Exam 3: NR 509 / NR509 (2026–2027 Updated) Advanced Physical Assessment | Questions and Answers | Verified Solutions | 100% Accurate | Grade A – Chamberlain

Exam 3: NR 509 / NR509 (2026–2027 Updated) Advanced Physical Assessment | Questions and Answers | Verified Solutions | 100% Accurate | Grade A – Chamberlain Q. Treatment for achalasia may include: 1. Balloon dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy. ANSWERS Balloon dilation of the lower esophageal sphincter. Q. Nausea is difficult to discern in a young child. What question might you ask to determine if a child has nausea? 1. "Are you sick to your tummy?" 2. "Are you hungry?" 3. "Are you eating the way you normally eat?" 4. "Are you nauseous?" ANSWERS "Are you hungry?" Q. Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1. "Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel." 2. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." 3. "Antacids contain caffeine, which decreases bowel transit time." 4. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel." ANSWERS "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel." Q. When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1. Eat foods higher in carbohydrates. 2. Eat 3 large meals plus 3 snacks per day. 3. Eat foods with a moderate fat and protein content. 4. Drink fluids with each meal. ANSWERS Eat foods with a moderate fat and protein content. Q. Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? 1. Ursodiol (Actigall). 2. Ibuprofen (Advil). 3. Prednisone (Deltasone). 4. Surgery is the only answer. ANSWERS Ursodiol (Actigall). Q. You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1. Peritonitis. 2. A liver or spleen abscess. 3. A liver or spleen metastatic tumor. 4. Irritable bowel syndrome. ANSWERS Irritable bowel syndrome. Q. Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she: 1. Needs to begin the hepatitis B series as soon as possible. 2. Needs to be tested again because one reading is not indicative of immunity. 3. Is permanently immune to hepatitis B. 4. Has an acute hepatitis B infection. Is permanently immune to hepatitis B. Q. Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you she is sure it is going to be malignant. How do you respond? 1. "Don't worry. Gastric ulcers are not cancerous." 2. "About 95% of gastric ulcers are benign." 3. "You have about a 50% chance of having gastric cancer from your ulcer." 4. "Even if it is cancer, surgery is 100% successful." ANSWERS "About 95% of gastric ulcers are benign." Q. Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1. "Occasionally he accumulates blood in the gut." 2. "There is an interruption of the normal clotting mechanism." 3. "Long-term alcohol abuse has made his vessels very friable." 4. "His bone marrow has been affected." ANSWERS "There is an interruption of the normal clotting mechanism." Q. In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for: 1. Decreased peripheral perfusion. 2. Hyperventilation. 3. Irritability. 4. Hyperthermia. ANSWERS Decreased peripheral perfusion. Q. What is the recommended treatment to eradicate a Helicobacter pylori infection? 1. Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3. Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4. Bismuth, doxycycline, metronidazole, and ranitidine. ANSWERS Amoxicillin, clarithromycin, and omeprazole for 2 weeks. Q. he screening guidelines for colon cancer recommend which of the following for the general population? 1. Colonoscopy starting at age 50. 2. Colonoscopy starting at age 45. 3. Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4. Fecal occult blood test (FOBT) and rectal exam starting at age 45. ANSWERS Colonoscopy starting at age 50. Q. Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1. Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2. Drink at least 2000 mL of fluids per day. 3. Decrease her dietary fiber for 1 month. 4. Take stool softeners as prescribed. ANSWERS Decrease her dietary fiber for 1 month. Q. Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction. ANSWERS As having metabolic syndrome. Q. Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1. A gastric ulcer. 2. Gastritis. 3. Pelvic inflammatory disease. 4. Pancreatitis. ANSWERS Pelvic inflammatory disease. Q. You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? 1. Rovsing sign. 2. Psoas sign. 3. Obturator sign. 4. McBurney sign. ANSWERS Obturator sign. Q. Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1. Appendicitis. 2. Gastroenteritis. 3. Acute pancreatitis. 4. Rocky Mountain spotted fever. ANSWERS Appendicitis A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms? 1. Botulism. 2. Salmonella. 3. Lyme disease. 4. Vitamin C deficiency. Botulism. A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1. Internal hemorrhoid. 2. External hemorrhoid. 3. Bleeding peptic ulcer. 4. Rectal fissure. Internal hemorrhoid. Which gastrointestinal disease below could theoretically be completely eradicated with a total colectomy? 1. Crohn's disease. 2. Irritable bowel syndrome. 3. Ulcerative colitis. 4. Celiac disease. Ulcerative colitis. . Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? 1. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea. 2. Nocturnal perianal and perineal pruritus. 3. Diarrhea, cramps, and malaise. 4. Ascites and facial and extremity edema. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: 1. Anxiety and panic attacks. 2. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Infection by Helicobacter pylori. 4. A family history of peptic ulcers. Infection by Helicobacter pylori. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1. Appendicitis. 2. Crohn's disease. 3. Cholecystitis. 4. Irritable bowel syndrome. Cholecystitis. What is the most common bacterial cause of traveler's diarrhea? 1. Escherichia coli. 2. Campylobacter jejuni. 3. Salmonella. 4. Shigella. Escherichia coli. A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and inferior to his rib cage. It disappears when he is sitting up fully. What is the patient's diagnosis? 1. Ventral (epigastric) hernia. 2. Inguinal hernia. 3. Femoral hernia. 4. Umbilical hernia. Ventral (epigastric) hernia. What is the best diagnostic test to confirm the diagnosis of celiac disease? 1. Anti-tTG IgA. 2. Anti-dsDNA. 3. Colonoscopy. 4. Anti-CCP protein. Anti-tTG IgA. The metabolism of which drug is not affected in Marsha, age 74? 1. Alcohol. 2. Anticonvulsants. 3. Psychotropics. 4. Oral anticoagulants. Alcohol. Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? 1. Incubation. 2. Prodromal. 3. Icteric. 4. Convalescent. Icteric. Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may: 1. Develop diarrhea. 2. Lose too much weight. 3. Develop hemorrhoids. 4. Vomit after she eats. Develop diarrhea. Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1. Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2. Eat smaller meals. 3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4. Stop smoking. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1. Inguinal hernia. 2. Epigastric hernia. 3. Umbilical hernia. 4. Incisional hernia. Epigastric hernia You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3. Amoxicillin (Amoxil) and omeprazole (Prilosec). 4. Clarithromycin (Biaxin) and metronidazole (Flagyl). A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). Icterus due to hyperbilirubinemia is seen when the serum level of bilirubin is greater than? 1. 2.5 mg/dL. 2. 1.0 mg/dL. 3. 2.0 mg/dL. 4. 0.5 mg/dL. 2.5 mg/dL. What would you expect to see on an abdominal series that would lead toward a diagnosis of small-bowel obstruction? 1. Air-fluid levels. 2. A lead pipe colon. 3. Free air under the diaphragm. 4. Steeple sign. Air-fluid levels. Which of the following is the most common cause of acute pancreatitis? 1. Gallstone obstruction of the pancreatic duct. 2. Alcoholism. 3. Hypertriglyceridemia. 4. Gallstone obstruction of the pancreatic duct and alcoholism. Gallstone obstruction of the pancreatic duct and alcoholism. You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have: 1. Yogurt. 2. Foods containing whey. 3. Prehydrolyzed milk. 4. Oranges. Foods containing whey. . Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1. Campylobacter jejuni. 2. Clostridium botulinum. 3. Clostridium perfringens. 4. Staphylococcus. Clostridium botulinum Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli. Cryptosporidiosis Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1. "Do not donate blood until one year after diagnosis." 2. "Abstain from sex altogether." 3. "There is no possibility of transmission through razors or toothbrushes." 4. "Abstain from sex during your period." "Abstain from sex during your period." Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1. Left-sided pleural effusion. 2. Bluish discoloration over the flanks. 3. Bluish discoloration around the umbilicus. 4. Jaundice. Bluish discoloration over the flanks Which of the following is not true regarding hepatitis C? 1. The greatest rate of infection in the general population is seen in people born between 1945 and 1965. 2. Many hepatitis C infections are asymptomatic. 3. Hepatitis C is seen more frequently in men than women. 4. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer. A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD? 1. Order an endoscopy. 2. Order a Helicobacter pylori blood test. 3. Try adding ranitidine to the patient's regimen. 4. Try adding bismuth to the patient's regimen. Order an endoscopy Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1. Antibiotics. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Oral contraceptives. 4. Antifungals. Nonsteroidal anti-inflammatory drugs (NSAIDs). You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1. Cirrhosis. 2. Inflammation of the kidney. 3. Inflammation of the spleen. 4. Peritonitis. Inflammation of the kidney. Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? 1. Sedimentation rate. 2. Liver enzyme levels. 3. Vitamin A, B complex, and C levels. 4. Bilirubin level. Vitamin A, B complex, and C levels. You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will: 1. Decrease her fat intake. 2. Increase her fiber intake. 3. Continue her daily use of aspirin. 4. Increase her fluid intake. Increase her fluid intake. Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? 1. Enterococci. 2. Escherichia coli. 3. Klebsiella. 4. Staphylococci. Escherichia coli. To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? 1. Crohn disease. 2. Ulcerative colitis. 3. Infectious colitis. 4. Ischemic colitis. Crohn disease. Which of the following medications/drugs are not known to cause heartburn or dyspepsia? 1. Alcohol. 2. Motrin. 3. Prednisone. 4. Tylenol. Tylenol. A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1. Appendicitis. 2. Cholecystitis. 3. Constipation. 4. Gastroenteritis. Appendicitis. Which is the most common presenting symptom of gastric cancer? 1. Weight loss. 2. Dysphagia. 3. Hematemesis. 4. Gastrointestinal bleeding. Weight loss. Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1. Cheese. 2. Leafy green vegetables. 3. Raw fruits and vegetables. 4. Dried beans. Cheese. When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1. Eat foods higher in carbohydrates. 2. Eat 3 large meals plus 3 snacks per day. 3. Eat foods with a moderate fat and protein content. 4. Drink fluids with each meal. Eat foods with a moderate fat and protein content. A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient? 1. Sigmoidoscopy. 2. Abdominal series. 3. Computed tomography (CT) scan with oral contrast. 4. Abdominal ultrasound. Computed tomography (CT) scan with oral contrast. Which of the following is not a risk factor for cholecystitis? 1. Female gender. 2. Obesity. 3. Sickle cell anemia. 4. Younger age. Younger age. All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1. Anticholinergics, such as scopolamine (Donnatal). 2. Antidopaminergic agents, such as prochlorperazine (Compazine). 3. Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4. Tetrahydrocannabinols, such as dronabinol (Marinol). Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1. Constipation. 2. Colorectal cancer. 3. Irritable bowel syndrome. 4. Acute appendicitis. Colorectal cancer. Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? 1. Metronidazole (Flagyl). 2. Supportive care. 3. Quinolone antibiotics. 4. Gastric lavage. Supportive care. Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1. Age. 2. Infection. 3. Pain. 4. Length of time between exacerbations. Infection. A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of the following do you initially rule out? 1. Rocky Mountain spotted fever. 2. Measles. 3. Appendicitis. 4. A food allergy. Appendicitis. Sally, age 21, is to undergo a tonsillectomy. She has heard about permanent taste changes after a tonsillectomy. What do you tell her? 1. " As the tongue is responsible for sweet, sour, salty, and bitter taste abilities, they will all be affected somewhat." 2. "You will have some alterations, but we'll have to wait and see how you are affected personally." 3. "You may notice a slight difference initially, but there are no lasting changes in taste." 4. "About half of the patients have some permanent alterations in the sense of taste." "You may notice a slight difference initially, but there are no lasting changes in taste." Your client's 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child's diarrhea, how do you respond? 1. "She must be lactose intolerant from the formula, and this is altering the fluid balance." 2. "Her body's telling you that it's time to introduce some solids into her system." 3. "The virus is causing irritation of the gastrointestinal lining, which causes diarrhea." 4. "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients." The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients." Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1. "You should have two to three stools per day." 2. "You should defecate once a day." 3. "You should have at least three stools per week." 4. "There is no such thing as a 'normal' pattern of defecation." "There is no such thing as a 'normal' pattern of defecation." Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? 1. Vitamin B12. 2. Iron. 3. Folic acid. 4. Calcium. Folic acid. You are trying to differentiate between functional (acquired) constipation and Hirschsprung disease in a neonate. Distinguishing features of Hirschsprung disease include which of the following? 1. Small ribbonlike stools. 2. Obvious abdominal pain. 3. Female gender. 4. Small weight gain. Small ribbonlike stools. Dottie brings in her infant, who has gastroesophageal reflux. What do you tell her about positioning her infant? 1. "Always position infants on their back to prevent sudden infant death syndrome." 2. "Rotate your infant between lying on the back and on the stomach." 3. "Your infant should be placed on the left side." 4. "Place your infant in whatever position she remains quiet." "Always position infants on their back to prevent sudden infant death syndrome." Hepatitis D is an RNA virus that requires a coinfection with which of the following strains of hepatitis in order to replicate? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis E. Hepatitis B. What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A. Digital trauma. A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and mild fatigue. On examination, the client has a tender, tortuous temporal artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive procedure to help with diagnosis? 1. Magnetic resonance imaging (MRI) of the head. 2. Erythrocyte sedimentation rate (ESR). 3. Electroencephalogram (EEG). 4. Otoscopy. Erythrocyte sedimentation rate (ESR). Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1. Acute otitis media. 2. Chronic otitis media. 3. External otitis. 4. Temporomandibular joint (TMJ) syndrome. External otitis. In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction. A foreign body. A 62-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Herpetic conjunctivitis. 4. Diabetic retinopathy. Angle-closure glaucoma. You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days. Supportive measures and lubricating drops (artificial tears). When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse practitioner should document this finding as: 1. Conductive deafness. 2. Perceptive deafness. 3. A normal finding. 4. Nerve damage. A normal finding. Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1. "The eardrum, in most cases, heals within several weeks." 2. "We need to schedule Aaron for a surgical repair." 3. "He must absolutely stay out of the water for 3 to 6 months." 4. "If the eardrum is not healed in several months, it can be surgically repaired." "The eardrum, in most cases, heals within several weeks." A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? 1. Topical steroids and close follow-up with an ophthalmologist. 2. Sending the patient to the emergency department for immediate ophthalmology consult. 3. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. 4. Cold compresses and frequent handwashing. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Cataracts. 4. Macular degeneration. Open-angle glaucoma. A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient's symptoms? 1. Order a computed tomography (CT) scan to rule out acoustic neuroma. 2. Start her on high-dose Augmentin. 3. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4. Immediate referral to an ear, nose, and throat (ENT) specialist. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? 1. Symptom management and reassurance that symptoms will resolve with time. 2. Computed tomography (CT) of the head. 3. Amoxicillin 80 to 90 mg/kg/d. 4. Augmentin 45 mg/kg/d. Amoxicillin 80 to 90 mg/kg/d. Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1. Glomerulonephritis. 2. Rheumatic heart disease. 3. Scarlet fever. 4. Hemolytic anemia. Hemolytic anemia. You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? 1. Maxillary. 2. Ethmoid. 3. Frontal. 4. Sphenoid. Ethmoid. While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? 1. The nasolabial folds. 2. The openings between the margins of the upper and lower eyelids. 3. The thyroid gland in relation to the trachea. 4. The distance between the trigeminal nerve branches. The openings between the margins of the upper and lower eyelids. Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis. Iritis A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? 1. Tension. 2. Migraine. 3. Cluster. 4. Temporal arteritis. Migraine Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist. Prescribe nasal steroids and oral decongestants. Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1. Classic migraine. 2. Tension headache. 3. Sinus headache. 4. Cluster headache. Tension headache. Regular ocular pressure testing is indicated for older adults taking: 1. High-dose inhaled glucocorticoids. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Insulin. High-dose inhaled glucocorticoids. Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1. Otitis media. 2. Otitis media with effusion. 3. Otitis externa. 4. Primary otalgia. Otitis externa. What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral? 1. There is a change in the child's hearing threshold to greater than 25 dB. 2. The child has become a fussy eater. 3. The child's speech and language skills seem slightly delayed. 4. Persistent rhinitis is present. There is a change in the child's hearing threshold to greater than 25 dB. Which manifestation is noted with carbon monoxide poisoning? 1. Circumoral pallor of the lips. 2. Cherry-red lips. 3. Cyanosis of the lips. 4. Pale pink lips. Cherry-red lips. t the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? 1. Pseudostrabismus. 2. Strabismus. 3. Esotropia. 4. Exotropia. Esotropia. Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue depressor, which assists you in making which of the following diagnoses? 1. Leukoplakia. 2. Lichen planus. 3. Oral candidiasis. 4. Oral cancer. Oral candidiasis. How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? 1. Movable, discrete, soft, and nontender lymph nodes. 2. Enlarged, warm, tender, and firm but freely movable lymph nodes. 3. Hard, unilateral, nontender, and fixed lymph nodes. 4. Nontender, mobile, and firm but not hard lymph nodes. Nontender, mobile, and firm but not hard lymph nodes. A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis? 1. Viral conjunctivitis. 2. Bacterial conjunctivitis. 3. Allergic conjunctivitis. 4. Blepharitis. Viral conjunctivitis. The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1. Amoxicillin (Amoxil). 2. Amoxicillin and potassium clavulanate (Augmentin). 3. Azithromycin (Zithromax). 4. Prednisone (Deltasone). Amoxicillin and potassium clavulanate (Augmentin). Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like "a curtain came down over my eye." She doesn't have any pain or redness. What do you suspect? 1. Retinal detachment. 2. Acute angle-closure glaucoma. 3. Open-angle glaucoma. 4. Cataract. Retinal detachment. Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: 1. Eye discomfort. 2. Slow progression. 3. A ciliary flush. 4. No change in or slightly blurred vision. A ciliary flush. Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis. Iritis. Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis. Trigeminal neuralgia. Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1. Ciprofloxacin (Cipro). 2. Azithromycin (Zithromax). 3. Amoxicillin (Amoxil). 4. Cephalexin (Keflex). Azithromycin (Zithromax). What is the most common bacterial pathogen associated with acute otitis media? 1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Streptococcus pyogenes. 4. Moraxella (Branhamella) catarrhalis. Streptococcus pneumoniae. Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1. Otitis media. 2. Otitis media with effusion. 3. Otitis externa. 4. Primary otalgia. Otitis externa. Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? 1. Use a cotton-tipped applicator daily to remove all moisture and potential bacteria. 2. Wash daily with soap and water. 3. Apply mineral oil to counteract dryness. 4. Avoid topical corticosteroids. Apply mineral oil to counteract dryness. The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: 1. A congenital cataract. 2. Retinoblastoma. 3. Persistent hyperplastic primary vitreous. 4. Retinal detachment. A congenital cataract. Which of the following statements about macular degeneration is not true? 1. Macular degeneration is characterized by gradual loss of peripheral vision. 2. Macular degeneration is the leading cause of blindness in people younger than 60. 3. Tobacco use is a risk factor for macular degeneration. 4. There are 2 different types of macular degeneration: wet and dry. Macular degeneration is characterized by gradual loss of peripheral vision. Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? 1. Conjunctivitis. 2. Iritis. 3. Subconjunctival hemorrhage. 4. Acute glaucoma. Iritis. Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: 1. Bell palsy. 2. A lesion affecting the trigeminal nerve. 3. A stroke—brain attack, cerebrovascular accident (CVA). 4. Shingles. A lesion affecting the trigeminal nerve. When you are assessing the internal structure of the eye of your 59-year-old patient, the absence of a red reflex may indicate: 1. A cataract or hemorrhage into the vitreous humor. 2. Acute iritis. 3. Nothing; this is a normal finding in older adults. 4. Diabetes or long-standing hypertension. A cataract or hemorrhage into the vitreous humor. Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1. Allergic rhinitis. 2. Viral rhinitis. 3. Nasal polyps. 4. Nasal vestibulitis from folliculitis. Allergic rhinitis. Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer's ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. Mandy, 44, was given a diagnosis of flu 1 day ago and wants to start on the "new flu medicine" right away. What do you tell her? 1. "The medication is effective only if started within the first 72 hours after symptoms begin." 2. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week." 3. "The medicine has not proven its effectiveness." 4. "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms." "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms." An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: 1. Antibiotics. 2. A biopsy of the rash. 3. Immediate hospitalization. 4. Ophthalmological consultation. Ophthalmological consultation. You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4. Grade 3 Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1. Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3. Order a complete blood count (CBC). 4. Consult with your collaborating physician. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1. Maxillary sinus. 2. Ethmoid sinus. 3. Sphenoid sinus. 4. Frontal sinus. Maxillary sinus. You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome. Stevens-Johnson syndrome Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? 1. The offending organism is a bacterium, and Jonathan should be treated with antibiotics. 2. Convalescence is usually only a few days, and Jonathan should be back to normal in a week. 3. Mononucleosis is rarely contagious. 4. Jonathan should avoid contact sports and heavy lifting. Jonathan should avoid contact sports and heavy lifting. Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1. A labyrinthectomy. 2. Pharmacological therapy. 3. A vestibular neurectomy. 4. Wearing an earplug in the ear that has the most hearing loss. A vestibular neurectomy. Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1. A throat culture. 2. A Monospot test. 3. A rapid antigen test. 4. A Thayer-Martin plate test. Monospot test April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that they may be cancerous skin lesions. You tell her that they are probably: 1. Xanthelasmas. 2. Pingueculae. 3. The result of arcus senilis. 4. Actinic keratoses. Xanthelasmas. A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the club. These symptoms are most characteristic of which of the following? 1. Sensorineural loss. 2. Conductive loss. 3. Tinnitus. 4. Vertigo. Sensorineural loss. Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look "sunken in." What do you suspect? 1. Hypothyroidism. 2. Normal age-related changes. 3. Cushing syndrome. 4. A detached retina. Normal age-related changes. Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1. "Dilute the oral medication with one tablespoon of water for easier digestion." 2. "Take the medication with meals so that it's absorbed better." 3. "Swish and swallow the medication." 4. "Apply the medication only to the lesions." "Swish and swallow the medication." Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? 1. Aspirin therapy as prophylaxis for heart attack. 2. Ranitidine (Zantac) for gastroesophageal reflux disease. 3. Alprazolam (Xanax), an anxiolytic. 4. Atenolol (Tenormin), a beta blocker for high blood pressure. Atenolol (Tenormin), a beta blocker for high blood pressure. Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? 1. Epiglottitis. 2. Group A beta-hemolytic streptococcal pharyngitis. 3. Tonsillitis. 4. Diphtheria. Epiglottitis. You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor. Stridor. A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Cataracts. 4. Macular degeneration. Open-angle glaucoma. Mallory brings her 4-week-old infant to the office because she noticed small, yellow-white, glistening bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as: 1. Bednar aphthae. 2. Epstein pearls. 3. Buccal tumors. 4. Exostosis. Epstein pearls. Which of the following is not a cause of conductive hearing loss? 1. Presbycusis. 2. Cerumen impaction. 3. Otitis media. 4. Otosclerosis. Presbycusis. A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1. Viral pharyngitis. 2. Mononucleosis. 3. Streptococcal pharyngitis. 4. Upper respiratory infection. Mononucleosis. The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1. Amoxicillin (Amoxil). 2. Amoxicillin and potassium clavulanate (Augmentin). 3. Azithromycin (Zithromax). 4. Prednisone (Deltasone). Amoxicillin and potassium clavulanate (Augmentin). Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: 1. A superficial, translucent, subepithelial, vesicle-like lesion in the oral mucosa. 2. A white, painless, firm, ulcerated lesion with indurated borders. 3. An abnormal white coating of the dorsal surface of the tongue. 4. A round, smooth, firm lump on the lateral side of the tongue. A white, painless, firm, ulcerated lesion with indurated borders. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD). Gastroesophageal reflux disease (GERD). Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? 1. Nasal polyps are usually precancerous. 2. Nasal polyps are benign growths. 3. The majority of nasal polyps are neoplastic. 4. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma. Nasal polyps are benign growths. Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: 1. Medications. 2. Dietary supplements. 3. Corrective lens surgery. 4. Optical devices. Corrective lens surgery. Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids. Oral steroids. Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: 1. Herpes simplex. 2. Aphthous ulcers. 3. Candidiasis. 4. Oral cancer. Candidiasis. Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1. Dental abscess. 2. Acute rhinosinusitis. 3. Chronic rhinosinusitis. 4. Nasal tumor. Acute rhinosinusitis. Which of the following patients would not be a candidate for outpatient treatment of influenza? 1. A 62-year-old male with a history of myocardial infarction 5 years ago. 2. A 2-year-old female with a history of a congenital heart defect. 3. A 72-year-old male without a past medical history. 4. A 15-year-old female with a history of recent outpatient knee surgery. A 2-year-old female with a history of a congenital heart defect. A patient presents to your primary care clinic with diarrhea. What about the diarrhea would be concerning for a parasitic infection? 1. It presented 8 hours after eating rare fish. 2. It has lasted longer than 7 days. 3. The patient describes it as "rice water." 4. It is bloody. It has lasted longer than 7 days. A 50-year-old female diabetic patient presents to your urgent care center complaining of chest discomfort. Which of the following symptoms would lead you to believe her chest pain is related to gastroesophageal reflux rather than a cardiac etiology? 1. Chest pain radiates to the jaw and left arm. 2. Chest pain is worse with walking. 3. Chest pain started while eating spicy food. 4. Chest pain is associated with nausea. Chest pain started while eating spicy food. The ABCDEs of skin cancer can help you diagnose a cancerous skin lesion. Which of the following definitions does not accurately describe the corresponding letter of the acronym? 1. A = asymmetry. 2. B = boarder irregularity. 3. C = color. 4. D = diameter greater than 8 mm. D = diameter greater than 8 mm A patient presents to your primary care office for a blood pressure check. You have recently started them on an antihypertensive medication. However, on physical exam, the patient continues to have an elevated blood pressure. Which of the following symptoms would not be concerning for a hypertensive crisis? 1. Chest pain. 2. Visual changes. 3. Tinnitus. 4. Severe headache. Tinnitus. Which of the following headache descriptions does not match the accompanying diagnosis? 1. Worst headache of your life = subarachnoid hemorrhage. 2. Headache associated with aura = migraine headache. 3. Unilateral temporal headache with associated pulsatile sensation = tension headache. 4. Headache associated with loss of consciousness = intracranial pressure change. Unilateral temporal headache with associated pulsatile sensation = tension headache. A 20-year-old female presents to your urgent care clinic complaining of a cat bite. The patient recently adopted a cat. She was playing with the cat yesterday when the cat bit her on the arm. What antibiotic should be prescribed to prevent infection? 1. Augmentin. 2. Amoxicillin. 3. Bactrim. 4. No antibiotic is necessary. Augmentin. Ingestion of which of the following objects always requires surgical or endoscopic removal? 1. Button batteries. 2. Coins. 3. Sharp objects. 4. Food bolus. Button batteries. You are examining a patient in the emergency department following a closed head injury and you notice their pupils do not constrict when bright light is shone into them. To what cranial nerve would this suggest damage? 1. Cranial nerve (CN) III. 2. Cranial nerve (CN) II. 3. Cranial nerve (CN) IV. 4. Cranial nerve (CN) VI. Cranial nerve (CN) III. What bacterium causes Rocky Mountain spotted fever? 1. Rickettsia rickettsii. 2. Borrelia burgdorferi. 3. Orientia tsutsugamushi. 4. Centruroides exilicauda. Rickettsia rickettsii. As a general rule, when treating hypothermia, at what rate do you want to warm the patient's temperature? 1. 1-2°C an hour. 2. 0-1°C an hour. 3. 0.5°C an hour. 4. 2-3°C an hour. 1-2°C an hour. The remodeling of a scar can take how long? 1. 6 months. 2. 3 months. 3. 1 month. 4. 2 weeks. 6 months. How soon after a facial laceration should sutures be removed? 1. 4 to 6 days. 2. 3 to 4 days. 3. 7 to 10 days. 4. 10 to 14 days. 4 to 6 days. A patient on which of the following medications is at risk of sun poisoning? 1. Doxycycline. 2. Lexapro. 3. Labetalol. 4. Percocet. Doxycycline. What lifestyle choice increases the risk of upper respiratory infection? 1. Smoking. 2. Alcohol use. 3. Cocaine use. 4. Multiple sexual partners. Smoking. Which of the following is not a risk factor for the development of sinusitis? 1. Asthma. 2. Smoking. 3. Deviated septum. 4. History of tonsillectomy. History of tonsillectomy. A 15-year-old female presents to your urgent care center complaining of a sore throat for 3 days. Her vital signs are as follows: temperature 102.1°F, pulse (P) 70, blood pressure (BP) 130/85, oxygen saturation 97%. The patient denies cough. On physical exam, she has pearly white exudates on the tonsils, erythema of the throat, and palpable anterior cervical chain lymphadenopathy. What is the recommended treatment? 1. Starting the patient on antibiotics. 2. Starting the patient on prednisone. 3. Awaiting culture results prior to treatment. 4. Recommending supportive treatment. Starting the patient on antibiotics. In which of the following scenarios is antibiotic treatment necessary following an injury to the skin? 1. Laceration requiring sutures from a knife cut while cutting an avocado. 2. Laceration requiring sutures on the foot of a diabetic. 3. Laceration requiring sutures on the hand of someone who has not had a tetanus booster in the last 5 years. 4. "Road rash" abrasion from a bicycle accident. Laceration requiring sutures on the foot of a diabetic. You have seen a client who has tested positive for syphilis. You have treated the client; tested the client for other potential sexually transmitted diseases, including human immunodeficiency virus (HIV); counseled the client about safe sexual practices; and scheduled the client to return at 3 and 6 months for repeat serologic testing. The tests at those times demonstrated that no further syphilis was present. Should you have taken any other action? 1. No, you have treated the client appropriately. 2. Yes, you must report the case to the local health authorities. 3. Yes, you need to notify all sexual contacts. 4. Yes, you must follow up on the client's HIV status. Yes, you must report the case to the local health authorities. The term collaboration is best defined as: 1. Interdisciplinary teamwork. 2. A protocol arrangement with a physician. 3. Case management. 4. Cooperation with another to achieve mutual goals while not losing sight of one's own interests. Cooperation with another to achieve mutual goals while not losing sight of one's own interests. Which of the following nonverbal communication techniques is important in the establishment of rapport with a client? 1. Taking notes only while the client is talking. 2. Making direct eye contact with the client, with periodic breaks to take or check notes. 3. Having a desk between you and the client. 4. Wearing jeans in the clinical setting to ensure your comfort. Making direct eye contact with the client, with periodic breaks to take or check notes. An emancipated minor is a client who is younger than age 18 but who is considered a competent adult with the authority to accept or refuse medical treatment. How do you determine if the 16-year-old you are seeing is an "emancipated minor"? 1. No 16-year-old would be considered an emancipated minor. 2. Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court. 3. The client claims that he is free from all parental control. 4. The client is accompanied by an older friend who states that he or she is the client's guardian and will accept legal responsibility. Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court. Mrs. Hernandez, age 79, is insisting on discharge from the skilled nursing facility where she is receiving rehabilitation after a left hip replacement. She lives alone and has very little support. You do not think she is ready for discharge. Mrs. Hernandez's insistence on discharge is an example of your client exercising her right to: 1. Self-determination. 2. Beneficence. 3. Justice. 4. Utilitarianism. Self-determination. Techniques used to enhance a client's adherence to a treatment plan include: 1. Stressing the dangers of missing medications. 2. Giving clear written instructions and simplifying the drug regimen. 3. Allowing plenty of time between follow-up visits so the client has time to adjust to the regimen. 4. Explaining the importance of the regimen to the family. Giving clear written instructions and simplifying the drug regimen. Health behaviors can be difficult to change. Which of the following is most important in influencing behavioral change? 1. Motivation. 2. Health beliefs. 3. Cognitive knowledge. 4. Social supports. Motivation. Sally, an advanced practice registered nurse (APRN), sees Mr. Bell, who is suffering from congestive heart failure. She increases his diuretic but makes no note of his potassium and orders no replacement potassium. Mr. Bell returns a week later for routine laboratory testing. His potassium level is found to be low; however, Mr. Bell has no complaints. Sally orders a potassium supplement to begin immediately as well as a follow-up potassium level measurement. Is Sally guilty of malpractice? 1. Yes, because she breached a standard of care. 2. No, because no harm came to the client. 3. No, because she took remedial action. 4. Yes, because she was negligent. No, because no harm came to the client. Which of the following describes a situation in which medical information may be passed on without client consent? 1. When the client has a gunshot wound. 2. When a potential employer asks for it. 3. When certifying absence from work. 4. When talking to another health care provider. When the client has a gunshot wound. The research function of the advanced practice registered nurse (APRN) may be operationalized as both a consumer of research findings and a researcher. Being a consumer of research findings involves a number of activities, including: 1. Reading the literature, analyzing its clinical applicability, and using new interventions. 2. Organizing and conducting a research study. 3. Data collection. Reading the literature, analyzing its clinical applicability, and using new interventions. As an advanced practice registered nurse (APRN), you begin a new job in a small practice with 2 other physicians. You have been hired to be a partner in the practice, but the eldest partner is reluctant to allow you to take on new clients. This is an example of: 1. Role stress. 2. Role strain. 3. Role insufficiency. 4. Role conflict. Role conflict. Certain