pre-supper NPH is peaking around 2 AM (8-hour onset) and causing hypoglycemia. By moving the NPH dose to later, sleep is not affected but coverage is adequate. Regimens in other options would not accomplish this goal (Kutty et al, 2003). *Plan/Endocrine Category Points Earned: 0/1 Correct Answer: B Your Response: A 82. A 34-year old woman is found to have a 2.5-cm non-tender breast mass on clinical exam. She takes oral contraceptives. Follow-up after menses reveals the mass is still present. Axillary nodes are non-palpable. Mammography indicates bilateral denseness in the breast but no dominant mass. What action by the FNP is best? A. Discontinue OCPs and schedule follow-up check in 3 months. B. Order MRI of the affected breast. C. Reassure the woman based on negative mammography findings. D. Order ultrasound and consider aspiration or excision based on its finding. Ultrasonography should be ordered to discriminate between a solid and fluid-filled mass. Other options are not appropriate, because breast cancer must be ruled out (Kutty et al, 2003). *Plan/Female Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 83. Which recommendation about ophthalmologic evaluation of diabetic patients is inaccurate? A. Women with gestational diabetes should have dilated eye exams each trimester. B. Patients with type 1 diabetes should have a dilated exam 5 years after diagnosis. C. All diabetic patients should have annual dilated fundoscopic exams. D. Patients with type 2 diabetes should be examined by an ophthalmologist at the time of diagnosis. There is no recommendation for dilated eye exams in women with gestational diabetes mellitus. Guidelines for ophthalmologic follow-up in those with diabetes include the other recommendations (Vander and Gault, 2002). *Plan/Eye Category Points Earned: 1/1 Correct Answer: A Your Response: A 84. An adult male presents with a 3-day history of dysuria and penile discharge. Gram stains of the discharge reveal gram-negative cocci. Given this finding, the patient should be treated for: A. E. coli B. Gonorrhea C. Urea plasma D. Syphilis The scenario in this case points to gonorrhea as a cause of the patient’s STI; hence, treatment would consist of ceftriaxone 125 mg IM (one-time dose), cefixime 400 mg PO, ofloxacin 400 mg PO, ciprofloxacin 500 mg PO, or levofloxacin 250 mg PO for 7 days. Since so many patients are co-infected with Chlamydia, some recommend additional coverage with azithromycin 1 gm PO as a single dose or doxycycline 100 mg PO BID × 7 days (Dambro, 2003). *Plan/Infectious Disease Category Points Earned: 0/1 Correct Answer: B Your Response: A 85. What antibiotic choice is most appropriate for a male patient with chronic prostatitis? A. Sulfonamide B. Trimethoprim C. Ciprofloxacin D. Tetracycline Men with chronic prostatitis need treatment with a fluoroquinolone at a standard dose for 4 to 12 weeks (examples: ofloxacin 300 mg BID or ciprofloxacin 500 mg BID) (Dambro, 2003). *Plan/Male Reproductive Category Points Earned: 0/1 Correct Answer: C Your Response: A 86. When should rubella immunization be administered to a pregnant woman? A. During the prenatal period B. At the outset of labor C. Upon weaning the baby D. Postpartum Rubella immunization consists of a live virus, which is teratogenic in pregnancy. In the non-immune woman, it should be given in the postpartum period, when pregnancy is impossible. Women should be advised to avoid pregnancy for a minimum of 3 months by using a reliable form of contraceptive (Loudermilk and Perry, 2004). *Plan Category Points Earned: 0/1 Correct Answer: D Your Response: A 87. The FNP notes that a urinalysis report shows that the specimen contained some WBCs and numerous epithelial cells. What action by the practitioner would be most appropriate given these findings? A. Increase the patient’s fluid intake. B. Notify the collaborative physician. C. Repeat the test. D. Prescribe a urinary antiseptic. Epithelial cells are indicative of contamination of a urine specimen and warrant repeating the specimen collection with a clean-catch specimen (Pagana and Pagana, 2003). *Plan/Genitourinary Category Points Earned: 0/1 Correct Answer: C Your Response: A 88. The FNP is performing an ophthalmologic exam. Which finding justifies referral to an ophthalmologist? A. Pulsation of veins at disk crossings B. Yellow-white physiologic cup C. AV ratio of 4:5 D. Cup-to-disc ratio in one eye is different than other A cup-to-disc ratio in one eye signifies loss of ganglion cells and is increased in glaucoma. This would be a referable condition. Other findings described are acceptable in an ophthalmologic exam (Vander and Gault, 2002). *Plan/Eye Category Points Earned: 0/1 Correct Answer: D Your Response: A 89. A 38-year-old African-American woman complains of pelvic pressure and backache and says her menses have become heavier in the last 6 months. The exam reveals a 12-week uterus with an irregular contour. These findings are consistent with a diagnosis of: A. Adenomyosis B. Missed abortion C. Endometriosis D. Uterine fibroid Uterine fibroids are more common in African-American women than other groups, cause pelvic pressure, backache, and increased uterine bleeding. Objective findings include an enlarged uterus with irregular contour (Carlson et al, 2002). *Plan/Female Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 90. During an annual exam, the FNP discovers a non-pruritic, non-tender hyper-pigmented lesion with irregular borders on a man’s upper back. He is a light-skinned, blue-eyed “sun worshipper” who has had several sunburns. There is no adenopathy. What action is most appropriate? A. Recommend the use of sunscreen and re-evaluate in 4 weeks. B. Refer for wide excisional biopsy as soon as possible. C. Schedule A and P and a lateral chest x-ray immediately. D. Perform a shave biopsy of the lesion for pathological analysis. The lesion described in this scenario is consistent with malignant melanoma, so referral for wide excisional biopsy is appropriate and should be done as soon as possible (Fitzpatrick and Aeling, 2001). *Plan/Dermatology Category Points Earned: 0/1 Correct Answer: B Your Response: A 91. A woman who is in her second day of treatment for vaginal candidiasis telephones the clinic to question whether she should continue the vaginal treatment during her period, which started today. Which response by the FNP is appropriate? A. “Hold the medicine while the flow is heavy but re-start in 24 hours.” B. “No, hold the medicine until menses ends, then re-start.” C. “Yes, continue the medication until it is all gone.” D. “Use a second dose for 2 days, since bleeding may displace some of the medicine.” Treatment should continue during menses (Hackley et al, 2006). *Plan/Infectious Disease Category Points Earned: 0/1 Correct Answer: C Your Response: A 92. Which of the following patients seen for vertigo is least in need of immediate evaluation? A. The vertigo was just reported and occurs only when the patient looks up or turns his head. B. The problem has a new onset and is associated with severe headache. C. The vertigo is of recent onset and the patient is experiencing numbness. D. The symptoms are new and the patient also has visual disturbances. New-onset vertigo associated with neurologic symptoms, visual disturbances, or headache suggests a serious pathologic process and demands immediate evaluation. Cervical dizziness, caused by compression of the vertebral artery by an osteophytic spur and resulting in diminished blood supply to the brain, may be provoked by looking upward or turning the head (Swartz and Longwell, 2005). *Plan/Ear Category Points Earned: 1/1 Correct Answer: A Your Response: A 93. An FNP who is co-managing a middle-aged patient with SLE with a physician is ordering hydroxychloroquine (Plaquenil). Which instructions for follow-up should be included in the management of the patient? A. Monitor weight every week throughout therapy. B. Obtain an eye examination every 6 months throughout therapy. C. Return to the clinic for a CBC every 6 months throughout therapy. D. Check blood pressure every month throughout therapy. Because quinine deposits can affect eyes when Plaquenil is used, patients on this drug are advised to have ophthalmologic evaluations every 6 months (Kidd et al, 2003). *Plan/Immune Category Points Earned: 0/1 Correct Answer: B Your Response: A 94. Which of the following actions is a primary prevention measure for burns? A. Use of a fire extinguisher B. No smoking in bed C. Creating an escape route D. Installation of a smoke detector Only teaching patients about not smoking in bed helps to prevent a fire from occurring (Kidd et al, 2003). *Plan/Emergency Category Points Earned: 0/1 Correct Answer: B Your Response: A 95. Bob presents to the College Health Clinic for a routine athletic physical. He has a cross-country running scholarship and is accustomed to running 8 to 10 miles at least 6 days per week. He ran this morning before the appointment hour. He was recently pre-screened by the athletics department before tryouts. He is 5’8” tall and weighs 137 pounds. Vital signs are normal, as is CBC. Urinalysis shows slight protein. What action by the FNP is appropriate? A. Immediate BUN and creatinine testing B. Advise no exercise for 72 hours, increase fluid intake, then re-check C. Immediate referral for BMI testing D. Suspect renal failure, refer to nephrologist The most common contributing factor to urinary protein in this situation is excess exercise and dehydration, and possibly inadequate food intake. The case does not address the level of proteinuria - possibly trace. Re-checking the urine in 72 hours without exercise is a reasonable action given the normal CBC (Molzahn and Butera, 2006). *Plan/Genitourinary Category Points Earned: 0/1 Correct Answer: B Your Response: A 96. A gardener complains that he has scratched his left eye. He cannot tolerate light and the eye is tearing, and he says it feels like “something is still in there.” The FNP can find no foreign body, but a fluorescein stain shows a 0.5-mm area on the cornea. The appropriate management plan for this man will not include: A. Application of antibiotic ophthalmic drops B. Close follow-up visits C. Use of topical anesthetic drops QID for several days D. Use of oral analgesics Topical anesthetic drops are not used; anesthetizing the eye would place the patient at risk of unrecognized complications for which pain is a typical symptom. Other strategies are appropriate (Vander and Gault, 2002). *Plan/Eye Category Points Earned: 0/1 Correct Answer: C Your Response: A 97. A 47-year-old executive, who is a long-term patient and has been followed for routine care and occasional minor illnesses for several years, presents today with complaints of impotence. He mentions that he awakens with an erect penis in the morning but is unable to achieve erection when he wants to make love to his wife. What plan is appropriate? A. Refer him immediately to a urologist. B. Order a penile tumescence study. C. Prescribe Viagra. D. Conclude that there is no organic cause for the problem and discuss counseling. Morning erections indicate that erectile dysfunction is not an organic entity. Counseling should be explored with the patient as a treatment option (Dambro, 2003). *Plan/Male Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 98. A 38-year-old patient presents seeking contraception. She describes her current relationship as “on again, off again.” She has never been pregnant and is a heavy smoker. What contraceptive choice is best for this woman? A. IUD B. Oral contraceptive pills C. Tubal ligation D. Diaphragm For a relationship that involves irregular sexual intimacy, tubal ligation is not the optimal choice; because she is a heavy smoker, and over 35, the pill is not a safe choice. The IUD is questionable because this level of protection is not needed. Moreover, her description of the relationship implies a possibility of infection risk (Kidd et al, 2003). *Plan/Female Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 99. When performing an annual gynecologic exam, the FNP notes bruising on both the patient’s upper arms in the distinct pattern of fingers. When the FNP mentions the bruises, the woman responds, “Clumsy me! I fell over my son’s tricycle—it’s nothing.” Which comment by the FNP is most appropriate? A. “I believe someone grabbed you tightly by your upper arms.” B. “The bruises seem to be in the shape of someone’s hands.” C. “I am concerned about you and I don’t think you are being truthful here.” D. “Was this really the accident you describe?” The most appropriate response by the FNP is noting the observed findings in a matter-of-fact manner, offering the patient an opportunity to disclose abusive treatment (Kidd et al, 2003). *Plan/Violence Category Points Earned: 0/1 Correct Answer: B Your Response: A 100. A 15-year-old male is brought to the ER by his grandfather during a vacation. The boy has had intense scrotal pain for 2 hours. The FNP notes an edematous scrotum that is exquisitely tender, making palpation of the epididymis impossible. There remains uncertainty as to whether the diagnosis is epididymitis or testicular torsion. Which action is best? A. Antibiotic therapy B. Scrotal support and an ice pack C. Morphine and moist heat D. Referral to a surgeon General measures for treatment of epididymitis include scrotal support with elevation, NSAIDs or oral narcotics for analgesia, ice pack, and antibiotics. Since the diagnosis remains uncertain, referral to a surgeon for evaluation is appropriate. In men under 35 years of age, doxycycline or tetracycline for 10 days is an appropriate antibiotic (Dambro, 2003). *Plan/Male Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 101. A 70-year-old man is accompanied to the clinic by his daughter, who reports that he telephoned her during the night complaining of trouble urinating. The patient confirms difficulty voiding and that the “last few dribbles of urine” he passed was bloody. An examination reveals the following: an asymmetrical firm prostate about 6 cm in diameter with a firm discrete nodule palpable. The PSA level is 18. Which plan is most appropriate, given these findings? A. Prescribe finasteride (Proscar) to decrease prostatic hypertrophy and follow up in 3 months. B. Treat the patient for prostate infection and re-evaluate in 2 weeks. C. Obtain a catheterized urine specimen to objectify the level of hematuria. D. Refer to urologist for biopsy and evaluation of possible prostate cancer. An elevated PSA level and objective findings of the physical examination are suggestive of prostate cancer and justify referral to a urologist for evaluation and management. Other options are not appropriate choices in this situation (Dambro, 2003). *Plan/Male Reproductive Category Points Earned: 0/1 Correct Answer: D Your Response: A 102. In her last trimester of pregnancy, a woman experiences painless bleeding from the vagina while working in her rose garden. What measure is best for determining the reason for the bleeding? A. Refer for a culdocentesis. B. Order a pelvic CT scan. C. Order a pelvic ultrasonography. D. Perform a sterile vaginal examination. Vaginal examination is contraindicated in cases of vaginal bleeding! A pelvic ultrasonography can be used to diagnose what is likely placenta previa - a disorder of the 3rd trimester associated with painless vaginal bleeding (Loudermilk and Perry, 2004). *Plan Category Points Earned: 0/1 Correct Answer: C Your Response: A 103. What drug below is not an appropriate choice for treating tinea versicolor? A. Nizoral shampoo B. Oral Nizoral C. Cortisone cream D. Selsun shampoo Tinea versicolor is a common, benign, superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and the back. It is appropriately treated by an antifungal preparation; all of the choices offered here are antifungals with the exception of cortisone cream (Saunders Nursing Drug Handbook, 2005). *Plan/Dermatology Category Points Earned: 0/1 Correct Answer: C Your Response: A 104. The FNP is working with a diabetic patient who needs to be started on an antihypertensive agent. Which drug category will provide the most renal protection for this patient? A. ACE inhibitor B. Alpha blocker C. Calcium channel blocker D. Beta blocker The drug category that provides the greatest renal protection is ACE inhibitors (Kidd et al, 2003). *Plan/Genitourinary Category Points Earned: 1/1 Correct Answer: A Your Response: A 105. Which of the following children would not need referral to an audiologist? A. Child needing placement of tympanostomy tubes B. Child with a facial and ear deformity C. Child who failed a hearing screen D. Child with frequently diagnosed otitis media The child needing placement of tympanostomy tubes should be referred not to an audiologist for testing but to an ENT specialist for surgery (Bush, 2003). *Plan/Ear Category Points Earned: 1/1 Correct Answer: A Your Response: A 106. A patient with a long-standing history of diabetes mellitus is experiencing severe painful peripheral neuropathy. Which treatment is most appropriate? A. Acetaminophen with codeine B. Ice packs C. Gabapentin (Neurontin) D. Warm saline soaks Medications for painful diabetic neuropathy include topical capsaicin ointment applied BID x 2 weeks; neuromodulators such as carbamazepine, gabapentin, oxcarbazepine, topiramate; or tricyclic antidepressants such as amitriptyline or imipramine 2 hours before bedtime. Treatments with cold or heat are not recommended for diabetics, especially those with neuropathy. A narcotic analgesic is not an appropriate option (Unger, 2004). *Plan/Endocrine Category Points Earned: 0/1 Correct Answer: C Your Response: A 107. A man who has sustained an injury on the job has been assigned a case manager in workplace safety. The FNP should not expect that professional provider to: A. Advocate for the patient throughout the recovery process. B. Evaluate and monitor your patient’s progress to recovery and return to work. C. Decide on optimal treatment measures and timeline based on the FNP’s assessment and plan of care. D. Collaborate with the FNP to develop a return-to-work plan. Work injuries can require diverse health services, and the health care and benefits system can be complex. That’s why patients often find it challenging to understand and access the care and benefits they need. The nurse case manager can help by acting as an advisor, an advocate, and a mentor throughout recovery and return to work. Nurse case managers do not make diagnoses or treatment decisions, nor do they make judgments about a patient’s eligibility for benefits. Their role is to coordinate and facilitate access to timely and appropriate health care services and to ensure continuity throughout the recovery process (Workplace Safety and Insurance Board, http://www.wsib.on.ca/wsib/wsibsite.nsf/public/HealthNurseCaseManagers). *Plan/Female Reproductive Category Points Earned: 0/1 Correct Answer: C Your Response: A 108. The FNP diagnoses Fifth disease in a 6-year-old whose mother accompanied him to the clinic. The woman is 24 weeks pregnant. What anticipatory guidance is appropriate for the mother? A. “Because you’ve been exposed to this condition, your fetus faces a risk of congenital deafness.” B. “Exposure does not cause birth defects or mental retardation, even if the fetus gets exposed.” C. “I am going to arrange for you to see a perinatologist about immediate intrauterine exchange transfusion.” D. “You are too far along for an abortion, so you need to be prepared for this baby to have mental retardation.” Half of all women have immunity to parvovirus B19, so they and their babies have protection from infection. Even if a woman is susceptible and gets infected with parvovirus B19, she usually experiences only a mild illness. Likewise, her unborn baby usually does not have any problems attributable to parvovirus B19 infection. Less than 5% of the time, infection causes spontaneous abortion or is associated with severe anemia in the unborn baby. Sometimes, however, parvovirus B19 infection will cause the unborn baby to have severe anemia, and the woman may have a miscarriage. This occurs in less than 5% of all pregnant women who are infected with parvovirus B19 and occurs more commonly during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or mental retardation (http://www.cdc.gov/ncidod/dvrd/revb/respiratory/B19andpreg.htm). *Plan/Infectious Disease Category Points Earned: 0/1 Correct Answer: B Your Response: A 109. Nurse practitioners participate in a table-top simulated bioterrorism event in which a car bomb has been used to demolish a public building. Their assignment is to plan care for the following victim: a 24-year-old woman who is wandering aimlessly at the disaster site, appearing distraught but physically uninjured despite having many co-workers killed or seriously injured within her immediate work space. What strategy in their written plan of care should be questioned by the simulation evaluator? A. Help her connect with family members or friends. B. Encourage her to talk about the disaster experience to debrief. C. Insist that she receive psychiatric counseling immediately. D. Provide information about support services she can access later. This young woman might well need psychiatric intervention at some point; however, mandating such counseling immediately is not appropriate and should be questioned by the evaluator. The other options are appropriate (Langan and James, 2005). *Plan/Violence Category Points Earned: 0/1 Correct Answer: C Your Response: A 110. Where would the nurse practitioner expect to palpate the uterine fundus in a woman at 12 weeks’ gestation? A. Beneath the symphysis pubis B. Slightly above the symphysis pubis C. At the umbilicus D. Halfway between the symphysis pubis and umbilicus The fundal height is monitored throughout pregnancy to note normal fetal growth versus abnormal uterine size related to intrauterine growth retardation, multiple pregnancy, excess amniotic fluid, or fetal macrosomia. At 12 weeks, the fundus is slightly above the symphysis pubis. Halfway between umbilicus and symphysis is noted at 16 weeks’ gestation, while a fundus level with the umbilicus is found at 20 weeks. After about 22 weeks, the uterine fundus will measure in centimeters equal to weeks of gestation (ie, 22 cm at 22 weeks, 24 cm 24 weeks, etc) until lightening, when the uterus drops into the pelvis (Loudermilk and Perry, 2004). *Plan Category Points Earned: 0/1 Correct Answer: B Your Response: A 111. You are auditing a chart for evidence of appropriate care for the patient with Ménière’s syndrome. Which notation fails to demonstrate appropriate care? A. Recommending bedrest during acute attacks B. Decreasing salt intake to decrease endolymphatic pressure C. Encouraging intake of red wine daily D. Cautioning the patient about position changes The questionable strategy here is encouraging red wine intake daily, because alcohol, along with caffeine and nicotine, should be restricted with this disorder (Swartz and Longwell, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 112. An NP is evaluating an 18-year-old for testicular cancer. Which sign is not suggestive of this malignancy? A. There is an enlarged testicle on one side. B. The left testicle has become significantly smaller. C. There is enlargement or tenderness of the breasts. D. The scrotum seems darker in color. A lump in the scrotum is a common sign of testicular cancer noted by the man himself. Other signs include (1) any enlargement of a testicle; (2) a significant loss of size in one of the testicles; (3) a feeling of heaviness in the scrotum; (4) a dull ache in the lower abdomen or in the groin; (5) a sudden collection of fluid in the scrotum; (6) pain or discomfort in a testicle or in the scrotum; and (7) enlargement or tenderness of the breasts (How to Do a Testicular Self-exam, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 113. Miriam is a woman with a high risk for premature labor based on two previous premature births. She is attending a support group for this patient population taught by a nurse practitioner. In a particular session, group members are sharing what they know about decreasing their risks. Which patient comment should be clarified by the NP leader? A. “My husband and I may need to abstain from sex or use condoms during the last weeks of my pregnancy.” B. “We should avoid nipple stimulation as part of sexual activity.” C. “I need to limit my fluid intake, since swelling is an additional concern.” D. “I need to be able to recognize and respond quickly to signs of contractions.” Instead of limiting fluid, those at risk of PTL need to avoid dehydration by taking additional fluids. The other strategies are not unlikely in minimizing the risk of preterm labor. Limiting fluid intake is counterproductive and should be clarified as such (Moos, 2004). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 114. Why would an NP choose insulin glargine (Lantus) for a woman with type 2 diabetes who already is taking pioglitazone (Actos) and metformin? A. The benefit of this insulin is its ability to preserve pancreatic function. B. It is released quickly because of a depot form. C. It was designed only for use in conjunction with oral agents. D. The insulin is a long-acting insulin with 24-hour basal coverage. Insulin glargine is a long-acting insulin analog capable of providing 24-hour basal insulin coverage when administered once daily at bedtime. Its activity profile, which lacks a pronounced peak, more closely resembles that of endogenous basal insulin than that of other intermediate- or long-acting insulins and appears more likely to be associated with a reduced incidence of hypoglycemia, particularly nocturnal hypoglycemia. Insulin glargine physiologically provides basal insulin, but for most patients, a rapid-acting insulin such as insulin lispro before or with meals will need to be included in the treatment regimen to achieve optimal management of blood glucose concentrations (Levine et al, 2002). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 115. Which of the following comments by the patient indicates a need for additional teaching regarding her NTG patch? A. “I may get a headache when I start the NTG.” B. “I should place the patch on my abdomen.” C. “I should be careful when I go from sitting to standing.” D. “I should leave the patch on until I replace it with another patch.” Leaving NTG on for 24 hours causes it to rapidly lose its effectiveness. Increasing the dose does not overcome this problem. All other answers are true (Saunders Drug Update, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 116. An NP caring for a woman with vulvar pain provides thorough teaching about self-care practices that might be of value in reducing symptoms. Which statement by the woman after instruction indicates that she has misunderstood the information and needs clarification? A. “I should avoid scented items for perineal hygiene.” B. “A sitz bath followed by patting myself dry might be soothing.” C. “Extra lubricant, even sparing use of lidocaine ointment, before sex might help the discomfort.” D. “I should wear control top support pantyhose or a girdle as counter pressure against my bottom.” Pantyhose should actually be avoided. Other options are correct (Giglis and Andrest, 2004). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 117. The NP is talking with a woman who recently found out that she is pregnant. Which of the following comments by the patient indicates that she understands the issue of immunizations during pregnancy? A. “If I get the varicella vaccine, it will prevent the baby from getting chickenpox.” B. “I have only had one MMR, so I should get that as soon as possible.” C. “The flu vaccine is recommended for pregnant women during the last second to third trimester.” D. “Live attenuated influenza vaccine is recommended for pregnant women during the last second to third trimester.” Tetanus is safe to give during pregnancy. MMR, varicella, and the live attenuated influenza vaccine are contraindicated in pregnancy (CDC, 2006). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 118. An NP has been following a 16-year-old for amenorrhea and decides to use a progesterone challenge test in the evaluation. Information about the procedure is provided to the girl and her mother. What comment by the mother indicates that further teaching is needed? A. “A positive test is evident by heavy bleeding.” B. “She should have withdrawal bleeding within 1 week of the final dose.” C. “Withdrawal bleeding rules out structural problems.” D. “She will take a hormone pill for 5 consecutive days.” Withdrawal bleeding from a progesterone challenge test requires slight spotting to be positive. Other options are accurate (Hatcher et al, 2004). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 119. Which of the following comments of the patient indicates a need for more teaching regarding the use of the EpiPen for bee stings? A. “I should avoid wearing perfume when I am out hiking.” B. “I should carry the EpiPen with me at all times.” C. “I should wear an alert bracelet telling about my allergies.” D. “When I go outside I should wear bright colors to avoid getting stung.” If a patient is allergic to bee stings, the patient should carry the EpiPen at all times, wear an allergic alert bracelet, and avoid wearing perfume. Bright clothes should be avoided when outdoors, since that attracts bees (Kidd et al, 2003). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 120. A patient has been treated for migraine headaches with sumatriptan. She returns to the office because the headaches have increased in frequency and she has been taking the sumatriptan at least one or two times a week. What is the appropriate intervention at this point? A. Prescribe an opioid for pain control. B. Recommend biofeedback therapy. C. Begin amitriptyline 25 mg at HS. D. Order an MRI. When a patient begins to have more than two headaches a month, preventive therapy should be initiated. First-line preventive agents include propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate. Opioids are not preventive agents. Biofeedback may be an adjunct therapy but should be used with preventive medication. More frequent headaches do not require an MRI (Modi and Lowther, 2006). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 121. The mother of a new family in the practice brings in her twin daughters, both of whom are treated for GABHS pharnygitis for the second time this year. Two weeks ago their older brother was treated as a first-time patient. The FNP educates this woman about pharyngitis and its management. Which comment by the woman indicates that the information has been misunderstood? A. “Aspirin will make the girls feel much better.” B. “I will clean all toothbrushes carefully after this episode to cut down on survival of the bacteria.” C. “If we keep spreading this condition about, we need to search for an asymptomatic carrier in our home.” D. “Until they have been on the antibiotics for 24 hours, they are contagious.” If pharyngitis occurs repeatedly, a search for an asymptomatic carrier in the family or household is worthwhile. Cleaning toothbrushes and orthodontic devices is important because bacteria can survive for as long as 15 days when they are not rinsed away. The disease is contagious until 24 hours’ worth of antibiotic therapy has been administered. The incorrect statement here is about aspirin use; children and adolescents should not be given aspirin because it increases their risk of developing Reye’s syndrome (Hayes et al, 2001). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 122. The NP is caring for an elderly woman with herpes zoster and overhears a comment the patient makes about the cause of her condition. Which one is accurate? A. “I had chickenpox as a child; my immune system is weak and the virus got reactivated.” B. “I ate some steak tartare—that raw stuff—I think it caused this rash.” C. “I suppose I got the infection from my grandson, who has just had German measles.” D. “I should have used better hand washing so I wouldn’t have been exposed to this bacteria.” Herpes zoster involves reactivation of a latent varicella virus that occurs when one’s immune system is weakened. It is common in the elderly population (Fitzpatrick, 2001). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 123. Which of the follow-up interventions is best for a patient who is HIV positive? A. Check serology after vaccination for hepatitis A and B. B. Give pneumovax as soon as the patient is diagnosed. C. Administer the smallpox vaccine. D. Prescribe prophylactic potassium V penicillin therapy. The serology should be checked after hepatitis A and B vaccines to determine immune response. Pneumovax should be given only if the CD4 count is >200 per mm because of the blunted immune response. Live virus vaccines are not given to patients who are HIV+. Antibiotics are not recommended as a prophylactic measure; they are generally targeted toward specific illnesses, such as PCP (Khalsa, 2006). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 124. Which of the following is not true regarding hypothermia? A. If the patient is not shivering, it can be assumed that the body temperature is within the normal range. B. The diagnosis is confirmed if the rectal temperature is below 90°F or 35°C. C. Ventricular fibrillation is the most likely cause of death. D. Patients with hypothermia may appear clumsy or confused. Ventricular fibrillation is the most likely cause of death; patients with hypothermia appear confused, clumsy, or apathetic. Hypothermia occurs when the rectal temperature is below 90°F or 35°C. Generally if a patient is shivering, the core temperature is >90°F; however, if the patient is obtunded and not shivering, the core temperature is usually <90°F (Rakel and Bope, 2005). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 125. Which aspect of communicating with the media by an NP during a disaster is inappropriate? A. Speculating on the cause and likely perpetrators before facts are known B. Designating one person per shift as official provider of facts to the media C. Providing information in short sound bytes D. Providing facts only, not qualifications Speculation while awaiting facts is not an appropriate strategy for dealing with the press; other strategies are appropriate ones (Langan and James, 2005). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 126. Which of the following patients should not take diphenhydramine (Benadryl) at night for sleep? A. A 23-year-old college student B. A 37-year-old female with diarrhea C. A 70-year-old patient with glaucoma D. A 35-year-old male who is stressed by his workload Diphenhydramine does help with sleep; however, it is not recommended for use in insomnia. It has several side effects such as dizziness, blurred vision, dry mouth, and diminished cognitive function and therefore is not recommended for the elderly (Elliott, 2001). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 127. A 70-year-old woman has severe osteoporosis. She was started on alendronate (Fosamax) and calcium with vitamin D, but a repeat DEXA scan in 2 years did not reveal much improvement. What is a next step for this woman since she is at high risk for a fracture? A. Begin teriparatide (Forteo). B. Increase the amount of calcium. C. Double the dose of alendronate. D. Start salmon calcitonin (Miacalcin). Teriparatide (Forteo) is a recombinant human parathyroid hormone recommended for use in severe osteoporosis for patients who are at high risk for fractures. It can be given for 2 years. Increasing the dose of alendronate and calcium is not recommended. Salmon calcitonin is a first-line agent for patients who cannot take other agents (Zizic, 2004). *Evaluation Category Points Earned: 1/1 Correct Answer: A Your Response: A 128. Which infant examined by the FNP today shows normal weight? A. Allen, who weighed 8 pounds at birth and weighs 12 pounds at 6 months B. Trent, who weighed 9 pounds at birth and weighs 22 pounds at the 4-month visit C. Maria, who weighed 4 pounds, 10 ounces at birth and weighs 10 pounds at the 1-year visit D. Butch, who weighed 7 pounds at birth and now weighs 22 pounds at the 1-year visit Infants typically double their birth weight within the first 4 months of life and triple their weight by the end of the first year (Kidd et al, 2003). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 129. Which of the following patients is a candidate for the influenza vaccine? A. Patient with moderate illness B. Patient with Guillain-Barré syndrome C. Patient with egg allergies D. Patient who is diabetic According to the CDC, any patient with egg allergies, Guillain-Barré syndrome, or a moderate/severe illness should not receive the influenza vaccine. A patient with diabetes should get the influenza vaccine. (Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm (MMWR 2006 Jul 28;55(RR10):1-42). *Evaluation/Health Promotion Category Points Earned: 0/1 Correct Answer: D Your Response: A 130. An FNP orders rubella vaccine for a postpartum woman and provides instructions. Which comment by the woman indicates that she has understood the information correctly? A. “It will not be safe for me to donate blood for at least 6 months.” B. “I should not get pregnant for at least 3 months.” C. “I should not kiss my 3- and 5-year olds for the next few days.” D. “I should give my baby formula for the next 2 days.” Only “I should not get pregnant for at least 3 months” is accurate. Because rubella vaccine involves a live virus and because rubella is a known teratogen, pregnancy is contraindicated (Loudermilk and Perry, 2004). *Evaluation Category Points Earned: 0/1 Correct Answer: B Your Response: A 131. A teenager was diagnosed with mono. Which comment by the patient indicates that she has understood the instructions? A. “The tiredness should go away in a week.” B. “I need to take antibiotics to cure mono.” C. “I am not able to play basketball.” D. “I can continue all my activities.” Contact sports and heavy lifting should be avoided for 4 weeks in a patient with mono because of the enlarged liver and spleen and possible rupture of the spleen. Antibiotics are not effective for mono. Fatigue may last several months and should be the guide for the patient’s activity level (Ebell, 2004). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 132. The NP prescribes permethrin (Elimite) 5% cream for a patient with scabies and provides thorough directions for its use. What procedure shows that the patient has understood the directions? A. Cream was applied on affected areas for 1 hour and washed off. B. Cream was placed carefully on lesions only—not on any affected skin. C. Cream was applied to the affected areas and left for 2 days. D. Cream was applied from the neck down and left for 8 hours. The correct procedure for using permethrin for scabies treatment involves leaving the cream on from the neck down for 8 hours before rinsing it away (About Pediatrics [2004] http://pediatrics.about.com/od/scabies/a/04_scabies.htm). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 133. Which of the following interventions is considered primary prevention for developmental delays and disabilities? A. Early referral to specialist if delay is suspected B. A developmental program such as First Steps for developmentally delayed children C. Avoidance of alcohol during pregnancy D. Screening for inborn errors in metabolism Primary prevention is an activity that occurs before development of the problem, so in this case the only activity that can prevent a developmental delay or disability is the avoidance of alcohol during pregnancy. Screening is a secondary prevention activity, while a First Steps program is a tertiary preventive activity (AAP, 2001). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 134. Which of the following conditions causes a decreased drive to breathe that results in hypoxemia and hypercapnia? A. Glomerular nephritis B. Asthma C. Parkinson’s D. Emphysema Chronic emphysema may cause a lowered oxygen level and increased carbon dioxide level. The lowered O2 and increased CO2 level is the stimulus to breathe (McCance and Huether, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 135. A 57-year-old male has a prostate biopsy indicative of cancer. What diagnostic test is not an expected follow-up to this diagnosis? A. MRI B. Chest x-ray C. Bone scan D. Sigmoidoscopy Lung and bone metastasis are most common in the event of positive prostate cancer biopsy. Bone metastasis eventually occurs in 80% of cases (Wallace, 2004). *Evaluation Category Points Earned: 0/1 Correct Answer: D Your Response: A 136. Which of the following is true concerning iron replacement therapy in iron deficiency anemia? A. The patient can determine when he/she feels back to normal and can stop the iron replacement. B. Iron replacement should continue for a minimum of 1 year. C. Hemoglobin stores should normalize 6 weeks after replacement. D. Iron sulfate should be given once weekly. Iron sulfate should be given for up to 6 months, 1 to 3 times a day. The hemoglobin stores normalize in about 6 weeks. The patient may feel better but is not able to determine when therapy should be discontinued. (Kidd et al, 2003). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 137. A patient has been treated with an H2 blocker followed by a PPI for her GERD. When she returns for a follow-up visit, she indicates that she is still waking at night with heartburn and coughing. Which action by the FNP in this case reveals the standard of care? A. Add an antacid to her treatment regimen. B. Elevate the head of the bed on blocks. C. Refer for endoscopy. D. Administer the H2 blocker and PPI together. If a patient has been treated with both an H2 blocker and PPI without relief, this patient may have Barrett’s esophagus; endoscopy is the appropriate intervention at this point (Rakel and Bope, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: C Your Response: A 138. A patient with hypertension comes into the office complaining of a dry cough. Which of the following is the most likely cause of the cough? A. Beta blocker B. ACE inhibitor C. HCTZ D. Angiotension receptor blocker ACE inhibitors cause a cough because of increased bradykinin. The other agents are not known to produce a cough (Saunders Drug Update, 2005). *Evaluation Category Points Earned: 0/1 Correct Answer: B Your Response: A 139. When should a child under the age of 2 be referred for specialty care of asthma? A. After repeated hospitalizations for asthma B. At the first onset of wheezing C. If the child requires daily long-term therapy D. If the coughing is more severe at night A child [Show More]