NURS 654 Final Exam 2021 With Complete Solution

A major teaching point for patients diagnosed with epilepsy is Correct answer- A patient with absence seizures may never have a driver's license Which of the following mental health disorders is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses Correct answer- Schizophrenia Inattention and a sleep-wake cycle disturbance are hallmark symptoms of Correct answer- Delirium Which of the following tools may be used to evaluate a person's suicide risk Correct answer- SAD Personas A 13-year-old adolescent is seen with attention and concentration difficulties accompanied by a drop in school grades. During the history, you find he has multiple electronic devices in his bedroom, including computer, gaming system, and TV. You determine education is needed regarding bedtime behavior. This teaching is known as Correct answer- Sleep Hygiene A 6-year-old female patient presents with fear of riding in a car following involvement in a motor vehicle accident 8 weeks ago. Which of the following symptoms would not be seen in post-traumatic stress disorder Correct answer- Hypersomnolence A 16-year-old adolescent presents with a persistent lack of energy, anhedonia, depressed mood, and decreased appetite for the past four months. Which of the following components is most important in the assessment of the cause of the patient's symptoms. Correct answer- Verify if the patient has an suicidal ideation Which cranial nerve is affected in a patient with a CVA who has difficulty chewing Correct answer- Cranial Nerve V What antiplatelet agent is most widely used for secondary prevention of stroke Correct answer- Aspirin Which of the following antidepressant medications is the least likely to manifest discontinuation symptoms Correct answer- Fluoxetine Which herbal preparation may cause delirium and should be avoided in the elderly Correct answer- St Johns Wort Based on your understanding of pediatric attachment behavior, when is the most likely age for separation protest and stranger wariness to occur Correct answer- 7-12 months About 90% of headaches are Correct answer- Without pathological cause A ratchet- like rhythmic contraction, especially in the hand, during passive stretching, is known as Correct answer- cog wheeling It is important for the clinician to discuss the long-term effects of sexual assault on survivors. Which of the following is the most common long-term effect of sexual assault Correct answer- PTSD Which of the following persons fits the classic description of a patient with multiple sclerosis (MS). Correct answer- 32 year old female Polysomnography is a useful diagnostic test to evaluate for which of the following disorders? Correct answer- Obstructive sleep apnea and restless leg syndrome When administered at the beginning of an attack, oxygen therapy may help this kind of a headache Correct answer- Cluster Which of the following is a common side effect of the tricyclic class of antidepressants often prescribed for neuropathic pain Correct answer- Dry mouth and dry eyes A score of 20-25 on this test indicates early-stage Alzheimer's disease Correct answer- MMSE A 15 year old male presents to the clinic with complaints of enlarged breasts. The patient is very self conscious about this and "would like it go away". The patient is not overweight. Which of the following questions would the family nurse practitioner not want to include in the history of the patient? Correct answer- Do you drink coffee Examples of how pain medicine specialists can aid in the end of life care include? Correct answer- All of the above, Acupuncture, nerve ablation, spinal cordotomy Which of the following routes of administration is the most vulnerable to "first-pass" hepatic effects of pain medications? Correct answer- Oral Which of the following is a typical description of nociceptive pain Correct answer- Sharp, aching, throbbing The single most important supplemental therapy to consider when starting patients on opiods for pain is Correct answer- Laxatives for constipation What is the goal of treatment for precocious puberty? Correct answer- To obtain normal adult height The Arizona Secretary of State registers all but which of the following documents on its website? Correct answer- Last will and testament A 6 year old female has had a recent growth spurt, and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the FNP do next? Correct answer- Refer the child to a pediatric endocrinologist for management A 20 year old female presents to the clinic with complaints of fatigue and facial hair growth. Upon examination, the FNP notices that the patient has a moon face appearance with truncal obesity. The patient does admit to being on steroids frequently for her asthma. Which of the following conditions does the FNP believe that the patient has? Correct answer- Cushings An x ray would be done on the L spine of someone with cushings syndrome to rule out which of the following? Correct answer- Osteoporosis What is pseudo precocious puberty? Correct answer- Puberty elated to tumors in testicle/ovaries Which of the following is not true about breakthrough cancer pain? Correct answer- It is the same as incident pain The mother of a female infant is concerned that her daughter is developing breasts. The FNP notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? Correct answer- Premature thelarche, which will resolve over time A 5 year old African American female presents to the clinic with her mother. The mother states that she is concerned that the child is "developing too soon". After beginning the physical assessment, the FNP discovers that the patient is at Tanner Stage II. Which of the following is not a differential diagnosis for the FNP to consider? Correct answer- Acute lymphoblastic leukemia The ideal medicine to treat breakthrough cancer pain would Correct answer- Have a rapid onset and the ability to easily adjust the dose Signing a death certificate: Correct answer- Requires successful completion of an education module housed on the Arizona Board of Registered Nurses website You are completing a family meting for a patient with moderately advanced Alzheimers type dementia in which you have been describing the nature and likely course of the disease. The patient is unable to participate. In concluding the meeting it is most important to: Correct answer- Summarize the plan for care SPIKES protocol for breaking bad news reminds clinicians that: Correct answer- Breaking bad news can be executed as a stepwise approach, gathering information of the patient current knowledge is an important goal to help determine the patients readiness to hear the news, allows the provider to partner with the patient in the treatment plan that meets the desires of the patient The FNP is taking care of a 16 year old male who was diagnosed with Addison's disease. How will the FNP manage this patients treatment? Correct answer- Continue the glucocorticoid replacement An x ray of the wrist would be done for a child with precocious puberty to determine which of the following? Correct answer- Determine bone age Which of the following is a microcytic hypochromic anemia? Correct answer- Iron- deficiency anemia A 2 day old infant presents to the clinic, with the mother, for a well child check. The FNP touches the patient's skin and finds that there is an increase jaundice coloration to the child. The patients mother was O- and the child was born AB +. What condition is the FNP most worried about with this patient? Correct answer- Neonatal hyperbilirubinemia The family nurse practitioner evaluates a 5 year old child who presents with pallor and obtains lab revealing a hemoglobin of 8.5 g/dl and a hematocrit of 31%. How will the nurse practitioner manage this patient. Correct answer- Prescribe elemental iron and recheck labs in 1 month The family nurse practitioner provides primary care for a 30 onth old child with sickle cell anemia who has had one dose of 23-valent pneumococcal vaccine. Which of the following actions is appropriate for health maintenance in this child? Correct answer- Administer an initial meningococcal vaccine A 61 year old female presents with headaches, epistaxis, and plethora of the hands and face. On physical exam, the family nurse practitioner notes splenomegaly. The patients laboratory studies reveal increased red blood cells and increased platelet count. She is otherwise in good health. What is the most likely diagnosis? Correct answer- Polycythemia vera The family nurse practitioner is taking care of a 75 year old Vietnam veteran who had been xposed to Agent Orange and is now presenting with new complaints of fatigue and night sweats. The patient's previous visits and labs have been unremarkable. However, the family nurse practitioner reviews the patients most recent lab work and notices that the WBCs are increased. The faily nurse practitioner suspects leukemia. Which type of leukemia is most likely in this patient? Correct answer- Acute myeloid leukemia A 50 year old male presents to the clinic with complaints of lower back pain without any known injury. The family nurse practitioner orders an x ray, which shows multiple lytic lesions present in his lumbar spine. What condition does the family nurse practitioner think the patient might have? Correct answer- Multiple myeloma The family nurse practitioner examines a 5 year old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechia, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The family nurse practitioner will refer this child to a specialist for which of the following? Correct answer- Bone marrow biopsy A 23 year old woman has symptoms of fatigue and is not feeling well. She appears well and the physical exam is normal, but her hemoglobin is 9.8 with a mean corpuscular volume of 76. Her family history is positive for thalassemia. She also mentions a history fo heavy menses. Which of the following would be most helpful in distinguishing thalassemia from oe of pure iron deficiency anemia? Correct answer- Serum ferritin determination A 67 year old man presents with faigue. His hemoglobin value is 9.2. The blood film show hypochromic microcytic cells. His serum iron is decreased, TIBC is increased, and ferritin is decreased. What is the most likely diagnosis? Correct answer- Iron deficiency anemia You are taking care of an 80 year old male with COPD and diabetes. His most recent lab work indicates that he is anemic Based on his history, which type of anemia would you expect him to have? Correct answer- Anemia of chronic disease Acute lymphocytic leukemia is usually diagnosed by: Correct answer- A bone marrow biopsy A 4 year old caucasion male presents to the clinic with his mother. The patients mother states that the child has had a continuous fever 101.5 F that is worse at night for the last 2.5 weeks. The patients mother denies any cough or other symptoms of illness. The mother states that he does not have the energy to play the games that he normally plays. What condition should the family nurse practioner worry about with this patient? Correct answer- Acute lymphoblastic leukemia A complete blood count on a 12 month old infant reveals microcytic hypochromic anemia with hemoglobin of 9.5. the infant has mild pallor with no hepatosplenomegaly. Which of the following would the FNP suspect? Correct answer- Iron deficiency anemia Signs and symptoms of anemia, regardless of the specific cause or type, include all of the following except? Correct answer- Shakiness or jitterness A 70 year old man presents with fatigue and the following lab results hg 9, MCV 70, RDW 19%. A critical diagnosis to consider is Correct answer- Gastrointestinal blood loss The FNP reviews a patient's complete blood count with differential white blood cell values and recognizes a "left shift" because of: Correct answer- an elevated neutrophil count A 30 year old female patient has thalassemia minor. Which of the following should be limiting in her diet? Correct answer- Iron The anemia associated with chronic disease is Correct answer- normocytic and normochromic How can the FNP confirm that a patient has hodgkin's lymphoma when reviewing the findings of a lymph biopsy? Correct answer- Presence of reed Sternberg cells The FNP sees a 12 month old infant who is being fed goat's milk and a vegetarian diet. The child is pale and has a beefy red sore tongue and oral mucous membranes. Which of the following tests should the FNP order to evaluate this child's condition? Correct answer- RBC folate, iron, and b12 levels When performing a neurologic exam to assess for meningeal signs in an infant, the primary family nurse practitioner will attempt to elicit the Kernig's sign by Correct answer- Extending the leg at the knee with the infant supine The diagnostic criteria required for COPD is an FEV1/FVC ratio of less than 70% via spirometry. Spirometry must be conducted: Correct answer- Postbronchodilator Sleep apnea (central or obstructive) is typically diagnosed via which of the following? Correct answer- Split polysomnography A 15 year old female presents to the clinic with cerebral palsy. Due to her inability to ambulate, the family nurse practitioner should evaluate the child for possible deficiencies in which of the following nutrients? Correct answer- Ca and vitamin D Women are at highest risk for developing postpartum depression for up to how long after childbirth? Correct answer- 6 months Careful monitoring of COPD patients with the annual pulse oximetry or blood gases must be documented if they do not use supplemental oxygen and have a postbronchodilator FEV1 of less than: Correct answer- 70% A 6 year old female has had a recent growth spurt, and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the FNP do next? Correct answer- Refer the child to a pediatric endocrinologist for management NSAID or daily ASA equal to or greater than 81 mg must always include documentation that GI bleeding risk was discussed with the patient in addition to GI bleeds, what additional risks do NSAIDS post to the elderly Correct answer- Increase in blood pressure, peripheral edema, decreased renal function, all of the above Which of the following symptoms is not part of the diagnostic criteria for post traumatic stress disorder (PTSD)? Correct answer- Hypersomnolence Which of the following statements best explains the importance of palliative care? Correct answer- Multiple harmful physiologic effects can occur from uncontrolled pain The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes development but no pubic or axillary hair. What is the likely diagnosis? Correct answer- Congenital adrenal hyperplasia, causing breast development Observing a 10 year old child stepping on and off the scale to be weighed is an easy way to partially screen for which of the following? Correct answer- Balance and proprioception When assessing a 1 year old who presents with a history of a fall, what would be used to determine appropriate level of consciousness? Correct answer- Cries in response to being examined Acetaminophen at doses greater than 3gm daily may cause liver toxicity. For the geriatric patient, in addition to carefully monitoring meds that may contain acetaminophen, care should be taken to do all but which of the following? Correct answer- Avoid first generation antihistamines, such as Claritin and Zyrtec At what age does autism commonly become apparent? Correct answer- 3 years Three college aged students have developed meningitis. A dorm mate is concerned and comes to see you. Which for the following is the most appropriate next step in management? Correct answer- Ampicillin and Rocephin Which of the following would be important to monitor in a child receiving methylphenidate for the treatment of attention deficit hyperactivity disorder? Correct answer- Growth parameters A 46 year old male complains of recurrent episodes of sudden onset dizziness. He notices a spinning sensation when sitting up or lying down in bed. The symptoms usually last for about 30-45 seconds. He denies any hearing change or additional neurological symptoms. His physical examination is essentially normal. A Dix-Hallpike (Nylen-Barany) maneuver reproduces his symptoms. Which of the following is the most likely diagnosis. Correct answer- Benign positional vertigo Your patient is experiencing extrapyramidal side effects from his antipsychotic medications. The FNP would most likely take which of the following approaches to treating the side effects? Correct answer- Treat the patient with anticonvulsants Pulmonary embolism (PE_ triples between ages 65 to 90. For your patient with the first episode of PE, how long should anticoagulant use continue? Correct answer- A minimum of 6 months In end stage renal failure, a cardiovascular event may become the cause of death due to which of the following? Correct answer- Hyperkalemia Smoking cessation counseling should be documented as having been given: Correct answer- To patients if they are smokers, to other household members if they are smokers, at least annually. All of the above An adolescent female reports unilateral headache pain associated with abdominal pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for six months but reports little relief from symptoms. What will the FNP do? Correct answer- Refer the adolescent to a Pediatric neurologist for neuroimaging A 25 year old female states that she has been feeling more irritable and worries constantly about her children, who recently started school. She also worries about her father, who was recently diagnosed with high blood pressure. She is concerned that her husband might leave her because they have been fighting more often than usual. She appears restless and frequently fidgets, wringing her hands while speaking. She adds that she has been on edge for at least eight months and that she is having problems doing her job, which is another of her worries. Which of the following diagnoses is most likely? Correct answer- Generalized Anxiety Treatment for severe COPD, (FEV1 30%) should include Correct answer- Regular treatment with one or more bronchodilators, inhaled steroids, rehabilitation. All of the above Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration? Correct answer- Fluoxetine Which of the following best describes the difference between asthma and COPD in the older adult? Correct answer- The bronchodilator response to inhaled B-agonist declines with age, older adults are more likely to need continual asthma treatment to control their disease, methacholine challenges are contraindicated in older adults. All of the above Chronic constipation often is associated with chronic opiod use. If the patients develop opiod induced constipation, the FNP must document which of the following? Correct answer- Initiation of a stool softener or laxative, recommendation for increased fiber, recommendations for adequate fluid intake. All of the above A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child's speech and that the child has vomited twice in the exam room. Which course of action is warranted? Correct answer- Admit the child to the hospital for a neurology consult What is pseudo precious puberty? Correct answer- Puberty related to tumors in testicles/ovaries Which mediation is considered first line treatment for alzheimer's dementia Correct answer- Aricept A 16 year old child who has had a single nonfebrile seizure has a normal neurologic exam. Which one of the following diagnostic tests is indicated Correct answer- EEG Which of the following is most accurate about heat therapy for the treatment of pain? Correct answer- Heat therapy may be highly effective for muscle spasms Which of the following statements is most appropriate regarding advanced care planning in the terminally ill patient? Correct answer- Advanced care planning should include a designated proxy for decision making if the patient is eventually unable to do so Assessment for persistent pain should be done annually on all vulnerable older adults. If the patient is cognitively impaired the following may be documented to meet this quality measure: Correct answer- Behavioral assessment, standardized pain scale such as the faces pain scale, proxy report on level of pain by caregiver. All of the above Which of the following is the most prevalent psychiatric condition in the United States Correct answer- Anxiety Which of the following is true about pulmonary fibrosis? Correct answer- The mainstay of treatment, besides referral to a pulmonologist, is oral corticosteroids A 35 year old female presents to the office with unilateral throbbing headache with occasional photophobia. Which drug is not an appropriate prophylactic medication? Correct answer- Sumatriptan (Imitrex) Patients who are 75 years old or older who are prescribed NSAIDS should also receive gastroprotection with which of the following? Correct answer- Misoprostol and PPI Age-related pulmonary changes include which of the following? Correct answer- Acceleration of aging, if smoker Assessing for adherence with prescribed medications and developing a plan for what to do if the medications are stopped are major treatment issues for which of the following? Correct answer- bipolar A 32 year old female patient presents tot eh clinician after experiencing four episodes in the atleast month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted 10-15 minutes, making her fearful and even afraid to leave her house The clinican suspects panic disorder but wants to rule out any organic causes. Which of the following medical conditions can mimic the signs of a panic attack? Correct answer- Pheochromocytoma, hyperthyroidism, cardiac arrhythmias. All of the above A 33 year old male who is a CEO of a major company reports moderate bilateral, dull, frontal pressure around his head that is usually present all day. He denies any visual disturbances. Which medication would be most appropriate for him to take first? Correct answer- NSAID In vulnerable older adults, which of the following is an indication to order spirometry? Correct answer- Noncardiac exertional dyspnea, chronic coughing or wheezing for more than 6 months, two or more episodes a year of bronchitis. Any of the above A 20 year old female presents to the clinic with complaints of fatigue and facial hair growth. Upon examination, the FNP notices that the patient has a moon face appearance with truncal obesity. The patient does admit to being on steroids frequently for her asthma. Which of the following conditions does the FNP believe that the patient? Correct answer- Cushings syndrome The hallmark of absence seizure is: Correct answer- a blank stare Patients presenting with all but which of the following should be scheduled for spirometry to work up COPD? Correct answer- Family history of COPD The FNP is educating a teenage patient about the effects of marijuana. The patient started she has smoked marijuana for years and believes it does not interfere with her life. What is a significant long term sequela of marijuana use about which other FNP should educate this patient? Correct answer- Memory Impairment Antidepressant discontinuation syndrome is less likely if the patient: Correct answer- Gradually taper off SSRI B12 deficiency symptoms Correct answer- pale, beefy red sore tongue and oral mucous membranes Polymyalgia Rheumatica symptoms Correct answer- aching in hips and shoulder, low grade fever, fatigue, difficult getting up from lying down or a seated position What does blood cells of polycythemia vera look like? Correct answer- Increased red blood cells and increased platelet count. Signs and symptoms of polycythemia vera Correct answer- Headaches, epistaxis, plethora of the hands and face, splenomegaly Symptoms of oligoarticular JIA Correct answer- Stiffness and warmth in right knee and left ankle for 8 to 9 months. Sjogrens syndrome symptoms Correct answer- Can have history of RA, decreased hearing, gritty feeling eyes, and dry mouth Celiac disease symptoms Correct answer- Short stature, hx of poor weight gain, vomiting, chronic diarrhea Diagnostic testing for celiac disease Correct answer- Anti-endomysial antibodies (EMA) is diagnostic Raynauds medication treatment Correct answer- Angiotensin Converting Enzyme Inhibitor, ace inhib Distinguishing thalassemia and iron deficiency anemia via lab testing Correct answer- Serum Ferritin Determiniation Medications to avoid in the geriatric patient Correct answer- Avoid first generation antihistamines, such as Claritin and Zyrtec NSAID risk in the elderly Correct answer- Increase in blood pressure, peripheral edema, decreased renal function Most prevalent psychiatric disorder in the US Correct answer- Anxiety HIV seroconvert timeframe Correct answer- Between 3 weeks and 6 months Left shift indications and lab characteristics Correct answer- an elevated neutrophil count Rheumatoid arthritis symptoms Correct answer- Symmetrical inflammation, antinuclear antibody examination is indicated Autism onset and diagnosis Correct answer- Appears at 3 years Multiple myeloma x ray findings Correct answer- lytic bone lesions Postpartum depression and onset/duration Correct answer- Highest risk for up to 6 months after childbirth Combination of tb medication most effective for HIV patient Correct answer- Isoniazid, rifampin, ethambutol, and pyrazinamide Carpal Tunnel syndrome and medication treatment Correct answer- Celecoxib (NSAID) for early treatment Agent Orange and Leukemia associated Correct answer- Acute Myeloid Leukemia What does IDA cell look like? Correct answer- Microcytic Hypochromic Having cushings makes you more prone to? Correct answer- osteoporosis Cushing S/s Correct answer- Fatigue, facial hair, moon face, truncal obesity A 48-year-old patient with a history of rheumatoid arthritis presents to the clinic with a complaint of decreased hearing, "gritty" feeling eyes, and a dry mouth. Which of the following diagnoses would you consider? Correct answer- Sjogren's syndrome A 40-year-old male presents to your office with complaints of swelling and redness in his wrist. He reports there is pain in the wrist during the early morning hours that improves as the day progresses. You suspect rheumatoid arthritis and order an x-ray. Which of the following would you least expect to see on the film/report? Correct answer- Juxta articular sclerosis A diagnosis was given to a young child, systemic lupus erythematosus (SLE). The child's parents ask if there is a cure. What should the family nurse practitioner tell the parent? Correct answer- Periods of remission may occur, but there is no permanent cure. A 40-year-old Federal Express office manager is diagnosed with carpal tunnel syndrome. You are advising him on proper forms of management. Which of the following medications would be best for early treatment of his symptoms? Correct answer- Celecoxib A patient presents for follow-up and reports symptoms consistent with a musculoskeletal disorder. Which of the following most likely present with symmetrical inflammation? Correct answer- Rheumatoid arthritis A 4-month-old infant has a history of reddened, dry, itchy skin. The family nurse practitioner notes fine papules on the extensor aspect of the infant's arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment? Correct answer- Moisturizers Which of the following tests provides the best assessment for carpal tunnel syndrome? Correct answer- Phalen's test Becky, a 17-year old patient, just received her first meningococcal conjugate vaccine. What is the ideal waiting period before she receives the booster dose? Correct answer- Patient does not require a booster The parent of a school-age child who is diagnosed with oligoarticular JIA asks the family nurse practitioner what exercises the child may do to help reduce the symptoms. What will the family nurse practitioner recommend? Correct answer- swimming A 55-year-old female presents to your office with complaints of aching in her hips and shoulder stiffness. She reports the symptoms began 2 to 3 weeks ago with a low-grade fever, fatigue, and difficulty getting up from lying down or a seated position. Which of the following is she most likely experiencing? Correct answer- Polymyalgia rheumatica You have diagnosed a 52-year-old female with Raynaud's phenomenon. As the family nurse practitioner, you understand which medications are helpful in relieving the symptoms associated with Raynaud's phenomenon. Which of the following is helpful in relieving the symptoms associated with Raynaud's phenomenon? Correct answer- Angiotensin converting enzyme inhibitor Giant cell arteritis is associated with which of the following conditions? Correct answer- Polymyalgia rheumatica A child has a fever and arthralgia. The family nurse practitioner learns that the child had a sore throat 3 weeks ago and auscultates a murmur during the clinic visit. Which of the following tests will the family nurse practitioner order? Correct answer- ASO titer The parent of a school-age child reports that the child usually has allergic rhinitis symptoms beginning each fall and that non-sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the family nurse practitioner do? Correct answer- Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season. A 64-year-old male patient who is HIV-positive has a TB skin test return with a 5 mm elevation. You confirm the diagnoses of TB and prescribe a traditional drug regimen. What is the minimum period of time the patient is expected to be on this regimen? Correct answer- 9 month You are evaluating an x-ray film/report of a 62-year-old female patient with osteoarthritis. Which of the following findings do you most likely expect to find? Correct answer- narrowing of joint spaces The family nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 8 to 9 months without back pain. The family nurse practitioner should refer the child to a rheumatology specialist to evaluate for which of the following? Correct answer- Oligaoarticular JIA An adolescent who has exercise-induced asthma is on the high school track team and recently began to practice daily during the school week. The adolescent uses two puffs of albuterol via a metered-dose inhaler 20 minutes before exercise but reports a decreased effectiveness since beginning daily practice. What will the family nurse practitioner do? Correct answer- Order a daily inhaled corticosteroid medication A 32-year-old HIV-positive patient presents to your office for follow-up with complaints of having a low-grade fever, fatigue, decreased appetite, and a dry cough. During the office visit, he coughs in front of you, producing red-tinged sputum. You order a chest x- ray, which reveals a small homogeneous infiltrate in the upper lobes. Given the most likely condition, what combination of drugs would be most effective for treatment? Correct answer- Isoniazid, rifampin, ethambutol, and pyrazinamide What is the typical timeframe in which an HIV-infected person most commonly will convert from HIV to HIV positive? Correct answer- Between 3 weeks and 6 months Ms. Gonzalez is a 78-year-old female with well-controlled hypertension. She is taking hydrochlorothiazide and presents with a 3-day history of unilateral throbbing headache and difficulty chewing because of pain. On physical examination, you find a tender noncompressible temporal artery. Blood pressure is 160/88 mmHg, apical pulse is 98 bpm, and respiratory rate is 22/minute. She is visibly uncomfortable. The optimal technique to confirm a diagnosis of temporal arteritis is: Correct answer- Biopsy of temporal artery A school-aged child who uses a short-acting beta agonist (SABA) and an inhaled corticosteroid medication is seen in the clinic for an acute asthma exacerbation. After four puffs of a SABA every 20 minutes for three treatments, spirometry testing shows a FEV1 of 60% of the child's personal best. What will the family nurse practitioner do next? Correct answer- Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely. A 48-year-old patient is being evaluated for knee injury and pain. When is an antinuclear antibody examination of the knee most often indicated? Correct answer- If rheumatoid arthritis is suspected During a regular follow-up visit of a 24-month-old patient, the exam reveals signs of short stature. The past medical history reveals poor weight gain and recurrent gastrointestinal symptoms that include vomiting and chronic diarrhea. This leads you to suspect celiac disease. Which of the following findings may assist you in establishing this diagnosis and determining the etiology of the patient's short stature? Correct answer- Anti-endomysial antibodies (EMA) A child who has been diagnosed with asthma for several years has been using a short- acting beta agonist (SABA) to control symptoms. The family nurse practitioner learns that the child recently began using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and a FEV1 of 75% of personal best. What should the family nurse practitioner do next? Correct answer- Add a daily inhaled corticosteroid Most adult poisonings are Correct answer- Accidental Most common mammalian bites Correct answer- dog