NR511 / NR 511: Differential Diagnosis & Primary Care Practicum Midterm Exam (Davis Edge) Review Questions Latest Update : Chamberlain College Of Nursing

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NR-511 Differential Diagnosis & Primary Care Practicum Mid-term (Davis Edge) Review Questions (Answer Key – Last Page) Question 1. Treatment for achalasia may include: 1. Balloon ... dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy. Question 2. Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? 1. Ursodiol (Actigall). 2. Ibuprofen (Advil). 3. Prednisone (Deltasone). 4. Surgery is the only answer. Question 3. All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1. Anticholinergics, such as scopolamine (Donnatal). 2. Antidopaminergic agents, such as prochlorperazine (Compazine). 3. Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4. Tetrahydrocannabinols, such as dronabinol (Marinol). Question 4. You auscultate Julie’s abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1. Peritonitis. 2. A liver or spleen abscess. 3. A liver or spleen metastatic tumor. 4. Irritable bowel syndrome. Question 5. Which is the most common presenting symptom of gastric cancer? 1. Weight loss. 2. Dysphagia. 3. Hematemesis. 4. Gastrointestinal bleeding. Question 6. The metabolism of which drug is not affected in Marsha, age 74? 1. Alcohol. 2. Anticonvulsants. 3. Psychotropics. 4. Oral anticoagulants. Question 7. Nausea is difficult to discern in a young child. What question might you ask to determine if a child has nausea? 1. “Are you sick to your tummy?” 2. “Are you hungry?” 3. “Are you eating the way you normally eat?” 4. “Are you nauseous?” Question 8. Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1. Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2. Drink at least 2000 mL of fluids per day. 3. Decrease her dietary fiber for 1 month. 4. Take stool softeners as prescribed. Question 9. Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she: 1. Needs to begin the hepatitis B series as soon as possible. 2. Needs to be tested again because one reading is not indicative of immunity. 3. Is permanently immune to hepatitis B. 4. Has an acute hepatitis B infection. Question 10. Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you she is sure it is going to be malignant. How do you respond? 1. “Don’t worry. Gastric ulcers are not cancerous.” 2. “About 95% of gastric ulcers are benign.” 3. “You have about a 50% chance of having gastric cancer from your ulcer.” 4. “Even if it is cancer, surgery is 100% successful.” Question 11. You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have: 1. Yogurt. 2. Foods containing whey. 3. Prehydrolyzed milk. 4. Oranges. Question 12. Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction. Question 13. Tom has just been diagnosed with celiac disease. Which of the following might you tell him? 1. There is a new pharmaceutical cure for celiac disease. 2. A strict gluten-free diet is the only treatment for celiac disease. 3. Your children will not be at a higher risk for developing this disease. 4. The presence of celiac disease is decreasing dramatically in the United States. Question 14. Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1. “You should have two to three stools per day.” 2. “You should defecate once a day.” 3. “You should have at least three stools per week.” 4. “There is no such thing as a ‘normal’ pattern of defecation.” Question 15. Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1. Campylobacter jejuni. 2. Clostridium botulinum. 3. Clostridium perfringens. 4. Staphylococcus. Question 16. Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1. Constipation. 2. Colorectal cancer. 3. Irritable bowel syndrome. 4. Acute appendicitis. Question 17. Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1. Cheese. 2. Leafy green vegetables. 3. Raw fruits and vegetables. 4. Dried beans. Question 18. Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli Question 19. Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1. “Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel.” 2. “Antacids contain sorbitol or mannitol, which are sugars that aren’t absorbed and can cause fluid to be drawn into the bowel.” 3. “Antacids contain caffeine, which decreases bowel transit time.” 4. “Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel.” Question 20. Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1. “Do not donate blood until one year after diagnosis.” 2. “Abstain from sex altogether.” 3. “There is no possibility of transmission through razors or toothbrushes.” 4. “Abstain from sex during your period.” Question 21. Marcie just returned from Central America with traveler’s diarrhea. Which is the best treatment? 1. Metronidazole (Flagyl). 2. Supportive care. 3. Quinolone antibiotics. 4. Gastric lavage. Question 22. Your client’s 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child’s diarrhea, how do you respond? 1. “She must be lactose intolerant from the formula, and this is altering the fluid balance.” 2. “Her body’s telling you that it’s time to introduce some solids into her system.” 3. “The virus is causing irritation of the gastrointestinal lining, which causes diarrhea.” 4. “The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients.” Question 23. Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week’s symptoms. Which stage of viral hepatitis do you suspect? 1. Incubation. 2. Prodromal. 3. Icteric. 4. Convalescent. Question 24. When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1. Eat foods higher in carbohydrates. 2. Eat 3 large meals plus 3 snacks per day. 3. Eat foods with a moderate fat and protein content. 4. Drink fluids with each meal. Question 25. Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? 1. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea. 2. Nocturnal perianal and perineal pruritus. 3. Diarrhea, cramps, and malaise. 4. Ascites and facial and extremity edema. Question 26. Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1. Antibiotics. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Oral contraceptives. 4. Antifungals. Question 27. Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? 1. Vitamin B12. 2. Iron. 3. Folic acid. 4. Calcium. Question 28. Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may: 1. Develop diarrhea. 2. Lose too much weight. 3. Develop hemorrhoids. 4. Vomit after she eats. Question 29. Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1. A gastric ulcer. 2. Gastritis. 3. Pelvic inflammatory disease. 4. Pancreatitis. Question 30. Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1. Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2. Eat smaller meals. 3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4. Stop smoking. Question 31. You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? 1. Rovsing sign. 2. Psoas sign. 3. Obturator sign. 4. McBurney sign. Question 32. Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1. Inguinal hernia. 2. Epigastric hernia. 3. Umbilical hernia. 4. Incisional hernia Question 33. You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1. Cirrhosis. 2. Inflammation of the kidney. 3. Inflammation of the spleen. 4. Peritonitis. Question 34. Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1. “Occasionally he accumulates blood in the gut.” 2. “There is an interruption of the normal clotting mechanism.” 3. “Long-term alcohol abuse has made his vessels very friable.” 4. “His bone marrow has been affected.” Question 35. In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for: 1. Decreased peripheral perfusion. 2. Hyperventilation. 3. Irritability. 4. Hyperthermia. Question 36. Olive has an acute exacerbation of Crohn’s disease. Which laboratory test value(s) would you expect to be decreased? 1. Sedimentation rate. 2. Liver enzyme levels. 3. Vitamin A, B complex, and C levels. 4. Bilirubin level. Question 37. You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: 1. Anxiety and panic attacks. 2. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Infection by Helicobacter pylori. 4. A family history of peptic ulcers. Question 38. You are trying to differentiate between functional (acquired) constipation and Hirschsprung disease in a neonate. Distinguishing features of Hirschsprung disease include which of the following? 1. Small ribbonlike stools. 2. Obvious abdominal pain. 3. Female gender. 4. Small weight gain. Question 39. You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will: 1. Decrease her fat intake. 2. Increase her fiber intake. 3. Continue her daily use of aspirin. 4. Increase her fluid intake. Question 40. Dottie brings in her infant, who has gastroesophageal reflux. What do you tell her about positioning her infant? 1. “Always position infants on their back to prevent sudden infant death syndrome.” 2. “Rotate your infant between lying on the back and on the stomach.” 3. “Your infant should be placed on the left side.” 4. “Place your infant in whatever position she remains quiet.” Question 41. Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1. Left-sided pleural effusion. 2. Bluish discoloration over the flanks. 3. Bluish discoloration around the umbilicus. 4. Jaundice. Question 42. Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1. Appendicitis. 2. Gastroenteritis. 3. Acute pancreatitis. 4. Rocky Mountain spotted fever. Question 43. Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1. Age. 2. Infection. 3. Pain. 4. Length of time between exacerbations. Question 44. A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of the following do you initially rule out? 1. Rocky Mountain spotted fever. 2. Measles. 3. Appendicitis. 4. A food allergy. Question 45. Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? 1. Enterococci. 2. Escherichia coli. 3. Klebsiella. 4. Staphylococci. Question 46. To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client’s histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? 1. Crohn disease. 2. Ulcerative colitis. 3. Infectious colitis. 4. Ischemic colitis. Question 47. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1. Appendicitis. 2. Crohn’s disease. 3. Cholecystitis. 4. Irritable bowel syndrome. Question 48. You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3. Amoxicillin (Amoxil) and omeprazole (Prilosec). 4. Clarithromycin (Biaxin) and metronidazole (Flagyl). Question 49. Which of the following medications/drugs are not known to cause heartburn or dyspepsia? 1. Alcohol. 2. Motrin. 3. Prednisone. 4. Tylenol. Question 50. Icterus due to hyperbilirubinemia is seen when the serum level of bilirubin is greater than? 1. 2.5 mg/dL. 2. 1.0 mg/dL. 3. 2.0 mg/dL. 4. 0.5 mg/dL. Question 51. A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster. What is the likely cause of the patient’s symptoms? 1. Botulism. 2. Salmonella. 3. Lyme disease. 4. Vitamin C deficiency. Question 52. What is the most common bacterial cause of traveler’s diarrhea? 1. Escherichia coli. 2. Campylobacter jejuni. 3. Salmonella. 4. Shigella. Question 53. A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn’t vomited and didn’t eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient’s likely diagnosis? 1. Appendicitis. 2. Cholecystitis. 3. Constipation. 4. Gastroenteritis. Question 54. Hepatitis D is an RNA virus that requires a coinfection with which of the following strains of hepatitis in order to replicate? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis E. Question 55. Which of the following is not true regarding hepatitis C? 1. The greatest rate of infection in the general population is seen in people born between 1945 and 1965. 2. Many hepatitis C infections are asymptomatic. 3. Hepatitis C is seen more frequently in men than women. 4. If hepatitis is asymptomatic it doesn’t cause cirrhosis or liver cancer. Question 56. A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient’s GERD? 1. Order an endoscopy. 2. Order a Helicobacter pylori blood test. 3. Try adding ranitidine to the patient’s regimen. 4. Try adding bismuth to the patient’s regimen. Question 57. What is the recommended treatment to eradicate a Helicobacter pylori infection? 1. Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3. Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4. Bismuth, doxycycline, metronidazole, and ranitidine. Question 58. A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1. Internal hemorrhoid. 2. External hemorrhoid. 3. Bleeding peptic ulcer. 4. Rectal fissure. Question 59. A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and inferior to his rib cage. It disappears when he is sitting up fully. What is the patient’s diagnosis? 1. Ventral (epigastric) hernia. 2. Inguinal hernia. 3. Femoral hernia. 4. Umbilical hernia. Question 60. What is the best diagnostic test to confirm the diagnosis of celiac disease? 1. Anti-tTG IgA. 2. Anti-dsDNA. 3. Colonoscopy. 4. Anti-CCP protein. Question 61. What would you expect to see on an abdominal series that would lead toward a diagnosis of small-bowel obstruction? 1. Air-fluid levels. 2. A lead pipe colon. 3. Free air under the diaphragm. 4. Steeple sign. Question 62. A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient? 1. Sigmoidoscopy. 2. Abdominal series. 3. Computed tomography (CT) scan with oral contrast. 4. Abdominal ultrasound. Question 63. Which gastrointestinal disease below could theoretically be completely eradicated with a total colectomy? 1. Crohn’s disease. 2. Irritable bowel syndrome. 3. Ulcerative colitis. 4. Celiac disease. Question 64. The screening guidelines for colon cancer recommend which of the following for the general population? 1. Colonoscopy starting at age 50. 2. Colonoscopy starting at age 45. 3. Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4. Fecal occult blood test (FOBT) and rectal exam starting at age 45. Question 65. Which of the following is not a risk factor for cholecystitis? 1. Female gender. 2. Obesity. 3. Sickle cell anemia. 4. Younger age. Question 66. Which of the following is the most common cause of acute pancreatitis? 1. Gallstone obstruction of the pancreatic duct. 2. Alcoholism. 3. Hypertriglyceridemia. 4. Gallstone obstruction of the pancreatic duct and alcoholism. Question 67. Which of the following is not a modifiable risk factor? 1. Weight. 2. Stress level. 3. Race. 4. Physical activity level. Question 68. In relation to writing a patient encounter note, the acronym SOAP stands for which of the following words? 1. Subjective, objective, assessment, plan. 2. Symptoms, objective, assessment, pills. 3. Subjective, outward findings, assessment, plan. 4. Symptoms, objective, assessment, plan. Question 69. Which of the following demonstrates a subjective finding? 1. Pain level. 2. Pulse rate. 3. Eye color. 4. Extremity edema. Question 70. Which of the following is not a subjective finding? 1. Headache. 2. Respiratory rate. 3. Shortness of breath. 4. Ankle pain. Question 71. Which of the following is not one of the generalized patterns of nursing care included in the Circle of Caring model? 1. Intelligence. 2. Patience. 3. Advocacy. 4. Courage. Question 72. Which of the following doesn’t fall under the umbrella of health promotion as a nurse practitioner? 1. Information about online dating. 2. Exercise programs. 3. Immunizations. 4. Nutrition support. Question 73. Which of the following statements about health promotion is false? 1. Health promotion is a benefit to add to your practice if you have time. 2. Health promotion helps to prevent diseases. 3. Health promotion includes early screening to detect diseases. 4. Health promotion includes helping to restore health after a patient has had an illness. Question 74. As a primary care provider, which of the following topics is not typically important for adults aged 20 to 40? 1. Focusing on increasing lifespan. 2. Career development. 3. Self-image. 4. Family relationships. Question 75. As a nurse practitioner, which of the following would not be an example of primary health promotion? 1. Posting health articles on your social media account. 2. Speaking to patients at each visit about strategies for maintaining/attaining a healthy life. 3. Lecturing at local community centers about diabetes. 4. Organizing a 5K running event for the patients in your practice. Question 76. Which of the following refers to an aspect of a patient’s health that can be changed or affected by a health intervention? 1. Modifiable risk factor. 2. Nonmodifiable risk factor. 3. Adjustable risk factor. 4. Changeable risk factor. Question 77. Which of the following refers to an aspect of a patient’s health that cannot be changed or affected by a health intervention? 1. Modifiable risk factor. 2. Nonmodifiable risk factor. 3. Adjustable risk factor. 4. Changeable risk factor. Question 78. Which of the following statements defines health literacy? 1. The level to which a patient can understand, gain access to, and make proper medical decisions. 2. The ability of a patient to read health pamphlets. 3. The extent to which a patient can travel to see a medical provider. 4. The ability of a patient to write in the language of the health practitioner. Question 79. Which of the following patients is health literate? 1. A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive. 2. A 70-year-old patient with dementia. 3. A 22-year-old migrant worker who only speaks Spanish. 4. A 45-year-old college graduate with no health insurance. Question 80. Which of the following initiatives does not fall under the National Prevention Strategy? 1. Diabetes management. 2. Tobacco-free living. 3. Healthy eating. 4. Mental and emotional well-being. Question 81. All of the following statements about the US Preventive Services Task Force (USPSTF) are true except? 1. All of the recommendations made by the USPSTF are strong recommendations. 2. This is a private sector group without government ties. 3. This group makes recommendations about preventive medicine. 4. All of the USPSTF recommendations are considered mandatory in primary care. Question 82. The study of the way diseases are spread through groups and what causes and helps spread these diseases is called? 1. Epidemiology. 2. Pathology. 3. Physiology. 4. Kinesiology. Question 83. Which of the following statements does not belong in the past medical history portion of your chart note? 1. Your patient had lab work at their last appointment that was negative. 2. Your patient had a cholecystectomy 3 years prior. 3. Your patient’s father passed away from lung cancer. 4. Your patient has an allergy to penicillin. Question 84. You have a patient who presents with ankle pain. Which of the following facts or observations does not belong in the physical exam portion of your note? 1. The patient’s pain started after a fall off his skateboard. 2. The patient has a normal pulse and normal sensation of the foot. 3. The patient has edema in his ankle. 4. The patient has limited motion of his ankle. Question 85. An 81-year-old patient presents for a physical. She recently had a fall and now has problems walking up her stairs. The only restroom in the house is on the second floor. She also has a flight of stairs outside her house she has to navigate in order to reach street level, and this is difficult for her. Where does this information belong in your chart note? 1. Functional health patterns. 2. Review of systems. 3. Plan. 4. Assessment. Question 86. Documentation in your patient’s chart is important for all the following reasons except? 1. Documentation is only important for recording your side of the visit so you can reduce your liability in the event of a lawsuit. 2. Documentation allows you to communicate your findings to another provider. 3. Documentation allows you to remember the office visit so you can best treat the patient in the future. 4. Documentation allows you to create a record of the visit and record your patient’s findings and treatment plans. Question 87. Telehealth has shown a drastic increase in utilization by patients in which of the following fields of medicine? 1. Psychology and psychiatry. 2. Pediatrics. 3. Primary care. 4. Dermatology. Question 88. The OLD CARTS (onset, location, duration, character, aggravating/alleviating factors, radiation, timing, severity) mnemonic is best used in which part of your chart note? 1. History of present illness. 2. Plan. 3. Diagnosis. 4. Physical exam. Question 89. A nurse practitioner is practicing based on the rule-based actions he was taught in school and doesn’t understand when/where those rules may be inappropriate. Which following statement best describes this skill level? 1. Novice. 2. Advanced beginner. 3. Proficient. 4. Expert. Question 90. How often should you receive a Tdap booster when no injury history is present? 1. Every 10 years. 2. After 18 you don’t need a booster unless you have a laceration. 3. Every 20 years. 4. Every 5 years. Question 91. What type of reaction following an immunization is considered serious and requires reevaluation? 1. Temperature greater than 103˚F. 2. Fatigue. 3. Temperature of 100.2˚F. 4. Erythema and soreness at the injection site. Question 92. Mildred, an independent 92-year-old woman, is moving into her daughter’s home. Her daughter comes to see you seeking information to help keep her mother from falling. Which of the following interventions would you suggest she do to help prevent Mildred from falling? 1. Install an intercom system in Mildred’s bedroom. 2. Limit the time Mildred is home alone. 3. Hire an aide to assist Mildred 24 hours a day. 4. Remove all loose rugs from floors and install hand grasps in bathtubs and near toilets. Question 93. Eileen, a 42-year-old woman, comes to your office with a chief complaint of fatigue, weight loss, and blurred vision. Eileen has a past medical history that is negative for any chronic medical problems. You obtain a fasting chemistry panel, lipid profile, complete blood count (CBC), and hemoglobin A1c (HbA1c). The results of the blood work show Eileen’s blood sugar elevated at 356 mg/dL, total cholesterol elevated at 255, high-density lipoprotein (HDL) cholesterol low at 28, low-density lipoprotein (LDL) cholesterol elevated at 167, triglycerides 333, and HbA1c 12. On questioning Eileen further, you discover that both her grandmothers had adult-onset diabetes mellitus. You diagnose type 2 diabetes mellitus. Your treatment plan should include a cholesterol-lowering agent, an agent that lowers blood sugar, and which other class of medication? 1. Angiotensin-converting enzyme (ACE) inhibitor. 2. Diuretic. 3. Weight loss medication. 4. Beta blocker. Question 94. Mark, a 56-year-old man, comes to your practice seeking help quitting smoking. You prescribe varenicline (Chantix), a prescription medication, to aid with his attempt. What instructions do you give Mark regarding how to stop smoking with Chantix? 1. Start the Chantix today according to the dosing schedule and then quit smoking after the 12-week medication schedule. 2. Start the Chantix today according to the dosing schedule and then pick a date to stop smoking about 7 days after starting Chantix. 3. Pick a date to stop smoking and start Chantix that day according to the dosing schedule. 4. Start Chantix today, take it twice a day for 2 weeks, and then stop smoking. Question 95. Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Joseph receive today regarding the care of his feet? 1. “Wash your feet with cold water only.” 2. “See a podiatrist every two years, inspect your own feet monthly, and apply lotion to your feet daily.” 3. “Go to a spa and have a pedicure monthly.” 4. “See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas.” Question 96. How do you respond when Jill, age 42, asks you how long she should work out each week? 1. Exercise for at least 30 minutes every day. 2. Exercise a total of 2 hours per week. 3. Exercise for at least 20 minutes 3 or more days per week. 4. Exercise for at least 30 minutes 5 days per week. Question 97. Marvin is a gay man who is ready to “come out.” What is the last step in the process of coming out? 1. Testing and exploration. 2. Identity acceptance. 3. Identity integration and self-disclosure. 4. Awareness of homosexual feelings. Question 98. Sandra, a 27-year-old nurse, states that she does not want to get the hepatitis B virus vaccine because of its adverse effects. You tell her that the most common adverse effect is: 1. Fatigue. 2. Headache. 3. Pain at the injection site. 4. Elevated temperature. Question 99. A lab value that is commonly decreased in older adults is: 1. Creatinine clearance. 2. Serum cholesterol. 3. Serum triglycerides. 4. Blood urea nitrogen. Question 100. Dennis, age 62, has benign prostatic hyperplasia (BPH). He tells you that he voids at least 4 times per night and that he has read about a preventive drug called terazosin hydrochloride (Hytrin) that might help him. What do you tell him? 1. “It’s not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck.” 2. “It changes the pH of the urine and prevents infections caused by urinary stasis.” 3. “It relaxes the urethra.” 4. “It shrinks the prostate tissue.” Question 101. Harry is taking his entire family to Central America and is wondering about protection against bites from malaria-causing mosquitoes. What advice do you give him? 1. Use an insect repellent with diethyltoluamide (DEET) for the entire family, applying it sparingly to small children. 2. Make sure the family is in well-screened or indoor areas from dusk to dawn. 3. Use an insect repellent with diethyltoluamide (DEET) for adults and permethrin for children, and stay inside from dusk to dawn. 4. Stay inside from dusk to dawn, and use an insect repellent with permethrin. Question 102. You are sharing with your client the idea that he needs to get some counseling to deal with his severe stress because it is affecting his physiological condition. Which of the following hormonal changes occurs during severe stress? 1. A decrease in catecholamines. 2. An increase in cortisol. 3. A decrease in antidiuretic hormone. 4. A decrease in aldosterone. Question 103. Margaret, age 29, is of medium build and 5 ft 4 in tall. You estimate that she should weigh about: 1. 105 lb. 2. 110 lb. 3. 120 lb. 4. 130 lb. Question 104. Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily? 1. Drink all the soda you like—it has no effect on your bone density. 2. It has not been proved that smoking affects bone loss. 3. Replace estrogen when you reach menopause. 4. Perform aerobic exercise at least 3 times a week. Question 105. Martha, age 82, has an asymptomatic carotid bruit on the left side. What do you recommend? 1. Acetylsalicylic acid, or aspirin (ASA), therapy. 2. Coumadin therapy. 3. Surgery. 4. No treatment at this time. Question 106. Susie, age 5, comes to the clinic for a well-child visit. She has not been in since she was 2. Her immunizations are up to date. What immunizations would you give her today? 1. None; wait until she is 6 years old to give her her booster shots. 2. Diphtheria, tetanus, and pertussis (DTaP); Haemophilus influenzae type B (Hib); and measles, mumps, and rubella (MMR). 3. Diphtheria, tetanus, and pertussis (DTaP) and inactivated polio vaccine (IPV). 4. Diphtheria, tetanus, and pertussis (DTaP); inactivated polio vaccine (IPV); and measles, mumps, and rubella (MMR). Question 107. Mary, a 70-year-old woman with diabetes, is at your office for her 3-month diabetic checkup. Mary’s list of medications includes metformin (Glucophage XR) 1000 mg daily, an angiotensin-converting enzyme (ACE) inhibitor daily, and 1 baby aspirin (ASA) daily. Mary’s blood work showed a fasting blood sugar (FBS) of 112 and glycosylated hemoglobin (HbA1c) of 6.5. You tell Mary that her blood work shows: 1. That her diabetes is under good control and she should remain on the same medications. 2. That her diabetes is controlled and she needs to have her medications decreased. 3. That her diabetes is not controlled and her medications need to be increased. 4. That her diabetes has resolved and she no longer needs any medication. Question 108. Sandy, a 68-year-old woman, presents to your office for screening for osteoporosis. She states that her grandmother and mother both lost inches in their old age. She has been postmenopausal for the past 15 years and never took any hormone replacement medications. She is Caucasian, weighs 108 lb, and is 5 ft 1 in tall on today’s measurement. When do women lose the greatest amount of bone density? 1. During adolescence. 2. The first year of menopause. 3. The first 10 years after menopause. 4. Bone loss occurs continuously at the same rate from menopause to death. Question 109. Jan’s mother has Alzheimer disease (AD). Jan tells you that her mother’s recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, “Is this as bad as it gets?” You tell her that her mother is in which stage of the disease? 1. Stage 1. 2. Stage 2. 3. Stage 3. 4. Stage 4. Question 110. Herbert, a 69-year-old man, comes to your office complaining of nocturia. On questioning Herbert, you find that for the past 3 months he has been getting up at least 5 times a night to void. He came in to seek help today because of his wife’s insistence that he be checked out. When you perform the digital rectal exam, you find that his prostate protrudes 3 to 4 cm into the rectum. What grade would you assign to Herbert’s prostate enlargement? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4. Question 111. When performing a sports physical exam on Kevin, a healthy 16-year-old boy, which question in the history is important to ask Kevin or his guardian? 1. Did anyone in your family ever have sudden cardiac death? 2. Does anyone in your family have elevated cholesterol levels? 3. Did you ever have any injury requiring stitches? 4. Does anyone in your family have a history of asthma? Question 112. If a screening test used on 100 individuals known to be free of breast cancer identified 80 individuals who did not have breast cancer while missing 20 of the individuals, the specificity would be: 1. 80%. 2. 60%. 3. 40%. 4. 20%. Question 113. Harvey, age 55, comes to the office with a blood pressure (BP) of 144/96 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the examination, it remains 144/96. What should your next action be? 1. Start him on an angiotensin-converting enzyme (ACE) inhibitor. 2. Start him on a diuretic. 3. Have him monitor his blood pressure at home. 4. Try nonpharmacological methods and have him monitor his blood pressure at home. Question 114. Mimi, age 52, asks why she should perform a monthly breast self-examination (BSE) when she has her mammograms on schedule. You respond: 1. “If you are faithful about your annual exams and mammograms, that is enough.” 2. “More breast abnormalities are picked up by mammograms than by clinical exams or BSE.” 3. “More than 90% of all breast abnormalities are first detected by self-examination.” 4. “Self-examinations need to be performed only every other month.” Question 115. Julia, age 18, asks you how many calories of fat she is eating when 1 serving has 3 g of fat. You tell her: 1. 12 cal. 2. 18 cal. 3. 27 cal. 4. 30 cal. Question 116. Marian’s husband, Stu, age 72, has temporal arteritis. She tells you that his physician wants to perform a biopsy of the temporal artery. She asks if there is a less invasive diagnostic test. What test do you tell her is less invasive? 1. Computed tomography (CT) scan. 2. Magnetic resonance imaging (MRI). 3. Electroencephalogram (EEG). 4. Color duplex ultrasonography. Question 117. For which patient would you administer the human papillomavirus (HPV) vaccination? 1. Susie, age 7. 2. Janice, age 17, who had a baby 6 months ago and is breastfeeding. 3. Alice, age 18, who is allergic to yeast. 4. Jill, age 25, who is pregnant. Question 118. Which of the following individuals should get the shingles (herpes zoster) vaccine? 1. Jerry, who has a mild upper respiratory tract infection and is allergic to neomycin. 2. Tim, who has been on prolonged use of high-dose steroids for his chronic obstructive pulmonary disease (COPD). 3. Joan, whose husband recently had shingles and who is trying to get pregnant. 4. Joe, who has a stressful job. Question 119. A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient’s diagnosis? 1. Viral conjunctivitis. 2. Bacterial conjunctivitis. 3. Allergic conjunctivitis. 4. Blepharitis. Question 120. A 25-year-old male presents with “bleeding in my eye” for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient’s sclera of the right eye only and takes up less than 50% of the eye. The patient’s remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? 1. Topical steroids and close follow-up with an ophthalmologist. 2. Sending the patient to the emergency department for immediate ophthalmology consult. 3. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. 4. Cold compresses and frequent handwashing. Question 121. A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Cataracts. 4. Macular degeneration. Question 122. A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient’s symptoms? 1. Order a computed tomography (CT) scan to rule out acoustic neuroma. 2. Start her on high-dose Augmentin. 3. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4. Immediate referral to an ear, nose, and throat (ENT) specialist. Question 123. Which of the following is not a cause of conductive hearing loss? 1. Presbycusis. 2. Cerumen impaction. 3. Otitis media. 4. Otosclerosis. Question 124. What is the most common bacterial pathogen associated with acute otitis media? 1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Streptococcus pyogenes. 4. Moraxella (Branhamella) catarrhalis. Question 125. A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? 1. Symptom management and reassurance that symptoms will resolve with time. 2. Computed tomography (CT) of the head. 3. Amoxicillin 80 to 90 mg/kg/d. 4. Augmentin 45 mg/kg/d. Question 126. You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome. Question 127. Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1. Glomerulonephritis. 2. Rheumatic heart disease. 3. Scarlet fever. 4. Hemolytic anemia. Question 128. A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1. Viral pharyngitis. 2. Mononucleosis. 3. Streptococcal pharyngitis. 4. Upper respiratory infection. Question 129. What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A. Question 130. Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids. Question 131. Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: 1. Herpes simplex. 2. Aphthous ulcers. 3. Candidiasis. 4. Oral cancer. Question 132. The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1. Amoxicillin (Amoxil). 2. Amoxicillin and potassium clavulanate (Augmentin). 3. Azithromycin (Zithromax). 4. Prednisone (Deltasone). Question 133. Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? 1. Conjunctivitis. 2. Iritis. 3. Subconjunctival hemorrhage. 4. Acute glaucoma. Question 134. Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like “a curtain came down over my eye.” She doesn’t have any pain or redness. What do you suspect? 1. Retinal detachment. 2. Acute angle-closure glaucoma. 3. Open-angle glaucoma. 4. Cataract. Question 135. You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha’s history and the fact that she complains of pain behind her eye. Which sinuses are affected? 1. Maxillary. 2. Ethmoid. 3. Frontal. 4. Sphenoid. Question 136. Mallory brings her 4-week-old infant to the office because she noticed small, yellow-white, glistening bumps on her infant’s gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as: 1. Bednar aphthae. 2. Epstein pearls. 3. Buccal tumors. 4. Exostosis. Question 137. Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: 1. Bell palsy. 2. A lesion affecting the trigeminal nerve. 3. A stroke—brain attack, cerebrovascular accident (CVA). 4. Shingles. Question 138. Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? 1. The offending organism is a bacterium, and Jonathan should be treated with antibiotics. 2. Convalescence is usually only a few days, and Jonathan should be back to normal in a week. 3. Mononucleosis is rarely contagious. 4. Jonathan should avoid contact sports and heavy lifting. Question 139. A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and mild fatigue. On examination, the client has a tender, tortuous temporal artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive procedure to help with diagnosis? 1. Magnetic resonance imaging (MRI) of the head. 2. Erythrocyte sedimentation rate (ESR). 3. Electroencephalogram (EEG). 4. Otoscopy. Question 140. Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1. “The eardrum, in most cases, heals within several weeks.” 2. “We need to schedule Aaron for a surgical repair.” 3. “He must absolutely stay out of the water for 3 to 6 months.” 4. “If the eardrum is not healed in several months, it can be surgically repaired.” Question 141. When you are assessing the internal structure of the eye of your 59-year-old patient, the absence of a red reflex may indicate: 1. A cataract or hemorrhage into the vitreous humor. 2. Acute iritis. 3. Nothing; this is a normal finding in older adults. 4. Diabetes or long-standing hypertension. Question 142. Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: 1. Eye discomfort. 2. Slow progression. 3. A ciliary flush. 4. No change in or slightly blurred vision. Question 143. Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1. Acute otitis media. 2. Chronic otitis media. 3. External otitis. 4. Temporomandibular joint (TMJ) syndrome. Question 144. While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? 1. The nasolabial folds. 2. The openings between the margins of the upper and lower eyelids. 3. The thyroid gland in relation to the trachea. 4. The distance between the trigeminal nerve branches. Question 145. When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse practitioner should document this finding as: 1. Conductive deafness. 2. Perceptive deafness. 3. A normal finding. 4. Nerve damage. Question 146. What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral? 1. There is a change in the child’s hearing threshold to greater than 25 dB. 2. The child has become a fussy eater. 3. The child’s speech and language skills seem slightly delayed. 4. Persistent rhinitis is present. Question 147. A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the club. These symptoms are most characteristic of which of the following? 1. Sensorineural loss. 2. Conductive loss. 3. Tinnitus. 4. Vertigo. Question 148. Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1. Allergic rhinitis. 2. Viral rhinitis. 3. Nasal polyps. 4. Nasal vestibulitis from folliculitis. Question 149. A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? 1. Tension. 2. Migraine. 3. Cluster. 4. Temporal arteritis. Question 150. Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist. Question 151. Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis. Question 152. Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: 1. A superficial, translucent, subepithelial, vesicle-like lesion in the oral mucosa. 2. A white, painless, firm, ulcerated lesion with indurated borders. 3. An abnormal white coating of the dorsal surface of the tongue. 4. A round, smooth, firm lump on the lateral side of the tongue. Question 153. Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer’s ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming. Question 154. Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis. Question 155. Mandy, 44, was given a diagnosis of flu 1 day ago and wants to start on the “new flu medicine” right away. What do you tell her? 1. “The medication is effective only if started within the first 72 hours after symptoms begin.” 2. “If you treat a cold, it goes away in 7 days; if you don’t treat it, it goes away in 1 week.” 3. “The medicine has not proven its effectiveness.” 4. “I’ll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms.” Question 156. Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “sunken in.” What do you suspect? 1. Hypothyroidism. 2. Normal age-related changes. 3. Cushing syndrome. 4. A detached retina. Question 157. Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1. Ciprofloxacin (Cipro). 2. Azithromycin (Zithromax). 3. Amoxicillin (Amoxil). 4. Cephalexin (Keflex). Question 158. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that “some foods get stuck” and she has been having “heartburn” at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD). Question 159. Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1. A labyrinthectomy. 2. Pharmacological therapy. 3. A vestibular neurectomy. 4. Wearing an earplug in the ear that has the most hearing loss. Question 160. Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? 1. Epiglottitis. 2. Group A beta-hemolytic streptococcal pharyngitis. 3. Tonsillitis. 4. Diphtheria. Question 161. Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? 1. Nasal polyps are usually precancerous. 2. Nasal polyps are benign growths. 3. The majority of nasal polyps are neoplastic. 4. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma. Question 162. Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? 1. Aspirin therapy as prophylaxis for heart attack. 2. Ranitidine (Zantac) for gastroesophageal reflux disease. 3. Alprazolam (Xanax), an anxiolytic. 4. Atenolol (Tenormin), a beta blocker for high blood pressure. Question 163. An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: 1. Antibiotics. 2. A biopsy of the rash. 3. Immediate hospitalization. 4. Ophthalmological consultation. Question 164. Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: 1. Medications. 2. Dietary supplements. 3. Corrective lens surgery. 4. Optical devices. Question 165. You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4. Question 166. Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1. “Dilute the oral medication with one tablespoon of water for easier digestion.” 2. “Take the medication with meals so that it’s absorbed better.” 3. “Swish and swallow the medication.” 4. “Apply the medication only to the lesions.” Question 167. Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1. Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3. Order a complete blood count (CBC). 4. Consult with your collaborating physician. Question 168. Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1. A throat culture. 2. A Monospot test. 3. A rapid antigen test. 4. A Thayer-Martin plate test. Question 169. April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that they may be cancerous skin lesions. You tell her that they are probably: 1. Xanthelasmas. 2. Pingueculae. 3. The result of arcus senilis. 4. Actinic keratoses. Question 170. Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1. Classic migraine. 2. Tension headache. 3. Sinus headache. 4. Cluster headache. Question 171. Regular ocular pressure testing is indicated for older adults taking: 1. High-dose inhaled glucocorticoids. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Insulin. Question 172. In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction. Question 173. Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1. Otitis media. 2. Otitis media with effusion. 3. Otitis externa. 4. Primary otalgia. Question 174. A 62-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Herpetic conjunctivitis. 4. Diabetic retinopathy. Question 175. Which manifestation is noted with carbon monoxide poisoning? 1. Circumoral pallor of the lips. 2. Cherry-red lips. 3. Cyanosis of the lips. 4. Pale pink lips. Question 176. Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? 1. Use a cotton-tipped applicator daily to remove all moisture and potential bacteria. 2. Wash daily with soap and water. 3. Apply mineral oil to counteract dryness. 4. Avoid topical corticosteroids. Question 177. The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: 1. A congenital cataract. 2. Retinoblastoma. 3. Persistent hyperplastic primary vitreous. 4. Retinal detachment. Question 178. At the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? 1. Pseudostrabismus. 2. Strabismus. 3. Esotropia. 4. Exotropia. Question 179. Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these “curds” with a tongue depressor, which assists you in making which of the following diagnoses? 1. Leukoplakia. 2. Lichen planus. 3. Oral candidiasis. 4. Oral cancer. Question 180. Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1. Dental abscess. 2. Acute rhinosinusitis. 3. Chronic rhinosinusitis. 4. Nasal tumor. Question 181. Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1. Maxillary sinus. 2. Ethmoid sinus. 3. Sphenoid sinus. 4. Frontal sinus. Question 182. How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? 1. Movable, discrete, soft, and nontender lymph nodes. 2. Enlarged, warm, tender, and firm but freely movable lymph nodes. 3. Hard, unilateral, nontender, and fixed lymph nodes. 4. Nontender, mobile, and firm but not hard lymph nodes. Question 183. You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days. Question 184. You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor. Question 185. When teaching your client about medication you are prescribing, the most important point(s) to discuss initially is(are): 1. The action of the drug and its adverse effects. 2. Whether to take the drug on a full or empty stomach. 3. What it is for, how much to take, and when to take it. 4. What to do if the client experiences any adverse effects. Question 186. The Agency for Healthcare Research and Quality (AHRQ) was established to: 1. Mandate treatment protocols. 2. Dictate health care policy based on voluminous research. 3. Promote evidence-based practice. 4. Develop cost-effective interventions. Question 187. Advanced practice registered nurses (APRNs) are affected by laws and rules, although these vary by state. Which of the following is affected by state laws and regulations? 1. Delegation of authority by physicians. 2. How many clients you must see every hour. 3. Universal health care law. 4. Making no more than 5 referrals for 1 client. Question 188. You have seen a client who has tested positive for syphilis. You have treated the client; tested the client for other potential sexually transmitted diseases, including human immunodeficiency virus (HIV); counseled the client about safe sexual practices; and scheduled the client to return at 3 and 6 months for repeat serologic testing. The tests at those times demonstrated that no further syphilis was present. Should you have taken any other action? 1. No, you have treated the client appropriately. 2. Yes, you must report the case to the local health authorities. 3. Yes, you need to notify all sexual contacts. 4. Yes, you must follow up on the client’s HIV status. Question 189. The term indemnity insurer refers to an insurer: 1. In a health maintenance organization (HMO). 2. In a preferred provider organization (PPO). 3. That pays for the medical care of the insured. 4. That pays health care providers on a per-visit, per-procedure basis. Question 190. What must you do as an advanced practice registered nurse (APRN) before billing for visits? 1. Establish a collaborative agreement with a physician. 2. Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer. 3. Provide evidence of continuing medical education. 4. Obtain a Drug Enforcement Administration (DEA) number. Question 191. Which of the following is the best method for evaluating the efficacy of a new clinical intervention? 1. A case report. 2. A descriptive study. 3. A randomized controlled trial. 4. A correlational study. Question 192. Because of the potential for exploitation of older adults, the geriatric population is designated a vulnerable one when it comes to obtaining informed consent for serving as a research subject. Safeguards you should adhere to when conducting research on a geriatric population include which of the following? 1. Assessing the competence of the individual before obtaining consent. 2. Obtaining permission from the family or staff. 3. Stressing how important the research is and why their participation and perspective, as older adults, are important. 4. Determining if the research is exempt, in which case you do not need to obtain consent to participate. Question 193. Negligence is the predominant legal theory of malpractice liability. Negligence includes: 1. Failure to give necessary care. 2. Failure to discharge. 3. Failure to share information with family. 4. Failure to provide shelter and food. Question 194. While counseling Mr. Brown, a patient newly diagnosed with diabetes, the advanced practice registered nurse (APRN) hands him a pamphlet on foot care. She notices that he puts it away, saying he will read it later. What might this behavior indicate? 1. Being overly dependent on others. 2. Having a low literacy level. 3. Having a high level of motivation. 4. Memorization of the information that is being taught. Question 195. If conflict arises during a job negotiation, you should consider: 1. Separating the issue from the person. 2. Always standing your ground. 3. Getting a legal opinion. 4. Basing your actions on the contract a friend of yours has secured in a local practice. Question 196. Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. This means that the: 1. HMO reimburses the provider on a fee-for-service basis. 2. HMO reimburses the provider a predetermined fee per client per month based on the client’s age and sex. 3. Fee paid to the provider fluctuates with the treatment. 4. Provider is reimbursed by each individual client or family. Question 197. Which of the following statements about case management is true? 1. Case management oversees the client throughout acute care hospitalization. 2. Case management is organized around a system of interdisciplinary resources and services. 3. Case management depends on physician-driven leadership to oversee the illness episode. 4. Case management is applicable to the rehabilitative portion of the illness episode. Question 198. Elder abuse and neglect are increasing concerns, and it is estimated that 4% to 10% of older Americans are abused or neglected. What is the legal responsibility of the health care provider in reporting elder abuse and neglect? 1. The health care provider should discuss the suspected abuse or neglect with the client. 2. The health care provider should discuss the suspected abuse or neglect with the client’s family. 3. The health care provider must report the suspected abuse or neglect to the appropriate state protective agency. 4. The health care provider must confirm the suspected abuse or neglect before reporting it to the appropriate state protective agency. Question 199. Relapse is a common phenomenon seen during behavioral changes. Useful strategies for the health care provider to institute to aid the client in a relapse situation include: 1. Using fear to reinforce the need to change. 2. Telling the client that the relapse is a learning opportunity in preparation for the next action stage. 3. Stressing the need to stay “straight.” 4. Involving the family in stressing the need to stay “straight.” Question 200. Mrs. Smith, age 85, lost her husband 6 months ago. Since that time, she has been overwhelmed and has had difficulty coping. Today, she is in your office, tearful, weak, and discouraged. Her mobility is also becoming increasingly limited because of her need for a hip replacement. She is indecisive, expresses fear about the surgery, and tells you she does not want the surgery. Your best action is to: 1. Treat the client’s psychological problems and provide support. 2. Respect the client’s wishes. 3. Consider placing the client in an assisted living facility. 4. Explain to the client that she is depressed and will feel better after the surgery. Question 201. The Affordable Care Act (ACA) passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health insurance exchange is to: 1. Create an online marketplace for the sale and purchase of health insurance for consumers. 2. Require each state to sell health insurance policies to consumers. 3. Reduce the overall out-of-pocket cost of health insurance to the consumer. 4. Require small businesses with 50 employees or less to buy health insurance coverage for their employees. Question 202. An emancipated minor is a client who is younger than age 18 but who is considered a competent adult with the authority to accept or refuse medical treatment. How do you determine if the 16-year-old you are seeing is an “emancipated minor”? 1. No 16-year-old would be considered an emancipated minor. 2. Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court. 3. The client claims that he is free from all parental control. 4. The client is accompanied by an older friend who states that he or she is the client’s guardian and will accept legal responsibility. Question 203. An effective method for assessing a client’s retention and understanding of educational materials is: 1. Asking the client to restate what you have reviewed. 2. Providing a pathophysiology book for your client to take home and read. 3. Repeating your explanations of disease pathophysiology. 4. Objective testing. Question 204. It is important to do which of the following before negotiating a contract? 1. Do your homework. 2. Hire a lawyer. 3. Plan a signing-of-contract dinner. 4. Stand your ground. Question 205. Mrs. Hernandez, age 79, is insisting on discharge from the skilled nursing facility where she is receiving rehabilitation after a left hip replacement. She lives alone and has very little support. You do not think she is ready for discharge. Mrs. Hernandez’s insistence on discharge is an example of your client exercising her right to: 1. Self-determination. 2. Beneficence. 3. Justice. 4. Utilitarianism. Question 206. Techniques used to enhance a client’s adherence to a treatment plan include: 1. Stressing the dangers of missing medications. 2. Giving clear written instructions and simplifying the drug regimen. 3. Allowing plenty of time between follow-up visits so the client has time to adjust to the regimen. 4. Explaining the importance of the regimen to the family. Question 207. Health behaviors can be difficult to change. Which of the following is most important in influencing behavioral change? 1. Motivation. 2. Health beliefs. 3. Cognitive knowledge. 4. Social supports. Question 208. When counseling on health behavior change, the advanced practice registered nurse (APRN) would say which of the following? 1. “Stop smoking. Here is a pamphlet.” 2. “Why are you still smoking?” 3. “What are your thoughts about quitting smoking at this time?” 4. “You should quit smoking; it isn’t good for your health.” Question 209. The purpose of a block grant is to: 1. Provide more comprehensive services for Medicaid recipients. 2. Encourage individuals to obtain their own health insurance so they will not need government assistance. 3. Allow states to have greater flexibility in providing services to the poor. 4. Decrease the proportion of state taxes allocated to pay for Medicaid. Question 210. Sally, an advanced practice registered nurse (APRN), sees Mr. Bell, who is suffering from congestive heart failure. She increases his diuretic but makes no note of his potassium and orders no replacement potassium. Mr. Bell returns a week later for routine laboratory testing. His potassium level is found to be low; however, Mr. Bell has no complaints. Sally orders a potassium supplement to begin immediately as well as a follow-up potassium level measurement. Is Sally guilty of malpractice? 1. Yes, because she breached a standard of care. 2. No, because no harm came to the client. 3. No, because she took remedial action. 4. Yes, because she was negligent. Question 211. You are working in an emergency department as an advanced practice registered nurse (APRN). An adolescent boy is brought in, unconscious, with a head injury after being struck by a car. He has no identification, and there is no parent or adult with him. What should you do? 1. Provide the appropriate medical treatment even if it involves surgery. 2. Do everything except order a blood transfusion, even if it is indicated, because you do not know the client’s religious preferences. 3. Call the hospital attorney before instituting any care. 4. Contact all local police stations in an attempt to identify the client and find his parents before instituting treatment. Question 212. There are advantages to owning your own practice. However, there are also barriers to the ability to do this. These barriers include which of the following? 1. Getting and keeping a collaborating physician, if required by law; getting on managed care panels; and getting privileges at hospitals. 2. Getting privileges at hospitals, getting referrals from hospital emergency departments, and lack of knowledge. 3. Inability to find a collaborating physician, inability to find clients, and lack of empathy. 4. Lack of legal authority to admit clients to nursing homes, to order home care, and/or to direct hospice services, and lack of ability to manage client care without clear medical oversight and supervision. Question 213. You are attempting to elicit a history from Mr. Barnes during his first visit to your office. He is becoming increasingly angry and belligerent. He says, “Can’t you hurry up? Dr. Smith never takes this long! Why are all these questions necessary?” You respond: 1. “I’m sorry, Mr. Barnes, but I need these questions answered.” 2. “I want to provide the best possible care for you, Mr. Barnes.” 3. “Perhaps your wife can assist with some of these questions.” 4. “You seem very upset, Mr. Barnes. Could you share with me what is bothering you?” Question 214. Which of the following statements related to statistical techniques and their usage in research is true? 1. Statistical significance and clinical significance are the same. 2. If a journal article you are writing is required to be limited in length, you should delete the descriptive statistics and keep the inferential statistics. 3. Correlational coefficients imply causality. 4. To determine the appropriate statistical test to use, consider sample size, level of measurement, and data type. Question 215. Prescriptive authority for advanced practice registered nurses (APRNs): 1. Is permitted only under protocol. 2. Is mandated by law in more than 40 states. 3. Varies by state. 4. Includes the ability to prescribe controlled substances. Question 216. Mr. Brill, age 50, is a house painter who has smoked 2 to 3 packs of cigarettes per day since he was 20 years old. He comes in to the clinic complaining of a chronic cough. When you discuss his smoking behavior, he states, “I know I need to stop smoking, but I’m under too much stress right now.” Mr. Brill is at which stage of change? 1. The precontemplative stage. 2. The contemplative stage. 3. The action stage. 4. The maintenance stage. Question 217. Which of the following statements best describes the term patient engagement? 1. The provider is the best judge of a patient’s health care needs. 2. There are shared responsibilities and accountabilities between the provider and the patient. 3. The provider is the ultimate source of information about a patient’s health status. 4. Health care is ultimately the individual’s responsibility. Question 218. Which of the following describes a situation in which medical information may be passed on without client consent? 1. When the client has a gunshot wound. 2. When a potential employer asks for it. 3. When certifying absence from work. 4. When talking to another health care provider. Question 219. Mr. Griffin, age 85, has been given a diagnosis of bowel cancer, and surgery is indicated. He is mentally alert; however, he is refusing to give consent for the procedure. You respond by: 1. Ordering a psychiatric consultation. 2. Having your collaborating physician talk with the client. 3. Respecting his wishes. 4. Talking with his family. Question 220. The term credentialing means that: 1. An individual is permitted to practice advanced practice nursing. 2. The practitioner has met certain criteria through licensure, certification, and education. 3. An individual has completed a program of study. 4. An individual has prescriptive authority. Question 221. When caring for a client who speaks a language different from yours, the ideal strategy is to: 1. Use gestures to convey the meaning of words and use a foreign language dictionary of medical terms. 2. Rely on family members to interpret. 3. Review the case first with an interpreter before beginning the clinical visit. 4. Use a pad and pencil to pass information back and forth with an interpreter. Question 222. Which of the following strategies can help foster client compliance? 1. In-depth client education. 2. High-frequency medication dosing. 3. Providing positive feedback and reinforcement. 4. Monitoring serum drug levels to assess therapeutic range. Question 223. The term collaboration is best defined as: 1. Interdisciplinary teamwork. 2. A protocol arrangement with a physician. 3. Case management. 4. Cooperation with another to achieve mutual goals while not losing sight of one’s own interests. Question 224. You are interviewing a client who becomes tearful. An appropriate response is to: 1. Ask if the client has a support person with them. 2. Sit quietly with the client and offer a tissue. 3. Offer to get a glass of water to help the client compose himself or herself. 4. Let the client have privacy and spend the time reviewing the chart and background of the client. Question 225. The best way you, as an individual advanced practice registered nurse (APRN), can make a difference or real impact is by: 1. Reading about issues in the newspaper. 2. Writing letters to the editor supporting APRNs. 3. Thinking positively about the work you do. 4. Supporting a Democratic candidate. Question 226. Which of the following nonverbal communication techniques is important in the establishment of rapport with a client? 1. Taking notes only while the client is talking. 2. Making direct eye contact with the client, with periodic breaks to take or check notes. 3. Having a desk between you and the client. 4. Wearing jeans in the clinical setting to ensure your comfort. Question 227. You are seeing your client for the first time, and he says, “I like that you are a physician assistant.” You tell him you are a nurse practitioner, and he asks you how the two are different. Your best answer is: 1. A nurse practitioner has much more training than a physician assistant (PA). 2. Nurse practitioners cannot practice independently. 3. Physician assistants do not have the breadth of knowledge nurse practitioners have. 4. Physician assistants are health care professionals who are authorized by the state to practice medicine under the license of a physician, whereas nurse practitioners have an independent base of knowledge—ie, advanced nursing knowledge—and independent licensure to practice. Question 228. It is important to prepare for your interview as an advanced practice registered nurse (APRN). You should be prepared to answer which of the following? 1. How old you are and how many children you have because your childcare responsibilities might affect how you are able to do your job. 2. Whether you are prepared to advertise the practice using your own funds as well as other things you can bring to the practice. 3. What you can bring to the practice and whether you will be able to see clients in a 10- to 15-minute block of time to make yourself revenue-producing. 4. Why you should be hired, how many clients per day you will see, what you can bring to the practice, your willingness to work evenings and/or weekends and to take calls, and how independent you are in your practice. Question 229. Denial of provider status is something that seriously impedes a nurse practitioner’s ability to practice. If that occurs, some steps one can take include: 1. Requesting that your clients lobby on your behalf, going to the newspapers, and reapplying. 2. Requesting that your physician colleagues intervene on your behalf and writing critical letters to the organization in question. 3. “Bashing” the organization to others, reapplying, and contacting an attorney. 4. Writing letters to the organization’s president and chief executive officer (CEO), activating others to lobby on your behalf, and reapplying after a 6-month period. Question 230. When caring for clients from a different culture, which of the following is an important piece of assessment data? 1. Determining the ultimate decision maker. 2. Making decisions based on your general knowledge about the cultural background of the client. 3. Determining the family’s perception of the cause of the client’s problem. 4. Understanding that clients from other cultures expect their health care provider to be an authority figure. Question 231. The research function of the advanced practice registered nurse (APRN) may be operationalized as both a consumer of research findings and a researcher. Being a consumer of research findings involves a number of activities, including: 1. Reading the literature, analyzing its clinical applicability, and using new interventions. 2. Organizing and conducting a research study. 3. Data collection. 4. Ensuring protection of human subjects. Question 232. Your client is convinced her illness has been caused by the ill will of a family member. Her description of her illness is an example of her: 1. Explanatory reasoning. 2. Lack of understanding of scientific medicine. 3. Delusional ideation. 4. Cultural bias. Question 233. In the outpatient office setting, the most common reason for a malpractice suit is failure to: 1. Properly refer. 2. Diagnose correctly in a timely fashion. 3. Obtain informed consent. 4. Manage fractures and trauma correctly. Question 234. Mr. Jones, age 44, is admitted to the emergency department complaining of chest pain. Which of the following actions would be the best way to establish a therapeutic relationship with Mr. Jones? 1. Asking several quick and specific questions in rapid succession to establish the exact nature of this emergent clinical situation. 2. Asking open-ended questions to elicit pertinent clinical data. 3. Reassuring the client that he is in good hands, in a well-equipped emergency department, and that everything will be okay. 4. Asking the client about his anxiety level. Question 235. As an advanced practice registered nurse (APRN), you begin a new job in a small practice with 2 other physicians. You have been hired to be a partner in the practice, but the eldest partner is reluctant to allow you to take on new clients. This is an example of: 1. Role stress. 2. Role strain. 3. Role insufficiency. 4. Role conflict. Question 236. Certain characteristics differentiate research from quality improvement. Which of the following is an example of research? 1. Client satisfaction being evaluated relative to existing practice. 2. An intervention—well supported in the literature—being implemented and evaluated. 3. A standardized assessment tool (eg, risk assessment for falls) being implemented and evaluated. 4. A new intervention being implemented and compared with current practice to determine which is better. Question 237. The primary purpose of an institutional review board (IRB) is to: 1. Protect human subjects. 2. Evaluate the scientific merit of proposed research. 3. Oversee and coordinate the research efforts of an institution. 4. Oversee and coordinate the research efforts of an individual. Question 238. Which of the following statements about Medicaid is true? 1. Medicaid is a federal plan created to provide care for indigent persons. 2. Medicaid pays for family planning services, dental care, and eyeglasses. 3. Eligibility requirements for Medicaid are mandated by the Health Care FinancingAdministration. 4. Medicaid is a program for the indigent financed jointly by the federal and state governments. Question 239. Which of the following statements about malignant melanomas is true? 1. They usually occur in older adult males. 2. There will usually be no family history of melanoma. 3. They are common in populations with dark skin. 4. The prognosis is directly related to the thickness of the lesion. Question 240. Justin, an obese 42-year-old, cut his right leg 3 days ago while climbing a ladder. Today his right lower leg is warm, reddened, and painful, without a sharply demarcated border. What do you suspect? 1. Diabetic neuropathy. 2. Cellulitis. 3. Peripheral vascular disease. 4. A beginning stasis ulcer. Question 241. Elizabeth, age 83, presents with a 2-day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules at that site. What do you suspect? 1. Varicella. 2. Herpes zoster. 3. Syphilis. 4. Rubella. Question 242. Which of the following statements about macular degeneration is not true? 1. Macular degeneration is characterized by gradual loss of peripheral vision. 2. Macular degeneration is the leading cause of blindness in people younger than 60. 3. Tobacco use is a risk factor for macular degeneration. 4. There are 2 different types of macular degeneration: wet and dry. Question 243. What intervention would not be included in the definition of secondary prevention? 1. Sexually transmitted infection (STI) testing 2. Preventive mammography. 3. Testicular self-examination. 4. Routine immunizations. Question 244. A patient asks how to avoid contracting pharyngitis and tonsillitis. Which piece of advice is not appropriate for this patient? 1. “Replace your toothbrush as soon as you develop a sore throat.” 2. “Use condoms or dental dams when performing oral sex.” 3. “Take antibiotics when well to avoid future infections.” 4. ”Avoid low-humidity environments.” Question 245. Between ages 7 and 18, both boys and girls are immunized against the following diseases: 1. Tetanus, diphtheria, pertussis, meningitis, and human papillomavirus. 2. Tetanus, diphtheria, pertussis, and rotavirus. 3. Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and hepatitis A. 4. Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and hepatitis C.   Answer Key 1. 1 2. 1 3. 3 4. 4 5. 1 6. 1 7. 2 8 [Show More]

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