Quiz 5 NR 601 MATURE AND AGING ADULT Q & As BEST EXAM SOLUTION LATEST UPDATE 2023 RATED A+, Exams of Nursing

Download Quiz 5 NR 601 MATURE AND AGING ADULT Q & As BEST EXAM SOLUTION LATEST UPDATE 2023 RATED A+ and more Exams Nursing in PDF only on Docsity! Nr 601 week 5 quiz Answered(MATURE AND AGING ADULT) Question 1 2 / 2 pts Question 2 2 / 2 pts Quiz 5 NR 601 MATURE AND AGING ADULT Which of the following laboratory results meets criteria for diagnosis of diabetes? random blood glucose greater than 126 mg/dL with classic symptoms of hyperglycemia positive urine ketones random glucose greater than 200 mg/dL with classic symptoms of hyperglycemia Hgb A1C 6.4% The criterion for the diagnosis of diabetes is either two fasting blood glucose readings with results greater than or equal to 126 mg/dL or a random blood glucose reading greater than or equal to 200 mg/dL if symptoms of diabetes are present. Random glucose is not the appropriate test. In older adults, the glucose reading after a 2-hour oral glucose tolerance test (OGTT) rises more rapidly than the fasting glucose. Kennedy p.370 Which “P” is a component of “the 3 P’s” of diabetes mellitus? polygraphia Nr 601 week 5 quiz Answered(MATURE AND AGING ADULT) polyphagia pain Nr 601 week 5 quiz Answered(MATURE AND AGING ADULT) Question 5 0 / 2 pts prescribe Metformin 500 mg po daily repeat fasting glucose in 1 week repeat fasting glucose in 1 year A fasting plasma glucose > 126 mg/dL requires further testing. In the absense of unequivocal hyperglycemia, result should be confirmed by repeat testing . A HgbA1C is the correct answer becasue the repeat testing should be completed without delay. Retesting in a week or a year is a delay. Metformin should not be initatiated until the diagnosis is confirmed . Dunphy p.925 A newly diagnosed patient with Type 2 diabetes mellitus (DM) is 66 inches in height. The patient's weight is 200 lbs, and the A1c is 7.1%. What is the best initial treatment? Correct Answer diet, exercise, and metformin diet, exercise, and insulin diet and exercise no treatment necessary at this time At 66 in and a weight of 200 lbs. the patient has a BMI of 32.3. If you did not have an ability to calculate, the weight of 200 is higher than a normal BMI. The ADA and AACE Nr 601 week 5 quiz Answered(MATURE AND AGING ADULT) recommend that patients with recent onset T2DM (A1C < 7.5%) start with lifestyle changes and monotherapy. Dunphy p.927 Nr 601 week 5 quiz Answered(MATURE AND AGING ADULT) Week 6 DE QS 106 Endocrine and Metabolic Problems and Urgent Care Issues Question 5. The process of aging resultsir . An increase in liver weight and mass. V@ 2.A decreased absorption of fat-soluble vitamins. 5. AN increase in enzyme activity. 4, Constricted pancreatic ducts. Rationales ‘ption1: Theres decrease in the number and size of hepatic cells, leadirg toa decrease in liver weight and mass. Option2: The process of aging resultsin a decreased absorpticn of fat-soluble vitamins, ‘Oplion3: Thereis a decrease in enzyme activity, which diminishes the livers ability to detonify drugs. This increases the risk of toxic levels of mary medications in older adults, Option4: Theres calsfication of she pancreatic vessels, and the ducts distend and dilate. These changes lead to a decrease in the production of lipase. [Pagereference: 1284] Course Topic: Endocrine anc Metabolic Froblems | Area of Practicels):Adul-Gerontology Primary Care;Family Practice | APN Knowledge Areas}: Pathoptysiclogy | Testing Domain: Assess | Cognitive Level: Comprehension [Understanding] intolerance, increased sweating, palpitations, tachycardia, nervousness, iritabilit Question 6. Sigrid, ag fatigue, and muscle weak , appears with a 3-month history of he Which test would you order first? blood chemistry panel Thyroid-stimulating hormone 35 nction studies. 4. Electrocardiogram. Rationales BC) will need t perfor Option 1: if antithyroid drugs are used, @ complete blood coun el should be ordered frst because the symptoms suggest hyperthyroidis isthe best > hyperthyroidism include a free triiodothyronine (T,) or thyroxine (T,) level, Ts resin diac Option: Foraclient screening t antibodies, including thyrotropin receptor antibody (TRAb). Tests not routinely performed but that may be helpfulinclude hich help to sociated with a toxic goiter. uptake, and thyroid aut snd a thyroid scan (with iodine-123 [3°1] or technetium-991m iodine uptab mine the etiology of the hyperthyroidism and assess the functional status of any palpable thyroid irregularities or nodu performed. Option 3: antithyroid drugs are used, liver function tests will need to b 1se ofthe palpitations, but once the thyroid is stabilized, the cardiac rhythm usually returns to normal Option 4: An electrocardiogram may be ordered be: [Page reference: 884] Primary Care; Family Practice | Course Topic: Endocrine and Metabolic Problems | Area of Prac APN Knowledge Area(s): Diagnostic T Clinical Decision-Making | Testing Dom: ‘and Therapeutic Procedure Cognitive Level: Analysis [Analyzing]  Question 7. Acli medical ni 1, Glipizide (Glucotrol). 2, Sitagliptin (Januvia). 3. Exenatide (Byetta ¥ @ 4. Metformin (Glucophage) Rationales Option 1: ues such as sulfonylureas can c s a second, cost-effective choice. Option 2: idyl peptidase- (DPP4) inhibitors such asst ecretios gon secretion, and suppress hepatic glucose production and peripheral glucose uptake and metabolism, Option 3: nt, exenatide (Byetta), is an incretin mimetic thet often indi 2 lower risk of hypoglycemia, od choice over a sulfonylurea as dual ther ts, and evidence for lor Option 4: y, and cost, metformin isthe cornerstone of monotherapy unless there is a contraindication, such as renal disea: risk of lactic acid is, Metformin often h rent ofthe lipid profile, and imp 2s insulin sensitivity in peripheral tissues. Th eneficial effet fibrinolys risk of hyp: gradually increasing as needed to a maximum dose of 200 the lowest dose of 5 lactic acidosis [Page referen« = 927-929) Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adut- Gerontology Primary Care; Family Practice APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy, Disease Management | Testing Domain: Plan | Cognitive Level: Application (Applying! rted on therapeutic lifestyle changes (TLCs) and  thyroid drug (ATD) methimazole (Tapazole), so you make ita point to check his: Question 8, Mr. Reynolds is on the an 1, lycatec hemoglobin (HOA,). Complete blood coun: (CBC) and liver transarrinases. 3. Uric aci¢ level. 4, Total thyroxine (Ta). Rationales Option 1: HbA. .iz monitored in cliente with diabetes, Option2: ATDe cancauce agrarulocytosie and hepatic injury; therefore, CEC and liver stucies chould be done. Option: Uric asidis monitored in clients with gout. Option 4: Thyroid function tests are needed in patients taking ATs; however, thyrnid-stimuslating hormone (TSH) and free Ts ate preferced, [Page reference: 886] Course Topic: Endocrineand Meteboiic Problems | Area of Practice(s): Adult-Gerontology rimary Care; Family Practice | APH Knowledge Area(s): Disyiosiic Tests end Therapeutic Provalures, Disease Managernent | Testing Domain Evaluate | Cognitive Level: ys Arnal  Question 11. After an oral cholecystogram, Sam complains of bumingor urination. This is because of: Armild reaction lo Ure vonuastimedium, Biliary obstruction. 2. Contraction of the gallbladder. ¥® 4. The presence of dye in the urine. Rationales Option 1: A reaction tothe contrast medium would prncace sysaptams sich as urticaria, nausea, vomiting, and dyspnea. Option2: Anoral cholecystogram ix dane ta asses fer hillary chetruction. Ontion3: To obtain a better reading during a cholecystozram, cortraction ofthe gallbladder may be desirable and may be accomplished by having the dient consume ¢ high-fat meal during the procedure Option 4: After an eral chale-ystagram, some penple experience burning on urination hecauce ofthe presence of dye in the urine. This is helped by forcing Fuids. [Page reference: 539] Course Topic: Endocrineand Metabolic Problems | Area of Practice(s): Aduit-Gerontology Primary Cares Femity Fractice | [APH Knowledge Area(s): Differential Diagnosis Clinical Decision-Making | Testing Domain:Plan | Cognitive Level: Applicaton [Applying]  Question 12. Which c ss of antihypertensive Any CE) inhibitors. jotensin-conver ing enzyme 2, Calcium channel blockers. vv ® 3. Beta blockers. 4. Alpha blockers. Rationales Option 1: ACE inhibitors are the first choice fore Option 2: 1m channel blockers provid: Option3: Beta blockers may be problematic in clients have compelling indications (such as corones right occur. Decreasing the possibility beta blocker it isimportant to explain that instead of blockers. Option4: Alpha blockers provide smooth control and an improved lipid profil. [Page referen« 2925) Course Topic: Endocr [APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy Question 13. The mejor risk factor for thyroid cancer is: 1. Inadequate iouive intake. 2. Presonee of a goiter. V@ 4. Exposure to radiation. 4,Smoking. Rationales Option: There ents may be problematic for cli ts with diabetes who have hypertension because they slow the progression of diabetic low blood sugar by selecting appropriate agents and adjusting d schycardia, he or neand Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; in:Plan | Cogri with diabetes? propathy. nd glucose control lock what is often the first sign of hypoglycemia—tachycardia. Many clients 1ckere. In these clients, the need for a beta blocker out rick that er signs of hypoy amily Practice fe Level: Comprehension (Understanding! Increased incidence of thyrolc cancer in areas where lodine ceficlency Is more common. Option2: There sen increased incidence of thyroid cancerin areas where goiter's more common. Option: The miejur risk Facior for Lhyroid tancer isexposure to radiation, usuelly tut Weal chilrran fer an enlarged shymus, enlarged tonsils, and acne. Several milion children were expased In this manner. Ir may alse neu in irevid uals who have had radiation therapy to the face or upper chast. Option: Cigarette smoking isa risk acter for bladder and lung cancer kut not thyroid cancer. [Page reference: 698] LU the head aid riech, Un 1950, 1adiativn Lrealients were giver lo course topic: endocrine anc Vetabolic Problems | rea of Practica(s): Adul-Geroncolagy bnmary ara; +amlly Practice APN Knowledge area(s): Population Healt’ and Epidemiology | Testing Domaln: Assess | Cognitive Level: Comprehension [Understanding] with diabetes may be necessary. Ifa client with diabetesis on a that are not affected by beta  Question 14, Marty has pheochromocytoma. You instruct him to: ¥® 1,Void frequently in small amounts. Not exercise for more than 30 minutes at a time. 3. Avoid sleeping in the prone position, 4, Take steroids. Rationales Option: Clients wit clients should also be advised to avoid smoking; drugs that may influ activities that might di should ed, Option2: Clients should avoi Option3: Clients should avoid activities that n ;echolami Option 4: Clients should a [Page reference: 900] Course Top APN Knowledge Area Question 15, Je‘frey, age 1/, has gynecomastia. You should also assess him for 1. Obesity. 2, Encocrine asnormali V® 8, Testicular cancer, 4. Tuberculosis, Rationales h pheochromocytoma should be told to void frequently in small amounts and to avoid lace abdominal organs, such as bending, exercising, straining, and vigorous palpation of the abdome activities that might displace abdominal organs. isplace abdominal organs. \docrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | Disease Management, Health Promotion and Patient Education | Testing Domain: Plan ition, to prevent stim st /e Level: Application (Applying) Option: While Jetrey may be obese, which would probably accentuste his gyneccmactia, itis the more sericus problem ct test cular cancer that reeds to be addressed. Option2: Gyneccmastia can occur secondary to hyperthyroidism ard other endocrine imbalances. Optionz: Gyneccmactia may be the first sigr of testicular cancer. Its also associated with breast, adrenal, putter, lung, snd hepatic malignancies. Hypeganadism produces law tastosterane levals in man with normal estrogen levels, Alteraton in breast tissue responsiveness. sar secondary to cirhosig, chronic obstructive ung disease, malnutrition, hyperthyroidism anc other endocrine imbstances, tuberculosis, Gynecemastia can oct and chronic renal disease, Gyrecenestia can ota secondary ba tuberculosis ormenal actuaty can resulein gynecomastia, Course Topict [rdoc:ine anc Vetakolic rablems | Area of Practice(s): Family Practice; Pediatrics | APM Knowledge Area(s}: Ilealth Assessment, Pathophysiology | Testing Domain re Levelt Analysis [Analyzing] Assess | Cognit  Question 20. and symptoms would be consistent with this condition? 1. Hypoglycemia and glycosuria. 2. Decreased respiratory rate with shallow respirations, 3. Polydipsia and an increased blood pH. tonuria and polyuria. Rationales Option 1: Hyperglycemia, not hypoglycemia, is a symptom of DKA. Option2: Very deep, not shallow, respirations are a symptom of DKA Option: Adecreased, not increased, blood pH is a symptom of DKA. Option 4: 1s and symptoms of dlabetic ketoacidosis include Ku anorexia, and headact smaul breathi uria and a decreased blood pH respiratory mov [Page reference: 915] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making | Test 1g Domain: Diagnose | Cogn ormone (TSH) can lead to: Question 21. A low thyroid-stimulating hi ¥® 1, Osteoporosis. 2. Weight gain. 3. Bradycardia Brittle hair Rationales Option 1: Hyperthyroidism presents with a suppressed TSH and elevated free thyroxine (T,). Manifestations include wi silky kin. The increased metabolic state of hyperthyroidism can cause cardiac dysrhyth there is excessive thyroid replacement Option2: Manifestations of hyperthyroidism include w Option 3: Manifestations of hyperthyroidism include tachycardia (not bradycardia] Option: Manifestations of hyperthyroidism include warm, silky skin (not brittle hai) [Page reference: 894] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adul ontology Primary Care; Family Practice | ‘APN Knowledge Area(s): Pathophysiology, Diagnostic Tests an utic Procedures | Test nts), hype loss, tachycardia, diarthea, anxiety sess | Cognitive Level a client with type 1 diabetes, is hospitalized with an admitting diagnosis of diabetic ketoacidosis (DKA). Which of the following signs slycemia, glycosuria, polyuria, polydipsia, ive Level: Application [Applying] ‘omprehension [Understanding  Question 22. Sara, age 40, has diabetes and is now experiencing anhidrosis on the hands and feet, increased sweating on the face and trunk, dysphagia, anorexia, and heartburn. Which complication of diabetes do you suspect? 1. Macrocirculation changes. circulation changes 3, Peripheral neuropathies. ¥® 4. Autonomic neuropathies. Rationales Option 1: Macrocirculation changes include an early onset of atherosclerosis and peripheral vascular insufficiency with claudication, ulcerations, and gangrene of Option2: Micracirculation changes include diabetic retinopathy with retinal ischemia and loss of vision and diabetic nephropathy with hypertension, albuminuria, edema, inability to move thee th headache, ey Option: Peripheral neuropathies include changes in sensation in the feet and hands; palsy of cranial nerve Il the chest; and motor and sensory down, oF to the middle; pain or loss of cutaneous sensation ficts in the anterior thigh and n unk, dysphagia, anorexia, nclude ant eating on the Optiona: Autor absence of sweating) on the hands and f heartburn, constricted pupils, nausea and vomiting, constipation, and diabetic diarrhe ic neuropathi [Page reference: 933] Course Topic: Endocrine and Metabolic Probl erontology Primary Care; Family Practice | ms | Area of Practice(s): Adult ‘APN Knowledge Area(s): Health Assessment, Differential Diagnosis Clinical Decision-Making, Disease Management | Testing Dom: ive Levels Analysis [Analy  Question 23. Martin, age 62, has acute nontransient abdominal pain that grows steadil back. The pain has lasted for days. He is also complaining of nausea, vomiting, sweating, worse in the epigastric area and radiates straight through t tenderness and distention and a lo weakness, and pallor. Physical examination reveals abdo at do you suspect? V® 2. Acute pancreatitis. 3, Cirrhosis, Cushing syndrome. Rationales Option holecystitis is in the upper right quadrant and is intermittent, usually after a fatty meal. Option 2: the pancreas nd supporting structures. Alt may be acute o that increases in the epigast ion, and low-grade fever. P ‘of activated pancreatic e mes into the surrounding renchyma, with subse c jomiting, sweating, weakne: itis occurs primar y in middle-aged adults and slightly more often in women than in m Option 3: ‘The gastrointestinal (i) manifestations of cithosis include par enlargement, esophageal or rectal varices, peptic ulcers, and gas Option: The clinical manif . 2 peptic [Page reference: 607] 3, which would result in intermittent pain relate meals. Course Topi \docrine and Metabolic Problems | Area of Practice(s}: Adult Health Assessment, Differential APN Knowledge Area rontology Primary Care; Family Practice | jagnosis Clinical Decision-Making | Testing Domain: Diagnose | Cogni Question 29. Option 1: Option2: For Option3: Bet Option a: [Page reference: 922] Course Top APN Knowledge Area Question 28. Masor 1. You should treat it the same as in a client without diabetes. ¥® 3.You should treat it very aggressively, preferably with angiotensin-converting enzyme (ACE) inhibitors. You should initiate therapy when the blood pr 10 mm Hg more than the conventional the Rationales Option: Bec use hypertension is implicated National n accelerating the microangiopathy of diabetes (es (C8) therapy should be initiated when the patient has a blood py lower goal of 130/20 in clients with DM, ommitt Option: ing to the beneficial e with DM with hypertension, cts of reducing albuminuria and glomerular pr Option 3: ACE inhibitors should be initiated in patients with diabetes and an elevated blood pre: Option a: ending on the guidelines, th be initiated when blood pressure reac [Page reference: 932] Course Top \docrine and Metabolic Problems APN Knowledge Area Pharmacologic Therapy and Polypharmacy, Disease Management | Testing Domal day. She comes to the office because she has developed a severe upp of her acute infection, you know that Betty is likely to require: respiratory 1. Adecrease in her daily insulin dosage ‘An increase in her daily insulin dosage. 3. Ahigh-calorie dietary intake and no insulin change. ‘Achange in her i ‘om NPH to insulin aspart (NovoLog) Rationales is likely to require an increase in her daily insul ients with diabetes requiring insulin, an increas increasing her regular insulin dose by just 2 units and then monitoring her blood sugar level yi likely to require an increase in her daily insulin dos: nd no increase in dietary caloric intake. {At some point, a more ph logic insulin regime asal-bolus) might be con: red, \docrine and Metabolic Problems Pharmacologic Therapy and Polypharmacy, Disease Management, Comorbidity | Tes peutic guidelin inopathy and nephropathy) mm Hg. other re, angiotensin-converting en than conventional ‘Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | tty, age 40, has had type 1 diabetes for 20 years and takes a combination of neutral protamine Hagedorn in their daily insulin dosage is usually required inthe presence of a ‘Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | Domain: Plan | Cogs 2, has diabetes mellitus (DM) and is overweight. You now find that he is hypertensive. How should you treat his hypertension? 2. Because insulin affects most antihypertensive drugs, you should try diet and exercise first before ordering any antihypertensives. according to the Eight inhibitors ive Level: Analysis [Analyzing] tute infection. Betty should begin by fe Level: Analysis [Analyzing] apeutic guidelines NPH) and regular insulin every tion with chills, fever, and production of yellow sputum. Because  Question 30. Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin un exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? 1. “Let's adjust your oral antidiabetic agents instead 2. “That’s a myth. People usually change their eating habits when taking this, d that’s what causes the weight loss. De 2 diabetes, you never want to be on injectable insulin. Let's try it. Your glycohemoglobin will be wered and you may lose weight. Rationales Option 1: Adjusting the client’ oral antidiat ‘agents may not be as effective, but these drugs are less expensive, Option2: —Exenatide (Byetta) can cause weight loss in some individuals. Option: Glucagon-\ike peptide Option 4: Unlike many oral an digestion and the pr exercise to imprc at encour: lycemic control in adul [Page reference: 930] Course Topic: Endocrine and Metabolic foblems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area ease Management, Pharmacologic Therapy and Polypharmacy, Health Promotion and Patient Education | Testing Dom: fe Level: Analysis [Analyzing] Question 31. Mary, age 72, has been taking insulin for several years. SI insulin in the long-acting insulin box and vice versa. She just took 22 unit she tried to do a fingerstick to test her glucose level but . "Keep trying to get a fingerstick and call me back with the results. ‘Call 911 before you collapse. 3 . “Drive Immediately to the emergency room. Drink four ounces of fruit juice. Rationales Mary should eventually be able to get a fingerstick but does not need to cal fit is okay. Option 2: Drinking 407 of fruit juice will probably correct the problem, so she may not ne Option: Ifher blood ugar is low, Mary should certainly not drive herself to the eme Option: Treatment of hypoglycemia is 15 g of carbohydrat the elevation in blood sugar that The milk option is preferred to dec fF orange jul should wait for 15 minut 0 see ifthe symptoms subside and repeat the treatment need: be pres riends should be instructed on ts use. <4. All patients on insulin shoul [Page reference: 937] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | ‘APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy, Therapeutic Communication | Testing Don in: Pian | Cognitive Level: Analysis [Analyzing control. He has heard that ust called you because she realized that yesterday she put her short-acting of regular insulin when she was supposed to take only 5 units. She says that was unable to obtain any blood. She states that she feels fine. What do you tell her to do first? init  Question 32. A client with hyperthyroidism presents with a complaint of a “gritty” feeling in her e s. Over the past week, her visual acuity has diminished, and her ability to see colors has changed. She also has a feeling of pressure behind her eyes. The next step for the nurse practitioner is to: 1. Order a thyroid ultrasound. v 3. Order a total thyroxine (Te) 4, Prescribe a beta-adrenergic blocker. Rationales Option 1: Option2: The practitioner should refer the client for an imn cases of 2. client with Graves or prednisone diagnosis of thyro Option: This course of action would prolong treatment and ¢ Option 4: This course of action would prolong treatment and does not add [Page reference: 888] Course Topic: Endocrine and Metabolic Problems 2. Refer the client for immediate evaluation by an ophthalmologist. long treatment and does not ad ient’s need to seek an immediate evaluation b diate evaluation by an ophthalmologist. Clinically recognized Graves ophthalmopathy occurs in about 50% of thy with these complait client's need to seek an immediate evaluation by an ophthalmolog's ‘sneed to seek an immediate evaluation by an ophthalmologist. ‘Area of Practice(s): Adult-Gerontology Primary Care; Famil [APN Knowledge Area(s): Disease Management, Pathophysiology Plan | Cognitive Level  Question 36. Lynne has Cushing syndrome. You would expect to have or develop: ¥® 1, Onychomycosis. 2. Generalized increased pigment: tion of the skin, 3. Hair loss. 4. Excitability and nervoi Rationales Option 1: Cushing syndrome results in an excessive amount of adrenocorticotropic hormone, which stimulates the secretion of glucocorticoids, mineralocorticoids, and androgenic steroids from the adrenal cortex. In the ortisol, fungal infections ofthe skin, nails, and oral mucosa, such as onychomycosis and tinea versicolor, are common and skin wounds h Option2: Addison dis Option3: Other symptoms of Cushing syndrome inc Option: Other symptoms of Cushing syndrome include fatigue and weakness (not \n of adrenocortical hormones, usually results in increased pigmentation of the 2, which isa deficiency in xcitability and nervousness [Page reference: 902] Course Topic APN Ki oblems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | \docrine and Metaboli in: Assess | Cognitive Level: Application [Applying] 1g Dom owledge Area(s): Health Assessment, Pathophysiology | Test  Question 37. Joy has goul. In leaching her about her disease, which food do you tell her is allowsed! in the diet? 1. Asparagus. 2. Beans. ¥® 3,Broccoli 4, Mushrooms. Rationales ‘Asparagus is high in purine, leans are hig in purine, Toods highin purine should be avoided by clients with gout. Broccoli is not high in purine. foods high in purine incluce all meats and seafood, meat extracts and agravies, yeast end yeast extracts, beans, peas, lentils, cetmeal, spinach, asoaragus, cauliflower, and mushrooms. Wine ard alcohol in excessive amounts impair the ability ofthe kidneys to excrete uric ccd and should be used in maderat’on, Option’: Mushrcoms areFigh im punne. [Page reference: ¥52] Course Topits Endouine and Velabolic Problers | Area of Practices); Adul-Geron.ology Primety Care; Fa APN Knowledge Area(s): Health @romoton and Fatient Education | Testing Domain: Plan | Cognitive Level: Aoplcation [Applying] ly Prective Question 38. Tamika, who has diabetes, states that she heard fiber is especially good to include in her diet. How do you respond? 1. “Fiberis important in all diets. 2. “Too much fiber interferes with insulin, so include only a moderate amount in your diet. V® 3."Fiber, especially soluble fiber, helps improve carbohydrate metabolism, so it is more important in the diet of persons with diabetes: 4. “You get just the amount of fiber you need with a normal diet. Rationales Option 1: While fiber is important in all diets, this answer does not address why fiber is especially good to include in the det ofa patient with diabetes. Option2: A especially soluble fiber, helps improv gh in fb ‘bohydrate metabolism Option: Fiber is importantin the dietary manager ipoprotein cho nent of diabetes. diet high in fiber, esp fiber, helps improve carbohydrate met total cholesterol and low-d bles a rol. Soluble foundin d zucchini, cauliflower, broccoli Option 4: It should not be assumed that individuals get enough fiber d their diet beca [Page reference: 927] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | lan | Cogn APN Knowledge Area Health Promotion and Patient Education, Pathophysiology | Test  Question 39. Mark has type 1 diabetes and has mild hyperglycemia. What effect does physical activity (exercise) have on his blood glucose level? 1. It may cause it to vary a little V® 2 ltmay decrease it. 3. It may elevate it 4. It may fluctuate greatly either way. Rationales Option 1: For individuals withou as marathon running, Option2: Clients with insulin-dependent diabetes mellitus (IDDM), type 1 diabetes—who have mil with marked hyperglycemia may exp their level is too high (greate nd refrain from exercising sia may experience a rise in their blood glucose Option3: Clients with marked hyperg! mia, his blood gluc Option 4: Since Mark has mild hyperg! 3€ level may drop during phy: [Page reference: 919] el generally varies little during physical activity unless the activity is intense and of very long duration, st yperglycemia ma han 300 mg/dl). activity Oo 8 perience a drop in their blood glucose leve level. Clients with IDDM should check their blood Course Topic: Endocrine and Metabolic Problems | Area of Practices): Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area(s): Pathophysiology | Test pplication [Applying] 1g Domain: Assess | Cognitive Level: Question 40. Morris has had ty 1. Order a 24-hour urinalysis. ¥® 2.Start him on an angiotensin-converting enzyme (ACE) inhibitor. 3. Stress the importance of strict blood sugar control. 4. Send him to a dietitian because he obviously has not be following his diet. Rationales Option: Ordering 2 24-hour urinalysis will nt give you any additional information Option2: Morris should be started on a ! inhibitor such as enalapril vasotec). ‘causes efferent inhibiting th sin system, whic leading cau onan angiot Option: You do want to stress tight glycemic cont Option: You may pos microalbuminuria, [Page reference: 920] Course Topic: Endocrine and Metaboli APN Knowledge Area( isease Management, Pharmacologic Therapy and Polypharmacy | Tes 1 diabetes for 10 years. Several recent urinalysis reports hat inhibitors offer renopr lation, and by improving glomerular perme Inhibitors also have this beneficial effect on clients with diabetes who are normotensive and even hypot Jonitoring for microalbuminuria is one method for id in-converting enzyme (ACE) inhibitor n bly send Morris toa dietitian, but he needs to be started on an angiotensin-converting enzyme (ACE) inhibitor now shown microalbuminuria. Your next step would be to: Oo 8 cts by reduc sure. They do traglomerularp uc lity, which causes a sive. Diabetic nephropathy isthe fying early nephropathy use he is already ready exhibiting oblems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | valuate | Cognitive Level: Analysis [Analyzing]  icator of Question 45. When you inspect the integumentary system of clients with endocrine disorders, a finding of coarse hair may be an 1. Addison disease 2. Diabetes mellitus. 3. Cushing syndrome. Hypothyroidism. Rationales Indicators of Addison dise se include hyperpigmentatior Option2: Indicator yates mellitus include hypopigmentation. jae over the abdomen, and bruisi Option: Indicators of Cushing syndrome include irs tism, hyperpigmentati crine disorders, a finding of coa or of hypothyroidism. Fine hair perpigmentation with both Addison disease and Cushing syndrome; hypo ith Cushing syndrome. Option 4: During inspection ofthe integumentary system of clients with e rehyrodism; hirsutism with yperthyro with hy P iae over the abdomen and bruising w diabetes melitu Jism, and hypothyroidism; and [Page reference: 891-892] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area(s): Health Assessment, Pathophysiology | Testing Domain: Assess | Cognitive Levels Comprehension Question 46. Sandra, age 28, has secondary obesity. Which of the following may have caused this? 1. Taking in more calories than are expen v® 2. Polycystic ovary syndrom 3. Antihypertensive medications Asedentary lifestyle. Rationales than are expended. This type of obesity re Option 1: Essential obesity isthe most prevalent type of obesity and is the result of taking in more calo interactions of genetic and environmental factors (cultural, metabolic, social, and psychological) polycystic ovary syndrome, hypothalamic disease, hypothyroidism, and insulinoma. Some i rare; possible causes include Cush Option2: Secondary ob: and phenothiazines. medications associated with weight gain include gl. tricyclic antidepr Option: Antihypertensive medications do not ead to obesity dary, obesity Option a: [Page reference: 87] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | Diagnose | Cognitive Level: Analysis [Analyzing] [APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making, Pathophysiology | Testing Dom:  Question 47. Which is the only curative treatment option for primary hyperparathyroidism (PHPT)? Il calcimimetic cinacalcet. 1. Ty 2. Hormone therapy. ¥ ® 3. Parathyroidectomy. 4. Bisphosphonates. Rationales Option iccinacales reats the underlying cause of PHPT by binding tot! type calcium-sensing receptor on the surface of th parathyroid glands, which increas extracellular calcium, which then reduces the excess secretion of parathyroid hormone (PTH). Its used forthe treatment of secondary hyperparathyroidism but not for PHPT, Option2: Hormone therapy is not used by itself. Low doses of en shown to reduce calcium, prevent ne loss, and improve bone der Option3: The only curative treatment n for PHPT isa parathyroidectomy.Itiss Option 4: Although the first generation of bisphosphon eatment ofthe skeletal manifestations of PHPT, the newer bisphosphonates, such as alendronate (Fosamax), increase b thyroid hormone (PTH) secretion and thus will not: cium. [Page reference: 879] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Primary Care; Family Practice | ‘APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy, Disease Management | Testing Domain: Pian | Cogn smprehension [Understanding] Question 48. A patient presents to your primary care office with abnormal lab results. On physical exam, you tap the patient's facial nerve around the zygomatic arch, just anterior to the earlobe. This describes which of the following tests and is associated with which of the following lab abnormalities? 1, Trousseau sign, hypocalcemia ¥® 2. Chvostek sign, hypocalcem 3. Chvostek sign, hypercalcemia, 4, Lachman test, hypercalcemia Rationales Option 1: Trousseau sign is po fein hypocalcemia but s described as spasms of the hand and wrist following inflation of a blood pressure cuff in the arm. Option2: Thetest de meone with hypocalcemia and is called Chu bed in the question is positive in Option3: The test described in the question is consistent with Chvostek sign but is not consistent with hypercalcemia; itis consistent with hypocalcemia, Option 4: ALachman testis positive in resence of anterior cruciate ligament tears in the knee. [Page reference: 875] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area(s): Diagnostic Tests and Therapeutic Procedures | Testing Dom Level ication [Applying]  Question 49. Whal is |he mos! common cause of gynecomastia? V@ 1.Puberty. 2. Druguse. 3, Testicular failure. 4, Malnutrition. Rationales Puberty is the most common cause of gynecomastia; most of these cases are self-limiting. bruguse isa less commen cause of gynecemactia. Option’: Testicular falure sa less commen cause of gyrecomastia. Malnutrition is2 less common cause of gynecomastia [Page reference: R16] Course Topic: Crdocrine anc Metatolic roblems | Area of Practice(s Adult-Cerontology Acute Care: Adult-Cerontology Primary Cares Family Practice | APN Knowledge Area(s): Diegnostic Tests and Therapeutic Procedures | Testing Domain: Assess | Cognitive Level: Knowledge [Remembering] Question 50. Which of the following conditions is a common pathological cause of hirsutism? ¥® 1. Polycystic ovary syndrome. 2. Adklison disease. 3. Hyperthyroidism. 4. Alopect Rationales Option: _Ninezy percent of people with polycystic ovary syndreme have azsocictec hirsutism. Option: Alltlisnn disease s assorted! w crated with hairloss, not excessive hatr growth. option: Hyperthyroidism Option: Alopecia is the loss of hairon the bccy. [Page reference: 8771 Course Topic: Endocrine anc Vetatolic Problems | Area of Practica(s): Adul-Gerontology Acute Care; Adu-Gerontolegy Primary Cara; Family Practice | APN Knowledge Area(s): Diferential Diagnosis Clinical Decision-Vaking | lesting Domain: Assese | Cognitive Leval: Knowledge [ememoenng]  Question 55. A 35-year-old male presents to your office complaining of fatigue, weight loss, nausea, and abdominal pain. On physical exam, you notice he has orthostatic hypotension and hyperpigmented skin. You do a morning cortisol level, which is low. The plasma adrenocorticotropic hormone (ACTH) is elevated. How would you treat this patient? 1. Oral prednisone. ¥® 2. Hydrocortisone. 3. Androgen replacement. 4. Fludrocortisone. Rationales Option 1: Thisis reserved for patients that d n't respond well to hydrocortisone. Option2: Hydroc nes the treatmen choice for primary adrenal insufficiency (Addison dist Option 3: Thisis supplemental inthe treatment of primary adrenal insufficiency Option a: is reserved for patients with electrolyte disturbances associated with primary adrenal insufficien [Page reference: 907] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult- Gerontology Primary Care; Family Practice | [APN Knowledge Area(s): Disease Management | Testing Domain: Treatment | Cognitive Levet Analysis (Analyzing Question 56. Which of the following statements about diabetes mellitus is untrue? 1, Diabetes mellitus isthe most common etiology of renal failure in the United States. 2. Diabetes mellitus is the most common endocrine disorder in the United States. 3. Diabetes mellitus is characterized by impaired insulin secretion and insulin action. ¥® 4,Diabetes mellitus is curable. Rationales Option: This is true itis also the most common etiology of acquired blindness. Option2: This istrue; it affects over 30 milion people. Option: These ae the 2 characterizations that apply to diabetes melitus Option: Diabetes metus is manageable with ifestyle modifications and medications but isnot curable. {Page reference: 909] Course Topic: Endocrine and Metabolic Problems | Area of Practices): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice | [APN Knowledge Area(s): Disease Management | Te Level: Knowledge [Remembering]  Question 57. What is the primary pathological irregularity associated Y® A.Nonfunctio ig beta cells. 2. Insulin resistance. 3. Overproducing beta cells, Elevated free fatty acids in the plasma. Rationales Option 1: Beta cells in the pancreas secrete insulin, When they don’t work, your body can't Ic Option2: Thi commonly associated with Witus typ Option3: Thisisa beta cell reaction associated with hyperglycemi Option4: Thisisa product of hypergiyes mia, not the cause of diabetes mellitus type 1 [Page reference: 911] Course Topic: Endocrine and Metabolic Problems ‘APN Knowledge Area(s): Pathophysiology | Test Question 58. V hich of the followi ng would not cont ma diagnosis of diabe 1. Glycated hemoglobin (HbAsc) of 7.0. 2. Fasting glucose of 155. ¥® 3. Random glucose o Oral glucose tolerance test with a plasma glucose of 250. Rationales Option 1: An HbA Option2: A fasting lucose greater than 126 is diagnostic of diabetes. Option: Arandom cose greater than with associated symptoms such as weightloss, polyuria, and Optiona: Anoral gl glucose greater than 200 is d [Page reference: 913] Course Top Wdocrine and Metabolic Problems | Area of Practice(s): Adult APN Knowledge Area(s): Disease Management | Te ontology Acute Care; Adult-Gerontology Primary Care; ith diabetes mellitus type 1? olydipsia, is diagnostic of diabetes. in: Diagnose | Cognitive Level: Knowledge [Remembering] ly Practice |  Question 59. Which of the following is not a risk factor for diabetes mellitus type 2? 1. Body mass index (BM!) greater than 25. 2. History of gestational diabetes. V® 3. Caucasian race 4. History of polycystic ovary syndrome (PCOS) Rationales Option 1: Ml greater than 25 i a risk factor for diabetes mellitus type 2 Option2: Ahistory of gestational diabete: with the development of diabetes mel ater in life. Option3: Caucasians are less likely than African Americans, Asian Americans, Latin Americans, and Native Americans to des mellitus type2. Option a: nith PCOS are more likely to develop diabetes m [Page reference: 923] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; APN Knowledge Area(s): Disease Management | ive Level: Knowledge [Reme Question 60. Which of the following statements about metformin is untrue? 1. Metformin works by decreasing hepatic glucose production and increasing peripheral cell sensitivity to insulin, Metformin can cause lactic acidosis. tformin is typically used in conjunction with other diab 4, Metformin cannot be used in patients with signifi it renal impairment. Rationales Option 1: Thisis metformin’s mechanism of action. Option2: Metformin has a black box warning due to this side effect associated with its use Option: Metformin is first-line treatment for diabetes type 2 and can be used as monotherapy. Option 4: The glomerular fitration rate must be greater than 45 in order to use metformin, [Page reference: 928] Course Topic: Endocrine and Metabolic Problems | Area of Practice(s): Adul ontology Acute Care; Adult-Gerontology Primary Care; ly Practice | APN Knowledge Area(s): Pharmacologi jerapy and Polypharmacy | Testing Domai n | Cognit ive Level: Knowledge [Remembering]  Question 65. Which of the following patients would not be a candidate for outpatient treatment of influenza? 1. 62-year-old male with a history of myocardial infarction 5 years ago. V® 2.A2year-old female with a history of a congenital heart defect. 3. 72-year-old male without a past medical history. ‘A.15-year-old female with a history of recent outpatient knee st gery. Rationales Option 1: This patient has a history ofa heart attack but is 5 years out; this does nc necessitate an inpatient stay. Option2: Patients les: inpatient en 9 risk of complications from influenza and would be best treated in an vironment. Option3: This patient is elderly but healthy and can be followed closely as an outpatient Option: As ong as she s othe knee not make the patient a candi healthy, n for an inpatient sta [Page reference: 1200] Course Topic: Uigent Care Problems | Area of Practice( ontology Acute Care; Adult-Gerontology Primary Care; Family Practice [APN Knowledge Area(s): Disease Manage 19 | Cognitive Level: Analysis [Analyzing] Question 66. What lifestyle choice increases the risk of upper respiratory infection? V® A. Smoking. 2. Alcohol use. 3. Cocaine use. 4, Multiple sexual partners. Rationales Option 12 Smokingineases tne risk of upiee vespivalony infec tion Uption2: Alcohol use does not incrcse the risk of upper resoiratery intaction. Optio Druguse dees notincrease the risk of upper respiratory infection. Option’: Having multiple sexual partners does not ncraase the risk of upper respiratory infection. [Page reference: 1204 Course Topic: Urgent Care Problenss | Area uf Practive(s); Adull-Geronloloyy Sule Care; Adull-Gerontolugy Primety Cate; Fat APN Knowledge Area(s): Disease Management | Testing Domain: Assess | Cognitive Levels Analysis [Analyzing] iy Practice |  Question 67. A 65-year-old female presents to your urgent care center complaining of a cough. She has a past medical history of myocardial infarction, hypertension, hyperlipidemia, and diabetes. She states she had this cough last year and received a Z-Pak, and it made her feel better, so she is requesting one now. Her vital signs are as follows: pulse (P) 85, blood pressure (BP) 140/90, oxygen saturation 95% on room air, temper F. Upon further questioning, her cough has been going on for 3 weeks and is nonproductive. She also notes some shortness of breath, mostly with periods of ambulation. She denies chest pain. She notes that recently her feet and legs have become more swollen. You do not have access to an x-ray at your facility. What is the most concerning cause of the patient's cough that would be in your differential diagnosis? V® 4. Congestive heart failure 2. Pneumonia. 3. Bronchitis. 4, Deep vein thrombosis. Rationales Option: The patient has dyspnea on ‘ough, and no fever. This is likely not an infectious cough. She also has lower extremity edema. Option2: The patient has had a chronic non} ithout fever; th is unlikely pneumonia, Option: Dyspnea on exertion and lower extremity swell jptoms of bronchi thas. Option: while! heart fallure, There is no mention o erythema, al of which generally accompany deep vein thrombosis. most likely caused by alpable cords, calf pain, or ingin the lower ext [Page reference: 1201] Course Topic are; Family Prac nt Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Prin [APN Knowledge Area(s): Disease Management | Te Domain: Assess | Cognitive Level: Analysis [Analyzin Question 68. A 70-year-old man presents to your ur and nonproductive. He denies fevers, chills, and w on room air. His chest x-ray shows enlarged lung fi nt care clinic complaining of a cough. He states he has had the cough for 6 weeks. The cough is dry ight loss. The patient admits to a 50-year history of smoking 1 pack per day. His pulse oximetry is 93% Ids. What would you recommend as the next step in his car V® A. That he see his primary doctor to discuss a computed tomography (CT) scan of the chest. Oxygen through a nasal cannula until the cough stops. 3. An albuterol inhaler. Accourse of oral steroids. Rationales Option’: The patient has a greater than 40-pack:year history of smoking: his chronic cough is concerning for lung cancer. ACT scan should be recommended. Option2: This may help the patient ifhe is short of breath, but he is not complaining of this, and his oxygen saturation for a long-time smoker. Option: Thisis the treatment for asthma Option 4: ch as asthma exacerbation, [Page reference: 1201] Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Prac [APN Knowledge Area(s): Disease Managen Domain; ive Level: Analysis [Analyzing]  Question 69. A 5-year bilateral erythema of his conjunctivae and watery drainage. He complains of pruritus of both eyes. The patient also has clear drainage from his nose and a sore throat. On physical exam of his throat, you notice erythema of his tonsils but no exudates. What is the most likely cause of the patient's symptoms? 2. Rhi Mor Rationales Option 1: Option: Option 3: Option a: J male presents to your urgent care clinic with his mother. TI inovirus. ‘occus pneumoniae. raxella catarrhalis. is isthe most common cause of viral c nctivtis hi but mon cause of viral conjun isa common cause of viral not the most This is a bacterial cause of pneumonia This sa bacterial cause of many issues, including respiratory and sinus proble [Page reference: 1201] Course Topic APN Knowledge Area Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adul Don Pathophysiology | Te Diagnose | Cogr Question 70, Which of the following is not a risk factor tor the development ot sinusitis? 1. Asthma. 2. Smoking. 3. Deviated septum. V® 4. History of tonsil Rationales Option: Optio Asthma sa risk actor for sinusits. ‘Sinking is ask Fa: Fos sisi ption2: Having deviated septum is ansk ‘actor for sirusts. Option: Having 2 history ofa tonsillectomy does not increase the risk of sinusitis, [Page reference: 1202] Course Topic: Urgent Care Problems | Area ot Practice(s): Adult-Gerantolegy Acute Care; Adult-Gerontolagy Pr' the most common ive Level: Knowledge patient was sent home from school for use of viral conju Gerontology Primary Care; Family Practice | [Remembering] Cara; Family Practice | APN Knowledge Area(s): Uisease Management | testing Domain: Assess | Cognitive Level: Knowledge [Nemmembenng] je redness. He has  Question 75. A 20-year-old male presents to your urgent care center complaining of headaches for 2 weeks. The patient's severe and last 15 to 30 minutes. He has had 3 to 4 severe headaches in the last 2 w idaches are intermittent but eks. He denies a past medical history and has had no recent trauma. The patient’s physical exam shows right-sided rhinorrhea, conjunctivitis, and facial swelling. What is the likely cause of the patient’s symptoms? 1. Brain tumor. Cluster headaches. 4, Sinus infection. Rationales Option 1: The patient has no neurologic changes that would suggest a brain tumor Option2: The patient's symptoms are consistent with luster head: Option 3: Migraine headaches normally have triggers; there is no noted trigger for this patient’s headaches. Option 4: The patient has no fevers and has episodic complaints that are moré [Page reference: 1205] Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Prin ; Family Practice | ent | Tes [APN Knowledge Area(s): Disease Managen Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 76, Which of the following is not associated with panic disorder? 1L. Family history of mental health issues. 2. Female sex. ¥® 3.Smoking. 4. Hislory of molestation as a child Rationales Option: Atamily history ct mertal health issues increases the risk ot developing panic disorder. Option2: More women than men experience panic disorder Option: making does nat incraase the rsk of panic discrder, Option4: Ahistory of treumatic event increases the risk of developing panic disorder. [Page reference: 1205] Course topic: urgent Care Problems | area of Practice(s)! adult-Geron:ology Acute Care; Adult-Gerontology erimary Care; Faruly Practice | APN Knowledge area(s): Discase Management | Testing Domaln: sss255 | Cognitive Leval: <nowledge [Remembering]  Question 77. A patient presents to your primary care clinic with diarrhea. What about the diarrhea would be con 1. It presented 8 hours after eating rare fish. V® 2.Ithas lasted longer than 7 days. 3. The patient describes it as “rice water 4, itis bloody. Rationales Option 1: This timeline is typical with a foodborne illness and does not Option2: Diarrhea that lasts longer than 7 days is concerning for ap: Option3: Rice water stool is described when a patient has ac Option 4: This description would lead you to think of a bacterial cause. [Page reference: 1206] Course Topic Jigent Care Problems | Area of Practice(s): Ad APN Knowledge Area(s): Disease Management | Testing Don Question 78. A 50-year-old female diabetic patient presents to your urgent care center complaining of chest discomfort. Which of the following geal reflux rather than a cardiac etiology? symptoms would lead you to believe her c 1. Chest pain radiates to the jaw and left arm. 2. Chest pain is worse with walking. ¥® 3.Chest pain started hile eating spicy food Chest pain is associated with nau Rationales Option Cchest pain associated wit Option2: pain ated with exercise is concerning for angina, Option: Angina is typically not assoc d with eat Option 4: A female diabetic can experience chest pain a [Page reference: 1207] Course Topic: Urgent Care Problems | Area of Practice( [APN Knowledge Area(s): Disease Manage t | Testi lera infection Gerontology Acute Care in: Diagnose | Cognitive Level: Kno t pain is related to gastroesoph: fadiation tothe jaw or arm is typical of anginas reflux p be a parasitic infec jlt-Gerontology Prin ledge [Remembering] oclated with nausea, Females and diabetics often experience aty ): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice vel: Analysis [Analyze] ning for a parasitic infection? are; Family Practice |  Question 79. The ABCDEs of skin cancer can help you diagnose a cancerous skin lesion. Which of the following definitions does not accurately describe the corresponding letter of the acronym? 1, A= asymmetry. 2. B= boarder irregularity. 3.C=color D= diameter greater than 8 mm. Rationales Option 1: An asymmetric lesion is more concerning for cancer than a symmetric lesion Option2: _Amole with an irregular boarder is concerning for cancer. Option3: Multiple colors in a skin lesion or mole would be concerning for cancer Option 4: Adiameter greater than 6 mm would be [Page reference: 1207] Course Topic: Uigent Care Problems | Area of Practice( ontology Acute Care; Adul ontology Primary Care; Family Practice [APN Knowledge Area(s): Disease Manage Diagnose | Cog vel: Analysis [Analyze] Question 80. A patient presents to your primary care office for a blood pressure check. You have recently started them on an antihypertensive medication. However, on physical exam, the patient contin concerning for a h to have an elevat blood pressure. Which of the following symptoms would not be ypertensive crisis? 1. Chest pair Visual changes. ¥® 3.Tinnitus. Severe headache. Rationales Option 1: Chest pain associated with, levated blood pressure is concerning. Option2: visual changes are concerning for a hype Option3: Tinnitus is nonspecific for end org n damage associated with a hyp Option: Severe headache an iood pressure noid hemorrhage or impending hemorrk stroke, [Page reference: 1208] Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Prin ; Family Practice | ‘APN Knowledge Area(s): Disease Management | Te Domain: Diagnose | Cognitive Level: Analysis [Analyze  Question 85. A patient presents to your urgent care office complaining of lightheadedness, dizzin vehicle accident 7 days ago. Originally, these complaints were more severe, but they have slowly decr s, and problems concentrating following a motor ased in intensity. What is the patient's diagnosis? 1. Concussion. ¥® 2.Postconcussion syndrome. 3. Cerebral hemorrhage, 4, Malingering Rationales Option 1: This fered a concussion but is now experiencing symptoms c stent with postconcussion syndrome, which can last up to 6 months after a Option2: The ld refer the nt is exper neurologist to get a computed tomography (CT) scan of the head. ion syndrome. if they have not received one since the car acc Option3: There are no neurologic chang} est the patient is having a cerebral hemorthage Option 4: There 3f malingering in the patient's complaint, and ther isnothing to suggest: [Page reference: 1231] Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice | Domain; APN Knowledge Area Disease Management | Tes sess | Cognitive Levet: Analysis [Analyze Question 86. A patient presents to your urgent care center for evaluation following a motor vehicle accident. lethargic and has thin, accident? On physical exam, the patient seems nasal drainage. You also note bruising around the eyes and mastoid process. What injury did the patient sustain in the car ¥® 4, Basilar skull fracture. Epidural 3. Subdural hi ‘oncussion. Rationales Option1: The dai es and mastoid process is associated with basilar skull fracture, an from the patient's nose is cerebrospinal fluid. The bruising around t ergency condition. Option 2: A computed tomography (CT) scan would be need to diagr Option: Acon this conditior uted tomography (CT) scan would be needed ti Option: Concussions are not associated with cerebrospinal fluid leaks. [Page reference: 1232] Course Topic: Urg Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice | APN Knowledge Area(s): Disease Management | Te Domain: Diagnose | Cognitive Level: Analysis [Analyze  Question 87. When a ali is diagnosed with an epiciermal hemalorna, which artery is ruptured in the brain? V® 4. Middle meningeal artery. 2. Temporal artery. 3. Basilarartery. 4, Vertebral artery. Rationales The middle meningeal artery is ruptured, causing an epidural hematoma. | he temporal artery s psthologtc in the secting of zemporal artentis. The basilar artery is not associated with ar epidural hematoma. Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Geron:ology Acute Care: Adult-Gerontology Primery Care: "amily Practice | APN Knowledge Area(s): Disease Management | Testing Domain: Diagnose | Cognitive Level Knowledge [Remembering] he head following a minor head trauma? Question 88. Which of the following patients needs a computed tomography (CT) scan o! Y® LApatier king Coumadin. 2. Achild under th age of 5. 3. A patient complaining of a headache. ‘A patient with nausea following a head injury. Rationales Option 1: Aspirin therapy alone does not necessitate a CT scan, but us vix of Coumadin does, Option2: CT scan ary to limit radiation expos id be avoided, nd clear neure y in children, unless absolutely n mental status, ction. Option3: _Aheadache aloneis not sufficient to warrant a CT scan following a minor head injur Option 4: Nausea alone isnot sufficient to warrant a CT scan following a minor head injury [Page reference: 1235] blems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice Course Topic: Urgent Care Pr t | Testi ssess | Cognitive Level: Kn [APN Knowledge Area(s): Disease Manage [Remembering]  Question 89. A 25-year-old construction worker con -omplaint is bilateral heel pain. The patient's x-rays confirm bilateral calcaneal the body should you x-ray? into the emergency department after a third-story fall at his construction site. The patient’s main Lf ractures. Based on the patient’s mechanism of injury, what other part of V® A. Lumbar spine. Bilateral shoulders. ibs. Bilateral wrists Rationales be concerned about possible fracture ofthe lumbar spine and hips, The force from the fall can move through the byt Option 1: Following a fall and calcaneal fracture, you need t body and cause other fra vin these ain in both heels. wtmay not complain of eas due to being distract Option2: shoulder arly associated with calcanealfract Option 3: Rib fractures are not necessarily associated with calcaneal fractures. Option a: Wrist fracture ated with [Page reference: 1237] Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice | Disease Management | Testing Domain: APN Knowledge Area sess | Cognitive Level: Analysis [Analyze Question 90, Following a sprain/strain injury, the PRICE acronym is helptul in treating a patient’s symptoms. Which of the following dees not correspond to the PRICL acronym? A. Rest. 2. lee. V® 3. Crutches. 4. Elevation. Rationales Option: Resting the injured aree will make the pain better ard aid in healing. Option 2: Icing the inured ar2a for chon periadsaf me helns decrease swelling and pan. Option2: While the use of crutches can halp with a lower extremity injury, the Cin this acronym stands tor compressi Option4: Elevating the injured area will help decrease swelling, [Page reference: 1239] Course Topic: Urgent Care Problems | Area ot Practice(s): Mdult Gerontology /cute Cares Adult Gerontology Primary Cares Family Practice | reat | Cognitive Level: Knowledge [Remembering] ABN Knowledge Area(s): Disease Vanagemant | Testing Domai  Question 95. A patient presents lo {he emerge arterial blood gas? V® 1. Metabolic acidosis. 2, Metabolic alkalosis, 3. A normal blond gas. 4, Respiratory at Rationales Option: option: Option: Option 0sis. Aspit ise salieylale, or salicylic acid; you would see nmetabulc avivsis, Aspirin is 2 salicylate, or salicylic acids you would see mstabolicacicosis. Aspirin is salicylate, or salicylic acid: you would see metabolic acicosis. Aspleta Is 2 salleylate, or salieylle actds you would see metabolic acicosis. [Page reference: 1249] Course Topic: Urgent Care Problems | Area of Practice(s); Acult-Ge-ontology Acute Care; Adult Gerontology Primary Care; Family Practice APN Knowledge Area(s): Pathophysiology | Testing Domai Diagnose | Cogni Question 96. What bacterium causes Rocky Mountain spotted fever? VO 1. Rickettsia rickettsii 2. Borrelia burgdorteri 3. Oriensia tsutsugamushi. 4, Contreroides cxilicauda, Rationales Option: “This she fie teri val cotises Richy Mavala jae fever it trast ay ele licks. Thi bacterium causes Lyme diccate and is tranemitted by deer teks. This bacterium can ceuse scrub typhus and is transmitted by chiggers. Iie s a specias of scorpion; itis not a bacterium. [Page reference: 1255] Course Topic: Urgent Care Problenss | Area uf Practive(s); Adull-Geronloloyy Sule Care; Adull-Gerontolugy Primety Cate; Fat APN Knowledge Area(s): Disease Management | Testing Domain: Assess | Cognitive Level: Knowledge [Remembering] wey department. You are concemed they have Laken Loo many aspirin, Whal would you expect lo see on an Levelt Analysis [Analyzel  Question 97. A patient presents to the emergency department by ambulance directly from football practice. The patient is tachycardic tachypneic, and hypotensive. Their skin is hot and dry, and their core body temperature is 104°F. What is this patient's diagnosis? V® A.Heat stroke, 3. Heat syncope. Heat cramps. Rationales Option 1: This patient has a core body temperature of 104°F; this is the diagnostic criterion that diff lates heat stroke from heat exhaustion, Option2: In heat exhaustion you would expect the patient to have a lower temperature and be: smpensating more ‘ough sweating and hypertension Option3: This refers toa syncopal event due to heat. Option 4: Thisre joclated with heat or dehydration. [Page reference: 1264] Course Topic: Uigent Care Problems | Area of Practice( ontology Acute Care; Adu ontology Primary Care; Family Practice [APN Knowledge Area(s): Disease Manage sess | Cognitive Level: Analysis [Analyze] Question 88. Following a diagnosis of heat stroke, the goal is to decrease the patient's temperature to what number in the first hour? 1.108F ve 2.102 3. 100°F 4.99°F, Rationales ‘lhe polis to reduce the patents leenperatione te 102°F wil ovate. The goal i to reduce the patient's temperature te 102° within the frst hour ot care, Ifyou decrease the temperature below 101" + you risk hypothermia, Option’: Ifyou decrease the ta mparature below 1UI*r, you riskehypotnarmia. [Page reference: 126/] Course Topic: Urgent Care Problenss | Area uf Practive(s): Adull-Geronloloyy Sule Care; Adull-Geronlolugy Primiety Cates F iy Practice | APN Knowledge Area(s): Disease Management | Testing Domain: Assess | Cognitive Level: Knowledge [Remembering]  Question 99. Hypotheriniais defined asa core holy temperature less than? 1.96, VO DOF, 3.93°F. A.0'F, Rationales ypothermia's defined as a core bacy temperature less than! ypothermuais det ned ze a core body temperature lessthan ts". Liypothermiais def ned as 2 core bocy temperature less than & Hypothermia\s det ned 2s a core hacy temperature less than o5°F Course Topic: Urgent Care Problems | Area of Practice(s): Adult-Geron:ology Acute Care: Adult-Gerontology Primery Care: "amily Practice | APN Knowledge Area(s): Disease Management | Testing Domain: Assess | Cognitive Levels Knowledge [Remembering] Question 100. As a general rule, when treating hypothermia, at what rate do you want to warm the patient’s temperature? v@ 11-2'Canhour 2.0-1°C an bi 3.0.5°Can hour. 4.2-3°C an hour. Rationales Option: Goncrally, ycu want to warm a hypothermic patient's kody temperature 1 2°C an hour. Option2: Generally, you wan! lnwarn a hypothermic palienlsbady Lemperaluve 17°C an hou Option: Generally, ycu want to warm a hypothermic patient's kody temperature 1-2°C an hour. Option: Generally, ycu want to warm a hypothermic patient's body temperature 1-2°C en hour. [Page reference: 1269] Course Topic: Urgent Care Problems | Area ot Practice(s): Adult-Gevor logy Acute Care; Adult-Gerontology Primary Cares Family Practice | APN Knowledge Area(s): Disease Management | testing Domain: Assess | Cognitive Level: <nowledge [kemembering]