South University NSG 6420 Question Bank for Week 1 to Week 9 Quiz, Final Exam, and Midterm Exam (2020, Latest): (Already graded A)

South University NSG6420 Question Bank for Week 1 to Week 9 Quiz, Final Exam, and Midterm Exam NSG6420 Week 1 Quiz Question 1. The major impact of the physiological changes that occur with aging is: Reduced physiological reserve Reduced homeostatic mechanisms Impaired immunological response All of the above Question 2. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Less obesity rates than women Prostate enlargement Testosterone Less estrogen than women Question 3. The cytochrome p system involves enzymes that are generally: Inhibited by drugs Induced by drugs Inhibited or induced by drugs Associated with decreased liver perfusion Question 4. Functional abilities are best assessed by: Self-report of function Observed assessment of function A comprehensive head-to-toe examination Family report of function Question 5. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Hemoglobin and Hematocrit Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) Serum ferritin and serum iron Total iron binding capacity and transferrin saturation Question 6. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Hemoglobin 12 g/dl, MCV decreased, MCH decreased Hemoglobin 12 g/dl, MCV increased, MCH increased Hemoglobin 12 g/dl, MCV normal, MCH normal Hemoglobin 12 g/dl, MCV decreased, MCH increased Question 7. The pathophysiological hallmark of ACD is: Depleted iron stores Impaired ability to use iron stores Chronic unable bleeding Reduced intestinal absorption of iron Question 8. The main focus of treatment of patients with ACD is: Replenishing iron stores Providing for adequate nutrition high in iron Management of the underlying disorder Administration of monthly vitamin B12 injections Question 9. In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? Serum iron Total iron binding capacity Transferrin saturation Serum ferritin Question 10. Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except: Sore throat Fever Weight loss Headache Question 11. Essential parts of a health history include all of the following except: Chief complaint History of the present illness Current vital signs All of the above are essential history components Question 12.Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Clinical practice guideline Clinical decision rule Clinical algorithm Clinical recommendation Question 13. The first step in the genomic assessment of a patient is obtaining information regarding: Family history Environmental exposures Lifestyle and behaviors Current medications Question 14.In autosomal recessive (AR) disorders, individuals need: Only one mutated gene on the sex chromosomes to acquire the disease Only one mutated gene to acquire the disease Two mutated genes to acquire the disease Two mutated genes to become carriers Question 15. In AR disorders, carriers have: Two mutated genes; two from one parent that cause disease A mutation on a sex chromosome that causes a disease A single gene mutation that causes the disease One copy of a gene mutation but not the disease Question 16. A woman with an X-linked dominant disorder will: Not be affected by the disorder herself Transmit the disorder to 50% of her offspring (male or female) Not transmit the disorder to her daughters Transmit the disorder to only her daughters Question 17. According to the Genetic Information Nondiscrimination Act (GINA): Nurse Practitioners (NPs) should keep all genetic information of patients confidential NPs must obtain informed consent prior to genetic testing of all patients Employers cannot inquire about an employee’s genetic information All of the above Question 18. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Colon cancer in family member at age 70 Breast cancer in family member at age 75 Myocardial infarction in family member at age 35 All of the above Question 19. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: Variable expressivity related to inherited disease Dysmorphic features related to genetic disease De novo mutations of genetic disease Different penetrant signs of genetic disease Question 20.In order to provide a comprehensive genetic history of a patient, the NP should: Ask patients to complete a family history worksheet Seek out pathology reports related to the patient’s disorder Interview family members regarding genetic disorders All of the above NSG6420 Week 2 Quiz (latest): South University Question 1. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: Acoustic neuroma Cerumen impaction Otitis media Ménière’s disease Question 2. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Bacterial sinusitis Allergic rhinitis Drug abuse Skull fractur Question 3. A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with antibiotics to prevent complications and to shorten the course of disease. Which of the following antibiotics should be considered when a patient is allergic to Penicillin? Amoxicillin EES (erythromycin) Bicillin L-A Dicloxacillin Question 4. Presbycusis is the hearing impairment that is associated with: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster Question 5. Epistaxis can be a symptom of: Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above Question 6. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Question 7. A 26 year old patient presents with cough and general malaise for 3 days. They note that their eyes have been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel miserable’ and demand something to make them feel better. What would be the best first plan of treatment? Saline nasal spray for congestion and acetaminophen as needed for pain. Z-pack (azithromycin) for infection and Cromolyn nasal for congestion Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion Cephalexin for infection and Cromolyn ophthalmic for congestion Question 8. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above Question 9. Dizziness that is described as "lightheaded" or, "like I'm going to faint," is usually caused by inadequate cerebral perfusion and is classified as? Presyncope Disequilibrium Vertigo Syncope Question 10. It is important to not dilate the eye if ____ is suspected. Cataract Macular degeneration Acute closed-angle glaucoma Chronic open-angle glaucoma Question 11. Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any history of headaches or migraines. What would the most likely diagnosis be? Vestibular neruitis Benign paroxysmal positional vertigo Vestibular migraine Benign hypertensive central vertigo Question 12. Which of the following patients with vertigo would require neurologic imaging? A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not disappear when she focuses. A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix-Hallpike maneuver. A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test is positive. A 28-year-old otherwise well woman with new onset constant vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze is fixed. Question 13.A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Bacterial conjunctivitis Allergic conjunctivitis Chemical conjunctivitis Viral conjunctivitis Question 14. In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? History of prior red-eye episodes Grossly visible corneal defect Exophthalmos Photophobia Question 15. A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Bacterium Allergen Virus Fungi Question 16. Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Sinus pain, increased vascular permeability, and bronchodilation Bronchospasm, vascular permeability, and vasodilatation Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction Vasodilatation, bronchodilation, and increased vascular permeability Question 17. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) Migraine Question 18. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia Question 19. Rheumatic heart disease is a complication that can arise from which type of infection? Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae Question 20. A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy.Which of the following diagnostic tests should be considered? Mono spot Strep test Throat culture All of the above NSG6420 Week 3 Quiz (latest): South University Question 1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis Question 2. A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be? Observation and reassurance Treatment with an antibiotic such as amoxicillin Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler. Question 3.Emphysematous changes in the lungs produce the following characteristic in COPD patients? Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum Question 4. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: No palpable vibration is felt Decreased fremitus is felt Increased fremitus is felt Vibration is referred to the non-obstructed lobe Question 5. Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma? Clear, watery nasal drainage with nasal turbinate swelling Pharyngeal exudate and lymphadenopathy Clubbing, cyanosis and edema. Diminished lung sounds with rales in both bases Question 6.Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Computed tomography (CT) scan Chest X-ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan Question 7. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Exercise-induced cough Bronchiectasis Alpha-1 deficiency Pericarditis Question 8. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: Pneumothorax Pleural effusion Pneumonia Pulmonary embolism Question 9. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner.Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? Pulmonary edema Heart failure Pulmonary embolism Pneumonia Question 10. A cough is described as chronic if it has been present for: 2 weeks or more 8 weeks or more 3 months or more 6 months or more Question 11. Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze? Chest X-ray Methacholine challenge test Spirometry, both with and without bronchodilation Ventilation/perfusion scan Question 12. In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include: Symptoms daily with nighttime awakening more than 1 time a week. FEV1 60%, but predicted 80%. FEV1/FVC reduced 5% Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 80% predicted. FEV1/FVC normal Symptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 80% predicted. FEV1/FVC normal Symptoms throughout the day with nighttime awakenings every night. FEV1 60% predicted. FEV1/FVC reduced 5% Question 13. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough Question 14. Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistent asthma, the preferred option for maintenance medication is: High-dose inhaled corticosteroid and leukotriene receptor antagonist Oral corticosteroid—high and low dose as appropriate Short acting beta2 agonist inhaler and theophylline Low dose inhaled corticosteroid and long acting beta2 agonist inhaler Question 15. A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Can be treated as an outpatient Requires hospitalization for treatment Requires a high dose of parenteral antibiotic Can be treated with oral antibiotics Question 16. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X-ray Elevated white blood cell count Question 17. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Barrel-shaped chest Clubbing Pectus excavatum Prolonged capillary refill Question 18. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: Legionnaires' disease Malaria Tuberculosis Pneumonia Question 19. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer Tuberculosis Pneumonia COPD Question 20. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident.Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Pulmonary embolism Pleural effusion Pneumothorax Fracture of ribs NSG6420 Week 4 Quiz (latest): South University Question 1: Which of the following is the most important question to ask during cardiovascular health history? Number of offspring Last physical exam Sudden death of a family member Use of caffeine Question 2. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Women with ischemic heart disease many times do not present with chest pain Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction Elderly patients have the most severe symptoms A & B only Question 3. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: Echocardiogram Exercise stress test Cardiac catheterization Myocardial perfusion imaging Question 4. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: Mitral Valve Prolapse Referred Pain from Cholecystitis Pericarditis Pulmonary Embolus Question 5. Which symptom is more characteristic of Non-Cardiac chest pain? Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm Pain tends to occur with movement, stretching or palpation Pain usually lasts less than 10 minutes and is relieved by nitroglycerine Pain is aggravated by exertion or stress Question 6. What is the most common valvular heart disease in the older adult? Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Question 7. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Angina Pericarditis Mitral valve prolapse Congestive heart failure Question 8. The aging process causes what normal physiological changes in the heart? The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis Cardiology occurs along with prolapse of the mitral valve and regurgitation Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves Hypertrophy of the right ventricle Question 9. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris Question 10. A common auscultatory finding in advanced CHF is: Systolic ejection murmur S3 gallop rhythm Friction rub Bradycardia Question 11. Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: Anemia Anxiety Hyperthyroidism All of the above Question 12. The best way to diagnose structural heart disease/dysfunction non-invasively is: Chest X-ray EKG Echocardiogram Heart catheterization Question 13. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Pneumonia Pleuritis Pneumothorax A and B Question 14. A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, 1 dorsalis pedis pulse in the right foot, and 2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? Arterial insufficiency Femoral vein thrombus Venous insufficiency Peripheral neuropathy Question 15. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Femoral vein thrombosis Femoral artery thrombus Venous insufficiency Musculoskeletal injury Question 16. Your 54 year old patient, Mr. A, presents to your clinic with a 2 day history of severe shoulder pain. On initial assessment you note that in addition to shoulder findings his blood pressure on the ‘good’ arm is 162/100. You review his history and on his last visit his blood pressure was 120/70. He has a medical history of sleep apnea and has used anabolic steroids when body building as a younger adult. In addition to caring for Mr. A’s chief complaint of shoulder pain, you also: Start a thiazide diuretic, discussing the importance of adherence Discuss with him his new diagnosis of hypertension and the importance of taking medication. Schedule a follow up appointment after pain has subsided to take additional blood pressure readings Start an ACE inhibitor because with his history he may also be diabetic. Question 17. You decide to order labs today to help with the diagnosis and management of hypertension in Mr. A. Which of the following labs are indicated to assist in the medical management of Mr. A if he meets the diagnostic criteria for hypertension? Serum Sodium Thyroid function tests Fasting serum cholesterol panel Complete liver function enzyme panel Question 18. Lifestyle modifications reduce blood pressure, enhance antihypertensive medication efficacy, and decrease cardiovascular risks. Which lifestyle change will decrease blood pressure the most? Physical activity Dietary sodium reduction DASH diet Weight reduction Question 19. Mr. A returns to your clinic and a diagnosis of hypertension is made. He is started on a diuretic and counseled on lifestyle modifications including increasing activity and smoking cessation. On his next visit you note that his blood pressure remains elevated. Before referring to a specialist you should do all of the following except: Assure medications are at appropriate dose Identify any underlying medical condition that requires treatment Review diet with Mr. A and refer to dietician if it is diet problematic Determine he has ‘white coat’ hypertension because his home readings are also elevated Question 20. Mr. A has many issues that seem to be interfering with his health outcomes. In order to negotiate and formulate a patient-centered management plan you take the time to gather more information. This can be started by asking the following question: What do you think caused your hypertension and how has it affected your life? I see that you are 20 pounds overweight -- do you exercise? Does you wife help you to manage your diet and medication? Taking your blood pressure everyday is important so that I can see what happens each day. Do you do this? NSG6420 Week 5 Midterm Quiz (latest): South University 1. Question : A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Exercise-induced cough Bronchiectasis Alpha-1 deficiency Pericarditis Question 2. Question : A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? C-reactive protein level of 3 mg White blood cell count of 11,000 Direct serum bilirubin level of 0.3 mg/dl Serum amylase level of 145 U/L Question 3. Question : What is the most common valvular heart disease in the older adult? Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Question 4. Question : Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Clinical practice guideline Clinical decision rule Clinical algorithm Clinical recommendation Question 5. Question : A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: Appendicitis Cholecystitis Bowel Obstruction Diverticulitis Question 6. Question : During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: COPD Pneumothorax A normal finding Pleural effusion Question 7. Question : Essential parts of a health history include all of the following except: Chief complaint History of the present illness Current vital signs IN All of the above are essential history components Question 8. Question : Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Femoral vein thrombosis Femoral artery thrombus Venous insufficiency Musculoskeletal injury Question 9. Question : A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Women with ischemic heart disease many times do not present with chest pain Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction Elderly patients have the most severe symptoms A & B only Question 10. Question : Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis Question 11. Question : Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: Thrush Laryngeal cancer Carotidynia Thyroiditis Question 12. Question : Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X-ray Elevated white blood cell count Question 13. Question : Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Sinus pain, increased vascular permeability, and bronchodilation Bronchospasm, vascular permeability, and vasodilatation Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction Vasodilatation, bronchodilation, and increased vascular permeability Question 14. Question : Which of the following is not a contributing factor to the development of esophagitis in older adults? Increased gastric emptying time Regular ingestion of NSAIDs Decreased salivation Fungal infections such as Candida Question 15. Question : A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: 50 x 2-pack years 100-pack years 50-year, 2-pack history 100-pack history Question 16. Question : Epistaxis can be a symptom of: Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above Question 17. Question : The most common cause of eye redness is: Conjunctivitis Acute glaucoma Head trauma Corneal abrasion Question 18. Question : Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: Diverticulitis Colon cancer Appendicitis Peptic ulcer disease Question 19. Question : An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: Mallory-Weiss tear Esophageal varices Gastric ulcer Colon cancer Question 20. Question : A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: Digital rectal examination Endoscopy Pelvic examination Urinalysis Question 21. Question : Which of the following is the most common cause of heartburn-type epigastric pain? Decreased lower esophageal sphincter tone Helicobacter pylori infection of stomach Esophageal spasm Peptic ulcer disease Question 22. Question : Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: Anemia Anxiety Hyperthyroidism All of the above Question 23. Question : Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? Acute MI GERD Pneumonia Angina Question 24. Question : Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. Acute pancreatitis Duodenal ulcer Biliary colic IN Cholecystitis Question 25. Question : A specific exam used to evaluate the gall bladder is: Psoas sign Obturator sign Cullens sign Murphy’s sign Question 26. Question : An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? Identification of a fluid wave Positive Murphy’s sign Palpable spleen Midepigastric pain that is not reproducible with palpation Question 27. Question : Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Hemoglobin and Hematocrit Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) Serum ferritin and Serum iron Total iron binding capacity and transferrin saturation Question 28. Question : A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: Inflammatory bowel disease Irritable bowel syndrome Giardiasis Norovirus gastroenteritis Question 29. Question : (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? Abdominal plain films Liver function tests Amylase/lipase IN Urinalysis Question 30. Question : In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia Question 31. Question : A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: CBC with differential Stool culture and sensitivity Abdominal X-ray Colonoscopy Question 32. Question : According to the Genetic Information Nondiscrimination Act (GINA): Nurse Practitioners (NPs) should keep all genetic information of patients confidential NPs must obtain informed consent prior to genetic testing of all patients Employers cannot inquire about an employee’s genetic information All of the above Question 33. Question : What test is used to confirm the diagnosis of appendicitis? CBC Flat plate of abdomen Rectal exam CT of abdomen with attention to appendix Question 34. Question : A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: IN Can be treated as an outpatient Requires hospitalization for treatment Requires a high dose of parenteral antibiotic Can be treated with oral antibiotics Question 35. Question : A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Bacterium Allergen Virus Fungi Question 36. Question : An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? Atypical pneumonia Peptic ulcer disease Gastroesophageal reflux Mononucleosis (Epstein-Barr) Question 37. Question : A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Peptic ulcer disease Barrett’s esophagus Esophageal varices Pancreatitis Question 38. Question : Which of the following medications are commonly associated with the side effect of cough? Beta blocker Diuretic ACE inhibitor Calcium antagonist Question 39. Question : When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Hemoglobin 12 g/dl, MCV decreased, MCH decreased Hemoglobin 12 g/dl, MCV increased, MCH increased Hemoglobin 12 g/dl, MCV normal, MCH normal Hemoglobin 12 g/dl, MCV decreased, MCH increased Question 40. Question : If it has been determined a patient has esophageal reflux, you should tell them: They probably have a hiatal hernia causing reflux They probably need surgery They should avoid all fruit juices Smoking, alcohol, and caffeine can aggravate their problem NSG6420 Week 6 Quiz (latest): South University Question 1.Which ethnic group has the highest incidence of prostate cancer? Asians Hispanics African Americans American Indians Question 2.Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals? Every 6 months Yearly Every 2 years Every 2 to 4 years Question 3. Your 55-year-old male patient presents to your office with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately? Ultrasound of the abdomen Abdominal X-ray Digital rectal examination Spiral CT scan Question 4. The most common complication of an untreated urinary obstruction due to a ureteral calculus is: Ureteral rupture Hydronephrosis Kidney mass Renal artery stenosis Question 5. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is: Lower urinary tract infection Nephrolithiasis Hydronephrosis Pyelonephritis Question 6. On a physical examination for employment, a 45-year-old male shows no significant findings and takes no medications. Past medical history and surgery are unremarkable. On urinalysis, hematuria is present. The urinalysis is repeated on another day and still reveals microscopic hematuria. It is important to recognize that painless hematuria can be diagnostic of: Urinary tract infection Bladder cancer Nephrolithiasis Pyelonephritis Question 7. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should: Refer the patient for transrectal ultrasound guided prostate biopsy Obtain an abdominal X-ray of kidneys, ureter, and bladder Recognize this as a normal finding that requires periodic follow up Obtain urine culture and sensitivity for prostatitis Question 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: Increased estrogen production’s influence on the bladder and ureter Decline in bladder outlet function Decline in ureteral resistance pressure Laxity of the pelvic muscle Question 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is not a potential side effect of this procedure? Urinary incontinence Impotence Dribbling urine Selected low back pain Question 10. Your 77-year-old patient complains of frequent urination, hesitation in getting the stream started, and nocturnal frequency of urination that is bothersome. On DRE, there is an enlarged, firm, non-tender, smooth prostate. The clinician should recognize these as symptoms of: Urethritis Benign prostatic hyperplasia Prostatitis Prostate cancer Question 11. Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate: Upper urinary tract infection Normal bacteriuria Lower urinary tract infection Urethritis Question 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/ml. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 ml; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 ml; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age-associated change? PSA level of 3.3 ng/ml Decreased bladder capacity Involuntary detrusor contradictions Increased postvoid residual urine volume Question 13. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination? Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigued. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis. Thorough abdominal and gynecological exam to rule out masses and identify any tenderness. A rectal examination to rule out colon cancer as a secondary site for breast cancer. Question 14. A 27-year-old male comes in to the clinic for symptoms of dysuria, urinary frequency, as well as urgency and perineal pain.Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate. The clinician should recognize these as signs of: Prostatitis Prostate cancer Urethritis Benign prostatic hyperplasia Question 15. Which of the following males would be at greatest risk for testicular cancer? John, a 52-year-old, married African American Attorney who lives in Detroit, MI Jacob, a 22-year-old, homosexual male, who works as an accountant, resides in Cumming GA, and has a history of cryptorchidism Andy, a 27-year-old, Caucasian, single male who resides in Waukesha, WI and works as a maintenance mechanic Ryan, a 34-year-old healthy, married man from Sweden, who works as a Registered Nurse in Boston, MA Question 16. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is: Lower urinary tract infection Pyelonephritis Nephrolithiasis Hydonephrosis Question 17. Which of the following disorders can cause urinary incontinence? Cystocele Overactive bladder Uterine prolapse All of the above Question 18. Your 18 year old sexually active patient presents with sudden right sided groin pain that is sharp and constant. Inspection of his genitals reveals a swollen and erythematous right scrotum. His right testicle is exquisitely tender, swollen and has no palpable masses. Elevation of the testis results in no reduction in pain. The left scrotum and the testicle are normal. Epididymis and other scrotal contents were within normal limits. The scrotum does not transilluminate. Cremasteric reflex is present on the left side but absent on the right. There is no penile discharge, inguinal lymphadenopathy, or hernias. Based on the history and physical exam your immediate concern is for: Torsion Infection Cancer Rupture Question 19. The Prehn sign is utilized to distinguish epididymitis from testicular torsion. Epididymitis is considered when the Prehn sign is positive. When is the Prehn sign determined to be positive? Pain is relieved by lifting of the testicle. Tenderness is limited to the upper pole of the testis. Lightly stroking or pinching the superior medial aspect of the thigh causes testicular retraction. A small bluish discoloration is visible through the skin in the upper pole. Question 20. Which of the following exam findings makes the diagnosis of testicular tumor more likely? A scrotal mass that is accompanied by exquisite tenderness. Testicular swelling is mostly fluid and transilluminates easily A testicular mass that is non-tender to palpation Dilated and tortuous veins in the pampiniform plexus NSG6420 Week 7 Quiz (latest): South University Question 1.When a patient presents with a skin-related complaint, it is important to first: Fully inspect all skin lesions before asking the patient how the lesion in question developed Obtain a full history about the development of the skin lesion prior to the physical examination Complete a full physical examination of the body prior to inspecting the skin lesion Examine the skin lesion without hearing a health history in order to not prejudice the diagnosis Question 2. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? Tinea versicolor Seborrheic keratosis Verruca Herpes zoster Question 3. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that: All symptoms should disappear within three days Oral medications can dramatically reduce the duration and intensity of his symptoms He has chickenpox and can be contagious to his grandchildren He has a sexually transmitted disease Question 4. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? Ignore the lesion, as it is associated with aging. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. Perform a biopsy or refer to a dermatologist. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away. Question 5. The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in: Pityriasis Rosea Shingles Psoriasis Lymes Disease Question 6. Mr. Fitzgerald is a 68-year-old previously healthy man with a history of significant sun exposure who presents with a progressively enlarging 18 x 16 mm erythematous pruritic oval patch on his left forearm that has been present for three to four years. Your differential would include all of the following EXCEPT: Fungal skin infection Eczema Seborrheic Keratosis Squamous cell carcinoma of the skin Question 7. What kind of lesions are caused by the herpes simplex virus? Scales Vesicles Plaques Urticaria Question 8. Among the following conditions, which needs to be treated with systemic antifungal agents? Tinea pedis/tinea magnum Tinea corporis/tinea cruris Tinea capitis/Tinea unguium (onychomycosis) Tinea pedis /tinea faciale Question 9. Which lesions are typically located along the distribution of dermatome? Scabies Herpes zoster Tinea Dyshidrosis Question 10. A smooth round nodule with a pearly gray border and central induration best describes which skin lesion? Seborrheic keratosis Malignant melanoma Herpes zoster Basal cell carcinoma Question 11. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? Cellulitis is two times more common in women Facial cellulitis is more common in people 55 There is low incidence of cellulitis in patients with diabetes Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency Question 12. Folliculitis is most commonly due to: Contact dermatitis Varicella zoster Dermatophytes Staphylococcal infection Question 13. The anti-inflammatory properties of topical corticosteroids result in part from their ability to induce vasoconstriction to the small blood vessels in the upper dermis. Of the following, which is the most potent topical corticosteroid? Hydrocortisone 2.5% Triamcinolone acetonide 0.1% Betamethasone dipropionate 0.05% Alclometasone dipropionate 0.05% Question 14. Which of the following descriptions accurately documents cellulitis? Cool, erythematous, shiny hairless extremity with decreased pulse Scattered, erythematous ring-like lesions with clear centers Clearly demarcated, raised erythematous area of face Diffusely inflamed skin that is warm and tender to palpation Question 15. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with: Melanoma Basal cell carcinoma Leukoplakia Senile lentigines Question 16. Which of the following descriptions best illustrates assessment findings consistent with tinea capitis? Circular erythematous patches with papular, scaly annular borders and clear discharge Inflamed scaly dry patches with broken hairs Web lesions with erythema and scaling borders Scaly pruritic erythematous lesions on inguinal creases Question 17. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a: Bacterial folliculitis Basal cell carcinoma Bullous impetigo Epidermoid cyst Question 18. Patient presents with complaint of a “swollen node” under his arm. The area is tender and the node has progressed in size over the past few days. Which of the following should be included in your differential diagnosis? Hidradenitis suppurativa Epidermoid cyst Furuncle Both A and C Question 19. A patient suffered a laceration of the shin three days ago, and today presents with a painful, warm, red swollen region around the area. The laceration has a purulent exudate. The clinician should recognize that the infected region is called: Contact dermatitis Folliculitis Hidradenitis suppurativa Cellulitis Question 20. A woman complains of malaise and arthralgias. You note a butterfly-shaped, macular, erythematous rash across her cheeks and nose. These conditions are common in: Psoriasis Lichen planus Systemic lupus erythematosus Erythema nodosum NSG6420 Week 8 Quiz (latest): South University Question 1. Which of the following best describes the pain associated with osteoarthritis? Constant, burning, and throbbing with an acute onset Dull and primarily affected by exposure to cold and barometric pressure Begins upon arising and after prolonged weight bearing and/or use of the joint Begins in the morning and limits continued ambulation Question 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: Recommending she increase her dietary intake of Calcium and Vitamin D Ordering once a year bisphosphonate and a proton pump inhibitor Participate in a fall prevention program Dual-energy X-ray (DEXA) scan and updating immunizations Question 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: Green leafy vegetables Beer, sausage, fried seafood Sugar Gluten and bread items Question 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: Osteoarthritis Rheumatoid arthritis Fibromyalgia Polymyalgia rheumatica Question 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of: Osteoarthritis Rheumatoid arthritis Scleroderma Sarcoidosis Question 6. Which of the following statements about osteoarthritis is true? It affects primarily weight-bearing joints It is a systemic inflammatory illness The metacarpal phalangeal joints are commonly involved Prolonged morning stiffness is common Question 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days Doxycycline 100 mg twice daily for 5 days Prednisolone 35 mg four times a day for 5 days Ice therapy Question 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: Fibromyalgia Sarcoidosis Systemic lupus erythematosus Rheumatoid arthritis Question 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? Beta blocker ACE inhibitor Statin medication Metformin Question 10. A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? Joint infection Chondromalacia patella Prepatellar bursitis All of the above Question 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical examination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate: Knee ligament injury Osgood-Schlatter disease Prepatellar bursitis Chondromalacia patella Question 12. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon? Straight leg raising sign Lumbar herniated disc on X-ray Loss of left sided patellar reflex Urinary incontinence Question 13. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of: Carpal tunnel syndrome Osteoarthritis of the wrist Epicondylitis Cervical osteoarthritis Question 14. Which of the following describes the pathology of De Quervain’s tenosynovitis? Irritation of a tendon located on the radial side of the wrist, near the thumb Impingement of the median nerve, causing pain in the palm and fingers Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist Ulnar nerve compression at the olecranon process Question 15. What is the most common cause of hip pain in older adults? Osteoporosis Osteoarthritis Trauma due to fall Trochanteric bursitis Question 16. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an X-ray of the feet be ordered? Yes, there is tenderness over the fifth metatarsal No, there is not tenderness over the navicular bone Yes, the patient cannot bear weight on the foot A and C Question 17. 38-year-old Asian male, Mr. Chen, with past medical history significant for prehypertension who has recently taken up softball presents with three to five weeks of shoulder pain when throwing overhead. Ice minimally alleviates pain. Medications: Naproxen minimally alleviates shoulder pain. Allergies: Penicillin-associated rash. Family history: Brother has rheumatoid arthritis. Which of the following musculoskeletal causes of shoulder pain would merit urgent diagnosis and management? Adhesive capsulitis Septic subacromial bursitis Impingement of the supraspinatus tendon Calcific tendinopathy Question 18. If Mr. Chen had restricted passive as well as active ROM of the shoulder, what problems involving the shoulder might you consider? Adhesive capsulitis Rotator cuff tear Tendinopathy of the long head of the biceps Rotator cuff impingment Question 19. What is the essential dynamic stabilizer of the shoulder joint? Labrum Rotator muscle group Glenohumeral ligaments Teres major muscle Question 20. Given Mr. Chen’s repetitive overhead activities, some injury to his rotator cuff muscle group is most likely. Of the following exam findings, which one would not support the diagnosis of rotator cuff tendinopathy? Positive Apley’s Scratch test Weakness and pain with empty can testing Limited active ROM Inability to raise arm above his head Week 9 Quiz 1. Question : When assessing a patient who complains of a tremor, the nurse practitioner must differentiate essential tremor from the tremor of Parkinson’s disease. Which of the following findings are consistent with essential tremor? The handwriting is not affected by the tremor The tremor occurs with purposeful movements The tremor occurs at rest The tremor gets worse with alcohol ingestion Question 2. Question : An older adult client with a history of a seizure disorder comes into the clinic for a routine check-up. Although seizure free, the client continues on long-term phenytoin treatment. The nurse practitioner would assess for which of the following long-term effects? Lid lag and nystagmus Gingival hyperplasia and nystagmus Nystagmus and microcytic anemia Gingival hyperplasia and iron deficiency anemia Question 3. Question : An elderly patient is maintained on phenytoin therapy for a history of a seizure disorder. In addition to periodic serum drug concentrations, which of the following are needed for annual evaluation?