Quiz Flashcards
(138 cards)
1
Q
A 30-year-old male patient with no previous history of urinary tract infection (UTI) has both positive leukocyte esterase and nitrites on a random urine dipstick during a well-patient exam.
This represents a(n):
A
Complicated UTI. All UTIs in men are complicated.
2
Q
A patient with a purulent skin and soft tissue infection (SSTI) presents to the clinic. A history reveals a previous MRSA infection in a family member. The primary care provider performs an incision and drainage of the lesion and sends a sample to the lab for culture.
What is the next step in treating this patient?
A
Prescribe oral clindamycin. MRSA is not responsive to Augmentin, and empiric treatment for presumed MRSA should begin until the cultures return.
3
Q
A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice daily ketoconazole cream prescribed by the primary care provider.
What will the provider order for this patient?
A
Oral itraconazole. An oral antifungal is an alternative but special attention to liver risk must be evaluated.
4
Q
A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes.
What will the primary care provider recommend as first-line treatment?
Famiciclovir
Acyclovir
Topical medications
Valacyclovir
A
Acyclovir is the least expensive and just as effective in preventative therapy.
5
Q
A patient is diagnosed with herpetic whitlow and in a follow-up evaluation, is noted to have paronychial inflammation of the tendon sheath in one finger.
What is a priority treatment for this patient?
A
Immediate referral to the ED or surgery. Tendon sheath infection in herpetic whitlow places the finger/hand at risk.
6
Q
A 40-year-old woman reports pain at the thumb base in one hand radiating to the distal radius. The primary care provider learns that the woman knits for a hobby and is able to elicit the pain by asking the patient to pour water from a pitcher.
Which condition is suspected in this patient?
A
De Quervain tenosynovitis. Pain and numbness at the thumb base and a history of repetitive finger motions are classic signs. Rest and immobilization is the usual treatment.
7
Q
A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. Upon examination, the patient’s lungs are clear and oxygen saturation is 97% on room air.
What will the provider recommend?
A
Symptomatic treatment and follow up. There are no serious complication risks like comorbidity and antivirals may take a day or two for effect. Respiratory distress signs would indicate need for ED referral.
8
Q
A 25-year-old patient has a tuberculosis skin test which reveals an area of induration of 12 mm. The patient is a recent immigrant from Mexico and lives in a homeless shelter.
What is the recommended treatment for this patient?
A
INH preventative therapy is indicated in patients younger than 35 with skin test of >10mm.
9
Q
What is the recommended treatment for a patient with mild symptoms of babesiosis who is diagnosed with a positive PCR assay?
A
Atovaquone and azithromycin for seven to ten days
Patients with mild to moderate symptoms of babesiosis and a positive PCR assay should be treated, and atovaquone plus azithromycin is the treatment of choice. A negative PCR would indicated observation and symptomatic treatment.
10
Q
A patient comes to a clinic with reports of unilateral arm pain and weakness with mild neck pain. The provider notes that the patient prefers holding the affected arm crossed in front of the throat. A history reveals a recent onset of sexual dysfunction.
What does the provider suspect based on this history?
A
Cervical myelopathy
Patients with neurological symptoms have radicular neck pain, which is usually greater in one arm and involves neurological findings. Patients with concurrent lower extremity findings may have cervical myelopathy and should be evaluated immediately.
11
Q
Which policy has the Centers for Medicare and Medicaid Service (CMS) implemented to reduce adverse events associated with care transitions?
A
Reduction of payments for patients readmitted within 30 days after discharge
12
Q
What is the purpose of clinical research trials in the spectrum of translational research?
A
Examination of safety and effectiveness of various interventions
13
Q
What is the purpose of clinical research trials in the spectrum of translational research?
A
Examination of safety and effectiveness of various interventions
14
Q
What would be considered a secondary prevention strategy?
A
Lipid screening
Primary - Vaccines, Lifestyle Recommendations
Secondary - Screenings
Tertiary - Disease Management, Support Groups
15
Q
Who is a chlamydia screening recommended for, according to USPSTF guidelines?
A
Sexually active women ages 24 and younger
16
Q
Which two types of wellness exams are applicable for the first year of coverage for those who turn 65 years of age and enroll in Medicare?
A
A Welcome to Medicare visit and an annual wellness visit
17
Q
During the annual wellness visit with a 56-year-old patient, the primary care provider notes that the patient rarely exercises.
What exercise regimen will the provider recommend for this patient?
A
At least 150 minutes of moderate-intensity exercise and muscle-strengthening exercises at least two days per week.
18
Q
Which vaccines may be given to a pregnant woman who reports not having had any vaccinations as a child but requests vaccines during her pregnancy?
A
Hep B, Inactivated Flu, TdaP
MMR and live vaccines are not recommended in pregnancy
19
Q
A 38-year-old patient with obesity and a strong family history of diabetes expresses interest in losing weight, but is intimidated by the need to lose 60 pounds in order to reach normal weight and reduce the risk of chronic disease.
What can the primary care provider say that could help motivate the patient in losing weight?
A
Sustained weight loss of just 7% body weight is associated with decreased risk of obesity-related chronic disease
20
Q
A primary care provider administers the “Newest Vital Sign” health literacy test to a patient newly diagnosed with a chronic disease.
What is gained by administering this test?
A
Understanding of and ability to discuss health care concerns. This test is a screening tool for health literacy.
21
Q
During a routine wellness exam, the primary care nurse practitioner notes an irregular radial pulse and irregular heart sounds. The patient’s vital signs are: BP 126/84, HR 105, RR 16, T 98.8°F (37.1°C).
What should the nurse practitioner do next?
A
Order a STAT ECG. The patient is stable, if there were signs of hemodynamic compromise an ED referral is appropriate.
22
Q
A patient reports using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The primary care provider notes redness and discharge along the eyelid margins with clear conjunctivae.
What is the recommended treatment?
A
Compresses, lid scrubs, and antibiotic ointment. This patient has symptoms of blepharitis without conjunctivitis. Initial treatment involves lid hygiene and antibiotic ointment may be applied after lid scrubs.
23
Q
A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge.
What is the initial treatment for this patient?
A
Prescribe antibiotic ear drops. The tear is likely a result of the infection. Refer the patient to an otolaryngologist may be considered but is not the initial treatment.
24
Q
A patient has a sore throat, a temperature of 101.3°F (38.5°C), tonsillar exudates, and cervical lymphadenopathy.
What will the primary care provider do next to manage this patient’s symptoms?
A
Perform a rapid antigen swab to determine if group A b-hemolytic streptococcus GAS is present. (Strep swab)
25
A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted.
What is the next step in managing this patient?
Increase the dose of the antibiotics
Administer the pneumonia vaccine
Perform a diagnostic bronchoscopy
Perform an open lung biopsy
Perform a diagnostic bronchoscopy. You need to exclude or confirm possible carcinoma, fungal, or other disease as the cause.
26
A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The primary care provider notes both direct and rebound tenderness with palpation of the abdomen.
What is the significance of this finding?
It suggests severe acute pancreatitis with peritonitis. Having both direct and rebound tenderness is a sign suggesting severe peritonitis.
27
Which diagnostic test will the primary care provider order for a 30-year-old woman who has right upper quadrant abdominal pain, nausea, and vomiting?
Abdominal ultrasound. Any woman of child bearing age should get ultrasound before CT. A good rule of thumb is ultrasound (cheaper, in-office) before CT.
28
What will the primary care provider initially recommend to a patient who develops diarrhea after gastric surgery?
Avoiding liquids with meals. Initial suggestions for treating postoperative diarrhea will include avoiding fluids during meals and lying down after meals.
29
A young adult patient is being treated for hypertension and is noted to have a resting blood pressure of 135/88 mm Hg just after finishing a meal. After standing, the patient has a blood pressure of 115/70 mm Hg.
What is the likely cause of this change in blood pressure?
Neurogenic orthostatic hypotension
Postprandial hypotension
A hyperglycemic episode
Antihypertensive medications
Antihypertensive medications. Medications used to treat hypertension may cause orthostatic hypotension and neurogenic and postprandial are more common in older patients.
30
Which symptoms exhibited by a patient with abdominal pain are suggestive of appendicitis?
Patients with appendicitis typically have pain that begins in the epigastric or periumbilical area and migrates to the right lower quadrant. Abdominal rigidity is common, as are low-grade fever and nausea and vomiting. Pain precedes other symptoms and when the symptoms occur in any other order, the diagnosis of appendicitis should be questioned.
31
An advanced practice registered nurse (APRN) is working with a patient who has had recurrent cystitis. The patient has implemented many changes, including drinking cranberry juice, increasing water intake, urinating after intercourse and discontinued use of a diaphragm, and replacing with oral contraceptives. In discussion with the patient, the APRN learns that the cystitis symptoms seem to be linked to frequency of intercourse.
Which order should the APRN make for prophylactic treatment?
Ciprofloxacin 125 mg within 24 hours of intercourse. Prophylactic pharmacotherapy for postcoital cystitis is recommended. Ciprofloxacin 125–250 mg within 24 hours of intercourse is appropriate.
32
A daycare worker is assessed by an advanced practice registered nurse (APRN) due to complaints of sudden-onset of scattered macular and vesicular lesions on the palms and between fingers, arms, and soles of the feet, buttocks, and legs. The patient has a temperature of 101.2°F (38.4°C). The APRN diagnoses hand, foot, and mouth disease.
Which action should the APRN take to assist this patient?
With hand, foot, and mouth disease, fluid intake should be increased to alleviate dehydration.
33
A 35-year-old patient meets with an advanced practice registered nurse (APRN) to discuss a low back pain that began three days earlier and has never occurred before. The pain and stiffness intensifies after sitting for long periods of time, and the patient is concerned about the problem impacting work.
Which action should the APRN take first to assist this patient?
Normal activities should not be eliminated in acute, first-time low back pain. Alternating between sitting and standing should be considered.
34
A patient presents to the clinic with a sudden onset of fever, chills, headache, and malaise during the winter months. Upon assessment, the advanced practice registered nurse (APRN) notes a temperature of 103°F (39.4°C), clear nasal discharge, a dry cough, and enlarged cervical lymph nodes. Abdominal exam reveals no splenomegaly.
Which diagnosis should the APRN suspect for this patient?
Influenza is an acute infection of the respiratory tract that occurs primarily during the winter months. Symptoms include fever, chills, headache, malaise, clear nasal discharge, a dry cough, and enlarged cervical lymph nodes.
35
An adult patient with chronic obstructive pulmonary disease (COPD) is seen by an advanced practice registered nurse (APRN) with complaints of a productive cough that is worse in the morning and improves throughout the day.
The patient reports smoking a half a pack of cigarettes each day for the past 15 years. Assessment results include a respiratory rate of 30 breaths per minute with rhonchi and wheezing bilaterally. The spirometry results reveal the FEV1 is 65%, and the FVC is 45%.
How should the APRN classify this patient's stage of COPD?
Mild chronic obstructive pulmonary disease (COPD) has spirometry results of FEV1 (forced expiratory volume in 1 sec.) of 70–79% and FVC (forced vital capacity) of 60–69%.
36
An advanced practice registered nurse (APRN) is assessing a patient who presents to the clinic with complaints of morning cough, sputum production, and dyspnea with activity for the last three months. Vital signs are within normal limits. Chest X-ray is unremarkable. Office spirometry is conducted and pre- and post-bronchodilator administration shows no improvement with expiratory and capacity values of less than 70%.
Which diagnosis should be suspected by the APRN?
Chronic obstructive pulmonary disease (COPD) presents with morning cough, sputum production, and increasing dyspnea with activity. The spirometry results post-bronchodilator administration with expiratory and capacity values of less than 70% indicate COPD.
37
A patient arrives at a clinic for a regularly scheduled visit. During the examination, the patient shares that they have been experiencing angina, radiating pain, and tingling and numbness in the right hand over the past week. The advanced practice registered nurse (APRN) establishes that the patient is not in acute distress but suspects the patient has coronary artery disease.
Which initial action should the APRN take?
Conduct a thorough history and physical examination
The optimum assessment of coronary artery disease (CAD) is a thorough history and physical examination that includes prior medical history of myocardial infarction (MI) or CAD and the patient's present complaints, such as angina, radiating pain, tingling, or numbness.
38
A patient is being evaluated by an advanced practice registered nurse (APRN) for a follow-up visit after being discharged from the hospital for a transient ischemic attack (TIA).
Which action should the APRN perform as part of the patient’s long-term treatment plan?
A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain and may be a warning sign of a future cerebrovascular accident (CVA, stroke). It is important for the patient to be able to recognize and report signs of a stroke.
39
A patient is being evaluated by an advanced practice registered nurse (APRN) about problems with watery, liquid stools. The patient had been on a broad-spectrum antibiotic for two weeks. The APRN suspects a secondary complication.
Which test will confirm the APRN's suspicion?
Because this patient presents with watery, liquid stools and a recent history of antibiotic usage, a secondary complication of clostridium difficile (c. diff) is suspected. A positive polymerase chain reaction (PCR) test will confirm the patient has c. diff.
40
A patient is speaking with an advanced practice registered nurse (APRN) about problems with chronic gastroesophageal reflux disease that is no longer responding to the previously prescribed proton pump inhibitor medication.
Which disease should the APRN suspect in this patient?
Barrett esophagus is a complication of chronic GERD, even in patients who take PPIs.
41
An advanced practice registered nurse (APRN) is assessing and screening a new patient for primary preventative measures. The patient asks the APRN about the purpose of these measures.
Which explanation should be provided by the APRN?
They identify behaviors needing intervention before problems occur.
42
A 28-year-old male is being seen in the primary care office for his annual wellness exam. During the assessment, the patient notes that he has a girlfriend and is sexually active. He states that he is concerned about sexually transmitted illnesses and asks the advanced practice registered nurse (APRN) if he should get the human papillomavirus (HPV) vaccination.
How should the APRN respond?
It is recommended that the human papillomavirus (HPV) vaccination be given to males aged 13 to 21 years who have not previously received the HPV vaccination or who have not completed the three-dose series.
43
An advanced practice registered nurse (APRN) in a large accountable care organization (ACO) sees patients of many different cultures and ethnic backgrounds and wants to ensure each patient's values and perspectives are acknowledged.
Which form of ongoing training is required to meet this goal?
Cultural sensitivity and awareness training
44
A 40-year-old female patient is being seen in the primary care clinic for an annual exam and wants to arrange any preventative screenings needed for her age. The advanced practice registered nurse (APRN) conducts a blood pressure (BP) screening and orders laboratory tests to evaluate blood glucose and cholesterol level.
Which additional screening should the APRN order for this patient?
A mammography screening for women, with or without a clinical breast examination, is recommended every two years for women age 40 through age 74.
45
A 48-year-old patient who recently immigrated to the United States, comes to the office for an evaluation of their recently diagnosed diabetes mellitus (DM). The patient is fluent in written and verbal English. However, during the teaching session planning, the advanced practice registered nurse (APRN) notices the patient appears disengaged and rarely makes eye contact during the session. The APRN recognizes that health literacy components need to be incorporated into the presentation.
How should the APRN plan to collect assessment information from this patient?
Ask for clarification on the cultural context for the planned treatment. If a patient is a recent immigrant, the cultural conflicts are more common in planned treatment.
46
An adult patient is being assessed by an advanced practice registered nurse (APRN). During the exam, the APRN witnesses the patient suddenly losing consciousness.
Which action should the APRN take first to assist this patient?
This represents an emergency and the first priority is to check for a pulse. If the APRN does not definitely feel a pulse, cardiopulmonary resuscitation (CPR) should be started.
47
An 18-year-old patient is being evaluated by an advanced practice registered nurse (APRN) because of a severe sore throat, difficulty swallowing, and a fever of 102°F (38.9°C). Upon visual inspection of the throat, purulent drainage is noted behind the right tonsil. A diagnosis of peritonsillar abscess is suspected.
Which referral should the APRN make?
To an emergency department. A peritonsillar abscess (PTA) is an accumulation of pus within the peritonsillar tissues, between the tonsil and the pharyngeal constrictor muscle. This should be considered an emergency and surgical intervention would likely be required with needle aspiration, incision and drainage, or tonsillectomy.
48
A 45-year-old patient comes to the clinic complaining of generalized malaise, fever, productive cough, and intermittent chest pain with respiration that began two days before. The symptoms have increased in severity and have not improved with the use of over-the-counter (OTC) pain and cold medication. There is no history of current or past smoking, and the patient is not on any routine medications.
Assessment data reveals a temperature of 102°F (38.9°C); pulse of 86 beats per minute; and respirations of 24 breaths per minute. Decreased breath sounds with wheezing noted bilaterally with dullness to lung percussion are present. The advanced practice registered nurse (APRN) suspects bacterial community-acquired pneumonia.
Which chest X-ray finding supports the APRN's suspicions?
Alveolar consolidation and pleural effusion seen on a chest X-ray would confirm the diagnosis of bacterial community-acquired pneumonia.
49
Which method of treatment is used for traumatic pneumothorax?
Tube thoracostomy
Placement of a small-bore catheter
Needle aspiration of the pneumothorax
Observation for spontaneous resolution
Tube thoracotomy in trauma, a small bore or needle may be considered in minor simple pneumothorax
50
Which diagnostic test will confirm the presence of a pulmonary embolism (PE) in a patient who has undergone surgical immobilization for a femur fracture and reports dyspnea and chest pain with inspiration and has a heart rate of 120 beats per minute?
CT Angiography
ABGs guide oxygen therapy, and D-Dimer/EKG can rule out other
51
Which initial treatment will be helpful for a patient who is diagnosed with mild restless leg syndrome (RLS) that occasionally interferes with sleep?
Supplemental iron
A dopaminergic agonist
A continuous positive airway pressure (CPAP) device
Hot baths and exercise
Patients with mild restless leg syndrome (RLS) may benefit from massage, hot baths, exercise, and good sleep hygiene.
52
A patient reports abdominal and back pain with anorexia and nausea. During an examination, the primary care provider notes a pulsatile abdominal mass.
What is the provider's initial action?
This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by ultrasound. After a size is estimated, referral to surgery or the ED may be needed.
53
During a routine health maintenance examination, the primary care provider auscultates a carotid bruit. The patient denies syncope, weakness, or headache.
What will the provider do, based on this finding?
Carotid duplex ultrasound is the primary diagnostic tool for carotid stenosis. A carotid bruit in an asymptomatic patient is an indication for this test.
54
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The primary care provider administers a nitroglycerin tablet which does not relieve the discomfort.
What is the provider's next action?
Patients with these symptoms who do not respond to nitroglycerin are likely to have microvascular angina. Treatment is effective with beta blockers.
55
A patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision, nausea, and shortness of breath. The primary care provider notes a blood pressure of 185/115.
What is the recommended initial action for this patient?
Patients with a blood pressure >180/120 or those with signs of target organ symptoms should be admitted to inpatient treatment with specialist consultation.
56
Which medications will be ordered as empiric treatment while blood cultures are pending for a patient who has native valve endocarditis?
The most common organism in native valve endocarditis (NVE) is S. aureus; until resistance is known, treatment with penicillin and an aminoglycoside is needed, although most strains causing NVE are not penicillin-resistant.
57
Which laboratory test has the highest predictive value in diagnosing heart failure due to myocarditis?
B-type natriuretic peptide is highly sensitive and specific in diagnosing heart failure due to myocarditis.
58
A 75-year-old patient reports pain and a feeling of tiredness in both legs that is only relieved after sitting for 30 minutes or more.
What does the primary care provider suspect is causing these symptoms?
Buerger disease
Peripheral arterial disease
Cauda equina syndrome
Diabetic neuropathy
Patients with cauda equina syndrome, which causes spinal stenosis, will often not get symptom relief until they sit down for a period of time.
PAD would result in pain at rest, Buerger disease involves all limbs
59
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The primary care provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver.
Which cause will the provider suspect for this murmur?
Hypertrophic cardiomyopathy is characterized by murmurs on the left sternal border than change in intensity when the patients moves or bears down
60
What is the priority intervention for a patient who has a history of diverticular disease and has left-sided pain and reports seeing blood in the stool?
Referring the patient for a lower endoscopy
Prescribing an antispasmodic medication
Reminding the patient to eat a high-fiber diet
Ordering a CBC and stool for occult blood
Patients with suspected diverticular abscess or rectal bleeding need further evaluation and a referral for a lower endoscopy is warranted
61
When a patient reports experiencing chronic chest pain that occurs after meals, the primary care provider suspects gastroesophageal reflux disease (GERD) and prescribes a proton pump inhibitor (PPI). After two months, the patient reports improvement in symptoms.
What is the next action in treating this patient?
Often the effectiveness of treatment with a PPI is diagnostic and is equal to or better than more invasive and expensive testing. If the patient continues to show improvement, the patient is weaned off of the PPI. Most patients do well and there is no need to order tests or refer for evaluation. If patients do not do well, further testing is needed.
62
If a patient has both occasional "coffee ground" emesis and melena stools, then _______ bleeding is the most probable source.
Coffee ground emesis is usually old blood from an upper GI source, and melena is black, shiny, foul-smelling as a result of blood degradation and is usually upper GI in origin.
63
A recovering chronic alcoholic reports nausea, vomiting, diarrhea, and abdominal discomfort. A physical examination is negative for jaundice or ascites.
What will the primary care provider do initially?
Refer the patient to a specialist for evaluation and treatment
Order a complete blood count and liver function tests
Obtain a bilirubin level and prothrombin time
Reassure the patient that this is likely a viral gastroenteritis
Patients with alcoholic hepatitis may present initially with signs of gastroenteritis. Based on the history, even without jaundice and ascites, the provider should order a CBC and LFTs.
64
If a patient has an elevated indirect bilirubin, _________ may be the cause.
Indirect, or unconjugated, bilirubin is often associated with an increase in the destruction of RBCs, as with hemolytic anemia.
Direct bilirubin elevation is seen in alcohol cirrhosis or viral causes
65
A patient who is a chronic alcoholic reports weight loss, pruritus, and fatigue, and the primary care provider suspects cirrhosis of the liver. The patient’s urine and stools appear normal.
What do these findings indicate?
Liver failure and ascites
Early liver cirrhosis
Late liver cirrhosis
Viral hepatitis
Early symptoms of cirrhosis are characterized by this patient’s symptoms.
66
An adult develops chronic cough with episodes of wheezing and shortness of breath. The primary care provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes.
Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms?
Spirometry is used to confirm asthma.
67
Which test is most diagnostic for chronic obstructive pulmonary disease (COPD)?
Lung radiograph
COPD assessment test
Spirometry for FVC and FEV1
Forced expiratory time maneuver
Spirometry testing is the gold standard for diagnosis and assessment of COPD because it is reproducible and objective.
68
What is the recommended treatment for a 70-year-old male patient with an aortic aneurysm measuring 5.0 cm, poorly-controlled hypertension, and decompensated heart failure?
Immediate open surgical repair of the aneurysm
Endovascular stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm
No intervention is necessary for this patient
This patient’s aneurysm is less than 5.5 cm, so repair is not necessary at this time. Serial ultrasonic surveillance of the aneurysm is necessary to continue to evaluate its size.
69
An adult patient reports frequent episodes of syncope and lightheadedness. The primary care provider notes a heart rate of 70 beats per minute.
What will the provider do next?
Evaluate the patient’s orthostatic vital signs
70
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia, and does not take any medications.
What will the primary care provider do next to evaluate this patient?
Refer to a specialist for a sleep study
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN, and creatinine
This patient has prehypertension levels and should be evaluated. UA, CBC, BUN, and creatinine help to evaluate renal function and are in the initial workup.
71
A previously healthy patient develops myocarditis and presents with sudden onset of dyspnea, fatigue, and orthopnea. A family history is negative. The primary care provider suspects myocarditis.
What is the most likely etiology for this patient?
Viral infection is the most common cause of myocarditis.
72
A patient is diagnosed with peripheral arterial disease (PAD) and elects not to have angioplasty after an angiogram reveals partial obstruction in the patient's lower extremity arteries.
What will the primary care provider recommend to help with relief of symptoms in this patient?
Walking to the point of pain each day
73
What is the best treatment for H. pylori-related peptic ulcer disease?
PPI, amoxicillin, and clarithromycin for 10 days
PPI and clarithromycin for 14 days
H2RA, bismuth, metronidazole, and tetracycline for 14 days
H2RA and clarithromycin for 14 days
A PPI and clarithromycin for 14 days has documented improved effectiveness over other regimens in treating H. pylori-related peptic ulcer disease.
74
A 50-year-old, previously healthy patient has developed chronic gastritis.
What is the most likely cause of this condition, assuming the patient is from the United States?
In the United States, H. pylori accounts for nearly 100 percent of chronic superficial gastritis and approximately 90 to 95 percent of duodenal ulcers and 89 percent of gastric ulcers.
75
Which medication will be prescribed initially for a patient who is diagnosed with ulcerative colitis (UC)?B
Budesonide
Azathioprine
Sulfasalazine
Infliximab
Sulfasalazine is a 5-aminosalicylic acid used to induce remission in UC and is a first-line medication.
76
A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum.
What may be prescribed to help with the patient's symptoms?
Antitussive medications are occasionally useful for short-term relief of coughing.
77
Pneumonia Treatment
Usually - Doxycycline OR Azithromycin OR Clarithromycin
Comorbid disease or facility resident or had Abx in last 3 months - Moxifloxacin OR Levofloxacin
Usually 5-7 day run of antibiotics
May consider Macrolide plus amoxicillin/augmentin/cephalosporin
78
A previously healthy young adult clinic patient has symptoms of pneumonia, including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum.
Which treatment is recommended for this patient?
This patient likely has community-acquired pneumonia. The patient has typical symptoms and, even though the chest radiograph is normal, will require outpatient treatment. For community-acquired pneumonia in a previously healthy individual, treatment with a macrolide antibiotic is the recommended first-line therapy.
79
What causes pleural effusions? (Choose three.)
Breast cancer
Bronchiectasis
Allergies
Dehydration
Congestive heart failure
Breast cancer can cause pleural effusions due to cancer cells spreading to the pleural spaces. Bronchiectasis can cause pleural effusions as it causes a buildup of fluid in the lung. Congestive heart failure can cause pleural effusions as it can cause fluid in the lung.
80
What are signs and symptoms of ARDS? (Choose three.)
Low blood pressure
Wheezing
Bradycardia
Fever
Fast, shallow breathing
Low blood pressure, fever, and fast, shallow breathing are signs of ARDS. Other signs and symptoms include shortness of breath; tachycardia; productive cough; cyanotic lips, skin, and fingernails; confusion; fatigue; crackling, bubbling, or rattling sounds in the lungs; and chest pain, especially when taking deep breaths.
81
An adult patient has intermittent, crampy abdominal pain with vomiting. The primary care provider notes marked abdominal distention and hyperactive bowel sounds.
What will the provider initially do?
Obtain upright and supine radiologic views of the abdomen
Prescribe an antiemetic and recommend a clear liquid diet for 24 hours
Schedule the patient for a barium swallow and enema
Admit the patient to the hospital for consultation with a surgeon
If available, the primary care provider can order radiographic studies of the abdomen and chest. Once small bowel obstruction is confirmed or suspected, immediate hospitalization with surgeon referral is necessary
82
A patient develops acute diarrhea and then comes to the clinic two weeks later reporting profuse watery, bloody diarrheal stools six to eight times daily. The primary care provider notes a toxic appearance with moderate dehydration.
Which test is indicated to diagnose this patient?
Stool sample for C. difficile toxin
Wright stain of stool for white blood cells
Qualitative and quantitative fecal fat
Stool collection for 24-hour stool pH
Patients with acute onset diarrhea lasting more than two weeks with profuse, watery, bloody stools of more than six times in a 24-hour period warrants testing for C. difficile toxin.
83
Describe the advantage achieved by obtaining the patient's urine amylase levels in addition to his serum amylase levels.
Serum levels of amylase rise transiently but usually return to normal 1-2 days after resolution of the acute phase of disease. Levels of amylase in the urine, however, remain elevated 5-7 days after onset of disease. This is an important indicator of pancreatitis in patients who have had symptoms for three days or longer.
84
Which procedure will be used for a patient with a previous history of liver disease who has bile duct obstruction?
Open cholecystectomy
Laparoscopic cholecystectomy
Lithotripsy
Chemical dissolution of the gallstone
Patients with possible liver disease should have open cholecystectomy.
85
An advanced practice registered nurse (APRN) in a large accountable care organization (ACO) sees patients of many different cultures and ethnic backgrounds and wants to ensure each patient's values and perspectives are acknowledged.
Which form of ongoing training is required to meet this goal?
Ensuring that the care plan is based on the ethnicity of patients
Cultural disparity education
Ensuring that personal ethnic assumptions are reflected in the care plan
Cultural humility education
Cultural humility is an ongoing process requiring continued training and practice.
86
What will the primary care provider recommend for an asymptomatic female who is concerned about having come into contact with sexually transmitted gonorrhea and asks about antibiotics?
Trimethoprim-sulfamethoxazole
Cultures and treatment if symptoms appear
Amoxicillin-clavulanate for 10 days
Empirical ceftriaxone and azithromycin
Patients with gonorrhea usually have chlamydia as well, so treatment with both ceftriaxone and azithromycin is recommended.
87
Describe the point at which the renal function tests would have signified the need for dialysis in an adult patient.
In general, when the creatinine clearance in adults is less than 10-12 cc/min, dialysis is recommended.
In older patients, dialysis is recommended when the creatinine is greater than 10 mg/dL
88
A patient has acute renal colic, nausea, and vomiting, and a urinalysis reveals hematuria, but is otherwise normal. A radiographic exam shows several radiopaque stones in the ureter which are less than 1 mm in diameter. What will the primary care provider initially do to manage this patient?
Prescribe nifedipine and hospitalize the patient for intravenous antibiotics
Order a narcotic pain medication and increased oral fluids
Obtain a consultation with a urology specialist
Prescribe desmopressin and a corticosteroid medication
Stones that are less than 1 mm in diameter will usually pass spontaneously. The provider should counsel the patient to increase fluid intake and should prescribe adequate pain medication.
89
Which type of rash is suspected for a patient who is taking a sulfonamide antibiotic and develops a rash that begins peeling?
Urticaria
Erythema multiforme
Wheal and flare
Stevens-Johnson
Stevens-Johnson syndrome (SJS) rash typically peels in sheets, and is most strongly associated with sulfonamides, although other antibiotics and drugs may cause SJS
90
An adult patient has greasy, scaling patches on the forehead and eyebrows suggestive of seborrheic dermatitis.
Which actions are included in assessment and management of this patient's condition? (Choose two.)
Begin first-line treatment with a topical antifungal medication
Use topical steroids for several weeks to prevent recurrence of symptoms
Evaluate the scalp for dry, flaky scales and treat with selenium sulfide shampoo
Teach the patient that proper treatment is curative in most instances.
Topical antibacterial medications may be used to prevent Malassezia proliferation
First-line therapy for seborrheic dermatitis may include topical antifungals or corticosteroids. Adults with symptoms on the face or eyebrows are likely to have scalp lesions, since seborrheic dermatitis is usually a "top-down" disorder.
91
What is the primary goal of treatment for stasis dermatitis?
To decrease venous blood return
To reduce effects of venous hypertension
To increase the deposition of fibrin around capillaries
To reduce effects of venous hypotension
Decreasing venous hypertension by promoting venous blood return is the primary goal of treatment for stasis dermatitis.
92
A patient presents to the clinic with new onset urticaria and angioedema after sampling various food items at a local supermarket.
What is the priority assessment?
Auscultate the patient's lungs
Ask about previous allergic reactions
Determine which foods were sampled
Examine the patient's skin
The priority assessment when a patient presents with urticaria with or without angioedema is to rule out anaphylaxis.
93
What is the initial treatment of an uncomplicated corn on the medial aspect of the metatarsophalangeal joint of the right foot?
Recommend trying an over-the-counter corn solution along with warm Epsom salt soaks
Refer the patient to a podiatrist for evaluation and treatment
Pare down the lesion with a No. 15 scalpel, apply salicylic acid plaster over the lesion for two to three days, and then pare down the lesion further with a No. 15 scalpel
Recommend keratolytic agents for use at home, and foot pads to protect the area from friction
Generally, initial treatment of corns includes recommending shoes with sufficient space in the toe box, use of socks, keratolytic agents to remove excess skin, and padding over the corn to protect the skin from friction.
94
A patient has nasal congestion, fever, purulent nasal discharge, headache, and facial pain and begins treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the patient continues to have purulent discharge, congestion, and facial pain without fever.
What is the next course of action for this patient?
A referral to an otolaryngologist
A CT scan of the paranasal sinuses
A trial of azithromycin
Treatment failure is seen in patients who do not have symptom improvement and the provider has reconfirmed the diagnosis of acute bacterial rhinosinusitis (ABRS) and assessed for complications. In these patients, the choice of antibiotic treatment is based on likely resistant organisms. The lack of fever shows improvement, so this antibiotic may be used.
95
A patient comes in with seasonal rhinitis symptoms. Allergy testing reveals a sensitivity to various trees and grasses. What is this first-line treatment for this patient?
Intranasal steroids
Intranasal cromolyn
Antihistamine spray
Oral antihistamines
Intranasal steroids are the mainstay of treatment and are the most effective medication for preventing rhinitis symptoms.
96
A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. What is the initial course of action by the primary care provider?
Prescribe amoxicillin and refer to a dentist in two to three days
Recommend oral antiseptic rinses and follow-up in one week
Perform an incision and drainage of the edematous tissue
Refer to an oral surgeon for emergency surgery
The primary care provider may prescribe antibiotics, especially if the surrounding tissues are infected. Patients should follow up with a dentist in two to three days.
97
What is required to diagnose a patient who has gingival inflammation with several areas of ulceration and a small amount of purulent discharge?
Culture and sensitivity
Tzanck smear
Microscopic exam of oral scrapings
Physical examination
his patient has symptoms consistent with gingivitis, which may be diagnosed by physical examination alone.
98
An adult develops chronic cough with episodes of wheezing and shortness of breath. The primary care provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes.
Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms?
Spirometry
Allergy testing
Methacholine challenge test
Peak expiratory flow rate
Spirometry
99
Which test is most diagnostic for chronic obstructive pulmonary disease (COPD)?
Spirometry FVC and FEV1
100
What is the recommended treatment for a 70-year-old male patient with an aortic aneurysm measuring 5.0 cm, poorly-controlled hypertension, and decompensated heart failure?
This patient’s aneurysm is less than 5.5 cm, so repair is not necessary at this time. Serial ultrasonic surveillance of the aneurysm is necessary to continue to evaluate its size.
101
An adult patient reports frequent episodes of syncope and lightheadedness. The primary care provider notes a heart rate of 70 beats per minute.
What will the provider do next?
Assess orthostatic vital signs, then consider an EKG
102
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia, and does not take any medications.
What will the primary care provider do next to evaluate this patient?
Refer to a specialist for a sleep study
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN, and creatinine
This patient has prehypertension levels and should be evaluated. UA, CBC, BUN, and creatinine help to evaluate renal function and are in the initial workup.
103
A previously healthy patient develops myocarditis and presents with sudden onset of dyspnea, fatigue, and orthopnea. A family history is negative. The primary care provider suspects myocarditis.
What is the most likely etiology for this patient?
Viral infection is the most common cause
104
A patient is diagnosed with peripheral arterial disease (PAD) and elects not to have angioplasty after an angiogram reveals partial obstruction in the patient's lower extremity arteries.
What will the primary care provider recommend to help with relief of symptoms in this patient?
Walking to the point of pain each day
105
A 50-year-old, previously healthy patient has developed chronic gastritis.
What is the most likely cause of this condition, assuming the patient is from the United States?
H. pylori
106
Which medication will be prescribed initially for a patient who is diagnosed with ulcerative colitis (UC)?
Infliximab
Sulfasalazine
Budesonide
Azathioprine
Sulfasalazine is a 5-aminosalicylic acid used to induce remission in UC and is a first-line medication.
107
What is the best treatment for H. pylori-related peptic ulcer disease?
H2RA, bismuth, metronidazole, and tetracycline for 14 days
PPI and clarithromycin for 14 days
H2RA and clarithromycin for 14 days
PPI, amoxicillin, and clarithromycin for 10 days
A PPI and clarithromycin for 14 days has documented improved effectiveness over other regimens in treating H. pylori-related peptic ulcer disease.
108
n advanced practice registered nurse (APRN) is working with a patient who has had recurrent cystitis. The patient has implemented many changes, including drinking cranberry juice, increasing water intake, urinating after intercourse and discontinued use of a diaphragm, and replacing with oral contraceptives. In discussion with the patient, the APRN learns that the cystitis symptoms seem to be linked to frequency of intercourse.
Which order should the APRN make for prophylactic treatment?
Ciprofloxacin 125 mg within 24 hours of intercourse
Ofloxacin 100 mg qd x2 to begin one day before intercourse
Nitrofurantoin 50 mg qd x2 to begin one day before intercourse
Cephalexin 500 mg within 24 hours of intercourse
Prophylactic pharmacotherapy for postcoital cystitis is recommended. Ciprofloxacin 125–250 mg within 24 hours of intercourse is appropriate.
109
A daycare worker is assessed by an advanced practice registered nurse (APRN) due to complaints of sudden-onset of scattered macular and vesicular lesions on the palms and between fingers, arms, and soles of the feet, buttocks, and legs. The patient has a temperature of 101.2°F (38.4°C). The APRN diagnoses hand, foot, and mouth disease.
Which action should the APRN take to assist this patient?
Start drinking warm liquids
Increase fluid intake
Decrease fluid intake
Start using calamine lotion
With hand, foot, and mouth disease, fluid intake should be increased to alleviate dehydration.
110
A 35-year-old patient meets with an advanced practice registered nurse (APRN) to discuss a low back pain that began three days earlier and has never occurred before. The pain and stiffness intensifies after sitting for long periods of time, and the patient is concerned about the problem impacting work.
Which action should the APRN take first to assist this patient?
The natural process of low back pain is that most cases will resolve in a timely manner. The patient needs reassurance of this and should be permitted to return to work. If it becomes chronic, consider imaging or use of ergonomic solutions
111
A patient presents to the clinic with a sudden onset of fever, chills, headache, and malaise during the winter months. Upon assessment, the advanced practice registered nurse (APRN) notes a temperature of 103°F (39.4°C), clear nasal discharge, a dry cough, and enlarged cervical lymph nodes. Abdominal exam reveals no splenomegaly.
Which diagnosis should the APRN suspect for this patient?
Influenza is an acute infection of the respiratory tract that occurs primarily during the winter months. Symptoms include fever, chills, headache, malaise, clear nasal discharge, a dry cough, and enlarged cervical lymph nodes.
112
An adult patient with chronic obstructive pulmonary disease (COPD) is seen by an advanced practice registered nurse (APRN) with complaints of a productive cough that is worse in the morning and improves throughout the day.
The patient reports smoking a half a pack of cigarettes each day for the past 15 years. Assessment results include a respiratory rate of 30 breaths per minute with rhonchi and wheezing bilaterally. The spirometry results reveal the FEV1 is 65%, and the FVC is 45%.
How should the APRN classify this patient's stage of COPD?
Moderate (FEV1 <70)
Mild is less than 80, moderate less than 70, mod-severe less than 60, severe less than 50
113
An advanced practice registered nurse (APRN) is assessing a patient who presents to the clinic with complaints of morning cough, sputum production, and dyspnea with activity for the last three months. Vital signs are within normal limits. Chest X-ray is unremarkable. Office spirometry is conducted and pre- and post-bronchodilator administration shows no improvement with expiratory and capacity values of less than 70%.
Which diagnosis should be suspected by the APRN?
COPD presents with morning cough, sputum production, and increasing dyspnea with activity. The spirometry results post-bronchodilator administration with expiratory and capacity values of less than 70% indicate COPD.
114
A patient arrives at a clinic for a regularly scheduled visit. During the examination, the patient shares that they have been experiencing angina, radiating pain, and tingling and numbness in the right hand over the past week. The advanced practice registered nurse (APRN) establishes that the patient is not in acute distress but suspects the patient has coronary artery disease.
Recommend that the patient have a cardiac catheterization test
Conduct a thorough history and physical examination
Schedule the patient for a myocardial perfusion imaging test
Ascertain the family history of coronary artery disease and diabetes
The optimum assessment of coronary artery disease (CAD) is a thorough history and physical examination that includes prior medical history of myocardial infarction (MI) or CAD and the patient's present complaints, such as angina, radiating pain, tingling, or numbness.
115
A patient is being evaluated by an advanced practice registered nurse (APRN) for a follow-up visit after being discharged from the hospital for a transient ischemic attack (TIA).
Which action should the APRN perform as part of the patient’s long-term treatment plan?
A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain and may be a warning sign of a future cerebrovascular accident (CVA, stroke). It is important for the patient to be able to recognize and report signs of a stroke.
116
A patient is being evaluated by an advanced practice registered nurse (APRN) about problems with watery, liquid stools. The patient had been on a broad-spectrum antibiotic for two weeks. The APRN suspects a secondary complication.
Which test will confirm the APRN's suspicion?
C. diff infection, a PCR test is needed to confirm this
117
A patient is speaking with an advanced practice registered nurse (APRN) about problems with chronic gastroesophageal reflux disease that is no longer responding to the previously prescribed proton pump inhibitor medication.
Which disease should the APRN suspect in this patient?
Barrett esophagus may be diagnosed in individuals who have long-term gastroesophageal reflux disease (GERD) and who are no longer responding to proton pump inhibitor medication for GERD.
118
A patient reports trembling of both hands causing difficulty performing tasks with the hands. The primary care provider notes symmetric, rhythmic movements which are present at rest and no other neurological findings. A history reveals that the trembling decreases when the patient has a glass of wine with dinner.
What is the initial action to address the symptoms?
Referral to a neurologist
Prescribing a beta blocker medication
Evaluation in an emergency department
Reassurance that these symptoms will subside
This patient has symptoms consistent with essential tremors. Beta blockers are used as initial treatment when the tremor is functionally or socially problematic.
119
What is the recommended treatment for a patient with gout and impaired renal function who uses urate-lowering therapy (ULT) and is experiencing an acute gout flare involving one joint?
Administration of intra-articular corticosteroid
Therapy with NSAIDs begun within 24 hours
Oral colchicine for five days
Discontinuing ULT while treating the flare
Administration of intra-articular corticosteroid. Renal impairment means do not use NSAIDs or Colchicine.
120
What is the recommended treatment once an osteoporosis diagnosis is made?
Estrogen replacement
Yoga and weight-bearing exercises
Calcium and vitamin D
Bisphosphonate therapy
Bisphosphonate therapy should be started as soon as the diagnosis is made to reduce further bone loss. Calcium and Vit D are helpful for at risk / preventative as is exercise.
121
A patient is treated for a urinary tract infection and, three weeks later, presents with pain and swelling of one knee and in one hand, along with inflammation in both eyes.
Reactive arthritis
Infectious arthritis
Psoriatic arthritis
Ankylosing spondylitis
Reactive Arthritis can occur for up to 4 weeks post infection.
122
A patient is diagnosed with rheumatoid arthritis (RA) after a review of systems, confirmatory lab tests, and synovial fluid analysis.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Long-term glucocorticoid therapy
Disease-modifying anti-rheumatic drugs (DMARDs)
Non-pharmacological treatmentsWhat will the primary care provider order initially to treat this patient?
Treatment with DMARDs should be initiated as soon as the diagnosis of RA is established in order to achieve disease modification. This may be started by Primary Care until Rheumatology can see the patient.
123
What is a palpable purpuric rash most consistent with?
Central-vessel vasculitis
Medium-vessel vasculitis
Large-vessel vasculitis
Small-vessel vasculitis
A palpable purpuric rash is the most helpful physical examination finding of a small-vessel vasculitis. Large vessel Vasculitis causes issues in the Aorta / Vena Cava while Medium Vessel Vasculitis causes sores, pain, and lymph swelling.
124
What is recommended to prevent ophthalmic complications in patients with Bell palsy?
Lubricating eye drops and taping the ipsilateral eye closed at night are recommended measures in preventing ophthalmic complications in Bell palsy patients. Exposure keratitis from drying of the eye can result in blindness so lubricating eye drops should be used every two hours.
125
What is the recommended treatment for recurrent headaches occurring one or two times per month that generally occur with weather changes or when sleep patterns are disrupted and are described as severe, with throbbing on one side of the head and sometimes accompanied by nausea?
Topiramate
Gabapentin
Rizatriptan
Propranolol
This patient describes migraine headache without aura and has fewer than four per month. Therefore, an abortive medication, such as rizatriptan is recommended.
126
A patient is diagnosed with multiple sclerosis and begins disease modulating therapy (DMT) drugs.
What will the primary care provider tell the patient about this drug regimen during counseling?
It induces long-term remission.
It stops the progression of the disability.
It decreases the need for other medications.
It reduces the exacerbation rate.
DMT reduces exacerbations / flares of the disease; nothing induces long-term remission in MS
127
A patient with Parkinson disease (PD) has been taking carbidopa-levodopa (Sinemet) with good results, but develops increased dyskinesia. Which drug will be added to this patient’s regimen to help control this symptom?
Benztropine
Ropinirole
Amantadine
Tolcapone
This patient is having Tardive Dyskinesia. Amantadine is an antiviral agent that has antiparkinsonian activity. It is useful for controlling dyskinesia as adjunctive therapy to levodopa and is more effective than anticholinergic drugs.
128
A patient with a seizure disorder has seizures which begin with eye twitching and occasionally visual hallucinations.
Which site in the brain is the seizure focus?
Occipital sites causing complex partial seizures will have visual auras that may begin with eye twitching and visual hallucinations.
129
Which initial diagnostic test will the primary care provider order for a patient who is obese and has recurrent urinary tract infections and reports feeling tired most of the time?
Random serum glucose
C-peptide level
Thyroid studies
Hemoglobin (Hb) A1C
HbA1C, along with fasting plasma glucose or a two-hour plasma glucose during an oral glucose tolerance test (OGTT) are diagnostic of diabetes.
130
Which underlying cause is possible in a patient with normal renal function who has a serum potassium level of 6.0 mEq/L?
Hypertension
Malabsorption syndrome
Alcoholism
Adrenocortical deficiency
Adrenocortical deficiency often causes hyperkalemia
131
What is recommended to manage a patient with type 2 diabetes who has a low-density lipoprotein (LDL) level of 110 gm/dL?
Statin therapy until the LDL level is below 75 mg/dL
Prescription of a moderate or high intensity statin
Initial treatment with a low intensity statin medication
Dietary and lifestyle changes to modify risk
This patient is in one of the four groups of patients identified in current guidelines as one who would benefit from statin therapy because of type 2 diabetes. A moderate to high intensity statin should be prescribed.
132
Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels?
Atorvastin
Aspirin
Niacin
Metformin
Metformin is given to reduce hyperinsulinemia and lower insulin resistance, but also lowers plasma PAI-1 levels.
133
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative.
What is the initial treatment for this patient?
Beta blocker medications
Radioiodine therapy
Surgical resection of the thyroid gland
Thioamide therapy
Beta blockers should be initiated for patients with Graves disease to alleviate the alpha-adrenergic symptoms of hyperthyroidism then consider a Thioamide or refer to endocrine for radioiodine / surgery eval.
134
A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What else is likely to be present?
Decreased MCV, MCH, and MCHC
Decreased hematocrit
Paresthesias, koilonychia, and pica
Elevated total iron-binding capacity (TIBC)
This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level.
135
A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the primary care provider asks about a family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both had post-surgical complications related to bleeding. Which diagnosis is possible, based on this patient's history?
Hemophilia
Thrombophilia
Thrombocytopenia
Von Willebrand disease
Hemophilia is an X-linked recessive disorder affecting only males and carried by females. A family history of maternal males with bleeding disorders should clue the provider that this disorder is likely.
136
A primary care provider sees a new patient who reports having a diagnosis of chronic kidney disease for several years. The patient is taking one medication for hypertension, which has been prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate the status of this patient. Which laboratory finding indicates a need to refer this patient to a nephrologist?
Urine red blood cell (RBC) of 15/hpf
Albumin/creatinine ratio (ACR) of 325 mg/g
Blood pressure of 145/85 mm Hg
Glomerular filtration rate (GFR) of 35
ACR of 300+ indicates significant renal disease and warrants referral, a GFR of 35 indicated stage 3 CKD. and the BP is elevated but wouldn't itself indicate referral
137
A college student is brought to a clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The primary care provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient’s symptoms?
Schedule an appointment with a psychiatrist
Admit the patient for inpatient treatment
Counsel the parent to report any symptoms of depression
Begin treatment with lithium or lamotrigine
Patients with symptoms of mania should begin treatment with a mood stabilizer and the primary care provider should initiate treatment for an acute episode.
138
A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The primary care provider determines that these symptoms occur in relation to many events and concerns. What else will the provider question this patient about?
Body image and eating habits
Occupational performance
Headaches and bowel habits
Ability to manage social situations
This patient has symptoms consistent with generalized anxiety disorder (GAD) in which feelings occur in relation to many events. Patients with GAD often have headaches and irritable bowel syndrome.
