Module 2 Canvas Practice Questions

Question 1

Which of the following statements about the use of the bell on the stethoscope is accurate?
a. The bell is best used to listen for high-pitched sounds
b. The bell is best used to listen for low-pitched sounds
c. The bell should be pressed firmly against the chest wall.
d. The bell is best used with a tight seal around the edges

Answer 1

b. The bell is best used to listen for low-pitched sounds

Question 2

When documenting a family’s history of cardiac disease, it is most important to document
a. The number of years the family member had the condition
b. The age of onset
c. The type of treatment the family member received
d. How the disease was manifested

Answer 2

b. The age of onset

Reason: Age makes a difference in assessing cardiac risk factors. Whether a patient’s father had an MI at 45 or 95 will determine how the practitioner assesses risk factors.

Question 3

A college student presents with a sore throat, fever, and fatigue for several days. Exudates are noted on her enlarged tonsils. A careful lymphatic examination is performed and scattered small mobile lymph nodes are noted just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this?

Answer 3

Posterior Cervical

Reason: Likely mono

Question 4

One of the most important features to assess when checking any cranial nerve includes which of the following?
a. Strength
b. Symmetry
c. Mobility
d. Involuntary movements

Answer 4

b. Symmetry

Question 5

Which of the following questions will give you the MOST specific and precise information from which to continue your history for the chief complaint of “knee pain”?
a. What is your pain on a scale from 1-10?
b. Does it hurt more when you walk or kneel?
c. Will you point to where it hurts?
d. Is it swollen?

Answer 5

c. Will you point to where it hurts?

Question 6

During the physical exam, the clinician performs deep palpation beneath the right costal margin. The patient winces in pain and is unable to take a breath. This is known as ______ sign.

Answer 6

Murphy’s

Reason: This is descriptive of a positive Murphy’s sign which is associated with cholecystitis.

Question 7

The best assessment for pallor, regardless of a patient’s own skin color, can be found by looking at which of the following?
a. Palm and palmar crease
b. Conjunctival rim
c. Nailbeds
d. Tongue

Answer 7

b. Conjunctival rim

Question 8

Most persons with duodenal ulcer will test positive for
a. Heliobacter pylori.
b. Escherichia coli.
c. Streptococcus pyogenes.
d. Staphyloccus aureus.

Answer 8

a. Heliobacter pylori.

Question 9

The clinician is performing a cardiac examination on a patient with shortness of breath and palpitations. The clinician listens to the heart with the patient sitting upright, then changes to a supine position, and finally has her turn onto her left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?
a. Aortic - listening with the diaphragm of the stethoscope
b. Pulmonic - listening with the bell of the stethoscope
c. Mitral - listening with the bell of the stethoscope
d. Mitral - listening with the diaphragm of the stethoscope

Answer 9

c. Mitral - listening with the bell of the stethoscope

Question 10

The APRN is reading laboratory results for a patient who has jaundice and finds that the Hepatitis B surface antigen test is positive. This means that the patient has
a. developed antibodies for hepatitis B.
b. cirrhosis.
c. acute or carrier (active chronic) hepatitis B.
d. been immunized for hepatitis B.

Answer 10

c. acute or carrier (active chronic) hepatitis B.

Question 11

Checking for skin turgor loses its specificity in which of the following individuals?
a. Pregnancy
b. Elderly
c. Children
d. All of the above

Answer 11

b. Elderly

Question 12

A 25-year-old comes to the clinic for evaluation of fatigue. On examination a murmur is heard only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?

Answer 12

Mitral

Question 13

What determines whether an examination is focused or comprehensive?

Answer 13

Reason for the visit and extent of the illness

Reason: The reason for the visit and extent of the illness will determine which approach is used. If a patient presents for a specific problem, for example, red, runny eyes, the healthcare practitioner would perform a focused exam. New patients and those having routine physicals would have a more comprehensive exam.

Question 14

What change in a vein supports the development of varicose veins?
a. damage to the valves
b. decrease in osmotic pressure
c. damage to the venous endothelium
d. increase in hydrostatic pressure

Answer 14

a. damage to the valves

Question 15

Which of the following is true of a grade 4-intensity murmur?
a. It is moderately loud.
b. It can be heard with the stethoscope off the chest.
c. It can be heard with the stethoscope partially off the chest.
d. It is associated with a “thrill.”

Answer 15

d. It is associated with a “thrill.”

Question 16

Rebound tenderness is an exam technique to assess for _________________ .
a. peritoneal inflammation
b. Abdominal distention
c. ascites
d. abdominal masses

Answer 16

a. peritoneal inflammation

See readings for Appendicitis also, p.457 Bate’s Physical Assessment

Question 17

Which one of the following is the most reassuring that systemic disease does NOT exist in the patient with back pain?
a. Age over 50
b. Pain at night
c. Pain lasting more than 1 month or not responding to therapy
d. Pain that is bilateral

Answer 17

d. Pain that is bilateral

Systemic complaints. Constitutional symptoms—such as fever, chills, night sweats, malaise, or undesired weight loss—suggest infection or malignancy. These symptoms are of even greater concern if the patient has additional risk factors for infection, such as diabetes, recent bacterial infection, immunocompromised status, or injection drug use. Back pain in an injection drug user is generally assumed to be vertebral osteomyelitis or spinal epidural abscess until these conditions are ruled out with imaging studies. A recent genitourinary or GI procedure may predispose the patient to infection secondary to bacteremia.

Atypical pain features. Benign low back pain is typically described as a dull, aching pain that generally worsens with movement but improves when the patient is lying still. Red flags for tumor and infection include pain that occurs at night, awakens the patient from sleep, or is unrelenting despite appropriate analgesia and rest. The pain of a herniated disc may be worsened by coughing, sitting, or the Valsalva maneuver and is relieved by lying supine.5-7 Spinal stenosis is associated with bilateral sciatic pain that is worsened by activities such as walking, prolonged standing, and back extension and is relieved by rest and forward flexion. In my experience, night pain and unrelenting pain are the most worrisome symptoms that are commonly ignored in the evaluation of patients with back pain.

https://www.consultant360.com/article/acute-low-back-pain-recognizing-%25E2%2580%259Cred-flags%25E2%2580%259D-workup

Question 18

Obtaining an accurate blood pressure (BP) measurement requires
a. distracting the patient with conversation.
b. positioning the patient in a left lateral position.
c. the arm to be at heart level
d. using the lowest reading obtained.

Answer 18

c. the arm to be at heart level

Question 19

Skin turgor is best examined/assessed over which of the following anatomical areas?
a. Eyelids
b. Subclavicular area
c. Forearms
d. Axilla

Answer 19

b. Subclavicular area

Question 20

A 32-year-old woman presents for evaluation of low back pain. She notes a sudden onset of pain after lifting heavy boxes. She reports numbness and tingling in the left leg. What physical examination technique assesses for a herniated disc?
a. Leg-length test
b. Straight-leg raise
c. Kernigs sign
d. Range of Motion

Answer 20

b. Straight-leg raise

Question 21

On ophthalmascopic exam, the swelling and and bulging of the optic disk seen by the clinician in the patient with papilledema is the result of which of the following?
a. increased intracranial pressure pushing on the macula
b. Increased intracranial pressure with pushing on the optic nerve
c. ischemic changes of the macula
d. infarct of the head of the optic nerve head

Answer 21

b. Increased intracranial pressure with pushing on the optic nerve

Question 22

Which lymph nodes are just behind the sternocleidomastoid muscles bilaterally?

Answer 22

Posterior Cervical

Question 23

Excessive red cell lysis can be detected by measuring the serum

Answer 23

bilirubin.

Question 24

Which is the best position to accentuate an aortic regurgitation murmur, if it is present?

Answer 24

Upright, but leaning forward

Question 25

An accurate assessment of the PMI (point of maximal impulse) requires the clinician determine which of the following?
a. the set distance from the midsternal line
b. the nipple line
c. the halfway point between the acromioclavicular and sternoclavicular joints
d. the diameter of the apical pulse

Answer 25

c. the halfway point between the acromioclavicular and sternoclavicular joints

Question 26

T/F: Older adults have impaired wound healing because of decreased blood supply and depressed immune system.

Answer 26

True

Question 27

When teaching smokers about using nicotine gum to aid in smoking cessation, the clinician should tell them to
a. chew up to 6 pieces daily to help prevent nicotine withdrawal.
b. chew the gum like regular gum.
c. chew until it tingles and hold intermittently (“park it”) for 30 minutes.
d. drink a cup of coffee before chewing the gum to assist in nicotine absorption.

Answer 27

c. chew until it tingles and hold intermittently (“park it”) for 30 minutes.

Reason: pg 135 Nicotine gum directions are essential for avoiding GI upset and effective use: chew until tingling or peppery, then place between cheek and gum for 30 minutes.

Question 28

A woman has smoked a pack a day for 27 years. She tells her clinician, “I know I should stop smoking but I do not know how.” This woman is at which stage of change?

Answer 28

contemplation

Reason: The patient has come to the realization that she needs to stop smoking. She is receptive to teaching now (contemplation stage)

Question 29

A pre-diabetic female is very determined to not become diabetic like her mother. She is 39 years old, takes no medications and has a BMI of 25. She asks for your advice regarding exercise, you tell her:
a. Exercise at least 150 minutes per week and include resistance exercise in your routine.
b. Begin with isometric exercise and stretching, then gradually work up to walking 1-3 miles per day.
c. Begin exercising 60 minutes per day and gradually increase to at least 280 minutes per week of moderate intensity aerobic activity.
d. Exercise alone will not prevent diabetes.

Answer 29

a. Exercise at least 150 minutes per week and include resistance exercise in your routine.

Question 30

Which of the following medical conditions is most highly associated with intimate partner violence?
a. frequent colds.
b. confusion.
c. asthma.
d. depression.

Answer 30

d. depression.

Reason: Depression is one of the conditions that is particularly associated with intimate partner violence.

Question 31

Which of the following education points is true and the most likely to help an adolescent stop smoking?
a. “Nicotine is a stimulant”
b. “Men who smoke are more prone to erectile dysfunction”
c. “Nicotine will cause yellow teeth, smelly breath, and early skin wrinkling”
d. “Smoking will increase intelligence and help with your school performance”

Answer 31

c. “Nicotine will cause yellow teeth, smelly breath, and early skin wrinkling”

Reason: Adolescents think they are “bullet proof” and are not so concerned about health. They are, however, very concerned about how they look.

Question 32

Adverse effects of nicotine replacement therapies include:
a. Hypotension
b. Increased heart rate
c. Increased intraocular pressure

Answer 32

b. Increased heart rate

Question 33

A 25 year-old woman hopes to get pregnant in the next few months. Which statement about tobacco use is most likely to result in this woman successfully stopping smoking?
a. “Smoking while pregnant increases the risk for fetal heart anomalies.”
b. “Smoking will increase intelligence and help with work performance.”
c. “Nicotine inhibits the libido and orgasm.”
d. “Nicotine is a stimulant.”

Answer 33

a. “Smoking while pregnant increases the risk for fetal heart anomalies.”

Question 34

To achieve the ideal level of vitamin D (40-60 ng/mL), the nurse practitioner recommends that most individuals consume how much vitamin D daily?
a. 1,500 - 2,000 IU
b. 500 - 800 IU
c. 1,000 - 1,200 IU
d. 2,500 - 3,000 IU

Answer 34

a. 1,500 - 2,000 IU

Reason: Varney p 237.

Question 35

The normal microbiome benefits the host by
a. producing mucous.
b. producting exotoxins that kill non-normal flora.
c. inhibiting growth of non-normal flora.
d. producing endotoxins that prevent pathogens from growing

Answer 35

c. inhibiting growth of non-normal flora.

Question 36

Layne is a 29-year-old G2 P1001 at 6 weeks’ gestation who is seeing a midwife for a pregnancy intake visit. This visit includes an interview to assess diet and nutrition, substance use, physical activity, and safety, along with individualized counseling on these topics. This is an unplanned, wanted pregnancy and, upon questioning, Layne endorses smoking about one-half pack of cigarettes per day. She says, “I quit while I was pregnant with my first, but started again when she was 6 months old. It’s so stupid. I know it’s bad for all of us, and I feel really guilty but it’s hard. It just feels like such a stress reliever.” When asked if she gets any regular exercise, Layne tells the midwife that she enjoys taking her 18-month-old daughter, who weighs 24 pounds, hiking in the woods near their home and usually puts her in a carrier on her back. They do this about three times a week. She would like to continue but her mother thinks it is too strenuous. She asks if this will be harmful.

What is the best answer to Layne’s question about hiking with her daughter?

a. “A total of 2½ hours a week of moderate exercise is recommended in pregnancy. In general, whatever you’re used to doing when you’re not pregnant is still okay in pregnancy.”
b. “Lifting more than 20 pounds on a regular basis has been linked to preterm contractions. It would be best to let your daughter walk beside you or put her in a wagon.”
c. “Carrying extra weight for long periods can cause lower back pain and pelvic misalignment. I would switch to something that places less stress on your bones like swimming or a stationary bike.”
d. “Exercise is okay as long as you don’t raise your heart rate over 140 beats per minute. Be sure to stop and take your pulse if you feel like you’re exerting yourself.”

Answer 36

“A total of 2½ hours a week of moderate exercise is recommended in pregnancy. In general, whatever you’re used to doing when you’re not pregnant is still okay in pregnancy.”

Reason: Varney Ch 5. The United States Preventive Services Task Force recommends that pregnant women engage in 150 minutes of moderate-intensity aerobic activity per week. Healthy women who participate in vigorous-intensity aerobic activity prior to pregnancy may continue to do so during and after pregnancy, as long as they stay healthy and discuss their exercise activity with their healthcare provider

Question 37

A 25-year-old who receives live MMR vaccine will develop which type of immunity?

Answer 37

Active

Question 38

A 40-year-old house painter who has smoked 2 packs of cigarettes per day since she was 15 years old comes to clinic complaining of chronic cough. When the CNM discusses her smoking behavior, she states, “I know I need to stop smoking, but I’m under too much stress right now and I don’t want to get fat.” The client is at which stage of change?

Answer 38

Contemplative stage

Reason: In the contemplative stage patients will acknowledge the need to change behaviors/awareness of the problem.

Question 39

The correct recommendation concerning the rubella vaccine is:
a. Wait to get pregnant for one month after receiving the rubella vaccine.
b. The rubella vaccine is safe and recommended in the second and third trimesters.
c. Women of childbearing age should be vaccinated regardless of immunity.
d. To attain complete immunity, 3 vaccines in series are often needed.

Answer 39

a. Wait to get pregnant for one month after receiving the rubella vaccine.

Question 40

Which immunization schedule combination would be UNACCEPTABLE?
a. Live vaccine and killed vaccine same day.
b. Live vaccine followed by live vaccine the next day.
c. Killed vaccine followed by killed vaccine next day.

Answer 40

b. Live vaccine followed by live vaccine the next day.

Reason: If 2 live vaccines are not given simultaneously, the provider must wait at least 4 weeks before administering the second live vaccine. Inactivated vaccines can be given at any time before or after one another and live vaccines.

Question 41

Which of the following antibodies is matched with its appropriate role?
Correct Answer
a. IgM / first to challenge an antigen
b. IgG / largest of the immunoglobulins
c. IgE / found in gastric secretions
d. IgA / allergic reactions

Answer 41

a. IgM / first to challenge an antigen

Question 42

During an IgE-mediated hypersensitivity reactions, what causes bronchospasm?
a. smooth muscle contraction caused by histamine bound to H2 receptors
b. smooth muscle contraction caused by histamine bound to H1 receptors
c. bronchial edema caused by chemotactic factor
d. bronchial edema caused by binding of the cytotropic antibody

Answer 42

b. smooth muscle contraction caused by histamine bound to H1 receptors

Question 43

Which type of immunity is produced by an individual after either natural exposure to an antigen or after immunization?
a. passive-acquired immunity
b. passive-innate immunity
c. active-innate immunity
d. active-acquired immunity

Answer 43

d. active-acquired immunity

Question 44

Dramatic hypotension sometimes accompanies type 1 hypersensitivity reactions because
a. anaphylaxis results in large volume losses due to sweating.
b. massive histamine release from mast cells leads to vasodilation.
c. toxins released into the blood interfere with cardiac function.
d. hypoxia due to bronchoconstriction impairs cardiac function.

Answer 44

b. massive histamine release from mast cells leads to vasodilation.

Question 45

During type 1 hypersensitivity reactions, histamine released from degranulated mast cells causes:
a. gastric acid stimulation
b. elevated serum glucose
c. enhanced sebum production
d. bronchodilation

Answer 45

a. gastric acid stimulation

Question 46

It is true that some older adults have a decrease in pain
a. threshold.
b. tolerance.
c. transmission.
d. modulation.

Answer 46

b. tolerance.

Question 47

What causes the edema that occurs during an inflammatory response?
a. vasodilation of blood vessels
b. endothelial cell contraction
c. increased capillary permeability

Answer 47

c. increased capillary permeability

Question 48

A 19 year old male presents with sudden edema of his face, a sensation of throat tightness, and shortness of breath after a bee sting. His B/P is 78/44; pulse 102, respirations 24. This man is experiencing a/an
a. type 4 hypersensitivity.
b. complement cascade that will lead to respiratory arrest.
c. IgE mediated response to the bee sting.
d. IgA mediated response to the bee sting.

Answer 48

c. IgE mediated response to the bee sting.

Question 49

Which primary characteristic is unique for the adaptive immune response? The adaptive immune response is
a. is innate rather than acquired.
b. always short term.
c. similar each time it is activated.
d. specific to the antigen that initiates it.

Answer 49

d. specific to the antigen that initiates it.

Question 50

A patient who is given an intradermal injection of an antigen develops redness and induration at the site in 72 hours. This is an example of which of the following?
a. IgE mediated hypersensitivity
b. Tissue specific hypersensitivity
c. Immune complex mediated hypersensitivity
d. Cell mediated hypersensitivity

Answer 50

a. IgE mediated hypersensitivity

Question 51

What process causes heat and redness to occur during the inflammatory process?
a. endothelial cell contraction
b. platelet aggregation
c. vasodilation of blood vessels
d. decreased capillary permeability

Answer 51

c. vasodilation of blood vessels

Question 52

The first step in producing a protective humoral or cellular immune response is antigen presentation, where the macrophages function to
a. present antigenic fragments on their cell surfaces
b. activate T helper lymphocytes
c. stimulate cytokine production
d. interact with major histocompatibility complexes

Answer 52

a. present antigenic fragments on their cell surfaces

Question 53

The predominant antibody detectable in a typical primary immune response is
a. IgG
b. IgE
c. IgA
d. IgM

Answer 53

d. IgM

Question 54

Which manifestation of inflammation is systemic?
a. Pain and edema
b. Formation of exudates
c. Redness and heat
d. Fever and leukocytosis

Answer 54

d. Fever and leukocytosis

Question 55

Hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulin?
a. IgG
b. IgE
c. IgA
d. IgM

Answer 55

b. IgE

Question 56

Which of the following is a function of B lymphocytes?
a. interleukin-2 production
b. stimulation of T cells
c. antibody synthesis
d. cell lysis

Answer 56

c. antibody synthesis

Question 57

One benefit of the inflammatory response is to
a. create immunity against subsequent tissue injury.
b. provide specific responses toward antigens.
c. lyse cell membranes of microorganisms.
d. prevent infection of injured tissue.

Answer 57

d. prevent infection of injured tissue.

Question 58

The effects of histamine release include
a. bronchodilation.
b. vasoconstiction.
c. increased vascular permeability.
d. pupillary constriction.

Answer 58

c. increased vascular permeability

Question 59

A primary effector cells of the type 1 hypersensitivity response are
a. mast cells.
b. cytotoxic T cells.
c. monocytes.
d. neutrophils.

Answer 59

a. mast cells.

Question 60

Which chemical mediators induce pain during an inflammatory response?
a. Tryptase
b. Leukotrienes
c. Prostaglandins
d. Phospholipase

Answer 60

c. Prostaglandins

Question 61

Antigen-presenting cells function to
a. stimulate cytokine production by macrophages.
b. phagocytose and degrade foreign antigens.
c. initiate the complement cascade by way of the alternative pathway.
d. display foreign antigen on their cell surfaces bound to MHC.

Answer 61

d. display foreign antigen on their cell surfaces bound to MHC.

Question 62

What do major histocompatibility antigens help the immune system do?
a. distinguish self from non-self
b. determine whether to mount a primary or secondary response
c. identify haptens
d. recognize different blood types

Answer 62

a. distinguish self from non-self

Question 63

The best prevention for swimmer’s ear (external otitis) is to use
a. cotton-tipped applicator to dry the ear canals after swimming
b. hair dryer on the highest setting to dry the ears
c. ear drops made from alcohol and vinegar in each ear after swimming

Answer 63

c. ear drops made from alcohol and vinegar in each ear after swimming

Question 64

A woman presents to the clinic reporting sudden and severe pain in her right eye. She was seen the day prior for a vision exam at which her eyes were dilated. On exam, the woman’s eye is red with a rainbow-like halo around the pupil and a cloudy cornea. The best management plan is
a. Urgent referral to an ophthalmologist.
b. Prescribe ciprofloxacin ophthalmic drops.
c. Administer a topical beta blocker for initial treatment.
d. Ophthalmologist consult in the next 1-2 weeks.

Answer 64

a. Urgent referral to an ophthalmologist.

Reason: Iritis, uveitis, keratitis manangement

Question 65

A client comes to the emergency room because of eye pain, pupillary constriction, marked photophobia, and severe redness around the iris. The APRN assigned to triage assesses her and sees that her right eye is red and has conjunctival hyperemia and pupil constriction. The APRN will

a. Make an appointment for the client to be seen by an ophthalmologist in two weeks
b. Recognize this as an ophthalmologic emergency
c. Send the client home with antihistamine eye drops
d. Examine the client’s eye with a slit lamp to better see the corneal surface

Answer 65

b. Recognize this as an ophthalmologic emergency

Reason: Eye pain and conjunctival injection indicate iritis or uveitis and require urgent ophthalmologist referral. Treatment.

Question 66

A client presents to the clinic complaining of a headache in the frontal sinus area, which is worst in the morning and nasal congestion for the past two days. The client states the pain is worse with bending over and she has noted some yellow nasal discharge. Her vital signs are: R 18, P 88, BP 124/78, T 100.8*F. Based on this data, which of the following physical examinations should the APRN perform?

a. All the provided answers are correct
b. Examine her mouth and teeth
c. Otic examination
d. Inspect face for assymetry
e. Assess for Kernig sign

Answer 66

a. All the provided answers are correct

Reason: Physical examination for accurate diagnosis of sinusitis should include all of the following: VS, Temp for fever, facial asymmetry and dark circles under the eyes and / or periorbital edema assessment, evaluation of mouth, teeth and pharynx, evaluate the nasal tract, including nasal patency, transillumination of the sinuses, palpation of the maxillary and frontal sinuses, complete otic exam, assessment for meningeal irritation [Kernig and Brudzinski signs].

Question 67

A 19-year-old client is returning to school after Spring break and dropped by the clinic today. She complains of fever, sore throat, and malaise. She denies sneezing, runny nose, cough or known allergies.

On examination, the APRN sees a fiery red, peritonsillar area and posterior pharynx with 2+ tonsils and creamy white exudates. Her neck has swollen, tender, and her anterior and posterior cervical nodes are palpable. There is petechiae noted on the palate. Further questioning indicates that headache, malaise and fatigue were all present before the onset of the sore throat.

Because of the client’s classic presentation, appropriate laboratory testing to confirm the diagnosis is

a. Rapid strep screen
b. Rapid Influenza Diagnostic test
c. Monospot

Answer 67

c. Monospot

Question 68

The first-line antibiotic therapy for an adult with no known drug allergies and suspected group A beta hemolytic streptococcal pharyngitis is
a. penicillin
b. cephalexin (Keflex)
c. doxycycline (Vibramycin)

Answer 68

a. penicillin

Question 69

A woman reports ear fullness and pain for 4 days. She is afebrile. There is tenderness on movement of the tragus and pinna and the auditory canal appears inflamed and swollen.

What is the diagnosis?

a. Otitis Externa
b. Otitis Media
c. Labyrinthitis
d. Cerumen impaction

Answer 69

a. Otitis Externa

Question 70

A woman reports a left-sided frontal headache that worsens when she bends forward. She also has nasal congestion, sore throat, and yellowish nasal drainage. Her symptoms began 14 days ago and have steadily worsened. She is otherwise healthy, has no allergies, and has not used antibiotics for the last 3 months.

Which is the best management plan?

a. amoxicillin/clavulanate (Augmentin)
b. levofloxacin (Levaquin)
c. pseudoephedrine (Sudafed)
d. cetirizine (Zyrtec)

Answer 70

a. amoxicillin/clavulanate (Augmentin)

Reason: Acute sinusitis - management

Question 71

Acute otitis media is diagnosed when there is
a. Fluid in the middle ear for at least 3 months
b. An erythematous, opaque tympanic membrane
c. Fluid in the middle ear and a tympanic membrane that is translucent

Answer 71

b. An erythematous, opaque tympanic membrane

Question 72

Which symptoms would help confirm a diagnosis of sinusitis?
a. Clear nasal congestion, post nasal drip, and sore throat.
b. Headache, sore throat, and poor appetite.
c. Facial or dental pain, green nasal discharge, and headache.
d. Fever, earache, and neck pain.

Answer 72

c. Facial or dental pain, green nasal discharge, and headache.

Question 73

A client calls your clinic after being seen by her ophthalmologist 24 hours earlier for a corneal abrasion. She had been sent home with antibiotic ointment and told that the eye should improve by 48 hours. She says she did not sleep last night and the pain is much worse. Your next step is:

a. Have her come into the office immediately for a complete eye exam.
b. Contact the ophthalmologist to see this client immediately
c. Tell her to come into the office after 24 hours if the symptoms do not get better.

Answer 73

b. Contact the ophthalmologist to see this client immediately

Reason: Any corneal abrasion not healed in 24 hours requires an urgent ophthalmology referral. Referral indicator.

Question 74

The best treatment for viral conjunctivitis is
a. antibiotic ophthalmic ointment
b. cool compresses
c. tobramycin (Tobrex) ophthalmic drops
d. warm compresses

Answer 74

b. cool compresses

Question 75

A 22-year-old client presents to the clinic with a sore throat. She reports having rhinitis, fatigue and thinks she may have had a fever yesterday. The sore throat got worse this morning. She also says that she had several sore throats as a child and was usually treated with an antibiotic. On exam you note watery and reddened eyes, erythema and swollen tonsils in the throat without exudate, and non-tender lymph nodes. Her temperature is normal. What is your diagnosis?

a. Viral pharyngitis
b. Bacterial pharyngitis
c. Peritonsillar abscess
d. Mononucleosis

Answer 75

a. Viral pharyngitis

Question 76

A client is having a nose bleed. The APRN would instruct her to do what?
a. Lie down and put an ice pack at the back of her neck.
b. Hold pressure on the anterior part of her nose and sit upright.
c. Tilt her head back and place an ice pack between her eyes.
d. Stand up, put cold scissors down the neck of her shirt, and hold her head back.

Answer 76

b. Hold pressure on the anterior part of her nose and sit upright.

Question 77

A 25 year old woman has itchy, watery eyes; an itchy, runny nose; and sneezes a lot. It is worse every year in May when the trees bloom. She is healthy the rest of the year, but she dreads late spring each year, as she is “miserable” when these symptoms occur. She denies any drainage, beyond watery discharge and also denies fever, headache or any other signs indicating infection.

What pharmacological treatment options should the clinician discuss with the woman?

a. First generation antihistamines, second generation antihistamines and intranasal steroids
b. Only second generation antihistamines, because they are first line with fewer side effects and once a day dosing.
c. Only intranasal steroids, because they controlled symptoms best in randomized controlled trials
d. Both first and second generation antihistamines as both can play a role in symptom relief.

Answer 77

a. First generation antihistamines, second generation antihistamines and intranasal steroids

Question 78

A woman presents to the clinic reporting a sore throat. She reports a temperature of 100.1 F and a cough. On examination, the woman’s throat is erythematous. There are no tonsillar exudates and no anterior cervical lymphadenopathy. What is the best next step?
a. Recommend warm salt water gargles.
b. Order a rapid strep screen.
c. Prescribe penicillin (PenVK).

Answer 78

a. Recommend warm salt water gargles.

Reason: Viral Pharyngitis

Question 79

A woman presents with a report of unilateral eye irritation, a gritty, burning sensation, and excessive tearing. She denies purulent drainage from her eyes. Her children have had colds and have been diagnosed with “pink eye.” The clinician knows that the best plan of care is.
a. Immediate initiation of ophthalmic steroid drops.
b. Referral today to an ophthalmologist.
c. Antibiotic ophthalmic drops as directed until symptoms resolve.
d. To apply cool compresses several times daily.

Answer 79

d. To apply cool compresses several times daily.

Reason: Up to Date 9/8/22

Viral vs. Bacterial conjunctivitis

Viral: Common presentations — Viral conjunctivitis is typically caused by adenovirus, with many serotypes implicated [12Links to an external site.]. The conjunctivitis may be part of a viral prodrome followed by adenopathy, fever, pharyngitis, and upper respiratory tract infection, or the eye infection may be the only manifestation of the disease. Usually there is profuse tearing rather than discharge. Viral conjunctivitis is a self-limited process.

Antibiotics: Need for examination prior to therapy — Providers are often pressured to prescribe antibiotics for conjunctivitis, even when there is nothing to suggest a bacterial process. no patient should be treated for conjunctivitis without an examination. In principle, only those diagnosed with bacterial conjunctivitis should receive antibiotics.

Steroids: No role for corticosteroid use — Ophthalmic corticosteroids (either alone or in combination steroid/antibiotic drops) are not effective and have no role in the management of acute conjunctivitis by primary care clinicians [19Links to an external site.]. Corticosteroids can cause sight-threatening complications (eg, corneal scarring, melting, and perforation) when used inappropriately. Chronic ophthalmic corticosteroid treatments can also cause cataract and glaucoma [20,21Links to an external site.].

Question 80

Instructions for clients experiencing nosebleeds should include:
a. Sit upright with head tilted forward and apply firm continuous pressure for at least 15 minutes to the anterior aspect of the affected nostril. Following a nosebleed, vigorous exercise, aspirin, spicy foods and tobacco should be avoided, as well as, nasal trauma, including nose picking.
b. Sit with head tilted back and apply firm continuous pressure to the base of the nose for at least 15 minutes. Go to the emergency room if bleeding does not resolve in 30 minutes. For 3 days after a nosebleed lubrication should be applied to the mucous membranes and home humidification should be provided to minimize future occurrences.
c. Sit with head between knees while applying firm continuous pressure for at least 15 minutes to the anterior aspect of the affected nostril. Following a nosebleed, vigorous exercise, aspirin, spicy foods and tobacco should be avoided, as well as, nasal trauma, including nose picking.
Sit upright with head tilted forward and apply firm continuous pressure to the anterior aspect of the affected nostril for at least 10 minutes. Any nosebleed that does not resolve in 30 minutes requires specialist consultation.

Answer 80

a. Sit upright with head tilted forward and apply firm continuous pressure for at least 15 minutes to the anterior aspect of the affected nostril. Following a nosebleed, vigorous exercise, aspirin, spicy foods and tobacco should be avoided, as well as, nasal trauma, including nose picking.

Question 81

What is the most accurate classification of the common forms of coronary artery disease and hypertension?
a. Primary disorders with an autosomal dominant pattern of inheritance
b. Sequential genetic disorders related to age, ethnicity, and gender
c. Complex disorders resulting from gene–environment interactions
d. Secondary disorders caused by lifestyle choices

Answer 81

c. Complex disorders resulting from gene–environment interactions

Question 82

When a heart valve fails to open to its normal orifice size, it is said to be
a. regurgitant.
b. stenotic.
c. sclerotic.
d. incompetent.

Answer 82

b. stenotic.

Question 83

Why is warfarin (Coumadin) considered to be a high-risk medication?
a. it increases the risk of DVT
b. it has a narrow therapeutic range
c. it has a very short half life

Answer 83

b. it has a narrow therapeutic range

Question 84

What is the genetic contribution to the development of the most common forms of atherosclerosis?
a. Genetic predisposition expressed after exposure to a viral trigger
b. Single gene mutation following autosomal dominant inheritance
c. Variation in a variety of genes each exerting a small effect
d. Disordered mitochondrial function reducing energy production

Answer 84

c. Variation in a variety of genes each exerting a small effect

Reason: Objective 2, Beery, Workman, & Eggert, p. 265

Question 85

RH, a 72 year old female, has worsening left sided heart failure and her cardiac output is starting to decline. The renin-angiotensin-aldosterone system (RAAS) is activated and causes:
a. increased perfusion of the lungs.
b. decreased contractility and afterload.
c. decreased peripheral vascular resistance and plasma volume.
d. increased afterload and preload.

Answer 85

d. increased afterload and preload.

Question 86

The American Heart Association and the American College of Cardiology recommend that women with uncomplicated mitral valve prolapse should
a. be prescribed amoxicillin 2 grams approximately 30-60 minutes prior to giving birth.
b. receive routine prophylaxis for dental procedures only.
c. not receive routine prophylaxis for dental or other procedures (including labor).

Answer 86

c. not receive routine prophylaxis for dental or other procedures (including labor).

Reason: Antibiotic prophylaxis is no longer indicated in patients with mitral valve prolapse for prevention of infective endocarditis. The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy. Limited use of prophylaxis will likely reduce the unwanted selection of antibiotic-resistant strains and their unintended consequences such as C. difficile-associated colitis.

Question 87

The pain of angina pectoris is most likely to occur when
a. The vagus nerve is stimulated
b. Myocardial stretch has exceeded normal limits
c. Cardiac output falls below normal
d. Myocardial oxygen supply has fallen below normal

Answer 87

d. Myocardial oxygen supply has fallen below normal

Question 88

Aortic regurgitation is associated with
a. shortened ventricular ejection phase.
b. diastolic murmur.
c. elevated left ventricular/aortic systolic pressure gradient.
d. elevated systemic diastolic blood pressure.

Answer 88

b. diastolic murmur.

Question 89

In which of the following patient scenarios would an angiotensin receptor blocker (ARB) be contraindicated?
a. Patient with hypokalemia
b. Patient who is pregnant
c. Patient on a thiazide diuretic

Answer 89

b. Patient who is pregnant

Question 90

Nicotine increases atherosclerosis by the release of which of the following?
a. nitric oxide
b. histamine
c. angiotensin II
d. epinephrine

Answer 90

d. epinephrine

Question 91

A 49-year-old client presents to the clinic complaining of intermittent, sharp, stabbing chest pain which began late last night. The pain usually lasts 1-2 minutes and is aggravated by movement. She is able to point to the location of the pain along the ribs at the left sternal border. The APRN is able to reproduce the pain with palpation.

What should be the management of this patient?

a. Referral to cardiologist for further follow up
b. Immediate transport to the emergency department (ED).
c. A prescription for a non steroidal anti-inflammatory drug (NSAID)
d. Further testing to include stress test and angiography

Answer 91

c. A prescription for a non steroidal anti-inflammatory drug (NSAID)

Reason: Costochondritis - Management

Question 92

Which statement about atrial fibrillation is correct?
a. It is found exclusively in adults over 60 years old.
b. A variety of different genes contribute to its expression.
c. It is the most common genetic cardiac disorder worldwide.
d. When severe, it leads to long QT syndrome.

Answer 92

b. A variety of different genes contribute to its expression.

Question 93

Increased preload of the cardiac chambers that occurs due to reduced ejection fraction and increased residual end-systolic volume will lead to which patient symptom?
a. Edema
b. Decreased heart rate
c. Decreased respiratory rate
d. Excitability

Answer 93

a. Edema

Question 94

What is an expected change in the cardiovascular system that occurs with aging?
a. decreased left ventricular wall tension
b. varicosities
c. arterial stiffening
d. decreased aortic wall thickness

Answer 94

c. arterial stiffening

Question 95

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system have on stroke volume?
a. increases preload and increases afterload
b. decreases preload and decreases afterload
c. decreases preload and increases afterload
d. increases preload and decreases afterload

Answer 95

a. increases preload and increases afterload

Question 96

Myocardial ischemia symptoms are most related to involvement of the C8 to T4 spinal ganglia. In women, myocardial ischemia more often presents as:
a. Dyspnea
b. Indigestion and nausea
c. Numbness in the upper extremities
d. All listed answers

Answer 96

d. All listed answers

Question 97

Right-sided heart failure is usually a consequence of
a. congenital anomalies.
b. elevated right ventricular preload.
c. tricuspid valve defects.
d. left ventricular failure.

Answer 97

d. left ventricular failure.

Question 98

In examining a patient with suspected mitral valve prolapse, the APRN would expect to find a/an
a. early to midsystolic, cresendo-decrescendo murmur.
b. pansystolic murmur.
c. midsystolic click and mid to late reguritant murmur.
d. a low-pitched diastolic murmur.

Answer 98

c. midsystolic click and mid to late reguritant murmur.

Question 99

What is the initiating event that leads to the development of atherosclerosis?
a. macrophages adhere to vessel walls
b. injury to the endothelial cells lining the artery walls
c. release of the platelet-derived growth factor
d. release of inflammatory cytokines

Answer 99

b. injury to the endothelial cells lining the artery walls

Question 100

Which of the following is an important risk factor for coronary artery disease?

a. LDL 162
b. Total cholesterol 182
c. BMI 19.2
d. Hemoglobin A1C 5.2%

Answer 100

a. LDL 162

Question 101

What would the management of a client that presents with crushing, non localized chest pain lasting longer than 15 minutes and accompanied by diaphoresis, dyspnea, nausea and shooting pain down her left arm?

a. Pulse oximetry and VS’s after activating 911
b. Immediate referral to a cardiologist
c. Immediate pulse oximetry, ECG and stat cardiac treponins
d. ECG, pulse oximetry and vital signs.

Answer 101

a. Pulse oximetry and VS’s after activating 911

Question 102

Rheumatic heart disease is a complication of rheumatic fever that is a serious consequence of a/an

a. cell-mediated response to streptococci infection.
b. abnormal immune response to antigens expressed by beta-hemolytic streptococci.
c. infection caused by beta-hemolytic streptococci.
d. genetic predispostion to heart disease.

Answer 102

b. abnormal immune response to antigens expressed by beta-hemolytic streptococci.

Question 103

Left-sided heart failure will cause
a. decreased systemic vascular resistance.
b. peripheral edema.
c. pulmonary congestion.
d. jugular vein distention.

Answer 103

c. pulmonary congestion.

Question 104

What is an expected change in the cardiovascular system that occurs with aging?
a. varicosities
b. decreased left ventricular wall tension
c. decreased aortic wall thickness
d. arterial stiffening

Answer 104

d. arterial stiffening

Question 105

In which of the following patient scenarios would an angiotensin receptor blocker (ARB) be contraindicated?
a. Patient on a thiazide diuretic
b. Patient with hypokalemia
c. Patient who is pregnant

Answer 105

c. Patient who is pregnant

Question 106

A 58-year-old woman presents complaining of nausea, diaphoresis, substernal gnawing pain, shortness of breath and pain that extends into her neck.
The most likely diagnosis for this patient is:

a. GERD
b. Pulmonary embolism
c. Costochondritis
d. MI

Answer 106

d. MI

Reason: Nausea, diaphoresis, substernal gnawing pain, shortness of breath and pain that extends into her neck suggest MI.

Chest pain - referral indicator - emergent condition

Question 107

Which of the following is an important risk factor for coronary artery disease?

a. Total cholesterol 182
b. Hemoglobin A1C 5.2%
c. LDL 162
d. BMI 19.2

Answer 107

c. LDL 162

Question 108

Which is true regarding nifedipine (Procardia), a calcium channel blocker?
a. This medication can cause acute kidney injury.
b. This medication can lead to worsening heart failure.
c.This medication carries a high risk for angioedema.

Answer 108

b. This medication can lead to worsening heart failure.

Reason: This class can lead to worsening systolic heart failure.

UTD: Calcium channel blockers might be expected to have beneficial effects in systolic HF by reducing peripheral vasoconstriction and thereby reducing left ventricular afterload. However, these agents also have variable degrees of negative inotropic activity, and several studies demonstrated greater clinical deterioration in patients treated with nifedipine and diltiazem compared with placebo or isosorbide dinitrate [2,3]. As a result, these drugs have generally been avoided in patients with systolic HF, even for the treatment of coexisting angina or hypertension.

Question 109

The clinician prescribes lisinopril (Zestril) for a woman with hypertension. The clinician understands that this medication should be discontinued immediately if:
a. the blood pressure goal is not reached.
b. the woman becomes pregnant.
c. the woman develops a dry cough.
d. the woman is diagnosed with liver disease.

Answer 109

b. the woman becomes pregnant.

Question 110

A 56 year old female with hypertension is at risk for left sided heart failure because hypertension causes
a. increased afterload due to vascular resistance.
b. decreased preload due to fluid retention.
c. increased preload due to dehydration.
d. decreased afterload due to changes in the RAAS.

Answer 110

a. increased afterload due to vascular resistance.

Question 111

When managing hypertension in the elderly, it is important for the clinician to know:
a. Beta blockers are contraindicated in elders.
b. Elders are at particular risk for orthostatic hypotension so close monitoring is needed.
c. Because of their advanced age, multiple medications will be needed.

Answer 111

b. Elders are at particular risk for orthostatic hypotension so close monitoring is needed.

Question 112

SATA: In addition to eating according to the DASH eating plan what other lifestyle modifications should the clinician advise clients with elevated BP to make?
a. Lower weight to national insurance guideline levels by restricting calories to 1800 kcal per day.
b. Begin walking 60 minutes 5-7 days per week.
c. Increase physical activity starting with small changes in activity levels, such as a 15 minute walk 3 days per week, and build up to at least 30 minutes 3 to 4 days per week.
d. Work toward a healthy weight through diet changes and increased activity levels.

Answer 112

c. Increase physical activity starting with small changes in activity levels, such as a 15 minute walk 3 days per week, and build up to at least 30 minutes 3 to 4 days per week.
d. Work toward a healthy weight through diet changes and increased activity levels.

Question 113

Which diagnostic test should be ordered for all women with a new diagnosis of hypertension?
a. Electrocardiography (ECG)
b. Echocardiogram
c. CT of the chest
d. Exercise stress test

Answer 113

a. Electrocardiography (ECG)

Question 114

This 16 year old patient has swelling of the face and an increased blood pressure. To check kidney function, the APRN orders tests. The APRN knows that the glomerular filtration rate is most accurately reflected in the
a. blood urea nitrogen level.
b. serum osmolality.
c. creatinine clearance.
d. urinary output.

Answer 114

c. creatinine clearance.

Question 115

Which is a contraindication to initiating metoprolol tartrate (Lopressor)?
a. Chronic angina
b. Renal artery stenosis
c. Sinus bradycardia

Answer 115

c. Sinus bradycardia

Question 116

The clinician diagnosed a woman with hypertension 4 weeks ago. The plan included losartan (Cozaar) and lifestyle changes. The woman followed the lifestyle recommendations and is taking her medication as directed. The woman’s blood pressure today is 142/92. What is the best plan now?
a. Change the losartan (Cozaar) to a different antihypertensive.
b. Reinforce lifestyle modifications and reevaluate in 1 month.
c. Add a second antihypertensive medication.
d. Continue losartan (Cozaar) at the current dose for 4 additional weeks.

Answer 116

c. Add a second antihypertensive medication.

Reason: Per JNC 8 treatment guidelines. Goal SBP is less than 130 within 1 month of initiating treatment. If BP remains high with lifestyle modifications (salt restriction, wt loss, exercise, no alcohol, etc.) and pharmacological treatment, the dosage of the initial medication should be increased, or a second medication should be added. (FYI: Losartan is an angiotensin II receptor antagonist.)

Question 117

The APRN is examining a 70 year old woman with a long history of poorly controlled hypertension. Evidence of which of the following would indicate hypertensive target organ damage?
a. Left ventricular hypertrophy
b. Hyperinsulinemia and insulin resistance
c. Lipid abnormalities
d. Left lower leg ulcer

Answer 117

a. Left ventricular hypertrophy

Question 118

A woman is taking hydrochlorothiazide (HCTZ; Microzide) for hypertension. Which serum abnormality is a potential concern?
a. Hypercalcemia
b. Hypernatremia
c. Hypokalemia

Answer 118

c. Hypokalemia

Question 119

SATA: Pathophysiologically hypertension is caused by:
a. Increase in vessel diameter
b. Resistance of blood flow through the arteries
c. Inadequate amount of blood pumped to the heart
d. Decreased stroke volume

Answer 119

b. Resistance of blood flow through the arteries

Question 120

A client without medical problems reports a persistent cough and chest tightness for a little over 2 weeks. Vital signs are BP 126/76, pulse 87, respiratory rate 18, temperature 99.0 F. On exam the provider hears wheezing, and rhonchi that clears with cough. No other significant findings are noted on exam.

The APRN assessing the client suspects the client has

a. influenza
b. acute bronchitis
c. pneumonia
d. asthma exacerbation

Answer 120

b. acute bronchitis

Cough is the cardinal symptom in patients presenting with acute bronchitis. In most patients, the cough persists for 1 to 3 weeks, with a median duration of 18 days [3,12,26Links to an external site.]. The cough may be associated with either purulent or nonpurulent sputum production [3,27Links to an external site.]. The presence of purulent sputum is a nonspecific finding and does not appear to be predictive of bacterial infection or response to antibiotics [28,29Links to an external site.].Wheezing and mild dyspnea may accompany the cough. Both wheezing and rhonchi may be auscultated on physical examination; rhonchi usually clear with coughing.

UP to Date: Acute Bronchitis 9/1/22

Question 121

A 70-year-old female presents with a sudden onset of dyspnea and pleuritic chest pain. She denies chills and fever. She had a surgical hip replacement 2 weeks ago. What is her most likely diagnosis?

a. Pneumonia
b. Costochondritis
c. Pulmonary embolism
d. Myocardial infarction

Answer 121

c. Pulmonary embolism

Chest pain - referral indicator - emergent condition

Any time you see “SUDDEN ONSET” picture me waving a red flag! This is a safety question. Symptoms are consistent with a pulmonary embolism and her recent surgery places her at risk for this. Chest pain - referral indicator - emergent condition

Question 122

According to the CDC which of the following patient or patients require B6 (pyridoxine) supplementation while on INH (Isoniazid: Nydrazid) for latent TB?

a. Pregnant woman
b. Both of these patients on INH require supplementation.
c. Healthy adult

Answer 122

a. Pregnant woman

According to the CDC people at high risk for B6 deficiency should be supplemented with B6 while on INH. Vitamin B6 (pyridoxine) supplementation during isoniazid (INH) therapy is necessary in some patients to prevent the development of peripheral neuropathy. this includes pregnant women, HIV + and diabetics+ older adults.

Question 123

A 24-year-old female has been living in a shelter for 4 months. Today she appears in clinic complaining of productive cough, weight loss, weakness, anorexia, night sweats, and generalized malaise. These symptoms have been bothering her for 8 weeks.

What would be one of the first tests the APRN would order?

a. Tuberculin skin test
b. CT of the chest
c. Sputum culture
d. Complete blood count

Answer 123

a. Tuberculin skin test

There are several respiratory disorders with these symptoms. It is good to suspect TB, do a skin test and a chest x-ray today, and see if it is TB or something else.

Tuberculosis - diagnosis

Question 124

Which finding is associated with lobar consolidation and probable pneumonia?

a. decreased whispered pectoriloquy
b. bronchophony is absent
c. increased tympany to percussion
d. egophony is present

Answer 124

d. egophony is present

Egophony is a physical examination technique for help with diagnosing pneumonia.

Perform by asking the patient to say the letter “E” while listening with the stethoscope to each lung field: when egophony is present, the sound is transmitted as “A”. The unusually clear perception of the patient’s whispered words through the stethoscope.

Question 125

A woman reports a frontal headache, nasal congestion, sore throat, yellowish nasal drainage, and a temperature of 100* F. Her symptoms began about a week after she first noticed upper respiratory infection symptoms and have steadily worsened. The headache worsens when she bends forward.

What is the most likely diagnosis?

a. Acute Sinusitis
b. Chronic Sinusitis
c. Migraine
d. Allergic Rhinitis

Answer 125

a. Acute Sinusitis

Question 126

Which of the following best describes the use of anti-viral medications in the care of patients with or at risk for influenza?

a. These drugs are active only against influenza B.
b. Their use is an acceptable alternative to influenza vaccine.
c. Their primary action is in preventing influenza A during outbreaks.
d. Their use within 48 hrs of flu symptoms may minimize the severity of the disease.

Answer 126

d. Their use within 48 hrs of flu symptoms may minimize the severity of the disease.

Use of antiviral drugs for treatment of flu can reduce severity of the disease and reduce the duration of symptoms by one day.

Question 127

An elderly patient presents with a productive cough of 2 days duration and asks which type of cough suppressant to take. Which is the best approach?

a. Cough suppressants are not recommended when there is a productive cough.
b. An over the counter combination of an expectorant, cough suppressant, and decongestant
c. An over the counter combination of an expectorant and cough suppressant

Answer 127

a. Cough suppressants are not recommended when there is a productive cough.

Question 128

A patient asks which of the following Complimentary and Alternative (CAM) therapies is proven to prevent colds. The best answer is:

a. There is not a proven CAM therapy to prevent colds.
b. Echinacea
c. Vitamin C

Answer 128

a. There is not a proven CAM therapy to prevent colds.

Question 129

A 30-year-old otherwise healthy woman complains of a persistent, bothersome cough and chest tightness that she has had since she and her family all had the “flu” 2 weeks ago. Vital signs: BP 118/76, P 88, R 20, T 99.8*F. Lung exam reveals scattered wheezing with no rales, no increased tactile fremitus, and no egophony.
This woman probably has:

a. Chronic obstructive pulmonary disease
b. Asthma exacerbation
c. Acute bronchitis
d. Pneumococcal pneumonia

Answer 129

c. Acute bronchitis

Cough lasting 10-20 days or longer, substernal burning with inspiration, low-grade fever, in the absence of high fever and egophony suggest - acute bronchitis.

Question 130

A 22-year-old college student comes to clinic complaining of a persistent dry cough, headache and body aches that have lasted for the past 10 days. Lung exam reveals fine rales bilaterally but no sign of consolidation. The clinician suspects walking pneumonia. What is the causative agent for this client’s illness?

a. Haemophilus influenza
b. Legionella pneumonphilia
c. Streptococcus pneumonia
d. Mycoplasma pneumonia

Answer 130

d. Mycoplasma pneumonia

Question 131

Emphysema leads to a barrel chest, because it causes

a. prolonged inspiration.
b. muscle atrophy.
c. pulmonary edema.
d. air trapping.

Answer 131

d. air trapping.

Question 132

A previously healthy 33-year-old client presents complaining of high fever with chills, productive cough with purulent sputum and pain with attempts of deep breaths. Fever started suddenly this morning. Her history includes a half pack per day smoking habit. The APRN’s exam confirms pneumonia.

The APRN should treat this client with which of the following antibiotics?

a. High dose Augmentin
b. Tetracycline
c. A penicillin
d. A macrolide

Answer 132

d. A macrolide

“Walking pneumonia” (atypical pneumonia) - standard of care to treat with macrolide.

Pneumonia - management

Question 133

A client without medical problems reports that she had runny nose, mild sore throat and low-grade fever beginning 2 weeks ago. Over the last week, she has had a bothersome cough and chest tightness. Vital signs are BP 126/76, pulse 92, respiratory rate 22, temperature 99.1 F. On exam the provider hears wheezing, and rhonchi that clears with cough. No other significant findings are noted on exam.

The APRN assessing the client suspects the client has

a. influenza
b. acute bronchitis
c. pneumonia
d. asthma exacerbation

Answer 133

b. acute bronchitis

Question 134

A woman has acute bronchitis. She has no allergies. The midwife should choose which treatment?

a. a macrolide
b. high dose Augmentin
c. corticosteroid inhaler
d. rest, fluids & dextromethorphan

Answer 134

d. rest, fluids & dextromethorphan

Varney 6e p. 189. In most cases, the infection and the cough will resolve within 1-2 weeks with supportive therapy. (cough syrup). If cough is persistent after the primary infection has resolved and wheezing is noted, the use of an albuterol inhaler may provide relief. Rx inhaler, 2 puffs q 4-6 hours PRN. Antibiotics are not useful in the case of viral bronchitis.

Question 135

Which class of medication is the best treatment for acute asthma symptoms?

a. A long acting beta agonist
b. An inhaled corticosteroid
c. A short acting beta agonist

Answer 135

c. A short acting beta agonist

Question 136

Which of the following situations leads to increased asthma deaths?

a. Use of short acting beta agonist for rescue treatment.
b. Use of long acting beta agonist for rescue treatment.
c. Use of inhaled steroids to treat chronic inflammation.

Answer 136

b. Use of long acting beta agonist for rescue treatment.

Question 137

Which class of medication is the best treatment for acute asthma symptoms?

a. A long acting beta agonist
b. An inhaled corticosteroid
c. A short acting beta agonist

Answer 137

c. A short acting beta agonist

Question 138

The cornerstone of treatment for persistent asthma includes:

a. the use of inhaled corticosteroids.
b. daily long-acting bronchodilator therapy.
c. immediate referral to pulmonology.
d. the frequent use of rescue inhalers.

Answer 138

a. the use of inhaled corticosteroids.

Review the Chart for Ashthma Tx. Step 2 is for Persistent Asthma: Low-dose-ICS. A LABA is Step 4. Rescue Inhaler should not be used frequently. This is in our wheelhouse, no need for referral. If you see “refer” in an answer seriously consider if this is a SAFETY question. Only pick refer if you REALLY mean it.

Question 139

Ulcerative colitis is commonly associated with

a. fistula formation between loops of bowel.
b. malabsorption of nutrients.
c. inflammation and scarring of the submucosal layer of the bowel.
d. bloody diarrhea.

Answer 139

d. bloody diarrhea.

Question 140

A 16 year-old comes to the clinic complaining of diarrhea that began approximately 18 hours ago. She reports no nausea or vomiting and no mucus or blood in her stool. She denies unusual travel or consumption of unusual foods. She is afebrile. Laboratory testing for this patient at this time should include:

a. Stool for ova and parasites
b. Complete blood count
c. No testing
d. Stool for fecal leukocytes

Answer 140

c. No testing

In patients with mild, afebrile diarrhea without any blood in the stools; diagnostic testing is usually not indicated. Also, she has had this for less than 24 hours. Her symptoms along with the fact that she has had no unusual food or travel indicates that the cause of her diarrhea is probably viral and the illness self-limiting.

Question 141

A 35 year-old woman presents with intermittent gnawing abdominal pain which occurs about 2 hours after eating. Initially after eating, she experiences relief from the pain. She has frequent tension headaches and has been taking 800 mg of ibuprofen (Advil) twice per day, nearly every day, for the last month.

Which is the most likely diagnosis?

a. peptic ulcer disease
b. gastroesophageal reflux disease (GERD)
c. cholecystitis
d. irritable bowel syndrome

Answer 141

a. peptic ulcer disease

Question 142

When treating an acute diarrhea episode caused by food poisoning the provider understands:

a. It is important to select an agent that slows peristalsis quickly to resolve symptoms.
b. Anything that would slow peristalsis may do more harm than good.
c. Consumption of peppermint oil is beneficial.

Answer 142

b. Anything that would slow peristalsis may do more harm than good.

Question 143

A 40 year old woman is having right upper quadrant pain that radiates to the right shoulder blade, and fever. She has had similar episodes in the past. She does not smoke or drink alcohol. Her BMI is 27 and she drinks 2 cups of coffee per day. She had gestational diabetes with her last two children. Current medications include ibuprofen 400 mg 3-4 times a weeks for headache or knee pain, LoOrthotricyclen and, most recently, cholestyramine.

This woman’s risk factors for gallbladder stones include:

a. History of arthritis
b. Excessive caffeine
c. Oral contraceptives
d. Ibuprofen

Answer 143

c. Oral contraceptives

Risk factors include: increasing age; obesity; rapid weight loss; pregnancy; hormones or other drugs [i.e. Rocephin]; ethnicity; family history; female gender; other metabolic diseases.

Question 144

A woman reports a moderate level of rectal pain. The clinician examines the woman and finds an external hemorrhoid that is very tender and has a dark bluish appearance. Appropriate nurse-midwifery/WHNP management is:

a. lance the hemorrhoid in the office.
b. provide a prescription hemorrhoid ointment.
c. topical analgesics and warm sitz baths.
d. referral to a surgeon for hemorrhoid evacuation.

Answer 144

d. referral to a surgeon for hemorrhoid evacuation.

Question 145

A woman reports continuing GERD symptoms in spite of pharmacologic treatment with a proton pump inhibitor for the last 8 weeks. The next management step should be to

a. Refer to gastroenterology for endoscopy
b. Change her current medication to another class
c. Recommend more aggressive lifestyle changes
d. Increase the dosage of her current medication for GERD

Answer 145

a. Refer to gastroenterology for endoscopy

She has now been on a PPI for 8 weeks and is still not responding like you had hoped. It is now time to refer her to a gastroenterologist for an endosccopy.

Question 146

A 23 year-old woman presents with abdominal pain which started 4 hours ago. The pain began as a dull ache around her umbilical area but now is constant in her right lower abdomen. She reports anorexia, nausea and vomiting since the onset of pain.

This is most descriptive of:

a. Cholelithiasis
b. Appendicitis
c. Diverticulitis
d. Perforated peptic ulcer

Answer 146

b. Appendicitis

Her age along with the pattern and location of the pain make appendicitis the most likely diagnosis. You would also need to rule out ectopic pregnancy and a ruptured ovarian cyst.

Question 147

Which recommendation for preventing traveler’s diarrhea is NOT supported by evidence?

a. Begin chemoprophylaxis with Cipro on arrival and continue through duration of stay.
b. Drink only water that is bottled or treated and avoid ice cubes
c. Avoid undercooked meat
d. Avoid raw fruits and vegetables

Answer 147

a. Begin chemoprophylaxis with Cipro on arrival and continue through duration of stay.

Question 148

When a patient presents with diarrhea always ask if they have taken antibiotics within the last _________ months.

a. 9
b. 3
c. 6

Answer 148

b. 3

When patients present with diarrhea the provider should ask if the patient has taken antibiotics within the past 3 months

Question 149

A 60 year-old woman presents to the clinic reporting low abdominal pain that she rates 5/10, nausea, and constipation for the last 24 hours. The pain is colicky and in the left lower quadrant. Her temperature is 101 F. CBC shows leukocytosis and urinalysis is negative. The most likely diagnosis is:

a. Colon cancer
b. Diverticulitis
c. Pancreatitis
d. Diverticulosis

Answer 149

b. Diverticulitis

Based on her age, presenting signs symptoms and location of the pain; diverticulitis is the most likely diagnosis. Patients with just diverticulosis are generally asymptomatic.

Question 150

Most gallstones are composed of

a. phosphate.
b. calcium.
c. uric acid salts.
d. cholesterol.

Answer 150

d. cholesterol.

Question 151

Based on updated guidelines, which type of H Pylori testing is no longer recommended?

a. Serum
b. Fecal
c. Breath
d. Biopsy

Answer 151

a. Serum

“H. pylori testing” Unfortunately with serum testing, current and previous infection with H Pylori cannot be differentiated and is no longer recommended.

Question 152

A 65 year old woman presents with a burning/aching abdominal pain occurring about 1-2 hours after eating that she has never experienced before. Food and Tums relieve the discomfort temporarily. She is awakened in the middle of the night with the pain and she has gained 5 pounds in the last two weeks “because I eat to relieve the pain.” She smokes a pack of cigarettes a day and takes ibuprofen periodically for joint pain. She denies any chronic disease. Her vital signs and physical examination are normal except for epigastric tenderness.
Initial diagnostic testing should include:

a. All the provided answers are correct
b. Stool for occult blood
c. H. Pylori testing
d. CBC and differential
e. Endoscopy

Answer 152

a. All the provided answers are correct

Recommended labs for PUD should include:

CBC [screen for anemia / GI bleed]; liver function tests; calcium levels; H. pylori testing [breath or stool]; endoscopy [especially if over 50].

Question 153

On physical examination, a woman has right upper quadrant tenderness and a positive Murphy’s sign. The clinician suspects gall stones. The initial test the clinician should order is

a. TcHIDA scan
b. Oral cholecystogram
c. Flat plate x-ray of the abdomen
d. Gallbladder ultrasound

Answer 153

d. Gallbladder ultrasound

Ultrasound is the most practical imaging study for evaluation of the gallbladder. It is best performed after at least an 8 hour fasting period.

Question 154

Elevated serum lipase level is indicative of

a. pancreatitis.
b. appendicitis.
c. Celiac disease.
d. gallbladder disease.

Answer 154

a. pancreatitis.

Question 155

The most potent and most expensive treatment option for peptic ulcer disease is

a. H2 receptor antagonist (H2RA)
b. Metronidazole (Flagyl)
c. Clarithromycin
d. Proton pump inhibitor (PPI)

Answer 155

d. Proton pump inhibitor (PPI)

Question 156

Gastroesophageal reflux disease (GERD) is a result of:

a. excessive production of hydrochloric acid.
b. reverse muscular peristalsis of the esophagus.
c. presence of Helicobacter pylori in the esophagus.
d. a zone of low pressure of the lower esophageal sphincter (LES).

Answer 156

d. a zone of low pressure of the lower esophageal sphincter (LES).

Question 157

A common finding for a patient who has a non perforated duodenal ulcer would be:

a. rebound tenderness
b. hyperactive bowel sounds
c. epigastric tenderness midline between the umbilicus and the xiphoid process
d. a rigid abdomen

Answer 157

c. epigastric tenderness midline between the umbilicus and the xiphoid process

Epigastric tenderness is generally the only physical finding with uncomplicated PUD.

Question 158

A 30 year old woman presents with diarrhea for over 24 hours. She has a fever of 102.8, blood in her stools, diffuse abdominal pain and fecal leukocytes.

The cause of this is most likely:

a. Parasites
b. Viral
c. Bacterial
d. Lactose intolerance

Answer 158

c. Bacterial

The combination of high fever, blood in the stools, diffuse abdominal pain and fecal leukocytes all suggest a bacterial origin.

Question 159

The clinician has made a diagnosis of gastroesophageal reflux disease and would like to prescribe a proton pump inhibitor. Which medication would the clinician choose?

a. cimetidine (Tagamet)
b. sucralfate (Carafate)
c. esomeprazole (Nexium)
d. famotidine (Pepcid)

Answer 159

c. esomeprazole (Nexium)

Nexium = PPI, Pepcid = H2 Blocker, Tagamet = H2 Blocker, Carafate = Anti-Ulcer Agent, Gastrointestinal Agent

Question 160

Omeprazole (Prilosec) exerts its therapeutic effects by:

a. blocking the proton pump of the gastric parietal cells.
b. inhibiting the conversion of pepsinogen to pepsin.
c. increasing strength of peristalsis and lowering esophageal sphincter pressure.
d. inhibiting the action of histamine at the H2 receptors.

Answer 160

a. blocking the proton pump of the gastric parietal cells.

Question 161

A woman reports continuing GERD symptoms in spite of pharmacologic treatment with a proton pump inhibitor for the last 8 weeks. The next management step should be to

a. Recommend more aggressive lifestyle changes
b. Increase the dosage of her current medication for GERD
c. Change her current medication to another class
d. Refer to gastroenterology for endoscopy

Answer 161

d. Refer to gastroenterology for endoscopy

Question 162

A woman with a positive anti-HBs asks the clinician what this means. The clinician should tell her

a. “This test indicates that you are highly infectious”
b. “It indicates rapid Hepatitis B viral replication”
c. “This develops after infection or serves as an indicator of immunity”
d. “This is a potentially serious condition and you need to see a gastroenterologist”

Answer 162

c. “This develops after infection or serves as an indicator of immunity”

anti-HBs indicates either immune from nature infection or immune from Hep B vaccination, see CDC sheet in Module 6 “Interpretation of Hepatitis B serologic tests”.

Question 163

A 60 year-old woman presents to the clinic reporting low abdominal pain that she rates 5/10, nausea, and constipation for the last 24 hours. The pain is colicky and in the left lower quadrant. Her temperature is 101 F. CBC shows leukocytosis and urinalysis is negative. The most likely diagnosis is:

a. Diverticulosis
b. Pancreatitis
c. Diverticulitis
d. Colon cancer

Answer 163

c. Diverticulitis

Question 164

Which type of colon polyp is most likely to carry the risk of cancer?

a. Adenomatous
b. Sessile
c. Hyperplastic
d. Pedunculated

Answer 164

a. Adenomatous

Question 165

A pathologic change to the kidney related to hypertension is

a. compression of the renal tubule and oliguria.
b. decreased glomerular permeability and polyuria.
c. microalbumenuria.
d. obstruction of the renal tubule and azotemia

Answer 165

c. microalbumenuria.

Question 166

Which of the following is true concerning colon cancer?

a. Rectal carcinoma is more common than cancers involving the colon.
b. Right sided polypoid tumors often cause iron deficiency anemia.
c. Early manifestations include abdominal pain and cramping.
d. Most colon cancers are found during rectal examination.

Answer 166

b. Right sided polypoid tumors often cause iron deficiency anemia.

Question 167

Hypoactive bowel sounds and a positive Murphy’s sign would make the provider suspect

a. Peptic Ulcer Disease
b. Irritable bowel syndrome
c. Pancreatitis
d. Cholecystitis

Answer 167

d. Cholecystitis

Question 168

A 40 year old woman reports intermittent right upper quadrant pain that she rates as a 5. This is accompanied by nausea and vomiting. She states the pain radiates to her right shoulder and seems to get worse after eating fatty foods.

Which is the MOST likely diagnosis?

a. PUD
b. Hepatitis
c. GERD
d. Cholecystitis

Answer 168

d. Cholecystitis

Question 169

The APRN orders a hepatitis panel with the following results:

HBsAg: positive
IgM anti-HBc: positive
HBeAg: positive
These results indicate

a. been vaccinated for Hep B
b. Hep A and is highly contagious
c. Hep B and is highly contagious
d. Hep B and is recovering

Answer 169

c. Hep B and is highly contagious

HBsAg, IgM anti-HBc and HBeAg All indicate that he has hepatitis B (hep B surface antigen) and is highly contagious. IgG would indicate recovery.

Question 170

In a woman previously diagnosed with hepatitis B, what do elevations in AST and ALT indicate?

a. Biliary system obstruction
b. Pancreatic islet B cell destruction
c. Liver inflammation
d. Liver healing

Answer 170

c. Liver inflammation

Question 171

A liver panel shows that the following are POSITIVE: HBsAg, IgM anti-HBc, and HBeAg. These results indicate:

a. Hep B, recovering
b. Hep A, highly contagious
c. Hep C, recovering
d. Hep B, highly contagious

Answer 171

d. Hep B, highly contagious

Question 172

Which serum hepatitis antibody test indicates active disease?

a. Serum IgG
b. Serum IgA
c. Serum IgE
d. Serum IgM

Answer 172

d. Serum IgM

Question 173

The APRN ordered a hepatitis panel with the following results:

anti-HBs: positive
HBsAG: negative
IgM: negative
anti-HBc: negative
HBeAg: negative
These results indicate:

a. Active immunity through previous infection
b. Active immunity through vaccination
c. Current infection
d. No immunity

Answer 173

b. Active immunity through vaccination

If hepatitis B surface antibody is the ONLY marker, it would indicate immunity from vaccination. If IgG was also present, it would indicate immunity through previous infection.

Question 174

Which of the following statements about hepatitis A is false?

a. There is no carrier state.
b. It can be contracted through sexual contact.
c. It may progress to a chronic illness.
d. Rates of Hepatitis A are at a 40 year low in the US.

Answer 174

c. It may progress to a chronic illness.

Question 175

T/F: All women diagnosed with pyelonephritis need to be hospitalized.

Answer 175

False

Question 176

The most common sign/symptom of renal calculi is

a. pain.
b. vomiting.
c. hematuria.
d. oliguria.

Answer 176

a. pain.

Question 177

SATA: Which of the following statements is/are true?

a. Published studies have shown that postcoital voiding prevents cystitis.
b. Teaching women to wipe front to back can decrease the incidence of urinary infections according to published studies.
c. Trimethoprim/sulfasmethoxazole is the least expensive effective treatment available for the treatment of cystitis and should be recommended unless the patient is allergic or the community has high levels of resistance to this regimen.
d. Oral estrogen therapy is an appropriate treatment to prevent recurrent cystitis in a post menopausal woman.
e. Most women have relief of acute urinary tract symptoms within 72 hours of starting antibiotic treatment.

Answer 177

c. Trimethoprim/sulfasmethoxazole is the least expensive effective treatment available for the treatment of cystitis and should be recommended unless the patient is allergic or the community has high levels of resistance to this regimen.
e. Most women have relief of acute urinary tract symptoms within 72 hours of starting antibiotic treatment.

Question 178

T/F: A woman with symptoms of a urinary tract infection and a urinalysis negative for leukocyte esterase and for nitrates needs a urine culture.

Answer 178

True

Question 179

SATA: Which of the following are risk factors for upper urinary tract infection (pyelonephritis)?

a. Pregnancy
b. Untreated lower urinary tract infection (cystitis)
c. History of pyelonephritis
d. History of lower urinary tract infection a year ago
e. Sexual activity

Answer 179

a. Pregnancy
b. Untreated lower urinary tract infection (cystitis)
c. History of pyelonephritis

Question 180

T/F: Most women who have been treated for a UTI should have a test of cure after treatment.

Answer 180

False

Question 181

Which mineral accounts for the most common type of renal stone?

Answer 181

Calcium

Question 182

Which of the following are risk factors for lower urinary tract infection (cystitis)?

a. Pregnancy
b. Diabetes
c. Previous history of cystitis
d. Use of spermicides
e. Use of diaphragm for contraception
f. Sexual activity
g. History of UTI
h. Dysmenorrhea
i. High blood pressure

Answer 182

a. Pregnancy
b. Diabetes
c. Previous history of cystitis
d. Use of spermicides
e. Use of diaphragm for contraception
f. Sexual activity
g. History of UTI

Question 183

The most appropriate treatment for the client with an elevated TSH and a low free T3 and T4 is:

a. levothyroxine (Synthroid)
b. radioactive iodine therapy
c. propylthiouracil (PTU) (Propacil)
d. methimazole (Tapazole)

Answer 183

a. levothyroxine (Synthroid)

Question 184

After a dosage change of levothyroxine (Synthroid), what is the optimal time frame for the thyroid stimulating hormone (TSH) to be rechecked?

Answer 184

4-8 weeks

Question 185

Which of the following hormones is increased as adipocytes increase in size and will no longer decrease the appetite?

a. Leptin
b. Norepinephrine
c. Resistin
d. Insulin

Answer 185

a. Leptin

Question 186

Thyroid-stimulating hormone (TSH) is released to stimulate release of thyroid hormones and is inhibited when plasma levels of thyroid hormone are adequate. This is an example of

a. negative feedback.
b. neural regulation.
c. positive feedback.
d. physiologic regulation.

Answer 186

a. negative feedback.

Question 187

Which lab value would be expected for a person with hypothyroidism?

a. Increased thyroxine (T4)
b. Increased calcitonin
c. Increased thyroid-stimulating hormone (TSH)
d. Increased triiodothyronine (T3)

Answer 187

c. Increased thyroid-stimulating hormone (TSH)

Question 188

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be

a. an infective process.
b. due to bacterial infection.
c. an autoimmune process.
d. due to an enzymatic defect.

Answer 188

c. an autoimmune process.

Question 189

A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is

a. hypoglycemia caused by increased exercise.
b. dawn phenomenon from eating a snack before bedtime.
c. Somogyi effect from insulin sensitivity.
d. hyperglycemia caused by incorrect insulin administration.

Answer 189

a. hypoglycemia caused by increased exercise.

Question 190

A woman with a history of gestational diabetes has a hemoglobin A1C of 6.0%. Which medication is approved for the prevention of type 2 diabetes in this woman?

a. glipizide (Glucotrol)
b. sitagliptin (Januvia)
c. acarbose (Precose)
d. metformin (Glucophage)

Answer 190

d. metformin (Glucophage)

Question 191

Polyuria occurs with diabetes mellitus because of:

a. an elevation in serum glucose.
b. an increase in antidiuretic hormone.
c. the formation of ketones.
d. chronic insulin resistance.

Answer 191

a. an elevation in serum glucose.

Question 192

Regarding pharmacologic management of diabetes, which of the following statements is correct?

a. Individuals with type 1 diabetes benefit from oral hypoglycemic agents.
b. Metformin (Glucophage) may improve glycemic control by increasing insulin sensitivity.
c. Hypoglycemic incidents are rare with the use of sulfonylureas.

Answer 192

b. Metformin (Glucophage) may improve glycemic control by increasing insulin sensitivity.

Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. Insulin is the hormone that controls the level of sugar in your blood.

Question 193

The underlying pathogenic mechanism for both type 1 and type 2 diabetes mellitus is

a. Pancreatic beta cell destruction
b. Lack of exercise and chronic overeating
c. Impaired glucose transport into cells
d. Lack of insulin receptors

Answer 193

c. Impaired glucose transport into cells

Question 194

Which type of insulin is most likely to cause unintended hypoglycemia?

a. insulin glargine (Lantus)
b. insulin degludec (Tresiba)
c. insulin lispro (Humalog)
d. insulin detemir (Levemir)

Answer 194

c. insulin lispro (Humalog)

Lantus: Long-Acting. Levemir: long-acting. Tresbia: long-acting. Humalog- rapid-acting.

Question 195

A woman is taking levothyroxine (Synthroid), 75 mcg daily, and she begins to experience tachycardia and nervousness. If laboratory results match the symptom pattern, an appropriate change in medication regimen would be:

a. increasing the levothyroxine to 100 mcg daily.
b. adding atenolol 50 mg daily.
c. reducing the levothyroxine to 50 mcg daily.

Answer 195

c. reducing the levothyroxine to 50 mcg daily.

Question 196

A woman diagnosed with hypothyroidism 6 weeks ago is taking levothyroxine (Synthroid) 100 mcg daily as directed. She had a TSH drawn yesterday and the level was elevated. Which is correct management?

a. Increase the levothyroxine to 125 mcg daily.
b. Decrease the levothyroxine to 75 mcg daily.
c. Recheck the TSH in 4 weeks.

Answer 196

a. Increase the levothyroxine to 125 mcg daily.

Question 197

Which of the following is an example of negative feedback?

a. Increased breast milk release in response to baby’s suckling.
b. Glucogon secretion in response to decreasing blood sugar.
c. Estrogen peak and luteinizing hormone surge before ovulation.
d. Increased insulin release after eating pecan pie.

Answer 197

b. Glucogon secretion in response to decreasing blood sugar.

Question 198

The clinician is initiating pharmacotherapy for a patient with type 2 diabetes. What is the recommended first-line oral hypoglycemic agent for most people?

a. glipizide (Glucotrol)
b. canagliflozin (Invokana)
c. metformin (Glucophage)
d. sitagliptin (Januvia)

Answer 198

c. metformin (Glucophage)

Question 199

A thyroid gland that grows larger than normal is known as

a. colloidosis.
b. goiter.
c. cretinism.
d. myxedema.

Answer 199

b. goiter.

Question 200

The pathogenesis of Graves disease includes

a. diminished levels of thyroid-binding globulin.
b. high levels of circulating thyroid-stimulating immunoglobulins.
c. low levels of thyroid stimulating hormone.
d. low levels of thyroid-releasing hormone.

Answer 200

b. high levels of circulating thyroid-stimulating immunoglobulins.

Question 201

The American Diabetic Association recommends the following criteria for the diagnosis of diabetes:

a. Hgb A1C greater than or equal to 6.5%
b. A 2-hour plasma glucose level greater than or equal to 200 during an oral glucose tolerance test
c. All the provided answers are correct
d. In a client exhibiting symptoms, a random blood sugar greater than or equal to 200
e. A fasting plasma glucose greater than or equal to 126mg/dL

Answer 201

c. All the provided answers are correct

Question 202

A 30 year-old woman presents with headaches for several weeks. She also reports milky nipple discharge. Her last menstrual period was 4 months ago. The purpose of a prolactin level in this woman is to assess for

a. a possible pituitary tumor.
b. thyroid dysfunction.
c. Addison’s disease.
d. drug-induced galactorrhea.

Answer 202

a. a possible pituitary tumor.

Question 203

Which of the following patients is at highest risk for developing Type 2 diabetes?

a. 22 year old Caucasian male, college lacrosse player
b. 40 year old Native American male truck driver
c. 10 year old African American male
d. 45 year old Caucasian male nurse

Answer 203

b. 40 year old Native American male truck driver

Question 203

The pathophysiology of rheumatoid arthritis involves

a. immune cells accumulating in pannus and destroying articular cartilage.
b. excessive wear and tear and microtrauma that damage articular cartilage.
c. cysts developing in subchondral bone and creating fissures in articular cartilage.
d. free radicals attaching to the synovial membrane and tunneling into articular cartilage.

Answer 203

a. immune cells accumulating in pannus and destroying articular cartilage.

Question 204

The effects of excessive cortisol production include

a. immune suppression.
b. hypoglycemia.
c. inflammatory reactions
d. anorexia.

Answer 204

a. immune suppression.

Question 204

Which of the following types of diabetes results from the autoimmune destruction of the beta cells of the Islets of Langerhans?

a. Gestational diabetes
b. Type 1 diabetes
c. Maturity-onset diabetes of the young (MODY)
d. Type 2 diabetes

Answer 204

b. Type 1 diabetes

Question 205

Type 2 diabetes mellitus is best described as:

a. the presence of insulin autoantibodies that destroy beta cells in the pancreas.
b. the need for long acting insulin.
c. a resistance to insulin by insulin-sensitive tissues.
d. an increase of glucagon secretion from beta cells of the pancreas.

Answer 205

c. a resistance to insulin by insulin-sensitive tissues.

Question 206

When titrating levothyroxine (Synthroid) for a client with hypothyroidism, when should the clinician schedule a recheck of the TSH?

Answer 206

c. 6 weeks

while titrating check TSH every 6 weeks. Hypothyroidism - Management

Question 207

A woman requests labs that she needs for her post-thionamide therapy follow-up. This means that the woman had been treated for:

a. hypoparathyroidism and should have a serum calcium, PTH, Albumin and Fasting Phosphorus and a 24-hour urine calcium level.
b. hypothyroid and needs a TSH and T4 index.
c. hyperparathyroidism and should have a serum calcium, PTH, Albumin and Fasting Phosphorus.
d. hyperthyroidism and needs a TSH and T4 index, which she should have every 3-4 months.

Answer 207

d. hyperthyroidism and needs a TSH and T4 index, which she should have every 3-4 months.

From up to date 4/19/23

Thionamides – PropylthiouracilLinks to an external site. (PTU) and methimazoleLinks to an external site. are the thionamide drugs available in the United States. Carbimazole is a third option available in many countries, but not in North America. Methimazole (Tapazole) and carbimazole are interchangeable because carbimazole is completely metabolized to methimazole. The carbimazole dose required to yield an equivalent dose of methimazole is approximately 40 percent higher. (See ‘Pharmacokinetics’Links to an external site. above.)

MethimazoleLinks to an external site. has clinical advantages and less severe toxicity when compared with PTU, and it is usually preferred to PTU (except during the first trimester of pregnancy or during the initial treatment of thyroid storm). (See “Thionamides in the treatment of Graves’ disease”, section on ‘Choice of drug’Links to an external site..)

Question 208

A 44 year old woman reports fatigue, sensitivity to cold, and weight gain recently. These symptoms are most consistent with:

a. Thyroid Nodule
b. Thyroid cancer
c. Hypothyroidism
d. Hyperthyroidism

Answer 208

c. Hypothyroidism

Question 209

A 28 year old woman reports weight loss, palpitations, heat intolerance, and tremors. The MOST likely diagnosis is:

a. Subclinical Hypothyroidism
b. Hyperthyroidism
c. Subclinical Hyperthyroidism
d. Hypothyroidism

Answer 209

b. Hyperthyroidism

Question 210

The midwife should suspect hyperthyroidism in a woman with:

a. cold intolerance.
b. facial edema.
c. an elevated TSH.
d. palpitations.

Answer 210

d. palpitations.

Question 211

What is the MOST likely diagnosis for a 30 year old non-pregnant woman who has decreased thyroid-stimulating hormone (TSH) and increased free T3 and T4?

a. Hypothyroidism
b. Pituitary Insufficiency
c. Hyperthyroidism
d. Subclinical Hypothyroidism

Answer 211

c. Hyperthyroidism

Question 212

In tension-type headache, the patient will give a history of:

a. band-like head pain.
b. photophobia.
c. unilateral headache.
d. being awakened by headache.

Answer 212

a. band-like head pain.

Band-like head pain is “classic” complaint for tension-type headache. update 8.20.17 Objective: assessment / diagnosis

Question 213

Pain that lasts for 6 months or more is considered

Answer 213

Chronic pain

Question 214

A 53 year old client reports a headache. She denies any history of headaches. Her pain is 6/10. The pain was mild last night but woke her early this morning. Vital signs are normal. This normally active woman has some difficulty getting onto the exam table. DTRs are 1+ bilaterally; DTR’s have been 2+ and 3+ at previous visits. This client has:

a. tension headache
b. danger signs related to headache
c. cluster headache
d. migraine headache

Answer 214

b. danger signs related to headache

Danger signs for headache include:
Onset of headaches after age 50**
Headache described as worst H/A ever
Onset of new or different H/A
Onset of a headache that progressively worsens**
H/A with stiff neck, fever, malaise, N/V
Presence of aphasia, weakness, and / or poor coordination**
Asymmetry of pupillary response
Decreased DTR’s**
Papilledema
Painful temporal arteries
Personality change
Need only one to cause concern and refer to ER

Question 215

How do endorphins act to relieve pain?

a. stimulate afferent nerve fibers
b. attach to opiate receptor sites
c. inhibit cells in the spinal cord
d. block transduction of nociceptors

Answer 215

b. attach to opiate receptor sites

Question 216

Which is the most appropriate initial treatment for tension headaches?

a. verapamil (Calan)
b. sumatriptan (Imitrex)
c. ibuprofen (Motrin)
d. propranolol (Inderal)

Answer 216

c. ibuprofen (Motrin)

Question 217

A 20 year-old woman presents with paralysis of the right side of her face, drooping of the right eye, and drooling from the right corner of her mouth. The initial plan should include:

a. Antibiotics
b. Oral steroids
c. Referral to ophthamology
d. Referral to ear, nose, and throat

Answer 217

b. Oral steroids

This describes paralysis of the facial nerve (CN VII) associated with Bell’s Palsy.

Question 218

Which structure regulates eating behavior and energy metabolism?

a. hypothalamus
b. anterior pituitary
c. posterior pituitary
d. parietal lobe

Answer 218

a. hypothalamus

Question 219

A student who is unprepared is faced with an unexpected examination. Which of the following is expected as he responds to this stress?

a. decreased lipolysis
b. increased insulin release
c. increased gluconeogenesis
d. bronchoconstriction

Answer 219

c. increased gluconeogenesis

Question 220

Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of

a. norepinephrine and cortisol.
b. epinephrine and aldosterone.
c. epinephrine and norepinephrine.
d. vasopressin and cortisol.

Answer 220

c. epinephrine and norepinephrine.

Question 221

The hormone responsible for piloerection, increased sweat, and an increase in blood pressure during the initial stress response is

a. Norepinephrine
b. Epinephrine
c. Neuropeptide Y
d. Cortisol

Answer 221

a. Norepinephrine

Question 222

A 25 year-old client reports headaches that are unilateral, throbbing, moderately severe in intensity, and accompanied by nausea. The headaches usually last 12-18 hours. The most likely diagnosis is:

a. cluster headache
b. rhinosinusitis
c. migraine headache
d. tension headache

Answer 222

c. migraine headache

Question 223

A 24-year-old client presents with recurrent unilateral throbbing headache that causes her to lie down in a darkened room. A differential diagnosis is Migraine with Aura. Which of the following symptoms would be a significant positive for the aura portion of this diagnosis?

a. Irritability
b. Photophobia
c. Phonophobia
d. Visual disturbances

Answer 223

d. Visual disturbances

Question 224

Referred pain may be perceived at some distance from the area of tissue injury, but generally felt

a. within the same dermatome.
b. on the same side of the body.
c. with slightly less intensity.
d. within 10 to 15 centimeter area.

Answer 224

a. within the same dermatome.

Question 225

During a stress response, the helper T (Th)1 response is suppressed by which hormone?

a. growth hormone
b. ACTH
c. prolactin
d. cortisol

Answer 225

d. cortisol

Question 225

The basis of the specificity theory of pain is that:

a. The greater the tissue injury, the greater the pain.
b. Acute pain is specific only to certain injuries.
c. Injury to specific organs results in specific types of pain.
d. Chronic pain is generally less intense than acute pain.

Answer 225

a. The greater the tissue injury, the greater the pain.

Question 226

A college freshman is brought to student health with a severe headache and confusion. Upon physical exam, the clinician notes a temperature of 103.2 F. and nuchal rigidity. What is the most important next step?

a. Assess cranial nerve function.
b. Obtain a urine specimen for urinalysis.
c. Order a CBC with differential.
d. Transport to the ED immediately.

Answer 226

d. Transport to the ED immediately.

Question 227

As a result of the frequency and debilitating nature of a client’s migraine headaches, the ARNP offers to place her on preventive therapy. Which of the following medications would be appropriate?

a. propranolol (Inderal)
b. sumatriptan (Imitrex)
c. butalbital/aspirin/caffeine (Fiorinal)
d. ibuprofen (Motrin)

Answer 227

a. propranolol (Inderal)

All of the medications listed are for abortive rather than preventive therapy with the exception of propranolol (Inderal).

Question 228

A 65-year-old woman with no prior headache history reports onset of a constant headache 4 weeks ago that has been gradually worsening. Over the last week, the pain has been waking her up at night. A review of the patient’s chart reveals a 10 pound weight loss since her last visit two months ago. What is the nurse-midwife/WHNP’s best course of action?

a. Recommend stress-relief measures and acetaminophen (Tylenol).
b. Refer to neurology for an appointment within the next 2-3 weeks.
c. Consult immediately with a physician and anticipate brain imaging.
d. Prescribe sumatriptan (Imitrex) to use as needed.

Answer 228

c. Consult immediately with a physician and anticipate brain imaging.

Varney p. 206. Safety question: Red flags: HA onset 4 weeks ago. WORSENING. Pain wakes her up. Lost 10 lbs. Brain tumor should be on differential dx list. a. 2-3 weeks for a neuro appt is too long. b. We are way past Imitrex - need to rule out something more serious first. c. Way past stress-relief measures. d. She needs imaging- ASAP. (If the imaging were suspicious for anything, that would prompt neuro to consult ASAP - instead of waiting 2-3 weeks).

Question 229

Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?

a. ADH/Vasopressin
b. norepinephrine
c. cortisol
d. epinephrine

Answer 229

b. norepinephrine

Question 230

Which of the following would be the most appropriate first line management plan for a client diagnosed with Bell’s palsy?

a. Prednisone alone.
b. An antiviral alone.
c. Prednisone given along with an antiviral if facial paralysis is severe.
d. Surgical decompression of the facial nerve.

Answer 230

c. Prednisone given along with an antiviral if facial paralysis is severe.

Question 231

pain after lifting a heavy object yesterday. She has history of low back pain on and off for the past year, but this pain is now radiating down her right leg. She denies problems with urination or defecation. On exam, there is decreased range of motion of the spine in all planes. Straight leg raising at 35 degrees is positive on the right. Achilles tendon reflex on the right is diminished compared to the left with decreased sensation over the right lateral calf and heel.
The most likely etiology of this patient’s symptoms is:

a. Cauda equina syndrome
b. Herniated disc involving L2 root
c. Herniated disc involving L5 root
d. Rupture of the achilles tendon

Answer 231

c. Herniated disc involving L5 root

The straight leg raise response and lateral calf dermatome being affected indicates L5 and achilles reflex would indicate possible S1 involvement.

Question 232

A 40 year old woman is concerned about low back pain that began after she moved her sofa. On examination, there is no evidence of radiculopathy, however, there are muscle spasms.

Which of the following would be most appropriate for this patient?

a. cyclobenzaprine (Flexeril) for 4-7 days Muscle relaxer
b. ibuprofen (Motrin) for 5-7 days NSAIDS
c. hydrocodone (Lortab) for 5-7 days Opiates
d. diazepam (Valium) for 7-10 days Benzodiazepine

Answer 232

a. cyclobenzaprine (Flexeril) for 4-7 days Muscle relaxer

Cyclobenzaprine is a muscle relaxant and can be used to reduce muscle spasms. Objective: Plan / management

Question 233

A 76-year-old woman reports that yesterday she felt that the right side of her face and her right arm were numb for a few hours and then were better. Today she feels fine. This episode was probably a/an:

a. transient-ischemic attack (TIA).
b. Bell’s palsy flare.
c. mild ischemic stroke.
d. atypical migraine headache.

Answer 233

a. transient-ischemic attack (TIA).

Question 234

When a patient presents with severe neck pain and paresthesias in the arm and hand, the clinician should

a. order an arthritis panel and advise warm compresses.
b. order xrays of the neck.
c. refer her to a neurologist.
d. refer her to an orthopedic surgeon.

Answer 234

c. refer her to a neurologist.

Incapacitating pain and neurologic deficits indicate a need for referral to a spine specialist or neurologist.

Question 235

The most appropriate initial treatment of acute bursitis is

a. oral corticosteroids
b. intrarticular joint injection
c. nonsteroidal antiinflammatory drugs (NSAIDs)
d. physical therapy

Answer 235

c. nonsteroidal antiinflammatory drugs (NSAIDs)

Question 236

Referred pain may be perceived at some distance from the area of tissue injury, but generally felt

a. on the same side of the body.
b. with slightly less intensity.
c. within 10 to 15 centimeter area.
d. within the same dermatome.

Answer 236

d. within the same dermatome.

Question 237

The most debilitating complication of chronic shoulder immobility and pain is

a. subacromial impingement syndrome.
b. tendinitis.
c. over use of NSAIDs.
d. adhesive capsulitis.

Answer 237

d. adhesive capsulitis.

Adhesive capsulitis is most common complication, which causes loss of shoulder mobility.

Question 238

A 22 year old male is admitted to ER after an auto accident where he sustained a compound fracture of the femur. This patient is at risk for pulmonary embolism due to

a. fat.
b. air.
c. bacteria.
d. bone fragment.

Answer 238

a. fat.

Question 239

A 34 year old stay at home mother of three young children presents with a complaint of low back pain and pain with symptoms down her right leg. She states she has a hard time doing chores around the house like laundry, carrying her infant, and lifting her kids. Sitting at her computer makes her pain worse. She also states she is having sensations of tingling in her right leg and feelings of numbness on the lateral aspect of her right thigh and calf. Her back pain increases with coughing, sneezing, and bending over. Sometimes her leg pain is even more significant than her back pain. What is your initial diagnosis based on this subjective data?

a. Syndrome of lumbar radiculopathy
b. Neurogenic claudication
c. Muscle strain
d. Axil low back pain

Answer 239

a. Syndrome of lumbar radiculopathy

Syndrome of lumbar radiculopathy. Her symptoms of back and leg pain (with leg pain > back pain), tingling, numbness, pain increasing with cough/sneezing, and bending over/prolonged sitting. It is differentiated from axil low back pain due to the leg pain. Differentiated from neurogenic claudication in that sitting makes her pain worse, and muscle strain does not cause radiculopathy.

Question 240

The straight leg raise used to assess a patient with low back pain would help the CNM to diagnose

a. L5-S1 nerve root compression.
b. muscle strain.
c. ligament tear.
d. L1-L2 nerve root compression.

Answer 240

a. L5-S1 nerve root compression.

This test identifies irratation of the lower lumbar nerve roots (L5-S1).

Question 241

Which woman is most likely to have rheumatoid arthritis?

a. A 32 year-old with pain and stiffness in her wrists when she wakes in the morning.
b. A 72 year-old with severe pain, redness, and swelling in her right great toe.
c. A 60 year-old with left hip pain that is worse with activity.

Answer 241

a. A 32 year-old with pain and stiffness in her wrists when she wakes in the morning.

RA: chronic systemic, inflammatory disease with autoimmune features characterized by SYMMETRIC polyarticular joint swelling, joint pain and destruction, as well as morning stiffness, fatigue, fever, & comorbidities. TEST TAKING TIP: This answer choice was different from the others because the pain was bilateral. If you knew nothing about RA, you could guess this answer because it is different from the other two. IF all else fails.-Look for clues in the other answers to shine a spotlight on the right answer.

Question 242

A woman presents with moderately severe low back pain that began 3 days ago after lifting furniture. She denies radiation of pain to her lower extremities. She denies fever, unintended weight loss, or changes in bowel or bladder function. Aside from pain with range of motion, her physical examination is normal. What is the best plan of care?

a. Obtain an x-ray of the lumbar spine.
b. Order an MRI of the lumbar spine.
c. Prescribe ibuprofen (Advil).
d. Refer to a pain management clinic.

Answer 242

c. Prescribe ibuprofen (Advil).

Question 243

The client has acute bursitis of the subacromial bursa. The first-line therapy for this problem is

a. physical therapy for electrical stimulation.
b. active ROM, avoidance of activities that exacerbate the pain, and NSAIDs.
c. corticosteroid bursal injection and ice application for 15 minutes every 2 hours for a day.
d. bursal aspiration and arm/shoulder sling for 2 weeks.

Answer 243

b. active ROM, avoidance of activities that exacerbate the pain, and NSAIDs.

Activity with only the avoidance of movements that precipitate symptoms is recommended for shoulder pain and NSAIDs for decreasing inflammation and pain.

Question 244

A woman presents with worsening back for the last month with radiation to both lower extremities. She also reports fatigue and intermittent fevers. She denies bowel or bladder dysfunction. She has had a poor appetite and has lost 20 lbs. since her last office visit 8 weeks ago. What is the next step?

a. Prescribe an opioid pain reliever and refer for pain management.
b. Recommend alternating ice and heat and schedule a follow up visit in 2 weeks.
c. Prescribe a nonsteroidal antiinflammatory drug and refer for physical therapy.
d. Consult a physician immediately and prepare to order an MRI of the lumbar spine.

Answer 244

d. Consult a physician immediately and prepare to order an MRI of the lumbar spine.

Question 245

Peripheral edema may result from which of the following?

a. hypertension
b. venous insufficiency
c. arterial insufficiency
d. atherosclerosis

Answer 245

b. venous insufficiency

Question 246

A 71-year-old client has osteoarthritis with knee and hip pain. What is the safest treatment?

a. naproxen (Aleve)
b. acetaminophen (Tylenol)
c. ibuprofen (Advil)
d. fentanyl transdermal (Duragesic)

Answer 246

b. acetaminophen (Tylenol)

For OA: Acetaminophen is the first-line treatment in patients older than 65 years. FYI: Also Avoid NSAIDS in patients with prior GI ulcers or bleeds and in pt’s taking warfarin and/or corticosteroids. (Essential Evidence plus).

Question 247

The most appropriate initial treatment of acute bursitis is

a. intrarticular joint injection
b. nonsteroidal antiinflammatory drugs (NSAIDs)
c. physical therapy
d. oral corticosteroids

Answer 247

b. nonsteroidal antiinflammatory drugs (NSAIDs)

Question 248

A cashier presents with pain over the lower back without sciatica that is aggravated by sitting, standing and certain movements. On questioning, she tells you that it is relieved with rest. On examination, you find that she is tender in the lower lumbar area and there are muscle spasms. What is your initial diagnosis ?

a. Fibromyalgia
b. Herniated disc
c. Musculoskeletal strain

Answer 248

c. Musculoskeletal strain

Question 249

The decrease in sebaceous gland activity associated with age will cause skin

a. oiliness.
b. dryness.
c. atrophy.
d. heat loss.

Answer 249

b. dryness.

Question 250

An immediate hypersensitivity to an allergen or antigen that appears as itchy lesions on the skin and then disappear in 2-3 hours just to flare up again is:

a. urticaria.
b. pruitis.
c. atopic dermatitis.

Answer 250

a. urticaria.

Urticaria is an immediate hypersensitivity reaction that occurs after exposure to an allergen or antigen. Obj: Diagnosis

Question 251

Which of the following is/are common cause(s) of pancreatitis?

a. Idiopathic
b. All of the above
c. Alcoholism
d. Gallstones

Answer 251

b. All of the above

Question 252

A 40-year-old morbidly obese female with a bright red, burning, pruritic rash under both breasts and the suprapubic area. The probable diagnosis is:

a. intertriginous fungal infection
b. atopic dermatitis
c. staph dermatitis

Answer 252

a. intertriginous fungal infection

Intertrigo occurs where there is persistent skin-to-skin contact, erythema and pruritis suggests secondary fungal infection. Obj: Diagnosis

Question 253

Which of the following would be the best choice in treating mild impetigo?

a. Topical antibiotic cream such as mupirocin.
b. Topical antiviral cream such as acyclovir
c. Topical antihistamine cream such as diphenhydramine.

Answer 253

a. Topical antibiotic cream such as mupirocin.

Correct answer: impetigo is a bacterial infection and needs and antibacterial cream. Mild cases may be treated with topicals.

Question 254

What is essential education for a client newly diagnosed with psoriasis?

a. Psoriasis is a chronic, autoimmune disease process and adherence to prescribed regimens is important.
b. Psoriasis is a benign skin condition and is not associated with complications in other organ systems.
c. There are no identifiable triggers for psoriasis flares.
d. Psoriasis is treated with anti-histamines such as cetirizine (Zyrtec) or loratadine (Claritin).

Answer 254

a. Psoriasis is a chronic, autoimmune disease process and adherence to prescribed regimens is important.

Question 255

Acne rosacea differs from acne vulgaris in that:

a. Rosacea does not present with comedomes and vulgaris does.
b. Rosacea occurs in a younger population than vulgaris.
c. Rosacea does not respond to oral antibiotics and vulgaris does.

Answer 255

a. Rosacea does not present with comedomes and vulgaris does.

Question 256

Which immunoglobulin is elevated in atopic dermatitis?

a. IgE
b. IgG
c. IgA
d. IgM

Answer 256

a. IgE

Question 257

Which of the following causes tinea corporus?

a. bacteria
b. nematodes
c. fungus
d. virus

Answer 257

c. fungus

Question 258

Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:

a. Oral corticosteroids
b. Low dose corticosteroid cream
c. Immunomodulators

Answer 258

a. Oral corticosteroids

Oral corticosteroids are often required if severe or large skin surface area is involved as with severe cases of poison oak or ivy dermatitis.

Question 259

Impetigo is a skin infection caused by

a. Eschericha coli.
b. streptococci.
c. fungus.
d. parasites.

Answer 259

b. streptococci.

Question 260

A 50 year old woman reports a mole on her leg that has changed over the last several months. The lesion is asymmetrical and 1 cm x 6 mm. It has irregular borders and a rough texture. The lesion is probably:

a. Squamous cell carcinoma
b. Seborrheic keratosis
c. Basal cell carcinoma
d. Malignant melanoma

Answer 260

d. Malignant melanoma

Melanomas- “common among women with large numbers of moles”. More common on the legs and trunk. Rough texture, irregular outline, and of different colors. referral. Varney p. 215.

Question 261

Mild acne may be initially treated with:

a. A topical retinoid
b. Metrogel (Metronidazole)
c. Over the counter (OTC) benzoyl peroxide

Answer 261

c. Over the counter (OTC) benzoyl peroxide

Question 262

A 21 year old client, who works as a cashier at a fast food restaurant, is complaining of a rash on her hands for two weeks that her supervisor finds offensive. The rash itches and occasionally burns. She started using a new soap to clean counters at work about 3 weeks ago. Past history is significant for dry skin that she has treated with moisturizers and cortisone cream. The rash is on the palmar surface of her hands and on all her fingers, irregularly distributed in scaly, maculopapular erythematous patches. The nails are spared.

What is the diagnosis?

a. urticaria
b. cellulitis
c. contact dermatitis
d. atopic dermatitis

Answer 262

c. contact dermatitis

Question 263

A 17 year old recent high school graduate on her way to college, comes to clinic complaining of blisters that have erupted on her lip. She is concerned that she will pass these to her new boyfriend of one month. She states she has never had anything like this before. She has also had some body aches, sore throat and headache. On examination there is positive cervical lymphadenopathy, a cluster of tiny blisters with red rims and yellow fluid at the corner of her lower lip and an elevated temperature of 100.1*F, other vital signs are normal.

What is the diagnosis?

a. herpes simplex
b. cellulitis
c. impetigo
d. herpes zoster

Answer 263

a. herpes simplex

Question 264

An 80 year old client has an extremely painful rash along her rib cage on her left side. She denies any recent illness or health problems, but states the area was slightly itchy just before the rash appeared. On examination her skin appears normal except for along her left rib cage from approximately 3 inches from the spine to the mid-axillary line there is a raised, red rash, which on close inspection appears to be developing clear vesicles. There is positive lymphadenopathy palpated in the left axillary nodes. Vital signs: T 99.8*F, R 20, P 68, BP 138/88.

What is the diagnosis?

a. herpes simplex
b. herpes zoster
c. dermatitis
d. impetigo

Answer 264

b. herpes zoster

Question 265

Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:

a. Immunomodulators
b. Low dose corticosteroid cream
c. Oral corticosteroids

Answer 265

c. Oral corticosteroids

Question 266

A client presents with redness and pain to her right upper arm since yesterday. She reports fever and malaise. Her temperature is 100.8 F. The clinician notes an 8 cm x 10 cm reddened, elevated area with well defined borders on her right upper arm. The area is painful to touch and there are enlarged lymph nodes in the right axillary region. Her most likely diagnosis is:

a. deep vein thrombosis
b. contact dermatitis
c. folliculitis
d. cellulitis

Answer 266

d. cellulitis

Classic signs of cellulitis are erythema, induration and pain, these may be accompanied by malaise, fever and chills. Obj: Diagnosis

Question 267

Which term is used to identify a collection of infected hair follicles occurring most often on the back of the neck, the upper back, and the lateral thighs that forms a mass and evolves into an erythematous, painful, and edematous mass and drains through many openings?

a. Boils
b. Erysipelas
c. Carbuncles
d. Furuncles

Answer 267

c. Carbuncles

Question 268

Select the best patient teaching for the patient who is given topical metronidazole (Metrogel) for the treatment of acne rosacea.

a. Topical metronidazole is a category X drug.
b. Expect results in 1-2 weeks of treatment.
c. Anticipate that treatment will continue for a long period of time or, possibly, for life.

Answer 268

c. Anticipate that treatment will continue for a long period of time or, possibly, for life.

Question 269

Which of the following ethnic groups are most likely to develop keloids?

a. Caucasians
b. Arabians
c. Mexican Americans
d. African Americans

Answer 269

d. African Americans

Question 270

Which of the following factors is consistent with causing changes to the skin in normal aging?

a. an increase in vasculature
b. an increased strength in elastin
c. a decrease in atrophy
d. a decrease in lymphatic drainage

Answer 270

d. a decrease in lymphatic drainage

Question 271

A 64 year old woman has a raised, crusted lesion surrounding a center ulcer found on the top of her right ear. The woman is fair skinned and has had a lot of sun exposure over the years.

What is the best management plan?

a. Advise the woman that her lesion could be melanoma, educate her on the characteristics of melanoma, the typical process of diagnosis, treatments and course of the disease and make her up an appointment for a biopsy and follow-up before she leaves the office today.
b. Advise the woman that her lesion is basal cell carcinoma and reassure her that basal cell carcinoma is the least malignant and rarely metastasizes. Provide her with a list of providers, so she can make an appointment with for a biopsy to confirm her diagnosis.
c. Advise the woman that her lesion could be squamous cell carcinoma, educate her on the characteristics of squamous cell carcinoma, the typical process of diagnosis, treatments and course of the disease and make her up an appointment for a biopsy and follow-up before she leaves the office today.

Answer 271

c. Advise the woman that her lesion could be squamous cell carcinoma, educate her on the characteristics of squamous cell carcinoma, the typical process of diagnosis, treatments and course of the disease and make her up an appointment for a biopsy and follow-up before she leaves the office today.

Question 272

The potency of a topical corticosteroid can be enhanced the most by application:

a. To moist skin by gentle rubbing
b. After bathing
c. Of an occlusive dressing
d. With an emollient

Answer 272

c. Of an occlusive dressing

Occlusive dressings increase drug penetration in the skin. Obj:Plan / Pt Education

Question 273

An 80 year old client has an extremely painful rash along her rib cage on her left side. She denies any recent illness or health problems, but states the area was slightly itchy just before the rash appeared. On examination her skin appears normal except for along her left rib cage from approximately 3 inches from the spine to the mid-axillary line there is a raised, red rash, which on close inspection appears to be developing clear vesicles. There is positive lymphadenopathy palpated in the left axillary nodes. Vital signs: T 99.8*F, R 20, P 68, BP 138/88.

What is the best treatment plan?

a. antiviral therapy, analgesics and topical moist compresses
b. antiviral therapy and topical antibiotic ointment to prevent secondary infection
c. topical corticosteroid therapy, opiates for pain
d. non-steroidal anti-inflammatory drug therapy, topical lidocaine 2% every 2 hours and moist heat prn

Answer 273

a. antiviral therapy, analgesics and topical moist compresses

Herpes zoster (Shingles) - management

Question 274

Atopic dermatitis is due to

a. fungal infection.
b. parasitic infestation of the skin.
c. genetic predisposition.
d. superficial staphylococcal infection.

Answer 274

c. genetic predisposition.

Question 275

Conditions caused by a virus include

a. impetigo.
b. warts.
c. athlete’s foot.
d. boils.

Answer 275

b. warts.

Question 276

A 26-year-old woman reports “itchy feet.” She plays racquetball three times a week at a local gym and uses the locker room and shower. She has an erythematous, peeling rash over both feet, with maceration between the toes. It is most likely that she has:

a. contact dermatitis.
b. lichen planus.
c. psoriasis.
d. tinea pedis.

Answer 276

d. tinea pedis.

Question 277

Which of the following best describes psoriasis?

a. Erythematous papules with poorly defined borders and yellow scale.
b. Dry, erythematous patches of skin.
c. Thick red plaques with well defined borders and silvery white scales.

Answer 277

c. Thick red plaques with well defined borders and silvery white scales.

Psoriasis is an inflammatory, well-circumscribed, erythematous macular and papular lesion with loosely adherent silvery white scale. Obj: Diagnosis

Question 278

A woman presents to the clinic complaining of redness and pain in her right leg. She first noticed it yesterday and had noted a small sore on her ankle the day before that. She rates her pain as 7 out of 10. Her temperature is 101.1 F. Other vital signs are normal. The clinician notes a large area of erythematous, raised, shiny skin that encompasses her right calf with generalized swelling to the lower leg.

What is the most likely diagnosis?

a. cellulitis
b. dermatitis
c. impetigo
d. deep vein thrombosis

Answer 278

a. cellulitis

Question 279

A 50-year-old woman has facial erythema, telangiectasia, papules, pustules, and prominent facial pores. The most likely diagnosis is:

a. acne vulgaris.
b. acne rosacea.
c. tinea corporis.
d. systemic lupus erythematosis.

Answer 279

b. acne rosacea.

Question 280

Which of the following would be the best choice in treating mild impetigo?

a. Topical antiviral cream such as acyclovir
b. Topical antihistamine cream such as diphenhydramine.
c. Topical antibiotic cream such as mupirocin.

Answer 280

c. Topical antibiotic cream such as mupirocin.

Correct answer: impetigo is a bacterial infection and needs and antibacterial cream. Mild cases may be treated with topicals.

Question 281

The APRN is writing a prescription to treat a client’s acne. Which of the following dermatologic vehicles is the best choice for treating acne?

a. Creams
b. Gels
c. Ointments

Answer 281

b. Gels

Gels are cosmetically appealing and provide therapeutic advantages of ointments and cosmetic advantages of creams. Obj:Plan / Management

Question 282

Treatment of Herpes zoster includes:

a. acyclovir (Zovirax) within 72 hours of rash onset, prevention of secondary infection, and analgesics.
b. ibuprofen (Caldolor), ice baths for inflammation and pain, and prevention of secondary infections.
c. Lidocaine ointment, imiquimod (Aldara), and prevention of secondary infections.

Answer 282

a. acyclovir (Zovirax) within 72 hours of rash onset, prevention of secondary infection, and analgesics.

Treat herpes zoster (shingles) infections with acyclovir (Zovirax), within 72 hours of rash and secondary infection prevention and analgesics for pain as needed. Obj: Plan / Mgt.

Question 283

A 45 year old fair skinned woman who frequently works outside without a hat. She is concerned about a spot on her face that has been there about three months and seems to be enlarging. The lesion is a round ½ cm lesion on the side of her nose with a raised center, pearly border, and distinct margin. This lesion also has a couple of small, non-blanching blood vessels in it.

What is the most likely diagnosis?

a. Melanoma
b. Benign Lesions
c. Squamous Cell Carcinoma
d. Basal Cell Carcinoma

Answer 283

d. Basal Cell Carcinoma

Question 284

A 50 year old woman reports a mole on her leg that has changed over the last several months. The lesion is asymmetrical and 1 cm x 6 mm. It has irregular borders and a rough texture. The lesion is probably:

a. Squamous cell carcinoma
b. Basal cell carcinoma
c. Seborrheic keratosis
d. Malignant melanoma

Answer 284

d. Malignant melanoma

Melanomas- “common among women with large numbers of moles”. More common on the legs and trunk. Rough texture, irregular outline, and of different colors. referral. Varney p. 215.

Question 285

A 17 year old presents to clinic complaining of blisters that erupted on her lip yesterday. She is concerned that she will pass these to her new boyfriend of one month. She states she has never had anything like this before. She reports body aches, sore throat, and headache. On examination there is positive cervical lymphadenopathy, a cluster of tiny blisters with red rims and yellow fluid at the corner of her lower lip, and an elevated temperature of 100.1 F.

What is the best treatment plan?

a. Comfort measures only
b. Topical lidocaine
c. Oral valacyclovir (Valtrex)
d. Topical acyclovir (Zovirax)

Answer 285

c. Oral valacyclovir (Valtrex)

Herpes simplex management (Varney p. 478-480)—pt is likely having an initial/primary outbreak.

“All primary outbreaks should be treated to prevent prolonged or severe illness.” Subsequent outbreaks may still have sx but prodromal sx are milder.

no need to do serologic or viral testing.
Pharmacologic treatment:
Outbreak: 7-10 day treatment with Acyclovir or famciclovir or valacyclovir
Recurrent: 1, 2, or 5 days depending on med and dose
Suppression: 1-2x/day depending on med and dose

Question 286

A client presents with severe pruritis for the last 2 weeks that is worst at night. Her itching is worst between her fingers, in her armpits, and around her waist. The clinician notes a maculopapular rash in the affected areas with burrow tracks.
The most likely diagnosis is:

a. scabies
b. tinea corporis
c. body lice
d. poison ivy dermatitis

Answer 286

a. scabies

Question 287

What is the most common type of skin cancer?

a. Basal
b. Actinic keratosis
c. Melanoma
d. Squamous

Answer 287

a. Basal

Question 288

First line therapy in the treatment of anxiety disorders includes which of the following as monotherapy?

a. Benzodiazepines
b. Tricyclic antidepressants
c. Monoamine oxidase inhibitors
d. Selective serotonin reuptake inhibitors

Answer 288

d. Selective serotonin reuptake inhibitors

Question 289

Bupropion (Zyban, Wellbutrin) is contraindicated in persons

a. under 30 years old.
b. with seizure disorder.
c. who have diabetes.
d. over 60 years old.

Answer 289

b. with seizure disorder.

Zyban lowers seizure threshold and increases seizure activity.

Question 290

Which of the following questions is most useful in the assessment for generalized anxiety disorder?

a. Are you concerned you will embarrass yourself in public?
b. Do you have unpleasant thoughts come into your mind that are hard to get rid of?
c. Do you have shortness of breath and heart palpitations?
d. Do you worry about everyday activities even when there is no sign of trouble?

Answer 290

d. Do you worry about everyday activities even when there is no sign of trouble?

Question 291

A 32 year old reports tachycardia, sweating, numbness and tingling in her hands. The symptoms started two months ago, and occur unexpectedly for no apparent reason 2-4 times a week. Her physical exam shows no cardiac, respiratory or neurologic abnormalities.

The most likely diagnosis is:

a. Hypothyroidism
b. Panic attack
c. Excessive caffeine intake
d. Menopause

Answer 291

b. Panic attack

Question 292

A woman is teary and looks down at the ground as she slowly speaks. She states that she has had difficulty falling and staying asleep for at least one month. She states her appetite is poor and she has lost ten pounds. She says that she cannot find joy in anything that she does. She feels hopeless and doesn’t expect life to improve. What is the most likely diagnosis?

a. Suicidal Ideation
b. Major Depression
c. Dysthmic Disorder
d. Bipolar Disorder

Answer 292

b. Major Depression

Question 293

Find the best match between symptoms and the appropriate diagnosis. Assume all listed symptoms have been present more days than not for over 2 years.

Agitation, weight loss, insomnia, impaired decision making, anhedonia

Answer 293

Major Depressive Disorder

Question 294

Find the best match between symptoms and the appropriate diagnosis. Assume all listed symptoms have been present more days than not for over 2 years.

Impaired functioning, irritability, fear, worry

Answer 294

Generalized Anxiety Disorder

Question 295

Find the best match between symptoms and the appropriate diagnosis. Assume all listed symptoms have been present more days than not for over 2 years.

Impaired functioning, irritability, social conflict, inability to concentrate, rapid speech

Answer 295

Bipolar Disorder

Question 296

Find the best match between symptoms and the appropriate diagnosis. Assume all listed symptoms have been present more days than not for over 2 years.

Poor appetite and feelings of hopelessness

Answer 296

Persistent Depressive Disorder

Question 297

Which of the following symptoms is most consistent with a patient with bipolar disorder who is experiencing mania?

a. anhedonia
b. psychomotor retardation
c. increased need for sleep and weight gain
d. increased social and interpersonal conflict

Answer 297

d. increased social and interpersonal conflict

Question 298

Physical symptoms of bulimia include:

a. Cold intolerance
b. Dry skin
c. Hair loss
d. Dental enamel erosion

Answer 298

d. Dental enamel erosion

Question 299

The risk of suicide is increased in women who are depressed or who have bipolar disorder. Consequently, the CNM should

a. encourage the patient to decrease thoughts that make her depressed.
b. discourage substance use.
c. avoid asking questions about suicide.
d. ask if the patient has has thoughts of ending her own life.

Answer 299

d. ask if the patient has has thoughts of ending her own life.

Addressing a patient’s thoughts related to suicide / taking their own life is critical to suicide risk assessment.

Question 300

Which of the following symptoms is most consistent with a patient with bipolar disorder who is experiencing mania?

a. increased need for sleep and weight gain
b. anhedonia
c. increased social and interpersonal conflict
d. psychomotor retardation

Answer 300

c. increased social and interpersonal conflict

Question 301

How are malignant tumors different from benign tumors?

a. Benign tumors retain parental cell functions, and malignant tumors lose parental cell functions.
b. Malignant tumors grow by expansion, and benign tumors grow by invasion.
c. Malignant tumors lose plasma membranes, and benign tumors continue to produce them.
d. Benign tumors have totally normal features, and malignant tumors have totally abnormal features.

Answer 301

a. Benign tumors retain parental cell functions, and malignant tumors lose parental cell functions.

Question 302

By which process does “promotion” assist in cancer development?

a. Stimulating or enhancing cell division of cells damaged by a carcinogen.
b. Inflicting mutation at specific sites on the exposed cell’s DNA.
c. Increasing the transformed cell’s capacity for error-free DNA repair.
d. Making cancer cells appear more normal and escaping immunosurveillance.

Answer 302

a. Stimulating or enhancing cell division of cells damaged by a carcinogen.

Question 303

Autoimmune diseases may result from

a. overactive immune function.
b. increase in self-tolerance.
c. streptococcyl skin infection.
d. increased vascular inflammation.

Answer 303

a. overactive immune function.

Question 304

By what process does “initiation” assist in cancer development?

a. Inflicting mutations at specific sites on the exposed cell’s DNA.
b. Enhancing the cell division of cells damaged by a carcinogen.
c. Increasing the transformed cell’s capacity for error-free DNA repair.
d. Making cancer cells appear more normal and escaping immunosuppression.

Answer 304

a. Inflicting mutations at specific sites on the exposed cell’s DNA.

Question 305

Which of the following is characteristic of benign tumors? They

a. invade local tissues.
b. spread through lymph.
c. cause systemic symptoms.
d. their cells adhere tightly to one another

Answer 305

d. their cells adhere tightly to one another

Question 306

The CNM determines that the patient has costochondritis. This is based primarily on:

a. Point tenderness over the 3rd and 5th ribs
b. Recent history of a URI
c. Absence of fever
d. Pain aggravated by breathing

Answer 306

a. Point tenderness over the 3rd and 5th ribs

Question 307

Sickle cell disease is classified as a(an)

a. inherited autosomal recessive disorder.
b. inherited X-linked recessive disorder.
c. disorder initiated by alkalosis and excess oxygen.
d. disorder that is diagnosed most often in males.

Answer 307

a. inherited autosomal recessive disorder.

Question 308

How is progression different from metastasis?

a. Progression involves continual gene changes in a cancer cell that enhance its degree of malignancy; metastasis is the ability of a cell to invade other tissues.
b. Metastasis is dependent on gene mutations in suppressor genes; progression is dependent on gene mutations in oncogenes.
c. Progression cannot occur unless the process of metastasis occurs first.
d. Metastasis occurs in both benign and malignant cells; progression occurs only in malignant cells.

Answer 308

a. Progression involves continual gene changes in a cancer cell that enhance its degree of malignancy; metastasis is the ability of a cell to invade other tissues.

Question 309

When caring for a client diagnosed with mononucleosis, which one of the following requires referral to a medical colleague?

a. poor appetite
b. fever, 102 degrees for one week
c. splenomegaly
d. unilateral swelling of the soft palate

Answer 309

d. unilateral swelling of the soft palate

Question 310

Which of the following infectious agents has been identified as contributing to cancer development?

a. Helicobacter pylori
b. Escherichia coli
c. Streptococcus pneumoniae
d. Staphylococcus aureus

Answer 310

a. Helicobacter pylori

Question 311

Which statement regarding general cancer development is true?

a. The risk for cancer development increases with age.
b. Cancers usually develop in tissues that are missing a nucleus.
c. Children of older mothers have a greater risk for cancer development.
d. Mutations leading to cancer development occur in structural genes.

Answer 311

a. The risk for cancer development increases with age.

Question 312

Which of the following is considered a genetic thrombophilia?

a. Factor V Leiden.
b. Hemophilia.
c. Disseminated intravascular coagulopathy.
d. polycythemia.

Answer 312

a. Factor V Leiden.

Question 313

A Positive McBurney’s sign is indicative of

Answer 313

acute appendicitis

Question 314

A 49 year old woman was in a horrific boating accident 15 years ago and nearly drowned. Since that time, she has not been able to ride in a boat, just the thought of it causes her to shake and sweat and she still experiences nightmares about the accident. Her entire family loves water sports and frequently go boating, water skiing, or fishing. She will go to great lengths to avoid all these activities. What is the most likely diagnosis?

Answer 314

Posttraumatic Stress Disorder

Question 315

Which is a true contraindication to an immunization?

a. Diarrhea
b. Prior anaphylactic reaction to the vaccine
c. Current antimicrobial therapy
d. History of post immunization fever

Answer 315

b. Prior anaphylactic reaction to the vaccine

Question 316

Beta blockers should be avoided in patients with:

a. Persistent asthma
b. Alcohol use disorder
c. Severe kidney disease

Answer 316

a. Persistent asthma