Chapter 3 HEALTH PROMOTION | Over 200 Complete Verified Questions and Answers for Test Prep

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Chapter 3. Health Promotion MULTIPLE CHOICE 1. Which of the following is a primary prevention measure for a 76-year-old man newly diagnosed with a testosterone deficiency? A. Calcium supplem... entation B. Testicular self-examination C. Bone density test D. Digital rectal examination ANS: A PTS: 1 2. Which of the following is an example of secondary prevention in a 50-year-old woman? A. Yearly mammogram B. Low animal-fat diet C. Use of seat belt D. Daily application of sunscreen ANS: A PTS: 1 3. Which of the following is an example of tertiary prevention in a patient with chronic renal failure? A. Fluid restriction B. Hemodialysis 4 days a week C. High-protein diet D. Maintenance of blood pressure at 120/80 ANS: B PTS: 1 4. Immunizations are an example of which type of prevention? A. Primary B. Secondary C. Tertiary D. Quaternary ANS: A PTS: 1 5. The nurse is speaking to a patient regarding endemic diseases. Which of these choices describes an endemic statistic? A. The typical incidence of influenza in a country B. The surprise outbreak of malaria in new regions C. Higher levels of Ebola in a country when compared to the previous year D. Abnormal outbreak of measles in pockets of a country ANS: A PTS: 1 6. The nurse is reviewing old and current trends in disease history. Which of these would be considered an example of a sporadic outbreak? A. The number of people diagnosed with rabies virus in 2017 B. The number of people diagnosed with chlamydia in Texas over a 1-month period C. The number influenza cases diagnosed from 1918 to 1919 D. The number of common cold cases diagnosed in Washington between October 2016 and March 2017 ANS: A PTS: 1 7. Which accurately defines incidence rate? A. The number of old cases of a disease at a point in time B. The number of cases of a disease at a point in time divided by the percentage of the population at a point in time C. The number of total cases of a disease total diagnosed at a point in time D. The number of new cases of a disease diagnosed at a point in time ANS: D PTS: 1 8. What describes a pandemic? A. An event more than epidemic magnitude affecting a single community or country over a long period of time B. An event of epidemic magnitude affecting a single community or country in a short period of time C. An event of epidemic magnitude affecting multiple communities and countries in a short period of time D. An event less than epidemic magnitude affecting multiple communities and countries over a long period of time ANS: C PTS: 1 9. Which test of health literacy can be completed quickly and provide results comparable to more time-consuming tests? A. Test of Functional Health Literacy in Adults (TOFHLA) B. Patient Health Questionnaire (PHQ-9) C. Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) D. Newest Vital Sign (NVS) ANS: D PTS: 1 10. The nurse is working with a 65-year-old patient who was recently diagnosed with hypertension. The patient is concerned about their optimal health with their new diagnosis. Which nursing action is necessary for health promotion with the patient? A. Discussing appropriate stress management techniques B. Sharing with the patient how to increase sodium consumption C. Discussing with the patient exercises that increase heart rate D. Emphasizing the importance of avoiding flu vaccinations ANS: A PTS: 1 Chapter 5. Evidence-Based Care MULTIPLE CHOICE 1. What is the goal of nursing research? A. Make decisions regarding nursing education based on published literature B. Determine topics that could develop nursing knowledge C. Gather information from published literature to make decisions about application to clinical practice D. Conduct studies to develop a body of nursing knowledge ANS: D PTS: 1 2. Which is the most important question to ask in evidence-based practice? A. What findings constitute evidence? B. How will the findings be used? C. Is this a randomized controlled trial? D. What theory is being utilized? ANS: B PTS: 1 3. Nursing research should be utilized by: A. Nurses at the bedside B. Advanced practice nurses C. Nurse researchers D. Nurses at all levels of practice ANS: D PTS: 1 4. A clinical guideline may be found useful if the guideline was: A. Published 2 years ago B. Created using one group C. Authored by a relatively unknown source D. Funded by an anonymous source ANS: A PTS: 1 5. Practice guidelines are designed to: A. Be inflexible B. Be utilized in every circumstance C. Provide a reference point for decision making D. Be created by a professional organization to guide the practice of a profession ANS: C PTS: 1 6. Which of the following is an example of determining whether a crucial element of a guideline is applicable to your patients? A. There are no intended specific patients in the guideline. B. You are a primary-care provider and the guidelines were written for primary-care providers. C. Your patients have a much lower prevalence of a condition than the patients in the guideline. D. You are a pediatric oncologist and the guidelines were written for geriatric specialists. ANS: B PTS: 1 7. Which of the following would be considered the research design for Level I evidence? A. Single, well-designed, randomized clinical trial B. Systematic review of randomized clinical trial studies C. Well-designed controlled trials without randomization D. Systematic reviews of descriptive or qualitative studies ANS: B PTS: 1 8. Which of the following would be considered the research design for Level II evidence? A. Single descriptive or qualitative study B. Well-designed case control or cohort studies C. Single, well-designed, randomized clinical trial D. Systematic review of randomized clinical trial studies ANS: C PTS: 1 9. Which of the following would be considered the research design for Level III evidence? A. Well-designed controlled trials without randomization B. Systematic reviews of descriptive or qualitative studies C. Systematic review of randomized clinical trial studies D. Opinion of authorities and expert committees ANS: A PTS: 1 10. Which of the following would be considered the research design for Level IV evidence? A. Single descriptive or qualitative study B. Opinion of authorities and expert committees C. Systematic review of randomized clinical trial studies D. Well-designed controlled trials without randomization ANS: D PTS: 1 11. Which of the following would be considered the research design for Level V evidence? A. Systematic review of randomized clinical trial studies B. Well-designed controlled trials without randomization C. Systematic reviews of descriptive or qualitative studies D. Single descriptive or qualitative study ANS: C PTS: 1 12. Which of the following would be considered the research design for Level VI evidence? A. Systematic reviews of descriptive or qualitative studies B. Opinion of authorities and expert committees C. Well-designed case control or cohort studies D. Single descriptive or qualitative study ANS: C PTS: 1 13. Which of the following would be considered the research design for Level VII evidence? A. Well-designed controlled trials without randomization B. Opinion of authorities and expert committees C. Well-designed case control or cohort studies D. Single descriptive or qualitative study ANS: B PTS: 1 Section 1. Neurological Problems MULTIPLE CHOICE 1. Which statement about confusion is true? A. Confusion is a disease process. B. Confusion is always temporary. C. Age is a reliable predictor of confusion. D. Polypharmacy is a major contributor to confusion in older adults. ANS: D PTS: 1 2. Which of the following indicates a diagnosis of dementia? A. Onset after an infection B. Abrupt onset over a week C. Difficulty with long-term memory D. Hard time finding words ANS: D PTS: 1 3. Which of the following aspects of the patient history is a hallmark of delirium? A. Patient has chronic kidney disease. B. Patient has had aphasia for a year. C. Patient has diabetes mellitus. D. Patient has been getting lost driving home. ANS: A PTS: 1 4. Which of the following may trigger migraines? A. Taking an ibuprofen for muscle pain B. A cup of coffee with regular sweetener C. A glass of merlot wine D. Drinking a cup of green tea ANS: C PTS: 1 5. Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear? A. Meclizine B. Diphenhydramine C. Diamox D. Promethazine ANS: C PTS: 1 6. The hallmark of an absence seizure is: A. No activity at all B. A blank stare C. Urine is usually voided involuntarily D. The attack usually lasts several minutes ANS: B PTS: 1 7. Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)? A. A teenage male B. A 65-year-old male C. A 25-year-old female D. A 60-year-old female ANS: C PTS: 1 8. Which of the following is a specific test to MS? A. Magnetic resonance imaging (MRI) B. Computed tomography (CT) scan C. A lumbar puncture D. There is no specific test ANS: D PTS: 1 9. Over the course of 3 years, a patient has had two MS flares. The patient’s primary complaints during the episodes are bilateral tingling and pain in their legs, depression, and numbness in their right hand with complete recovery in between occurrences. Which MS classification fits their disease process? A. Clinically isolated syndrome B. Relapsing-remitting C. Primary progressive D. Secondary progressive ANS: B PTS: 1 10. A patient with MS is complaining of new-onset “electric tingling” in both their arms. Which medication specifically treats these acute exacerbations? A. Lemtrada B. Aubagio C. Zanaflex D. Depo-Medrol ANS: D PTS: 1 11. Which of the following is a risk factor for developing Alzheimer’s disease? A. Having a master’s or doctoral degree B. Patient is a physician C. Patient has Down’s syndrome D. History of neurological disease ANS: C PTS: 1 12. Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis? A. Cholinesterase inhibitors B. Anxiolytics C. Antidepressants D. Atypical antipsychotics ANS: A PTS: 1 13. The health-care provider is treating a patient who was hit in the head with a frying pan. Which of the following should the provider suspect? A. Intraparenchymal hemorrhage B. Subdural hematoma C. Epidural hematoma D. Subarachnoid hematoma ANS: B PTS: 1 14. Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery? A. Epidural hematoma B. Subdural hematoma C. Subarachnoid hematoma D. Intraparenchymal hemorrhage ANS: A PTS: 1 15. Which of the following must be completed prior to administering TPA (tissue plasminogen activator)? A. Full-body MRI B. Head x-ray C. Head CT D. Head MRI ANS: C PTS: 1 16. Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing? A. CN V B. CN VII C. CN IX D. CN X ANS: A PTS: 1 17. Which of the following has been linked to a delay in treatment for stroke? A. Patient has stroke symptoms at work. B. Patient experiences stroke during the day. C. Patient lives with a family member. D. Patient calls their primary-care provider (PCP) instead of 911 at sign of stroke. ANS: D PTS: 1 18. When a patient has a carotid bruit, which of the following should the PCP gather from the patient history? A. History of hemophilia B. History of peripheral vascular occlusive disease C. History of seizure disorder D. History of sickle cell disease ANS: B PTS: 1 19. Which patient is more likely to have a cluster headache? A. A female in her reproductive years B. A 40-year-old African American male C. A 55-year-old female who drinks 10 cups of coffee daily D. A 45-year-old male awakened at night ANS: D PTS: 1 20. Which patient is most likely to have myasthenia gravis (MG)? A. A 75-year-old Caucasian woman B. A 31-year-old Hispanic woman C. A 55-year-old African American male D. A 10-year-old Middle Eastern male ANS: B PTS: 1 21. Inattention and a sleep–wake cycle disturbance are the hallmark symptoms of: A. Dementia B. Alzheimer’s disease C. Parkinson’s disease D. Delirium ANS: D PTS: 1 22. Which type of meningitis is more benign, self-limiting, and caused primarily by a virus? A. Purulent meningitis B. Chronic meningitis C. Aseptic meningitis D. Herpes meningitis ANS: C PTS: 1 23. A patient has been diagnosed with meningitis caused by a Streptococcus pneumoniae infection. Which of the following treatments would be appropriate? A. Cefotaxime B. Isoniazid C. Acyclovir D. Amphotericin ANS: A PTS: 1 24. Which of the following should be started promptly if viral encephalitis is suspected? A. Oral amoxicillin B. IV acyclovir C. IV ampicillin D. Oral acyclovir ANS: B PTS: 1 25. What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster? A. A stabbing pain on one small area of the body B. A vesicular skin lesion on one side of the body C. A pain that is worse upon awakening D. A lesion on the exterior ear canal ANS: B PTS: 1 26. Which patient is most likely to be diagnosed with Guillain-Barré syndrome? A. A 6-month-old infant B. A 30-year-old man C. A 72-year-old woman D. A 50-year-old man ANS: C PTS: 1 27. Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her? A. “Most patients have complete recovery in 3 to 6 months.” B. “Unfortunately, you’ll probably have a small amount of residual damage.” C. “Don’t worry, I’ll take care of everything.” D. “You may have a few more episodes over the course of your lifetime but no permanent damage.” ANS: A PTS: 1 28. A patient is presenting with chorea (dance-like movements). Which of the following diseases might the patient have? A. Dementia B. Parkinson’s disease C. Wilson’s disease D. Huntington’s disease ANS: D PTS: 1 29. Which of the following signs would a health-care provider expect to see in a patient with Parkinson-plus disorder? A. Resting tremor B. Bradykinesia C. Rigidity D. Postural instability ANS: D PTS: 1 30. Which of the following is a sign or symptom of a migraine? A. Light sensitivity B. Nonpulsatile pain C. Nasal stuffiness D. Bandlike pain ANS: A PTS: 1 31. Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis? A. Greater than 25% B. Greater than 50% C. Greater than 75% D. Only for 100% occlusion ANS: B PTS: 1 32. Which of the following activities is part of the functional activities questionnaire? A. Asking the patient to unravel a Rubik’s cube B. Determining if the patient can drive on the highway C. Asking the patient about a news event from the current week D. Seeing if the patient can keep his or her home clean ANS: C PTS: 1 33. About 90% of all headaches are: A. Tension B. Migraine C. Cluster D. Without pathological cause ANS: D PTS: 1 34. Which statement is true regarding driving and patients with a seizure disorder? A. Once diagnosed with a seizure disorder, patients must never drive again. B. After being seizure free for 6 months, patients may drive. C. Each state has different laws governing driving for individuals with a seizure disorder. D. These persons may drive but never alone. ANS: C PTS: 1 35. Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given IV once a month? A. Glatiramer acetate B. Natalizumab C. Fingolimod D. Glucocorticoids ANS: B PTS: 1 36. The “freezing phenomenon” is a cardinal feature of: A. Parkinson’s disease B. Alzheimer’s disease C. A cerebrovascular accident (CVA) D. Bell’s palsy ANS: A PTS: 1 37. A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as: A. Spinothalamic dysfunction B. Ratcheting C. Cogwheeling D. Hand tremors ANS: C PTS: 1 38. Which condition is characterized by the impaired ability to learn new information along with a cognitive disturbance in either language, function, or perception? A. Guillain-Barré syndrome B. Parkinson’s disease C. Alzheimer’s disease D. Delirium ANS: C PTS: 1 39. A score of 12 to 24 on this test indicates intermediate Alzheimer’s disease: A. SLUMS B. MoCA C. FAST D. MMSE ANS: D PTS: 1 40. IV thrombolytic therapy following an ischemic CVA should be given within how many hours of symptom onset? A. 1 hour B. 3 hours C. 6 hours D. 12 hours ANS: B PTS: 1 41. When administered at the beginning of an attack, oxygen therapy may help this kind of headache? A. Tension B. Migraine C. Cluster D. Stress ANS: C PTS: 1 Section 2. Skin Problems MULTIPLE CHOICE 1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause? A. “You must be under a lot of stress lately.” B. “It is hereditary. Did your father experience this also?” C. “The cause is unknown, but we suspect it is due to an immunological mechanism.” D. “We’ll have to do some tests.” ANS: C PTS: 1 2. Gillian presents with a sudden onset of 102°F fever, emesis, tingling in the hands and feet, fatigue, and weakness. What is the potential diagnosis of this presentation? A. Urticaria B. Toxic shock syndrome C. Scabies D. Pediculosis ANS: B PTS: 1 3. Which of the following describes a bulla? A. Results from a defect in the dermoepidermal junction B. Interfaces between the epidermis and the dermis C. A small crusty plaque D. A dime-sized purulent pustule on the buttocks ANS: A PTS: 1 4. An example of ecchymosis is: A. A hematoma B. A keloid C. A bruise D. A patch ANS: C PTS: 1 5. Francine presents with a total loss of skin color in patchy areas of her body. What are the potential causes? A. Zidovudine B. Chlorpromazine C. Vitiligo D. Addison’s disease ANS: C PTS: 1 6. When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval-to-round shapes. What do you suspect they are? A. Spores B. Leukocytes C. Pseudohyphae D. Epithelial cells ANS: A PTS: 1 7. Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is the most appropriate treatment? A. Terbinafine 250 mg once daily × 12 weeks B. Noxafil 100 mg oral suspension × 2 daily C. Griseofulvin 500 mg once daily × 2 to 4 weeks D. Metronidazole 2% cream 5 g intravaginally × 7 days ANS: D PTS: 1 8. Tinea unguium is also known as: A. Onychomycosis B. Tinea versicolor C. Tinea manuum D. Tinea corporis ANS: A PTS: 1 9. Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this? A. Bullous impetigo B. Staphylococcal scalded skin syndrome (SSSS) C. Nonbullous impetigo D. Ecthyma ANS: D PTS: 1 10. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria? A. Staphylococcus aureus B. Clostridium perfringens C. S. pyogenes D. Streptococcus ANS: B PTS: 1 11. When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? A. A piece of hair or a thread B. Hyphae C. Leukocytes D. Spores ANS: B PTS: 1 12. What should be the initial management for a new wart? A. Tretinoin cream B. Liquid nitrogen cryotherapy C. Salicylic acid D. Watchful waiting ANS: D PTS: 1 13. Stacy has a verruca plana and she is using tretinoin cream. Which of the following is true? A. It should be applied at bedtime over the entire area that is affected. B. It should be applied twice daily for 1 week. C. It is not normal to have a fine scaling when using this medication. D. It is not normal to have erythema when using this medication. ANS: A PTS: 1 14. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers? A. Necrotizing fasciitis B. Periorbital cellulitis C. Erysipelas D. “Flesh-eating” cellulitis ANS: C PTS: 1 15. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and discuss that: A. HPV 16 and 18 usually cause anogenital warts. B. Penetrative intercourse is necessary to transmit anogenital warts. C. Anogenital warts are transmitted genital to genital. D. OTC home-based cryotherapy is a good choice for treatment. ANS: C PTS: 1 16. Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him. Which would be a good choice? A. Betamethasone dipropionate 0.05% B. Hydrocortisone base 2.5% C. Halcinonide 0.1% D. Desonide 0.05% ANS: B PTS: 1 17. Harvey has a rubbery, smooth, round mass on his chest that is compressible and has a soft-to- very-firm texture. What do you diagnose this as? A. A lipoma B. A nevus C. A skin tag D. A possible adenoma ANS: A PTS: 1 18. Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using snip excision? A. Do not use lidocaine as it may potentiate bleeding. B. Pinch the skin taut together. C. Use gel foam to control bleeding. D. This should be performed by a dermatologist only. ANS: C PTS: 1 19. The “B” in the ABCDEs of assessing skin cancer represents: A. Biopsy B. Best practice C. Boundary D. Border irregularity ANS: D PTS: 1 20. Gary has been diagnosed with HSV-2 genital herpes and is wondering what to expect. Which of the following is a credible teaching point? A. HSV-1 genital herpes occurs more frequently than HSV-2 genital herpes. B. The HSV lesions will never occur near the initial infection site. C. Burning and tingling at the site of initial infection can signal recurrence. D. Each recurrent HSV infection will be worse than the initial infection. ANS: C PTS: 1 21. Eighty percent of men have noticeable hair loss by what age? A. 35 B. 50 C. 70 D. 85 ANS: D PTS: 1 22. Prevalence of psoriasis is highest in which group? A. Scandinavians B. African Americans C. Asians D. Native Americans ANS: A PTS: 1 23. The most common precancerous skin lesion found in Caucasians is: A. A skin tag B. Actinic keratosis C. A melanoma D. A basal cell lesion ANS: B PTS: 1 24. Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation. There is some edema involved. You suspect: A. Necrotizing fasciitis B. Kaposi’s sarcoma C. Cellulitis D. A diabetic ulcer ANS: C PTS: 1 25. Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition? A. There are round, hypopigmented macules on his back. B. Josh has red papules on his face. C. There are crusted plaques in Josh’s groin area. D. There are white streaks on his neck. ANS: A PTS: 1 26. Tori is on systemic antifungals for a bad tinea infection. You are aware that the antifungals may cause: A. Renal failure B. Skin discoloration C. Breathing difficulties D. Hepatotoxicity ANS: D PTS: 1 27. Which scalp problem can be caused by a fever and certain drugs? A. Telogen effluvium (TE) B. Trichotillomania C. Psoriasis D. Alopecia areata ANS: A PTS: 1 28. Which of the following is a strong risk factor associated with increased melanoma risk? A. Patient had a 15 mm nevus. B. Patient has a history of multiple blistering sunburns in their teenage years. C. Patient’s uncle had melanoma. D. Patient is of African American descent. ANS: B PTS: 1 29. Which statement is true regarding chloasma, the “mask of pregnancy”? A. It is caused by a decrease in the melanocyte-stimulating hormone during pregnancy. B. This condition only occurs on the face. C. Exposure to sunlight will even out the discoloration. D. It is caused by increased levels of estrogen and progesterone. ANS: D PTS: 1 30. A patient presents with xerosis. What do you tell the patient about this condition? A. Daily hot baths can help to soothe the skin. B. Using a strong deodorant can improve the condition. C. It can be a side effect of depigmentation creams. D. It is uncommon in the elderly. ANS: C PTS: 1 31. Which medication used for scabies is safe for children 2 months and older? A. Permethrin cream B. Lindane C. Crotamiton lotion and cream D. Ivermectin ANS: A PTS: 1 32. Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis? A. Keratosis pilaris B. Dennie’s sign C. Keratoconus D. Pityriasis alba ANS: B PTS: 1 33. Which of the following statements about performing cryosurgery for actinic keratosis is true? A. It is better to slightly overfreeze the area, so you only have to do it once. B. Using liquid nitrogen, freeze each lesion for at least 30 seconds. C. Every lesion should be biopsied after using liquid nitrogen. D. The “freeze balls” should be approximately one-and-a-half times as wide as they are deep. ANS: D PTS: 1 34. Gerald presents with a very dark color on his right pinkie finger. What is the health-care provider’s next care step? A. Referral to a dermatologist for a nail biopsy B. Watchful waiting C. Discussing that the condition is benign and the patient can ignore it D. Follow up in 2 weeks to see if there is any change ANS: A PTS: 1 35. Which statement regarding necrotizing fasciitis is true? A. The hallmark of this infection is its slow and steady progression. B. Once the border of the infection is “established,” it does not spread. C. This is a medical emergency and gangrene can develop. D. The lesion is most dangerous, because it is painless. ANS: C PTS: 1 36. When staging a malignant melanoma using Clark’s levels, which level extends into the papillary dermis? A. Level I B. Level II C. Level III D. Level IV ANS: C PTS: 1 37. Which of these patients is most likely to have acne and resultant scarring? A. A 15-year-old Caucasian male B. A 17-year-old Hispanic female C. A 20-year-old Asian female D. A 21-year-old African American male ANS: B PTS: 1 38. A 20-year-old Hispanic male presents with multiple noninflammatory comedones on his chest and back with four small papules on his right upper arm. Which diagnosis is accurate? A. Mild acne B. Moderate acne C. Severe acne D. Nodulocystic acne ANS: A PTS: 1 39. A 40-year-old woman presents with inflammatory papules on her face, facial flushing when she drinks a glass of wine, telangiectasias, and dry eyes. Which of the following conditions is the most likely diagnosis? A. Acne vulgaris B. Hot tub folliculitis C. Rosacea D. Perioral dermatitis ANS: C PTS: 1 40. Rachel is a patient complaining of a pruritic erythematous rash on her face and hands that became apparent this morning. Which of the following questions would help determine whether she has contact dermatitis? A. “Do you have a history of itchy rashes?” B. “Do you have any food allergies?” C. “Do you have a history of rosacea?” D. “Have you used any new face wash or soap?” ANS: D PTS: 1 41. A 70-year-old patient presents with a poorly defined, pink, scaling rash on his face and scalp. When he asks what he can expect from this condition, you say: A. “If your rash is itchy, the itching may be worse when you are hot and sweaty.” B. “This is probably a one-time rash and should not come back.” C. “This condition does not run in families, so your children are not at risk of developing it.” D. “This rash is most common in people that have poor hygiene, so you will have to shower at least once a day.” ANS: A PTS: 1 42. Janet has psoriasis that covers 25% of her body. Which of the following treatment options should be considered? A. Referral to plastic surgery B. Methotrexate 10 mg daily C. Anthralin 0.1% ointment applied once a day D. A surgical consult ANS: B PTS: 1 43. Heidi has a fingerlike, flesh-colored projection emanating from a broad base on her mouth. Which of the following is the most likely diagnosis? A. Plantar wart B. Flat wart C. Verruca vulgaris D. Digitate wart ANS: D PTS: 1 44. Maria had impetigo and is seeing her health-care provider for a follow-up visit. Which of the following teaching points should the provider discuss? A. Keeping fingernails short can prevent the spread of impetigo. B. Impetigo can be prevented in the future by wearing a face mask. C. If a patient has impetigo in the future, they should clean everything in their home with bleach. D. Impetigo is spread by blood, so the patient should avoid donating blood. ANS: A PTS: 1 45. Jill is a patient complaining of a “bumpy” rash on her neck that is nonpruritic. She was recently on a ski trip and went in a hot tub. What is the most likely diagnosis? A. HSV-2 B. Folliculitis C. Acne vulgaris D. Actinic keratosis ANS: B PTS: 1 46. Graham has a single furuncle on his buttocks with no surrounding cellulitis. What is the best treatment option? A. Systemic antibiotics B. Cold compress to the site C. Incision and drainage D. Watchful waiting ANS: C PTS: 1 47. Jack is complaining of an extremely pruritic lesion that is round to a half circle in his genital area. Which of the following is the most likely diagnosis? A. Tinea cruris B. Tinea pedis C. Tinea versicolor D. Tinea manuum ANS: A PTS: 1 48. Which of the following is true of scabies? A. Scabies is more common in the Caucasian population. B. Scabies is transmitted through blood. C. Scabies is not associated with hygiene. D. Scabies is transmitted through close personal contact. ANS: D PTS: 1 49. Which of the following is true of pediculosis? A. Pruritus occurs before the sensitivity to the head louse. B. Patients can be asymptomatic or cause few symptoms in the first 2 weeks following exposure. C. In a patient’s first infection, they will develop symptoms within 24 to 48 hours. D. It is transmitted through droplets. ANS: B PTS: 1 50. How might a rash appear on a patient with a darker skin tone? A. Dark brown B. Light pink C. Bright red D. Deep purple ANS: A PTS: 1 51. What of the following is the most common appearance of Paget’s disease? A. Poorly defined, red, raised plaque on one nipple B. Scattered white papules on the nipples bilaterally C. Oval-shaped, erythematous scaling plaque with sharp margins on one nipple D. Raised, silvery-white patches on the nipples bilaterally ANS: C Section 3. Eye Problems MULTIPLE CHOICE 1. An acutely presenting, erythematous, tender lump within the eyelid is called: A. Blepharitis B. Hordeolum C. Chalazion D. Iritis ANS: B PTS: 1 2. A granulomatous infection of a meibomian gland that presents as a painless swelling on the eyelid is called a: A. Iritis B. Chalazion C. Viral conjunctivitis D. Nuclear cataracts ANS: B PTS: 1 3. Billy presents with edematous and erythematous lid margins and closer visual inspection with a Wood’s lamp reveals scaling. Which of the following conditions could be the diagnosis? A. Hordeolum B. Chalazion C. Blepharitis D. Iritis ANS: C PTS: 1 4. Which of the following is true about epiphora? A. It is uncommon that it’s a response to dry eye. B. It will lead to decreased tearing. C. It is common in infants. D. It will lead to increased irritation. ANS: D PTS: 1 5. The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis? A. Viral conjunctivitis B. Keratoconjunctivitis C. Bacterial conjunctivitis D. Allergic conjunctivitis ANS: C PTS: 1 6. Which is appropriate patient education to provide regarding bacterial conjunctivitis? A. The patient should continue to go to his or her job as a day-care teacher. B. The patient should make sure to practice proper hand washing. C. The patient should touch his or her eyes to apply medication. D. The patient will be infectious for only 24 hours after diagnosis of bacterial conjunctivitis. ANS: B PTS: 1 7. What of the following in the patient’s history would lead the provider to diagnose a corneal abrasion? A. Patient’s mother had a corneal abrasion. B. Patient wears glasses. C. Patient complains, “I feel like something is in my right eye.” D. Patient complains, “My eyes feel so dry.” ANS: C PTS: 1 8. Which subtype of cataracts is characterized by significant nearsightedness and a slow indolent course? A. Nuclear cataracts B. Cortical cataracts C. Posterior cataracts D. Immature cataracts ANS: A PTS: 1 9. Which of the following produces a slow and painless visual field loss that usually begins peripherally? A. Posterior cataracts B. Open-angle glaucoma C. Immature cataracts D. Macular degeneration ANS: B PTS: 1 10. Which of the following is TRUE regarding dietary supplements and cataracts? A. High doses of vitamin E prevent the progression of cataracts. B. Low doses of vitamin C increase age-related cataract development. C. There is no evidence that concretely proves the benefit of high-dose vitamin E to prevent cataracts. D. Weekly lutein prevents the formation of cataracts. ANS: C PTS: 1 11. Which of the following contribute to the development of chronic open-angle glaucoma? A. Myopia B. Multiple sclerosis C. Hyperopia D. Small cornea ANS: A PTS: 1 12. A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma? A. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma. B. The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient. C. Physical diagnosis relies on gonioscopic evaluation of the angle by an ophthalmologist. D. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve. ANS: C PTS: 1 13. Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure? A. 0 to 7 mm Hg B. 12 to 22 mm Hg C. 22 to 40 mm Hg D. 40 to 80 mm Hg ANS: B PTS: 1 14. Which of the following education points is essential to provide to the patient with glaucoma? A. Their medication may have adverse effects. B. Only the patient can instill eye drops. C. Eye infections are common and are not a concern. D. Eye exams must happen monthly. ANS: A PTS: 1 15. With regards to the relationship between diabetes and diabetic retinopathy, which of the following is TRUE? A. Diabetic retinopathy only occurs in patients with type 1 diabetes. B. Diabetic retinopathy is always the first sign that a patient has diabetes. C. The longer the patient has had diabetes, the more likelihood that they will develop retinopathy. D. Diabetic retinopathy only occurs in patients with type 2 diabetes. ANS: C PTS: 1 16. As diabetic retinopathy progresses, the presence of “cotton wool” spots can be detected. “Cotton wool” spots refer to: A. Microvascular infarctions B. Blood vessel proliferation C. Venous beading D. Retinal hemorrhage ANS: A PTS: 1 17. Marie has diabetes mellitus with proliferative retinopathy. How often should she see her ophthalmologist? A. Monthly B. Every 2 months C. Every 3 to 4 months D. Annually ANS: C PTS: 1 18. Who of the following is a patient with risk factors for macular degeneration? A. 50-year-old African American male B. 65-year-old Caucasian female C. 40-year-old Asian man D. 90-year-old Hispanic female ANS: B PTS: 1 19. Sarah is a patient with a complaint of feeling like she has “sand in her eye.” Which is the most likely diagnosis? A. Cataracts (blurred vision, inability to see dim lights, halos) B. Diabetic retinopathy (floaters, can’t see colors-why might fall, microaneurysms, cotton wool spots) C. Macular degeneration D. Keratitis sicca (dry eyes) ANS: D PTS: 1 20. A patient was diagnosed with gradual floaters that the provider determined did not require treatment. What is a common complaint when a patient has benign floaters? A. “In my right eye I see little dots when I stare in the direction of the sun.” B. “In both eyes I see bright white dots that block my vision when I am in a black room.” C. “I can’t see in my left eye when I look into a bright room.” D. “When I am in a dark room a big white dot blocks my field of vision in my left eye.” ANS: A PTS: 1 21. A patient is complaining of seeing “flashing lights.” What is the provider’s next step? A. Send the patient to ophthalmology immediately to evaluate for macular degeneration. B. Tell the patient that it is normal to see flashing lights occasionally. C. Send the patient to ophthalmology immediately to evaluate for a retinal tear or detachment. D. Tell the patient that they can wait to be seen by ophthalmology for 1 month. ANS: C PTS: 1 22. Robin presents with tearing in her right eye that started this morning. What is the most likely cause in the provider’s differential diagnosis? A. Dry eye B. Foreign body in the eye C. Diabetic retinopathy D. Cataract ANS: B PTS: 1 23. Which of the following medications used in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape? A. Pilocarpine B. Timolol C. Brinzolamide D. Acetazolamide ANS: A PTS: 1 Chapter 82. Putting Caring Into Practice: Caring for Self MULTIPLE CHOICE 1. The World Health Organization defines self-care as: A. An important global activity for all health-care providers B. A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health C. Essential to efficacious advanced practice nursing practice D. An awareness by the Advanced Practice Registered Nurse (APRN) of their self- care behaviors as related to diet, activity, and mental attitude ANS: B PTS: 1 2. Nurse theorist Dorothea Orem defines self-care activities as: A. Attainment of professional self-development goals B. Ability to persevere through hardship C. Striving to attain balance and harmony in one’s life D. Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life ANS: D PTS: 1 3. Self-care and personal development are built into the standards of practice of: A. The American Holistic Nurses Association B. The American Nurses Association C. The American Association of Nurse Practitioners D. The American Academy of Nursing ANS: A PTS: 1 4. There are many pressures inherent in primary-care practice today for APRNs. These pressures include all of the following: A. Electronic medical record, the Affordable Care Act, and the implementation of socialized medicine B. Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants C. Uncertainty, the team approach to care, and the need for patient-centered care D. Availability of medical information on the Internet, educational programs for patients, and Medicare drug benefits ANS: B PTS: 1 5. A new era of health care leads to: A. Greater opportunity for independent practice, yet increased legal risk in accountability for patients B. Lowered reimbursement for all health-care services and providers C. Decrease in status for health-care providers D. No ability to individualize care ANS: A PTS: 1 6. Compassion fatigue is another side effect of today’s health-care delivery system. This term means: A. The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN. B. This happens over time related to the need to see increasing numbers of patients in busy primary-care practices. C. This may persist over time, even when the APRN transfers to a new and different setting. D. Patients’ problems and circumstances can be so overwhelming that the APRN needs to set severe boundaries to maintain safe function. ANS: A PTS: 1 7. Another term used, burn out, is differentiated by: A. Numbness of feelings leading to substance abuse B. How novice APRNs feel at the end of the day in primary care C. Feelings of aloneness, desperation, and despair D. A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale ANS: D PTS: 1 8. The following statement is TRUE: A. APRNs are often sensitive to patients’ deficiencies but not their own. B. APRNs always respond appropriately to patients, families, and team members. C. APRNs are well-equipped from their APRN educational programs to care for self. D. Re-licensure in some states mandates continuing education units in self-care. ANS: A PTS: 1 9. Emotional intelligence is defined as: A. Being highly attuned to the needs of others B. The ability to engage in self-care C. Being able to recognize and understand the meaning of emotions, and how they affect other people D. The holistic integration of self-care and self-development practices ANS: C PTS: 1 10. APRNs need to develop their own self-care management plans. Two key elements of self-care management plans are: A. Taking vacations and keeping up with new knowledge and developments in medicine B. Resilience and positive intentionality C. Family support and a healthy diet D. Being physically and emotionally “fit” ANS: B PTS: 1 11. The term resilience implies: A. Ability to look to a higher power to get you through a crisis B. Response to difficult and adverse circumstances through positively adjusting to stressors C. That the APRN can weather any emergency D. Learning to set appropriate boundaries ANS: B PTS: 1 12. Qualities associated with resilience include: A. Hope, self-efficacy, and positivity B. Stick-to-it-ness, belief in a higher power C. Education, self-regulation, and use of activity to decrease stress D. Ability to take vacations and the availability of support systems and a secure work environment ANS: A PTS: 1 13. Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no backup and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies? A. Patsy distanced Sue by listening to her as little as possible. B. Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining. C. Patsy spoke privately with their supervisor, Pamela, stating that she did not think Sue could be successful in this environment. D. Patsy requested that Sue be assigned to a different APRN for orientation. ANS: B PTS: 1 14. The qualities of resilience that Patsy demonstrated when responding to Sue include: A. Protecting her own positive attitude by lessening her contact with Sue, a negative person B. The ego strength to admit failure in her ability to orient Sue, a destructive person C. Protecting her organization by sharing Sue’s deficiencies with their supervisor D. Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her ANS: D PTS: 1 15. According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice? A. Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy B. Review of materials on primary care before going into the work environment to increase one’s confidence, leading to caring energy C. Travel to sacred places D. Helping the poor and homeless—volunteering at a domestic violence shelter, for example—in addition to one’s regular practice ANS: A PTS: 1 Section 4. Ear, Nose, and Throat Problems MULTIPLE CHOICE 1. Which of the following is an example of sensorineural hearing loss? A. Perforation of the tympanic membrane B. Otosclerosis C. Cholesteatoma D. Presbycusis ANS: D PTS: 1 2. The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient’s mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? A. Weber test B. Schwabach test C. Rinne test D. Auditory brainstem response (ABR) test ANS: C PTS: 1 3. A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition? A. Otitis media B. Ménière’s disease C. Tinnitus D. Otitis externa ANS: D PTS: 1 4. In which of the following scenarios would otitis media (OM) be considered chronic? A. Patient has had repeated episodes of acute OM followed by continuous or intermittent otorrhea lasting for more than 3 months. B. Patient has had severe pain and intermittent otorrhea lasting for 2 months. C. Patient has had repeated episodes of acute OM followed by continuous or intermittent otorrhea lasting for more than 1 month. D. Patient has had severe pain and continuous otorrhea lasting for 3 months. ANS: A PTS: 1 5. Which of the following is helpful in evaluating patients with otitis media with effusion? A. Lumbar puncture B. MRI C. Computed tomography (CT) scan D. Ultrasound ANS: C PTS: 1 6. Which of the following treatments is appropriate for a patient who has acute otitis media and has an allergy to penicillin? A. Augmentin 875 mg two times daily for 10 days B. Suprax 400 mg daily for 7 days C. Amoxicillin 500 mg every 8 hours for 10 days D. Zithromax (Azithgromycin)500 mg on day 1, and then 250 mg daily for 4 days ANS: D PTS: 1 7. Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis? A. IgA B. IgE C. IgG D. IgM ANS: B PTS: 1 8. Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? A. Vasomotor rhinitis B. Rhinitis medicamentosa C. Atrophic rhinitis D. Viral rhinitis ANS: A PTS: 1 9. Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than: A. 4 weeks B. 8 weeks C. 12 weeks D. 16 weeks ANS: C PTS: 1 10. Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected? A. Penicillin V B. Amoxicillin C. Levofloxacin D. Clindamycin ANS: C PTS: 1 11. Which of the following can prevent chronic sinusitis? A. Patients in the same household with sinusitis should all use the same nasal spray B. Treating respiratory infections after a week of symptoms C. Using a dehumidifier during sinusitis attacks D. Surgery to correct anatomical blockages of the sinus ostia ANS: D PTS: 1 12. Which type of stomatitis results in necrotic ulceration of the oral mucous membranes? A. Vincent’s stomatitis(ulcer of mouth) B. Allergic stomatitis(oral mucosal immunoflammatory d/o) C. Aphthous stomatitis (canker sore) D. Herpetic stomatitis ANS: A PTS: 1 13. Which type of stomatitis is caused by continual exposure to chewing tobacco? A. Aphthous stomatitis B. Herpetic stomatitis C. Nicotinic stomatitis D. Allergic stomatitis ANS: C PTS: 1 14. The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection? A. Herpes simplex virus type 2 B. HIV C. Pneumonia D. Syphilis ANS: B PTS: 1 15. Which of the following conditions leads to erythematous patches with bluish-white centers on the lingual and buccal mucosa (Koplik’s spots): A. Syphilis B. Roseola paramyxovirus infection (Measles) C. Parotitis D. HIV ANS: B PTS: 1 16. Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting from infection with which of the following pathogens? A. Coxsackievirus B. Cytomegalovirus C. Francisella tularensis D. Group A streptococcus-responsible for Strep thraost ANS: D PTS: 1 17. Which of the following is a disorder of infectious etiology? A. Tonsillitis B. Kawasaki’s syndrome C. Pharyngitis related to allergies D. Pemphigus ANS: A PTS: 1 18. A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause? A. Gonorrhea B. Mononucleosis C. Influenza D. Herpes zoster ANS: B PTS: 1 19. A patient presents with nonvesicular lesions that are 2 to 10 mm, symmetrical, and scattered on the oropharynx and mouth. What is their most likely diagnosis? A. Corynebacterium diphtheriae B. Primary syphilis C. Candida infection D. Secondary syphilis ANS: D PTS: 1 20. A patient presents to the clinician with a sore throat, fever of 100.7°F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be? A. The patient should be instructed to rest and increase fluid intake, as the infection is most likely viral and will resolve without antibiotic treatment. B. Because the patient does not have strep throat, the clinician should start broad- spectrum antibiotics in order to cover the offending pathogen. C. A throat culture should be performed to confirm the results of the rapid strep test. D. The patient should be treated with antibiotics for strep throat, as the rapid strep test is not very sensitive. ANS: C PTS: 1 21. Jean has acute otitis externa with fluid that is black and malodorous. Which of the following is responsible for the infection? A. Fungal infection B. Staphylococcus infection C. Pseudomonas infection D. Allergic reaction ANS: A PTS: 1 22. You have a patient who is a positive for strep on rapid antigen testing (rapid strep test). You order amoxicillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5°F in office). You also note significant lymphadenopathy, most notably in the posterior and anterior cervical chains, some hepatosplenomegaly, and a diffuse rash. You decide: A. To refer the patient B. That he is having an allergic response and needs to be changed to a macrolide antibiotic C. That his antibiotic dosage is not sufficient and should be changed D. That he possibly has mononucleosis concurrent with his strep infection ANS: D PTS: 1 23. Which of the following medications is safe to use when an adult patient has a perforated tympanic membrane? A. Chloroxylenol 1 mg, 4 to 5 drops in the affected ear three times per day for 7 days B. Floxin otic 10 drops in affected ear for 7 days C. Pramoxine HCL 10 mg, 4 to 5 drops in affected ear three times per day for 7 days D. Hydrocortisone 10 mg/mL, 3 drops in affected ear three times per day for 7 days ANS: B PTS: 1 24. Betty presents with tenderness on traction of the pinna in her right ear and when the provider places pressure on her right tragus, she expresses she is in pain. The clinician does not suspect a tympanic membrane rupture, but would like to make Betty more comfortable during the exam. Which of the following solutions should the clinician administer before attempting an examination? A. Normal saline B. Auralgan (Benzocaine Otic) C. Lidocaine D. Distilled water ANS: B PTS: 1 25. Which of the following is the form of external otitis in which bacterial infection extends from the auditory canal into the skull? A. Otitis media B. Otitis externa C. Necrotizing otitis D. Swimmer’s ear ANS: C PTS: 1 26. Though common as people age, what concerning disease can dysphonia(change in voice quality) be a cardinal sign for? A. Laryngeal cancer B. Viral infection C. Bronchitis D. Lung cancer ANS: A PTS: 1 27. A patient has dysphonia ×3 days as a result of a viral illness. Which of the following educational points is correct? A. As smoking has no effect on dysphonia, the patient can continue to smoke. B. The patient should continue to use their voice to exercise it. C. The patient should take cough medication with antihistamines. D. Make sure the patient has adequate fluid intake. ANS: D PTS: 1 28. A patient complains of dull and intermittent left-sided facial pain and left-sided headache that is worse in the morning. Which of the following diagnoses is most likely? A. Pharyngitis B. Temporomandibular disorder C. Temporomandibular joint disease D. Dysphonia ANS: B PTS: 1 29. A provider is examining a patient with temporomandibular joint disease (TMJ). Which of the following results would the provider expect from the exam? A. The mandibular opening is 40 mm. B. There are no sounds elicited from the exam. C. The mandible deviates to the left side. D. The patient is able to open the mouth without pain or sound. ANS: C PTS: 1 30. Which of the following medications for temporomandibular disorder has the warning that patients should NOT drive while taking it? A. Flexeril B. Naprosyn C. Tylenol D. Elavil ANS: A PTS: 1 31. What is the most common site of hemorrhage for epistaxis? A. Nasopharynx B. Nostril C. Posterior nasal cavity D. Little’s area ANS: D PTS: 1 32. What is the initial treatment for uncomplicated anterior epistaxis? A. Tilting the head back so the blood does not run out of the nose B. Applying firm and continuous pressure superior to the nasal alar cartilages for 10 to 15 minutes C. Applying firm and continuous pressure to the nostril for 5 minutes D. Letting the nose bleed clot and leaning the head forward ANS: B PTS: 1 33. A patient just had epistaxis and the provider is counseling them on what to do when they go home. Which of the following should be included? A. Make sure to talk during future nose bleeds to reassure the people around you. B. When nose bleeds occur, if you have blood in your mouth, spit it out. C. Avoid hot liquids after a nose bleed. D. With future nose bleeds, drinking lukewarm beverages helps blood clot. ANS: C PTS: 1 34. Peter presents with complaints of right hearing loss that has been getting worse and a congruent headache. What is the most likely diagnosis? A. Acoustic neuroma B. Presbycusis C. Ménière’s disease D. Sensorineural hearing loss ANS: A PTS: 1 35. Which of the following complementary therapies can help a patient with tinnitus? A. Increase salt intake B. Stop smoking C. Not listening to music D. Increase caffeine intake ANS: B PTS: 1 Section 5. Respiratory Problems MULTIPLE CHOICE 1. A chronic cough lasts longer than: A. 3 weeks B. 8 weeks C. 6 months D. 1 year ANS: B PTS: 1 2. You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex? A. Baker phenomenon B. Arnold reflex C. Cough reflex D. Tragus reflex ANS: B PTS: 1 3. Based on these patients’ histories, which of the following should receive fungal serology testing for their chronic cough? A. A patient with a history of sickle cell disease B. A patient with a history of multiple sclerosis C. A patient with a history of celiac disease D. A patient with a history of AIDS ANS: D PTS: 1 4. Which of these patients should be given a decongestant? A. Gerta, a 41-year-old female with GERD B. Christine, a 15-year-old female with pneumonia C. Dan, a 60-year-old male with allergic rhinitis D. Andy, a 26-year-old with cystic fibrosis ANS: C PTS: 1 5. Which of the following herbal supplements should be used cautiously in a patient with hypertension? A. Licorice B. Horehound C. Peppermint D. Jasmine ANS: A PTS: 1 6. A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: A. Metoprolol B. Clopidogrel C. Tadalafil D. Captopril ANS: D PTS: 1 7. Lisa is a 25-year-old Hispanic female experiencing chest tightness, a feeling of suffocation, and feels like she “can’t get air in.” She has no current history of heart or lung disease and did not exercise leading up to this attack. Which of the following is the most likely cause for this dyspnea? A. Severe chronic anemia B. Congestive heart failure C. Anxiety-related dyspnea D. Chronic obstructive pulmonary disease (COPD) ANS: C PTS: 1 8. Which of the following scales is useful to assess the degree of dyspnea with a score of 6 to 20? A. Borg scale B. Patient Health Questionnaire-9 scale C. Visual analog scale D. Global assessment of functioning scale ANS: A PTS: 1 9. Annie is a 30-year-old African American woman that complains of “coughing up blood.” What is a likely cause of her condition? A. Bronchogenic carcinoma B. Pulmonary embolus with infarction C. Mitral stenosis D. Bronchitis ANS: C PTS: 1 10. African American patients seem to have a negative reaction to which of the following asthma medications? A. Inhaled corticosteroids B. Long-term beta-agonist bronchodilators C. Leukotriene-receptor agonists D. Oral corticosteroids ANS: B PTS: 1 11. Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? A. Asthma B. Emphysema C. Chronic bronchitis D. Influenza ANS: C PTS: 1 12. You are using the CURB-65 clinical prediction tool to decide whether Latisha, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Which of the following risk factors would increase Latisha’s chance of CAP- associated mortality and complications? A. Temperature of 100°F B. Respiratory rate 22 breaths per minute C. Hemoglobin 9.5 g/dL D. History of diabetes mellitus ANS: D PTS: 1 13. Fredericka is a 40-year-old Hispanic female with a history of diabetes mellitus, hypertension, and HIV. She has a tuberculosis (TB) skin test. What is the smallest diameter of induration that would indicate a positive result? A. 2 mm B. 5 mm C. 8 mm D. 10 mm ANS: B PTS: 1 14. Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TST)? A. She is on a high-protein diet. B. She is an adolescent. C. She has been on a long-term corticosteroid therapy. D. She just got over a cold. ANS: C PTS: 1 15. Marci has been started on a TB regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically? A. Pyridoxine B. Thiamine C. Probiotic D. Phytonadione ANS: A PTS: 1 16. Which of the following patients is most likely to have squamous cell carcinoma? A. Janice, a 70-year-old female and is a nonsmoker B. Bill, a 65-year-old male with a 20-year history of smoking C. Sophie, a 30-year-old female with a family history of lung cancer D. David, a 90-year-old man whose brother passed away from lung cancer ANS: B PTS: 1 17. Amy has a history of lung cancer and is experiencing new-onset right side ptosis and miosis and says, “I’m so hot, but I’m not sweating.” Which of the following conditions can be attributed to her new-onset symptoms? A. Bell’s palsy B. Turner’s syndrome C. Murphy’s syndrome D. Horner’s syndrome ANS: D PTS: 1 18. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean? A. The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated. B. The cancer is in situ; it is spreading into the lymph nodes but the spread cannot be evaluated otherwise. C. The cancer is less than 3 cm in size and has not spread to the lymph nodes or other parts of the body. D. The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant spreading. ANS: C PTS: 1 19. Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do? A. Hand him literature about smoking cessation at every visit. B. Wait until he is ready to talk to you about quitting. C. Document in the record that he is not ready to quit. D. Continue to ask him at every visit if he is ready to quit. ANS: D PTS: 1 20. Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking? A. He should stop smoking today. B. He should stop smoking tomorrow. C. His quit date should be in 1 week. D. He will be ready to quit after the first 30 days. ANS: C PTS: 1 21. Which information should be included when you are teaching your patient about the use of nicotine gum? A. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa. B. Patients should not eat for 30 minutes prior to or during the use of the gum. C. Initially, 1 piece is chewed every 30 minutes while awake. D. Acidic foods and beverages should be encouraged during nicotine therapy. ANS: A PTS: 1 22. Which of these sputum strains would one use to test for a viral respiratory culture? A. Gram stain B. Direct fluorescent antibody stain C. Wright-Giemsa stain D. Acid-fast stain ANS: B PTS: 1 23. What is the first-line recommended treatment against Group A beta-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis? A. Penicillin B. Quinolone C. Cephalosporin D. Macrolide ANS: A PTS: 1 24. Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity? A. Mild intermittent B. Mild persistent C. Moderate persistent D. Severe persistent ANS: C PTS: 1 25. Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking? A. Inhaled corticosteroid B. Leukotriene-receptor antagonist C. Systemic corticosteroid D. Methylxanthines ANS: A PTS: 1 26. Your patient is on theophylline for his asthma. You want to maintain his serum levels between: A. 0 to 5 mcg/mL B. 5 to 10 mcg/mL C. 5 to 15 mcg/mL D. 10 to 20 mcg/mL ANS: C PTS: 1 27. George has COPD and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD? A. Stage 1 mild COPD B. Stage 2 moderate COPD C. Stage 3 severe COPD D. Stage 5 very severe COPD ANS: A PTS: 1 28. Most nosocomial pneumonias are caused by: A. Fungi B. Viruses C. Gram-negative bacteria D. Pneumococcal pneumonia ANS: C PTS: 1 29. Which of the following statements regarding TST is true? A. Tests should be read 48 hours after the injection. B. The size of the TST reaction has nothing to do with erythema but is based solely on induration. C. It is a type V T-cell-mediated immune response. D. The diameter of the induration is measured in centimeters. ANS: B PTS: 1 30. Which obstructive lung disease is classified as reversible? A. Asthma B. Chronic bronchitis C. Emphysema D. COPD ANS: A PTS: 1 31. Which of the following asthma medications should be used cautiously with geriatric patients? A. Atrovent B. Ventolin C. Singulair D. Asmanex ANS: B PTS: 1 32. Which statement about adenocarcinoma of the lung is accurate? A. It is the least common type of lung cancer, representing approximately 5% to 10% of cases. B. It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors. C. It is more common in men than in women and occurs almost entirely in cigarette smokers. D. It is aggressive, with rapid growth in primarily the liver and brain. ANS: B PTS: 1 33. Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors? A. He is a recovering alcoholic of 6 years. B. His collar size is 17 inches. C. He is the only person in his family who has this. D. He is extremely thin. ANS: B PTS: 1 34. What is the pressure needed for continuous positive air pressure (CPAP) to abolish apneas, snoring, and oxyhemoglobin desaturations in all positions and during REM sleep? A. 5 to 20 cm H2O B. 10 to 25 cm H2O C. 15 to 25 cm H2O D. 20 to 35 cm H2O ANS: A PTS: 1 35. What is a procedure that can be performed in the outpatient setting for a patient with obstructive sleep apnea? A. Mandibular advancement B. Laser-assisted uvulopalatoplasty C. Retroglossal obstruction removal D. Uvulopalatopharyngoplasty ANS: B PTS: 1 36. Tina is a 3-week-old who was recently diagnosed with influenza. Which of the following medications would be appropriate to treat her condition? A. Liquid oseltamivir B. Inhaled zanamivir C. Inhaled oseltamivir D. Liquid zanamivir ANS: A PTS: 1 37. The forced vital capacity is decreased in: A. Asthma B. Chronic bronchitis C. Emphysema D. Restrictive disease ANS: D PTS: 1 38. What is the most common cause of CAP? A. Streptococcus pneumoniae B. Klebsiella pneumoniae C. Legionella pneumoniae D. Pseudomonas aeruginosa ANS: A PTS: 1 39. Which of the following patients would you expect to have a decreased response to TST(TB test)? A. Julie, a 50-year-old postal worker with hypertension B. Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns C. Jill, a 16-year-old cheerleader with type 1 diabetes D. Mark, a 29-year-old tennis player who currently has a cold ANS: B PTS: 1 40. Which of the following is a possible consequence of sleep apnea? A. Asthma B. Increased white blood cells C. Insulin resistance D. Hyperactivity ANS: C PTS: 1 41. Which of the following conditions is associated with cigarette smoking? A. Glaucoma B. Increased sperm quality C. Bladder cancer D. Eczema ANS: C PTS: 1 42. Marta is taking TB drugs prophylactically. How do you instruct her to take them? A. Take them on an empty stomach to facilitate absorption. B. Take them with aspirin (ASA) to prevent flushing. C. Take them with ibuprofen to prevent a headache. D. Take them with food to prevent nausea. ANS: A PTS: 1 43. Which of the following statements regarding pulmonary function and cigarette smoking is true? A. Cigarette smoking causes an increase in circulating immunoglobulin levels. B. Cigarette smoking has no increased risk of COPD. C. Cigarette smoking decreases mucus production. D. Cigarette smoking increases the risk of pneumothorax. ANS: D PTS: 1 44. How much nicotine does an average cigarette contain? A. 5 to 10 mg B. 10 to 15 mg C. 15 to 20 mg D. 20 to 25 mg ANS: C PTS: 1 45. Madeline is a smoker in a primary-care visit with her provider. After her provider asks if she is willing to quit, she says she has decided to quit, has bought nicotine gum, and is interested in hearing about Chantix. Which of the following steps is Madeline in regarding behavioral changes and her attempts at cessation? A. Precontemplation B. Action C. Maintenance D. Preparation ANS: D PTS: 1 46. Eleanor would like to quit smoking, but she is unsure of the benefits, as she is 60 years old. Which of these is a benefit to quitting smoking that her provider should inform her of? A. Enhanced taste and smell B. Improved hearing C. Decreased risk of diabetes mellitus D. Decreased risk of sexually transmitted diseases ANS: A PTS: 1 47. The barrel-chest characteristic of emphysema is a result of: A. Chronic coughing B. Hyperinflation C. Polycythemia D. Pulmonary hypertension ANS: B PTS: 1 48. Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD? A. 3 hours B. 6 hours C. 11 hours D. 15 hours ANS: D PTS: 1 49. Which of these patients should be evaluated with serum alpha-antitrypsin levels? A. Jamie, a 70-year-old female with COPD with a history of smoking B. Ron, a 43-year-old male with COPD with a history of smoking C. Leslie, a 60-year-old female with clinical emphysema and no history of smoking D. Marshall, a 55-year-old male with clinical emphysema and no family history of early-onset COPD ANS: B PTS: 1 50. Which ethnic group has the highest lung-cancer incidence and mortality rates? A. African American men B. Scandinavian men and women C. Caucasian women D. Asian men ANS: A PTS: 1 Section 6. Cardiovascular Problems MULTIPLE CHOICE 1. What of the following patients is a candidate for statins? A. Jerry is a 55-year-old male with a history of syncope. B. Christa is a 65-year-old female with a history of myocardial infarction (MI). C. Manny is a 75-year-old male with a 10-year cardiovascular risk of 6.5%. D. April is an 80-year-old female with a low-density lipoprotein (LDL) level of 180. ANS: B PTS: 1 2. Which of the following is a chest wall syndrome? A. Myocardial infarction B. Angina C. Costochondritis D. Pericarditis ANS: C PTS: 1 3. Which of the following may help a clinician to determine whether palpitations are caused by a potentially lethal cardiac rhythm? A. Holter monitoring B. Complete blood count (CBC) C. Thyroid panel D. Computed axial tomography (CAT) scan ANS: A PTS: 1 4. A blood pressure (BP) of 150/90 is considered: A. Stage 2 hypertension B. Hypertensive C. Normal in healthy older adults D. Acceptable if the patient has diabetes mellitus (DM) ANS: C PTS: 1 5. Lifestyle modifications to manage hypertension (HTN) include: A. Maintaining a body mass index of 17 B. Restricting dietary sodium to 5 grams per day C. Engaging in exercise or physical activity for 90 minutes a day D. Limiting beer intake to 24 ounces per day ANS: D PTS: 1 6. Mary has hypertension and previously had a stroke. Which hypertensive drug has been shown to reduce stroke? A. Chlorthalidone B. Metoprolol C. Amlodipine D. Losartan ANS: A PTS: 1 7. Which high-density lipoprotein (HDL) level is considered cardioprotective? A. Greater than 30 B. Greater than 40 C. Greater than 50 D. Greater than 60 ANS: D PTS: 1 8. You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome? A. Her waist is 36 inches. B. Her triglyceride level is 140 mg/dL. Her BP is 128/84. C. D. Her fasting blood sugar (BS) is 108 mg/dL. ANS: A PTS: 1 9. Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours? A. Stable angina B. Unstable angina C. Variant (Prinzmetal’s angina) D. Probably not angina but hiatal hernia ANS: C PTS: 1 10. A patient is undergoing a cardiac stress test. Which of the following parts of their history could cause a false-positive reading? A. Patient is on labetalol. B. Patient is a man. C. Patient is on amlodipine. D. Patient has a potassium level of 4. ANS: A PTS: 1 11. Which of these patients is at a higher risk for developing deep vein thrombosis? A. Jerry, a 64-year-old man with a history of epilepsy B. Samantha, a 45-year-old female undergoing a hysterectomy C. Diane, a 15-year-old female with type 1 diabetes D. Ben, a 23-year-old male with a history of a pneumothorax ANS: B PTS: 1 12. Claire is a patient complaining that her left leg is cool, pale, smaller than her right, and has thick toenails. Which condition may she be experiencing? A. Peripheral artery disease B. Anemia C. Deep vein thrombosis D. Pulmonary embolism ANS: A PTS: 1 13. In which type of atrioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped? A. First-degree AV block B. Second-degree Mobitz I AV block C. Second-degree Mobitz II AV block D. Third-degree AV block ANS: B PTS: 1 14. What is the term for light-headedness, feeling faint, and muscular weakness with a cardiovascular origin? A. Presyncope B. Vertigo C. Dizziness D. Myocardial infarction ANS: A PTS: 1 15. A delta wave on the electrocardiogram (ECG) may be present in which condition? A. Prinzmetal’s angina B. Bundle branch block C. Wolff–Parkinson–White syndrome D. Aortic stenosis ANS: C PTS: 1 16. Which heart sound is associated with decreased elasticity of the left ventricle in left ventricular hypertrophy? A. A physiologic split S2 B. A fixed split S2 C. S3 D. S4 ANS: D PTS: 1 17. Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of: A. Severe asthma B. A common valvular lesion C. Severe hypertension D. A prosthetic heart valve ANS: D PTS: 1 18. Data from the Framingham Heart Study suggests that individuals who are normotensive at 55 years of age have how much lifetime risk of developing hypertension? A. 65% B. 75% C. 80% D. 90% ANS: D PTS: 1 19. Which pain characteristic is usually indicative of angina pectoris? A. Fleeting B. Moving C. Diffuse D. Localized ANS: C PTS: 1 20. Which of the following is the proper way to take a blood pressure measurement? A. Patient is in a reverse Trendelenburg position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 5 minutes before measurement B. Patient is in a sitting position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 5 minutes before measurement C. Patient is in a sitting position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 3 minutes before measurement D. Patient is in a reverse Trendelenburg position, cuff size has a bladder length of 70% and a width of 30% of arm circumference, patient has rested for 5 minutes before measurement ANS: B PTS: 1 21. What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia? A. About 20% B. About 30% C. About 50% D. Almost all ANS: B PTS: 1 22. Which of the following patient complaints indicates palpitations are due to increased catecholamine production? A. “I feel like my heart is pounding out of my chest and I have been sitting for an hour.” B. “I feel like my heart is in a vise and I can’t breathe.” C. “I feel like my heart is beating strongly after I just worked out.” D. “I feel like my heart is skipping beats.” ANS: C PTS: 1 23. What is the most common presenting complaint in congestive heart failure? A. Weight loss B. Palpitations C. Syncope D. Dyspnea ANS: D PTS: 1 24. Which of the following is true of peripheral edema? A. It is always independent of underlying disorders. B. Peripheral edema occurs more frequently in men than in women. C. When it involves the lower extremities, it may be caused by cardiac conditions. D. It is the accumulation of tissue fluid within organ systems. ANS: C PTS: 1 25. Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses? A. 911 should be called, and the patient should be transported immediately to the emergency department. B. One more dose of NTG may be tried. C. The person should be given two aspirin to chew. D. A portable defibrillator should be located to ascertain the cardiac rhythm. ANS: A PTS: 1 26. For the best therapeutic effect after an MI, thrombolytics should be administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can be of benefit up to how many hours after the initial presentation of MI symptoms? A. 6 hours B. 8 hours C. 10 hours D. 12 hours ANS: D PTS: 1 27. When teaching post-MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not be put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must be dated and discarded after how many months? A. 1 month B. 3 months C. 6 months D. As long as the tablets are kept in this special bottle, they will last forever. ANS: C PTS: 1 28. There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy? A. Stage A B. Stage B C. Stage C D. Stage D ANS: D PTS: 1 29. There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage do patients have refractory symptoms of heart failure? A. Stage A B. Stage B C. Stage C D. Stage D ANS: D PTS: 1 30. Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test? A. Brain natriuretic peptide B. C-reactive protein C. Serum albumin D. Erythrocyte sedimentation rate ANS: A PTS: 1 31. If a pulmonary embolus is suspected, which testing should be performed? A. Ultrasound B. Magnetic resonance imaging (MRI) C. V/Q scan D. D-dimer ANS: C PTS: 1 32. Which of the following doses of statins decrease LDL by up to 50% on average? A. Pravastatin 40 mg B. Simvastatin 20 mg C. Atorvastatin 80 mg D. Fluvastatin 40 mg ANS: C PTS: 1 33. What is true regarding the treatment of cilostazol? A. It causes vasoconstriction. B. It can be used when a patient has a degree of heart failure. C. It is used to treat leg pain due to blockages in the leg veins. D. It causes platelet aggregation. ANS: D PTS: 1 34. Which of the following medications can cause hyperlipidemia? A. High dose diuretics B. Exercising 30 minutes every day C. Hyperthyroidism D. Angiotensin II receptor blocker (ARB) use ANS: A PTS: 1 35. Which of the following complementary therapies may be helpful if a patient has orthostatic hypotension? A. Magnesium B. Beta-glucan C. Selenium D. Hawthorn ANS: D PTS: 1 36. In the CHADS2 Index for the stroke risk score for AF, the “A” stands for: A. Anticoagulation B. Autoimmune disease C. Age D. Antihypertension ANS: C PTS: 1 37. Which of these murmurs is also called a 50/50 murmur? A. Aortic sclerosis B. Hemic murmur C. Systolic ejection murmur D. Diastolic murmur ANS: A PTS: 1 38. Which of the following statements about dabigatran is true? A. It is difficult to keep the patient in therapeutic range. B. Anticoagulation cannot be immediately reversed. C. This agent is for the management of valvular atrial fibrillation. D. It has a longer half-life than warfarin. ANS: B PTS: 1 39. What value on the ankle-brachial index diagnoses peripheral artery disease? A. Less than 0.25 B. Less than 0.50 C. Less than 0.90 D. Greater than 1 ANS: C PTS: 1 40. Your patient with permanent atrial fibrillation asks what other options he has to warfarin. You tell him: A. There is a permanent implantable device, but you will have to continue the warfarin when you have it. B. We could try dabigatran, but it would require more laboratory monitoring. C. Rivaroxaban is a good alternative because it has an established antidote. D. Apixaban is an alternative medication because it does not necessitate dose titration. ANS: D PTS: 1 41. You just started Martha on HTN therapy. The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it? A. 1 month B. 3 months C. 6 months D. 1 year ANS: A PTS: 1 42. Janice is a 65-year-old Caucasian female with a history of osteoporosis and new-onset hypertension. Which of the following medications is appropriate as first line for Janice’s hypertension? A. Benazepril B. Hydrochlorothiazide C. Amlodipine D. Clonidine ANS: B PTS: 1 43. Fred is a 76-year-old man with a history of hypertension who recently suffered a post- myocardial infarction. Which of the following antihypertensive medications is appropriate? A. Hydrochlorothiazide B. Furosemide C. Spironolactone D. Lisinopril ANS: D PTS: 1 44. The care provider is assessing an ECG electrical axis, which shows a negative complex in lead I and a positive complex in augmented vector foot (aVF). Which describes this axis deviation? A. Normal axis B. Left axis deviation C. Right axis deviation D. Extreme right axis deviation ANS: C PTS: 1 45. Which of the following results might you see in a physical examination of a male patient with hypertension? A. S2 heart sound B. Distended neck veins C. Rhonchi D. Waist measurement 36 inches ANS: B PTS: 1 46. In which patient do premature ventricular contractions NOT need to be treated? A. Kelly, a 25-year-old female with an allergy to bee stings B. Mary, a 50-year-old female with a history of untreated anxiety C. Randy, a 45-year-old male with a history of hypotension D. Bill, a 65-year-old male with a history of angina ANS: A PTS: 1 47. What is the most common form of heart disease in a patient with atrial fibrillation? A. Hypertension B. Rheumatic heart disease C. Angina D. Coronary artery disease associated with heart failure ANS: D PTS: 1 48. What does digitalis compete with at binding sites on the cell membrane? A. Magnesium B. Potassium C. Sodium D. Calcium ANS: B PTS: 1 49. Which of the following will help a provider determine whether a patient is experiencing paroxysmal supraventricular tachycardia (PSVT) or ventricular tachycardia (VT)? A. An obstructed P wave B. Ability to calculate PR interval C. Frog sign D. Chvostek’s sign ANS: C PTS: 1 Section 7. Abdominal Problems MULTIPLE CHOICE 1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the examination? A. Lumbar puncture B. Family history of cardiac problems C. Contrast venography D. Pelvic exam ANS: D PTS: 1 2. Which of the following is a condition that results in colicky abdominal pain? A. Peptic ulcers B. Glisson’s capsule around the liver C. Peritoneum irritation D. Gallstones ANS: D PTS: 1 3. A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? A. Multivitamin B. Magnesium hydroxide C. Pepto-Bismol® D. Ibuprofen ANS: C PTS: 1 4. Which of the following is an appropriate strategy to manage constipation? A. Mildly exercise after breakfast. B. Five timed minutes on the toilet in which to defecate. C. Drink at least 48 ounces of fluids daily. D. Immediately begin pharmacologic treatment. ANS: A PTS: 1 5. A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis? A. Gastroenteritis B. Recent use of Imodium C. Lack of dietary fiber D. Decreased physical activity ANS: A PTS: 1 6. Cameron, 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes antacids with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain? A. The pain seems better when he smokes to relieve his nerves. B. Coffee and fried foods don’t bother him. C. He wakes at night coughing with a bad taste in his mouth. D. He likes to wear loose clothing. ANS: C PTS: 1 7. Gail, a 35-year-old female patient, is seen in the clinic in the morning. She complains of abrupt onset of nausea, vomiting, colicky abdominal cramps, and profuse watery diarrhea that began last night. Her vitals are BP: 110/70, HR: 110, temperature: 99°F, RR: 12. She recently came back from a vacation in Switzerland, ate leftovers for dinner last night, and had a cold 2 weeks ago. Which of the following is the most probable cause of her condition? A. Staphylococcus B. Shigella C. Rotavirus D. Entamoeba histolytica ANS: A PTS: 1 8. Hannah is a patient that just had an appendectomy after a diagnosis of appendicitis and had no complications. Which of the following patient education points is correct? A. “You will need to take laxatives to encourage defecation post-surgery.” B. “You will need to stay in the hospital for 2 weeks to recover.” C. “Your diet will be advanced when bowel sounds return.” D. “I will put you on narcotics to manage your pain.” ANS: C PTS: 1 9. Which of the following patients should be referred to a hepatologist? A. Patient with persistent elevation of HBsAg B. Patient with anti-HAV IgG C. Patient with IgG anti-HBs D. Patient with anti-HEV ANS: A PTS: 1 10. A 29-year-old is seen in the office with complaints of pain in his chest and belly. He quit smoking 6 months ago. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer® and Pepto-Bismol®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer? A. His use of Pepto-Bismol B. His age C. His use of Alka-Seltzer D. His smoking cessation ANS: C PTS: 1 11. Which of the following causes of gastrointestinal bleeding is found in the lower gastrointestinal tract? A. Erosive esophagitis B. Duodenal ulcer C. Meckel’s diverticulum D. Gastric ulcer ANS: C PTS: 1 12. Which of the following is most effective in diagnosing acute appendicitis? A. History and physical B. Sedimentation rate C. Kidney, ureter, and bladder x-ray D. Complete blood count (CBC) with differentials ANS: A. PTS: 1 13. Which of the following is true of appendicitis? A. Appendicitis is more common in Asian countries. B. Family history of appendicitis does not increase a patient’s risk of having appendicitis. C. Appendicitis is most common between the ages of 40 and 60. D. If appendicitis occurs in infants, it is associated with higher morbidity. ANS: D PTS: 1 14. Which of the following is associated with celiac disease (celiac sprue)? A. Malabsorption B. Constipation C. Rectal bleeding D. Esophageal ulceration ANS: A PTS: 1 15. A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis? A. Endometriosis B. Yersinia enterocolitica infection C. Appendicitis D. GERD ANS: A PTS: 1 16. Robin is a 57-year-old female presenting with diffuse abdominal pain. Which of the following statements from the provider to Robin is correct? A. “It does not matter that you feel pain not only in your stomach but also in your shoulder.” B. “Does moving around change the nature of your pain?” C. “All causes of abdominal pain do not necessitate a surgical referral.” D. “I noticed on examination that your stomach is rigid, and you stated your pain is quite severe. It is only necessary for a nurse to see you concerning this problem.” ANS: B PTS: 1 17. A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be? A. Obtain a complete history. B. Order a barium enema. C. Schedule a Bernstein’s test. D. Prescribe a trial of antispasmodics. ANS: A PTS: 1 18. A 28-year-old patient is seen in the clinic with colicky abdominal pain, particularly after meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely? A. Her age B. Frequent constipation C. Pain after meals D. Colicky abdominal pain ANS: A PTS: 1 19. A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary-care provider (PCP) establish the diagnosis of irritable bowel syndrome (IBS)? A. Feels relief after urination B. Pain wakes up patient from sleep C. Defecates in the middle of the night D. Pain is precipitated by eating ANS: D PTS: 1 20. Which of these is one of the most common dietary triggers of IBS? A. Gluten-free items B. Lactose C. Honey D. Meat ANS: B PTS: 1 21. Which of the following patients has an increased risk of epigastric hernia? A. Mark, a 45-year-old African American male with chronic obstructive pulmonary disease B. Gladys, a 93-year-old Hispanic female with dyslipidemia C. Tony, a 33-year-old Asian male with hypertension D. Whitney, a 22-year-old Caucasian female with anemia ANS: A PTS: 1 22. Elaine is a 32-year-old Hispanic woman who is 33 weeks pregnant. She complains that when she wipes after defecation she noticed “a red streak on the toilet paper.” Which of the following should be included in the differential diagnosis? A. Gastric ulcer B. Rectal prolapse C. Diverticulitis D. Irritable bowel syndrome ANS: B PTS: 1 23. A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the explanation of the pathology report? A. This is not premalignant tissue. B. This tissue is not resistant to gastric acid. C. This tissue supports healing of the esophagus. D. This tissue does not have an increased risk of developing esophageal adenocarcinoma. ANS: C PTS: 1 24. Which of the following dietary instructions should be given to a patient with GERD? A. Eliminate coffee. B. Drink hot toddies to relieve stomach distress. C. Recline and rest after meals. D. Increase the amount of spicy foods. ANS: A PTS: 1 25. After typical groin hernia surgery, the patient should be instructed to: A. Avoid work for 3 weeks. B. Stay in the hospital for 2 weeks. C. Avoid heavy lifting for 4 to 6 weeks. D. Return to normal activities after 1 month. ANS: C PTS: 1 26. A patient is diagnosed with Giardia lamblia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment? A. Vancomycin B. Penicillin C. Metronidazole D. Bactrim ANS: C PTS: 1 27. A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? A. Very early B. 3 to 4 hours after perforation C. Late in inflammation D. Appendicitis never presents with vague pain ANS: A PTS: 1 28. The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion? A. Use of fish oil vitamin B. Ethanol avoidance C. Cigarette smoking D. Prednisone use ANS: C PTS: 1 29. A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could be a cause of this problem? A. Increased bilirubin uptake B. Increased bilirubin excretion C. Biliary obstruction D. A serum bilirubin level of 0.5 mg/dL ANS: C PTS: 1 30. Angela is a 30-year-old G0P0 biracial Asian and Caucasian woman. Her body mass index (BMI) is 22 and her history includes anemia, epilepsy, and bee-sting allergy. Which of the following parts of her patient history would increase her risk of cholelithiasis? A. Nulliparity B. Bee-sting allergy C. BMI 22 D. Female gender ANS: D PTS: 1 31. A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about 1 month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point? A. Stool culture B. Liver enzymes C. Antihepatitis D virus D. Thyroid-stimulating hormone test ANS: C PTS: 1 32. On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis? A. Anti-HAV IgM B. HAV IgG C. Anti-HCV D. IgM anti-HBs ANS: A PTS: 1 33. A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings? A. Decreased alanine aminotransferase and decreased aspartate aminotransferase B. Elevated alkaline phosphatase C. Decreased indirect bilirubin D. Decreased white blood cells ANS: B PTS: 1 34. Which of the following are included in the Ranson’s criteria for assessing the severity of pancreatitis at the time of diagnosis? A. Blood glucose 180 mg/dL B. Age 45 years old C. Base deficit greater than 4 mEq/L D. Serum LDH greater than 25 IU/L ANS: C PTS: 1 35. Donna is a 36-year-old African American woman with chronic pancreatitis. Which of the following are necessary to manage her condition? A. One alcoholic drink a week maximum B. NSAIDs, which are the only analgesic appropriate for pain relief C. Treating serum glucose levels of 200 to 250 mg/dL D. A low-fat diet of less than 50 g of fat per day ANS: D PTS: 1 36. Which of the following diagnostic tests is ordered for a cecal volvulus bowel obstruction? A. Barium enema B. Colonoscopy C. Endoscopy D. Magnetic resonance imaging (MRI) ANS: A PTS: 1 37. Which of the following is part of the treatment plan for the patient with IBS? A. High-fiber diet B. A discussion that the goal of treatment is to cure their disease C. Daily laxatives D. A conversation about their expected shorter life span ANS: A PTS: 1 38. Leslie is a 35-year-old Caucasian woman who presents with weakness, anorexia, weight loss, and fatigue. Her history is significant for inflammatory bowel disease, Hashimoto’s thyroiditis, and cigarette smoking. Which of the following pieces of her history leads the clinician to believe she has primary sclerosing cholangitis? A. Age B. Gender C. Inflammatory bowel disease D. Smoker ANS: C PTS: 1 39. Carl has been diagnosed with Wilson’s disease. Which of the following should be included in his dietary education? A. Avoid calcium-containing foods. B. Increase protein intake with peanut butter. C. Limit shrimp intake. D. Increase fat intake by eating liver. ANS: C PTS: 1 40. Ron has cirrhosis and now presents with altered mental status after increasing protein intake because he was trying to increase muscle mass. Which of the following diseases should the clinician be concerned about? A. Hepatopulmonary syndrome B. Hepatic encephalopathy C. Hepatorenal syndrome D. Spontaneous bacterial peritonitis ANS: B PTS: 1 Section 8. Renal Problems MULTIPLE CHOICE 1. A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked? A. “Do you have a history of liver disease?” B. “What medications are you currently taking?” C. “Have you noticed swelling in your ankles?” D. “Do you have an autoimmune condition?” ANS: B PTS: 1 2. The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions? A. Repeat the test. B. Refer to a nephrologist. C. Measure the serum protein. D. Obtain a blood urea nitrogen (BUN) and creatinine. ANS: B PTS: 1 3. The clinician is speaking with Bernadette, who has recently been diagnosed with urinary incontinence. She has had this condition for a number of years, she is 5 feet 5 inches, and she weighs 140 pounds. Which of the following should the health-care provider be aware of? A. It is uncommon that Bernadette has this condition because she is female. B. Most patients should wait 3 months for follow-up after diagnosis. C. Since Bernadette has a regular body mass index, she probably has a positive body image. D. Bernadette may be suffering from depression and may need a psychiatric consult. ANS: D PTS: 1 4. A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria? A. NSAIDs B. Rhubarb C. Vitamin A D. Red meat ANS: A PTS: 1 5. A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI? A. Thick, green discharge B. Fever, chills, costovertebral angle (CVA) tenderness C. Blood in urine and frequency D. Foul-smelling discharge, perineal itch ANS: C PTS: 1 6. Which of the following patients is most likely to have urge incontinence? A. Mary, a 35-year-old female with a history of four vaginal deliveries B. Devon, a 40-year-old male with a history of multiple sclerosis C. Dan, a 67-year-old male with a history of diabetes mellitus D. Cheryl, a 95-year-old female who takes Norpace daily ANS: B PTS: 1 7. A 30-year-old patient presents with pain on urination. The urine microscopy of clean-catch urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis? A. Lower urinary-tract infection B. Chlamydia infection C. Candidiasis D. Pyelonephritis ANS: A PTS: 1 8. A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria. Which of the following diagnoses is most likely given the above information? A. Pyelonephritis B. Cystitis C. Renal calculi D. Bladder tumor ANS: A PTS: 1 9. Which of the following information patients with a UTI can receive Bactrim DS? A. Mary, a 25-year-old who is 25 weeks pregnant B. Donna, a 55-year-old with an allergy to sulfa C. Lisa, a 33-year-old who is breastfeeding her 3-week-old daughter D. Tiffany, a 16-year-old with a hypersensitivity to penicillin ANS: D PTS: 1 10. Which of the following Macrobid doses is appropriate to treat a lower UTI? A. 200 mg bid × 14 days B. 100 mg bid × 5 days C. 500 mg daily × 8 days D. 800 mg daily × 2 days ANS: B PTS: 1 11. A patient is seen in the office complaining of severe flank pain and hematuria. The clinician should assess this patient for which risk factor for poststreptococcal glomerulonephritis? A. Hypertension B. Constipation C. Tubal ligation D. Diabetes ANS: A PTS: 1 12. A patient is diagnosed with urge incontinence. Before prescribing Detrol LA, the provider should question the patient about which of these contraindications to this medication? A. Diarrhea B. Parkinson’s disease C. Closed-angle glaucoma D. Breast cancer ANS: C PTS: 1 13. A patient is diagnosed with overactive bladder. Which of the following instructions should be given to this woman? A. “Limit the amount of water that you drink.” B. “Eliminate caffeine from your diet.” C. “Wear panty liners.” D. “You should not attempt pregnancy.” ANS: B PTS: 1 14. A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of the following actions should be taken next? A. Send a urine specimen for microscopy and evaluate for fungal colonies. B. Increase the dose of antibiotic. C. Order a cystoscopy. D. Order a different antibiotic. ANS: A PTS: 1 15. Which of the following are predisposing factors for pyelonephritis? A. Pregnancy B. Dehydration C. Smoking D. Alkaline urine ANS: A PTS: 1 16. Which of the following types of proteinuria is associated with Hodgkin’s disease? A. Tamm-Horsfall proteinuria B. Tubulointerstitial area involvement C. Altered glomerular capillary permeability D. Bence Jones proteinuria ANS: D PTS: 1 17. When proteinuria is detected in a low-risk patient, which laboratory testing should be ordered in addition to Bence Jones proteins? A. Serum glucose B. Lipid panel C. Hemoglobinopathy D. Cerebrospinal fluid (CSF) lumbar puncture ANS: B PTS: 1 18. Jeremy is a 27-year-old who comes to the clinic complaining of red-tinged urine. The clinician performs a urine dipstick and finds that the protein is 2+. Which of the following from Jeremy’s history is related to this finding? A. He is training for a marathon. B. He recently broke a toe. C. He began taking Lexapro 2 weeks ago. D. He works in an office setting. ANS: A PTS: 1 19. Which of the following is true regarding the cause of isolated hematuria? A. It is usually caused by anemia. B. It can be due to bleeding in the urethra. C. It is can be due to hemoglobinopathies. D. It is usually due to sickle cell disease. ANS: B PTS: 1 20. Which of the following medications may be linked to dysuria? A. Vitamin A B. Mirena C. Paxil D. Gabapentin ANS: C PTS: 1 21. A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed? A. 3-day course of oral antibiotics B. Hospitalization C. Encourage cranberry juice intake D. 6-week course of antibiotics ANS: B PTS: 1 22. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses? A. Pancreatitis B. Urinary tract infection C. Prostate tumor D. Gastroesophageal reflux disease ANS: A PTS: 1 23. Which of the following instructions should be given to the patient with nephrolithiasis? A. Take ibuprofen, 600 mg every 8 hours. B. Take Tums for stomach upset. C. Drink more black tea. D. Increase intake of vegetables, like spinach. ANS: A PTS: 1 24. Which of the following patients is at risk for developing urinary-tract cancer? A. The 45-year-old woman who is 10 lbs underweight B. The 78-year-old man who smokes three packs of cigarettes a day C. The 84-year-old man who worked in an office setting D. The 25-year-old woman who has a lactose allergy ANS: B PTS: 1 25. Which of the following medications will help reduce urinary excretion of nephrolithiasis- forming substances? A. Furosemide B. Triamterene C. Calcium supplement D. Hydrochlorothiazide ANS: D PTS: 1 26. Ryan has a UTI and has been prescribed Ceclor. Which of the following side effects should he be made aware of? A. Emesis B. Abdominal discomfort if taken without food C. Nausea D. Flatulence ANS: C PTS: 1 27. A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments? A. Chemotherapy B. Nephrectomy C. Palliative treatment D. Radiation ANS: B PTS: 1 28. A patient has just had a total nephrectomy for renal cell carcinoma. Which of the following follow-up strategies is appropriate? A. Computed tomography (CT) scan of abdomen and renal fossa in 3 to 6 months B. Magnetic resonance imaging (MRI) of abdomen and kidneys in 2 to 4 months C. X-ray of abdomen and renal fossa in 6 to 8 months D. No follow-up is necessary. ANS: A PTS: 1 29. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is considered a risk factor for this type of cancer? A. History of alcoholism B. Sedentary lifestyle C. Obesity D. 65-year smoking history ANS: D PTS: 1 30. A 40-year-old woman presents to the clinic with complaints of dull and achy flank pain and hematuria. She also notes, “I think I have a mass in my stomach.” She works in a chemical plant and has a sedentary lifestyle. Which of the following parts of her history lead the clinician to believe she may have renal cell carcinoma? A. Age B. Gender C. Works in chemical plant D. Sedentary lifestyle ANS: C PTS: 1 31. Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer? A. Kidneys, ureter, bladder x-ray B. Cystoscopy with biopsy C. Magnetic resonance imaging D. Urine tumor marker (NMP22) ANS: B PTS: 1 32. A 78-year-old man says he has been diagnosed with Stage 0 bladder cancer and asks the provider what that means. Which is the best response? A. “There is no such thing as Stage 0 cancer.” B. “You have cancer that has spread to the surrounding tissue.” C. “Your cancer has spread to other organs.” D. “Your cancer must be cured by removing your bladder.” ANS: C PTS: 1 33. Talia has bladder cancer that has grown into the fatty tissue surrounding the bladder and to her vagina. The cancer has not spread to distant sites or lymph nodes. What is an appropriate treatment option? A. Palliative care only B. External beam radiation therapy C. Only chemotherapy is appropriate D. Radical cystectomy and lymph node resection ANS: D PTS: 1 34. The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia? A. Patient is on lisinopril B. Nephrolithiasis C. Recent infection where gentamicin was used in treatment D. Ureteral obstruction ANS: A PTS: 1 35. The patient is diagnosed with ARF. Which of the following conditions is the most common cause? A. Renal calculi B. Acute tubular necrosis C. Cardiac failure D. Acute glomerulonephritis ANS: B PTS: 1 36. Danielle presents to the clinic, saying “I do not feel like I want to eat.” She also notes she is experiencing lethargy, nausea, headache, and muscle cramps. She “did not go to the bathroom a lot” yesterday. Which of the following stages of acute kidney injury (AKI) is Danielle in? A. Initiating stage B. Oliguric stage C. Diuretic stage D. Recovery stage ANS: A PTS: 1 37. Which of the following physical examination manifestations are consistent with a patient in ARF? A. Weight gain B. Glycosuria C. Irritability D. Hypotension ANS: D PTS: 1 38. Laqueena has chronic kidney disease (CKD). Her glomerular filtration rate (GFR) is 33 mL/min per 1.73 m2 of body surface area. Which of the stages does her GFR fall under, as defined by the Third National Health and Nutrition Examination Survey? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 ANS: C PTS: 1 39. Which of the following examination findings should be expected in a patient with CKD? A. Weak, thready pulse B. Auscultatory crackles C. Hypotension D. Pleural friction rub ANS: B PTS: 1 40. Which of the following strategies is useful when managing hypertension in a patient with CKD? A. Keep HbA1c of less than 7.5%. B. For a patient with proteinuria of more than 1 g/day, target BP is 135/85 mm Hg. C. Avoid systolic BP less than 100 mm Hgc. D. For a patient with proteinuria of less than 1 g/day, goal BP is no more than 130/80 mm Hg. ANS: D PTS: 1 41. Carol has CKD. Her creatinine levels are now 12 mg/dL. She would like to know what to expect next. What does the provider tell her? A. Due to her advanced renal failure, her survival time without intervention is 100 to 150 days. B. She does not require intervention and she will require dialysis once her creatinine levels reach 15 mg/dL. C. She requires dialysis and must have an arteriovenous graft this week to start dialysis in 1 week. D. She will be placed on the transplant list once her creatinine levels are greater than 16 mg /dL. ANS: A PTS: 1 Section 9. Gender-Related Health Problems MULTIPLE CHOICE 1. Which of the following is a correct recommendation of when to begin prostate screening? A. Men with no symptoms of prostate cancer and who are in good health should start screening at age 60. B. Asian American men should start screening at age 45. C. Men who have had a brother diagnosed with prostate cancer before the age of 65 should start screening at 45. D. Caucasian men should start screening at age 55. ANS: C PTS: 1 2. A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following is the most common sign of a prostatic problems in men with nocturia? A. Psychogenic nocturia B. Urethral polyp C. Irritative posterior urethral lesion D. Benign prostatic hypertrophy ANS: D PTS: 1 3. A 76-year-old man is seen in the office for complaints of urinary tract infection (UTI). The clinician should explore which of these causes of UTI in men? A. Urethral polyps B. Epididymitis C. Selective serotonin reuptake inhibitor (SSRI) medication D. Prostatodynia ANS: B PTS: 1 4. A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? A. Refer to urologist immediately. B. Obtain a computed tomography (CT) scan. C. Instruct the patient to elevate the scrotum. D. Prescribe ibuprofen. ANS: A PTS: 1 5. An 82-year-old man is seen in the primary-care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? A. Prostatodynia B. Lupus disease C. Trichomoniasis infection D. Fungal infection ANS: D PTS: 1 6. Which of the following would be an appropriate treatment for a patient with mild benign prostatic hyperplasia (BPH)? A. Referral to urologist for surgery. B. Prescribe a trial of tamsulosin. C. Recommend cranberry supplements. D. Have a period of watchful waiting. ANS: D PTS: 1 7. A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis? A. Testosterone level B. Prostate-specific antigen C. Nocturnal penile tumescence and rigidity D. Prolactin level ANS: A PTS: 1 8. Peter is a 40-year-old male with a recent diagnosis of low testosterone. Which of the following counseling points is correct regarding low testosterone? A. Testosterone deficiency is due to hypergonadism. B. Abstaining from cigarette smoking has no effect on testosterone C. Lowering your HbA1c may improve your testosterone levels. D. Stress has no effect on testosterone levels. ANS: C PTS: 1 9. Which of the following should be considered in a patient presenting with erectile dysfunction? A. Diabetes mellitus B. Hypotension C. Wellbutrin D. UTI ANS: A PTS: 1 10. A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? A. Peyronie’s disease B. Damage to the pudendal artery C. Scarring of the urethra D. Testicular torsion ANS: A PTS: 1 11. The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? A. Erectile dysfunction B. Glaucoma C. Hypotension D. Headache ANS: A PTS: 1 12. Which of the following is an aerobic gram-negative bacteria involved in prostatitis? A. Streptococcus faecalis B. Pseudomonas C. Staphylococcus D. Diphtheroids ANS: B PTS: 1 13. The 56-year-old man with chronic prostatitis should be treated with levofloxacin for how long? A. 3 to 7 days B. 14 to 21 days C. 4 to 6 weeks D. 6 to 12 weeks ANS: C PTS: 1 14. John presents with complaints of a “weird feeling that hurts” in his buttocks. He notes that he often feels urgency to urinate and defecate, but “nothing comes out” when he tries. Which of the following diagnoses is most likely? A. Urinary tract infection B. Prostatitis C. Erectile dysfunction D. Peyronie’s disease ANS: B PTS: 1 15. A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate. He is not a long-distance runner. Which of the following would lead you to a diagnosis of prostatodynia versus prostatitis? A. Long-distance runners are more likely to have prostatodynia than prostatitis. B. Prostatodynia presents with signs and symptoms of prostatitis, but without inflammation. C. Prostatodynia usually has a bacterial origin, whereas prostatitis has a relation to internal urethral sphincter problems. D. Patients with prostatodynia usually have a history of recurrent UTIs, whereas patients with prostatitis do not. ANS: B PTS: 1 16. A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism? A. Escherichia coli B. Staphylococcus aureus C. Chlamydia trachomatis D. Pseudomonas aeruginosa ANS: C PTS: 1 17. Carl is a 24-year-old male who presents with scrotal pain that radiates to his flank. It manifested 3 hours ago. He also complains of pain at the tip of his penis, cloudy urine, and urethral discharge. Which of the following conditions is most likely? A. Testicular torsion B. Epididymitis C. Prostatodynia D. Prostatitis ANS: B PTS: 1 18. Which test is used to confirm a diagnosis of epididymitis? A. Urinalysis B. Gram stain of urethral discharge C. Complete blood cell count with differential D. Ultrasound of the scrotum ANS: D PTS: 1 19. Treatment for epididymitis includes which of the following? A. Warm sitz baths B. Scrotal elevation C. Masturbation D. Heat application ANS: B PTS: 1 20. Which of the following data is indicative of testicular torsion? A. Absent cremasteric reflex B. Pain relieved on testicular elevation C. Testicle very low in the scrotum D. Swollen scrotum with “red dot sign” ANS: A PTS: 1 21. A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find? A. The scrotum will be dark. B. The scrotum will appear light pink or yellow. C. The scrotum will appear milky white. D. The internal structures will be clearly visible. ANS: B PTS: 1 22. During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious? A. A nodular and unusually firm gland B. A smooth gland C. A tender gland D. A boggy gland ANS: A PTS: 1 23. A patient presents complaining of pain and enlarged testes that feel like “a bag of worms.” Which diagnosis should the provider most likely assess for? A. Prostate cancer B. Varicocele C. Hydrocele D. Testicular cancer ANS: B PTS: 1 24. Which of the following is a complementary therapy for BPH? A. Red raspberry leaf tea B. Saw palmetto C. Black cohosh D. Vitamin A ANS: B PTS: 1 25. A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which understanding of the Jewett rating system? A. The cancer involves the seminal vesicles. B. There is metastatic disease to regional lymph nodes. C. The cancer is confined to the capsule. D. There is metastasis to distant organs. ANS: A PTS: 1 26. A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects? A. May have cold flashes B. May have hot flushes C. May have increased libido D. May have testicular torsion ANS: B PTS: 1 27. A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following risk factors leads the clinician to suspect potential testicular cancer? A. Patient is 65 years old B. Prior cryptorchidism C. Family history of colon cancer D. Living in a city ANS: B PTS: 1 28. What is the treatment of choice for a patient diagnosed with testicular cancer? A. Radical orchidectomy B. Lumpectomy C. Radiation implants D. Chemotherapy ANS: A PTS: 1 29. A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan? A. Every month B. Every 3 to 4 months C. Every 6 to 12 months D. Every year ANS: B PTS: 1 30. Tyler is a 16-year-old male who the clinician is counseling on sexually transmitted infections (STIs). Which statement made by the clinician is correct? A. “Untreated gonorrhea can lead to many health problems, and if it is not treated it can lead to a syndrome that affects your entire body called disseminated gonococcal infection.” B. “Most STIs are untreatable, and, if contracted, you will have potentially fatal health complications.” C. “Though STIs are treatable, gonorrhea isn’t and always results in permanent penile damage.” D. “The only untreatable STI is chlamydia, and it is also the most common.” ANS: A PTS: 1 31. The clinician is seeing Jalissa, a 17-year-old patient, for a well woman’s exam. She mentions that she has been depressed and has been yo-yo dieting because she feels “so fat.” She marked “no” to whether she feels safe in her home on her intake form, and mentions she is worried about getting STIs from her boyfriend of three months. Which of the following is the correct way to interact with the patient, based on her history? A. “The amount of time allotted for your well woman exam does not allow time to talk about depression today.” B. “I know you said you are concerned about your body image, but your weight looks good to me.” C. “You mentioned on your intake form that you do not feel safe in your home. Why is that?” D. “You’ve been dating your boyfriend for three months, but you haven’t had an STI screening yet? That’s not safe.” ANS: C PTS: 1 32. Which of these patients needs a cervical cancer screening? A. Lisa, a 45-year-old patient who has atypical squamous cells of uncertain significance (ASCUS) and a human papillomavirus (HPV) positive Pap 1 month ago B. April, a 26-year-old patient who had a negative Pap with negative HPV 1 year ago C. Sondra, a 66-year-old patient who had a negative Pap with negative HPV 11 years, 6 years, and 1 year ago D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago ANS: D PTS: 1 33. Which of the following is true of the IUD (intrauterine device)? A. The IUD is 95% effective at preventing pregnancy. B. The IUD has an inhibitory effect on sperm capacitation. C. The IUD can only be inserted at menses. D. The IUD can only be inserted in women with multiparity. ANS: B PTS: 1 34. Alice has been diagnosed with breast cancer. Its TNM staging is T2, N1, M0. She would like to know what this means. Which statement made by the clinician is accurate? A. “Your tumor is 4 cm, has metastasized to a moveable lymph node, but has not metastasized to another location.” B. “Your tumor is 5.5 cm and has not metastasized to lymph nodes or anywhere else.” C. “Your tumor is 1.5 cm, has metastasized to a moveable lymph node, but has not metastasized to another location.” D. “Your tumor is 3 cm, has metastasized to a moveable lymph node, and has only metastasized to supraclavicular lymph nodes.” ANS: A PTS: 1 35. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? A. Human papillomavirus B. Endometrial hyperplasia C. Vaginismus D. Polycystic ovarian syndrome ANS: A PTS: 1 36. A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? A. Ceftriaxone B. Doxycycline C. Acyclovir D. Metronidazole ANS: A PTS: 1 37. A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? A. Gonorrhea B. HPV C. Chlamydia D. Trichomoniasis ANS: C PTS: 1 38. A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? A. Trichomonas B. Bacterial vaginosis C. HPV D. Herpes simplex virus ANS: B PTS: 1 39. Which of the following medications is the treatment of choice for Trichomonas? A. Metronidazole B. Ceftriaxone C. Diflucan D. Doxycycline ANS: A PTS: 1 40. A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? A. “It is probably just a cyst because that is the most common breast mass.” B. “We will order a mammogram and ultrasound to help establish a diagnosis.” C. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.” D. “Because your lump is painful, it is most likely not cancer.” ANS: B PTS: 1 41. Tina is an 18-year-old female who would like to start using the transdermal contraceptive patch. Which of the following instructions should the clinician discuss with Tina? A. Obesity can decrease the effectiveness of the patch. B. The patch should be applied to the buttocks or breasts. C. The patch is changed every 10 days. D. If a patch becomes detached for less than 24 hours, it cannot be reapplied. ANS: A PTS: 1 42. A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? A. Pregnancy test B. Pelvic ultrasound C. Endometrial biopsy D. Platelet count ANS: A PTS: 1 43. A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia? A. Menopause B. Dehydration C. Excess progesterone D. Excess lubrication ANS: A PTS: 1 44. A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? A. Fluconazole B. Estrogen vaginal cream C. Metronidazole D. Doxycycline ANS: A PTS: 1 45. A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? A. Pregnancy test B. Complete blood cell count C. Thyroid-stimulating hormone D. Urine dip for protein ANS: A PTS: 1 46. A 40-year-old woman is seen for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes “occasionally” and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best and most effective for this patient? A. Transdermal contraceptive patch B. Oral contraceptive C. Condom D. Vaginal contraceptive sponge ANS: C PTS: 1 47. A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate? A. “You must be having menopause.” B. “The hot flashes are a result of the antiestrogenic effects of tamoxifen.” C. “Tamoxifen use has no increased incidence of endometrial cancer.” D. “The drug will have no effect on vaginal lubrication.” ANS: B PTS: 1 48. A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes? A. Pelvic inflammatory disease B. Oral contraceptive use for 15 years C. Early menarche D. Diet high in soy protein ANS: A PTS: 1 49. When assessing a woman for infertility, which of the following tests should be done first? A. Hysterosalpingogram B. Magnetic resonance imaging (MRI) C. Analysis of partner’s sperm D. Estrogen level ANS: C PTS: 1 50. A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause? A. “Are you sexually active?” B. “How long have you been underweight?” C. “Was your mother pregnant with you when she was of advanced maternal age?” D. “Have you noticed any changes in your moods lately?” ANS: B PTS: 1 51. What is the most common cause of secondary amenorrhea? A. Pregnancy B. Pituitary dysfunction C. Inadequate estrogen levels D. Genetic disorders ANS: A PTS: 1 52. A 22-year-old woman is diagnosed with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient’s symptoms? A. At least 4 cups of green tea daily B. Regular exercise C. Take vitamin A supplements D. Eat a diet high in iron ANS: B PTS: 1 53. A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of secondary dysmenorrhea? A. Pelvic inflammatory disease B. Endometriosis C. Sexually transmitted infections D. Ovarian cyst ANS: B PTS: 1 54. A 26-year-old woman tells the clinician that she has endometriosis, because she has frequent pelvic pain. The clinician also should consider which of these differential diagnoses? A. Diverticulitis B. Cholelithiasis C. Kidney stones D. Ovarian cysts ANS: D PTS: 1 55. Which of the following would be appropriate treatment for a woman with mild endometriosis? A. Oral contraceptives B. Leuprolide acetate injections C. Nafarelin nasal spray D. Hysterectomy ANS: A PTS: 1 56. A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses? A. Postmenopausal syndrome B. Infertility C. Mittelschmerz D. Polyp ANS: D PTS: 1 57. A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first? A. Transvaginal ultrasound B. Endometrial biopsy C. MRI D. Abdominal computed tomography scan ANS: A PTS: 1 58. Dorothy is a 45-year-old female who complains of a mass in her left breast, dull nipple pain, tenderness of the left nipple, and pasty left nipple discharge. Which of the following conditions should the clinician be most suspicious for? A. Intraductal papilloma B. Hamartomas C. Duct ectasia D. Fibroadenoma ANS: C PTS: 1 59. A 45-year-old woman is seen because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response? A. “You are approaching menopause.” B. “You have a hormonal imbalance.” C. “Your FSH is normal, but your pituitary is making too much LH.” D. “There is an imbalance between your ovaries and pituitary.” ANS: A PTS: 1 60. Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal? A. Pregnancy B. Estrogen level C. Progesterone level D. LH level ANS: A PTS: 1 61. A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer? A. Her numerous pregnancies B. Her age at menopause C. Her father’s history of lung cancer D. Her grandmother’s history of colon cancer ANS: D PTS: 1 62. Which of the following medications is an oral estrogen product for women with menopause? A. Provera 2.5 mg B. Estrace 0.01% C. Alora 0.025 mg D. Premarin 0.3 mg ANS: D PTS: 1 63. Which of the following is an alternative treatment for breast tenderness with premenstrual syndrome? A. Evening primrose oil 250 mg orally up to 3 times daily 2 to 3 days before menses B. Black cohosh 40 to 200 mg orally daily C. Vitamin B complex 50 mg orally daily D. Jasmine essential oil aromatherapy ANS: A PTS: 1 64. A 47-year-old woman presents with complaints of pain with intercourse, intense itching “down there,” and states “it looks different down there.” She denies bleeding, foul odor. Which of the following diagnoses should the clinician consider most likely? A. Atrophic vaginitis B. Trichomoniasis C. Candidiasis D. Vulvar lichen sclerosus ANS: D PTS: 1 Section 10. Musculoskeletal Problems MULTIPLE CHOICE 1. One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure? A. Bone B. Synovium C. Tendons D. Fascia ANS: B PTS: 1 2. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: A. Articular B. Inflammatory C. Nonarticular D. Noninflammatory ANS: A PTS: 1 3. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain? A. Decreased C-reactive protein B. Hyperalbuminemia C. Morning stiffness D. Weight gain ANS: C PTS: 1 4. Which of the following statements concerning the musculoskeletal examination is true? A. The uninvolved side should be examined initially and then compared to the involved side. B. The part of the body that is causing the patient pain should be examined first. C. When possible, the patient should not be asked to perform active ROM exercises to avoid causing pain. D. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient. ANS: A PTS: 1 5. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM but cannot move it above gravity. Which numeric grade of muscle strength would you give this patient? A. 1 B. 2 C. 3 D. 4 ANS: B PTS: 1 6. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis? A. History of hypertension B. Her affected shoulder is also her dominant arm. C. Her history of type 1 diabetes D. Her work as a secretary predisposes her to repetitive motions. ANS: C PTS: 1 7. Jennifer is an 18-year-old woman who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation? A. Anterior dislocations are not painful, and ROM is normal. B. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses. C. X-rays are the only diagnostic testing appropriate to assess a dislocation. D. Most traumatic dislocations are posterior. ANS: B PTS: 1 8. Fred has been diagnosed with a trigger finger of the ring finger. Which of the following management strategies is appropriate? A. Surgical removal of the tendon sheath B. NSAIDs C. Local anesthetic injection into the tendon sheath D. Splinting ANS: C PTS: 1 9. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? A. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. B. People with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. C. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. D. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. ANS: B PTS: 1 10. Which of the following statements is true regarding the treatment of carpal tunnel syndrome? A. The goal of treatment is to prevent flexion and extension movements of the wrist. B. Splints are not used in carpal tunnel syndrome, because they restrict complete movement of the fingers and wrist. C. Corticosteroid injections are encouraged in the treatment of carpal tunnel syndrome. D. Treatment that encourages fluid retention, to keep the joints lubricated, is an emphasis of treatment. ANS: A PTS: 1 11. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? A. Morning stiffness and limited mobility of the lumbar spine B. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain C. Fever, chills, and elevated erythrocyte sedimentation rate D. Pathologic fractures, severe night pain, weight loss, and fatigue ANS: B PTS: 1 12. The clinician has instructed Sirius, a 23-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? A. “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.” B. “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.” C. “You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.” D. “It is important to take NSAIDs on an empty stomach in order to increase absorption.” ANS: A PTS: 1 13. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? A. Gastrocnemius weakness B. A reduced or absent ankle reflex C. Numbness in the lateral foot D. Saddle area anesthesia ANS: D PTS: 1 14. Which of the following statements is true concerning the management of the client with a herniated disc? A. Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use. B. An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. C. Intolerable pain for more than a 3-month period is an indication for surgical intervention. D. Most disc hernias require opioids for long term pain relief. ANS: C PTS: 1 15. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? A. Valgus stress test B. McMurray circumduction test C. Lachman test D. Varus stress test ANS: B PTS: 1 16. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as: A. Apprehension sign B. Bulge sign C. Thumb sign D. Lachman sign ANS: A PTS: 1 17. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs? A. Ability to bear weight immediately after the injury B. Development of minor ankle swelling after the injury C. Slight bruising over the injury site 2 days after injury D. Crepitation with palpation or movement of the ankle ANS: D PTS: 1 18. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician? A. “Complementary therapies should be considered only if surgical interventions are not successful.” B. “I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition.” C. “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai chi, are being studied for use in the treatment of osteoarthritis and acupuncture can be used and is safe and well tolerated.” D. “It would be crazy to use complementary therapies to treat such a serious condition.” ANS: C PTS: 1 19. Chris is a 28-year-old male who complains of lower back pain that began 3 days ago. The pain is worse when he stands or bends, and it is somewhat relieved when he sits. The clinician performs the straight-leg raise test and it is negative. Plain film x-ray is positive. Which diagnosis is most likely? A. Osteoarthritis B. Spinal stenosis C. Scoliosis D. Muscle strain ANS: D PTS: 1 20. A clinician has performed a synovial fluid analysis and the results are as follows: visual analysis: turbid and yellow, viscosity: decreased, 52,000 white blood cells (WBCs) per mm3, polymorphonuclear leukocytes (PMNs): 75%, protein: 5 g/dL. Which of the following conditions could this result be attributed to? A. Rheumatoid arthritis B. Osteoarthritis C. Gout D. Septic arthritis ANS: D PTS: 1 21. Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways? A. By increasing the erosive activity of osteoclasts B. By promoting osteoclastogenesis C. By inhibiting osteoclast apoptosis D. By increasing the activity of osteoblasts ANS: D PTS: 1 22. Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis? A. Bone alkaline phosphatase levels B. Urinary N-telopeptide assay C. Bone mass density measurement by densitometry D. Magnetic resonance imaging ANS: C PTS: 1 23. What is the recommended daily calcium intake for men 70 years and younger? A. 500 mg/day B. 750 mg/day C. 1,000 mg/day D. 1,500 mg/day ANS: C PTS: 1 24. Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates? A. Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs. B. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying. C. This class of drugs can be taken at any time of the day without regard to meals. D. This class of drugs should be taken with orange juice to increase absorption. ANS: B PTS: 1 25. Which of the following medications is appropriate to treat Paget’s disease? A. Boniva B. Fosamax C. Reclast D. Forteo ANS: C PTS: 1 26. Which of the following statements concerning fibromyalgia is true? A. Muscle pain that is caused by the development of trigger points within the muscle cannot occur concurrently with fibromyalgia. B. A cause of myalgia can be fibromyalgia. C. Bursitis cannot coexist with pain from fibromyalgia. D. Fibromyalgia is an inflammatory musculoskeletal disorder. ANS: B PTS: 1 27. One of the most frequent presenting signs/symptoms of osteoporosis is: A. Goiter B. Abnormal serum calcium C. Elevated urine biochemical markers D. Bony fracture ANS: D PTS: 1 28. Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening 1 week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is: A. Ecchymosis, edema, and erythema over the lateral epicondyle B. Pain at the elbow that radiates into the forearm and pain and weakness with gripping objects C. Inability to supinate and pronate the arm D. Inability to flex or extend the elbow against resistance ANS: B PTS: 1 29. A clinician is examining a vertebral fracture, and the examination and diagnostic findings have shown a compression of the anterior column that includes both endplates. What type and subtype are these? A. Compression fracture, type A B. Burst fracture, type B C. Seat-belt type injury, level two D. Fracture-dislocation, shear ANS: A PTS: 1 30. Which of the following would lead the clinician to suspect a tumor when paired with low back pain? A. Minor trauma with sneezing in elderly with osteoporosis B. History of spinal procedure C. Sudden loss of bowel or bladder function D. Unintended weight loss >10% of body weight in 6 months ANS: D PTS: 1 31. A 70-year-old female fell 2 weeks ago and developed immediate pain in her left elbow on the lateral epicondyle. She thought she just bruised it, but is now worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. During your examination, you find she has moderate swelling and ecchymosis, but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do? A. Make an immediate referral for an orthopedic surgical evaluation without further assessment. B. Tell her that it takes time for these bruises to improve, so she should be patient. C. Prescribe a splint for her left wrist and begin corticosteroid injections. D. Send her to the emergency room for reduction of this obvious wrist fracture. ANS: C PTS: 1 32. Debbie is a 43-year-old female being evaluated for a wrist injury. The clinician is assessing for median nerve compression by having Debbie maintain forced flexion of her wrist for 1 minute with the dorsal surface of each hand pressed together. Which of these tests did the clinician just perform? A. Allen’s test B. Phalen’s test C. Tinel’s sign D. Finkelstein’s test ANS: B PTS: 1 33. In which of these athletes is posterior impingement syndrome most commonly seen? A. Cross country runner B. Swimmer C. Soccer player D. Ballet dancer ANS: D PTS: 1 34. The clinician is assessing Sally’s diffuse hip pain. How should the clinician begin the examination? A. Begin the range-of-motion examination with an assessment of the motion that causes pain. B. Physical examination of the hip must first assess its position at rest. C. The patient should move the hip prior to radiographic studies to determine whether they are necessary. D. Flexion and extension of the affected hips’ extremity should only be performed with the knee straight. ANS: B PTS: 1 35. Felice is a 66-year-old female who complains that walking and prolonged standing causes pain and weakness in her legs and buttocks. She expresses that she has short-term relief when she leans on the shopping cart. When she sleeps on her back, she sometimes wakes up in the night in pain. Which of the following diagnoses is most likely? A. Multiple sclerosis B. Herniated lumbar disc C. Lumbar spinal stenosis D. Cervical spondylosis ANS: C PTS: 1 36. Which of the following is a risk factor for overuse syndrome with tendonitis? A. Body mass index <18 B. Hypothyroidism C. Rheumatoid arthritis D. Cardiac disease ANS: C PTS: 1 37. Which diagnostic test is the diagnostic gold standard for patients that have tendonitis and have failed conservative treatment? A. Plain x-ray films B. Magnetic resonance imaging (MRI) C. Computed tomography (CT) scan D. Surgical exploration ANS: B PTS: 1 38. Connie is a 63-year-old seamstress who presents with pain at the base of her right thumb on abduction and extension of her right thumb. She also complains of pain on the radial side of her right wrist with lifting. Which of these diagnostic tests will help to determine if she has de Quervain’s tenosynovitis? A. Allen’s test B. Phalen’s maneuver C. Tinel’s sign D. Finkelstein’s test ANS: D PTS: 1 39. Gladys has begun taking Prolia for osteoporosis. Which of the following should be included in teaching about this medication? A. This medication is an oral pill daily. B. This medication decreases the risk of infection. C. It is contraindicated in the event of hypocalcemia. D. A drug holiday every 8 months is recommended. ANS: C PTS: 1 40. Willow is a 67-year-old female and her bone mineral density is more than 1 SD below the young adult reference mean. What is her diagnosis? A. Normal bone mineral density B. Osteopenia C. Osteoporosis D. Severe osteoporosis ANS: B PTS: 1 Section 11. Endocrine and Metabolic Problems MULTIPLE CHOICE 1. A patient is 66 inches in height, weighing 200 lbs, and newly diagnosed with type 2 diabetes mellitus (DM). The A1c is 7.1%. What is the best initial treatment? A. No treatment at this time B. Diet and exercise C. Diet, exercise, and metformin D. Diet, exercise, and exogenous insulin ANS: C PTS: 1 2. The clinician suspects that a patient seen in the office has hyperthyroidism. Which test should the clinician order on the initial visit? A. Sensitive thyroid-stimulating hormone (TSH) assay and T4 B. Free T4 and serum calcium C. Nuclear scintigraphy with radiolabeled iodine (123I) D. Magnetic resonance imaging ANS: A PTS: 1 3. Which statement made by a patient with type 1 diabetes indicates successful teaching regarding general guidelines for exercise? A. “I will not exercise if my blood sugar is 315.” B. “I should just check my blood glucose after exercise.” C. “I should eat more carbohydrates if my blood glucose is less than 200.” D. “I will exercise when my urine ketones are positive but blood sugar is 260.” ANS: A PTS: 1 4. A male patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first? A. Administer glucagon subcutaneously. B. Have him drink 4 ounces of juice. C. Call 911. D. Ask him about his usual eating habits. ANS: B PTS: 1 5. A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which condition that the patient also has would be a contraindication to taking metformin? A. Ulcerative colitis B. Inflammatory bowel disease C. Chronic obstructive pulmonary disease D. Renal disease ANS: D PTS: 1 6. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which test should be ordered next? A. Serum calcium B. Thyroid-stimulating hormone C. Electrolytes D. Urine specific gravity ANS: B PTS: 1 7. The clinician has been doing diabetic teaching for a patient with type 1 diabetes with no retinopathy. Which statement by the patient would indicate that teaching has been effective? A. “As long as I don’t need glasses, I don’t have to worry about going blind.” B. “I know I need to have my eyes checked every 2 years.” C. “My primary doctor will check my eyes.” D. “I will see my eye doctor when my vision gets blurry.” ANS: B PTS: 1 8. A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense and +1 Achilles reflex. Which of the following would be an appropriate treatment? A. Tricyclic antidepressants B. Angiotensin-converting enzyme inhibitors C. Aspirin D. Insulin ANS: A PTS: 1 9. After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient? A. Suggest the patient use a heating pad to improve circulation. B. Refer to a podiatrist for a foot-care treatment plan. C. Send the patient for acupuncture treatments. D. Recommend increased intake of vitamin B12. ANS: B PTS: 1 10. Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She is also having problems sleeping at night. On physical examination, the clinician finds an irregular heartbeat and hyperactive reflexes. The differential diagnosis should include which condition? A. Myxedema B. Thyrotoxicosis C. Cushing’s syndrome D. Pan-hypopituitarism ANS: B PTS: 1 11. The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which information? A. RAI prevents the peripheral conversion of T4 to T3. B. RAI binds free T4. C. RAI destroys thyroid tissue. D. RAI reduces freely circulating iodine. ANS: C PTS: 1 12. A patient is diagnosed with hypothyroidism. Which electrocardiogram change should the clinician observe as a manifestation of the disease? A. Sinus bradycardia B. Atrial fibrillation C. Supraventricular tachycardia D. U waves ANS: A PTS: 1 13. After 6 months of Synthroid therapy, the clinician should expect which result in the repeat thyroid-stimulating hormone studies? A. Elevated B. Normal C. Low D. Undetectable ANS: B PTS: 1 14. Which laboratory finding should the clinician observe in a patient with untreated Graves’ disease? A. Elevated TSH B. Decreased T3 C. Decreased TSH receptor antibody test D. Elevated antithyroglobulin antibodies ANS: D PTS: 1 15. The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate teaching has been effective? A. “I’ll take my pill before breakfast.” B. “I know to take my Glucotrol at bedtime.” C. “It is important to take my medication right after I eat.” D. “Since I only like to eat two meals a day, I can take the pill between my meals.” ANS: A PTS: 1 16. A male patient with diabetes asks the clinician why he needs to check his blood sugar at home even when he feels good. Which response by the clinician would be most appropriate? A. “Control of glucose will help postpone or delay complications.” B. “Regularly checking blood sugar will help you.” C. “Monitoring glucose will promote a sense of connectedness.” D. “Because you know it is the right thing to do for your disease.” ANS: A PTS: 1 17. How often should the clinician examine the feet of a person with diabetes? A. Every year B. Every 6 months C. Every 3 months D. Every visit ANS: D PTS: 1 18. The clinician sees a patient who has a body mass index (BMI) of 32.4 kg/m2. How would the clinician classify this patient? A. Overweight B. Obesity Class 1 C. Obesity Class 2 D. Obesity Class 3 ANS: B PTS: 1 19. Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient? A. Elevated uric acid level B. Elevated blood urea nitrogen C. Decreased urine pH D. Decreased C-reactive protein ANS: A PTS: 1 20. Which blood test would confirm a diagnosis of diabetes mellitus? A. A1c 5.5% B. Fasting plasma glucose level of 120 mg/dL C. Oral glucose tolerance test 250 mg/dL (2-hour level) D. Random plasma glucose level 175 mg/dL ANS: C PTS: 1 21. Which test should the clinician order to confirm Charcot foot? A. Bone scan of lower extremities B. Computed tomography (CT) scan C. X-ray of the foot D. Culture of the foot ulcer ANS: C PTS: 1 22. A vegetarian patient with gout asks the clinician about foods to avoid. The clinician should advise the patient to avoid which of the following foods? A. Rice B. Carrots C. Spinach D. Potatoes ANS: C PTS: 1 23. The clinician should question the patient with suspected gout about use of which of these medications? A. Antihypertensives B. Thiazide diuretics C. Cardiac glycosides D. Potassium supplements ANS: B PTS: 1 24. The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which data would be most significant for this patient? A. A history of enlarged tonsils in the 1940s B. Recent exposure to mumps C. Vegetarian diet D. Allergy to iodine ANS: A PTS: 1 25. Which of the following is essential for diagnosing thyroid cancer? A. Fine needle aspiration biopsy B. Thyroid ultrasound C. Computed tomography scan D. Magnetic resonance imaging ANS: A PTS: 1 26. Which of the following is a common sign of type 2 DM? A. Anorexia B. Recurrent yeast infection C. Fluid overload D. Elevated high-density lipoprotein cholesterol ANS: B PTS: 1 27. Which medication can cause hyperglycemia? A. Prednisolone (Omnipred) B. Metformin (Glucophage) C. Levothyroxine (Synthroid) D. Cephalexin (Keflex) ANS: A PTS: 1 28. Which laboratory test result is diagnostic for hypoglycemia? A. A1c 7.0% B. Fasting blood sugar of 75 mg/dL C. Glucose level 43 mg/dL D. Random glucose level 64 mg/dL ANS: C PTS: 1 29. Which medication for type 2 diabetes mellitus would be contraindicated during pregnancy? A. Insulin B. Metformin (Glucophage) C. Glipizide (Glucotrol) D. Acarbose (Precose) ANS: C PTS: 1 30. A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which condition should be included in the differential diagnosis? A. Peripheral vascular disease B. Pheochromocytoma C. Cushing’s disease D. Acromegaly ANS: B PTS: 1 31. Which action would the clinician take to elicit Chvostek’s sign? A. Check serum level of glucose after drinking a glass of juice. B. Tap the facial nerve below the zygomatic arch anterior to the earlobe. C. Press into the lower quadrant of the abdomen and release quickly. D. Pump a blood pressure cuff 20 mm Hg above the patient’s systolic pressure. ANS: B PTS: 1 32. The clinician should examine which area for gynecomastia? A. Female’s vagina B. Male’s breast C. Male’s penis D. Female’s ovaries ANS: B PTS: 1 33. Which slightly elevated laboratory result would the clinician observe in a patient with idiopathic hirsutism? A. Free testosterone B. Luteinizing hormone (LH)/follicle-stimulating hormone (FSH) C. Serum calcium D. Albumin ANS: A PTS: 1 34. The clinician is assessing for the most common cause of increased neck size. Which area would the clinician exam? A. Salivary glands B. Lymph nodes C. Thyroid D. Trachea ANS: C PTS: 1 35. Which “P” is a component of “the 3 P’s” of diabetes mellitus? A. Pain B. Paresthesia C. Pallor D. Polyphagia ANS: D PTS: 1 36. A woman presents with new-onset hoarseness with hemoptysis. For which condition should the clinician focus an examination? A. Hyperthyroidism B. Pheochromocytoma C. Cushing’s syndrome D. Thyroid cancer ANS: D PTS: 1 37. Which statement by the patient would indicate teaching has been successful regarding management of Cushing’s syndrome at home? A. “I will take cortisone on an empty stomach.” B. “I will stay away from large crowds.” C. “I will maintain a low-protein diet.” D. “I will avoid foods high in potassium.” ANS: B PTS: 1 38. The patient presents to the clinic with a “buffalo hump,” weight gain, easy bruising, and hyperpigmentation. Which initial diagnostic test should the clinician order? A. 1 mg overnight dexamethasone suppression test B. Abdominal computer tomography scan C. RAI uptake testing D. Early-morning salivary cortisol ANS: A PTS: 1 39. The clinician suspects a patient has Addison’s disease. Which clinical manifestation would the clinician observe upon a physical examination? A. Moon face B. Central obesity C. Hyperpigmentation D. Myxedema coma ANS: C PTS: 1 40. Which hydrocortisone dose would the clinician prescribe for a patient with Addison’s disease? A. 25 to 50 mg daily B. 0.5 to 0.2 mg daily C. 20 mg in the morning and 10 mg in early evening D. 2 to 4 mg in the morning and 1 to 2 mg in the evening ANS: C PTS: 1 41. The patient with type 1 diabetes is exhibiting Kussmaul respirations, anorexia, fatigue, and increased thirst. Which condition should the clinician manage? A. Hypoglycemia B. Somogyi effect C. Diabetic ketoacidosis D. Hyperosmolar hyperglycemic syndrome ANS: C PTS: 1 42. The patient has hyperosmolar hyperglycemic syndrome. Which laboratory findings would the clinician observe? A. Plasma bicarbonate 8 mEq/L B. Blood glucose level 40 mg/dL C. Serum osmolality 420 mOsm/kg D. Blood pH 7.20 ANS: C PTS: 1 43. Which question should the clinician ask to determine the most frequent cause of diabetic ketoacidosis? A. “How often are you taking the insulin?” B. “Which type of infection have you experienced recently?” C. “What type of diet have you been following?” D. “Is there any reason you don’t like taking your medications?” ANS: B PTS: 1 44. A patient with type 1 diabetes has diabetic ketoacidosis. Which first-line treatment should the clinician prescribe? A. NPH insulin B. Regular insulin C. IV normal saline D. Thiazolidinedione ANS: B PTS: 1 45. A nondiabetic patient has idiopathic hypoglycemia. Which dietary instruction should the clinician share with the patient? A. Follow a low-protein, high-carbohydrate diet B. Allow caffeine at each meal C. Avoid nuts and seeds D. Eat six small meals a day ANS: D PTS: 1 46. The clinician is using the HALT acronym to help a patient identify overeating triggers. What does the “T” represent? A. Tired B. Tense C. Temper D. Threats ANS: A PTS: 1 47. The patient weighs 350 lbs and is on a weight loss program. After 6 months, which ideal weight in pounds should the clinician observe? A. 335 B. 325 C. 315 D. 305 ANS: C PTS: 1 48. Which instruction should the clinician include in patient teaching regarding management of obesity? A. Occasionally skipping meals is acceptable. B. Try to use nonstick cookware when baking or frying. C. High-intensity physical activity is recommended. D. Exercise for about 100 minutes per week. ANS: B PTS: 1 49. The patient has metabolic syndrome. The patient is at increased risk for which condition? A. Anxiety disorder B. Gallbladder disease C. Diabetes mellitus D. Hyperparathyroidism ANS: C PTS: 1 50. A 45-year-old male presents with throbbing podagral pain and tophi in the ear pinnae. Which medication should the clinician prescribe for this acute attack? A. Colchicine (Colcrys) B. Probenecid (Benemid) C. Allopurinol (Zyloprim) D. Pegloticase (Krystexxa) ANS: A PTS: 1 Section 12. Hematological and Immunological Problems MULTIPLE CHOICE 1. Sandra is 70 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit? A. Acute lymphoblastic leukemia (ALL) B. Acute myelogenous leukemia (AML) C. Chronic myelogenous leukemia (CML) D. Chronic lymphocytic leukemia (CLL) ANS: D PTS: 1 2. Which type of bone marrow transplant is obtained from an identical twin? A. Xenograft B. Autologous C. Allogeneic D. Syngeneic ANS: D PTS: 1 3. During treatment for anaphylaxis, which site is used for the initial injection of epinephrine? A. Antecubital vein B. Abdomen C. Upper lateral thigh D. Deltoid ANS: C PTS: 1 4. After the initial treatment for anaphylaxis, which medication should be added to prevent late- phase anaphylactic reactions? A. Albuterol B. Diphenhydramine C. H2 blocker D. Corticosteroid ANS: D PTS: 1 5. When analyzing synovial fluid, if it has 10,000 white blood cells/mcL with 80% polymorphonuclear neutrophils (PMNs), it may be indicative of which of the following conditions? A. None, this is a normal result B. Scleroderma C. Rheumatoid arthritis D. Sickle cell disease ANS: C PTS: 1 6. Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist? A. Methotrexate (Rheumatrex) B. Etanercept (Enbrel) C. Rituximab (Rituxan) D. Anakinra (Kineret) ANS: A PTS: 1 7. Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate? A. PEP treatment regimens contain two antiretroviral medications. B. PEP should be started within 72 hours of exposure. C. PEP follow-up requires renal function tests at 6 weeks after beginning PEP. D. PEP will prevent potential hepatitis C infection, if present. ANS: B PTS: 1 8. For which patient would the clinician recommend annual HIV testing? A. One who is in a mutually monogamous relationship that engages in anal sex B. One who is a migrant worker C. One who is diagnosed with viral hepatitis D. One who is pregnant with second child from another male ANS: C PTS: 1 9. Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate? A. A favorable prognostic trend B. Disease progression C. The need to be more aggressive with Reuben’s medications D. Drug resistance mutations ANS: A PTS: 1 10. A patient with atrial fibrillation is taking warfarin (Coumadin) and has an international normalized ratio (INR) of 4.0 with no active bleeding. How should the clinician manage this patient? A. Stop the medication for 1 week, and then repeat the INR. B. Withhold 1 or more days of anticoagulant therapy. C. Restart therapy at a lower dose immediately. D. Slowly increase the dose over 3 days. ANS: B PTS: 1 11. The patient with severe iron deficiency anemia is eating ice chips. Which term should the clinician use to document this finding? A. Cheilosis B. Anorexia C. Hypochromasia D. Pica ANS: D PTS: 1 12. As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin? A. Two B. Three C. Four D. Five ANS: B PTS: 1 13. What is the most common cause of microcytic anemia? A. Anemia of chronic disease B. Sideroblastic anemia C. Iron-deficiency anemia D. Pernicious anemia ANS: C PTS: 1 14. Which symptom is the cardinal subjective symptom of sickle cell crisis? A. Pain B. Nausea C. Light-headedness D. Palpitations ANS: A PTS: 1 15. Which phrase describes rheumatoid arthritis (RA)? A. Localized synovial joint destruction B. Chronic exocrine dysfunction C. Systemic inflammatory disease D. Antibody-mediated cellular cytotoxicity response ANS: C PTS: 1 16. Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process? A. Erythrocyte sedimentation rate B. White blood cell count C. Polymorphonuclear cells D. C-reactive protein (CRP) ANS: D PTS: 1 17. Infectious mononucleosis results from an acute infection with which of the following? A. Epstein-Barr virus B. Acute HIV infection C. Guillain-Barré D. Hepatitis ANS: A PTS: 1 18. Which condition is the most common cause of generalized musculoskeletal pain in women ages 20 to 55? A. Chronic fatigue syndrome B. Anemia C. Fibromyalgia syndrome D. Sports-related injuries ANS: C PTS: 1 19. After returning from visiting his grandchildren in Connecticut, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. Which disease should the clinician be considering? A. Rubella B. Lyme disease C. Fibromyalgia syndrome D. Shingles ANS: B PTS: 1 20. Dryness of the eyes and mouth is typical of which condition? A. Sjögren’s syndrome B. Allergic reaction C. Hypothyroidism D. Sideroblastic anemia ANS: A PTS: 1 21. Exposure to ultraviolet (UV)-B and UV-A rays is a triggering factor for acute exacerbations of which condition? A. Rheumatoid arthritis B. Gout C. Systemic lupus erythematosus D. Sjögren’s syndrome ANS: C PTS: 1 22. What is the current goal of treatment for a patient with HIV infection? A. Viral suppression to undetectable levels B. Compete eradication of the virus C. Limit contact with uninfected individuals D. Total abstinence ANS: A PTS: 1 23. Which test should the clinician use to initially screen for HIV? A. Western blot B. Enzyme-linked immunosorbent assay C. HIV-1/2 antigen/antibody combination immunoassay D. Nucleic acid amplification testing ANS: C PTS: 1 24. Which lab test would the clinician order to monitor for a significant side effect from tenofovir disoproxil fumarate? A. Urine protein B. Allele genetic testing C. Sodium level D. Hemoglobin ANS: A PTS: 1 25. Which drug category of antiretroviral (ARV) therapy is generally effective in crossing the blood–brain barrier and may be useful in managing HIV-associated dementia? A. Nucleoside reverse transcriptase inhibitors B. Protease inhibitors C. Integrase inhibitors D. Nonnucleoside reverse transcriptase inhibitors ANS: D PTS: 1 26. Spontaneous bruising may be seen with platelet counts below what level? A. 100,000 cells/mL B. 75,000 cells/mL C. 50,000 cells/mL D. 30,000 cells/mL ANS: D PTS: 1 27. Which type of fatigue may improve with exercise after awakening? A. Functional B. Acute C. Persistent D. Anemia associated ANS: A PTS: 1 28. Which assessment finding presents with early rheumatoid disease? A. Pain and swelling in both small and large peripheral joints B. Rigid joints with diminished range of motion C. Joint swelling and immobility on rising D. A cardiac rub with pulmonary friction rub ANS: C PTS: 1 29. Which test is diagnostic of RA? A. Rheumatoid factor B. Erythrocyte sedimentation rate C. C-reactive protein D. Anti-citrulline-containing peptide titers ANS: D PTS: 1 30. What is the mainstay of management for infectious mononucleosis? A. Antivirals B. Symptom control C. Corticosteroids D. Isolation ANS: B PTS: 1 31. Chronic fatigue syndrome (CFS) tends to occur in which individuals? A. Active, highly functional adults B. Depressed middle-aged adults C. Individuals with a depressed immune system D. Individuals who are hypochondriacs ANS: A PTS: 1 32. What is the bulls-eye rash of Lyme disease called? A. Erythema infectiosum B. Viral exanthem C. Erythema migrans D. Morbilliform exanthem ANS: C PTS: 1 33. Which condition if left untreated will progress to complaints that include multiple joint arthritis? A. Sjögren’s syndrome B. HIV/AIDS C. Guillain-Barré D. Lyme disease ANS: D PTS: 1 34. Keratoconjunctivitis sicca is a classic sign of which condition? A. Systemic lupus erythematosus B. Sjögren’s syndrome C. Fibromyalgia syndrome D. Lyme disease ANS: B PTS: 1 35. Which person is four times more likely to develop systemic lupus erythematosus (SLE) than a Caucasian? A. One of African descent B. An Asian C. A Hispanic D. One from the Middle East ANS: A PTS: 1 36. The older adult patient has an infection. The clinician should assess for which clinical manifestation? A. Fever B. Dementia C. Confusion D. Ecchymosis ANS: C PTS: 1 37. Which aspect should the clinician consider when trying to determine the cause of lymphadenopathy? A. Prothrombin time B. Marital status C. Patient’s age D. Blunt trauma ANS: C PTS: 1 38. The patient has a fever of 104.2°F (40.1°C). Which condition should the clinician be considering as the etiology of the fever? A. Urinary tract infection B. Infectious hepatitis C. Tuberculosis D. Pancreatitis ANS: D PTS: 1 39. Which type of hypersensitivity reaction should the clinician suspect in a patient who has an elevated IgE level? A. 1 B. 2 C. 3 D. 4 ANS: A PTS: 1 40. In which area would the clinician evaluate a tender point in a patient with suspected fibromyalgia syndrome (FMS)? A. Fifth rib B. Trapezius C. Maxillary D. Midforearm ANS: B PTS: 1 41. A patient has CFS. Which strategy should the clinician consider to manage this patient? A. Bedrest B. High-impact exercise C. Thermal biofeedback D. Cognitive-behavioral therapy ANS: D PTS: 1 42. Which classic rash should the clinician assess for in a patient with SLE? A. Butterfly B. Bulls-eye C. Ringworm D. “Slapped” cheeks ANS: A PTS: 1 43. Which blood cell is excessively elevated in a person who has polycythemia? A. Platelets B. Neutrophils C. Red blood cells D. All types of blood cells ANS: C PTS: 1 44. Which treatment would the clinician recommend for a patient who has relative polycythemia? A. Rehydration B. Antihistamines C. Weekly phlebotomies D. Referral to hematologist ANS: A PTS: 1 45. Which behavior would the clinician advise the patient with sickle cell anemia to avoid? A. Becoming overhydrated B. Taking folic acid supplements C. Becoming physically overtaxed D. Taking rest periods during the day ANS: C PTS: 1 46. The clinician must differentiate chronic vitamin B12 deficiency anemia from folate deficiency anemia. Which action should the clinician take? A. Obtain a complete blood count B. Assess for peripheral neuropathy C. Inspect for smooth surface on tongue D. Determine the size of the red blood cell ANS: B PTS: 1 47. Which finding from the bone marrow aspiration is typical in a patient with CML? A. Schistocytes B. Howell-Jolly bodies C. Hemoglobin S gene D. Philadelphia chromosome ANS: D PTS: 1 48. How long would the clinician inform the patient to rest after onset of infectious mononucleosis? A. 4 days B. 10 days C. 2 weeks D. 4 weeks ANS: D PTS: 1 49. A patient presents with symptoms of infectious mononucleosis. Which lab chemistry test should the clinician order? A. Viral load B. Hemoglobin A1c C. Western blot assay D. Heterophile antibody test ANS: D PTS: 1 50. The advance practice registered nurse (APRN) is providing a community health program for the prevention of Lyme disease. Which information should be included? A. Safe sex practices B. Hiking precautions C. Smoking cessation D. Vaccination schedules ANS: B PTS: 1 Section 13. Psychosocial Problems MULTIPLE CHOICE 1. The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Dopamine D. Serotonin ANS: B PTS: 1 2. The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least: A. 1 month B. 3 months C. 6 months D. 12 months ANS: C PTS: 1 3. A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack? A. Pheochromocytoma B. Hyperthyroidism C. Cardiac arrhythmias D. All of the above ANS: D PTS: 1 4. Which of the following is considered first-line treatment for panic disorders? A. Benzodiazepines B. Selective serotonin reuptake inhibitors (SSRIs) C. Tricyclic antidepressants D. Cognitive behavioral therapy ANS: D PTS: 1 5. Which of the following symptoms is NOT part of the diagnostic criteria for post-traumatic stress disorder (PTSD)? A. Hypersomnolence B. Blunted feelings C. Loss of interest in significant activities D. Intrusive recurrent recollections of the event ANS: A PTS: 1 6. Which of the following neuroendocrine abnormalities is implicated in depression? A. Decrease in adrenal size B. Hypersecretion of cortisol C. An exaggerated response of thyrotropin (TRH) to infusion of thyroid-releasing hormone D. Increased inhibitory response of glucocorticoids to dexamethasone ANS: B PTS: 1 7. The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is NOT true concerning SSRIs in comparison to tricyclic antidepressants? A. SSRIs are more effective than TCAs. B. SSRIs take less time to work than TCAs. C. SSRIs have a more favorable side-effect profile than TCAs. D. SSRIs are not lethal in overdose. ANS: A PTS: 1 8. After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor? A. 2 weeks B. 3 weeks C. 4 weeks D. 5 weeks ANS: D PTS: 1 9. It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period? A. Prior to the antidepressant reaching therapeutic levels B. As the mood lifts in response to antidepressant treatment C. During dosage or medication adjustments D. After the patient reveals suicidal thoughts or plans ANS: B PTS: 1 10. A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the following approaches to treating these side effects? A. Give the patient a “drug holiday” until the symptoms resolve and then restart the medication. B. Switch the patient to a different antipsychotic. C. Treat the patient with anticholinergics. D. Treat the patient with anticonvulsants. ANS: C PTS: 1 11. According to Kübler-Ross, the stages of grief occur in which order? A. Anger, denial, depression, bargaining, acceptance B. Anger, denial, bargaining, acceptance, depression C. Denial, anger, depression, bargaining, acceptance D. Denial, anger, bargaining, depression, acceptance ANS: D PTS: 1 12. The clinician is educating a patient about the effects of marijuana. The patient stated that she has been smoking for years and believes the use does not interfere with her life. What is the potential long-term sequelae of marijuana use that the clinician should educate this patient about? A. Memory impairment B. Sexual dysfunction C. Dry mouth D. There are no long-term consequences of marijuana use ANS: A PTS: 1 13. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter? A. GABA B. Acetylcholine C. Dopamine D. Serotonin ANS: C PTS: 1 14. What blood alcohol level corresponds with the signs of stupor and confusion? A. 0.05 B. 0.1 C. 0.2 D. 0.3 ANS: D PTS: 1 15. Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep? A. Every 30 to 40 minutes B. Every 60 to 80 minutes C. Every 90 to 100 minutes D. Every 180 to 200 minutes ANS: C PTS: 1 16. Which of the following is a laboratory finding commonly found in patients with anorexia nervosa? A. Hypophosphatemia B. Hypermagnesmia C. Leukocytosis D. Decreased TRH ANS: A PTS: 1 17. Which of the following is the only drug used to treat bulimia that is approved by the U.S. Food and Drug Administration? A. Sertraline B. Fluoxetine C. Citalopram D. Imipramine ANS: B PTS: 1 18. Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)? A. Liver function B. Vision C. Growth parameters D. Renal function ANS: C PTS: 1 19. It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault? A. Depression B. Obsessive-compulsive disorder C. Substance abuse D. PTSD ANS: D PTS: 1 20. Women are at the highest risk for developing peripartum depression for up to how long after childbirth? A. 1 to 3 weeks B. 1 month C. 3 to 6 months D. 7 months to 1 year ANS: A PTS: 1 21. Which is the most prevalent psychiatric condition in the United States? A. Depression B. Anxiety C. Substance-related addictions D. Gambling addiction ANS: B PTS: 1 22. What is recorded as clinical category two of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)? A. Clinical disorder or focus of clinical attention B. Personality or environmental problems C. Environmental and psychosocial stressors D. Global assessment of functioning ANS: C PTS: 1 23. Which of the following may be used to evaluate a person’s suicide risk? A. CAGE B. SANE C. SAD PERSONAS D. DIGFAST ANS: C PTS: 1 24. What is the essential feature of bipolar-I? A. Hyperactivity B. Mania C. Depression D. Anxiety ANS: B PTS: 1 25. Bipolar disorder requires differential diagnosis from all of the following except? A. Substance abuse and medication effects B. Medical and neurological disorders C. Cluster B personality disorders and depression D. Obsessive-compulsive disorder ANS: D PTS: 1 26. All benzodiazepines are associated with: A. Potential anterograde amnesia B. Dopamine-related movement disorders C. Serotonin syndrome D. Xerostomia and agitation ANS: A PTS: 1 27. Which medication is used as a first-line treatment in the management of bipolar disorder? A. Gabapentin B. Lamotrigine C. Carbamazepine D. Topiramate ANS: C PTS: 1 28. HITS is a validated instrument used to identifying intimate partner violence. What does HITS stand for? A. Hit, Injured, Threatened, Scared B. Hurt, Insult, Threaten, Scream C. Humiliated, Isolated, Tortured, Scarred D. Harm, Injury, Terror, Shame ANS: B PTS: 1 29. Emotional dysregulation is common in: A. Children with obsessive-compulsive disorder B. Adults with schizophrenia C. Adults with attention deficit-hyperactivity disorder D. Children with tic disorders ANS: C PTS: 1 30. The stooped posture, motor slowness, and minor cognitive impairments of patients with major depressive disorders are similar to the signs of disorders of the basal ganglia, such as: A. Parkinson’s disease B. Stevens-Johnson syndrome C. Neurological disease D. Huntington’s disease ANS: A PTS: 1 31. A serious physical illness in any organ category is: A. An independent risk factor for geriatric suicide B. Likely to occur with body dysmorphic disorder C. Associated with mood disorders D. Likely to produce anxiety or panic disorders ANS: A PTS: 1 32. Suicide plans are assessed on all of the following, EXCEPT: A. Specificity B. Possibility C. Availability D. Lethality ANS: B PTS: 1 33. What is the median reduction in life expectancy among those with mental illness? A. 15.4 years B. 10.1 years C. 5.7 years D. 9.2 years ANS: B PTS: 1 34. Which of the following is a potential adverse reaction to clozapine (Clozaril)? A. Prolonged QT interval B. Hyperprolactinemia C. Postural hypotension D. Myocarditis ANS: D PTS: 1 35. Each of the following antidepressants does NOT have significant liver CYP P450 interaction effects? A. Paroxetine B. Fluoxetine C. Fluvoxamine D. Olanzapine ANS: D PTS: 1 36. What term describes random quick jerking movements that flow from joint to joint? A. Dystonia B. Chorea C. Myoclonus D. Compulsions ANS: B PTS: 1 37. Instead of reporting symptoms of body dysmorphic disorder (BDD) to the primary-care provider, patients often request which of the following? A. Referrals to plastic surgeons, orthodontists, or dermatologists B. Antidepressant medications C. Nutritional counseling services D. Unnecessary laboratory tests ANS: A PTS: 1 38. What is the leading preventable cause of death and disability? A. Opioid addiction B. Obesity C. Tobacco use D. Stress ANS: C PTS: 1 39. What is a common adverse reaction for children prescribed Risperdal for autism-associated irritability? A. Gynecomastia B. Parkinsonian-like syndrome C. Bradycardia D. Rebound hypertension ANS: B PTS: 1 40. What is the advantage of guanfacine (i.e., Tenex, Intuniv) over clonidine (i.e., Catapres, Kapvay) for the treatment of ADHD? A. Tapering off is not required on discontinuation B. Therapeutic effect is instantaneous C. Wider range of available dosages D. Less sedation and longer duration of action ANS: D PTS: 1 41. What is a differential diagnosis of autism spectrum disorder? A. Speech sound disorder B. Duchenne muscular dystrophy C. Structural brain malformations D. Hypoxic ischemic brain injury ANS: A PTS: 1 42. Which intervention has been shown to diminish feelings of isolation, improve coping skills, and decrease the need for hospitalization in schizophrenia? A. Cognitive behavioral therapy B. Peer-delivered services C. Family-based therapy D. Assertive community treatment (ACT) model of care ANS: B PTS: 1 43. What is the likely result of the over-prescription, over-supply, and over-production of opioids? A. Opioid use B. Opioid abuse C. Opioid dependence D. Opioid resistance ANS: B PTS: 1 44. What is the health impact of low-dose alcohol consumption? A. Increased risk of developing alcohol addiction B. Increased risk of coronary artery disease C. Increased excitation of critical ion channels D. Increased high-density lipoproteins ANS: D PTS: 1 45. Echolalia is sometimes demonstrated by people with which disorder? A. Autism B. Alcoholism C. ADHD D. Asperger’s ANS: A PTS: 1 46. What prenatal factor could increase risk for ADHD? A. Exposure to lead B. Zinc deficiency C. Maternal allergies D. Central nervous system (CNS) infections ANS: B PTS: 1 47. If stimulant drugs are not tolerated or contraindicated for the treatment of ADHD, what medication may produce a therapeutic effect? A. Daytrana B. Vyvanse C. Warfarin D. Atomoxetine ANS: D PTS: 1 48. What is the presentation of a complex motor tic? A. Simultaneous shoulder shrugs and head turns B. Eye blinks and extension of extremities C. Throat clearing and finger raising D. Barking, screaming, and snorting ANS: A PTS: 1 49. What is the most prevalent psychiatric comorbidity of ADHD? A. Antisocial personality disorder B. Generalized anxiety disorder C. Oppositional defiant disorder D. Social phobias ANS: C PTS: 1 50. What severity level of intellectual disability is demonstrated by a child whose language and academic skills markedly lagging behind peers, misperceive social cues, and have a simpler spoken language than their peers? A. Mild B. Moderate C. Severe D. Profound ANS: B PTS: 1 Section 14. Urgent Care Problems MULTIPLE CHOICE 1. Which type of heat-related illness involves a core body temperature of at least 104°F and may present with hot dry skin, acute mental status changes, absent sweat, and tachypnea? A. Heat cramps B. Heat syncope C. Heat exhaustion D. Heat stroke ANS: D PTS: 1 2. What percentage of burns is involved using the rule of nines if both front legs are burned? A. 9% B. 18% C. 24% D. 36% ANS: B PTS: 1 3. Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries? A. Clotrimazole cream (Lotrimin) B. Mafenide acetate (Sulfamylon) C. Silver nitrate D. Silver sulfadiazine (Silvadene) ANS: D PTS: 1 4. A sunscreen with a sun-protection factor of at least what number will block most harmful ultraviolet radiation? A. 4 B. 8 C. 10 D. 15 ANS: D PTS: 1 5. Which clinical feature is a late sign of increased intracranial pressure? A. Dilated, nonreactive pupils B. Altered level of consciousness C. Loss of judgment D. Amnesia ANS: A PTS: 1 6. What number represents normal neurological function on the Glasgow Coma Scale? A. 7 B. 9 C. 10 D. 15 ANS: D PTS: 1 7. Which diagnostic test is the best to diagnose a subdural hematoma? A. History B. Positron emission tomography C. Magnetic resonance imaging (MRI) D. Computed tomography (CT) scan ANS: C PTS: 1 8. Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point? A. 5% to 15% B. 20% to 25% C. 30% to 50% D. 60% to 80% ANS: C PTS: 1 9. Most adult poisonings are: A. Intentional and self-inflicted B. Accidental C. Caused by someone wishing to do harm to the person D. Not attributed to any reason ANS: A PTS: 1 10. Which method is used to remove heavy metals, such as lead? A. Chelation B. Dialysis C. Gastric lavage D. Bowel irrigation ANS: A PTS: 1 11. If a previously frostbitten area becomes frostbitten again after it has healed, what might occur? A. Permanent tissue damage may occur, resulting in necrosis to that body part. B. The area will be super sensitive. C. The area is prone to a repeat frostbite. D. The area is as susceptible as any other area. ANS: A PTS: 1 12. What population represents almost 75% of wounds? A. Boys in the mid-to-late teens B. Men in their early 20s C. Women in the mid-40s D. Toddlers between 18 and 30 months ANS: B PTS: 1 13. Which solution should be used when irrigating lacerated tissue over a wound on the arm? A. Dilute povidone-iodine solution B. Hydrogen peroxide (H2O2) C. Saline solution infused with an antibiotic D. Saline irrigation or soapy water ANS: D PTS: 1 14. Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact? A. Superficial burns B. Superficial partial-thickness burns C. Deep partial-thickness burns D. Full-thickness burns ANS: C PTS: 1 15. Which carboxyhemoglobin (COHb) level correlates with the clinical symptoms of confusion, lethargy, and ST-segment depression on the electrocardiogram? A. Less than 10% B. 20% COHb C. 30% COHb D. 40% to 60% COHb ANS: C PTS: 1 16. Which causes the greatest percentage of mammalian bites? A. Dogs B. Cats C. Humans D. Rodents ANS: A PTS: 1 17. Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue? A. Tick B. Brown recluse spider C. Wasp D. Stinging caterpillar ANS: B PTS: 1 18. What condition is sometimes confused with anaphylaxis from an insect sting? A. Heat stroke B. Toxic syndrome C. Vasovagal reaction D. Inflammatory response ANS: C PTS: 1 19. Delayed serum sickness–type reactions in response to multiple bee, wasp, or fire-ant stings can be managed with which of the following? A. A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2 weeks B. An oral antihistamine, such as hydroxyzine, for 2 weeks C. An H2 blocker such as cimetidine for 1 week D. 0.1 mg (1 mL of 1:10,000 solution epinephrine) in 10 mL of normal saline and administer as a slow IV push over 10 minutes ANS: A PTS: 1 20. After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)–filled spaces within the head? A. Pneumocephalus B. Hemotympanum C. Battle’s sign D. Raccoon sign ANS: A PTS: 1 21. CSF may leak through the cribriform plate region of the skull following a head injury and cause which of the following? A. Ear CSF otorrhea B. Leakage of CSF from the eye C. Nasal CSF rhinorrhea D. Leakage of CSF from the mouth ANS: C PTS: 1 22. What condition is characterized by a brief loss of consciousness, then a brief “lucid” moment, followed by momentary unconsciousness minutes after the injury? A. Concussive hematoma B. Bleeding dyscrasias C. Subdural hematoma D. Epidural hematoma ANS: D PTS: 1 23. A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? A. CN II B. CN III C. CN IV D. CN V ANS: C PTS: 1 24. A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? A. A sprain B. A strain C. A partial fracture D. A fracture ANS: B PTS: 1 25. In a healthy adult, the process of remodeling after fracture of the humerus takes how long? A. Approximately 4 weeks B. Approximately 2 months C. Approximately 3 months D. Approximately 4 months ANS: B PTS: 1 26. A patient who sustains blunt chest trauma and/or penetrating chest trauma must have which of the following imaging examinations? A. Upright anterior/posterior and lateral chest x-ray B. Supine anterior/posterior and lateral chest x-ray C. Upright bilateral chest x-ray D. Supine anterior/posterior chest x-ray ANS: A PTS: 1 27. If a suspected pneumothorax is discovered in the primary-care setting, what should happen first? A. Emergency medical services should be activated. B. Support cardiovascular and respiratory status as needed. C. Administer supplemental oxygen to reabsorb the pneumothorax. D. Initiate stabilizing treatments, including emergency chest-tube placement. ANS: A PTS: 1 28. Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication? A. Phenobarbital B. Diazepam C. Ritalin D. Acetaminophen ANS: D PTS: 1 29. Pink, cherry-red tissues and skin may result from which type of poisoning? A. Arsenic B. Lead C. Carbon monoxide D. Strychnine ANS: C PTS: 1 30. In which type of burn is the injury more extensive than it appears, and the cardiac conduction system may be affected, leading to sudden death or arrhythmias? A. Chemical burns B. Electrical burns C. Radiation burns D. Thermal burns ANS: B PTS: 1 31. Eddie, age 4, presents to the emergency department with a live insect trapped in his ear canal causing a lot of distress. What should be your first step? A. Remove the insect with tweezers. B. Immobilize the insect with 2% lidocaine. C. Sedate Eddie with diazepam. D. Shine a light in the ear for the insect to “find its way out.” ANS: B PTS: 1 32. When giving discharge instructions to a patient with a laceration injury to his lower leg, which is the most important one? A. Recommend isometric exercises to prevent a deep vein thrombosis (DVT). B. Recommend cleansing the wound every 4 hours to prevent an infection. C. Keep the leg elevated at waist level to prevent any edema. D. Keep the leg completely immobile to prevent extension of the laceration. ANS: A PTS: 1 33. Cerebellar function may be assessed by performing which examination/test? A. Gag reflex B. Pupillary response C. Romberg’s test D. Apley’s test ANS: C PTS: 1 34. In the epithelialization phase of wound healing, the wound will have only what percentage of its normal tensile strength at 3 weeks? A. Less than 15% B. 15% to 20% C. 25% to 40% D. Greater than 50% ANS: B PTS: 1 35. Which of the following statements is true about antibiotic prophylaxis for most wounds? A. Antibiotics are not indicated. B. Antibiotics should always be ordered for a wound. C. Antibiotics need to be ordered for at least 2 weeks. D. Antibiotics should be ordered only if sutures are in place. ANS: A PTS: 1 36. Which condition is often an unrecognized contributor to heat-related illness? A. Autonomic neuropathy B. Beta-adrenergic blockade C. Myocardial infarction D. Acclimatization ANS: B PTS: 1 37. Why do benzodiazepines have less potential for toxicity than barbiturates? A. They cause decreased neuronal activity, depressed central sympathetic tone, and inhibit cardiac contractility. B. They increase ligand affinity and the frequency of ion channel opening, but not the duration of time the channel remains open. C. They act directly on inhibitory gamma-aminobutyric acid (GABA) receptors. D. They increase the average opening time of chloride ion channels. ANS: B PTS: 1 38. What is the most common cause of infectious conjunctivitis? A. Adenovirus B. Rhinovirus C. Staphylococcus aureus D. Streptococcus ANS: A PTS: 1 39. A patient presents to the emergency department with delirium, dilated pupils bilaterally, and hypoactive bowel sounds. Skin is flushed and dry; mucous membranes are dry. Upon admission, a urinary catheter was inserted with no output. These clinical manifestations describe which common toxidrome? A. Cholinergic B. Sedative-hypnotic C. Anticholinergic D. Sympathomimetic ANS: C PTS: 1 40. Why are people with cystic fibrosis (CF) especially vulnerable to heat stroke? A. Intravascular coagulation prevents the production of chloride. B. Blood flow to the skin is impaired in temperatures above 95°. C. Sweat glands are inactive in CF. D. Salts from perspiration are not reabsorbed after sweating. ANS: D PTS: 1 41. What is true about an acclimatized person? A. Aldosterone secretions are diminished B. Heat dissipation is impeded C. Cardiac output increases D. Aerobic muscle metabolism decreases ANS: C PTS: 1 42. If no clinical decompensation is noted when evaluating a poisoned patient, what should you do next? A. Evaluate for signs of trauma and central nervous system involvement. B. Evaluate the airway, breathing, and circulation. C. Order a basic metabolic panel and liver function test panel. D. Obtain a urine sample for a toxicology screen. ANS: A PTS: 1 43. What should you use to alkalinize urine to a pH of greater than 7.0? A. Dextrose B. Sodium bicarbonate C. Activated charcoal D. Ipecac syrup ANS: B PTS: 1 44. What is the most dangerous complication of acute mastoiditis? A. Otitis media with effusion B. Meningitis C. Tympanic membrane rupture D. Intracranial abscess ANS: D PTS: 1 45. What would confirm if the joint was tapped in a knee fracture? A. A presence of hemarthrosis with fat globules B. The inability to flex the knee joint C. A large effusion D. Pain is elicited during passive range of motion ANS: A PTS: 1 46. Hyperhidrosis (trench foot) is a differential diagnosis for what condition? A. Hyperthermia B. Necrosis C. Frostbite D. Erythema pernio ANS: C PTS: 1 47. What is the aim of gastrointestinal decontamination for poisoned patients? A. Evacuating toxins from the stomach before they can be absorbed. B. Neutralizing the poison by inducing vomiting and diarrhea. C. Restricting the amount of xenobiotic from reaching the systemic circulation. D. Absorbing the toxins that have reached systemic circulation. ANS: C PTS: 1 48. What must be present for a diagnosis of acute diarrhea? A. Positive test for bacterial, viral, or parasitic infection B. Passing six or more stools daily without improvement for at least 3 days C. Loose stools with fever greater than 100°F D. Greater than 50% ANS: B PTS: 1 49. Which of the following is not a cause of secondary constipation? A. Hard stools B. Diet C. Pregnancy D. Medications ANS: A PTS: 1 50. Which of the following is not a differential diagnosis of heat stroke? A. Cerebrovascular accident B. Central nervous system infections C. Diabetic ketoacidosis D. Alcohol intoxication ANS: D PTS: 1 Chapter 76. Sports Physicals MULTIPLE CHOICE 1. Which of the following is TRUE regarding sports physicals? A. The sports physical as a screening tool changes and updates yearly. B. They are meant to exclude athletes who are not in shape from participation in sports. C. The sports physical is a formal requirement, and it is done annually. D. They are only done prior to junior year to determine participation in high school sports. ANS: C PTS: 1 2. Tatiana is receiving a sports physical to participate in cross-country running. She receives her exam from a single provider, who is examining all of the athletes one after the other in the nurse’s office at school. Which of the following is a problem with this exam format for sports physicals? A. It is expensive, and her school will have to use a large amount of its budget to fulfill the sports physical requirement. B. It lacks individual attention that could increase the risk of insufficient medical history. C. It is disorganized, and the athletes may have the potential for inadequate integration of findings. D. It lacks privacy and the students may feel that their medical information is not being kept confidential. ANS: B PTS: 1 3. Tyler is a 16-year-old football player who has an appointment for his sports physical. He had a head hit yesterday while playing with friends, and went to the emergency room. He was discharged with a diagnosis of a concussion. Today he feels dizzy, has noise sensitivity, and had trouble sleeping last night. Which of the following options is best for the clinician to pursue? A. Complete a formal Balance Error Scoring System (BESS) and neuropsychologic testing before clearing him to play. B. Clear him to play, because the emergency room discharged him and these symptoms are normal after a head hit. C. Clear him to play in a week when his symptoms will subside. D. Refuse to clear him because he had a concussion and should not be playing football at all anymore. ANS: A PTS: 1 4. The clinician is seeing Dahlia, a 15-year-old swimmer, for a sports physical. During examination, she notes she has had difficulty breathing while swimming over the last 3 days. Which of the following options is best for the clinician to pursue? A. Clear her to participate in swimming, as it is common to have some days of difficulty on exertion, especially if she has not been as active the week before. B. Refer Dahlia to the sports trainer prior to clearing her so she can work on her form and have less difficulty on exertion. C. Complete a workup for pulmonary hypertension, anemia, asthma, and cardiovascular issues prior to clearing her for participation. D. Send her to the emergency room immediately, as this is very concerning and needs to be urgently addressed. ANS: C PTS: 1 5. Richard is a 14-year-old male with a history of a broken radius, hemophilia, and attention deficit-hyperactivity disorder (ADHD). He is requesting a sports physical because he would like to be more active. He asks which sport would be best for him. Based on Richard’s history, which sport would be the best fit? A. Football B. Swimming C. Rugby D. Wrestling ANS: B PTS: 1 6. Which of the following is the most common cause of cardiac death in athletes? A. Hypertrophic cardiomyopathy B. Supraventricular tachycardia C. Atrial flutter D. Conduction block ANS: A PTS: 1 7. Dominic is a 17-year-old male who is 6 feet 6 inches tall. He has a thin build, pectus carinatum, and flexible joints. Which of the following tests should the clinician perform for Dominic? A. Chest x-ray to evaluate for signs of potential pneumothorax B. Abdominal computed tomography (CT) scan to assess for stomach distention C. Magnetic resonance imaging (MRI) to evaluate for scoliosis of the spine D. Echocardiography to assess for signs of aortic root dilatation ANS: D PTS: 1 8. Henry is an 18-year old male who would like to play soccer. He was the star forward last year, and would like to continue playing because his team is counting on him for their championship game. The clinician has discovered that he has scabies. Which of the clearance options is appropriate at this time? A. Unrestricted clearance. B. Clearance if he promises to refrain from contact with the other players during the game. C. Clearance after completion of treatment for scabies. D. Disqualification. ANS: C PTS: 1 9. Which of the following should be gathered from the family history during a sports physical? A. History of ADHD B. History of heart disease C. History of broken bones D. History of cancer ANS: B PTS: 1 10. Which of the following sports would be appropriate for a patient with sickle cell disease? A. Football B. Boxing C. Archery D. Wrestling ANS: C PTS: 1 11. The clinician is examining the skin of Mary, who would like to be cleared to play beach volleyball. What is the clinician’s most important focus point when looking at her skin? A. Color of her skin, to see if she is easily sunburnt B. Acne, to see if she has sensitivity to perspiration C. Freckles, to assess if she potentially has a melanoma D. Contagious diseases, such as tinea, boils, impetigo, or herpes ANS: D PTS: 1 12. Daphne is a 16-year-old female who has renal agenesis. Which of the following sports would she be cleared to play? A. Fencing B. Wrestling C. Soccer D. Lacrosse ANS: A PTS: 1 13. Ralph is a 13-year-old male with a history of anophthalmia. Which sport should the clinician clear him to play? A. Baseball B. Golf C. Martial arts D. Field hockey ANS: B PTS: 1 14. The clinician is examining the back of Christian, a 15-year-old male. What is the correct way for the clinician to check for hamstring flexibility? A. Christian should sit on the exam table and touch his toes. B. Christian should stand up straight and flex 45 degrees forward at the waist. C. Christian should sit on the exam table and twist from side to side. D. Christian should stand up straight and flex 90 degrees forward at the waist. ANS: D PTS: 1 15. Alexa is a 17-year-old female who participates in figure skating. Which of the following issues is she at risk for being in an aesthetic sport? A. Bulimia B. Drug abuse C. Asthma D. Presyncope ANS: A PTS: 1 Chapter 77. Primary Care of Older Adults MULTIPLE CHOICE 1. Which of the following is true regarding old age and life expectancy? A. It is always defined as an adult aged 65 and older. B. The human life cycle is mostly consistent throughout the world. C. Old age is not a definite biological state. D. The life expectancy in the United States exceeds all other countries. ANS: C PTS: 1 2. Which of the following is of particular importance when caring for the elderly population? A. Emphasizing episodic health needs instead of chronic health needs B. Taking time to examine potential poverty as financial resources dwindle over time C. Providing integrated-care approach designed around the needs of the provider, so they can coordinate care for the patient D. Providing care while paying the minimal cost so that standards are met ANS: B PTS: 1 3. Madonna is a 77-year-old female who presents to the clinic for an annual wellness examination. Which subcategory of the older population does she fit into, based on her age? A. Young-old B. Old C. Old-old D. Oldest-old ANS: B PTS: 1 4. Which theory regarding the aging process is linked to cancer and Alzheimer’s disease? A. Replicating senescence B. Weakening of the immune system C. Oxidative damage D. Telomere shortening ANS: C PTS: 1 5. What is the key to increase physical activity in older adults? A. Motivation B. Having a partner to exercise with C. Belonging to a fitness center D. Owning home fitness equipment ANS: A PTS: 1 6. Which of the following is especially important for ensuring the safety of older adults? A. Removing firearms from the home due to the high rate of depression in older adults B. Making sure the hot water heater is set below 130oF C. Encouraging yearly tests to assess ability to drive safely D. Assessing fall risk and history of falls ANS: D PTS: 1 7. Which vaccine is recommended for adults over 65 years and that is administered every 10 years? A. Hepatitis B vaccine B. Tdap vaccine C. Pneumococcal vaccine D. Zostavax ANS: B PTS: 1 8. What does the I stand for in the mnemonic DELIRIUM used to assess causes for delirium in an older patient? A. Infection B. Identity crisis C. Influenza D. Internal injury ANS: A PTS: 1 9. Clinicians should ask older adults about their end-of-life plans when older patients are: A. Recovering from surgery B. Receiving an emergency procedure C. Undergoing an outpatient procedure D. Coming in for a problem outpatient visit ANS: C PTS: 1 10. What is an integumentary system age-related change? A. Increased body odor B. Decreased heat loss C. Moistness D. Decreased hair production ANS: B PTS: 1 11. Which of the following is a cardiovascular age-related change? A. Faster heart rate B. Increased sensitivity to changes in blood pressure C. Increased cardiac responsiveness to stress D. Reduced stroke volume ANS: D PTS: 1 12. Which of the following is a normal age-related laboratory change? A. Increase in erythrocyte sedimentation rate B. Decreased blood urea nitrogen C. Increase in hematocrit D. Decrease in urine protein ANS: A PTS: 1 13. Which clinical recommendation is Grade A, meaning it has consistent, good-quality, patient- oriented evidence? A. There are benefits to initiate aspirin use for primary prevention of cardiovascular disease and colorectal cancer in adults aged 70 or older. B. There are benefits to asking adults about tobacco use, advising them to stop using tobacco, and providing U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation. C. There are benefits to screen for impaired visual acuity in older adults. D. There are benefits to completing a screening mammography in women aged 75 years or older. ANS: B PTS: 1 14. What does the S stand for in the SPICES Geriatric Syndrome Markers? A. Sciatica B. Sexually transmitted infections (STIs) C. Sleep disturbances D. Sexual problems ANS: C PTS: 1 15. Which question will help identify older adults who are at risks for falls? A. Have you fallen in the past 2 years? B. Do you feel unsteady when you are sitting? C. Do your caregivers worry about you falling? D. Do you worry about falling? ANS: D PTS: 1 Chapter 78. Palliative Care and Pain Management MULTIPLE CHOICE 1. Which of the following statements is TRUE regarding pain? A. If a patient complains of pain but has no physical signs, he or she is most likely exhibiting drug-seeking behaviors. B. Acute pain is more intense and severe than chronic pain. C. Pain is a subjective experience related to actual or potential tissue damage. D. Nociceptive pain represents a normal response to injury of tissue. ANS: D PTS: 1 2. Which of the following would be a cause of neuropathic pain? A. Bone metastases B. Poststroke pain C. Musculoskeletal inflammation D. Postsurgical incisional pain ANS: B PTS: 1 3. Which drug is considered the MOST effective medication for pain in terminally ill patients? A. Codeine B. Hydrocodone C. Morphine D. Hydromorphone ANS: C PTS: 1 4. Unlike palliative care, hospice provides: A. Emotional support B. Care to patients at end of life only C. Spiritual services D. Relies on combined knowledge and skill ANS: B PTS: 1 5. An 8-year-old patient is admitted to the hospital due to Reye’s syndrome. Which medication was most likely the cause? A. Tylenol B. Motrin C. Aspirin D. Advil ANS: C PTS: 1 6. A patient is 11 years old and recently had her tonsils removed. Which of the following medications is safe to give to this patient? A. Ultram B. Ultracet C. Codeine D. Tylenol ANS: D PTS: 1 7. Which of the following best describes the onset of action for a fentanyl patch after application? A. 12 to 16 hours B. 1 to 2 hours C. 17 to 19 hours D. 4 to 6 hours ANS: A PTS: 1 8. How often should clinicians reassess a patient that is on chronic opioids? A. 2 weeks B. 1 week C. 4 weeks D. 3 weeks ANS: C PTS: 1 9. Which antiepileptic medication is an effective treatment for nerve pain? A. Amitriptyline B. Codeine C. Methadone D. Gabapentin ANS: D PTS: 1 10. Which type of pain arises from muscle joints and cutaneous tissue? A. Somatic pain B. Neuropathic pain C. Visceral pain D. Nociceptive pain ANS: C PTS: 1 11. Which best describes a challenge with creating palliative care provision in community health centers and primary care? A. Providing an important service to the community B. Working with long-term patients with known history C. Help with responsibilities in a primary-care setting D. Not enough time to work with patients and families on goals of care and advanced directives ANS: D PTS: 1 12. Which of the following is the best description of dyspnea? A. An oxygen saturation of less than 90% B. Respiratory rate greater than 24 C. A psychological state resulting in the feeling of air hunger D. A subjective feeling of breathlessness ANS: D PTS: 1 13. For acute pain, how many days are considered sufficient for treatment with opioids? A. 3 B. 5 C. 4 D. 9 ANS: A PTS: 1 14. Scopolamine patch is one drug of choice to manage which of the following conditions that can contribute to dyspnea? A. Copious secretions B. Cough C. Anxiety D. Effusion ANS: A PTS: 1 15. Which option best defines delirium? A. Sudden onset B. Impaired attention C. Affective changes D. Delusions ANS: A PTS: 1 16. Which of the following classes of drugs should be used as first-line therapy for treatment of delirium? A. Benzodiazepines B. Antipsychotics C. Anticonvulsants D. Antidepressants ANS: B PTS: 1 17. Which of the following is a role of the palliative-care team? A. Detecting cancer in asymptomatic patients B. Coordinating care provided by all health-care providers C. Identifying the patient’s quality of life D. Providing goal options to family and patients ANS: B PTS: 1 18. Which of the following is an example of how to assess pain? A. Description of the pain B. Timing of the pain C. When the pain stopped D. What improved the pain ANS: C PTS: 1 19. According to the American Pain Society, an example of the first-line therapy for mild pain includes which of the following? A. Tylenol B. Hydrocodone C. An opioid D. Muscle relaxant ANS: A PTS: 1 20. You are providing end-of-life care to an elderly patient with a history of heart failure. The patient complains of dyspnea. What is often the first line treatment for this condition? A. Oxygen B. Benzodiazepines C. Opioids D. Nonpharmacological solution ANS: A PTS: 1 Chapter 79. Ethical and Legal Issues of a Caring-Based Practice MULTIPLE CHOICE 1. Which statement about the American Nurses Association Code of Ethics is accurate? A. Each state’s legal requirements exceed those of the Code. B. A primary purpose of the Code is to show physicians that nurses are professional. C. Nurses, with input from physicians, formulated the Code for all nurses. D. The Code sets forth the values and ethical principles that guide clinical decisions. ANS: D PTS: 1 2. Which ethical principle reflects respect for all persons and their self-determination? A. Autonomy B. Beneficence C. Justice D. Veracity ANS: A PTS: 1 3. The clinician is using the mnemonic ETHICAL to solve a practice dilemma. What does the “A” represent? A. Accountability B. Autonomy C. Assess D. Act ANS: D PTS: 1 4. In an outpatient setting, what is the most common reason for a malpractice suit? A. Breach of confidentiality B. Failure to diagnose correctly C. Medication-related errors D. Lack of informed consent ANS: B PTS: 1 5. Which type of liability insurance covers only situations in which the incident occurred and the claim was made while the policy was in effect? A. Claims made policy B. Occurrence policy C. An employment coverage policy D. A “tail policy” ANS: A PTS: 1 6. Which insurance plan was the first to allow members to choose nurse practitioners as their primary-care provider and pay them the same rate as physicians for the same care? A. Blue Cross/Blue Shield Plan B. Medicare/Medicaid Plan C. Oxford Health Plan D. United Health Insurance Plan ANS: C PTS: 1 7. What is the primary rationale for using a decision tree to analyze ethical dilemmas? A. Shows the best solution B. Explains the ethical principles C. Delineates the legal parameters D. Allows all options to be considered ANS: D PTS: 1 8. In the model for future Advanced Practice Registered Nurse (APRN) practice, what does the “C” of LACE represent? A. Commitment B. Consensus C. Certification D. Collaboration ANS: C PTS: 1 9. Which action is best to employ in order to avoid a lawsuit? A. Obtain good liability insurance. B. Work with a collaborating physician. C. Follow documentation principles. D. Maintain open communication. ANS: D PTS: 1 10. Which statement or question made by the clinician represents paternalism in health care? A. “Continuing to drink is not healthy. I don’t want to have to give your eulogy.” B. “If you do not follow my instruction, I will remove myself from your case.” C. “I will help you in this process, but in the end you must make the decision.” D. “You don’t want to come across as uncooperative, do you?” ANS: B PTS: 1 11. What is the purpose of the Nurse Practice Act of each state? A. Establishing legal standards B. Promoting high-quality nursing care C. Protecting the nurse after licensure D. Determining exceptions to credentialing ANS: A PTS: 1 12. Which phrase describes deontology? A. The greatest amount of happiness or the least amount of harm for the greatest number B. The consideration of consequences with the calculation of benefits C. The belief that the ends justify the means D. The principle of universalizability ANS: D PTS: 1 13. Which element is a primary focus of health-care reform? A. Illness management B. Fee-for-service C. Disease prevention D. Bankruptcy reduction ANS: C PTS: 1 14. Which ethical principle and concept are most congruent? A. Veracity – fairness B. Nonmaleficence – do no harm C. Beneficence – keeping promises D. Justice – truth telling ANS: B PTS: 1 15. The Joint Commission mandates that all health-care organizations have which component in place? A. A mechanism for the consideration of ethical issues B. A standing ethics committee C. A resident parish nurse D. A lawyer who is knowledgeable about ethics ANS: A PTS: 1 16. What is the relationship between ethics and law? A. Ethical codes are legally binding. B. What one ought to do is the legal aspect. C. Legal actions may be both ethical and unethical. D. There is no relationship between the law and ethics. ANS: C PTS: 1 17. Which statement accurately describes the APRN’s scope of practice? A. Regulation of the APRN’s practice ensures public understanding. B. This delineates the permissible boundaries of APRN professional practice. C. It expands the APRN’s practice outside each state’s nurse practice act provisions. D. Each APRN defines his or her own aspect of practice to be included in a protocol. ANS: B PTS: 1 18. Which board administers and defines advanced nursing practice in all states? A. The Board of Nursing B. The Board of Medicine C. The Board of Pharmacy D. It is different for each state. ANS: D PTS: 1 19. Which condition must be present to establish malpractice? A. The APRN must be paid for the services in question. B. The provider must have a duty to the patient. C. The clinician must act in a similar manner as a prudent person. D. The plaintiff must prove an indirect link between harm and duty breach. ANS: B PTS: 1 20. Which requirement regarding prescriptive privilege is granted to APRNs in all states? A. Additional medication training B. Need for countersignatures by physicians C. Statutory independent prescribing authority D. Certification in prescription drug administration ANS: C PTS: 1 Chapter 80. The Business of Advanced Practice Nursing MULTIPLE CHOICE 1. Identify the primary challenge for insurance carriers in today’s health delivery model. A. Preventing illness B. Screening for disease C. Educating the public D. Reducing health-care spending ANS: D PTS: 1 2. Medicare benefits were offered to U.S. beneficiaries beginning in 1965. What was the service added with the Medicare D plan in 2006? A. Health-care screening B. Health-care education C. Pharmaceutical coverage D. Durable medical equipment coverage ANS: C PTS: 1 3. The cost of care provided by an APRN is approximately: A. One-quarter that of a physician B. One-third that of a physician C. One-half that of a physician D. One and one-half that of a physician ANS: C PTS: 1 4. How do bundled payments differ from fee-for-service or global capitation? A. Bundled payments are designed to reduce the number of payments to providers. B. Bundled payments align payment to care outcomes delivered by the team. C. Bundled payments reduce the amount of paperwork required for payment. D. Bundled payments allow for streamlined and coordinated billing for providers. ANS: B PTS: 1 5. Patients require education prior to accessing health-care services for the following reason: A. Many patients do not understand policy benefits and payment responsibility. B. Services may change across the beneficiary year. C. Copayments and deductibles may have already been met by the patient. D. Coding may need to be adjusted to meet the terms of the patient’s benefits. ANS: A PTS: 1 6. What replaced the Sustainable Growth Rate (SGR) formula? A. Advanced Alternate Payment Model (APM) B. Merit-Based Incentive System (MIPS) C. Medicare Access and CHIP Reauthorization D. Quality Payment Program (QPP) ANS: D PTS: 1 7. Accounting keeps track of the financial state of a business. The accounting report that demonstrates the growth in assets is: A. Net income statement B. Balance sheet C. Cash flow statement D. Operating statement ANS: A PTS: 1 8. Medicare advantage plans are Medicare managed care organizations (MCOs). These plans must be approved by the Centers for Medicare and Medicaid Services (CMS) as alternative carriers for Medicare beneficiaries. Which of the following is not a characteristic of these plans? A. Offer additional benefits B. Offer lower copayments C. Follow Medicare benefit rules D. Follow the Commercial Carriers rules ANS: C PTS: 1 9. The Current Procedural Terminology (CPT) and payment fee values are applicable only to CMS services and are regulated and paid by the regional CMS carriers. How does this impact MCOs? A. MCOs are the only groups able to adjust standard payment rules. B. MCOs can independently determine whether to utilize certain CPT code rules and/or the reimbursement values for the payment year. C. MCOs can create personalized CPT codes. D. MCOs must continue to use modifiers. ANS: B PTS: 1 10. All medical practices are required by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services. Why is this so critical? A. Electronic software allows CMS to audit all medical practices’ performance. B. Electronic filing protects patient information as required by the Health Insurance Portability and Accountability Act. C. Electric billing and automated electronic filing sets makes timely transition to new provider fee schedule rates possible. D. Medical record software eliminates the possibility for duplicate bills and overcharging patients. ANS: C PTS: 1 11. All health-care practices should develop a compliance plan. Compliance plans offer practice safeguards that prevent which of the following? A. Malpractice claims B. Conflict-of-interest claims C. Health Insurance Portability and Accountability Act violations D. Occupational Safety and Health Administration violations ANS: B PTS: 1 12. What is the purpose of an Evaluation and Management Audit Tool? A. To justify CPT coding B. To provide guidelines for CMS review C. To assist in estimating profit/loss for patient visits D. To allow hospitals to comply with CMS guidelines ANS: A PTS: 1 13. Each state has criteria defining the level of collaboration required between the Advanced Practice Registered Nurse (APRN) and an oversight physician. Which is among the questions an APRN should seek when selecting a practice setting? A. List of practice limitations as an APRN B. Standard hourly rate as office staff C. Expectation for net revenue generation D. Standard benefit package offered to office staff ANS: C PTS: 1 14. Identify one of the primary reasons for an APRN to develop a business plan: A. To monitor monthly actual expense to budgeted expense B. To reduce the likelihood of litigation action C. To identify the marketing needed to grow the APRN practice D. To assure accreditation standards are met ANS: C PTS: 1 15. Despite the growth in the numbers of APRNs over the last decades, the role of the profession is often not understood by the public. What actions should APRNs undertake to market their services to the public? A. Request that the physician act as an APRN spokesperson. B. Increase articles in nursing professional journals about the APRN role. C. Personally seek out the news media to communicate their value. D. Rely on patients to communicate their benefits to neighbors. ANS: C PTS: 1 Chapter 81. The 15-Minute Hour: Practical Approaches to Behavioral Health for Primary Care MULTIPLE CHOICE 1. According to the World Health Organization data on 1,500 patients around the world, how many patients presenting with medical/somatic complaint had a psychiatric problem? A. 25% of all patients B. One-quarter of all patients C. One-half of all patients D. 60% of all patients ANS: A PTS: 1 2. Integrating mental health techniques and approaches, such as the 15-minute hour, into the primary-care patient encounter is important for a number of reasons. These include: A. Decreasing the patient’s stress and increasing your reimbursement B. Encouraging coping strategies and increasing professional satisfaction C. Assisting patients in reliving traumatic experiences D. Decreasing care clinician stress ANS: B PTS: 1 3. Valliant (1979) discusses the “ubiquity of stress.” Ubiquity of stress maintains that: A. In a current and rapidly changing society, stress can be viewed as a positive. B. Eustress is counterproductive. C. The overwhelmed can functionally regress. D. Dream therapy has been found to be an effective treatment of overwhelming stress. ANS: C PTS: 1 4. Basic human needs are identified as: A. Autonomy and feeling valued by others B. Exhilaration and productivity C. Spirituality D. Career success and material rewards ANS: A PTS: 1 5. Commonalities among psychotherapeutic techniques include the following: A. Dream therapy, listening, and reflection B. Psychodrama, group psychotherapy, and 12-step programs C. Self-help groups D. Obtaining external perspective and participation in a helping relationship ANS: D PTS: 1 6. The goals of the 15-minute hour approach include: A. Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning B. Emerge with a higher level of functioning and commitment to long-term psychotherapy C. Accept need for antidepressant therapy and psychiatric referral; share concerns with primary-care clinician D. Improve family functioning and sexual performance as well as accept need for antidepressant medication ANS: A PTS: 1 7. BATHEing the patient refers to: A. A technique used in primary care to get the patient to accept the need for psychological or psychiatric referral B. A technique used to facilitate cultural understanding C. A technique used to perform psychotherapy D. A technique that is a quick screen for psychiatric issues and interventions for psychological problems ANS: D PTS: 1 8. BATHEing the patient is an advanced practice nursing intervention that allows the practitioner to: A. Develop a therapeutic relationship without “owning” the patient’s problem B. Conduct psychological counseling within the context of the primary-care encounter C. Focus on the “process” and not the assessment D. Make the patient and family happier ANS: A PTS: 1 9. The BATHE technique was developed more than 20 years ago and has been used extensively in primary care and family practice. The new “Positive BATHE” stresses: A. A belief that all things are possible through positive affirmations B. A belief that one should only refer to practitioners who embrace the viewpoint of positive psychology C. Health promotion, gratitude, autonomy, and positive thought D. The patient’s problems and concerns ANS: C PTS: 1 10. Which of the following scenarios best demonstrates the relationship between physical health and distress? A. A patient’s high-calorie diet contributes to his diagnosis of type 2 diabetes. B. A patient with an elevated HbA1C reports that he was recently evicted from his home. C. A patient with depression reports an increase in suicidal thoughts. D. A patient reports feeling “numb” after learning that her malignant tumor is inoperable. ANS: B PTS: 1 11. One benefit of BATHEing a patient is that: A. It allows providers an in-depth exploration of patient’s presenting problems. B. It assumes that ambivalence is a normal part of the change process. C. It utilizes the therapeutic relationship to help patients in a time-sensitive approach. D. It can be done only with extensive training in therapeutic technique. ANS: C PTS: 1 12. One benefit of motivational interviewing (MI) is: A. It assumes that ambivalence is a normal part of the change process. B. It can be utilized during routine office visits. C. It is a therapeutic technique which is not necessarily time intensive. D. All are benefits of MI. ANS: D PTS: 1 13. Which is not a basic principle of MI? A. People often continue behaviors with negative consequences for reasons unknown to the provider. B. The patient is the expert on his/her behavior. C. Providers are obligated to inform each patient of the negative consequences of their behaviors. D. Helping patients understand ambivalence for change is often more powerful than direct instruction. ANS: C PTS: 1 14. The primary purpose of the “Positive BATHE” is intended to help patients by: A. Focusing on autonomy and accomplishment B. Creating a stronger therapeutic alliance C. Helping the patient change negative behaviors D. Engaging the patient during the psychosocial assessment ANS: A PTS: Chapter 82. Putting Caring Into Practice: Caring for Self MULTIPLE CHOICE 1. The World Health Organization defines self-care as: A. An important global activity for all health-care providers B. A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health C. Essential to efficacious advanced practice nursing practice D. An awareness by the Advanced Practice Registered Nurse (APRN) of their self- care behaviors as related to diet, activity, and mental attitude ANS: B PTS: 1 2. Nurse theorist Dorothea Orem defines self-care activities as: A. Attainment of professional self-development goals B. Ability to persevere through hardship C. Striving to attain balance and harmony in one’s life D. Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life ANS: D PTS: 1 3. Self-care and personal development are built into the standards of practice of: A. The American Holistic Nurses Association B. The American Nurses Association C. The American Association of Nurse Practitioners D. The American Academy of Nursing ANS: A PTS: 1 4. There are many pressures inherent in primary-care practice today for APRNs. These pressures include all of the following: A. Electronic medical record, the Affordable Care Act, and the implementation of socialized medicine B. Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants C. Uncertainty, the team approach to care, and the need for patient-centered care D. Availability of medical information on the Internet, educational programs for patients, and Medicare drug benefits ANS: B PTS: 1 5. A new era of health care leads to: A. Greater opportunity for independent practice, yet increased legal risk in accountability for patients B. Lowered reimbursement for all health-care services and providers C. Decrease in status for health-care providers D. No ability to individualize care ANS: A PTS: 1 6. Compassion fatigue is another side effect of today’s health-care delivery system. This term means: A. The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN. B. This happens over time related to the need to see increasing numbers of patients in busy primary-care practices. C. This may persist over time, even when the APRN transfers to a new and different setting. D. Patients’ problems and circumstances can be so overwhelming that the APRN needs to set severe boundaries to maintain safe function. ANS: A PTS: 1 7. Another term used, burn out, is differentiated by: A. Numbness of feelings leading to substance abuse B. How novice APRNs feel at the end of the day in primary care C. Feelings of aloneness, desperation, and despair D. A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale ANS: D PTS: 1 8. The following statement is TRUE: A. APRNs are often sensitive to patients’ deficiencies but not their own. B. APRNs always respond appropriately to patients, families, and team members. C. APRNs are well-equipped from their APRN educational programs to care for self. D. Re-licensure in some states mandates continuing education units in self-care. ANS: A PTS: 1 9. Emotional intelligence is defined as: A. Being highly attuned to the needs of others B. The ability to engage in self-care C. Being able to recognize and understand the meaning of emotions, and how they affect other people D. The holistic integration of self-care and self-development practices ANS: C PTS: 1 10. APRNs need to develop their own self-care management plans. Two key elements of self-care management plans are: A. Taking vacations and keeping up with new knowledge and developments in medicine B. Resilience and positive intentionality C. Family support and a healthy diet D. Being physically and emotionally “fit” ANS: B PTS: 1 11. The term resilience implies: A. Ability to look to a higher power to get you through a crisis B. Response to difficult and adverse circumstances through positively adjusting to stressors C. That the APRN can weather any emergency D. Learning to set appropriate boundaries ANS: B PTS: 1 12. Qualities associated with resilience include: A. Hope, self-efficacy, and positivity B. Stick-to-it-ness, belief in a higher power C. Education, self-regulation, and use of activity to decrease stress D. Ability to take vacations and the availability of support systems and a secure work environment ANS: A PTS: 1 13. Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no backup and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies? A. Patsy distanced Sue by listening to her as little as possible. B. Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining. C. Patsy spoke privately with their supervisor, Pamela, stating that she did not think Sue could be successful in this environment. D. Patsy requested that Sue be assigned to a different APRN for orientation. ANS: B PTS: 1 14. The qualities of resilience that Patsy demonstrated when responding to Sue include: A. Protecting her own positive attitude by lessening her contact with Sue, a negative person B. The ego strength to admit failure in her ability to orient Sue, a destructive person C. Protecting her organization by sharing Sue’s deficiencies with their supervisor D. Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her ANS: D PTS: 1 15. According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice? A. Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy B. Review of materials on primary care before going into the work environment to increase one’s confidence, leading to caring energy C. Travel to sacred places D. Helping the poor and homeless—volunteering at a domestic violence shelter, for example—in addition to one’s regular practice ANS: A PTS: 1 [Show More]

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