Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024, Exams of Nursing

Download Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 and more Exams Nursing in PDF only on Docsity! Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Acute Care Exam 1 A primary care provider notes painless, hard lesions on a patient’s external ears that expel a white crystalline substance when pressed. What diagnostic test is indicated? Rheumatoid factor Endocrine studies Biopsy of the lesions Uric acid chemical profile A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient? Oral hygiene measures Nystatin oral suspension Surgical excision Oral acyclovir A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient’s symptoms? Prescribe empiric penicillin Perform a rapid antigen detection test Refer to an otolaryngologist Order an antistreptolysin O titer A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient complains of blurred vision, haloes around lights, and vomiting. It began yesterday evening. On exam, the eye is red, tender and inflamed. The cornea is hazy and pupil reacts poorly to light. The most likely diagnosis in this patient is: Macular degeneration Acute angle glaucoma Increased intracranial pressure Detached cornea A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.) CBC with platelets Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 BUN and creatinine PT and PTT Liver function tests PT/INR A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? Chronic otitis externa Acute otitis externa Otitis media with effusion Acute otitis media Patient has been diagnosed with acute rhinosinusitis. Symptoms began 3 days ago. Based on the most likely etiology, how should this patient be managed? Azithromycin and decongestant Decongestant and analgesic Levofloxacin Amoxicillin with clavulanate The vast majority of rhinosinusitis is of viral etiology, antibiotics would not be helpful and would only lead to continued antibacterial resistance. If symptoms persist for longer than 10 days, reevaluation is necessary with possible antibiotics at that time A 20-year-old male of Hispanic descent who reports a history of a cold that resolved 2 weeks ago except for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies fever. The patient tells you that he is very allergic to Keflex and erythromycin. Vital signs are stable except temperature is 99.2°F. Which showed the following conditions is most likely? Fever secondary to previous viral URI Acute sinusitis Acute bronchitis Hay fever Patient's symptoms match most closely to acute sinusitis which includes cough, facial pain, low- grade fever An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications? Chloramphenicol biopsyrecu Dexamethasone Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A pediatric patient has otalgia, fever of 38.8° C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action? Remove the cerumen and visualize the tympanic membrane Perform a tympanogram on the right ear Recommend symptomatic treatment for fever and pain Treat empirically with amoxicillin 80 to 90 mg/kg/day A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of: Belpharitis A chalazion A hordeolum Dacryocystitis Group A strep pharyngitis: Is commonly accompanied by inflamed uvula Can be accompanied by abdominal pain Is characterized by single symptom Usually does not have exudative symptoms Group A strep is usually accompanied by multiple symptoms with abrupt onset. GI symptoms are common such as nausea, vomiting, no abdominal pain. Inflamed uvula is not common Which symptoms may occur with vestibular neuritis? (Select all that apply.) Nausea and vomiting Disequilibrium Fever Tinnitus Hearing loss A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful? Discouraging chewing gum Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Topical corticosteroids Cool compresses Surgical drainage A NP preforms a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be? Cotton wool spots Hemorrhages Exudates Microaneurysm The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient? Administer empiric intravenous antibiotics and steroids Obtain an immediate consultation with an otolaryngologist Perform a thorough examination of the oropharynx Have the child lie down and administer high-flow, humidified oxygen A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment? Prescribe analgesics and follow up in 1 to 2 days Order antibiotic ear drops if signs of infection occur Refer the patient to an otolaryngologist for evaluation Reassure the patient that this will heal without problems Papilledema is noted n a patient with a headache. What is the importance of papilledema in this patient? it is not related to the headache this is a common finding in patients with headache it is an incidental finding in patient with migraines It could be an important finding in this patient A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient? Intranasal steroids Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Antihistamine sprays Intranasal comolyn Oral antihistamine A patient with gingival inflammation with several areas of separated ulceration and a small amount of purulent discharge. What is required to diagnose this condition? Microscopic exam of oral scrapings Physical examination Tzank smear Culture and sensitivity A 70 year old male has a yellowish, triangular nodule near the iris. This is probably: A chalazion A pinguecula A stye Subconjunctival hemorrhage. A 32-year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. 6 weeks ago, she was treated with amoxicillin for a URI. It cleared without incident. Which be recommended today? Prescribe amoxicillin again Do not prescribe an antibiotic, only a decongestant as indicated Prescribe amoxicillin-clavulanate today Prescribe a decongestant and an antihistamine A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient’s vital signs are normal. What is the most likely diagnosis for this patient? Allergic rhinitis Acute sinusitis Viral rhinitis Chronic sinusitis The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. Based on the most likely diagnosis, what should the NP tell the caregivers about this condition? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Prescribe an ophthalmic antibiotic solution Advise the patient that the condition is benign and will resolve spontaneously A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms? 1. Herpes simplex virus 2. Bacterial infection 3. Candida albicans 4. Human papillomavirus A patient diagnosed with strep throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable? 1. Different macrolide antibiotic should be prescribed 2. Penicillin or cephalosporin with beta-lactamase coverage should be considered 3. The patient should wait another 24 hours for improvement 4. That antibiotics should be changed to a first generation cephalosporin A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend for this patient? 1. Consultation for immunotherapy 2. Oral antihistamines each morning 3. Oral decongestants as needed 4. Daily intranasal steroids A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient 1. Assess airway safety and vital signs 2. Clear the blood with suction to identify site of bleeding 3. Apply firm, continuous pressure to the nostrils 4. Have the patient sit up straight and tilt the head forward A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood red area. What is this termed? 1. Acute iritis 2. Conjunctivitis Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 3. Subconjunctival hemorrhage 4. Glaucoma During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion? It is benign and will not need intervention. Immediate surgery is recommended. This is most likely malignant. A biopsy should be performed. A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which measure may help with symptomatic relief for patients with underlying allergic rhinitis? Oral mucolytics Intranasal steroids Saline solution rinses Topical decongestants A 32-year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. 6 weeks ago, she was treated with amoxicillin for a URI. It cleared without incident. Which be recommended today? Prescribed amoxicillin–clavulanate today Prescribed amoxicillin again Prescribe a decongestant and an antihistamine Do not prescribe an antibiotic, only a decongestant as indicated [Rationale: Amoxicillin is not indicated when a beta-lactamase producing organism and suspected, this is the case as patient took antibiotics 6 weeks ago. Amoxicillin–clavulanate is a good choice as it covers a beta-lactamase producers. And bacteria etiology is suspected as symptoms have persisted for 10 days. A decongestant can be added, however this does not substitute antibiotics in this case] A patient has been taking amoxicillin for treatment of a dental abscess. In a follow-up visit, the provider notes edema of the eyelids and conjunctivae. What is the next action? Hospitalize the patient for an endodontist consultation Suggest using warm compresses to the eyes for comfort Recommend follow up with a dentist in 2 to 3 days Prescribe amoxicillin clavulanate for 10 to 14 days Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A 58 year old farmer presents with a wedge shaped, pinkish, clear growth on the nasal side of his eye. He states that it has been present for a while, but only recently began to feel as if a foreign body was in his eye. This is probably a: Pterygium Xanthelasma Stye Pinguecula A 39 year old has a sudden onset of painful right red eye. He reports sensitivity to light and the sensation of a foreign body, though his history for a foreign body is negative. He does not wear contact lenses. How should the NP manage this? Treat for viral conjunctivitis Refer to ophthalmology Treat for bacterial conjunctivitis Observe for 24 hours if visual acuity is normal No clear diagnosis can be made from signs/symptoms, but there are several red flags. collectively the red flags necessitate a referral. There is no mention of eye discharge necessary for conjunctivitis. Red flags present point more towards active corneal process although glaucoma should also be a differential A child has recurrent impaction of cerumen in both ears and the parent asks what can be done to help prevent this. What will the provider recommend? Removing cerumen with a cotton-tipped swab Try thermal-auricular therapy when needed Use an oral irrigation tool to remove cerumen Clean the outer ear and canal with a sof t cloth A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding? Speech reception test Impedance audiometry Pure tone audiogram Tympanogram A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination reveals slight redness in the ear canal with a clear odorless fluid. This is suggestive of: Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Unilateral cataracts Papilledema is noted in a patient with a headache. What is the importance of papilledema in this patient? It could be an important finding in this patient it is an incidental finding in patient with migraines this is a common finding in patients with headache it is not related to the headache Papilledema could represent swelling of the optic nerve head and disc secondary to increased intracranial pressure (ICP). The cardinal symptom of ICO is a headache; papilledema is a secondary finding. It is not a common finding in patient with general headache A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary at this time? Urgent drainage of the mass CT scan of facial structures Ice packs to reduce facial swelling Surgery to reduce the nasal fracture Week 2 – Pulmonary A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? Empiric treatment with a macrolide antibiotic A 22 year old tall, thin and athletic man comes into your primary care clinic complaining of pain with breathing and progressively worsening shortness of breath. In order of sequence, what will be your next steps? -Obtain more history, auscultate the lungs and send pt to the ER for a stat CXR and further evaluation. -Obtain more history, and immediately send him to the ER Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms? Infection Patients with pneumonia reports that he has rust-colored sputum. With pathogen should the nurse practitioner suspect? Streptococcus pneumoniae Clinical description of mucus does not really help and clinical decision making regarding pneumonia, but certain clinical characteristics are associated with specific types of pneumonia. Scant or watery sputum is associated with atypical pathogens like mycoplasma and clamydophila. Thick, discolored sputum may be associated with bacterial pneumonia. A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Complete blood count A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication Administer LAIV influenza vaccine Perform a nasal swab for RT-PCR assay Which patient might be expected to have the worst FEV1? Patient with bronchiolitis A controlled asthma patient A 65 her old with emphysema A 60-year-old with pneumonia Forced expiratory volume in 1 second (FEV1)is the worst in patients with obstructive disease such as emphysema. An FEV1 should not be performed in patients with pneumonia and bronchiolitis because they would have diminished respiratory capacity related to the infection Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient’s dyspnea? Breathing exercises Anxiolytic drugs Supplemental oxygen Opioid medications Which are causes of pleural effusions? (Select all that apply.) Allergies Bronchiectasis Breast cancer Congestive heart failure Dehydration Pleurisy is not a diagnosis but rather a symptom of many localized and systemic disease that needs further evaluation in order to find the cause of the problem. True False A patient with cough and fever is found to have infiltrates on chest x-ray. Would this is likely diagnosis Tuberculosis Pneumonitis Pneumonia Acute bronchitis Infiltrates on x-ray in conjunction with clinical findings of fever and cough should direct the NP to consider pneumonia as diagnosis Dyspnea, tachypnea and pleuritic CP are classic presentation of a pulmonary emboli. If your pt is complaining of calf or thigh leg pain, you should suspect compartment syndrome pulmonary embolism (PE) peripheral neuropathy with fracture deep vein thrombosis (DVT) Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Peak expiratory flow rate Methacholine challenge test The major laboratory abnormality noted in patients who have pneumococcal pneumonia is: Gram stain positive Leukopenia Eosinophilia Leukocytosis Increased white count is typical in patients with bacterial pneumonia. Eosinophils can be increased in patients but developed pneumonia secondary to irritating substances such as toxic gas. Leukopenia is an ominous finding, especially in older patients, indicating poor prognosis The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent? The infant should have an influenza vaccine now with a booster in 1 month. The rest of the family and all close contacts should have the influenza vaccine. The infant should be given prophylactic antiviral medications. The infant should have the live attenuated influenza vaccine (LAIV). When initially treating adults with acute bronchitis, which of the following should the nurse practitioner be least likely to order: Antitussives Expectorants Antibiotics Bronchodilators Which of the following infections can cause a "barky" cough? Croup Which method of treatment is used for traumatic pneumothorax? 1. Placement of small-bore catheter 2. Needle aspiration of the pneumothorax 3. Observation for spontaneous resolution 4. Tube thoracostomy Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? 1. CT angiography 2. Electrocardiogram 3. D-dimer 4. Arterial blood gases A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient’s pneumonia. 1. Tuberculosis 2. S. pneumoniae 3. Mycoplasma 4. TrueA virus A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next? 1. Prescribe an antibiotic 2. Recommend an NSAID 3. Order a chest radiograph 4. Refer to a cardiologist A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? 1. Taking an oral corticosteroid 2. Administering two more doses of albuterol 3. Going to the emergency department 4. Coming to the clinic for evaluation The following requires immediate intervention and hospitalization (choose all that apply) 1. Primary spontaneous pneumothorax (PSP) Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 2. Secondary spontaneous pneumothorax 3. PSP with less than 2-3 cm between the lung and chest wall 4. Tension pneumothorax An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient? 1. Isolation if paroxysmal cough develops 2. Symptomatic care only 3. Pertussis vaccine booster 4. Azithromycin daily for 5 days What disease is usually managed with short acting oral long-acting inhaled anticholinergic medications?! COPD Bronchitis Asthma Bronchiectasis Anticholinergics can improve lung function and COPD. Anticholinergics are not to be used as a lone agent to manage symptoms of asthma. Bronchitis is a viral infection and is self-limiting, does not usually require inhalers. The patient has cough, pharyngitis, nasal discharge, and fever. He has been diagnosed with acute bronchitis. Which symptom is least likely in the first 3 days of this illness? Cough A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings? Hepatic disease Pulmonary infection Pulmonary embolus Congestive heart failure Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 HDL cholesterol </= 40 mg/dL Elevated waist circumference Fasting plasma glucose ≧100 mg/dL Decreased plasminogen activator inhibitor 1 levels A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? Giving a rapid-acting carbohydrate A 38-year-old male patient presents for his annual exam. He reports nervousness and weight loss, but denies any changes in his dietary intake or exercise level. Based on these findings and the following lab values, more what is the most likely diagnosis? TSH 0.01 (normal 0.4-3.8) Free T4 6 (normal 0.8-2.8) Free T3 205 (normal 70-205) Hyperthyroidism TSH is low and T4 is high indicating hyperthyroidism Excessive thirst and volume of dilute urine may be a symptom of: Diabetes insipidus Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia. Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment Chvostek’s sign Renal calculi Lef t ventricular hypertrophy Perioral paresthesias Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? 2.4 uIU/L 0.4 uIU/L Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 0.2 uIU/L 4.2 uIU/L Some of the hallmark characteristics of hyperosmolar hyperglycemic state are: Blood glucose over 1000 mg/dL Slow onset (over days) Higher prevalence in type 1 diabetics Negative ketones The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient: Has impaired fasting glucose Should have a hemoglobin A1c performed Has normal blood glucose values Should continue to monitor glucose at home A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? A thyroidectomy will be necessary. She will need lifelong medication. This condition may be transient. She should be referred to an endocrinologist. A 76-year-old obese patient has fatigue, thirst, and frequent urination. She was asked to measure a.m. fasting glucose value for one week. The values range from 142-1 75 mg/dL. She is now back to your clinic due to persistent symptoms, this patient: Should have a hemoglobin A1C performed for diagnosis Can be diagnosed with type 2 diabetes Has prediabetes Has impaired fasting glucose Impaired fasting glucose can be diagnosed when to fasting glucose readings are between 100-125 mg/dL. The conjunction of classic symptoms of hyperglycemia with a fasting blood glucose over 126 mg/dL consistently is diagnostic for diabetes. A1c is not required to diagnose diabetes in this case, but can be done to establish a baseline. Untreated hyperglycemia may lead to all of the following complications except: Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Vitiligo Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death. Which choice best describes the most common presentation of a patient with type 2 diabetes? Insidious onset of hyperglycemia with weight gain Most patient's with type 2 diabetes are asymptomatic at presentation. They are identified because of screening and identification of risk factors. Diabetes usually has an insidious onset and is associated with weight gain. An acute onset is typical of patients with type 1 diabetes. Microalbuminuria develops after several years of having diabetes Mr. Jones is a type I diabetic that presents to your clinic with nausea/vomiting and weakness. You do random blood sugar test in clinic and his blood sugar is 550. You are not able to obtain a urine sample at this time. What is your next action? Treat with insulin and order chemistry and urine labs Treat with insulin Send to ED Order a urine test to be done at the lab This patient is a type I diabetic with symptoms and blood glucose that should lead NP to consider DKA. DKA is treated in the inpatient setting as it requires insulin, IV rehydration, and careful monitoring of electrolytes. The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level? 10 weeks 2 weeks 4 weeks 6 weeks Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Acanthosis nigricans is associated with all of the following disorders except: Tinea versicolor A 65-year-old patient presents to your clinic with evidence of hyperthyroidism. In assessing her cardiovascular status, which should NP assess immediately? Cardiac enzymes Electrocardiogram A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed? TSH 32.7 (normal 0.4-3.8) Free T4 0.09 (normal 0.8-2.8) LDL 190mg/dL Total cholesterol 260mg/gL Increase levothyroxine dose A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Thyroid ultrasound Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Inappropriate secretion of PTH along with hypercalcemia A 50-year-old female presents for her annual exam. She complains of fatigue and weight gain. She has a following lab results. What should the NP order? TSH 7 (normal 0.4-3.8) Repeat TSH plus free T4 Patient presents with elevated TSH as well as possible symptoms of hypothyroidism. A repeat of TSH and free T4 should be done to determine presence and degree of hypothyroidism. Replacement therapy is generally not initiated until the TSH is greater than 10 and direct measurement of serum T4 is obtained. there is no nodule or other indications in this scenario for an ultrasound. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers: The TSH level A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Beta blocker medications A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Hemoglobin A1C A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Thyroid ultrasound Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Renal calculi Lef t ventricular hypertrophy Cognitive impairment A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? This condition may be transient. The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient: Should have a hemoglobin A1c performed Weight gain is one of the potential symptoms of diabetes, however it is a nonspecific symptom, the patient did not have any of the other classic diabetes symptoms. His nonfasting glucose log has a wide range. Confirmation of prediabetes versus normal finding versus diabetes should be done with repeat testing, preferably with hemoglobin A1c. A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed? TSH 32.7 (normal 0.4-3.8) Free T4 0.09 (normal 0.8-2.8) LDL 190mg/dL Total cholesterol 260mg/dL Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Has impaired fasting glucose Should have a hemoglobin A1c performed Should continue to monitor glucose at home A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Radionucleotide imaging Serum calcitonin Thyroid ultrasound Serum TSH level A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She should be referred to an endocrinologist. This condition may be transient. A thyroidectomy will be necessary. She will need lifelong medication. Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? 0.2 uIU/L 2.4 uIU/L 0.4 uIU/L 4.2 uIU/L A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed? TSH 32.7 (normal 0.4-3.8) Free T4 0.09 (normal 0.8-2.8) LDL 190mg/dL Total cholesterol 260mg/dL Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Encourage lifestyle modifications Increase levothyroxine dose Decrease levothyroxine dose Begin statin therapy This patient has a low T4 with elevated TSH and hence needs an increase in levothyroxine. Dyslipidemia is common finding when TSH exceeds 10. The NP should first treat hypothyroidism and then proceed with repeat of lipid testing. The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level? 4 weeks 6 weeks 10 weeks 2 weeks Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic. Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Inappropriate secretion of PTH along with hypercalcemia Week 4 – Cardiovascular (CV) An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What will the provider do next? Evaluate the patient’s orthostatic vital signs Which are causes of secondary hypertension? (Select all that apply.) Nonsteroidal anti-inflammatory drugs Sleep apnea Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Oral contraceptives You're treating your patient for heart failure exacerbation. Which medications could potentially exacerbate heart failure? Naproxen Aspirin Atorvastatin Furosemide While doing the cardiac exam on a 45-year-old, you notice any irregular rhythm with a pulse rate of 110 bpm. The patient is alert and not in distress. What is the likely diagnosis? Atrial fibrillation Atrial fibrillation is an irregular rhythm. In ventricular fibrillation patient would be unstable. Right bundle branch block does not cause rhythm irregularities. Second-degree AV block can cause rhythm irregularity, but is usually accompanied with bradycardia. A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic? Using a vagal maneuver or carotid massage Which are factors can cause a heart murmur? (Select all that apply.) High rates of flow through a normal valve Backward flow through a septal defect Forward flow into a dilated vessel A 28-year-old has a grade 3 murmur. Which characteristic indicates a need for referral? A fixed split A split this created because of closure of valves. For example, and S2 is created by closure of an aortic and pulmonic valve. Normal these split with inspiration and almost never with expiration. Splits should never be fixed. This could indicate pathology such as atrial septal defect, pulmonic stenosis, or possibly mitral regurgitation. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action? Give the patient a beta blocker medication A patient has shortness of breath. if heart failure is the etiology, which test demonstrates the highest sensitivity in diagnosing this? B-type natriuretic peptide (BNP) When BNP is elevated, the sensitivity and specificity is 98% and 92%, favoring a diagnosis of heart failure. Echocardiograms I used to evaluate internal structures of the heart and established an ejection fraction and is useful and diagnosis of heart failure, but does not give a correlation to patient's current symptoms. chest x-ray can indicate pulmonary congestion such as with congestive heart failure, but BNP is more sensitive measure Which are factors can cause a heart murmur? (Select all that apply.) Forward flow into a dilated vessel rrect! High rates of flow through a normal valve Backward flow into a normal vessel rrect! Backward flow through a septal defect Low rates of flow into a cardiac chamber An elderly female without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms? Digital subtraction angiography ect! Doppler ankle, arm index Magnetic resonance angiography Segmental limb pressure measurement A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic?ect! Using a vagal maneuver or carotid massage Giving a beta blocker Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Providing a loading dose of digoxin Administration of intravenous adenosine A 43-year-old Hispanic male presents to clinic for uncomplicated lower leg cellulitis. During her exam, you notice an audible diastolic murmur best heard in the mitral listening point. he does not have any significant cardiovascular symptoms. The murmur is probably: Acute mitral regurgitation Chronic mitral regurgitation Mitral stenosis Mitral valve prolapse A 35-year-old man has a history of an upper respiratory viral infection 4 weeks ago. He reports that he started feeling dyspnea and now complains of sharp pain in the middle of the chest that is worse when he lies down. Physical exam is within normal limits with the exception of pericardial rub on auscultation. The most likely diagnosis would be: Pulmonary embolism Esophageal reflux Pericarditis Pneumonia A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? Ultrasound of the mass to determine size Immediate referral to a thoracic surgeon Scheduling an MRI to evaluate for aortic disease Ordering computerized tomography angiography A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do? Continue to monitor the patient every 3 years Reassure the patient that these findings are expected Consult with the cardiologist to determine appropriate diagnostic tests Admit the patient to the hospital for evaluation and treatment Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A 90-year-old is presenting to clinic with isolated systolic hypertension. Which of the following antihypertensive medications are preferred for the treatment of this condition" Calcium channel blockers and thiazide diuretics Beta blockers and potassium sparing diuretics Angiotensin-converting enzyme inhibitors and loop diuretics Alpha blockers and calcium channel blockers And calcium channel blockers and thiazide diuretics are preferred. There is generally no preference 1 over another unless there is other significant comorbidities. Beta blockers are no longer recommended as first line for hypertension treatment. Alpha blockers is a possible treatment but is not first-line. Loop diuretics are not recommended specifically for hypertension treatment. A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient? Order urinalysis, CBC, BUN, and creatinine Assess serum cortisol levels Refer to a specialist for a sleep study Continue to monitor blood pressure at each health maintenance visit A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Transfer to the PCI-capable institution Administer heparin Give the patient an oral beta blocker Initiate fibrinolytic treatment Current American Heart Association (AHA) recommendations include: (Select all that apply.) A rate of 100 compressions per minute at a minimum A compression depth of 1½ inches or more on an adult Using a ratio of 2 rescue breaths to 30 compressions Untrained rescuers giving compressions without breaths Rescue breaths given during 2 seconds to allow full chest rise Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 2. Ultrasound of the mass to determine size 3. Scheduling an MRI to evaluate for aortic dz 4. Immediate referral to a thoracic surgeon A 43-year-old Hispanic male presents to clinic for uncomplicated lower leg cellulitis. During her exam, you notice an audible diastolic murmur best heard in the mitral listening point. he does not have any significant cardiovascular symptoms. The murmur is probably: 1. Acute mitral regurgitation 2. Chronic mitral regurgitation 3. Mitral valve prolapse 4. Mitral stenosis A 90-year-old is presenting to clinic with isolated systolic hypertension. Which of the following antihypertensive medications are preferred for the treatment of this condition" 1. Angiotensin-converting enzyme inhibitors and loop diuretics 2. Calcium channel blockers and thiazide diuretics 3. Beta blockers and potassium sparing diuretics 4. Alpha blockers and calcium channel blockers An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? 1. Prescribe a calcium channel blocker 2. Admit to the hospital for evaluation and treatment 3. Add a beta blocker to the patient’s regimen 4. Increase the dose of the thiazide medication A patient is diagnosed with PAD and elects not to have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 1. Daily aspirin therapy to prevent clotting 2. Statin therapy with clopidogrel 3. Walking to the point of pain each day 4. Walking slowly for 15 to 20 minutes twice daily A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action? 1. Administer a second nitroglycerin tablet 2. Prescribe a calcium channel blocker medication 3. Give the patient a beta blocker medication 4. Start statin therapy and refer the patient to a cardiologist An elderly woman has been taking digoxin for 10 years. Her EKG is showing a new onset of atrial fibrillation. Her pulse is 64 bpm. She denies any significant cardiovascular symptoms. Which of the following interventions is most appropriate? 1. Order an electrolyte panel and digoxin level 2. Order a serum TSH, digoxin level, electrolyte panel 3. Order a digoxin level and decrease her digoxin dose by half while waiting for results 4. Discontinued digoxin and order another 12-lead EKG A patient taking atorvastatin for newly diagnosed dyslipidemia complains of fatigue, weakness, muscle aches in his lower back, arms, legs for the past 3 days. It has not improved with rest. How should this be managed initially? 1. Ask about nighttime muscle cramps 2. Check liver enzymes first 3. Stop atorvastatin immediately 4. Order a CPK level A 70 year old male patient complains of a bright red colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a recent URI. The only medicine he is taking is aspirin 1 tablet daily. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Which of the following is most likely? 1. Acute uveitis 2. Corneal abrasion 3. Acute bacterial conjunctivitis 4. Subconjunctival hemorrhage The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. based on the most likely diagnosis, what should the NP tell the caregivers about this condition? Pain is normal in the affected eye This usually begins as a viral infection Anterior cervical lymphadenopathy is common It produces blurred vision in the affected eye A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment? Correct! Order antibiotic ear drops if signs of infection occur Reassure the patient that this will heal without problems Prescribe analgesics and follow up in 1 to 2 days Refer the patient to an otolaryngologist for evaluation A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention at this time? Turn the child’s head to the side to prevent aspiration of blood Correct! Immobilize the child’s head and neck and call 911 Place nasal packing in both nares to stop the bleeding Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient? Correct Answer Azithromycin (I don’t think this is correct. I could be wrong) Trimethoprim-sulfamethoxazole You Answered Oseltamivir Clindamycin The major laboratory abnormality noted in patients who have pneumococcal pneumonia is: Leukopenia Correct! Leukocytosis Eosinophilia Gram stain positive Increased white count is typical in patients with bacterial pneumonia. Eosinophils can be increased in patients but developed pneumonia secondary to irritating substances such as toxic gas. Leukopenia is an ominous finding, especially in older patients, indicating poor prognosis Which patient might be expected to have the worst FEV1? Patient with bronchiolitis A 60-year-old with pneumonia Correct! A 65 her old with emphysema A controlled asthma patient Forced expiratory volume in 1 second (FEV1)is the worst in patients with obstructive disease such as emphysema. An FEV1 should not be performed in patients with pneumonia and bronchiolitis because they would have diminished respiratory capacity related to the infection An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Add a beta blocker to the patient’s regimen Prescribe a calcium channel blocker Increase the dose of the thiazide medication Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Correct! Admit to the hospital for evaluation and treatment A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient? Refer to a specialist for a sleep study Assess serum cortisol levels Correct! Order urinalysis, CBC, BUN, and creatinine mitral stenosis Continue to monitor blood pressure at each health maintenance visit A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Transfer to the PCI-capable institution Give the patient an oral beta blocker Administer heparin Correct! Initiate fibrinolytic treatment A 43-year-old Hispanic male presents to clinic for uncomplicated lower leg cellulitis. During her exam, you notice an audible diastolic murmur best heard in the mitral listening point. he does not have any significant cardiovascular symptoms. The murmur is probably: Correct! Mitral stenosis Chronic mitral regurgitation Acute mitral regurgitation Mitral valve prolapse Mitral valve prolapse is unlikely as it is a systolic murmur. Acute mitral regurgitation usually develops after rupture of papillary muscles in the heart, patient would be presenting with significant symptoms. Mitral regurgitation is also a systolic murmur. Mr. Smith is a 72-year-old patient takes warfarin for chronic atrial fibrillation. His INR today is 4. The nurse practitioner should: Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Administer vitamin K and repeat INR in 2 hours Stop the warfarin for the next 4 days and repeat INR on day 5 Correct! Stop the warfarin today and repeat INR tomorrow. Admit to the hospital INR range for atrial fibrillation is usually 2-3 for chronic atrial fibrillation. Stopping warfarin for 4 days with certainly decrease INR, but his overkill, and would put patient at risk for thromboembolism when INR is subtherapeutic. Vitamin K is not necessary for patients who are not bleeding due to high INR, or whose INR is less than 8. A 28-year-old has a grade 3 murmur. Which characteristic indicates a need for referral? An increase in splitting with inspiration Correct! A fixed split Changes in intensity with position changes Split S2 with inspiration A split this created because of closure of valves. For example, and S2 is created by closure of an aortic and pulmonic valve. Normal these split with inspiration and almost never with expiration. Splits should never be fixed. This could indicate pathology such as atrial septal defect, pulmonic stenosis, or possibly mitral regurgitation. A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Correct! Beta blocker medications Radioiodine therapy Surgical resection of the thyroid gland Thionamide therapy A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She should be referred to an endocrinologist. She will need lifelong medication. Correct! Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Pain occurring prior to nausea and vomiting An 83 year old is diagnosed with diverticulitis. The most common complaint is Bloating and crampiness Left lower quadrant pain Frequent belching and flatulence Rectal bleeding About 70% of pts diagnosed with diverticulitis will have let lower quadrant pain. An older patient presents with left lower quadrant pain. If diverticulitis is suspected, how should the NP proceed? CT scan of abdomen Which is the most common cause of pancreatitis in the United States? Gallstones A patient experiences a sharp pain with swallowing just under the sternum. This is more commonly associated with which condition? Infectious esophagitis A patient's CBC demonstrated anemia. Which diagnosis is likely based on this patient's laboratory values? MCV 74.1 fL (normal 80-95) MCH 24 pg (normal 27-31) MCHC 33% (normal 32-69) RDW 12% (normal 11-14.5) thalassemia Vitamin B12 deficiency anemia Ron deficiency anemia Anemia of chronic disease Thalassemia and iron deficiency anemia are both microcytic anemias. The RDW indicates variation in width of red blood cells, RDW is normal in thalassemia and is typically elevated and iron deficiency anemia. Vitamin B12 deficiency is a macrocytic anemia. Anemia of chronic disease is usually either a normocytic or a microcytic anemia. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 All of the following relieve symptoms of GERD except: Chewing breath mints A patient has both occasional “coffee ground” emesis and melena stools. What is the most probable source of bleeding in this patient? Upper GI Hepatic Lower GI Rectal A patient's CBC demonstrated anemia. Which diagnosis is likely based on this patient's laboratory values? MCV 114 fL (normal 80-95) MCH 29 pg (normal 27-31) MCHC 33.8% (normal 32-69) RDW 15% (normal 11-14.5) Pernicious anemia This patient has elevated MCV, indicating macrocytic anemia. iron deficiency is a microcytic anemia. Anemia of chronic disease is either a micro or normocytic anemia. Sideroblastic anemia is a microcytic anemia. Which medications may increase the prevalence of GERD? (Select all that apply.) Oral contraceptives Benzodiazepines Hormone replacements Calcium antagonists Aspirin A patient has a recent episode of vomiting and describes the vomitus as containing mostly gastric juice. What does this symptom suggest? Peptic ulcer A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action? Transfer the patient to the emergency department for a surgical consult Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A 74-year-old man presents with recurrent abdominal cramping and pain associated with diarrhea that occurs from 4-5 times per day. He reports that currently he is having an exacerbation. The stools are bloody with mucus and pus. The patient reports that he has lost weight and is always fatigued. The patient denies recent travel or outdoor camping. Which with the following conditions is most likely? Ulcerative colitis The most important clue for ulcerative colitis is bloody stools that are covered with mucus and pus along with systemic symptoms such as fatigue and low-grade fever What is the best treatment for H. pylori-related peptic ulcer disease? H2RA and clarithromycin for 14 days PPI and clarithromycin for 14 days H2RA, bismuth, metronidazole, and tetracycline for 10 to 14 days PPI, amoxicillin, and clarithromycin for 10 days A patient has fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms? Prescribing ursodeoxycholic acid Supportive care with close follow-up Hospitalization for emergent treatment Empiric treatment with antibiotics Which symptoms in a patient with abdominal pain are suggestive of appendicitis? (Select all that apply.) Pain occurring prior to nausea and vomiting Pain accompanied by low-grade fever Abdominal rigidity along with pain Pain that begins in the left lower quadrant Prolonged duration of right lower quadrant pain A 74-year-old man presents with recurrent abdominal cramping and pain associated with diarrhea that occurs from 4-5 times per day. He reports that currently he is having an exacerbation. The stools are bloody with mucous and pus. The patient reports that he has lost weight and is always fatigued. The patient denies recent travel or outdoor camping. Which with the following conditions is most likely? Correct! Ulcerative colitis Irritable bowel syndrome Giardiasis Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Acute cholecystitis A patient who has been taking an NSAID for osteoarthritis pain has newly diagnosed peptic ulcer disease. What is the initial step in treating this patient? Discontinue the NSAID Order prostaglandin therapy Prescribe a proton pump inhibitor Recommend an H2 receptor antagonist What choice below is most commonly associated with pancreatitis? Viral infection and cholecystitis Gallstones and alcohol abuse Hypertriglyceridemia and cholecystitis Appendicitis and renal stones A 24 year old female with pain and tenderness in the right lower abdominal quadrant. Pelvic exam ad UA are normal. WBC is elevated. Urine pregnancy test is negative. What is part of the differential diagnosis? Ectopic pregnancy Pelvic inflammatory disease UTI Appendicitis A patient reports anal pruritus and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient’s symptoms? Daily laxatives to prevent straining with stools A high-fiber diet and increased fluid intake Infiltration of a local anesthetic into the hemorrhoid Referral for possible surgical intervention All of the following are true statements about diverticula except: Supplementing with fiber, such as psyllium (Metamucil), is recommended Diverticula are located in the colon Most diverticula in the colon are infected with gram negative bacteria A low fiber diet is associated with the condition Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 What medication may be used to treat GERD if a patient has tried over the counter ranitidine without benefit? Pantoprazole Prescription strength ranitidine Calcium carbonate Prescription strength ranitidine An 8-month-old girl is brought by her grandmother to see the nurse practitioner because of intermittent, random episodes of vomiting, abdominal bloating, currant jelly stools, and irritability with poor appetite. The infant is stranding in the 10th percentile on the growth chart and appears lethargic. During the abdominal exam, a sausage like mass is palpated on the right side of the abdomen. The infant's presentation is highly suggestive of which condition? Inflammatory bowel disease Irritable bowel syndrome Intussusception Lactose intolerance The classic triad of intussusception is currant jelly stools, a sausage like mass, and pain. A sausage- shaped abdominal mass may be palpated on the right side of the abdomen. A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? Common bile duct obstruction A patient has nausea associated with chemotherapy. Which agent will be prescribed? Ondansetron A patient is in the clinic with a 36 hrs history of diarrhea and moderate dehydration. Interventions should include: Oral rehydration with an electrolyte replenishment solution Which description is more typical of a patient with acute cholecystitis? The patient is ill appearing and febrile A patient with acute cholecystitis usually c/o abd pain in upper right quadrant or epigastric pain. Many also have nausea. The patient lies still on the exam table as this condition is associated with peritoneal inflammation that is worse with movement. Elderly are less likely to exhibit Murphy's sign. Asymptomatic patients have cholelithiasis. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient who has a history of diverticular disease has left-sided pain and reports seeing blood in the stool. What is an important intervention for these symptoms? Prescribing an antispasmodic medication Ordering a CBC and stool for occult blood Referring the patient for a lower endoscopy Reminding the patient to eat a high-fiber diet A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? Chronic cholelithiasis Acute acalculous cholecystitis You Answered Infectious cholecystitis Common bile duct obstruction A 70 year old has bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient? Diverticulitis Anal fissure Colon cancer Hemorrhoids [Anal fissure usually produces pain with bowel movements.] A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action? Transfer the patient to the emergency department for a surgical consult A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? Common bile duct obstruction A patient present with abdominal pain and has the following laboratory findings. Would does this mean? HBsAg positive anti-HBc positive IgM Anti-HBc positive anti-HBs negative He has acute hepatitis B -- A positive hepatitis B surface antigen and a positive IgM means that this patient has acute hepatitis B. The first serological marker to be positive is the surface antigen. It can Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 ● Consuming a diet high in fiber ● Using bran to replace high-fiber foods ● Taking an anticholinergic medication ● Avoiding saturated fats and red meats Which medications may increase the prevalence of GERD? (Select all that apply.) ● Hormone replacements ● Oral contraceptives ● Aspirin ● Benzodiazepines ● Calcium antagonists All of the following are true statements about diverticula except: ● Supplementing with fiber, such as psyllium, is recommended ● Diverticula are located in the colon ● A low fiber diet is associated with the condition ● Most diverticular in the colon are infected with gram negative bacteria A patient present with abdominal pain and has the following laboratory findings. Would does this mean? HBsAg positive anti-HBc positive IgM Anti-HBc positive anti-HBs negative ● He has no immunity to hepatitis B ● He has immunity to hepatitis B ● More data is needed ● He has acute Hepatitis B A 43-year-old female patient reports a possible exposure to hepatitis C about 4 months ago. She now presents to the clinic with concerns due to new onset abdominal pain. She has the following laboratory values. Which statement is true about this patient? HBsAg negative anti-HBc negative Anti-HBs positive anti-HCV nonreactive HCV RNA not detectable Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 The patient does not have hepatitis C, but has immunity to hepatitis B More testing needed to determine this patient's hepatitis B status The patient has hepatitis B and hepatitis C The patient does not have hepatitis B, but could have hepatitis C Which of the following would be usual in a patient with biliary colic? Pain in upper abdomen in response to eating fatty foods Most patient who have an acute hepatitis B infection: Develop subsequent cirrhosis Are females Are acutely ill Have varied clinical presentations Which patient has the least worrisome symptoms associated with his diarrhea? One with: Duration of illness greater than 48 hours Bloody diarrhea Temp >101.3 F Moderate amount of watery diarrhea A patient has both occasional “coffee ground” emesis and melena stools. What is the most probably source of bleeding in this patient? Lower GI Hepatic Rectal Upper GI A 74 year old man presents with recurrent abdominal cramping and pain associated with diarrhea that occurs from 4-5 times per day.. Report that currently he is having an exacerbation. The stools are bloody with mucus and pus. The patient reports that he has lost weight and is always fatigued. He denies recent travel or outdoor camping. Which of the following conditions is most likely? Diverticulitis Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Irritable bowel syndrome Giardiasis Ulcerative colitis The most important clue is bloody stools covered in mucus and pus and systemic symptoms. The most important clue is bloody stools covered in mucus and pus and systemic symptoms. Which description is more typical of a patient with acute cholecystitis? Most are asymptomatic until a stone blocks the bile duct The elderly patient is more likely to exhibit Murphy's sign The patient rolls from side to side on the exam table The patient is ill appearing and febrile A patient with acute cholecystitis usually c/o abd pain in upper right quadrant or epigastric pain. Many also have nausea. The patient lies still on the exam table as this condition is associated with peritoneal inflammation that is worse with movement. Elderly are less likely to exhibit Murphy's sign. Asymptomatic patients have cholelithiasis. A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient’s symptoms? A high-fiber diet and increased fluid intake A patient has nausea associated with chemotherapy. Which agent will be prescribed? Meclizine Ondansetron Scopolamine Diphenhydramine Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A patient has a recent episode of vomiting and describes the vomitus as containing mostly gastric juice. What does this symptom suggest? Small bowel obstruction Bile duct obstruction Gastritis Peptic ulcer A patient has fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms? Prescribing ursodeoxycholic acid Empiric treatment with antibiotics Hospitalization for emergent treatment Supportive care with close follow-up A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? Infectious cholecystitis Acute acalculous cholecystitis Common bile duct obstruction Chronic cholelithiasis What is the best treatment for H. pylori-related peptic ulcer disease? H2RA, bismuth, metronidazole, and tetracycline for 10 to 14 days H2RA and clarithromycin for 14 days PPI, amoxicillin, and clarithromycin for 10 days PPI and clarithromycin for 14 days Which of the following would be usual in a patient with biliary colic? Presence of gallstones and unpredictable abdominal pain Presence of gallstones on imaging study Positive Murphy's sign Pain in upper abdomen in response to eating fatty foods Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Biliary colic refers to discomfort produced by contraction of the gallbladder, which often occurs in response to eating. Which patient has the least worrisome symptoms associated with his diarrhea? One with: Bloody diarrhea Moderate amount of watery diarrhea Duration of illness greater than 48 hours Temp >101.3 F A 24 year old female with pain and tenderness in the right lower abdominal quadrant. Pelvic exam ad UA are normal. WBC is elevated. Urine pregnancy test is negative. What is part of the differential diagnosis? UTI Pelvic inflammatory disease Appendicitis Ectopic pregnancy A 70 year old has bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient? Diverticulitis Anal fissure Hemorrhoids Colon cancer Anal fissure usually produces pain with bowel movements. Most patients who has acute hepatitis A infection: Develop fulminant disease Develop subsequent cirrhosis Become acutely ill Correct! Have a self limiting illness Week 6 – Genitourinary (GU) Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially? Voiding every 2 hours during the day A pregnant woman at 30 weeks gestation has proteinuria. What will the provider do next? Evaluate her blood pressure The provider is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result? This is a normal result. A patient's recent blood work indicates acute kidney injury. You know that acute kidney injury can be caused from: Heart failure exacerbation GERD Increase in metoprolol dose atrial fibrillation Heart failure exacerbation and cause decreased perfusion to the kidneys, leading to acute kidney injury. Changes in medications or nephrotoxic can cause acute kidney injury, metoprolol is not one of them. While patients with atrial fibrillation can have decreased cardiac output, it is often compensated to preserve renal perfusion A male patient complaints of dysuria. His urinalysis is positive for nitrates, leukocytes, and bacteria. What medication should be given and for how many days? Trimethoprim-sulfamethoxazole for 7-10 days First line treatment is similar to females which include TMP/SMX, nitrofurantoin, fosfomycin. The correct length of treatment is only in TMP/SMX in the possible answer choices. A patient who has diabetes has symptoms consistent with renal stones. Which type of stone is most likely in this patient? Uric acid A 30-year-old male patient has a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. What type of urinary tract infection does this represent? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Varicocele Chronic orchitis Testicular torsion Chronic epididymitis Palpation of varicose veins, described as "a bag of worms", is a classic symptom of varicocele. A patient with urolithiasis is more likely to Demonstrate RBC casts Have frequent UTIs Have chills and fever Be of male gender Males are more likely than females to have urolithiasis. There is no increased incidence of stone formation among patients with frequent UTIs. Patients with your urolithiasis may exhibit fever and chills of infection if associated with a very large stone, but this is not the usual case. RBC casts are formed in the renal tubules, this generally indicates glomerular injury, not urolithiasis. The daughter of an elderly, confused female patient reports that her mother is having urinary incontinence several times each day. What will the provider do initially? Perform a bladder scan to determine distention and retention Tell the daughter that this is expected given her mother’s age and confusion Order serum creatinine and blood urea nitrogen tests Obtain a urine sample for urinalysis and possible culture An asymptomatic pregnant woman has a positive leukocyte esterase and positive nitrites on a urine dipstick screening. What will the provider do next? Admit to the hospital Obtain a urine culture Prescribe trimethoprim-sulfamethoxazole Order a renal ultrasound Mrs. Jackson comes into her clinic complaining of new onset urinary incontinence when she laughs or sneezes. What should be used first line to treat her symptoms? Avoid caffeine and alcohol Kegel exercises Minimize fluids at nighttime Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Prescribe oxybutynin A patient has acute renal colic, nausea, and vomiting and a urinalysis reveals hematuria, but is otherwise normal. A radiographic exam shows several radiopaque stones in the ureter which are less than 1 mm in diameter. What will the primary provider do initially to manage this patient? Prescribe nifedipine and hospitalize for intravenous antibiotics Prescribe desmopressin and a corticosteroid medication orrec Order a narcotic pain medication and increased oral fluids Obtain a consultation with a urology specialist A 50-year-old male patient reports that he has a sensation of scrotal heaviness. He reports that the sensation is worse at the end of the day. He denies pain. What is likely etiology of these symptoms? Inguinal hernia A pregnant patient is found to have a urinary tract infection. What is the appropriate course of action? Prescribe nitrofurantoin Which factors increase the risk of renal stones? (Select all that apply.) Vitamin D excess Surgical menopause Snow skiing Excess antacid use Strenuous exercise A patient has urinary burning, frequency, and urgency. Her urinalysis is positive for leukocytes and negative for nitrates. A likely explanation is that the patient: Could be pregnant Has diabetes Has a sexually transmitted disease Has a nonobstructive kidney stone The patient is presenting with classic symptoms of a UTI, however this is not one of the possible answers. An alternative diagnosis that the provider should consider is STD. this is not a common presentation for a nonobstructive kidney stone. Pregnancy and diabetes may be associated with frequency and urgency, but not burning. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially? Increasing fluid intake to dilute the urine Taking pseudoephedrine daily Voiding every 2 hours during the day Referral to a physical therapist Which factors increase the risk of renal stones? (Select all that apply.) Excess antacid use Surgical menopause Vitamin D excess Snow skiing Strenuous exercise A female patient with the complaint of dysuria has a urine specimen that is positive for leukocytes and nitrates. There is blood in the specimen. The most appropriate diagnosis is: Urinary tract infection No answer text provided. UTI with hematuria Asymptomatic bacteriuria UTI or chlamydia A male patient complaints of dysuria. His urinalysis is positive for nitrates, leukocytes, and bacteria. What medication should be given and for how many days? Ciprofloxacin for 3 days Trimethoprim-sulfamethoxazole for 7-10 days Doxycycline for 7 days Nitrofurantoin for 14 days A female patient who is 45-year-old states that she is having urinary frequency. She describes episodes of "having to go right now" and not being able to wait. Her urinalysis results are within normal limits. What this part of the differential? Diabetes Lupus Stress incontinence Asymptomatic bacteriuria Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 4) A healthy 32 year old female has left-sided flank pain, nausea, and fever. Her urinalysis demonstrated hematuria and the presence of leukocytes, nitrates, WBC casts. What is the most likely diagnosis? Pyelonephritis The most common presentation of acute pyelonephritis includes fever, flank pain, and nausea and vomiting. Fever is so strongly correlated with acute pyelonephritis that it is unusual not to have a fever. Renal stone patients may have this presentation, but usually fever is not present. It is unlikely that cholecystitis would present with left sided flank pain. 5) A female patient who is 45-year-old states that she is having urinary frequency. She describes episodes of "having to go right now" and not being able to wait. Her urinalysis results are within normal limits. What this part of the differential? Diabetes Patients with diabetes can present with polyuria. In assessment of patient's risk factors should be done with strong consideration even to checking glucose level. Other possible diagnoses include urge incontinence and vaginitis. A urinalysis would show bacteriuria. 1) The provider is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result?rrect! This is a normal result. 2) A patient has acute renal colic, nausea, and vomiting and a urinalysis reveals hematuria, but is otherwise normal. A radiographic exam shows several radiopaque stones in the ureter which are less than 1 mm in diameter. What will the primary provider do initially to manage this patient? Correct! Order a narcotic pain medication and increased oral fluids 3) A 30-year-old male patient has a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. type of urinary tract infection does this represent?ect! Complicated 4) A patient has urinary burning, frequency, and urgency. Her urinalysis is positive for leukocytes and negative for nitrates. A likely explanation is that the patient: Correct! Has a sexually transmitted disease The patient is presenting with classic symptoms of a UTI, however this is not one of the possible answers. An alternative diagnosis that the provider should consider is STD. this is not a common Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 presentation for a nonobstructive kidney stone. Pregnancy and diabetes may be associated with frequency and urgency, but not burning. 5) Mrs. Jackson comes into her clinic complaining of new onset urinary incontinence when she laughs or sneezes. What should be used first line to treat her symptoms? Correct! Kegel exercises The patient has stress incontinence. The first-line approach with this patient is to attempt to strengthen the pelvic floor muscles. Anticholinergic may worsen incontinence because it will cause urinary retention. Avoiding caffeine and alcohol are especially helpful for patients with urge incontinence, would likely have minimal benefit with this patient. Minimizing fluids at nighttime will help if nocturia is a problem. A pregnant patient has asymptomatic bacteriuria. What is the likely pathogen? Staph aureus Klebsiella No pathogen Escherichia coli Of pregnant patient with asymptomatic bacteriuria should be treated with antibiotics because she is at high risk of developing pyelonephritis and/or preterm labor. The most common pathogen is Escherichia coli. An older male patient reports gross hematuria but denies flank pain and fever. What will the provider do to manage this patient? 1. Obtain a urine culture 2. Refer to cystoscopy and imaging 3. Perform a 24-hour urine collection 4. Monitor blood pressure closely A young adult male reports a gradual onset 3/10 dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient? 1. Consideration of underlying causes of this finding 2. Referral to an emergency department for surgical consultation 3. Reassurance that this is benign and may resolve spontaneously Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Which factors increase the risk of renal stones? (Select all that apply.) 1. Surgical menopause 2. Vitamin D excess 3. Strenuous exercise 4. Snow skiing 5. Excess antacid use A healthy 32 year old female has left-sided flank pain, nausea, and fever. Her urinalysis demonstrated hematuria and the presence of leukocytes, nitrates, WBC casts. What is the most likely diagnosis? 1. Cholecystitis 2. Renal stone 3. Pyelonephritis 4. UTI A patient's recent blood work indicates acute kidney injury. You know that acute kidney injury can be caused from: 1. GERD 2. Heart Failure exacerbation 3. Increase in metoprolol dose 4. Atrial fibrillation The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially? 1. Voiding every 2 hours during the day 2. Taking pseudoephedrine daily 3. Increasing fluid intake to dilute the urine 4. Referral to a physical therapist A pregnant woman at 30 weeks gestation has proteinuria. What will the provider do next? 1. Monitor serum blood glucose for gestational diabetes 2. Evaluate her blood pressure 3. Perform a 24-hour urine collection 4. Reassure her that this normal at this stage of pregnancy An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Uric acid Oxalate A 3-month-old male infant has edema and painless swelling of the scrotum. On physical examination, the provider is able to transilluminate the scrotum. What will the provider recommend? Immediate referral to a genitourinary surgeon for repair A Doppler ultrasound to evaluate the scrotal structures A short course of empiric antibiotic therapy Observation and reassurance that spontaneous resolution may occur 17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like "a bag of worms" are noted underneath the scrotal skin. The testicle is not swollen or reddened. The most likely diagnosis is: Chronic orchitis Chronic epididymitis Testicular torsion Varicocele Palpation of varicose veins, described as "a bag of worms", is a classic symptom of varicocele. A 16-year-old female patient is being treated for her first UTI. She had an allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated? Cephalexin Trimethoprim-sulfamethoxazole Ampicillin Nitrofurantoin Week 7 – Gynecology (GYN) and Sexually Transmitted Infections (STI) When seen on a wet mount like the following, clue cells would indicate the treatment by which of the following? Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1 Flagyl (Metronidazole) 500mg PO BID x 7 days No treatment needed Diflucan (Fluconazole) 150mg PO x 1 The uterus should sound to cm when measuring for Mirena IUD insertion to allow for the arms to open and proper alignment to occur. 6-9 cm; measured and forgotten about. 6-10 cm; measured and documented in the chart. 1-3 cm; measured and forgotten about. 3-5 cm; measured and documented in the chart. If cervical stenosis is met when performing IUD insertions, which of the following should be used to overcome resistance? 6 - 9 cm 12 - 15 cm 9 - 12 cm 3 - 6 cm A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulvall itching and discharge. He is asymptomatic. How should they be treated? They both should receive metronidazole Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 A 40 year old female patient returns to your clinic to review her pap smear results from the previous week. You tell her the test is abnormal with “atypical squamous cells of undetermined significance and HPV positive”. What is the appropriate next step of the following? Repeat cytology in 1 year Repeat cytology immediately Perform or refer out for colposcopy Repeat cytology in 2-4 months After an IUD is placed, the threads should be cut so approximately are visible. This should then be . 3 cm; measured and documented in the chart. 3 cm; measured and forgotten about. 6 cm; measured and documented in the chart. 6 cm; measured and forgotten about. You suspect that the patient you are seeing has HIV. which of the following is a sensitive screening test for human immunodeficiency virus? Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen HIV antibody test ELISA test Western blot test A 35 year old female presents for her well-woman exam with no complaints and no significant medical history. She admits to occasional unprotected intercourse with her partner, which is an unstable, but safe relationship. Upon exam, you note a green, frothy and malodorous discharge she states she has noticed on occasion, but thought it was normal. Wet mount shows the following image with a positive “Whiff Test”. What is your likely diagnosis?: Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 Vaginal candidiasis Syphilis may present as: Discharge Dysuria Painful lesions A rash Secondary syphilis can present as a rash, more commonly on the palms of the hands or soles of the feet. Lesions are usually painless. It usually does not produce significant dysuria or discharge. A 54-year-old female presents with small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. With diagnosis is least likely? Endometrial hyperplasia Ovarian cancer Uterine polyps Endometrial carcinoma Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding is an uncommon presentation of ovarian cancer, but can present this way. Other pathologies are usually evaluated before considering ovarian pathology. A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as pelvic inflammatory disease? Temperature greater than 101°F A nurse practitioner identifies filamentous structures and many uniform, oval-shaped structures during a microscopic exam of vaginal discharge. These are probably: Hyphae Typically filamentous structures, hyphae by the mechanism that allows fungal growth. Yeast may look like uniform oval shaped structures. Visualization of this should prompt immediate diagnosis of a fungal infection. Candida albicans is a specific fungus. Since many fungi can produce hyphae and yeast, it is not possible to diagnose Candida albicans specifically. A 31-year-old female patient presents with fatigue, fever, worsening unilateral low back pain for the past 5 days. Her pain is 5 out of 10 on the pain scale which has been unresponsive to ibuprofen. she denies abdominal pain, but is anorexic and nauseous. She denies vaginal discharge. Urinalysis demonstrates Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 hematuria, the presence of WBC casts, leukocytes, nitrates. Which should be included in differential diagnosis? Pyelonephritis The patient's complaint of unilateral low back pain is likely secondary to pyelonephritis. The presence of WBC casts in the urine strongly suggest a renal origin for pyuria. A patient who presents with this scenario has to be considered to have pyelonephritis until proven otherwise. Most women with PID have bilateral abdominal tenderness, usually in the lower quadrants. Purulent vaginal discharge and fever also common. A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what tests should be performed? Lymph node biopsy RPR Comprehensive metabolic panel HIV test Asymptomatic HIV infections often have persistent generalized lymphadenopathy. The uterus should sound to cm when measuring for Mirena IUD insertion to allow for the arms to open and proper alignment to occur. 3 cm; measured and documented in the chart. 6 cm; measured and forgotten about. 3 cm; measured and forgotten about. 6 cm; measured and documented in the chart. What is your treatment for Atrophic Vulvovaginitis? Diflucan (Fluconazole) 150mg PO x 1 Clindamycin 2% 5g applicator PV x 7 days Premarin cream 0.5g PV 1-3 x wk Flagyl (Metronidazole) 2g PO x 1 Chancroid considered a cofactor for transmission of: HIV Chlamydia Trichomonas Gonorrhea Chancroid is an STD. It is spread by sexual contact or by contacting pus from an infected lesion. The ulcers usually. Painful and then, but usually not painful in women. It is a cofactor in the transmission of HIV. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the public health department. The patient asks the NP not to report it because her husband works in the public health department. How show this be managed by the NP? Tell the patient that it will not be reported, but report it anyways Respect the patient's right to privacy and not report it Report it to the public health department but don't divulge all the de Report it to the public health department as required by law [If state law requires it, it should be reported. Patient names or other identifying data are not part of the reporting process, so the patient should not worry about being identified and associated with this finding.] A 26-year-old female patient has been diagnosed with gonorrhea. However should she be managed? Ceftriaxone only Ceftriaxone and azithromycin Cefixime and azithromycin Penicillin G Usual treatment for gonorrhea/Chlamydia includes ceftriaxone 250 mg IM in conjunction with 1 g azithromycin by mouth. A sexually active adolescent male has a warty growth on the shaft of his penis. It is painless. This is likely: Herpes Syphilis HPV Trichomonas This is not a clinical presentation of trichomonas because this produces a discharge. Syphilis produces a painless lesion that presents as an ulceration with a hard edge and clean yellow base. Herpes produces lesions but are usually painful. HPV produces warty growths as described above. A 19-year-old student who is on prescription combined oral contraceptive pills is being seen for lower GI pain. The nurse practitioner has obtained a Pap smear and is about to perform the bimanual exam. She gently remove the plastic speculum from the vagina. While the NP is performing the bimanual vaginal exam, the patient complaints of slight discomfort during palpation of the ovaries. Which with the following is a true statement? The uterus and ovaries are both sensitive to any Palpation The ovaries are sensitive to deep palpation but they should not be painful. Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 4. HIV and herpes A 65 year old female presents with c/o vaginal soreness and dysuria that has been intermittent for several years. She notes the pain is worse after intercourse with her husband of 30 years, with whom is in an monogamous relationship. She denies vaginal discharge and has not had a pap smear since her total hysterectomy ten years ago. She currently only takes a multivitamin. Your wet mount reveals few lactobacilli and increased parabasal cells. What is your likely diagnosis? 1. Trichomonas vaginalis 2. Bacterial vaginosis 3. Vaginal candidiasis 4. Atrophic vulvovaginitis A 40 year old female patient returns to your clinic to review her pap smear results from the previous week. You tell her the test is abnormal with “atypical squamous cells of undetermined significance and HPV positive”. What is the appropriate next step of the following? 1. Repeat cytology in 1 year 2. Repeat cytology immediately 3. Perform or refer out for colposcopy 4. Repeat cytology in 2-4 months A male patient presents with dysuria and penile discharge. He states that his female partner has been diagnosed with an STD, but he is not sure which one. Which of these should be part of the differential? 1. Bacterial vaginosis and trichomonas 2. Syphilis and chlamydia 3. Chlamydia and gonorrhea 4. HIV and herpes Syphilis may present as: Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 1. Discharge 2. Painful lesions 3. A rash 4. Dysuria In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the public health department. The patient asks the NP not to reported because her husband works in the public health department. How show this be managed by the NP? Report it to the public health department but don't divulge all the details Report it to the public health department as required by law Tell the patient that it will not be reported, but report it anyways Respect the patient's right privacy and not report it If state law requires it, it should be reported. Patient names or other identifying data are not part of the reporting process, so the patient should not worry about being identified and associated with this finding. Week 8 – Obstetrics (OB) A woman comes into clinic due to migraines with aura, but also requests oral contraceptives to prevent pregnancy. Which type of contraceptive will the provider recommend? Contraceptive implant Transdermal combination product Progestin-only contraception Combination oral contraceptive A mother who has been breastfeeding her infant for several weeks develops a fever x 24 hours, malaise, breast erythema, and breast tenderness. What will the provider recommend? Increased frequency of nursing and antibiotics initiated that covers S. aureus Ice packs and increased frequency of nursing Ice packs and cessation of nursing with breast pumping initiated Cessation of nursing and antibiotics initiated that covers S. aureus A patient in her first trimester of pregnancy is found to be infected with Chlamydia and gonorrhea. Which statement below is true? She should be treated now and rescreened later in pregnancy Final Exam Acute Care Exam 1 Top Rated Exam Study Guide 2024 She should be screened for other STDs later in pregnancy She should be treated now and rescreened if symptoms reappear She should be treated in the second trimester This patient should certainly be treated for Chlamydia and gonorrhea with azithromycin 1 g x1 and ceftriaxone 250 mg IM ×1. since the percentage of patients who become reinfected with an STD later in pregnancy is high, this patient should be rescreened later in pregnancy regardless of symptoms. Disastrous effects can occur if she is infected and left untreated while pregnant. A 44-year-old female who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure is 160/80, pulse 110, she is afebrile. Her labs revealed mild anemia, mild leukocytosis. On exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated to 3 cm. Which of the following is most likely? Inevitable abortion The classic symptoms of ectopic pregnancy are: Amenorrhea, vaginal bleeding, abdominal pain A woman at 32 weeks of gestation has a positive throat culture for Streptococcus pyogenes (strep throat). she denies allergies but becomes very nauseated with erythromycin. Which of the following is the best choice for this pregnant patient? Penicillin A 3-day-old, full-term female infant who is breastfeeding develops some jaundice. The transcutaneous bilirubin(TcB) reading in the office is in the intermediate risk zone. What will the provider tell the mother? To switch to formula and return to clinic within 5 days for reassessment To use a breast pump to increase her milk supply and increase baby to breast and return to clinic within 5 days for reassessment To decrease the frequency of breastfeeding and return to clinic within 5 days for reassessment To supplement feedings with extra water and return to clinic within 5 days for reassessment A woman who is taking oral contraceptive pills (OCPs) to prevent pregnancy calls the provider to report forgetting to take the pills for 4 days. She has not had sexual intercourse during that time. What will the provider recommend? Take 2 pills daily for 4 days and use an alternative method for 4 days