NR 511 TEST BANKS QUSTIONS AND ANSWERS, Quizzes of Nursing

Download NR 511 TEST BANKS QUSTIONS AND ANSWERS and more Quizzes Nursing in PDF only on Docsity! NR 511 Test Bank Solutions (Latest Update) AANP-FNP lightning round review-#2 1. How many sets of Kegels should be done each day to help with urinary incontinence? -Three sets of 10 a day 2. What is the first line treatment for allergic rhinitis? - intranasal corticosteroid—ie: Flonase. 3. What is the term used for the loss of high-pitched tones in geriatrics? -Presbycusis 4. What type of hearing loss does cerumen impaction cause? - Conductive hearing loss 5. You see an older woman bending over leaving on her shopping cart at the grocery store. What is the likely diagnosis? -Spinal stenosis 6. Multiple myeloma is disease of what? -Plasma cells 7. What test in the office can you use to help diagnose sciatica? - Straight leg test (Always pick the cheapest, most noninvasive tests first!!) 8. I have heel pain that is worse in the morning. What is my likely diagnosis? - Plantar fasciitis 9. The Lachman test is used to help diagnose what? - ACL 10. Other tests for acl include -anterior and posterior drawer tests 11. What is the treatment for gout and what would be the medication instructions for a flare? - Colchicine and take 1.2 mg at the first sign of flare, followed in 1 hour with a single dose of 0.6 mg. 12. What is a sign of colchicine toxicity? - Diarrhea 13. What is a common cause of posterior knee pain? -Baker’s cyst 14. Cotton wool spots, neovascularization and microaneurysms are all Eye exam findings in what condition? –Diabetes 15. And what about AV nicking and what it is? - HTN, when an artery crosses over a vein 16. What is the treatment for bacterial sinusitis? -Augmentin 17. I’m tired, have a sore throat and swollen posterior cervical nodes on exam. What is the likely diagnosis? -Mono--The best thing I can say to help differentiate those two for memory is that P in posterior is closer to M in mono in the alphabet so that’s how I remember! 18. Recall that swollen ANTERIOR cervical nodes are seen in - strep. 19. What is a common side effect of Pyridium, an anti-spasmodic for dysuria? -Orange colored urine 20. What would be included in your list of differentials for hematuria? -Bladder cancer, kidney stones, exercise induced, trauma, medications, infection, and BPH are the most common reasons 21. What is the medication treatment for MRSA? Bactrim 22. What are some symptoms a patient with lupus would complain of? - Fatigue, malar rash aka butterfly rash, and joint aches. 23.And what is the lab that you would order it to confirm it? -ANA 24. What is the term used to describe dry, itching skin? -Xerosis 25. What is the most common kind of skin cancer? - Basal cell carcinoma reminder that this cancer presents as a pearly domed nodule, pink or flesh colored and usually has telangiectasia present 26. What medication is used to treat a cat or dog bite? -Augmentin (dogmantin) 27. What do you think of when you hear a bright beefy red rash and what is the treatment? - Candidiasis and treatment is topical anti-fungal (e.g diaper rash) 28. How would you describe the prostate in BPH? 59. A low HDL and high trig level always means what? -Insulin insufficiency 60. The S1 is the closure of which valves? -AV valves, and S2 is closure of semilunar valves 61. On exam you feel a weakened peripheral pulse, what diagnosis do you think of? - PAD 62. An absent red reflex is indicative of what? Cataract 63. During an eye exam you note absent venous pulsations, what is this related to? -Papilledema 64. The Dix Hallpike maneuver is used to test for what condition? -Vertigo 65. What is the most well-known medication treatment for Vertigo? - Meclizine 66. What medication is prescribed for essential tremors? -BB (propranolol) 67. A young adult patient states that she is experiencing episodes of vision loss and abnormal limb sensations. What would be at the top of your list of differentials? - MS---and what would you do? REFER TO NEURO 68. When assessing a patient for dementia, what is the FIRST and best thing you should do? -GET A GOOD HX FROM PT BUT ALSO FAMILY 69. Name a difference between dementia and delirium? - Dementia is slow progress, delirium happens RAPIDLY 70. What is the MAIN cause of delirium? -Infection 71. Cranial Nerves review (just going over the MAIN ones I’ve seen in reviews/questions for the exam) --nose: 1 --vision: 2 --EOM: 3, 4, and 6 --trigeminal: 5 (trigeminal neuralgia) --facial: 7 (bell’s palsy)—HSV can cause Bell’s Palsy (keep in mind!) --ears: 8 --shoulders: 11 72. UTI treatment? - Macrobid 73. What about UTI in a pregnant pt? -Keflex or Amoxicillin 74. Anxiety…which meds to use for situational? -Benzos and GAD? SSRIs, SNRIs 75. What about OCD? SSRI, SNRI, TCA 76. Which population has the highest suicide rate? -Older, white males 77. What symptom is specific to the geriatric population when you think of UTIs? Confusion 78. PNA in Geri’s, how do they present? -We went over this last round, but felt it was important enough to repeat it. Tachypnea, extreme fatigue, and I didn’t mention last time but another thing to keep in mind with geris and PNA is that they MAY not have a fever with it because of decreased thermoregulation. Also can see delirium and falls. 79. What is the difference between sensitivity and specificity? - Sen= TRUE positive, they tested POSITIVE and HAVE the DA, whereas Spec= DON’T have the DA, tested NEG 80. What vitamin deficiency can alcohol lead to? -Thiamine deficiency (vit B1)---and INCREASED GGT levels 81. MMSE, what score indicates dementia? <24 (0-9 is severe) 82. 10mm+ for PPD is needed for continued investigation of TB for what two populations? -Healthcare workers and recent migrants. Note 5mm+ “ “-- HIV patients and immunosuppressant 83. What food is advised to try first in infants 4-6 months of age? -Rice cereal 84. What degree of curvature in scoliosis should warrant bracing? >20 degrees 85. Tanner staging, anyone need a refresher on this? 86. What is the leading cause of death in children? -ACCIDENTS 87. What sound during the Ortolani maneuver is a positive finding and signifies a possible hip abnormality (hip dysplasia) in infants. – -The "clunk" sound 88. A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? —Give BOTH the Hep B vaccine and immunoglobulin 89. Which method is used to diagnose gonorrheal pharyngitis or proctitis? —Thayer-Martin culture is recommended for screening to diagnose gonorrheal pharyngitis or proctitis. 90. What is the treatment for a medial tibial stress fracture (aka “shin splints”) -RICE Chapter 3. Health Promotion Multiple Choice Identify the choice that best completes the statement or answers the question. _A 1. Which of the following is a primary prevention measure for a 76-year-old man newly diagnosed with a testosterone deficiency? a. Calcium supplementation b. Testicular self-examination c. Bone density test d. Digital rectal examination __A__ 2. Which of the following is an example of secondary prevention in a 50-year-old woman? a. Yearly mammogram b. Low animal fat diet c. Use of seat belt d. Daily application of sunscreen ___B_ 3. Which of the following is an example of tertiary prevention in a patient with chronic renal failure? a. Fluid restriction b. Hemodialysis 4 days a week c. High-protein diet d. Maintenance of blood pressure at 120/80 __A__ 4. Immunizations are an example of which type of prevention? a. Primary b. Secondary c. Tertiary __D__ 3. Nursing research should be utilized by: a. Nurses at the bedside b. Advanced practice nurses c. Nurse researchers d. Nurses at all levels of practice __A__ 4. Applying evidence at the point of care requires: a. Readily available evidence-based resources b. Ability to review research literature c. Single articles in journals d. Current textbooks ___C_ 5. Practice guidelines are designed to: a. Be inflexible b. Be utilized in every circumstance c. Provide a reference point for decision making d. Be created by a professional organization to guide the practice of a profession ___B_ 6. Which of the following is a crucial element of developing a guideline? a. Creating a physician expert panel b. Reviewing the literature with ratings of available evidence c. Conducting an external review of a guideline d. Developing evidence-based tables ___B_ 7. Which of the following would be considered the research design for Level I evidence? a. Single, well-designed randomized clinical trial b. Systematic review of randomized clinical trial studies c. Well-designed controlled trials without randomization d. Systematic reviews of descriptive or qualitative studies ___C_ 8. Which of the following would be considered the research design for Level II evidence? a. Single descriptive or qualitative study b. Well-designed case control or cohort studies c. Single, well-designed, randomized clinical trial d. Systematic review of randomized clinical trial studies __A__ 9. Which of the following would be considered the research design for Level III evidence? a. Well-designed controlled trials without randomization b. Systematic reviews of descriptive or qualitative studies c. Systematic review of randomized clinical trial studies d. Opinion of authorities and expert committees __D__10. Which of the following would be considered the research design for Level IV evidence? a. Single descriptive or qualitative study b. Opinion of authorities and expert committees c. Systematic review of randomized clinical trial studies d. Well-designed controlled trials without randomization _C___11. Which of the following would be considered the research design for Level V evidence? a. Systematic review of randomized clinical trial studies b. Well-designed controlled trials without randomization c. Systematic reviews of descriptive or qualitative studies d. Single descriptive or qualitative study __C__12. Which of the following would be considered the research design for Level VI evidence? a. Systematic reviews of descriptive or qualitative studies b. Opinion of authorities and expert committees c. Well-designed case control or cohort studies d. Single descriptive or qualitative study ____B13. Which of the following would be considered the research design for Level VII evidence? a. Well-designed controlled trials without randomization b. Opinion of authorities and expert committees c. Well-designed case control or cohort studies d. Single descriptive or qualitative study Chapter 5. Evidence-Based Care Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: B PTS: 1 3. ANS: D PTS: 1 4. ANS: A PTS: 1 5. ANS: C PTS: 1 6. ANS: B PTS: 1 7. ANS: B PTS: 1 8. ANS: C PTS: 1 9. ANS: A PTS: 1 10. ANS: D PTS: 1 11. ANS: C PTS: 1 12. ANS: C PTS: 1 13. ANS: B Chapter 6. Neurological Problems Multiple Choice Identify the choice that best completes the statement or answers the question. ____D 1. Which statement about confusion is true? a. Confusion is a disease process. b. Confusion is always temporary. c. Age is a reliable predictor of confusion. d. Polypharmacy is a major contributor to confusion in older adults. ___C_ 2. Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear? a. Meclizine b. Diphenhydramine ___B_15. What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster? a. A stabbing pain on one small area of the body b. A vesicular skin lesion on one side of the body c. A pain that is worse upon awakening d. A lesion on the exterior ear canal ___A_16. Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her? a. “Most patients have complete recovery in 3 to 6 months.” b. “Unfortunately, you’ll probably have a small amount of residual damage.” c. “Don’t worry, I’ll take care of everything.” d. “You may have a few more episodes over the course of your lifetime but no permanent damage.” ___B_17. Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him: a. “L-dopa is neuroprotective.” b. “The primary goal of therapy is to replace depleted stores of dopamine.” c. “This is the only drug that can provide symptomatic benefit.” d. “This is the initial monotherapy drug.” ___D_18. Which of the following signs is seen in a patient with more advanced PD? a. Resting tremor b. Bradykinesia c. Rigidity d. Postural instability ___B_19. Which of the following is the most commonly experienced symptom of migraine? a. Light sensitivity b. Pulsatile pain c. Sound sensitivity d. Experiencing an aura ___B_20. Which of the following characteristics differentiates peripheral vertigo from central vertigo? a. The duration of central vertigo is shorter than that of peripheral vertigo. b. There is an auditory-associated symptom with peripheral vertigo and a visual- associated symptom with central vertigo. c. Central vertigo is positional, and peripheral vertigo is not. d. The onset of central vertigo is more sudden than that of peripheral vertigo. __B__21. Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis? a. Greater than 25% b. Greater than 50% c. Greater than 75% d. Only for 100% occlusion ___A_22. What antiplatelet agent is most widely used for secondary prevention of stroke? a. Aspirin b. Ticlopidine c. Clopidogrel d. Aspirin and clopidogrel ____D23. Which adjunctive diagnostic test should be used in the work-up of a patient with suspected Creutzfeldt-Jakob disease or transient epileptic amnesia? a. MRI b. CT c. Cerebrospinal fluid analysis d. EEG B____24. Which herbal preparation may cause delirium and should be avoided in an elderly patient? a. Sam-e b. Saint John’s Wort c. Melatonin d. Saw Palmetto ___C_25. Which of the following activities is part of the functional activities questionnaire? a. Asking the patient to unravel a Rubik’s cube b. Determining if the patient can drive on the highway c. Asking the patient about a news event from the current week d. Seeing if the patient can keep his or her home clean _D___26. About 90% of all headaches are? a. Tension b. Migraine c. Cluster d. Without pathological cause _C___27. Which statement is true regarding driving and patients with a seizure disorder? a. Once diagnosed with a seizure disorder, patients must never drive again. b. After being seizure free for 6 months, patients may drive. c. Each state has different laws governing driving for individuals with a seizure disorder. d. These persons may drive but never alone. __B__28. Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given intravenously once a month? a. Glatiramer acetate b. Natalizumab c. Fingolimod d. Glucocorticoids __A__29. The ‘freezing phenomenon’ is a cardinal feature of? I do not remember how the question was written a. Parkinson’s disease b. Alzheimer’s disease c. A CVA d. Bell’s palsy __C__30. A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as? a. Spinothalamic dysfunction b. Ratcheting c. Cogwheeling d. Hand tremors __B__31. Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly diagnostic of which condition? a. Guillain-Barré syndrome b. Parkinson’s disease c. Alzheimer’s disease d. Huntington’s disease ___C_32. Which condition is characterized by the impaired ability to learn new information along with either a cognitive disturbance in language, function, or perception? a. Guillain-Barré syndrome b. Parkinson’s disease c. Alzheimer’s disease d. Delirium __D__33. A score of 20 to 25 on this test indicates early-stage Alzheimer’s disease: 22. ANS: A PTS: 1 23. ANS: D PTS: 1 24. ANS: B PTS: 1 25. ANS: C PTS: 1 26. ANS: D PTS: 1 27. ANS: C PTS: 1 28. ANS: B PTS: 1 29. ANS: A PTS: 1 30. ANS: C PTS: 1 31. ANS: B PTS: 1 32. ANS: C PTS: 1 33. ANS: D PTS: 1 34. ANS: B PTS: 1 35. ANS: C PTS: 1 Chapter 7. Skin Problems Multiple Choice Identify the choice that best completes the statement or answers the question. ___C_ 1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause? a. “You must be under a lot of stress lately.” b. “It is hereditary. Did your father experience this also?” c. “The cause is unknown, but we suspect it is due to an immunologic mechanism.” d. “We’ll have to do some tests.” B____ 2. Which of the following is “a linear crack extending from the epidermis to the dermis?” a. An ulcer b. A fissure c. Lichenification d. An excoriation A____ 3. A bulla is: a. A vesicle larger than 1 cm in diameter b. An elevated solid mass with a hard texture; the shape and borders can be regular or irregular c. A superficial elevated lesion filled with purulent fluid d. Thinning of the skin (epidermis and dermis) that appears white or translucent C____ 4. An example of ecchymosis is: a. A hematoma b. A keloid c. A bruise d. A patch A____ 5. When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are? a. Spores b. Leukocytes c. Pseudohyphae d. Epithelial cells D____ 6. Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is a treatment that you usually recommend/order in nonpregnant patients, but is listed as a Pregnancy category D? a. Vagistat vaginal cream b. Monistat combination pack c. Terazol vaginal cream d. Diflucan, 150 mg A____ 7. Tinea unguium is also known as: a. Onychomycosis b. Tinea versicolor c. Tinea manuum d. Tinea corporis D____ 8. Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this? a. Bullous impetigo b. Staphylococcal scalded skin syndrome (SSSS) c. Nonbullous impetigo d. Ecthyma B____ 9. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria? a. Staphylococcal aureus b. Clostridium perfringens c. S. pyrogenes d. Streptococcus B____10. When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? a. A piece of hair or a thread b. Hyphae c. Leukocytes d. Spores D____11. Marci has a wart on her hand. She says she heard something about “silver duct tape therapy.” What do you tell her about his? a. It is an old wives’ tale. b. It is used as a last resort. c. Salicylic acid is more effective. d. It is a simple treatment that should be tried first. A____12. Which is the most potent and irritating dose of tretinoin? a. 0.05% liquid formulation b. 0.1% cream c. 1% foam d. 0.02% cream C____13. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers? a. Necrotizing fasciitis b. Periorbital cellulitis c. Erysipelas d. “Flesh-eating” cellulitis C____14. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and document this as a: c. Psoriasis d. Alopecia areata B____27. Why do people of African descent have a lower incidence of non-melanoma skin cancer? a. They have an increased number of melanocytes. b. Their darker skin protects from ultraviolet radiation. c. Their skin is thicker. d. Their immune system is stronger. D____28. Which statement is true regarding chloasma, the ‘mask of pregnancy’? a. It is caused by a decrease in the melanocyte-stimulating hormone during pregnancy. b. This condition only occurs on the face. c. Exposure to sunlight will even out the discoloration. d. It is caused by increased levels of estrogen and progesterone. C____29. When instructing your elderly client about treating her xerosis, what do you tell her? a. A daily hot bath may help the associated pruritus. b. Rub the skin briskly to make sure it is completely dry after bathing. c. Only take short tepid showers. d. Use a gel that is alcohol-based after bathing to soften the skin. A____30. Which medication used for scabies is safe for children 2 months and older? a. Permethrin cream b. Lindane c. Crotamiton lotion and cream d. Ivermectin B____31. Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis? a. Keratosis pilaris b. Dennie’s sign c. Keratoconus d. Pityriasis alba D____32. Which of the following statements about performing cryosurgery for actinic keratosis is true? a. It is better to slightly overfreeze the area, so you only have to do it once. b. Using liquid nitrogen, freeze each lesion for at least 30 seconds. c. Every lesion should be biopsied after using liquid nitrogen. d. The ‘freeze balls’ should be approximately one-and-a-half times as wide as they are deep. A____33. An example of a primary skin lesion is a/an: a. Bulla b. Scale c. Excoriation d. Fissure C____34. Which statement regarding necrotizing fasciitis is true? a. The hallmark of this infection is its slow and steady progression. b. Once the border of the infection is “established,” it does not spread. c. Loss of life or limb is a potential complication. d. The lesion is most dangerous, because it is painless. C____35. When staging a malignant melanoma using Clark’s levels, which level extends into the papillary dermis? a. Level I b. Level II c. Level III d. Level IV Chapter 7. Skin Problems Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: B PTS: 1 3. ANS: A PTS: 1 4. ANS: C PTS: 1 5. ANS: A PTS: 1 6. ANS: D PTS: 1 7. ANS: A PTS: 1 8. ANS: D PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: A PTS: 1 13. ANS: C PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: A PTS: 1 17. ANS: C PTS: 1 18. ANS: D PTS: 1 19. ANS: C PTS: 1 20. ANS: D PTS: 1 21. ANS: A PTS: 1 c. Venous beading d. Retinal hemorrhage _D___ 8. Which of the following is an example of sensorineural hearing loss? a. Perforation of the tympanic membrane b. Otosclerosis c. Cholesteatoma d. Presbycusis _C___ 9. The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient’s mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? a. Weber test b. Schwabach test c. Rinne test d. Auditory brainstem response (ABR) test _D___10. A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition? a. Otitis media b. Meniere’s disease c. Tinnitus d. Otitis externa _A___11. Otitis media is considered chronic when: a. Inflammation persists more than 3 months with intermittent or persistent otic discharge. b. There are more than six occurrences of otitis media in a 1-year period. c. Otitis media does not resolve after two courses of antibiotics. d. All of the above _C___12. The most significant precipitating event leading to otitis media with effusion is: a. Pharyngitis b. Allergies c. Viral upper respiratory infection (URI) d. Perforation of the eardrum _D___13. Patients with acute otitis media should be referred to a specialist in which of the following situations? a. Concurrent vertigo or ataxia b. Failed closure of a ruptured tympanic membrane c. If symptoms worsen after 3 or 4 days of treatment d. All of the above _B___14. Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis? a. IgA b. IgE c. IgG d. IgM _A___15. Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? a. Vasomotor rhinitis b. Rhinitis medicamentosum c. Atrophic rhinitis d. Viral rhinitis _C___16. Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than: a. 4 weeks b. 8 weeks c. 12 weeks d. 16 weeks __C__17. Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected? a. Penicillin V b. Amoxicillin c. Levofloxacin d. Clindamycin _D___18. In which of the following situations would referral to a specialist be needed for sinusitis? a. Recurrent sinusitis b. Allergic sinusitis c. Sinusitis that is refractory to antibiotic therapy d. All of the above _A___19. Which type of stomatitis results in necrotic ulceration of the oral mucous membranes? a. Vincent’s stomatitis b. Allergic stomatitis c. Apthous stomatitis d. Herpetic stomatitis _B___20. The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection? a. HSV type 2 b. HIV c. Pneumonia d. Syphilis _D___21. Heart valve damage resulting from acute rheumatic fever is a long-term sequela resulting from infection with which of the following pathogens? a. Coxsackievirus b. Cytomegalovirus c. Francisella tularensis d. Group A streptococcus _B___22. A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause? a. Gonorrhea b. Mononucleosis c. Influenza d. Herpes zoster __C__23. A patient presents to the clinician with a sore throat, fever of 100.7F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be? a. The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment. b. Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen. c. A throat culture should be performed to confirm the results of the rapid strep test. d. The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive. _A___24. Which of the following medications used in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape? a. Pilocarpine 21. ANS: D PTS: 1 22. ANS: B PTS: 1 23. ANS: C PTS: 1 24. ANS: A PTS: 1 25. ANS: D PTS: 1 26. ANS: B PTS: 1 TRUE/FALSE 1 . ANS: F PTS: 1 Chapter 9. Respiratory Problems Multiple Choice Identify the choice that best completes the statement or answers the question. __A__ 1. A chronic cough lasts longer than: a. 3 weeks b. 1 month c. 6 months d. 1 year __B__ 2. You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex? a. Baker phenomenon b. Arnold reflex c. Cough reflex d. Tragus reflex _C___ 3. Julie has a postnasal drip along with her cough. You assess her for: a. Asthma b. Sinusitis c. Allergic or vasomotor rhinitis d. Influenza __D__ 4. A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: a. Metoprolol b. Clopidogrel c. Tadalafil d. Captopril _B___ 5. African American patients seem to have a negative reaction to which of the following asthma medications? a. Inhaled corticosteroids b. Long-term beta-agonist bronchodilators c. Leukotriene receptor agonists d. Oral corticosteroids C____ 6. Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? a. Asthma b. Emphysema c. Chronic bronchitis d. Influenza D____ 7. You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Her score is 3. What should you do? a. Consider home treatment. b. Plan for a short inpatient hospitalization. c. Closely supervise her outpatient treatment. d. Hospitalize and consider admitting her to the intensive care unit. __C__ 8. Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TBT)? a. She is on a high-protein diet. b. She is an adolescent. c. She has been on long-term corticosteroid therapy. d. She just got over a cold. _A___ 9. Marci has been started on a tuberculosis (TB) regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically? a. Pyridoxine b. Thiamine c. Probiotic d. Phytonadione __C__10. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean? a. The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated. b. The cancer is in situ; it is spreading into the lymph nodes, but the spread cannot be evaluated otherwise. c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body. d. The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant spreading. D____11. Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do? a. Hand him literature about smoking cessation at every visit. b. Wait until he is ready to talk to you about quitting. c. Document in the record that he is not ready to quit. d. Continue to ask him at every visit if he is ready to quit. C____12. Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking? a. He should stop smoking today. b. He should stop smoking tomorrow. c. His quit date should be in 1 week. d. He will be ready to quit after the first 30 days. _A___13. Which information should be included when you are teaching your patient about the use of nicotine gum? a. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa. b. Patients should not eat for 30 minutes prior to or during the use of the gum. c. Initially, one piece is chewed every 30 minutes while awake. d. Acidic foods and beverages should be encouraged during nicotine therapy. D____14. Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead? a. Fever b. Headache c. Exudative pharyngitis d. Rhinorrhea b. Chronic bronchitis c. Emphysema d. Restrictive disease A____27. The most common cause of CAP is? a. Streptococcus pneumoniae b. Klebsiella pneumoniae c. Legionella pneumoniae d. Pseudomonas aeruginosa B____28. Which of the following patients would you expect to have a decreased response to TST? a. Julie, a 50-year-old postal worker b. Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns c. Jill, a 16-year-old cheerleader d. Mark, a 29-year-old tennis player C____29. Which of the following is a possible consequence of sleep apnea? a. Asthma b. Increased white blood cells c. Insulin resistance d. Hyperactivity C____30. Which of the following conditions is associated with cigarette smoking? a. Glaucoma b. Increased sperm quality c. Bladder cancer d. Eczema A____31. Marta is taking TB drugs prophylactically. How do you instruct her to take them? a. Take them on an empty stomach to facilitate absorption. b. Take them with aspirin (ASA) to prevent flushing. c. Take them with ibuprofen to prevent a headache. d. Take them with food to prevent nausea. _D___32. Which of the following statements regarding pulmonary function is true? a. Cigarette smoking accelerates the decline in pulmonary function tenfold. b. Smoking cessation can reverse most pathological changes. c. Cigarette smoking decreases mucus production. d. There is a normal age-related decline in pulmonary function. B____33. The barrel chest characteristic of emphysema is a result of: a. Chronic coughing b. Hyperinflation c. Polycythemia d. Pulmonary hypertension __D__34. Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD? a. 3 to 5 hours b. 6 to 10 hours c. 11 to 14 hours d. 15 to 18 hours _A___35. Which ethnic group has the highest lung cancer incidence and mortality rates? a. African American men b. Scandinavian men and women c. Caucasian women d. Asian men Chapter 9. Respiratory Problems Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: B PTS: 1 3. ANS: C PTS: 1 4. ANS: D PTS: 1 5. ANS: B PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: C PTS: 1 9. ANS: A PTS: 1 10. ANS: C PTS: 1 11. ANS: D PTS: 1 12. ANS: C PTS: 1 13. ANS: A PTS: 1 14. ANS: D PTS: 1 15. ANS: A PTS: 1 16. ANS: C PTS: 1 17. ANS: A PTS: 1 18. ANS: C PTS: 1 19. ANS: A PTS: 1 20. ANS: C PTS: 1 21. ANS: B PTS: 1 _C___ 9. Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours? a. Stable angina b. Unstable angina c. Variant (Prinzmetal’s angina) d. Probably not angina but hiatal hernia _A___10. Which ECG change is typical of cardiac ischemia? a. T-wave inversion b. ST-segment elevation c. Significant Q wave d. U-wave B____11. In which type of arterioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped? a. First-degree AV block b. Second-degree Mobitz I AV block c. Second-degree Mobitz II AV block d. Third-degree AV block __C__12. A Delta wave on the ECG may be present in which condition? a. Prinzmetal’s angina b. Bundle branch block c. Wolff-Parkinson-White syndrome d. Aortic stenosis __D__13. Which heart sound may be heard with poorly controlled hypertension, angina, and ischemic heart disease? a. A physiologic split S2 b. A fixed split S2 c. S3 d. S4 _D___14. Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of: a. Severe asthma b. A common valvular lesion c. Severe hypertension d. A prosthetic heart valve B____15. George, age 64, has cardiovascular disease (CVD), a total cholesterol of 280 mg/dL, and a systolic BP of 158. He is being treated for hypertension. You are doing a Framingham Risk Assessment on him. Which assessment factor would give him the highest number of points on the scale? a. His age b. His cholesterol level c. His systolic BP d. The fact that he is on antihypertensive medication _C___16. Which pain characteristic is usually indicative of cardiac pathology? a. Fleeting b. Moving c. Diffuse d. Localized B____17. What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia? a. About 20% b. About 30% c. About 50% d. Almost all _A___18. Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses? a. 911 should be called, and the patient should be transported immediately to the emergency department. b. One more dose of NTG may be tried. c. The person should be given two aspirin to chew. d. A portable defibrillator should be located to ascertain the cardiac rhythm. D____19. For the best therapeutic effect after a myocardial infarction (MI), thrombolytics should be administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can be of benefit up to how many hours after the initial presentation of MI symptoms? a. 6 hours b. 8 hours c. 10 hours d. 12 hours _C___20. When teaching post MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not be put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must be dated and discarded after how many months? a. 1 month b. 3 months c. 6 months d. As long as the tablets are kept in this special bottle, they will last forever. _D___21. There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy? a. Stage A b. Stage B c. Stage C d. Stage D _A___22. Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test? a. B-type natriuretic peptide b. C-reactive protein c. Serum albumin d. Erythrocyte sedimentation rate _C___23. Which test has long been considered the gold standard for a diagnosis of venous thromboembolism? a. Ultrasound b. Magnetic resonance imaging (MRI) c. Ascending venogram d. D-dimer __C__24. Statins are approved for which age group? a. Children over the age of 2 b. Children over the age of 6 c. Children over the age of 10 d. Only adolescents and adults _D___25. The American College of Cardiology/American Heart Association states which of the following regarding the use of non-statin lipid-lowering agents? a. Nicotinic acid derivatives are effective for lowering LDL and triglycerides (TGs). b. Bile acid sequestrates increase HDL. Chapter 10. Cardiovascular Problems Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: C PTS: 1 3. ANS: A PTS: 1 4. ANS: C PTS: 1 5. ANS: D PTS: 1 6. ANS: A PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: C PTS: 1 10. ANS: A PTS: 1 11. ANS: B PTS: 1 12. ANS: C PTS: 1 13. ANS: D PTS: 1 14. ANS: D PTS: 1 15. ANS: B PTS: 1 16. ANS: C PTS: 1 17. ANS: B PTS: 1 18. ANS: A PTS: 1 19. ANS: D PTS: 1 20. ANS: C PTS: 1 21. ANS: D PTS: 1 22. ANS: A PTS: 1 23. ANS: C PTS: 1 24. ANS: C PTS: 1 25. ANS: D PTS: 1 26. ANS: A PTS: 1 27. ANS: D PTS: 1 28. ANS: C PTS: 1 29. ANS: A PTS: 1 30. ANS: B PTS: 1 31. ANS: C PTS: 1 32. ANS: D PTS: 1 33. ANS: A PTS: 1 Chapter 11. Abdominal Problems Multiple Choice Identify the choice that best completes the statement or answers the question. __D__ 1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination? a. Digital rectal exam b. Pelvic exam c. Sexual history d. All of the above __C__ 2. A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? a. Multivitamin b. Magnesium hydroxide c. Pepto-Bismol® d. Ibuprofen _D___ 3. A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis? a. Gastroenteritis b. Inflammatory bowel disease c. Lactase deficiency d. All of the above _C___ 4. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain? a. The pain seems better when he smokes to relieve his nerves. b. Coffee and fried foods don’t bother him, c. He wakes at night coughing with a bad taste in his mouth. d. All of the above _C___ 5. A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer? a. His gender b. His age c. His use of Alka-Seltzer d. His ethnic origin _A___ 6. Which of the following is most effective in diagnosing appendicitis? a. History and physical b. Sedimentation rate c. Kidney, ureter, and bladder x-ray d. Complete blood count (CBC) with differentials __A__ 7. Which of the following is associated with celiac disease (celiac sprue)? a. Malabsorption b. Constipation c. Rectal bleeding d. Esophageal ulceration _D___ 8. A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis? a. Endometriosis b. Colon cancer c. Biliary obstruction d. All of the above _C___20. A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point? a. Stool culture b. Liver enzymes c. Antihepatitis D virus d. Thyroid-stimulating hormone test _A___21. On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis? a. Hepatitis A virus (HAV) IgM b. HAV IgG c. Anti-HAcAg d. Anti-HAsAg _B___22. A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings? a. Decreased alanine aminotransferase and decreased aspartate aminotransferase b. Elevated alkaline phosphatase c. Elevated indirect bilirubin d. Decreased white blood cells _A___23. A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson’s criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings? a. A high mortality rate b. An increased chance of recurrence c. A 7% chance of the disease becoming chronic d. All of the above _C___24. A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the NP to a diagnosis of inflammatory bowel disease? a. Intermittent constipation with periods of diarrhea b. Wakens at night with diarrhea c. History of international travel d. All of the above _A___25. Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? a. High fiber diet b. Tylenol with codeine c. Daily laxatives d. All of the above Chapter 11. Abdominal Problems Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: C PTS: 1 3. ANS: D PTS: 1 4. ANS: C PTS: 1 5. ANS: C PTS: 1 6. ANS: A PTS: 1 7. ANS: A PTS: 1 8. ANS: D PTS: 1 9. ANS: B PTS: 1 10. ANS: A PTS: 1 11. ANS: A PTS: 1 12. ANS: D PTS: 1 13. ANS: D PTS: 1 14. ANS: A PTS: 1 15. ANS: B PTS: 1 16. ANS: C PTS: 1 17. ANS: A PTS: 1 18. ANS: D PTS: 1 19. ANS: C PTS: 1 20. ANS: C PTS: 1 21. ANS: A PTS: 1 c. Closed-angle glaucoma d. Breast cancer __B__11. A patient is diagnosed with overactive bladder. Which of the following instructions should be given to this woman? a. “Limit the amount of water that you drink.” b. “Eliminate caffeine from your diet.” c. “Wear panty liners.” d. All of the above A____12. A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of the following actions should be taken next? a. Send a urine specimen for microscopy and evaluate for fungal colonies. b. Increase the dose of antibiotic. c. Order a cytoscopy. d. Order a different antibiotic. _A___13. Which of the following are predisposing factors for pyelonephritis? a. Pregnancy b. Dehydration c. Smoking d. Alkaline urine __B__14. A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed? a. 3-day course of oral antibiotics b. Hospitalization c. Encourage cranberry juice intake. d. 6-week course of antibiotics _D___15. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses? a. Pancreatitis b. Peptic ulcer disease c. Diverticulitis d. All of the above _A___16. Which of the following instructions should be given to the patient with nephrolithiasis? a. Take ibuprofen, 600 mg every 8 hours. b. Take Tums for stomach upset. c. Drink more black tea. d. Increase intake of vegetables, like spinach. _D___17. Which of the following patients is at risk for developing urinary tract cancer? a. The 45-year-old woman who is 100 lbs overweight b. The 78-year-old man who smokes three packs of cigarettes a day c. The 84-year-old man who worked in the asbestos mines d. All of the above B____18. A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments? a. Chemotherapy b. Nephrectomy c. Palliative treatment d. Radiation _D___19. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is considered a risk factor for this type of cancer? a. History of alcoholism b. Sedentary lifestyle c. Obesity d. 65-year smoking history _B___20. Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer? a. Kidneys, ureter, bladder x-ray b. Cystoscopy with biopsy c. Magnetic resonance imaging d. Urine tumor marker (NMP22) C____21. A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response? a. “There is no such thing as Stage D cancer.” b. “You have cancer that has spread to the surrounding tissue.” c. “Your cancer has spread to other organs.” d. “Your cancer can be cured by removing your bladder.” A____22. The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia? a. Recent heat stroke b. Nephrolithiasis c. Recent infection where gentamicin was used in treatment d. All of the above _B___23. The patient is diagnosed with ARF. Which of the following conditions is the most common cause? a. Renal calculi b. Acute tubular necrosis c. Cardiac failure d. Acute glomerulonephritis _D___24. An 82-year-old woman with renal failure is seen in the clinic. The provider should question the patient about the intake of which of these substances that can cause renal toxicity? a. Ibuprofen b. Captopril c. Losartan d. All of the above _A___25. Which of the following clinical manifestations are consistent with a patient in ARF? a. Pruritis b. Glycosuria c. Irritability d. Hypotension __B__26. Which of the following examination findings should be expected in a patient with chronic renal failure (CRF)? a. Weak, thready pulse b. Auscultatory crackles c. Hypotension d. Pleural friction rub C____27. Which of the following tests is most useful in determining renal function in a patient suspected of CRF? a. BUN and creatinine b. Electrolytes c. Creatinine clearance d. Urinalysis 21. ANS: C PTS: 1 22. ANS: A PTS: 1 23. ANS: B PTS: 1 24. ANS: D PTS: 1 25. ANS: A PTS: 1 26. ANS: B PTS: 1 27. ANS: C PTS: 1 28. ANS: D PTS: 1 TRUE/FALSE 1. ANS: F PTS: 1 2. ANS: T PTS: 1 Chapter 13. Men's Health Problems Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? a. Psychogenic nocturia b. Urethral polyp c. Irritative posterior urethral lesion d. Benign prostatic hypertrophy ____ 2. A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men? a. Urethral polyps b. Urinary tract infection (UTI) c. Anticholinergic medication d. All of the above ____ 3. A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? a. Refer to a urologist immediately. b. Obtain a computed tomography (CT) scan. c. Instruct the patient to elevate the scrotum. d. Prescribe ibuprofen. ____ 4. An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? a. Benign prostatic hyperplasia (BPH) b. Parkinson’s disease c. Prostate cancer d. All of the above ____ 5. Which of the following would be an appropriate treatment for a patient with mild BPH? a. Refer to a urologist for surgery. b. Prescribe a trial of tamsulosin. c. Recommend cranberry supplements. d. Reevaluate symptoms in 1 to 3 months. ____ 6. A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis? a. Testosterone level b. Prostate-specific antigen c. Nocturnal penile tumescence and rigidity d. Prolactin level ____ 7. Which of the following should be considered in a patient presenting with erectile dysfunction? a. Diabetes mellitus b. Hypertension c. Atherosclerosis d. All of the above ____ 8. A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? a. Peyronie’s disease b. Damage to the pudendal artery c. Scarring of the cavernosa d. All of the above ____ 9. The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? a. Erectile dysfunction b. Glaucoma c. Hypotension d. Headache ____ 10. The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis? a. Gram-positive cocci b. Gram-negative cocci c. Gram-positive bacillus d. Gram-negative bacillus ____ 11. The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg- sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long? a. 3 to 7 days b. 14 to 21 days c. 3 to 6 weeks d. 6 to 12 weeks ____ 12. A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment? a. Terazosin 2 mg PO once a day b. Ice pack to the scrotal area c. Saw palmetto 320 mg per day d. All of the above ____ 13. A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism? a. Escherichia coli b. Staphylococcus aureus c. Chlamydia trachomatis d. Pseudomonas aeruginosa ____ 14. Which test is used to confirm a diagnosis of epididymitis? a. Urinalysis b. Gram stain of urethral discharge c. Complete blood cell count with differential d. Ultrasound of the scrotum Chapter 13. Men's Health Problems Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: B PTS: 1 3. ANS: A PTS: 1 4. ANS: D PTS: 1 5. ANS: D PTS: 1 6. ANS: A PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: A PTS: 1 10. ANS: D PTS: 1 11. ANS: D PTS: 1 12. ANS: A PTS: 1 13. ANS: C PTS: 1 14. ANS: D PTS: 1 15. ANS: B PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: A PTS: 1 19. ANS: A PTS: 1 20. ANS: D PTS: 1 21. ANS: D PTS: 1 22. ANS: A PTS: 1 23. ANS: B PTS: 1 TRUE/FALSE 1. ANS: T PTS: 1 2. ANS: T PTS: 1 Chapter 14. Women's Health Problems Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? a. Human papillomavirus (HPV) b. Endometrial hyperplasia c. Vagismus d. Polycystic ovarian syndrome ____ 2. A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? a. Ceftriaxone b. Doxycycline c. Acyclovir d. Metronidazole ____ 3. A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? a. Gonorrhea b. HPV c. Chlamydia d. Trichomonas ____ 4. A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? a. Trichomonas b. Bacterial vaginosis c. HPV d. Herpes simplex virus ____ 5. Which of the following medications is the treatment of choice for trichomonas? a. Metronidazole b. Ceftriaxone c. Diflucan d. Doxycycline ____ 6. A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? a. “It is probably just a cyst because that is the most common breast mass.” b. “We will order a mammogram and ultrasound to help establish a diagnosis.” c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.” d. “Because your lump is painful, it is most likely not cancer.” ____ 7. A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? a. Pregnancy test b. Pelvic ultrasound c. Endometrial biopsy d. Platelet count ____ 8. A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia? a. Menopause b. Dehydration c. Excess progesterone d. Sexual trauma as a child ____ 9. A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? a. Fluconazole b. Estrogen vaginal cream c. Metronidazole d. Doxycycline c. Ovarian cancer d. All of the above ____ 22. A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first? a. Transvaginal ultrasound b. Endometrial biopsy c. MRI d. Abdominal computed tomography scan ____ 23. A 45-year-old woman is seen because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response? a. “You are approaching menopause.” b. “You have a hormonal imbalance.” c. “Your FSH is normal, but your pituitary is making too much LH.” d. “There is an imbalance between your ovaries and pituitary.” ____ 24. Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal? a. Pregnancy b. Estrogen level c. Progesterone level d. LH level ____ 25. A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer? a. Her numerous pregnancies b. Her age at menopause c. Her father’s history of lung cancer d. Her grandmother’s history of colon cancer ____ 26. A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment? a. Conjugated estrogen, 0.625 mg/day oral b. Estradiol, 7.5 mcg/24 hr vaginal ring c. Medroxyprogesterone, 10 mg/day oral d. Conjugated estrogen, 0.3 mg + medroxyprogesterone 1.5 mg/day oral True/False Indicate whether the statement is true or false. ____ 1. Oral contraceptive pills can cause endometrial cancer. ____ 2. A woman taking estradiol is at risk for developing endometrial cancer. ____ 3. Most breast cancer cases are in women with a family history of breast cancer. Chapter 14. Women's Health Problems Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: A PTS: 1 3. ANS: C PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: A PTS: 1 9. ANS: A PTS: 1 10. ANS: A PTS: 1 11. ANS: C PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: A PTS: 1 15. ANS: B PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: B PTS: 1 19. ANS: D PTS: 1 20. ANS: A PTS: 1 c. Recurrent dislocations are uncommon and would require great force to result in injury. d. Surgery is most commonly the treatment of choice. ____ 8. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. b. Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. c. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. d. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. ____ 9. Which of the following statements is true regarding the treatment of carpal tunnel syndrome? a. The goal of treatment is to prevent flexion and extension movements of the wrist. b. Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position. c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection. d. All of the above ____ 10. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? a. Morning stiffness and limited mobility of the lumbar spine b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain c. Fever, chills, and elevated erythrocyte sedimentation rate d. Pathologic fractures, severe night pain, weight loss, and fatigue ____ 11. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? a. “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.” b. “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.” c. “You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.” d. “It is important to take NSAIDs on an empty stomach in order to increase absorption.” ____ 12. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? a. Gastrocnemius weakness b. A reduced or absent ankle reflex c. Numbness in the lateral foot d. Paresthesia of the perineum and buttocks ____ 13. Which of the following statements is true concerning the management of the client with a herniated disc? a. Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use. b. An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. c. Intolerable pain for more than a 3-month period is an indication for surgical intervention. d. All of the above ____ 14. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? a. Valgus stress test b. McMurray circumduction test c. Lachman test d. Varus stress test ____ 15. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as: a. Apprehension sign b. Bulge sign c. Thumb sign d. None of the above ____ 16. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs? a. Inability to bear weight immediately after the injury b. Development of marked ankle swelling and discoloration after the injury c. Crepitation with palpation or movement of the ankle d. All of the above ____ 17. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician? a. “Complementary therapies should be considered only if surgical interventions are not successful.” b. “I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition.” c. “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy.” d. “It would be crazy to use complementary therapies to treat such a serious condition.” ____ 18. Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways? a. By decreasing the erosive activity of osteoclasts b. By promoting osteoclastogenesis c. By inhibiting osteoclast apoptosis d. All of the above ____ 19. Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis? a. Bone alkaline phosphatase levels b. Urinary N-telopeptide assay Chapter 15. Musculoskeletal Problems Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: A PTS: 1 3. ANS: C PTS: 1 4. ANS: A PTS: 1 5. ANS: B PTS: 1 6. ANS: C PTS: 1 7. ANS: B PTS: 1 8. ANS: A PTS: 1 9. ANS: D PTS: 1 10. ANS: B PTS: 1 11. ANS: A PTS: 1 12. ANS: D PTS: 1 13. ANS: C PTS: 1 14. ANS: B PTS: 1 15. ANS: A PTS: 1 16. ANS: D PTS: 1 17. ANS: C PTS: 1 18. ANS: A PTS: 1 19. ANS: C PTS: 1 20. ANS: D PTS: 1 21. ANS: B PTS: 1 22. ANS: B PTS: 1 23. ANS: D PTS: 1 24. ANS: D PTS: 1 25. ANS: B PTS: 1 26. ANS: C PTS: 1 TRUE/FALSE 1. ANS: T PTS: 1 2. ANS: F PTS: 1 Chapter 16. Endocrine/Metabolic Problems Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment? a. No treatment at this time b. Diet and exercise for 6-week trial c. Diet, exercise, and oral medication d. Diet, exercise, and exogenous insulin ____ 2. The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit? a. High sensitivity thyroid-stimulating hormone (TSH) and free T4 b. Free T4 and serum calcium c. Free T3 and T4 d. TSH and thyroxin antibodies ____ 3. A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes? a. Reduces postprandial blood glucose b. Reduces triglycerides and increases high-density lipoprotein (HDL) c. Reduces total cholesterol d. All of the above ____ 4. A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first? a. Check his blood sugar. b. Have him drink 4 ounces of juice. c. Call 911. d. Ask him about his usual eating habits. ____ 5. A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin? a. Ketoacidosis b. Cirrhosis c. Hypoglycemic episodes d. All of the above ____ 6. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next? a. Serum calcium b. TSH c. Electrolytes d. Urine specific gravity ____ 7. The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective? a. “As long as I don’t need glasses, I don’t have to worry about going blind.” b. “I know I need to have my eyes checked every year.” c. “My optometrist checks my eyes.” d. “I will see my eye doctor when my vision gets blurry.” ____ 8. A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment? a. Tricyclic antidepressants b. Capsaicin cream c. Vitamin B12 injections d. Insulin ____ 20. Mr. W, 53 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis? a. Fallen arch b. Arthritis c. Charcot joint d. Sprained ankle ____ 21. Which of the following tests should you order to confirm Mr. W’s diagnosis? a. Bone scan b. Computed tomography (CT) scan c. X-ray of the foot d. Culture of the ulcer ____ 22. A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods? a. Rice b. Carrots c. Spinach d. Potatoes ____ 23. The clinician should question the patient with suspected gout about use of which of these medications? a. Low-dose aspirin b. Thiazide diuretics c. Ethambutol d. All of the above ____ 24. The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which of the following data would be most significant for this patient? a. A history of tonsillectomy in the 1940s b. Recent exposure to mumps c. Vegetarian diet d. Allergy to iodine ____ 25. Which of the following is essential for diagnosing thyroid cancer? a. Fine needle aspiration b. Thyroid ultrasound c. CT scan d. Magnetic resonance imaging ____ 26. Which of the following are common signs of type 2 DM? a. Anorexia b. Recurrent yeast infection c. Weight gain d. Elevated HDL cholesterol ____ 27. Which of the following medications can cause hyperglycemia? a. Prednisone b. Metformin c. Synthroid d. Cephalexin ____ 28. Which of the following is diagnostic for diabetes mellitus? a. A1C 7.0 on one occasion b. Fasting blood sugar (FBS) of 100 mg/dL on two occasions c. Random glucose of 200 mg/dL on two occasions d. Two-hour post-load plasma glucose of 300 mg/dL on one occasion ____ 29. Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy? a. Insulin b. Metformin c. Glucotrol d. Precose ____ 30. A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which of the following should be included in the differential diagnosis? a. Anxiety disorder b. Pheochromocytoma c. Psychosis d. All of the above True/False Indicate whether the statement is true or false. ____ 1. Metformin is the first line of pharmacologic treatment for type 2 DM. ____ 2. Fruit juice with added sugar is the treatment of choice for anyone experiencing hypoglycemia. ____ 3. Lifestyle modification is the treatment of choice for metabolic syndrome. ____ 4. A BMI of 29 kg/m2 is considered obesity. ____ 5. Urine-free cortisol is one of four diagnostic tests recommended for Cushing’s syndrome. a. Autogenic b. Autologous c. Allogeneic d. Syngeneic ____ 3. During treatment for anaphylaxis, what site is used for the initial injection of epinephrine? a. IV b. Abdomen c. Upper lateral thigh d. Deltoid ____ 4. After the initial treatment for anaphylaxis, which medication should be added to prevent late-phase anaphylactic reactions? a. Albuterol b. Diphenhydramine c. An H2 blocker d. Corticosteroids ____ 5. When analyzing synovial fluid, if it is opaque, white, or translucent; has 5,000 leukocytes/Ml; 80% polymorphonuclear leukocytes (PMN); and a low red blood cell count, it may be indicative of which of the following conditions? a. This is a normal result. b. Scleroderma c. Rheumatoid arthritis d. Sickle cell disease ____ 6. Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist? a. Methotrexate (Rheumatrex) b. Etanercept (Enbrel) c. Rituximab (Rituxan) d. Anakinra (Kineret) ____ 7. Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate? a. PEP should be started within hours of exposure. b. PEP should be started within 72 hours of exposure. c. Renal and hepatic function tests should be done 6 weeks after beginning PEP. d. PEP will prevent potential hepatitis C infection if present. ____ 8. Which household solution should be used to clean a bathroom if sharing with a friend who has HIV? a. 100% bleach b. 50% bleach and 50% vinegar c. Nine parts H2O to one part bleach d. The friend must have his or her own bathroom. ____ 9. Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate? a. A favorable prognostic trend b. Disease progression c. The need to be more aggressive with Reuben’s medications d. The eradication of the HIV ____ 10. If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do? a. Stop the warfarin for 1 week, and then repeat the INR. b. Withhold one or more days of anticoagulant therapy. c. Restart therapy at a lower dose immediately. d. The prothrombin time and INR should be reevaluated within 1 month of the dosage adjustments. ____ 11. Which of the following is identified as an eating disorder in which a person craves food substitutes, such as clay, ice chips, and cotton, and is considered an objective finding associated with severe iron deficiency? a. Ferritin b. Porter’s syndrome c. Hypochromasia d. Pica ____ 12. As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin? a. Two b. Three c. Four d. Five ____ 13. What is the most common cause of microcytic anemia? a. Anemia of chronic disease b. Sideroblastic anemia c. Iron-deficiency anemia d. Thalassemia ____ 14. The cardinal subjective symptom of sickle cell crisis is which of the following? a. Pain b. Nausea c. Light-headedness d. Palpitations ____ 15. In the United States, what is the second most common connective tissue disease and the most destructive to the joints? a. Osteoarthritis b. Systemic lupus erythematosus (SLE) c. Rheumatoid arthritis d. Sjögren’s syndrome ____ 16. Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process? a. Erythrocyte sedimentation rate b. White blood cell count c. Polymorphonuclear cells d. C-reactive protein (CRP) ____ 17. Infectious mononucleosis results from an acute infection with which of the following? a. Epstein-Barr virus b. Acute HIV infection c. Guillain-Barré d. Hepatitis ____ 18. What is the most common cause of generalized musculoskeletal pain in women ages 20 to 55? a. Chronic fatigue syndrome (CFS) b. Anemia c. Fibromyalgia syndrome (FMS) d. Sports-related injuries ____ 19. After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering? a. A viral syndrome b. Lyme disease c. Rocky Mountain spotted fever d. Relapsing fever