FITZGERALD REVIEW 2 EXAM
QUESTIONS & DETAILED COMPLETE
SOLUTIONS ALL PASSED
Which of the following is not an expected finding for a patient with Meniere's disease?
A positive Romberg test
An abnormal Rinne test
Lateralization during the Weber test
Hearing loss - Correct Answer ✔✔ An abnormal Rinne test
An abnormal Rinne test. The Weber and Rinne tests are physical examination
techniques to assess for the presence of a conductive and/or sensorineural hearing loss
and findings can be suggestive of Meniere's disease. In Meniere's disease, the Weber
test shows lateralization to the unaffected ear. The Rinne test is usually normal (i.e., air
conductance exceeds bone conductance). The Romberg test is positive, with the patient
showing difficulty staying balanced when standing with eyes closed.
The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman
who reports a progressive worsening of her hearing in both ears. The NP removes a
large amount of cerumen from the patient's ears with stated resolution of her hearing
problem. Her hearing loss was likely of what nature?
Sensory
Sensorineural
Conductive
Neural - Correct Answer ✔✔ Conductive
Conductive. In this situation, the hearing loss was due to obstruction with cerumen in
the external ear canal. Another common reason for conductive hearing loss includes
middle ear effusion. Sensorineural loss is the most common form of progressive, high-
frequency hearing loss due to presbycusis or aging. Sensorineural hearing loss can
have many causes and results in the gradual loss of sound receptors and nerve
endings. Conductive hearing loss is usually temporary while sensorineural hearing loss
is permanent.
A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet
therapy with low-dose aspirin and clopidogrel. He complains about intermittent
headaches and says his friend mentioned about the use of feverfew. You caution the
patient that feverfew can be associated with:
Hypertension.
,Increased bleeding risk.
QTc prolongation.
Ventricular arrhythmia. - Correct Answer ✔✔ Increased bleeding risk.
Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family
and the supplement is derived from the leaves of the plant. Feverfew is used for
migraine and other types of headaches, as well as dizziness, rheumatoid arthritis, fever,
and abdominal pain, among other conditions. Its mechanisms of action include inhibiting
platelet aggregation, exhibiting anti-prostaglandin effects, and decreasing serotonin
release. Due to its antiplatelet effect, there is an increased risk of bleeding with use of
feverfew and should be used with caution or avoided altogether with concomitant
antiplatelet therapy, such as aspirin and/or clopidogrel.
The most important component of the initial assessment of an asthma exacerbation
includes a(n):
SaO2.
Objective measurement of lung function.
Chest X-ray.
Arterial blood gases. - Correct Answer ✔✔ Objective measurement of lung function.
Objective measurement of lung function. Asthma exacerbations, characterized by a
decrease in peak expiratory flow, are identified by spirometric assessment, which is the
most important and immediate indicator. After the exacerbation is managed, a
comprehensive health history will contribute to the holistic chronic management. Arterial
blood gases and SaO2 can be indicated later in the assessment if the patient continues
to deteriorate despite initial interventions. A chest radiograph is usually unchanged in an
asthma exacerbation and is not part of the initial assessment.
Which of the following statements about migraine headache is most accurate?
The pain is described as pulsating.
Migraines are more common in men than women.
Migraine with aura is more common than without aura.
The pain is typically bilateral. - Correct Answer ✔✔ The pain is described as pulsating.
The pain is described as pulsating. Migraine headache is one of the three most
common primary headache syndromes, and may occur with or without aura; migraine
without aura is the more common type. Migraine is most common in women of
childbearing age. The pain is typically described as unilateral and pulsating.
Risk factors for urinary tract infection in a 62-year-old woman can include each of the
following except:
Uterine prolapse.
Renal stones.
Diabetes mellitus.
,Well-controlled hypertension. - Correct Answer ✔✔ Well-controlled hypertension.
Well-controlled hypertension. UTIs occur more frequently in women than men and the
frequency increases with age. UTI rates are higher in postmenopausal women due to
decreased estrogen that can impact the vaginal flora, as well as the presence of uterine
prolapse that can cause incomplete bladder emptying. Comorbid chronic medical
conditions, such as diabetes, can also increase UTI risk. The presence of renal or
kidney stones can also increase risk of infection. Well-controlled hypertension is not a
substantial risk factor for UTI.
A 27-year-old woman presents complaining of pain on her upper thighs related to spilled
hot coffee on her lap. Physical examination reveals a burn site that is red, dry and
blanches briefly with pressure but without blisters. The NP categorizes this burn as:
First degree.
Second degree.
Third degree.
Fourth degree. - Correct Answer ✔✔ First degree.
First degree. A first degree burn is a superficial burn that affects only the epidermis. The
appearance of first degree burns is a burn site that is red, painful, dry, and without
blisters. A second degree burn can involve the upper layers of papillary dermis
(superficial partial thickness) or deeper layers of the dermis (deep partial thickness).
These burns appear red, blistered, and can be swollen. A third degree burn can involve
the dermis and underlying fat and can appear white or charred.
You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit
his blood pressure is 185/110 mm Hg but does not report any symptoms. Auscultation
will likely reveal:
S3 heart sound heard during early diastole
S3 heart sound heard during late diastole
S4 heart sound heard during early diastole
S4 heart sound heard during late diastole - Correct Answer ✔✔ S4 heart sound heard
during late diastole
S4 heart sound heard during late diastole. The S4 sound is the sound heard when a
stiff, non-compliant ventricular wall is being subjected to a sudden increase in pressure
that occurs during atrial contraction. At the end of diastole, the atria contracts, ejecting
its final contents into the ventricle just before the mitral valve closes. A stiff, non-
compliant ventricle vibrates in response to this pressure and creates the end-diastolic
sound known as an S4. The S4 sound is a marker of poor diastolic function and is most
often found in poorly-controlled hypertension or recurrent myocardial ischemia. The S4
heart sound that results from poor hypertension control usually resolves once the blood
pressure has been well controlled for a few weeks.
, The NP sees a 48-year-old woman for an initial visit at the clinic. She confesses that
she was diagnosed with hypertension 8 years ago but has not had any healthcare visit
or taken any antihypertensive medications since that time. During her evaluation, signs
of hypertension target organ damage can include any of the following except:
Aortic murmur.
Proteinuria.
Elevated AST and ALT.
Arterioventricular nicking of the retina. - Correct Answer ✔✔ Elevated AST and ALT.
Elevated AST and ALT. Long-standing poorly-controlled hypertension can lead to target
organ damage. Low-grade hypertensive retinopathy will not lead to visual changes but
can be detected by the narrowing of arteriolar branches and severe local constriction.
Damage to the kidney is detected by persistent proteinuria, while left ventricular
hypertrophy is detected by the presence of an aortic murmur upon auscultation.
Elevated AST and ALT are indications of liver damage, which is not a typical
consequence of prolonged hypertension.
A 50-year-old man presents with a complaint of low back pain. He reports that he needs
to lift 20?30 lbs on a regular basis at work. A neurological examination is normal. The
nurse practitioner understands that most episodes of low back pain are caused by:
Muscle or ligamentous strain.
Disk herniation.
An acute precipitating event.
Nerve impingement. - Correct Answer ✔✔ Muscle or ligamentous strain.
Muscle or ligamentous strain. In the setting of an otherwise normal history and physical
examination, the most common cause of low back pain is muscle or ligamentous strain
known as lumbago. Most episodes of low back pain do not have an identifiable
precipitating event, and while disk herniation and nerve impingement do occur, they are
much less common than lumbago.
Which of the following is most consistent with a 64-year-old man presenting with acute
coronary syndrome?
Continuous chest pressure lasting 15 minutes that occurs at rest
A 10-minute episode of chest tightness brought on by activity
Retrosternal pain for 30 minutes with diaphoresis
Localized chest pain that persists for 24 hours - Correct Answer ✔✔ Retrosternal pain
for 30 minutes with diaphoresis.
The hallmark feature of ACS is permanent cellular injury. The cells are oxygen-deprived
long enough to die. The threshold beyond which myocardium cannot survive without
oxygen is approximately 20 minutes. While the pain of hypoxia can be quite profound, if
oxygenation is restored before the 20-minute threshold, cells typically do not die and
infarction does not occur. Cell death also typically causes systemic responses such as
diaphoresis and nausea. Because of innervation patterns, ACS virtually always causes
pain that is ill-defined with respect to location and often radiates. Chest pain described
QUESTIONS & DETAILED COMPLETE
SOLUTIONS ALL PASSED
Which of the following is not an expected finding for a patient with Meniere's disease?
A positive Romberg test
An abnormal Rinne test
Lateralization during the Weber test
Hearing loss - Correct Answer ✔✔ An abnormal Rinne test
An abnormal Rinne test. The Weber and Rinne tests are physical examination
techniques to assess for the presence of a conductive and/or sensorineural hearing loss
and findings can be suggestive of Meniere's disease. In Meniere's disease, the Weber
test shows lateralization to the unaffected ear. The Rinne test is usually normal (i.e., air
conductance exceeds bone conductance). The Romberg test is positive, with the patient
showing difficulty staying balanced when standing with eyes closed.
The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman
who reports a progressive worsening of her hearing in both ears. The NP removes a
large amount of cerumen from the patient's ears with stated resolution of her hearing
problem. Her hearing loss was likely of what nature?
Sensory
Sensorineural
Conductive
Neural - Correct Answer ✔✔ Conductive
Conductive. In this situation, the hearing loss was due to obstruction with cerumen in
the external ear canal. Another common reason for conductive hearing loss includes
middle ear effusion. Sensorineural loss is the most common form of progressive, high-
frequency hearing loss due to presbycusis or aging. Sensorineural hearing loss can
have many causes and results in the gradual loss of sound receptors and nerve
endings. Conductive hearing loss is usually temporary while sensorineural hearing loss
is permanent.
A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet
therapy with low-dose aspirin and clopidogrel. He complains about intermittent
headaches and says his friend mentioned about the use of feverfew. You caution the
patient that feverfew can be associated with:
Hypertension.
,Increased bleeding risk.
QTc prolongation.
Ventricular arrhythmia. - Correct Answer ✔✔ Increased bleeding risk.
Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family
and the supplement is derived from the leaves of the plant. Feverfew is used for
migraine and other types of headaches, as well as dizziness, rheumatoid arthritis, fever,
and abdominal pain, among other conditions. Its mechanisms of action include inhibiting
platelet aggregation, exhibiting anti-prostaglandin effects, and decreasing serotonin
release. Due to its antiplatelet effect, there is an increased risk of bleeding with use of
feverfew and should be used with caution or avoided altogether with concomitant
antiplatelet therapy, such as aspirin and/or clopidogrel.
The most important component of the initial assessment of an asthma exacerbation
includes a(n):
SaO2.
Objective measurement of lung function.
Chest X-ray.
Arterial blood gases. - Correct Answer ✔✔ Objective measurement of lung function.
Objective measurement of lung function. Asthma exacerbations, characterized by a
decrease in peak expiratory flow, are identified by spirometric assessment, which is the
most important and immediate indicator. After the exacerbation is managed, a
comprehensive health history will contribute to the holistic chronic management. Arterial
blood gases and SaO2 can be indicated later in the assessment if the patient continues
to deteriorate despite initial interventions. A chest radiograph is usually unchanged in an
asthma exacerbation and is not part of the initial assessment.
Which of the following statements about migraine headache is most accurate?
The pain is described as pulsating.
Migraines are more common in men than women.
Migraine with aura is more common than without aura.
The pain is typically bilateral. - Correct Answer ✔✔ The pain is described as pulsating.
The pain is described as pulsating. Migraine headache is one of the three most
common primary headache syndromes, and may occur with or without aura; migraine
without aura is the more common type. Migraine is most common in women of
childbearing age. The pain is typically described as unilateral and pulsating.
Risk factors for urinary tract infection in a 62-year-old woman can include each of the
following except:
Uterine prolapse.
Renal stones.
Diabetes mellitus.
,Well-controlled hypertension. - Correct Answer ✔✔ Well-controlled hypertension.
Well-controlled hypertension. UTIs occur more frequently in women than men and the
frequency increases with age. UTI rates are higher in postmenopausal women due to
decreased estrogen that can impact the vaginal flora, as well as the presence of uterine
prolapse that can cause incomplete bladder emptying. Comorbid chronic medical
conditions, such as diabetes, can also increase UTI risk. The presence of renal or
kidney stones can also increase risk of infection. Well-controlled hypertension is not a
substantial risk factor for UTI.
A 27-year-old woman presents complaining of pain on her upper thighs related to spilled
hot coffee on her lap. Physical examination reveals a burn site that is red, dry and
blanches briefly with pressure but without blisters. The NP categorizes this burn as:
First degree.
Second degree.
Third degree.
Fourth degree. - Correct Answer ✔✔ First degree.
First degree. A first degree burn is a superficial burn that affects only the epidermis. The
appearance of first degree burns is a burn site that is red, painful, dry, and without
blisters. A second degree burn can involve the upper layers of papillary dermis
(superficial partial thickness) or deeper layers of the dermis (deep partial thickness).
These burns appear red, blistered, and can be swollen. A third degree burn can involve
the dermis and underlying fat and can appear white or charred.
You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit
his blood pressure is 185/110 mm Hg but does not report any symptoms. Auscultation
will likely reveal:
S3 heart sound heard during early diastole
S3 heart sound heard during late diastole
S4 heart sound heard during early diastole
S4 heart sound heard during late diastole - Correct Answer ✔✔ S4 heart sound heard
during late diastole
S4 heart sound heard during late diastole. The S4 sound is the sound heard when a
stiff, non-compliant ventricular wall is being subjected to a sudden increase in pressure
that occurs during atrial contraction. At the end of diastole, the atria contracts, ejecting
its final contents into the ventricle just before the mitral valve closes. A stiff, non-
compliant ventricle vibrates in response to this pressure and creates the end-diastolic
sound known as an S4. The S4 sound is a marker of poor diastolic function and is most
often found in poorly-controlled hypertension or recurrent myocardial ischemia. The S4
heart sound that results from poor hypertension control usually resolves once the blood
pressure has been well controlled for a few weeks.
, The NP sees a 48-year-old woman for an initial visit at the clinic. She confesses that
she was diagnosed with hypertension 8 years ago but has not had any healthcare visit
or taken any antihypertensive medications since that time. During her evaluation, signs
of hypertension target organ damage can include any of the following except:
Aortic murmur.
Proteinuria.
Elevated AST and ALT.
Arterioventricular nicking of the retina. - Correct Answer ✔✔ Elevated AST and ALT.
Elevated AST and ALT. Long-standing poorly-controlled hypertension can lead to target
organ damage. Low-grade hypertensive retinopathy will not lead to visual changes but
can be detected by the narrowing of arteriolar branches and severe local constriction.
Damage to the kidney is detected by persistent proteinuria, while left ventricular
hypertrophy is detected by the presence of an aortic murmur upon auscultation.
Elevated AST and ALT are indications of liver damage, which is not a typical
consequence of prolonged hypertension.
A 50-year-old man presents with a complaint of low back pain. He reports that he needs
to lift 20?30 lbs on a regular basis at work. A neurological examination is normal. The
nurse practitioner understands that most episodes of low back pain are caused by:
Muscle or ligamentous strain.
Disk herniation.
An acute precipitating event.
Nerve impingement. - Correct Answer ✔✔ Muscle or ligamentous strain.
Muscle or ligamentous strain. In the setting of an otherwise normal history and physical
examination, the most common cause of low back pain is muscle or ligamentous strain
known as lumbago. Most episodes of low back pain do not have an identifiable
precipitating event, and while disk herniation and nerve impingement do occur, they are
much less common than lumbago.
Which of the following is most consistent with a 64-year-old man presenting with acute
coronary syndrome?
Continuous chest pressure lasting 15 minutes that occurs at rest
A 10-minute episode of chest tightness brought on by activity
Retrosternal pain for 30 minutes with diaphoresis
Localized chest pain that persists for 24 hours - Correct Answer ✔✔ Retrosternal pain
for 30 minutes with diaphoresis.
The hallmark feature of ACS is permanent cellular injury. The cells are oxygen-deprived
long enough to die. The threshold beyond which myocardium cannot survive without
oxygen is approximately 20 minutes. While the pain of hypoxia can be quite profound, if
oxygenation is restored before the 20-minute threshold, cells typically do not die and
infarction does not occur. Cell death also typically causes systemic responses such as
diaphoresis and nausea. Because of innervation patterns, ACS virtually always causes
pain that is ill-defined with respect to location and often radiates. Chest pain described
