Test Bank Solutions for Midterm & Final Exam NR 511

(NR 511 Test Bank)

Lightning Round Review # 2 

1. Question: How many sets of Kegels should … done each day to help with urinary incontinence?
2. Question: What is the first line treatment for allergic rhinitis?
3. Question: What is the term … for the loss of high-pitched tones in geriatrics?
4. Question: What type of hearing loss does cerumen impaction cause?
5. Question: You see an older woman bending over leaving on her shopping cart at the grocery store. What is the likely … ?
6. Question: Multiple myeloma is disease of what?
7. Question: What test in the office can you use to help … sciatica?
8. Question: I have heel pain that is worse in the morning. What is my likely … ?
9. Question: The Lachman test is … to help … what?
10. Question: Other tests for acl include
11. Question: What is the treatment for gout and what would … the medication instructions for a flare?
12. Question: What is a sign of colchicine toxicity?
13. Question: What is a common cause of posterior knee pain?
14. Question: Cotton wool spots, neovascularization and microaneurysms are all Eye exam findings in what condition?
15. Question: And what about AV nicking and what it is?
16. Question: What is the treatment for bacterial sinusitis?
17. Question: I’m tired, have a sore throat and swollen posterior cervical nodes on exam. What is the likely … ?
18. Question: Recall that swollen ANTERIOR cervical nodes are … in
19. Question: What is a common side effect of Pyridium, an anti-spasmodic for dysuria?
20. Question: What would … included in your list of differentials for hematuria?
21. Question: What is the medication treatment for MRSA?
22. Question: What are some symptoms a patient with lupus would complain of?
23. Question: And what is the lab that you would order it to confirm it?
24. Question: What is the term … to describe dry, itching skin?
25. Question: What is the most common kind of skin cancer?
26. Question: What medication is … to treat a cat or dog bite?
27. Question: What do you think of when you hear a bright beefy red rash and what is the treatment?
28. Question: How would you describe the prostate in BPH?
29. Question: A1C> what is … T2DM? >6.5%
30. Question: My A1C is >10, what would … the medication of choice?
31. Question: Hypothyroidism is most common in what population?
32. Question: Your pediatric pt has bloody discharge in his ear, what’s the likely dx?
33. Question: Your patient presents with a burn and blisters are present. What degree burn is this?
34. Question: What is the treatment for pertussis?
35. Question: What bug causes the greatest mortality in community acquired pneumonia?
36. Question: What would … on xray of a pt with TB?
37. Question: Most common side effect of long-term inhaled corticosteroid use?
38. Question: S3 heart sound is a sign of what?
39. Question: What medication do use to treat a fib?
40. Question: What is pulsus paradoxus?
41. Question: The upcoming July 4th holiday reminds you of what …?
42. Question: Someone with high triglyceride levels is at increased risk of what?
43. Question: Subclinical hypothyroidism is described as what lab readings?
44. Question: A positive Markle test is significant of what?
45. Question: What differentials do you think of in someone with left upper quadrant pain?
46. Question: What about left lower quadrant?
47. Question: A positive Murphy’s sign is indicative of what?
48. Question: What … test would you order if this were positive?
49. Question: What is the first line treatment for GERD?
50. Question: I was going to go over hepatitis B markers but I think it’s harder to say that out loud versus seeing it on paper so going to skip that but of course remember to review those for the exam too!
51. Question: What … test should … done for suspicion of appendicitis?
52. Question: What is the confirmatory test for HIV? Per Leik 3rd edition,
53. Question: What is the treatment for syphilis?
54. Question: And what are some presenting features of syphilis?
55. Question: Gonorrhea treatment?
56. Question: Cervicitis is … in which … ?
57. Question: I am a healthy 63-year-old patient, what is my goal BP according to JNC 8?
58. Question: What should we keep in mind when prescribing for the elderly population?
59. Question: A low HDL and high trig level always means what?
60. Question: The S1 is the closure of which valves?
61. Question: On exam you feel a weakened peripheral pulse, what … do you think of?
62. Question: An absent red reflex is indicative of what?
63. Question: During an eye exam you note absent venous pulsations, what is this related to?
64. Question: The Dix Hallpike maneuver is … to test for what condition?
65. Question: What is the most well-known medication treatment for Vertigo?
66. Question: What medication is prescribed for essential tremors?
67. Question: A young adult patient states that she is experiencing episodes of vision loss and abnormal limb sensations. What would … at the top of your list of differentials?
68. Question: When assessing a patient for dementia, what is the FIRST and best thing you should do?
69. Question: Name a difference between dementia and delirium?
70. Question: What is the MAIN cause of delirium?
71. Question: Cranial Nerves review (just going over the MAIN ones I’ve … in reviews/questions for the exam)
72. Question: UTI treatment?
73. Question: What about UTI in a pregnant pt?
74. Question: Anxiety…which meds to use for situational?
75. Question: What about OCD?
76. Question: Which population has the highest suicide rate?
77. Question: What symptom is specific to the geriatric population when you think of UTIs?
78. Question: PNA in Geri’s, how do they present?
79. Question: What is the difference between sensitivity and specificity?
80. Question: What vitamin deficiency can alcohol lead to?
81. Question: MMSE, what score indicates dementia?
82. Question: 10mm+ for PPD is needed for continued investigation of TB for what two populations?
83. Question: What food is advised to try first in infants 4-6 months of age?
84. Question: What degree of curvature in scoliosis should warrant bracing?
85. Question: Tanner staging, anyone need a refresher on this?
86. Question: What is the leading cause of death in children?
87. Question: What sound during the Ortolani maneuver is a positive finding and signifies a possible hip abnormality (hip dysplasia) in infants?
88. Question: A newborn’s mother is discovered to … HBsAg(hepatitis B surface antigen) positive. Which of the following would you recommend for this infant?
89. Question: Which method is … gonorrheal pharyngitis or proctitis?
90. Question: What is the treatment for a medial tibial stress fracture (aka “shin splints”)?
    

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Chapter 3. Health Promotion

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which of the following is a primary prevention measure for a 76-year-old man newly … with a testosterone deficiency?
2. Question: Which of the following is an example of secondary prevention in a 50-year-old woman?
3. Question: Which of the following is an example of tertiary prevention in a patient with chronic renal failure?
4. Question: Immunizations are an example of which type of prevention?

True/False

5. Question: Indicate whether the statement is true or false.
   • Prevalence is the number of new cases of a particular disease.
   • The number of cases of a particular disease for the past 5 years is an example of the incidence rate.
   • “There are 1,185,000 cases of HIV/AIDS in the United States” is an example of the morbidity rate.
   • Endemic is the term … when the presence of an event is constant.
   • The “bird” flu of 2005 to 2006 is … a sporadic outbreak.
   • A pandemic affects many communities in a short period of time
     

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Chapter 5. Evidence-Based Care

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which of the following are parts of evidence-based practice?
2. Question: Which is the most important question to ask in nursing research?
3. Question: Nursing research should … utilized by:
4. Question: Applying evidence at the point of care requires:
5. Question: Practice guidelines are … to:
6. Question: Which of the following is a crucial element of developing a guideline?
7. Question: Which of the following would … the research design for Level I evidence?
8. Question: Which of the following would … the research design for Level II evidence?
9. Question: Which of the following would … the research design for Level III evidence?
10. Question: Which of the following would … the research design for Level IV evidence?
11. Question:Which of the following would … the research design for Level V evidence?
12. Question: Which of the following would … the research design for Level VI evidence?
13. Question: Which of the following would … the research design for Level VII evidence? 
    

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Chapter 6. Neurological Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which statement about confusion is true?
2. Question: Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?
3. Question: The hallmark of an absence seizure is:
4. Question: How often should drug levels … monitored when a seizure medication has controlled the seizures, and the drug level is adequate?
5. Question: Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)?
6. Question: Which of the following is a specific test to MS?
7. Question: Which drug for Alzheimer’s disease should … administered beginning at the time of … ?
8. Question: Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery?
9. Question: Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing?
10. Question: Which statement best describes a carotid bruit?
11. Question: Which patient is more likely to have a cluster headache?
12. Question: Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of?
13. Question: Which type of meningitis is more benign, self-limiting, and caused primarily by a virus?
14. Question: Which is the most sensitive neuroimaging test to evaluate patients with encephalitis?
15. Question: What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?
16. Question: Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her?
17. Question: Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him:
18. Question: Which of the following signs is … in a patient with more advanced PD?
19. Question: Which of the following is the most commonly experienced symptom of migraine?
20. Question: Which of the following characteristics differentiates peripheral vertigo from central vertigo?
21. Question: Carotid endarterectomy should … considered only for symptomatic patients with greater than what percentage of stenosis?
22. Question: What antiplatelet agent is most widely used for secondary prevention of stroke?
23. Question: Which adjunctive … test should … used in the work-up of a patient with suspected Creutzfeldt-Jakob disease or transient epileptic amnesia?
24. Question: Which herbal preparation may cause delirium and should … avoided in an elderly patient?
25. Question: Which of the following activities is part of the functional activities questionnaire?
26. Question: About 90% of all headaches are?
27. Question: Which statement is true regarding driving and patients with a seizure disorder?
28. Question: Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given intravenously once a month?
29. Question: The ‘freezing phenomenon’ is a cardinal feature of? I do not remember how the question was written
30. Question: A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as?
31. Question: Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly … of which condition?
32. Question: Which condition is characterized by the impaired ability to learn new information along with either a cognitive disturbance in language, function, or perception?
33. Question: A score of 20 to 25 on this test indicates early-stage Alzheimer’s disease:
34. Question: Intravenous thrombolytic therapy following an ischemic CVA should … given within how many hours of symptom onset?
35. Question: When administered at the beginning of an attack, oxygen therapy may help this kind of headache? 
    

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Chapter 7. Skin Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause?
2. Question: Which of the following is “a linear crack extending from the epidermis to the dermis?”
3. Question: A bulla is:
4. Question: An example of ecchymosis is:
5. Question: When looking under the microscope to … an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?
6. Question: Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is a treatment that you usually recommend/order in nonpregnant patients, but is listed as a Pregnancy category D?
7. Question: Tinea unguium is also known as:
8. Question: Sally, age 25, presents with impetigo that has … as infected with The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not … adequate. Which type of impetigo is this?
9. Question: Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria?
10. Question: When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect?
11. Question: Marci has a wart on her hand. She says she heard something about “silver duct tape therapy.” What do you tell her about his?
12. Question: Which is the most potent and irritating dose of tretinoin?
13. Question: Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers?
14. Question: Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and document this as a:
15. Question: Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him. Which would be a good choice?
16. Question: Harvey has a rubbery, smooth, round mass on his chest that is compressible and has a soft-to-very-firm texture. What do you … this as?
17. Question: Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using liquid nitrogen?
18. Question: The “B” in the ABCDEs of assessing skin cancer represents:
19. Question: The majority of HSV-1 and HSV-2 infections are asymptomatic so that only which elevated antibody titer shows evidence of previous infection?
20. Question: Eighty percent of men have noticeable hair loss by what age?
21. Question: Prevalence of psoriasis is highest in which group?
22. Question: The most common precancerous skin lesion found in Caucasians is:
23. Question: Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation. There is some edema involved. You suspect:
24. Question: Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?
25. Question: Tori is on systemic antifungals for a bad tinea infection. You are aware that the antifungals may cause:
26. Question: Which scalp problem can … caused by a fever and certain drugs?
27. Question: Why do people of African descent have a lower incidence of non-melanoma skin cancer?
28. Question: Which statement is true regarding chloasma, the ‘mask of pregnancy’?
29. Question: When instructing your elderly client about treating her xerosis, what do you tell her?
30. Question: Which medication … for scabies is safe for children 2 months and older?
31. Question: Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis?
32. Question: Which of the following statements about performing cryosurgery for actinic keratosis is true?
33. Question: An example of a primary skin lesion is a/an:
34. Question: Which statement regarding necrotizing fasciitis is true?
35. Question: When staging a malignant melanoma using Clark’s levels, which level extends into the papillary dermis? 
    

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Chapter 8. Eyes, Ears, Nose, and Throat

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: An acutely presenting, erythematous, tender lump within the eyelid is called:
2. Question: The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis?
3. Question: Which subtype of cataracts is … nearsightedness and a slow indolent course?
4. Question: Which of the following statements is true concerning the use of bilberry as a complementary therapy for cataracts?
5. Question: A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the … of chronic open-angle glaucoma?
6. Question: Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure?
7. Question: As diabetic retinopathy progresses, the presence of ‘cotton wool’ spots can … detected. Cotton wool spots refer to:
8. Question: Which of the following is an example of sensorineural hearing loss?
9. Question: The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient’s mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test?
10. Question: A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition?
11. Question: Otitis media is … chronic when:
12. Question: The most significant precipitating event leading to otitis media with effusion is:
13. Question: Patients with acute otitis media should … referred to a specialist in which of the following situations?
14. Question: Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis?
15. Question: Fluctuations and reductions in estrogen may … a contributing factor in which type of rhinitis?
16. Question: Sinusitis is … chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than:
17. Question: Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected?
18. Question: In which of the following situations would referral to a specialist … needed for sinusitis?
19. Question: Which type of stomatitis results in necrotic ulceration of the oral mucous membranes?
20. Question: The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection?
21. Question: Heart valve damage resulting from acute rheumatic fever is a long-term sequela resulting from infection with which of the following pathogens?
22. Question: A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause?
23. Question: A patient presents to the clinician with a sore throat, fever of 100.7°F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step … ?
24. Question: Which of the following medications … in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape?
25. Question: You have a patient who is a positive for Strep on rapid antigen testing (rapid strep test). You order amoxicillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5 F in office). You also note significant adenopathy, most notably in the posterior and anterior cervical chains, some hepatomegaly, and a diffuse rash. You decide:
26. Question: You are in the park playing with your children when you see that your friend is screaming for help. Her toddler has fallen and there is a stick lodged in his eye. The child is kicking and screaming and grabbing for the stick. You:

True/False

27. Question: Indicate whether the statement is true or false.
28. Severe pain associated with acute otitis media signifies perforation of the tympanic membrane
    

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Chapter 9. Respiratory Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: A chronic cough lasts longer than:
2. Question: You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex?
3. Question: Julie has a postnasal drip along with her cough. You assess her for:
4. Question: A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must … from:
5. Question: African American patients seem to have a negative reaction to which of the following asthma medications?
6. Question: Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO₂, and an increased PaCO₂. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your … ?
7. Question: You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have … with community-acquired pneumonia (CAP), should … hospitalized or treated at home. Her score is 3. What should you do?
8. Question: Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TBT)?
9. Question: Marci has been started on a tuberculosis (TB) regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically?
10. Question: Jolene has breast cancer that has … staged as T1, N0, M0. What might this mean?
11. Question: Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do?
12. Question: Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?
13. Question: Which information should … included when you are teaching your patient about the use of nicotine gum?
14. Question: Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead?
15. Question: What is the first-line recommended treatment against Group A b-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?
16. Question: Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV₁ is 60% to 80% predicted. How would you classify her asthma severity?
17. Question: Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she … taking?
18. Question: Your patient is on Therabid for his asthma. You want to maintain his serum levels between:
19. Question: George has chronic obstructive pulmonary disease (COPD) and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD?
20. Question: Most nosocomial pneumonias are caused by:
21. Question: Which of the following statements regarding TST is true?
22. Question: Which obstructive lung disease is classified as reversible?
23. Question: You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?
24. Question: Which statement about adenocarcinoma of the lung is accurate?
25. Question: Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors?
26. Question: The forced vital capacity is decreased in:
27. Question: The most common cause of CAP is?
28. Question: Which of the following patients would you expect to have a decreased response to TST?
29. Question: Which of the following is a possible consequence of sleep apnea?
30. Question: Which of the following conditions is associated with cigarette smoking?
31. Question: Marta is taking TB drugs prophylactically. How do you instruct her to take them?
32. Question: Which of the following statements regarding pulmonary function is true?
33. Question: The barrel chest characteristic of emphysema is a result of:
34. Question: Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
35. Question: Which ethnic group has the highest lung cancer incidence and mortality rates? 
    

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Chapter 10. Cardiovascular Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question

1. Question: Which group would most benefit from statins?
2. Question: If chest pain can … alleviated with time, analgesics, and heat applications, what might the differential … ?
3. Question: Sandra has palpitations that occur with muscle twitching, paresthesia, and fatigue. What specific … test might help determine the cause?
4. Question: A blood pressure (BP) of 150/90 is … :
5. Question: Lifestyle modifications to manage hypertension (HTN) include:
6. Question: Mary has hypertension and previously had a stroke. Which hypertensive drug would you order for her?
7. Question: Which high-density lipoprotein (HDL) level is … cardioprotective?
8. Question: You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome?
9. Question: Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours?
10. Question: Which ECG change is typical of cardiac ischemia?
11. Question: In which type of arterioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped?
12. Question: A Delta wave on the ECG may … present in which condition?
13. Question: Which heart sound may … heard with poorly controlled hypertension, angina, and ischemic heart disease?
14. Question: Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of:
15. Question: George, age 64, has cardiovascular disease (CVD), a total cholesterol of 280 mg/dL, and a systolic BP of 158. He is being treated for hypertension. You are doing a Framingham Risk Assessment on him. Which assessment factor would give him the highest number of points on the scale?
16. Question: Which pain characteristic is usually indicative of cardiac pathology?
17. Question: What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia?
18. Question: Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should … under the tongue every 5 minutes for three doses. What should … done if the pain has not been relieved after three doses?
19. Question: For the best therapeutic effect after a myocardial infarction (MI), thrombolytics should … administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can … of benefit up to how many hours after the initial presentation of MI symptoms?
20. Question: When teaching post MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not … put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must … dated and discarded after how many months?
21. Question: There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy?
22. Question: Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good … test?
23. Question: Which test has long been … the gold standard for a … of venous thromboembolism?
24. Question: Statins are approved for which age group?
25. Question: The American College of Cardiology/American Heart Association states which of the following regarding the use of non-statin lipid-lowering agents?
26. Question: Which of the following medications can cause hyperlipidemia?
27. Question: Jamie, age 55, has just started on a statin after having his liver function tests (LFTs) come back normal. He now asks you how often he has to have the LFTs repeated. What do you tell him?
28. Question: In the CHADS2 Index for the stroke risk score for AF, the ‘A’ stands for:
29. Question: Which murmurs are usually ‘watch and wait’?
30. Question: Which of the following statements about dabigatran is true?
31. Question: What value on the ankle-brachial index … peripheral artery disease?
32. Question: Your patient with permanent afib asks when he can discontinue his warfarin. You tell him:
33. Question: You just started Martha on HTN therapy. The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it? 
    

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Chapter 11. Abdominal Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: A 35-year-old female patient is … in the clinic complaining of abdominal pain. Which of the following should … included in the history and physical examination?
2. Question: A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could … responsible for the constipation?
3. Question: A patient is … with complaints of diarrhea. Which of the following should … included in the patient’s differential …?
4. Question: J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?
5. Question: A 29-year-old Englishman is … in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a … of gastric ulcer?
6. Question: Which of the following is most effective in … appendicitis?
7. Question: Which of the following is associated with celiac disease (celiac sprue)?
8. Question: A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should … … in the differential … ?
9. Question: A 46-year-old patient is … in the clinic with abdominal pain. Which of the following tests is essential for this patient?
10. Question: A 25-year-old accountant is … in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step … ?
11. Question: A 28-year-old patient is … in the clinic with colicky abdominal pain particular with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a … of diverticulitis unlikely?
12. Question: A 28-year-old patient is … with complaints of diarrhea. Which of the following responses to the history questions would help the primary care physician (PCP) establish the … of irritable bowel syndrome?
13. Question: A patient is … with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the explanation of the pathology report?
14. Question: Which of the following dietary instructions should … given to a patient with GERD?
15. Question: The patient with GERD should … instructed to eliminate which of these activities?
16. Question: A patient is … with giardia after a backpacking trip in the mountains. Which of the following would … an appropriate treatment?
17. Question: A 22-year-old is … complaining of vague belly pain. This type of pain is … at what point in appendicitis?
18. Question: The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?
19. Question: A patient is … with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could … a cause of this problem?
20. Question: A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would … most helpful in the differential … at this point?
21. Question: On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would … most helpful in confirming your … ?
22. Question: A patient is … in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings?
23. Question: A patient has acute pancreatitis with seven of the … criteria from Ranson’s criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings?
24. Question: A patient is … in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the NP to a … of inflammatory bowel disease?
25. Question: Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? 
    

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Chapter 12. Renal Problem

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: A patient is … in the clinic with a chief complaint of hematuria. To make a differential … , which of the following questions should … asked?
2. Question: The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?
3. Question: A patient is … complaining of “leaking urine when I sneeze.” Which of the following actions should the clinician take first?
4. Question: A patient is … in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might … the cause of hematuria?
5. Question: A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a … of lower UTI?
6. Question: A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable … ?
7. Question: A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria. Which of the following … is most … the above information?
8. Question: Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a UTI?
9. Question: A patient is … in the office complaining of severe flank pain. The clinician should assess this patient for which risk factor for kidney stones?
10. Question: A patient is … with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication?
11. Question: A patient is … with overactive bladder. Which of the following instructions should … given to this woman?
12. Question: A 34-year-old patient was treated for a UTI and has not … to antibiotic therapy. Which of the following actions should … taken next?
13. Question: Which of the following are predisposing factors for pyelonephritis?
14. Question: A 42-year-old woman is … in the clinic with fever, chills, vomiting, and severe dysuria. She is … with acute pyelonephritis. How should this patient … managed?
15. Question: A patient is … with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should … added to the list of differential … ?
16. Question: Which of the following instructions should … given to the patient with nephrolithiasis?
17. Question: Which of the following patients is at risk for developing urinary tract cancer?
18. Question: A patient is … in the clinic and … with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments?
19. Question: An 86-year-old woman is … in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is … a risk factor for this type of cancer?
20. Question: Which of the following … tests should … ordered for a patient suspected of having bladder cancer?
21. Question: A 78-year-old man is … with Stage D bladder cancer and asks the provider what that means. Which is the best response?
22. Question: The patient is … with acute renal failure (ARF). Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia?
23. Question: The patient is … with ARF. Which of the following conditions is the most common cause?
24. Question: An 82-year-old woman with renal failure is … in the clinic. The provider should question the patient about the intake of which of these substances that can cause renal toxicity?
25. Question: Which of the following clinical manifestations are consistent with a patient in ARF?
26. Question: Which of the following examination findings should … expected in a patient with chronic renal failure (CRF)?
27. Question: Which of the following tests is most useful in determining renal function in a patient suspected of CRF?
28. Question: Which of the following foods should be limited in a patient with CRF?

True/False

29. Question: Indicate whether the statement is true or false
30. The urine osmolality is greater than 500 mOsm/L in patients with postrenal ARF.
31. Cigarette smoking is a risk factor for CRF 
    

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Chapter 13. Men’s Health Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: A 63-year-old man is … in the clinic with a chief complaint of nocturia. Which of the following should … included in the differential … ?
2. Question: A 76-year-old man is … in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men?
3. Question: A 14-year-old male is … with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?
4. Question: An 82-year-old man is … in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should … included in the list of differential … ?
5. Question: Which of the following would … an appropriate treatment for a patient with mild BPH?
6. Question: A 30-year-old man is … with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a … ?
7. Question: Which of the following should … in a patient presenting with erectile dysfunction?
8. Question: A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely … ?
9. Question: The patient with BPH is … for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects?
10. Question: The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis?
11. Question: The 56-year-old man with chronic prostatitis should … treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long?
12. Question: A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a … of prostatodynia is made. Which is the appropriate treatment?
13. Question: A 23-year-old sexually active man is … in the clinic with unilateral painful testicular swelling, and he is … with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism?
14. Question: Which test is … to confirm a … of epididymitis?
15. Question: Treatment for epididymitis includes which of the following?
16. Question: Which of the following data is indicative of testicular torsion?
17. Question: A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?
18. Question: During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?
19. Question: A 78-year-old man is … with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?
20. Question: A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?
21. Question: A 22-year-old male is … in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should … included in the list of differential … ?
22. Question: What is the treatment of choice for a patient … with testicular cancer?
23. Question: A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan? 

True/False

24. Question: Indicate whether the statement is true or false.
25. Patients treated for Neisseria gonorrhoeae also should be treated for Chlamydia trachomatis.
26. Hepatitis A is … a sexually transmitted infection by the Centers for Disease Control and Prevention
    

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Chapter 14. Women’s Health Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?
2. Question: A 20-year-old woman is … in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?
3. Question: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to?
4. Question: A 45-year-old woman is … in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following … with this finding?
5. Question: Which of the following medications is the treatment of choice for trichomonas?
6. Question: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?
7. Question: A 26-year-old woman is … with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
8. Question: A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia?
9. Question: A 36-year-old woman is … with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?
10. Question: A 21-year-old woman is … in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?
11. Question: A 40-year-old woman is … for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes “occasionally” and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best for this patient?
12. Question: A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate?
13. Question: A 32-year-old woman is … in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes?
14. Question: When assessing a woman for infertility, which of the following tests should be done first?
15. Question: A 15-year-old girl is … in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause?
16. Question: What is the most common cause of secondary amenorrhea?
17. Question: A 22-year-old woman is … with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient’s symptoms?
18. Question: A 25-year-old woman is … in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?
19. Question: A 26-year-old woman tells the clinician that she has endometriosis, because she has frequent pelvic pain. The clinician also should consider which of these differential … ?
20. Question: Which of the following would be appropriate treatment for a woman with mild endometriosis?
21. Question: A 45-year-old woman is … in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following … ?
22. Question: A 48-year-old woman is … in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following … tests should the clinician order first?
23. Question: A 45-year-old woman is … because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response?
24. Question: Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal?
25. Question: A 60-year-old woman is … for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer?
26. Question: A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is … with atrophic vaginitis. Which of the following is the most appropriate treatment?

True/False

27. Question: Indicate whether the statement is true or false.
28. Oral contraceptive pills can cause endometrial cancer.
29. A woman taking estradiol is at risk for developing endometrial cancer.
30. Most breast cancer cases are in women with a family history of breast cancer 
    

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Chapter 15. Musculoskeletal Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
2. Question: You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
3. Question: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
4. Question: Which of the following statements concerning the musculoskeletal examination is true?
5. Question: You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient?
6. Question: Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this … ?
7. Question: Jennifer is an 18-year-old who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has … Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
8. Question: Anderson is a 35-year-old woman who has been recently … with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
9. Question: Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
10. Question: Sam is a 25-year-old who has been … with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a … of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
11. Question: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
12. Question: Janet is a 30-year-old who has recently been … with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
13. Question: Which of the following statements is true concerning the management of the client with a herniated disc?
14. Question: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury … experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
15. Question: The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
16. Question: The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?
17. Question: Jackson is a 65-year-old man recently … with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?
18. Question: Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways?
19. Question: Which of the following tests is … the gold standard for definitively … osteoporosis?
20. Question: What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
21. Question: Allen is a 60-year-old woman who has been … with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs …in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
22. Question: Which stage of Paget’s disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
23. Question: Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
24. Question: One of the most frequent presenting signs/symptoms of osteoporosis is:
25. Question: Thomas was … in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the … and is most consistent with lateral epicondylitis (tennis elbow) is:
26. Question: A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has … Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?

True/False

27. Question: Indicate whether the statement is true or false.
28. Osteoarthritis is primarily a noninflammatory condition.
29. The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis
    

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Chapter 16. Endocrine/Metabolic Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
2. Question: A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
3. Question: How often should the clinician examine the feet of a person with diabetes?
4. Question: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
5. Question: S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
6. Question: W, 53 years old, is … in the clinic with … about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely … ?
7. Question: Which of the following tests should you order to confirm Mr. W’s … ?
8. Question: A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods?
9. Question: The clinician should question the patient with suspected gout about use of which of these medications?
10. Question: The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which of the following data would be most significant for this patient?
11. Question: Which of the following is essential for … thyroid cancer?
12. Question: Which of the following are common signs of type 2 DM?
13. Question: Which of the following medications can cause hyperglycemia?
14. Question: Which of the following is … for diabetes mellitus?
15. Question: Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?
16. Question: A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which of the following should be included in the differential … ?

True/False

17. Question: Indicate whether the statement is true or false.
18. Metformin is the first line of pharmacologic treatment for type 2 DM.
19. Fruit juice with added sugar is the treatment of choice for anyone experiencing hypoglycemia.
20. Lifestyle modification is the treatment of choice for metabolic syndrome.
21. A BMI of 29 kg/m² is … obesity.
22. Urine-free cortisol is one of four … tests recommended for Cushing’s syndrome
    

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Chapter 17. Hematologic and Immune Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Sandra is 42 years old and has just been … with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit?
2. Question: Which type of bone marrow transplant is obtained from an identical twin?
3. Question: During treatment for anaphylaxis, what site is … for the initial injection of epinephrine?
4. Question: After the initial treatment for anaphylaxis, which medication should … added to prevent late-phase anaphylactic reactions?
5. Question: When analyzing synovial fluid, if it is opaque, white, or translucent; has 5,000 leukocytes/Ml; 80% polymorphonuclear leukocytes (PMN); and a low red blood cell count, it may be indicative of which of the following conditions?
6. Question: Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist?
7. Question: Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate?
8. Question: Which household solution should be … to clean a bathroom if sharing with a friend who has HIV?
9. Question: Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?
10. Question: If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do?
11. Question: Which of the following is identified as an eating disorder in which a person craves food substitutes, such as clay, ice chips, and cotton, and is … an objective finding associated with severe iron deficiency?
12. Question: As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin?
13. Question: What is the most common cause of microcytic anemia?
14. Question: The cardinal subjective symptom of sickle cell crisis is which of the following?
15. Question: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?
16. Question: Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?
17. Question: Infectious mononucleosis results from an acute infection with which of the following?
18. Question: What is the most common cause of generalized musculoskeletal pain in women ages 20 to 55?
19. Question: After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering?
20. Question: Dryness of the eyes and mouth is typical of which condition?
21. Question: Triggering factors for acute exacerbations of which of the following conditions include exposure to ultraviolet (UV)-B and UV-A rays?
22. Question: The current goal of treatment for a patient with HIV infection is which of the following?
23. Question: The most cost-effective screening test for determining HIV status is which of the following?
24. Question: An important complication of antiretroviral (ARV) therapy in patients with advanced AIDS is which of the following?
25. Question: Which drug category of ARV therapy is generally effective in crossing the blood–brain barrier and may be useful in managing HIV-associated dementia?
26. Question: Spontaneous bruising may be … with platelet counts below what level?
27. Question: Which type of the following is … by fatigue on awakening that may improve with exercise?
28. Question: Early rheumatoid disease is characterized by:
29. Question: Which test is … of rheumatoid arthritis?
30. Question: What is the mainstay of management for infectious mononucleosis?
31. Question: CFS tends to occur in which individuals?
32. Question: The exanthem of Lyme disease is:
33. Question: If left untreated, this condition will progress to complaints that include multiple joint arthritis.
34. Question: Keratoconjunctivitis sicca is a classic sign of which condition?
35. Question: Which person is four times more likely to develop SLE than a Caucasian?
    

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Chapter 18. Psychosocial Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?
2. Question: The criteria for … generalized anxiety disorder in the American Psychiatric Association’s … and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:
3. Question: A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack?
4. Question: Which of the … first-line treatment for panic disorders?
5. Question: Which of the … symptoms is not part of the … criteria for post-traumatic stress disorder (PTSD)?
6. Question: Which of the … neuroendocrine abnormalities is implicated in depression?
7. Question: The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the … criteria for depression. Which of the … is not true concerning SSRIs in comparison to tricyclic antidepressants?
8. Question: After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor?
9. Question: It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?
10. Question: A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the … approaches to treating these side effects?
11. Question: According to Kübler-Ross, the stages of grief occur in which order?
12. Question: The clinician is educating a patient about the effects of marijuana. The patient stated she has been smoking for years and believes the use does not interfere with her life. What is a significant long-term sequelae of marijuana use that the clinician should educate this patient about?
13. Question: Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?
14. Question: What blood alcohol level corresponds with the signs of stupor and confusion?
15. Question: Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep?
16. Question: Which of the … is a laboratory finding commonly found in patients with anorexia nervosa?
17. Question: Which of the … is the only drug for bulimia approved by the U.S. Food and Drug Administration?
18. Question: Which of the … would … important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)?
19. Question: It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the … is the most common long-term effect of sexual assault?
20. Question: Women are at the highest risk for developing postpartum depression for up to how long after childbirth?
21. Question: Which is the most prevalent psychiatric condition in the United States?
22. Question: What is recorded as clinical category two of the American Psychiatric Association’s … and Statistical Manual of Mental Disorders, 5th edition (text revision)?
23. Question: Which of the … may be … to evaluate a person’s suicide risk?
24. Question: Assessing for adherence with prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the … groups?
25. Question: Bipolar disorder requires differential … from all of the … except?

True/False

26. Question: Indicate whether the statement is true or false.
27. The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms.
28. Depressive episodes associated with bipolar disorder are treated the same as major depressive disorder.
29. Women in abusive relationships have a greater chance of being killed by their batterers when they leave the relationship than women who stay.
30. Adults must show childhood onset of symptoms to receive a … of ADHD.
31. Parkinson’s disease and dementing illnesses may commonly manifest depressive symptoms.
32. The best predictor of suicide risk is a history of suicide attempts.
33. A no-suicide contract can prevent a suicide attempt.
34. Depression is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses.
35. Clozapine (Clozaril) requires laboratory monitoring at specified frequencies with results reported to a national registry.
36. When combined with certain other medications, serotonin-specific antidepressants can have significant liver P450-interaction effects.
    

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Chapter 19. Emergency Problems

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea?
2. Question: What percentage of burns is involved … the rule of nines if both front legs are burned?
3. Question: Which drug commonly … for burns is active against a wide spectrum of microbial pathogens and is the most frequently … agent for partial- and full-thickness thermal injuries?
4. Question: A sunscreen with a sun-protection factor of at least what number will block most harmful ultraviolet radiation?
5. Question: Which clinical feature is the first to … in increased intracranial pressure?
6. Question: What is the normal number for the Glasgow Coma Scale?
7. Question: Which … test is the best to … a subdural hematoma?
8. Question: Patients with a spontaneous pneumothorax should … counseled that up to what percentage may experience a reoccurrence at some point?
9. Question: Most adult poisonings are:
10. Question: Which method is … to remove heavy metals, such as lead, that are ingested as poisons?
11. Question: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?
12. Question: What percentage of all visits to the emergency department (ED) are related to wounds?
13. Question: Which solution should … used when irrigating lacerated tissue over a wound on the arm?
14. Question: Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?
15. Question: Which carboxyhemoglobin (COHb) level correlates with the clinical symptoms of confusion, lethargy, and ST-segment depression on the electrocardiogram?
16. Question: Which causes the greatest percentage of mammalian bites?
17. Question: Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?
18. Question: Which of the … characteristics separates anaphylaxis from a vasovagal reaction?
19. Question: Delayed serum sickness–type reactions in response to multiple bee, wasp, or fire ant stings can be managed with which of the … ?
20. Question: After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)–filled spaces within the head?
21. Question: Cerebrospinal fluid (CSF) may leak through the cribriform plate region of the skull … a head injury and cause which of the … ?
22. Question: Which classic feature of an epidural hematoma may distinguish it from other skull hematomas?
23. Question: A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve?
24. Question: A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury?
25. Question: In a healthy adult, the process of remodeling after a fracture of the humerus takes how long?
26. Question: A patient who sustains blunt chest trauma and/or penetrating chest trauma must have which of the following imaging examinations?
27. Question: Josie, age 30, has a pneumothorax. It may … treated conservatively without a chest tube if it is deflated by what percentage?
28. Question: Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication?
29. Question: Pink, cherry red tissues and skin may result from which type of poisoning?
30. Question: In which type of burn is the injury more extensive than it appears, and the cardiac conduction system may be affected, leading to sudden death or arrhythmias?
31. Question: Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step?
32. Question: When giving discharge instructions to a patient with a laceration injury to his lower leg, which is the most important one?
33. Question: Cerebellar function may be assessed by performing which examination/test?
34. Question: In the epithelialization phase of wound healing, the wound will have only what percent of its normal tensile strength at 3 weeks?
35. Question: Which of the following statements is true about antibiotic prophylaxis for most wounds?
    

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Chapter 20. Palliative Care

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which of the following statements is true regarding pain?
2. Question: Which of the following would … a cause of visceral pain?
3. Question: According to the World Health Organization’s analgesic ladder, which drug combination would be most appropriate in an opiate-naïve patient who presents with moderate pain?
4. Question: A 75-year-old man is … as an outpatient for metastatic prostate cancer. Which of the following statements is true regarding the management of pain with opioids in the elderly?
5. Question: A patient had a transdermal fentanyl patch placed 2 hours ago and is not getting any pain relief. What would be the most appropriate intervention?
6. Question: A patient is preparing to … discharged to home with hospice. She is on a morphine patient-controlled analgesia (PCA) in the hospital. She is concerned as to whether she can stay on her morphine PCA at home even when she is not able to give herself boluses. What would be an appropriate response from the clinician?
7. Question: A patient taking PO hydromorphone for pain control has developed dysphagia. The clinician decides to switch the patient to IV hydromorphone. What ratio of IV:PO hydromorphone does the clinician need to know to calculate the proper dose?
8. Question: A patient is receiving long-acting oxycodone for pain control. The clinician thinks that he also will benefit from a short-acting oxycodone for breakthrough pain. How will the clinician figure out what the dose of short-acting oxycodone should be?
9. Question: A patient is … switched from hydromorphone to methadone in an attempt to achieve better pain control. How much should the dose of methadone be reduced when calculating the equianalgesic dose of the two drugs?
10. Question: If a patient requires six rescue doses for breakthrough pain in a 24-hour period, what would be an appropriate intervention?
11. Question: A patient with bone metastases from prostate cancer inquires whether he is a candidate for radiopharmaceuticals. Which of the following conditions would exclude him as a candidate?
12. Question: Which of the following is the best description of dyspnea?
13. Question: What would be an appropriate dose of morphine to give an opioid-naïve patient to manage tachypnea associated with dyspnea?
14. Question: Glycopyrrolate (Robinul) is one drug of choice to manage which of the following conditions that can contribute to dyspnea?
15. Question: Which characteristic of delirium helps to distinguish it from dementia?
16. Question: Which of the following classes of drugs should … as first-line therapy for treatment of delirium?
17. Question: Which of the … is a role of the advanced practice nurse in palliative cancer care?

True/False

18. Question: Indicate whether the statement is true or false.
19. Patients who are receiving life-prolonging therapies do not qualify for palliative care.
20. Some anticonvulsant drugs can be … as an adjuvant treatment for mild pain.
21. Oxygen has shown no benefit in alleviating dyspnea in patients without hypoxem 
    

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Chapter 21. Ethical and Legal Issues of a Caring-Based Practice

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Which statement about the American Nurses Association Code of Ethics is accurate?
2. Question: Which ethical principle reflects respect for all persons and their self-determination?
3. Question: When may confidentiality … overridden?
4. Question: In an outpatient setting, what is the most common reason for a malpractice suit?
5. Question: Which type of liability insurance covers only situations in which the incident … and the claim was made while the policy was in effect?
6. Question: Which insurance plan was the first to allow members to choose nurse practitioners as their primary care provider and pay them the same rate as physicians for the same care?
7. Question: Constructing a decision tree is helpful in analyzing ethical dilemmas, because a decision tree:
8. Question: In the consensus model for Advanced Practice Registered Nurse (APRN) regulation, the “C” of LACE represents?
9. Question: The main mechanism for avoiding a lawsuit involves:
10. Question: Paternalism in health care:
11. Question: The Nurse Practice Act of each state is responsible for:
12. Question: Deontology is:
13. Question: A situation that requires informed consent involves:
14. Question: Which ethical principle is the foundation on which health care rests?
15. Question: The Joint Commission mandates that all health-care organizations have:
16. Question: The relationship between ethics and law is such that:
17. Question: An APRN’s scope of practice includes all of the following statements EXCEPT:
18. Question: Which board administers and defines advanced nursing practice in all states?
19. Question: Three components must be present to establish malpractice. Which one does NOT apply?
20. Question: The Institute of Medicine stresses interprofessional collaboration between physicians and APRNs. Which statement supports this? 
    

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Chapter 22. Business of Advanced Practice

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: Identify the primary challenge for insurance carriers in today’s health delivery model.
2. Question: Medicare benefits were … to U.S. beneficiaries beginning in 1965. What was the service added with the Medicare D plan in 2006?
3. Question: With the growing shortage of primary care physicians, the demand for advanced practice registered nurses (APRNs) will increase between 2014 and 2016 from:
4. Question: Maintaining optimum cash flow is a basic fundamental concept in all businesses. Cash flow is … at the initial request for appointment and is … by practices that include:
5. Question: Patients require insurance counseling prior to accessing health-care services for the following reason:
6. Question: Health-care billing is a … reason for bankruptcy in the United States. The … provision of the Affordable Care Act (ACA) legislation was included to reduce this from occurring with insured patients:
7. Question: Accounting keeps track of the financial state of a business. The accounting report that demonstrates the growth in assets is:
8. Question: Medicare advantage plans, also called Medicare HMO Plans, are plans approved by the Centers for Medicare and Medicaid Services (CMS) as alternative carriers for Medicare beneficiaries. Which of the following is not a characteristic of these plans?
9. Question: Current procedural terminology (CPT) coding offers the uniformed language … for reporting medical services and procedures performed by physician and nonphysician practitioners. Clinicians are paid based on calculated resource costs that, in turn, are based on practice components. Which of the following is a part of the components … to calculate the per CPT code payment rate?
10. Question: Beginning in 2014, all medical practices will be … by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services. What is a primary reason for this implementation mandate?
11. Question: All health-care practices should develop a compliance plan. Compliance plans offer practice safeguards that prevent which of the following?
12. Question: Clinicians who learn how to code and document Evaluation and Management and clinician services will be more successful in gaining timely payment for care delivery. Which of the … CMS practices is … to financially penalize clinicians who do not bill according to CMS guidelines?
13. Question: Each state has criteria defining the level of collaboration required between the APRN and an oversight physician. Which is among the questions an APRN should seek when selecting a practice setting?
14. Question: Identify one of the primary reasons for an APRN to develop a business plan?
15. Question: Despite the growth in the numbers of advanced practice registered nurses (APRNs) over the last decades, the role of the profession is often not understood by the public. What actions should APRNs undertake to market their services to the public? 
    

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Chapter 23. The 15-Minute Hour

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: According to World Health Organization data on 1,500 patients in 15 separate world sites, how many patients presenting with medical/somatic complaint had a psychiatric problem?
2. Question: Integrating mental health techniques and approaches, such as the 15-minute hour, into the primary care patient encounter is important for a number of reasons. These include:
3. Question: Valliant (1979) discusses the “ubiquity of stress.” Ubiquity of stress maintains that:
4. Question: Basic human needs are … as:
5. Question: Commonalities among psychotherapeutic techniques include the following:
6. Question: The goals of the 15-minute hour approach include:
7. Question: BATHEing the patient refers to:
8. Question: BATHEing the patient is an advanced practice nursing … the practitioner to:
9. Question: The BATHE technique was … more than 20 years ago and … in primary care and family practice. The new “Positive BATHE” stresses:
10. Question: Which of the … scenarios best demonstrates the relationship between physical health and distress?
11. Question: One benefit of BATHEing a patient is that:
12. Question: One benefit of motivational interviewing (MI) is:
13. Question: Which is not a basic principle of MI?
14. Question: The primary purpose of the “Positive BATHE” is … to help patients by: 
    

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Chapter 24. Putting Caring into Practice: Caring for Self

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Question: The World Health Organization defines self-care as:
2. Question: Nurse theorist Dorothea Orem defines self-care activities as:
3. Question: Self-care and personal development are built into the standards of practice of:
4. Question: There are many pressures inherent in primary care practice today for APRNs. These pressures include all of the following:
5. Question: A new era of health care leads to:
6. Question: Compassion fatigue is another side-effect of today’s health-care delivery system. This term means:
7. Question: Another term …, burn out, is … by:
8. Question: The following statement is true:
9. Question: Self-compassion is the ability to … compassionate to one’s self and is positively … with emotional intelligence. Emotional intelligence is … as:
10. Question: APRNs need to develop their own self-management plans. Two key elements of self-management plans are:
11. Question: The term resilience implies:
12. Question: Qualities associated with resilience include:
13. Question: Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no back-up and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies?
14. Question: The qualities of resilience that Patsy demonstrated when responding to Sue include:
15. Question: According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice?