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100 Cards in this Set
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You are testing a client suspected of having Parkinson’s disease. You support the client’s elbow with his forearm extended in your hand and grasp his wrist, flexing the forearm. You find rigid resistance to this motion. This is considered which of the following? |
cogwheeling
Myerson’s sign Wilson’s sign pill rolling Hide ExplanationExplanation:Correct answer:cogwheeling Cogwheeling is resistance to passive movement. It is best felt in the elbow, wrist, and neck. |
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The FNP has an adult male patient in the clinic who woke up with one side of his face paralyzed. He cannot fully close his eyelid and has difficulty chewing and swallowing food on that side of his face. Which of the following is the most likely diagnosis? |
Bell’s Palsy trigeminal neuralgia focal migraine acute bacterial meningitis Hide ExplanationExplanation:Correct answer:Bell’s Palsy Bell’s Palsy is the abrupt onset of unilateral facial paralysis that is due to dysfunction of the motor branch of the facial nerve (CN 7). Facial paralysis can progress rapidly within 24 hours. Skin sensation remains intact but tear production on the affected side may stop. Most cases spontaneously resolve. |
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The research design that examines data related to past events to shed light on current behavior is which of the following? |
grounded theory historical phenomenologic nonrandom sample Hide ExplanationExplanation: Correct answer:historical Historical research systematically examines data related to past events to shed light on current behavior. It is one of the common qualitative research designs. |
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Jorge is an 18 month-old Hispanic male who presents with bluish black patches in the lumbosacral area. Bruising and child abuse have been ruled out. The diagnosis for this child would most likely be which of the following? |
nevus flammeus Mongolian spots erythema toxicum seborrheic dermatitis Hide ExplanationExplanation:Correct answer:Mongolian spots Mongolian spots occur in up to 80 to 90% of Black, Asian, Hispanic and Native American infants. They are blue to black-colored patches or stains that are commonly located in the lumbosacral area but can be located anywhere on the body. They usually fade by age 2 to 3 years. |
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One part of a spectrum of disease that is often found together with giant cell arteritis is which of the following? |
polymyalgia rheumatica migraine headache blindness brain tumor Hide ExplanationExplanation:Correct Answer:polymyalgia rheumatica Giant cell arteritis and polymyalgia rheumatica are thought to represent two parts of a spectrum of disease and are often found together. Blindness is a serious complication of the disease. |
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An otherwise healthy adult female patient presents with a series of dry, plaque-like skin lesions. She reports that they occasionally bleed when bumped but do not otherwise itch or suppurate. Which of the following is the MOST likely diagnosis for this patient? |
Psoriasis. Hyperhydrensis supperitiva. Keratosis pilaris. Skin cancer. Hide ExplanationExplanation:Correct Answer: Psoriasis This patient's lesions are consistent with psoriasis. Since she is otherwise healthy, do they do not indicate an underlying health condition Hyperhydrensis supperitiva. Keratosis pilaris. Skin cancer. Hide ExplanationExplanation:Correct Answer: Psoriasis This patient's lesions are consistent with psoriasis. Since she is otherwise healthy, do they do not indicate an underlying health condition |
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Which cranial nerve (CN) is associated with hearing problems or balance impairment? |
CN III CN V CN VII CN VIII Hide ExplanationExplanation:Correct answer:CN VIII CN VIII is the auditory or vestibulocochlear nerve. When this nerve does not functioin properly, hearing or balance is impaired. The Rinne test is part of the evaluation of this CN. |
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You are treating a patient in the office. You collect and process a Tzanck smear that is positive for giant multinucleated cells from a lesion. The nurse practitioner has knowledge that these are from: |
S. aureus herpes virus allergic reaction streptococci Hide ExplanationExplanation:The Correct answer is:Herpes virusThe diagnosis of herpes is usually straightforward because of its characteristic lesions. Confirmation of the diagnosis by a Tzanck smear will reveal giant multinucleated cells. Further, an allergic reaction, streptococci and S. aureus are not diagnosed with a Tzanck smear. |
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Your patient has “swimmer’s ear.” She has no other associated conditions. Your management of this patient will include which of the following? |
oral antibiotics application of local heat to outer ear for pain relief Valsalva maneuver decongestants Hide ExplanationExplanation:Correct answer:application of local heat to outer ear for pain relief “Swimmer’s ear” or otitis externa is an inflammation of the external auditory canal. Management includes application of local heat to outer ear for pain relief. Oral antibiotics are indicated only if there is associated otitis media or cellulitis of the outer ear is present. The Valsalva maneuver and decongestants are things that might be used to manage otitis media, not otitis externa. |
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You are conducting an assessment with a patient who expresses uncertainty about which treatment regimen to continue. She can continue to control her diabetes with diet, or she can investigate taking insulin daily. She is unsure which is the best choice for her. She is demonstrating |
Personal identity conflict.
Role conflict. Failure to thrive. Decision conflict. Hide ExplanationExplanation:Correct Answer: Decision conflict Patients will often struggle with decisions related to their health. When a patient experiences decision conflict, he or she may feel unable to make an important decision, even if he or she is the only person who can make that decision. |
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Your patient has presented in the first stage of Syphilis. Which of the following is the recommended treatment option? |
Doxycycline 100 mg PO bid x 2 weeks. Tetracycline 500 mg PO qid x 2 weeks. Ceftriaxone 1g IM or IV q 24 h x 8-10 days. Benzathine penicillin G 2.4 million U IM as a one-time dose. Hide ExplanationExplanation:Correct answer:Benzathine penicillin G 2.4 million U IM as a one-time doseThe above drug is the recommended treatment option, but for those with penicillin allergies, there are alternative treatment options. These are Doxycycline 100 mg PO bid x 2 weeks, Tetracycline 500 mg PO qid x 2 weeks, or Ceftriaxone 1 g IM or IV q 24 h x 8-10 days. |
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Which of the following would NOT be considered a risk factor for gastroesophageal reflux disease (GERD)? |
hiatal hernia underweight gastric outlet obstruction asthma Hide ExplanationExplanation:Correct Answer:underweight Being underweight is not a risk factor for GERD. Obesity is a risk factor. |
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Which of the following would NOT be considered a “red flag” for diagnosis of a headache that is something other than primary headache? |
change in attack frequency absence of systemic symptoms sudden or abrupt onset onset of headache with exertion Hide ExplanationExplanation:Correct Answer:absence of systemic symptoms The presence of systemic symptoms would be considered a “red flag” for a headache that is something other than a primary headache. These symptoms may include fever, weight loss or secondary headache risk factors such as HIV or malignancy. |
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The parents of a 9-year-old female have come to you to ask advice about handling behavior problems with this child. You would give them all of the following guidelines for using punishment EXCEPT: |
Use sparingly.
Let some time elapse after misbehavior before using punishment. Avoid physical punishment. Use mild punishment. Hide ExplanationExplanation:Correct answer:Let some time elapse after misbehavior before using punishment. This is not an appropriate guideline. Children should be punished quickly after misbehavior. Also, a brief reason should be given for punishment; and the child should be punished only if in control of self. |
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The family of a patient who is close to death appears to be very anxious even though they have always known that the patient would not survive for long. What is the primary action for you to take with this family? |
Tell them that others have gone through the same thing and they will feel relieved when the patient is finally at peace. Teach the family about what to expect as death approaches and explain that you are doing everything that you can for the patient. Advise them that there are groups available that will help them to cope with their grief. Divert their anxiety by asking what type of arrangements they have made for the person’s funeral. Hide ExplanationExplanation:Correct Answer:Teach the family about what to expect as death approaches and explain that you are doing everything that you can for the patient. Families, especially those who have never had to deal with the death of a family member before, need to be educated as to what to expect when their loved one is close to death. They should be told about the signs and symptoms of impending death so that they can cope more easily. They should also be reassured that everything that can be done for the patient is being done. |
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You have a patient whom you are assessing for rheumatoid arthritis. You understand that all of the following factors increase a person’s susceptibility to rheumatoid arthritis (RA) EXCEPT: |
positive family history intact immune system female gender heredity Hide ExplanationExplanation:Correct answer:intact immune system The factors increasing susceptibility to RA include heredity, positive family history, and being of the female gender. Protective factors include an intact immune system and male gender. |
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Mrs. Garber has a moderate case of shingles. Which of the following medications are you most likely to prescribe for Mrs. Garber’s shingles? |
Permethrin Griseofulvin doxycycline Valacyclovir Hide ExplanationExplanation:Correct answer:Valacyclovir Valacyclovir is the medication that is prescribed for shingles (herpes zoster) |
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Enuresis is involuntary urination after a child has reached the age when bladder control is usually attained. Management of primary nocturnal enuresis includes all of the following EXCEPT: |
limiting fluid intake before bedtime double voiding before bedtime avoiding punishment withholding verbal praise so as not to call attention to the problem Hide ExplanationExplanation:Correct Answer:withholding verbal praise so as not to call attention to the problemVerbal praise is an excellent means of motivational therapy for a child with primary nocturnal enuresis. Other means of motivational therapy include a reward system and keeping a dryness calendar. |
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A 15-year-old boy comes to the clinic after having been in a physical fight. He has some minor facial lacerations and a nosebleed. The FNP determines that the nosebleed is a posterior bleed. What is the next step that the FNP should take? |
Pack the affected nasal passage and send the patient home with instructions as to when to remove the packing. Send the patient to the ER. Try to stop the bleeding and prescribe a nasal decongestant. none of the above Hide ExplanationExplanation:Correct Answer:Send the patient to the ER.Posterior nasal bleeds may hemorrhage. The patient should be sent to the ER. |
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The most common cause of secondary hypertension is which of the following? |
heredity
environmental factors sympathetic nervous system renal conditions
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The nurse practitioner knows that all of the following are nonpharmacologic treatments for a patient with acute glomerulonephritis EXCEPT: |
Avoid high-potassium foods. Treat them as inpatient until edema and hypertension are under control. Restrict protein in presence of azotemia and metabolic acidosis. Encourage increased fluid intake. Hide ExplanationExplanation:The correct answer is:Encourage increased fluid intakeThe patient’s fluid intake should be restricted to only the amount the patient requires to replace lost fluids. The remaining answer choices are included in the treatment of acute glomerulonephritis. |
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The FNP is calculating the BMI (body mass index) for a patient who weighs 63.5 kg and is 1.75 m in height. Which of the following is closest to this patient’s BMI? |
18.5 19 19.7 20.7 Hide ExplanationExplanation:Correct Answer:20.7BMI is calculated by dividing a person’s weight by his height squared. In this case the person’s weight 63.5 kg is divided by 1.75 squared. This gives you a body mass index of 20.7. |
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______ is an example of a Skeletal Muscle Relaxant that can be used in the treatment of musculoskeletal disorders. |
ASA. Rofecoxib. Raloxifene. Baclofen. Hide ExplanationExplanation:Correct answer: Baclofen ASA - NSAID Rofecoxib - COX-2 Raloxifene - SERM Baclofen - Skeletal Muscle Relaxant |
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A patient who has been prescribed nifedipine for kidney stones should be advised not to take the medication with which of the following? |
Milk. Coffee. Food. Grapefruit juice. Hide ExplanationExplanation:Correct Answer: Grapefruit juice Grapefruit juice interferes with the ability of the liver to break down nifedipine. Patients can take this medication with food or without, and with other beverages. |
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A 46-year-old truck driver is in the office complaining of hemorrhoids. After the exam, the nurse practitioner discusses treatment options with him. All of the following are appropriate pharmacologic treatment EXCEPT: |
topical hydrocortisone preparations stool softeners local analgesic spray, suppository, or cream blood thinners Hide ExplanationExplanation:The Correct answer is:Blood thinnersBlood thinners are not indicated for the treatment of hemorrhoids. The remaining answer choices are treatment options for hemorrhoids. For instance, topical hydrocortisone preparations relieve pain, itching, and inflammation. Stool softeners, e.g. docusate sodium, reduce straining during defecation. Local analgesic spray, suppository, or cream (benzocaine, pramoxine, dibucaine, etc.) provide pain relief. |
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In terms of physiologic changes during pregnancy, which of the following is the least accurate statement? |
There is increased peristalsis from progesterone effects. Plasma volume increases 50% by the end of the third trimester. Decreased systolic and diastolic pressure occurs in the first trimester. Cardiac output increases by 1/3 by the last two trimesters. Hide ExplanationExplanation:Correct answer:There is increased peristalsis from progesterone effects. This is not accurate. There is decreased peristalsis from progesterone effects. This results in things like heartburn and constipation. |
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It is considered precocious puberty in a male if puberty starts before what age? |
9 years 10 years 12 years 13 years Hide ExplanationExplanation:Correct answer:9 years For boys, puberty starts at 9 years. It is considered precocious puberty if it begins before 9 years and delayed puberty if no testicular growth is seen by 14 years. |
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In advising a male patient with hypertension about lifestyle changes (according to JNC8) to help control the hypertension, the FNP would tell the patient to limit his alcohol intake to: |
< 4 drinks per day < 4 drinks per week < 1 drink per day < 2 drinks per day Hide ExplanationExplanation:Correct answer:< 2 drinks per day For moderation of alcohol consumption to control hypertension in men, the recommendation according to JNC8 is < 2 drinks per day. For women and lighter weight persons alcoholic drinks should be limited to < 1 drink per day. |
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A 45-year-old female comes to the clinic to check a “mole” that has been concerning her. She asks the FNP if this could be a melanoma. The FNP understands that all of the following are signs that the lesion could be a melanoma EXCEPT: |
It is of a uniform black or brown color.Its borders are irregular. It is asymmetric with non-matching sides. Its diameter is larger than 6 mm. Hide ExplanationExplanation:Correct answer:It is of a uniform black or brown color. All of the choices are correct except this one. One of the signs that a lesion may be a malignant melanoma is that the color is not uniform brown, black, red, white, or blue. Another sign is that it is an evolving lesion, either new or changing. |
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A mother brings her infant to the clinic to say that he has tearing in both eyes. The FNP also sees a mucoid discharge. Which of the following conditions/diseases might this indicate? |
congenital lacrimal duct obstruction Wilms tumor Fifth disease Kawasaki disease Hide ExplanationExplanation:Correct Answer:congenital lacrimal duct obstruction Congenital lacrimal duct obstruction is a failure of the tear duct to open at birth. A thin membrane blocks the entrance of the nasolacrimal duct causing tear blockage. This is a condition that spontaneously resolves. |
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Which of the following would you find only in tertiary syphilis? |
localized lymphadenopathy painless genital ulcer diffuse maculopapular rash involving palms and soles gumma Hide ExplanationExplanation:Correct answer:gummaGumma are granulomatous lesions involving skin, mucous membranes and bones. They are seen only in tertiary syphilis. The other choices may be seen in primary or secondary syphilis. |
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Which of the following might you see in the earliest stages of Lyme disease (3 – 30 days post-exposure)? |
gastritis hyperactivity cranial nerve palsies fever and chills Explanation:Correct answer:fever and chills This is a symptom of early stage Lyme disease along with erythema migrans and headache. As the disease progresses, cranial nerve palsies (especially facial nerve) are common and persistent fatigue is felt. Months to years after the initial infection, the disease is characterized by recurrent pauciarticular arthritis, usually affecting large joints and cardiac involvement. |
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A 23 year old female who presents with symptoms consistent with appendicitis should also be assessed for which of the following? |
Miscarriage. Ectopic pregnancy. Gallstones. Diverticulosis. Hide ExplanationExplanation:Correct Answer: Ectopic pregnancy Ectopic pregnancy occurs when the embryo implants outside the uterus. Early symptoms include abdominal pain and cramping, and may mimic appendicitis. |
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Your client has a softening of the bones. You have diagnosed osteomalacia. You understand that this is a result of a deficiency of which of the following nutrients? |
zinc calcium and vitamin D magnesium thiamin and niacin Hide ExplanationExplanation:Correct answer:calcium and vitamin D Osteomalacia is the adult form of rickets. These diseases cause poor bone formation in children and softening of bones in adults. They may cause the spine to bend and the legs to become bowed |
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You have a young adult female patient who comes to you because she has not had a menstrual period for several months. She is extremely thin for her height and you have determined that she is not pregnant. You suspect anorexia nervosa. Which of the following symptoms would be NOT be consistent with this diagnosis? |
denial of any problem manic episodes obsession with exercise feelings of guilt and shame Hide ExplanationExplanation:Correct Answer:manic episodesAll of the choices are consistent with your suspicion of anorexia except this one. Depression is more likely to occur. The person with anorexia feels fat and has an intense fear of gaining weight, and may have dizziness and gastrointestinal disorders, along with many other factors. |
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You suspect that your female patient is experiencing an ectopic pregnancy. Which of the following tests is the gold standard for diagnosis? |
serum beta-hCG-B-hCG radioimmunoassay transvaginal ultrasound culdocentesis laparoscopy Hide ExplanationExplanation:Correct Answer:transvaginal ultrasound The gold standard test for ectopic pregnancy is the transvaginal ultrasound. |
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Which of the following skin conditions would be most indicative of Kawasaki disease? |
smooth round papules 5 mm in size Koplik’s spot honey-colored crusted lesions bright red and swollen skin palms and soles Hide ExplanationExplanation:Correct Answer:bright red and swollen skin palms and solesThis is the condition most indicative of Kawasaki disease. You may also see strawberry tongue and bright red conjunctivitis with no exudate. |
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Sam is a 40-year-old male patient who comes to the office complaining of a sudden onset of severe “ice pick” pains behind one eye. He tells you that the headache is accompanied by tearing, a clear runny nasal discharge, and a drooping eyelid. What type of headache would you diagnose? |
muscle tension headache migraine headache cluster headache temporal arteritis Hide ExplanationExplanation:Correct Answer:cluster headacheCluster headaches are severe headaches with lancinating pain behind one eye that occurs several times a day, usually at the same times every day. Their cause is unknown and they are more common in adult males in their 30s and 40s. |
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A 65-year-old patient has presented with what is determined to be Crohn's disease. Of the following, which sign/symptom is LEAST likely noted with the patient? |
Weight gain. Low-grade fever. Abdominal pain. Malaise. Hide ExplanationExplanation:Correct Answer:Weight gain.There are a variety of signs/symptoms associated with Crohn's disease. Weight gain is typically not noted, but weight loss is. Other common signs/symptoms are postprandial bloating, nonbloody diarrhea, and abdominal mass in the lower quadrants. |
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A teenager is brought in by her mother with abdominal pain in the lower right quadrant. The patient says that she is not sexually active. She also has a fever and abdominal swelling. What should you look for in the exam? |
Grade II. Tonometry. Obturator sign. Gag reflex. Hide ExplanationExplanation:Correct answer:Obturator signThe patient's symptoms could indicate appendicitis or a blockage. The obturator sign is tested by asking the patient to bend the knees in such a way that will flex the obturator muscle. Pain may indicate appendicitis. |
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In making your diagnosis, you describe your elderly patient's skin condition as being linear. What does that mean? |
In streaks. In a ring. Netlike cluster. Along a neurocutaneous dermatome. Hide ExplanationExplanation:Correct Answer:In streaks. Annular - in a ringReticular - netlike clusterDermatomal - along a neurocutaneous dermatomeLinear - in streaks |
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There are five indicators for referring a patient with abdominal pain for a surgical consult. Which of the following is NOT one of them? |
bradycardia increased white blood cell count fever advanced age Hide ExplanationExplanation:Correct Answer:bradycardia The five big indicators that help identify those patients who need a surgical consult are: fever; increased white blood cell count; tachycardia; peritoneal signs; and advanced age. |
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e nurse practitioner treating women understands that the most common cancer in women in the United States is: |
malignant melanoma breast cancer colon cancer lung cancer Hide ExplanationExplanation:Correct Answer:breast cancerThe most common cancer in women in the United States is breast cancer. Lung cancer mortality is higher than breast cancer, however. |
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You would refer a patient to a burn center in all but which of the following cases? |
deep second-degree burns burns over a joint burns that are circumferential burns of greater than 8% TBSA Hide ExplanationExplanation:Correct Answer:burns of greater than 8% TBSA If burns are greater than 10% TBSA in patients under 10 years of age or over 50, you would refer to a burn center. You also would refer to a burn center if burns are greater than 20% of TBSA in all other patients. |
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A father brings in his 11-year-old daughter who is having recurrent abdominal pain. After organic diseases are ruled out, you develop a therapeutic plan for this child. This plan might contain all of the following EXCEPT: |
decreasing juice intake if frequent taking a fiber supplement decreasing fiber in the diet reassuring parents that there is no organic cause Hide ExplanationExplanation:Correct Answer:decreasing fiber in the dietThe child’s diet should be increased in fiber. The child may also take a fiber supplement (5g/day). |
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The process of evaluating the appropriateness of inpatient hospitalization is which of the following? |
risk management utilization review case management accreditation utilization review A utilization review is the process of evaluating the appropriateness of inpatient hospitalization. Proof of the medical necessity for the patient’s hospitalization is done mainly through chart reviews. |
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Loud, tinkling bowel sounds associated with hyperactivity of the bowel are known as ______. |
Periborborygmi. Borborygmi. Flatulence. Colonics. Hide ExplanationExplanation:Correct Answer:BorborygmiThese sounds result from a hyperactive bowel. Borborygmi is characterized by a rush of gurgling, tinkling sounds. These sounds are typically quite loud upon auscultation |
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A patient who has been prescribed Bactrim for a urinary tract infection should be advised to seek immediate medical attention if he experiences which of the following? |
Black, tarry stools. Decreased appetite. Nausea. Diarrhea. Hide ExplanationExplanation:Correct Answer:Black, tarry stools.Diarrhea is a common side effect of Bactrim and is not cause for concerns. Nausea and decreased appetite may also occur when taking this medication. Black or tarry stools, however, may indicate internal bleeding. Patients experiencing this should seek immediate medical attention. |
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Mrs. Archibald suffers from fibromyalgia. You have initiated treatment for her. When would you schedule a follow-up visit for Mrs. Archibald? |
within 1 week in 2 weeks in a month within 24 hours Hide ExplanationExplanation:Correct Answer:in a monthA follow-up visit in one month is appropriate for this patient. This should continue monthly until improvement in symptoms is noticed. |
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A 55 year old male patient who reports erectile dysfunction should be further evaluated for all but which of the following? |
Lung cancer. Diabetes. Depression. High blood pressure. Hide ExplanationExplanation:Correct Answer:Lung cancer. ED can be caused by a number of underlying health problems. Diabetes is the most common. It is not associated with lung cancer |
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Maggie is a 35-year-old patient with multiple sclerosis. Which of the following factors would predict a more adverse outcome for Maggie? |
younger age at onset female gender cerebellar involvement long first inter-attack intervals Hide ExplanationExplanation:Correct answer:cerebellar involvement This is a factor associated with an adverse outcome. Other factors are: older age at onset, male gender, persisting deficits in brain stem, and short first inter-attack interval. |
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A 33-year-old male patient has recently purchased a baby grand piano for $10,000 with funds from his 3 year old's college fund savings. The patient does not even play the piano. You know this is consistent with a manic episode in bipolar disease known as: |
good judgment racing motivation psychosis grandiosity Hide ExplanationExplanation:The Correct answer is:GrandiosityDuring a period of mania, the patient may have inflated self-esteem and grandiosity, decreased need for sleep, excessive talking, racing thoughts and flight of ideas and distractibility. Also, the patient may exhibit excessive involvement in pleasurable activities, such as compulsively purchasing the baby grand piano, that are associated with painful consequences later. For example, the consequence is the patient spent all of his child's college fund money. |
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Which of the following drugs that might be prescribed for a patient with asthma and chronic obstructive pulmonary disease (COPD) is not used specifically for treatment and prevention of bronchospasm? |
theophylline Montelukast Ipratropium Tiotropium Hide ExplanationExplanation:Correct Answer:Montelukast All of the medications might be used for treatment and prevention of bronchospasm except montelukast. This drug is a leukotriene receptor antagonist that inhibits the action of the inflammatory mediator (leukotriene) by blocking select receptor sites. it is a controller drug used to prevent inflammation. |
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About how many viral illnesses per year are common in infants and toddlers? |
up to 10 2 up to 15 3 Hide ExplanationExplanation:Correct Answer:up to 10Frequent (up to 10) viral illnesses per year are common in infants and toddlers. This is especially true for upper respiratory illnesses. |
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You are examining a 3-month-old infant. Your examination reveals misalignment of one eye. You understand that this is known as which of the following? |
amblyopia strabismus esotropia diplopia Hide ExplanationExplanation:Correct Answer:esotropia Esotropia is a misalignment of one or both eyes (cross-eyed). Infants younger than 20 weeks may have intermittent esotropia, which usually resolves spontaneously. |
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A discrete narrowing of the aorta, just opposite the site of the ductus arteriosus is which of the following? |
aortic stenosis pulmonary stenosis patent ductus arteriosus coarctation of the aorta Hide ExplanationExplanation:Correct answer:coarctation of the aorta Coarctation of the aorta is a discrete narrowing of the aorta, just opposite the site of the ductus arteriosus. It has two distinct presentations, one in the neonatal period, and one in infancy and childhood. |
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Risk factors for vitamin D deficiency include all but which of the following? |
gastric bypass surgery limited sun exposure low intake of citrus fruit renal disease Hide ExplanationExplanation:Correct answer:low intake of citrus fruit This is not a risk factor for vitamin D deficiency. All of the other choices are risk factors along with use of sunscreen when outdoors, use of Phenobarbital, hepatic disease and gastric bypass. |
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Which of the following clients suffering from influenza would NOT require a 24-hour call-back? |
adolescent elderly patient infant client with chronic disease Hide ExplanationExplanation:Correct answer:adolescent In normal circumstances the adolescent is least likely to require a follow-up in 24 hours. Infants, children, the elderly, and the chronically diseased client should be monitored closely. |
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Your 59-year-old female patient suffers from urge incontinence. You will prescribe which of the following as a first-line drug for her urge incontinence? |
pseudoephedrine Tolterodine Oxybutynin Imipramine Hide ExplanationExplanation:Correct Answer:Oxybutynin Oxybutynin is a first-line drug for treatment of urge incontinence. Pseudoephedrine is used for stress incontinence. Tolterodine and imipramine are also used for treatment of urge incontinence. |
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You are conducting a health assessment with a patient who tells you she has recently converted to Buddhism. She expresses that she feels very tired and run down. She reports frequent headaches and dizziness. You also notice that her fingernails curve upward. In the course of discussing her diet, you notice that she does not mention eating any meat, Which of the following is a likely cause of this patient's symptoms? |
Sickle cell anemia. Religious beliefs prohibiting the eating of meat. Contaminated milk products. Vitamin C deficiency. Answer:Religious beliefs prohibiting the eating of meat.While it is possible to eat a vegetarian diet and get enough iron, this patient appears to be anemic. If she has recently adopted vegetarianism, she may not yet be eating enough iron rich foods. When discussing diet with her, ask more about what she does eat and work to find iron rich foods that accommodate her religious restrictions. |
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A patient comes to the clinic with swelling behind his knee. He tells you that he has a sense of fullness behind the knee as if something is there. Of the following choices, which diagnosis is most likely? |
prepatellar bursitis olecranon bursitis trochanteric bursitis Baker cyst Hide ExplanationExplanation:Correct answer:Baker cyst This patient most likely has a Baker cyst. Your examination will show cystic swelling in the popliteal space. If the bursa ruptures there is acute swelling of the lower leg, mimicking deep vein thrombosis. |
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A patient who has giant cell arteritis may present with all except which of the following symptoms? |
dry cough low body temperature jaw claudication throat pain Hide ExplanationExplanation:Correct Answer:low body temperatureLow body temperature is not a symptom of giant cell arteritis. Fever is more likely. Other symptoms include: painful paralysis of a shoulder, scalp tenderness, visual changes, and vague pain in the tongue, head, neck nose or ears (among other symptoms). |
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You are examining a 67-year-old woman who may have osteoporosis. All of the following would be considered protective factors against osteoporosis EXCEPT: |
black race obesity high calcium intake early menopause Hide ExplanationExplanation:Correct Answer:early menopause Early menopause is a factor that would increase susceptibility to osteoporosis. Other factors increasing susceptibility include: increasing age, white or Asian race, family history, small stature, smoking, physical inactivity, female gender, low body weight, low calcium intake, and excessive alcohol intake. |
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You have a patient with deep vein thrombosis. Which of the following is NOT considered a risk factor for DVT? |
rheumatoid disease oral contraceptives male gender high altitude Hide ExplanationExplanation:Correct Answer:male genderBeing of the male gender is not a risk factor for DVT. There is a female preponderance. DVT occurs at the rate of approximately 1 – 2 million cases per year. |
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You have prescribed an analgesic for a patient with a urinary tract infection. She should be made aware of which of the following potential side effects? |
Blood in her urine. Vomiting. Orange or red urine. Nausea. Hide ExplanationExplanation:Correct Answer:Orange or red urineThis is a common side effect of some analgesics prescribed for UTIs. It is key to educate the patient about this so she does not become alarmed. |
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You diagnose your elderly patient as having psoriasis. What type of skin lesion is psoriasis? |
Scale. Excoriation. Lichenification. Fissure. Hide ExplanationExplanation:Correct answer: Scale Excoriation - marks as a result of scratching Lichenification - skin thickening that is similar to callus formation Fissure - thin, linear crack into epidermis Scale - raised and flaking |
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Your 20-year-old female patient is a model and feels under constant pressure to be thin. As a result she has developed bulimia. You might manage her condition by all of the following EXCEPT: |
TCAs SSRIs MAO inhibitors cognitive behavioral therapy Hide ExplanationExplanation:Correct answer:MAO inhibitors MAO inhibitors should be avoided for those with bulimia. They have a potential for severe food interactions and hypertensive crisis. |
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In the case of acute bacterial meningitis, to which of the following patients would you be most likely to use amoxicillin plus 3rd generation cephalosporin? |
6-month-old male 58-year-old female 25-year-old female 14-year-old male Hide ExplanationExplanation:Correct Answer:58-year-old female For adults over the age of 50 the treatment would most likely be amoxicillin plus 3rd generation cephalosporin. For infants it would be ampicillin or 3rd generation cephalosporin. For adults it would be 3rd generation cephalosporin plus chloramphenicol. |
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Which of the following diagnostic procedures are you most likely to order to measure the accuracy of the brain structure of a patient? |
EEG CT scan PET SPECT Hide ExplanationExplanation:Correct answer:CT scan A CT (computerized tomographic) scan measures the accuracy of brain structure. X-rays are taken of various transverse planes of the brain. Computer analysis reconstructs an image of each segment. It can detect possible lesions, abscesses, areas of infarction, or aneurysm. |
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A 56-year-old Caucasian female is in the office inquiring about menopause. What is the best way to define menopause and counsel her? |
Menopause is the last menstrual period. Menopause is the completion of 12 months of amenorrhea after the last menstrual period. Menopause is indicated by a FSH level of 30 and estradiol level of 30. Menopause does not cease the ability for natural reproduction. Hide ExplanationExplanation:The Correct answer is:Menopause is the completion of 12 months of amenorrhea after the last menstrual period Standardized developed definitions for menopause events were created in 2001 by the Stages of Reproductive Aging Workshop. These standards state that menopause is defined as the completion of 12 months of amenorrhea after the last menstrual period. Due to the fact that FSH levels are variant, it is not the best indicator of menopause. |
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What is the lifetime risk to the average American man of having latent prostate cancer? |
10% 3% 67% 40% Hide ExplanationExplanation:Correct answer:40% The average American man has a 40% lifetime risk of latent prostate cancer. He also has an approximate 10% risk of clinically significant disease and an approximate 3% risk of dying of prostate cancer. |
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patient complains of Polydipsia. In the ROS, which system should be focused on? |
Cardiovascular. Skin. Endocrine. Respiratory. Hide ExplanationExplanation:Correct answer: Endocrine Polydipsia is excessive thirst. This indicates that the endocrine system is affected. The ROS to focus on is the endocrine system. |
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Which of the following is NOT one of the preferred drugs for simple and complex, partial seizures? |
clonazepam carbamazepine phenytoin valproic acid Hide ExplanationExplanation:Correct answer:clonazepam Clonazepam is a drug used to treat myoclonic and atonic seizures. The preferred drugs for simple and complex, partial seizures include: carbamazepine, phenytoin, divalproex sodium, and valproic acid. |
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What do you expect to find in the cerebral spinal fluid (CSF) when evaluating a patient who has aseptic or viral meningitis? |
low opening pressure glucose at about 30% serum levels low protein level predominance of lymphocytes Hide ExplanationExplanation:Correct Answer:predominance of lymphocytesTo eliminate or support a diagnosis of meningitis, a lumbar puncture to evaluate cerebral spinal fluid is often done. Pleocytosis, defined as a white blood cell (WBC) count of more than 5 cells/mm of CSF, is an expected finding in meningitis caused by bacterial, viral, tubercular, fungal, or protozoan infection. An elevated CSF opening pressure is also a nearly universal finding, not a low one. Normal glucose levels and normal or high protein levels are also noted findings with meningitis. |
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An older female patient comes to the FNP complaining of a generalized itchiness at night that keeps her up. The nurse diagnoses scabies. In treating the patient the FNP would do all of the following EXCEPT: |
Prescribe permethrin lotion to be left on for 8 to 14 hours. Tell the patient that the itching should disappear with the first use of the prescribed lotion. Tell the patient to wash all of her bedclothes and other items in hot water. Tell the patient that she can place bedclothes in plastic storage bags for a week to get rid of the mites that cause scabies. Hide ExplanationExplanation:Correct Answer:Tell the patient that the itching should disappear with the first use of the prescribed lotion.The FNP should not tell the patient that the itching will disappear quickly. Individuals with scabies often have a significant problem with pruritus even after permethrin treatment because of the presence of dead mites and their waste trapped in the skin. This debris is eliminated from the body over a few weeks and then the itchiness will let up. |
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Mrs. Norwich is a young mother whose baby suffers from colic. She tells you that it is a strain on her and she does not know how to handle it. You would tell this mother that all of the following may help EXCEPT: |
gentle bouncing feeding smaller quantities formula feeding walking outdoors Hide ExplanationExplanation:Correct Answer:formula feeding All of the choices would help except this one. Formula feeding is not a measure that will help or hurt colic. Any safe activity that uses rhythmic noise and movement will help. |
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Which of the following are considered abnormal pulmonary system findings? |
Vesicular breath sounds are soft and low in the lower lobes of the lungs. Percussion produces a hyperresonance. Bronchial breath sounds are louder in the upper lobes. Stronger vibrations are felt on the upper lobes and softer vibrations on lower lobes when patient says “99.” Hide ExplanationExplanation:Correct answer:Percussion produces hyperresonance. This is an abnormal findings. Percussion should produce resonance; not hyperresonance or a dull tone. |
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Which of the following is the most common reason for a patient with progressive valvular heart disease to have ongoing medical care? |
dysrhythmias embolic disease endocarditis heart failure Hide ExplanationExplanation:Correct answer:heart failure Heart failure is the most common reason for a patient with progressive valvular heart disease to have ongoing medical care. The nurse should emphasize to the patient that valve surgery is not a cure and that regular follow-up with a health care provider will be required. |
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You are providing care to a patient who has been admitted for a hip replacement. She has a history of cardiovascular disease and has been taking warfarin. Which of the following is likely to be used to decrease her risk of DVT after surgery? |
Bed rest. Increased doses of warfarin. Low doses of another anticoagulant. An IVC filter. Hide ExplanationExplanation:Correct Answer:An IVC filter.An inferior vena cava (IVC) filter is used to lower the risk of deep vein thrombosis (DVT). The IVC filter is used in cases where anticoagulant therapy is not advised, such as in patients with increased risk for bleeding. This patient's warfarin use increases her risk for bleeding and make it inadvisable to use other anticoagulants. She is at elevated risk of DVT due to her history of heart disease. She is a typical candidate for IVC filter. |
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Your management of a patient with acute pyelonephritis on an outpatient basis might include all but which of the following? |
Ciprofloxacin
Sulfamethoxazole/trimethoprim follow-up in 2 weeks Ofloxacin Hide ExplanationExplanation:Correct Answer: follow-up in 2 weeksYou might prescribe any of the drugs mentioned. You would treat adults as outpatient if not toxic and follow up in 12 to 24 hours. You would hospitalize children and pregnant women for IV antibiotics. |
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Of the following, which of the following medications would an NP prescribe for a patient with campylobacter jejuni? |
Metronidazole.
Erythromycin. Ampicillin. Trimethoprim-sulfamethoxazole. Hide ExplanationExplanation:Correct answer: Erythromycin The preceding drugs are typically used in treating the following: - Campylobacter jejuni: Erythromycin - Salmonella: Ampicillin - Shigella: Trimethoprim-sulfamethoxazole - Giardia lamblia: Metronidazole |
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You are educating your diabetic patient about foot care. Which of the following foot care recommendations for this patient would be inappropriate? |
Trim nails squarely. Check feet daily. Go barefoot whenever possible. Report redness or skin breakdown promptly to health care provider. Hide ExplanationExplanation:Correct answer:Go barefoot whenever possible. Patients with diabetes should pay special attention to foot care since problems with the feet are the main cause of amputations in the United States. The patient should be cautioned to never go barefoot. |
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You are reviewing the tuberculin skin reaction tests of several persons. Which one of the following would be considered to have a positive tuberculin skin test reaction if the induration is ≥ 5 mm? |
mycobacteriology laboratory personnel children less than 4 years old persons with clinical conditions that place them at high risk patients with organ transplants Hide ExplanationExplanation:Correct answer:patients with organ transplants A patient who has had an organ transplant and has a tuberculin skin test reaction that shows an induration of ≥ 5 mm is considered to have a positive reaction. The other choices would be considered to have a positive reaction with an induration of ≥ 10 mm. |
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You are conducting an assessment with a female patient in her early 30s. She tells you that around the time of her menstrual period, she experiences difficulty passing stool. She has abdominal cramping and sometimes has episodes of diarrhea alternating with episodes of being unable to defecate at all. Your patient is displaying symptoms of which of the following? |
Irritable bowel syndrome. Inflammatory bowel disease. Colitis. Gastroenteritis. Hide ExplanationExplanation:Correct Answer: Irritable bowel syndrome Irritable bowel syndrome, or IBS, is marked by cramping, constipation, diarrhea and other gastrointestinal symptoms which can vary by person. Women may have worsened symptoms around their menstrual periods, suggesting that reproductive hormones worsen IBS. |
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The NP is examining a patient of her's that has recently started a vegan diet. She complains of increased fatigue. The NP is concerned that she is not getting enough of which vitamin? |
Vitamin C. Vitamin K. Vitamin D. Vitamin B12. Hide ExplanationExplanation:Correct answer: Vitamin B12 The lack of B12 can caused increased fatigue. Vitamin B12 is generally found in animal products, such as meat and dairy, and are not consumed on a vegan diet. The NP should advise her patient to add a vitamin B12 supplement or provide a list of vegan-approved foods that are rich in B12 to add to her diet.. |
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All of the following are accurate statements about West Nile virus and its treatment EXCEPT: |
West Nile virus encephalitis cases are not reportable to state health departments. West Nile virus must be reported to CDC. Patients should immediately be referred to an infectious disease specialist. Patients with deteriorating mental status should be referred immediately for hospitalization. Hide ExplanationExplanation:Correct answer:West Nile virus is not reportable to state health departments. This is not accurate. West Nile virus encephalitis cases must be reported to state health departments. The CDC must also be informed of West Nile virus. |
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Your patient with tuberculosis has a resistant strain of TB. You will prescribe a second-line drug for him. Which of the following drugs would be used in a second-line drug therapy? |
Isoniazid (INH) Rifampin (Rifadin) Ethambutol (Myambutol) Cycloserine (Seromycin) Hide ExplanationExplanation:Correct answer:Cycloserine (Seromycin) Cycloserine (Seromycin) inhibits cell-wall synthesis and is a second-line drug for TB patients. The others are first-line drugs. Cycloserine may cause personality changes, psychosis or rash and is contraindicated in individuals with histories of psychosis. This drug is used in treatment of resistant strains of TB. |
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A new mother is unable to breast feed. The FNP's advice about bottle feeding would include all but which of the following? |
The amount of formula the infant needs at 0 to 1 month is about 2 – 4 oz. every 3 to 4 hours. The amount of formula the infant needs at 2 – 4 months is about 5 – 7 oz. every 4 to 5 hours. Iron-fortified formulas are best. Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies. Hide ExplanationExplanation:Correct answer:Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies. The FNP would not tell the bottle-feeding mother this information. It is incorrect. The FNP would only suggest partial hydrolysate formula if the infant is at risk for atopic diseases, for instance a strong family history of atopic disease. |
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Which of the following is NOT a symptom of benign prostatic hyperplasia? |
Dysuria.
Urinary urgency. Hematuria. Nocturia. Hide ExplanationExplanation:Correct Answer:Hematuria.BPH does not cause hematuria, or blood in the urine. Symptoms of BHP include urinary urgency, urinary hesitancy, dysuria, and incontinence. |
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Anna Maria is a 25-year-old patient who has been experiencing chronic pelvic pain. Which of the following diseases is more likely to cause chronic pelvic pain rather than acute pelvic pain? |
interstitial cystitis ectopic pregnancy ovarian cysts PID Hide ExplanationExplanation:Correct answer:interstitial cystitis Interstitial cystitis is more likely to cause chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic pelvic pain include: endometriosis, leiomyomas, and malignancy |
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Olecranon bursitis is located in which of the following places? |
shoulder knee elbow heel Hide ExplanationExplanation:Correct answer:elbow Olecranon bursitis is located in the elbow. There is pain and swelling behind the elbow. It is often described as a ball or sac hanging from the elbow. Risk factors include prolonged pressure or trauma to the elbow. |
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You are treating a patient for a knee sprain. The nurse practitioner understands that initial management includes: |
anti-anxiety medications rest, ice, compression, and elevation activity as tolerated X-rays Hide ExplanationExplanation:The Correct answer is:Rest, ice, compression and elevationRest, ice, compression, and elevation, which is often abbreviated as RICE, is a standard initial management for a knee sprain, along with anti-inflammatory medications. X- rays are not necessary for a sprain. Further, activity is usually withheld for 48 hours. |
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Jason is a 45-year-old male patient in the early stage of Lyme disease, erythema migrans. When you examine Jason at this stage of the disease you would expect to see which of the following? |
honey-colored crusts red target lesions Koplik’s spots sandpaper-type rash Hide ExplanationExplanation:Correct answer:red target lesions Red target lesions that expand and grown in size are symptoms of erythema migrans, early Lyme disease. This disease is caused by the bite of an Ixodes tick infected with Borrelia burgdorferi. If untreated, infection becomes systemic and affects multiple organ systems. |
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For the patient with mild ulcerative colitis, the nurse practitioner knows the primary therapy is: |
amoxicillin metronidazole sulfasalazine cephalexin Hide ExplanationExplanation:Correct Answer:sulfasalazine Sulfasalazine is the treatment recommended for patients with mild ulcerative colitis. Additionally, it results in symptomatic improvement in 50-75% of patients diagnosed with mild ulcerative colitis. If no response is seen after 2-4 weeks, the addition of prednisone is recommended. The remaining answer choices are not first line initial therapy. |
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Which of the following is NOT a teratogen that will cause structural abnormalities during pregnancy? |
aminoglycosides sulfa drugs lithium cocaine Hide ExplanationExplanation:Correct Answer:sulfa drugsSulfa drugs are contraindicated in the third trimester because they can cause hemolysis in utero with resulting hyperbilirubinemia. They are not teratogens. All of the other drugs are teratogens. Aminoglycosides can cause deafness; lithium can cause cardiac defects; cocaine can cause CVAs and mental retardation. |
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The FNP has diagnosed a patient as having herpes keratitis. He refers the patient to an ophthalmologist. The FNP understands that the ophthalmologist will treat the patient with which of the following? |
Zovirax steroid ophthalmic drops support therapy only none of the above Hide ExplanationExplanation:Correct answer:Zovirax The ophthalmologist will treat the patient with Zovirax or Valtrex BID until the problem is resolved. The ophthalmologist would not treat the patient with steroid ophthalmic drops because this would worsen the condition. |
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You have a 62-year-old female patient who is post-menopausal and whom you have diagnosed as having an ovarian cyst. The cyst is 4 cm and the client has no other risk factors. Which of the following actions would you take for this patient? |
Refer for emergency care. Do nothing. Recheck her at 6 weeks. Refer to a surgeon. Hide ExplanationExplanation:Correct answer:Recheck her at 6 weeks. If the patient is post-menopausal, the cyst is smaller than 5 cm, and the patient does not have any other risk factors, you would recheck her in 6 weeks, and then again at 3 months, and then 6 months. Refer the patient if there is any increase in size of the mass |
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A 15-year-old boy comes to the clinic after having been in a physical fight. He has some minor facial lacerations and a nosebleed. The FNP determines that the nosebleed is a posterior bleed. What is the next step that the FNP should take? |
Pack the affected nasal passage and send the patient home with instructions as to when to remove the packing. Send the patient to the ER. Try to stop the bleeding and prescribe a nasal decongestant. none of the above Hide ExplanationExplanation:Correct Answer:Send the patient to the ER.Posterior nasal bleeds may hemorrhage. The patient should be sent to the ER. |
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Sarah is a 30-year-old female who has PMS. You would recommend all of the following for Sarah EXCEPT: |
PMS support group avoiding aerobic activities scheduling difficult situations for symptom-free intervals stress reduction Hide ExplanationExplanation:Correct Answer:avoiding aerobic activities You would not recommend that she avoid aerobic activities; you would advise your patient to do regular aerobic exercise. Also advise reduction of caffeine and methylxanthines. This is especially helpful for breast tenderness. |
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You are treating a 66-year-old woman who you suspect has colorectal cancer. The nurse practitioner knows that which of the following is TRUE concerning this disease? |
Most colorectal cancers are found during rectal examination. Early manifestations of this disease include maladaptive deficiency anemia. Later disease presentation often includes iron deficiency anemia. Early manifestations of this disease include severe abdominal pain. Hide ExplanationExplanation:The Correct answer is:Later disease presentation often includes iron deficiency anemia.Colorectal cancer is the second leading cause of cancer in the United States. A person with this disease is usually asymptomatic until the disease is quite advanced. In advanced colorectal cancer, the patient will have iron deficiency anemia and vague abdominal complaints. The mass is most often beyond the examiners digit during the rectal exam. |
