LEIK FNP Practice Questions and answers, Graded A+. TESTBANK.

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LEIK FNP Practice Questions and answers, Graded A+. TESTBANK. A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (... BP) at this visit is 168/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease? A) It increases the chances of adverse effects to her health B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics D) None of the statements are true - ✔✔B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic. NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure by decreasing renal blood flow. 2. All of the following are infections that affect mostly the labia and vagina except: A) Bacterialvaginosis B) Candidiasis C) Trichomoniasis D) Chlamydia trachomatis - ✔✔D) Chlamydia trachomatis Infections that commonly affect the labia and vagina include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity. The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: A) Cholecystitis B) Acute appendicitis C) Inguinal hernia D) Gastriculcer - ✔✔B) Acute appendicitis. Signs and symptoms of an acute abdomen include invol- untary guarding, rebound tenderness, boardlike abdomen, and a positive obtu- rator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his/her side with knees extended, or when pain occurs with active flexion of his/her thigh at the hip. Treatment for mild preeclampsia includes all of the following except: A) Bed rest except for bathroom privileges B) Close monitoring of weight and blood pressure C) Close follow-up of urinary protein, serum creatinine, and platelet count D) A prescription of methyldopa (Aldomet) to control blood pressure - ✔✔D) A prescription of methyldopa (Aldomet) to control blood pressure Recommended care for women diagnosed with preeclampsia includes bed rest with bath- room privileges, weight and BP monitoring, and closely following urine protein and serum protein, creatinine, and platelet counts. Oral medications are not used as first-line treatment. All of the following services are covered under Medicare Part A except: A) Inpatienthospitalizations B) Medicines administered to a patient while hospitalized C) Nursing home care D) Surgeons - ✔✔C) Nursing home care Medicare A coverage includes inpatient hospitalization and skilled care given in a certified skilled nursing facility. Most nursing home care is custodial care (help with bathing, dressing, using a bathroom, and eating). This care is not covered by Medicare A. A 28-year-old student is seen in the school health clinic with complaints of a hacking cough that is productive of small amounts of sputum and a runny nose. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right lung. The total white blood cell count is 10,500/uL. What is the most likely diagnosis? A) Streptococcal pneumonia B) Mycoplasma pneumonia C) Acute bronchitis D) Legionnaires disease - ✔✔B) Mycoplasma pneumonia Mycoplasma pneumonia is the organism most com- monly seen in children and young adults. It is easily spread from droplets, from sneezing and coughing, in close proximity. Diagnosis is based on symptoms and x-ray results of infiltrates in lower lobes. A 39-year-old migrant worker presents to the clinic 2.5 days after a purified protein derivative (PPD) test. What minimum size of induration would be considered posi- tive for this patient? A) 3 mm B) 5 mm C) 10 mm D) 15 mm - ✔✔C) 10 mm The PPD is administered on the volar aspect of the lower arm and read 48 hours after the test is given. The PPD result must have induration and measure 10 mm or greater to be positive in a low-risk patient. Induration (firmness with palpation) must be present. If the site has erythema but no induration, result would be negative. Color is not important. All of the following are correct statements regarding the role of the person named in a durable power of attorney except: A) The agent's decisions are legally binding B) The agent can make decisions in other areas of the patient's life such as financial issues C) The agent can decide for the patient who is on life support when that life support can be terminated D) The patient's spouse has a right to override the agent's decisions - ✔✔D) The patient's spouse has a right to override the agent's decisions The person named in a durable power of attorney (the agent) is designated by the patient to make all medical decisions, as well as any decisions regarding the patient's private affairs in the event that the patient becomes incompetent and unable to make his/her own decisions. No one has the ability to override the agent's decision. All of the following are true statements regarding Munchausen syndrome except: A) It is considered a mental illness B) The patient has a medical illness that causes an anxiety reaction and denial C) The patient fakes an illness in order to gain attention from health care providers D) The patient has an inconsistent medical history along with a past history of frequent hospitalizations - ✔✔B) The patient has a medical illness that causes an anxiety reaction and denial Munchausen syndrome is a psychiatric disorder in which the patient fakes a medical illness or disorder to gain attention from health care provid- ers. These patients commonly use the emergency department frequently to gain attention. Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema? A) Calcium channel blockers B) Angiotensin-converting enzyme (ACE) inhibitors C) Beta-blockers D) Diuretics - ✔✔C) Beta-blockers Beta-blockers should be avoided in patients with a history of emphysema. Studies have shown evidence of a reduction in forced expiratory volume in 1 second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator response to beta agonists in patients receiving non-selective beta- blockers and high doses of cardioselective beta-blockers. A 30-year-old chef complains of pruritic hives over her chest and arms but denies difficulty swallowing or breathing. She reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate? A) Perform a complete and thorough history B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID C) Give an injection of epinephrine 1:1000 intramuscularly stat D) Call 911 - ✔✔A) Perform a complete and thorough history Prior to prescribing medications, a complete and thorough history must be performed to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency to require calling 911. Which of the following findings is most likely in young primigravidas with pregnancy-induced hypertension? A) Abdominal cramping and constipation B) Edema of the face and the upper extremities C) Shortness of breath D) Dysuria and frequency - ✔✔B) Edema of the face and the upper extremities Common signs and symptoms of pregnancy-induced hypertension include edema of the face and the upper extremities, weight gain, blurred vision, elevated BP, proteinuria, and headaches. Which of the following symptoms is associated with B12 deficiency anemia? A) Spoon-shaped nails and pica B) An abnormal neurological exam C) A vegan diet D) Tingling and numbness of both feet - ✔✔D) Tingling and numbness of both feet Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or numbness in fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia. A second triple screen on a 35-year-old primigravida reveals abnormally low lev- els of the alpha fetoprotein and estriol and high levels of human chorionic gonad- otropin. Which of the following interventions is the best choice for this patient? A) Order an ultrasound B) Order a computed tomography (CT) scan of the abdomen C) Order a 24-hour urine for protein clearance D) Assess for a history of illicit drug or alcohol use - ✔✔A) Order an ultrasound Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be ordered to further evaluate the fetus for characteristics of Down syndrome and/or fetal demise. All of the following are true statements about diverticula except: A) Diverticula are located in the colon B) A low-fiber diet is associated with the condition C) Most diverticula in the colon are infected with gram-negative bacteria D) Supplementingwithfibersuchaspsyllium(Metamucil)isrecommended - ✔✔C) Most diverticula in the colon are infected with gram-negative bacte- ria Diverticuli in the colon can be infected with both gram-negative and gram- positive bacteria. Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? A) Chancroid B) Chlamydia trachomatis C) Herpes genitalis D) PID (pelvic inflammatory disease) - ✔✔B) Chlamydia trachomatis When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis. Kyphosis is a late sign of: A) Old age B) Osteopenia C) Osteoporosis D) Osteoarthritis - ✔✔C) Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain. A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be? A) Normal B) Higher than normal C) Lower than normal D) None of the above - ✔✔B) Higher than normal Alpha fetoprotein is produced in the fetal and maternal liver. Higher levels of alpha fetoprotein are commonly seen in multiple gestations due to the growing fetuses and enlargement of the livers. Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis? A) Calcium channel blocker B) Angiotensin-converting enzyme (ACE) inhibitor C) Beta-blocker D) Diuretic - ✔✔A) Calcium channel blocker Calcium channel blockers act by blocking the cal- cium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones. The Lachman maneuver is used to detect which of the following? A) Knee instability B) Nerve damage of the knee due to past knee injuries C) The integrity of the patellar tendon D) Tears on the meniscus of the knee - ✔✔A) Knee instability The Lachman maneuver is a test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament. When an adolescent male's penis grows more in length than width, at which of the following Tanner stages is he classified? A) Tanner Stage II B) Tanner Stage III C) Tanner Stage IV D) Tanner Stage V - ✔✔B) Tanner Stage III Tanner Stage III in males consists of penis lengthening and darker, coarse pubic hair, which begins to curl Fetal TORCH infections can cause microcephaly, mental retardation, hepatospleno- megaly, and intrauterine growth retardation. The acronym TORCH stands for: A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes B) Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities D) Toxins, other infections, roseola, candidiasis, and head abnormalities - ✔✔A) Toxoplasmagondii, other infections, rubella, cytomegalovirus, and herpes The acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. Although several of the conditions listed in the other answer options can also cause fetal problems, they are not included in the TORCH acronym. Human papilloma virus (HPV) infection of the larynx has been associated with: A) Laryngeal neoplasia B) Esophageal stricture C) Cervical cancer D) Metaplasia of esophageal squamous cells - ✔✔A) Laryngeal neoplasia HPV infection of the larynx has been associated with laryngeal neoplasia; HPV infection of the cervix is associated with cervical cancer. Mr. Brown is a 65-year-old carpenter complaining of morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam, the nurse notices the presence of Heberden's nodes. Which of the fol- lowing is most likely? A) Osteoporosis B) Rheumatoid arthritis C) Degenerative joint disease D) Reiter's syndrome - ✔✔C) Degenerative joint disease Heberden's nodes are commonly seen in degenerative joint disease. Heberden's nodes are bony nodules located on the distal interphalangeal joints (DIPs). What does a positive posterior drawer sign in a 10-year-old soccer player signify? A) An abnormal knee B) Instability of the knee C) A large amount of swelling on the knee D) An injury of the meniscus - ✔✔B) Instability of the knee The drawer sign is performed on the knee or ankle to assess for knee instability. The affected knee will have more laxity when compared to the unaffected knee. A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient? A) Advise the mother that her pregnancy is progressing well B) Order an ultrasound of the uterus C) Refer her to an obstetrician for an amniocentesis D) Recommend bed rest with bathroom privileges - ✔✔A) Advise the mother that her pregnancy is progressing well From 20-35 weeks' gestation, fundal height should equal weeks gestation. If greater than 2 cm within the gestational week of pregnancy, further testing should be performed to evaluate fetal growth A multigravida who is at 34 weeks of gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fun- dus is: A) Midway between the umbilicus and the lower ribs B) At the level of the umbilicus C) From 33 to 35 cm D) From 32 to 34 cm - ✔✔C) From 33 to 35 cm After 20 weeks gestation, fundal height in centimeters should measure approximately the same as the number of weeks of gestation Which of the following laboratory tests is used in primary care to evaluate renal function? A) Electrolyte panel B) Creatinine C) Alkaline phosphatase D) Blood urea nitrogen (BUN) to creatinine ratio - ✔✔B) Creatinine Serum creatinine is measured to evaluate renal function. Creatinine is the end product of creatine metabolism. Creatinine clearance is not affected by fluid or dietary intake of meat. All of the following are false statements regarding acute gastritis except: A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder B) Chronic lack of dietary fiber is the main cause of the disorder C) The screening test for the disorder is the barium swallow test D) The gold standard to evaluate the disorder is a colonoscopy - ✔✔C) The screening test for the disorder is the barium swallow test The gold standard for diagnosing gastric disease is biopsy of gastric and/or duodenal tissue by upper endoscopy. Chronic use of NSAIDs disrupts the production of prostaglandins, which decreases blood supply and then breaks down the protective layer of the mucosa, which leads to gastric disease. Signs and symptoms of depression include all of the following except: A) Anhedonia and changes in appetite B) Decreased energy and irritability C) Apathy and low self-esteem D) Apraxia and fatigue - ✔✔D) Apraxia and fatigue Apraxia is a disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so. Common signs of depression include anhedonia (loss of interest in activities that the patient finds pleasurable), unintentional weight loss or gain, fatigue, change in appetite, insomnia or hypersomnia, feelings of guilt and worthlessness, and recurrent thoughts of suicide. Which of the following is an accurate description of eliciting for Murphy's sign? A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle B) Bend the patient's hips and knees at 90 degrees, then passively rotate hip exter- nally, then internally C) Ask the patient to squat, then place the stethoscope on the apical area D) Press into the abdomen deeply, then release it suddenly - ✔✔A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle Murphy's sign is positive if pain occurs when performing RUQ palpation while the patient takes a deep inspiration, causing the patient to abruptly stop the deep breath due to pain. As the liver is palpated, it will descend and push up against the inflamed gallbladder and cause sharp pain (cholecystitis). A 28-year-old multipara who is at 32 weeks of gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? A) Placenta abruptio B) Placenta previa C) Acute cervicitis D) Molar pregnancy (hydatidiform mole) - ✔✔B) Placenta previa Placenta previa occurs when abnormal implantation of the placenta occurs. A common symptom of placenta previa is painless, bright red bleeding. Epidemiologic studies show that Hashimoto's disease occurs most commonly in: A) Middle-aged to older women B) Smokers C) Obese individuals D) Older men - ✔✔A) Middle-aged to older women Hashimoto's disease commonly occurs in middle-aged to older women. A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: A) Hot flashes B) Irregular menstrual periods C) Severe vaginal atrophic changes D) Cyclic mood swings - ✔✔C) Severe vaginal atrophic changes As women reach menopause, changes that may occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal changes, such as dryness and thinning, may also begin to occur A 63-year-old patient with a 10-year history of poorly controlled hypertension presents with a cluster of physical exam findings. Which of the following indicate target organ damage commonly seen in hypertensive patients? A) Pedal edema, hepatomegaly, and enlarged kidneys B) Hepatomegaly, AV nicking, bibasilar crackles C) Renal infection, S3, neuromuscular abnormalities D) Glaucoma, jugular vein atrophy, heart failure - ✔✔B) Hepatomegaly, AV nicking, bibasilar crackles With long-term, uncontrolled hypertension, organ damage may occur. Organs commonly affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding, blindness), heart (heart dis- ease, left ventricular hypertrophy, MI, and/or CHF), and kidneys (renal failure, proteinuria). A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion? A) Vaginal bleeding and cramping are present, but the cervix remains closed B) Vaginal bleeding and cramping are present along with a dilated cervix C) The fetus and placenta are all expelled D) The products of conception and the placenta remain inside the uterus along with a dilated cervix - ✔✔A) Vaginal bleeding and cramping are present, but the cervix remains closed Threatened abortion is defined as vaginal bleeding and cramping with- out the presence of cervical dilation. A 30-year-old female who is sexually active complains of a large amount of milk- like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely? A) Trichomonas infection B) Bacterial vaginosis C) Candidal infection D) A normal finding - ✔✔B) Bacterial vaginosis Bacterial vaginosis is a bacterial infection of the vagina. Signs and symptoms include copious off-white to gray discharge with foul odor without vaginal erythema or irritation. Wet prep will show positive for clue cells. When performing a wet prep, the "whiff test" will be positive for a strong "fishy" odor when vaginal discharge is mixed with one drop of KOH. The Pap smear result on a 20-year-old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action? A) The NP needs to do cervical cultures to verify the presence of gonorrhea B) Prescribe metronidazole vaginal cream for the patient over the phone C) Call the patient and tell her she needs a repeat Pap smear in 6 months D) Advise the patient to use a Betadine douche at bedtime x 3 days - ✔✔A) The NP needs to do cervical cultures to verify the presence of gonor- rhea Cultures should be taken at the time of the Pap smear, as the patient may not return for later diagnostic testing. While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient's labia. The patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described? A) Chronic scabies infection B) Lichen sclerosus C) Chronic candidal vaginitis D) A physiologic variant found in some older women - ✔✔B) Lichen sclerosus Lichen sclerosus is a disease of the skin, in which white spots appear on the skin and change over time. It is most commonly seen in the genital and rectal areas, but can appear in other areas. The spots are usually shiny and smooth and can eventually spread into patches. The skin appears thin and crinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms The heart sound S2 is caused by: A) Closure of the atrioventricular valves B) Closure of the semilunar valves C) Opening of the atrioventricular valves D) Opening of the semilunar valves - ✔✔B) Closure of the semilunar valves The heart sound S2 is caused by closure of the semilunar valves. A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas? A) Between the umbilicus and the suprapubic bone B) Just rising above the suprapubic bone C) Between the suprapubic bone and the xiphoid process D) Between the umbilicus and the xiphoid proces - ✔✔B) Just rising above the suprapubic bone At 12 weeks gestation, the uterus measures approximately the size of a grapefruit, which would be felt just above the suprapubic bone on bimanual exam. All of the following are covered under Medicare Part B except: A) Persons age 65 years or older B) Durable medical equipment C) Mammograms annually starting at age 50 D) Anesthesiologist's services - ✔✔D) Anesthesiologist's services Medicare Part B covers: 1) outpatient physician visits, labs, x-rays; 2) durable medical equipment; 3) mammograms/colonoscopy after age 50 years annually; 4) rehabilitation. Anesthesiologist's services are covered by Medicare Part A. All of the following patients are at higher risk for suicide except: A) A 66-year-old White male whose wife of 40 years recently died B) A high school student with a history of bipolar disorder C) A depressed 45-year-old female with family history of suicide D) A 17-year-old teen who has only 1 close friend in school - ✔✔D) A 17-year-old teen who has only one close friend in school Risk factors for suicide include: 1) elderly white males (especially after the death of a spouse); 2) past history of suicide; 3) family history of suicide; 4) plans for use of a lethal weapon such as a gun or knife; 5) female gender has a higher attempt rate, but males have a higher success rate; 6) personal history of bipolar disorder or depression. A 70-year-old male patient complains of a bright red spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on is Bayer aspirin 1 tablet a day. Which of the following is most likely? A) Corneal abrasion B) Acute bacterial conjunctivitis C) Acute uveitis D) Subconjunctival hemorrhage - ✔✔D) Subconjunctival hemorrhage Subconjunctival hemorrhage is a benign disorder that occurs from an increase in intraocular pressure that may be caused by coughing, vomiting, forceful exerrtion in labor during childbirth, straining while having a bowel movement, weight lifting, or lifting a heavy object. Which of the following is appropriate follow-up for this 70-year-old patient? A) Referral to an optometrist B) Referral to an ophthalmologist C) Advise the patient that it is a benign condition and will resolve spontaneously D) Prescribe an ophthalmic antibiotic solution - ✔✔C) Advise the patient that it is a benign condition and will resolve spontaneously A subconjunctival hemorrhage is a benign disorder that resolves without any treatment Jason, an 8-year-old with type 1 diabetes, is being seen for a 3-day history of fre- quency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially? A) Urine for culture and sensitivity B) 24-hour urine for protein and creatinine clearance C) 24-hour urine for microalbumin D) An intravenous pyelogram - ✔✔A) Urine for culture and sensitivity An 8-year-old male patient with the diagnosis of diabetes has a high risk of urinary tract infections. A large amount of leukocytes in the urinalysis is abnormal and he has been having symptoms of frequency and nocturia for the past 3 days. The urine culture would be ordered because he has a high risk of infection. The urine culture and sensitivity (C&S) is the best evaluation for diagnosing a urinary tract infection. All of the following are not recommended for the outpatient treatment of mild preeclampsia except: A) Severe sodium restriction B) Restrict fluid intake to less than 1 liter per 24 hours C) Aldomet (methyldopa) 250 mg PO (orally) BID D) Bed rest on the left side with bathroom privileges - ✔✔D) Bed rest on the left side with bathroom privileges Outpatient treatment for mild pre-eclampsia includes bed rest on the left lateral side with bathroom privileges. The best test for diagnosing congenital glaucoma is which of the following? A) Fluorescein staining B) Tonometry C) Snellen vision exam D) The refractive index - ✔✔B) Tonometry A tonometer is used to measure the intraocular pressure (IOP) of the eye to screen for glaucoma. Normal range IOP is 10-22 mm Hg. Rocky Mountain spotted fever is caused by the bite of the: A) Mosquito B) Tick C) Insect D) Flea - ✔✔B) Tick Rocky Mountain spotted fever is caused by a tick bite from a tick that was infected with the parasite Rickettsia rickettsii. The mortality rate is 1%-7% if left untreated. All of the following are false statements about atopic dermatitis except: A) Contact with cold objects may exacerbate the condition B) It does not have a linear distribution C) It is associated with bullae D) The lesions have vesicles that are full of serous exudate - ✔✔B) It does not have a linear distribution Atopic dermatitis is a skin condition in which the lesions occur in a linear fashion. They may have many different stages, including erythematous papules and vesicles, with weeping, drainage, and/or crusting. Lesions are commonly found on the scalp, face, forearms, wrists, elbows, and backs of the knees. Commonly pruritic. Also known as eczema. A mother brings in her 4-year-old daughter who just started attending preschool. She tells the nurse practitioner that her child is complaining of burning and itching in both eyes along with a runny nose. During the physical exam, the child's eyes appear injected bilaterally. The throat is red and her inferior nasal turbinates are swollen. Which of the following is most likely? A) Herpes keratitis B) Corneal ulcer C) Viral conjunctivitis D) Bacterial conjunctivitis - ✔✔C) Viral conjunctivitis Viral conjunctivitis is inflammation of the conjunctiva with common complaints of red, itchy eyes, without signs of infection. A sexually active woman is complaining of amenorrhea and vaginal spotting. On exam, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner initially order? A) Flat plate of the abdomen B) Complete blood count (CBC) with white cell differentials C) Urine pregnancy test D) Pelvic ultrasound - ✔✔C) Urine pregnancy test A urine pregnancy test should be performed to rule out miscarriage and/or tubal pregnancy. A toddler with congenital heart disease is seen for a 1-week history of facial and lower-extremity edema accompanied by shortness of breath. The child's mother reports that the child's appetite has been poor. The chest x-ray reveals that the child has congestive heart failure (CHF). Which of the following heart sounds are found in these patients? A) S1 and S2 B) S1, S2, and S3 C) S1, S2, and S4 D) Still's murmur and S4 - ✔✔B) S1, S2, and S3 Congestive heart failure is the inability of the heart to pump a sufficient amount of blood to the organs to meet the body's requirements. It is common to hear S1, S2, and S3 heart sounds on exam. Common signs and symptoms include fatigue, shortness of breath with activity, and edema of lower extremities. A 53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitioner diagnoses a Grade II sprain. The initial treatment plan includes which of the following? A) Application of cold packs the first 24 hours followed by applications of low heat at bedtime B) Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours C) Rechecking the knee in 24 hours and isometric exercises D) The application of an Ace bandage to the affected kne - ✔✔B) Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours Elevation of the injured knee above the heart will reduce the amout of swelling that can occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30-45 minutes between icings of the limb is recommended. Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is contraindicated in which of the following conditions? A) G6PD deficiency anemia B) Lead poisoning C) Beta thalassemia minor D) B12 deficiency anemia - ✔✔A) G6PD deficiency anemia Glucose-6-phosphate dehydrogenase (G6PD) defi- ciency is a hereditary condition that occurs when the red blood cells break down, causing hemolysis, due to a missing or lack of a sufficient enzyme that is needed to help the red blood cells work efficiently. Certain foods and medications may trigger this reaction and hemolysis will occur. Some of these medications include antimalarial drugs, aspirin, nitrofurantoin, NSAIDs, quinidine, quinine, and sulfa medications. The mother of an 11-year-old boy with sickle cell anemia calls on the phone complaining that her son woke up because of a painful penile erection that will not go away. The nurse practitioner's most appropriate intervention is: A) Insert a Foley catheter and measure the child's intake and output for the next 24 hours B) Insert a Foley catheter to obtain a specimen for a urinalysis and urine for C&S (culture and sensitivity) C) Recommend an increase in the child's fluid intake D) Recommend immediate referral to the ER - ✔✔D) Recommend immediate referral to the ED Priapism (painful penile erection not related to sexual activity) is a true urologic emergency that may lead to permanent erectile dysfunction and penile necrosis if not treated appropriately. It can be associated with a number of medical conditions (sickle cell anemia, leukemia, or spinal cord injury) and/or some pharmacologic agents A positive Coombs test on an Rh-negative pregnant woman means: A) The mother has autoantibodies against Rh-positive red blood cells (RBCs) B) The fetus has autoantibodies against maternal RBCs C) The mother does not have Rh factor against fetal RBCs D) The fetus does not have RBC autoantibodies - ✔✔A) The mother has autoantibodies against Rh-positive red blood cells (RBCs) The mother's autoantibodies can attack the fetus's Rh-positive red blood cells and cause destruction of these cells, which can cause severe anemia and com- plications in the fetus. Today this is preventable with the administration of anti- RhD immunoglobulin (Rho(D) immune globulin) to an Rh-negative mother at 28 weeks gestation and after birth if the newborn is Rh positive. Folic acid supplementation is recommended for women who are planning pregnancy in order to: A) Prevent renal agenesis B) Prevent anencephaly C) Prevent kidney defects D) Prevent heart defects - ✔✔B) Prevent anencephaly Folic acid supplementation during pregnancy has been shown to decrease the risk of neural tube defects of the fetus All of the following are possible causes for secondary hypertension except: A) Acute pyelonephritis B) Pheochromocytoma C) Renovascular stenosis D) Coarctation of the aorta - ✔✔A) Acute pyelonephritis Pheochromocytoma is an adrenal gland tumor in which there is increased production of the hormones adrenaline and noradrena- line, which may cause long-term elevation in blood pressure. Renovascular steno- sis is a narrowing of one or both arteries leading to the kidneys. It can cause severe hypertension and irreversible kidney damage. Coarctation of the aorta is a con- genital heart defect of the aorta; it is a narrowing of the aorta that causes the heart to work harder to get blood to flow through the narrow aortic passageway to other organs, which in turn causes an increase in blood pressure. Fitz-Hugh-Curtis syndrome is associated with which following infection? A) Syphilis B) Chlamydia trachomatis C) Herpes genitalis D) Lymphogranuloma venereum - ✔✔B) Chlamydia trachomatis Fitz-Hugh-Curtis is a complication of having pelvic inflammatory disease that was caused by a vaginal infection, such as gonorrhea or Chlamydia trachomatis. This causes inflammation and infection in the pelvic cavity. Left untreated, this infection can cause adhesions that stretch from the peritoneum to the liver. A nursing home resident reports to his physician that his previous roommate was recently started on tuberculosis treatment. A Mantoux test and chest x-ray are ordered for the patient. What is the minimum size of induration considered positive for this patient? A) 3 mm B) 5 mm C) 10 mm D) 15 mm - ✔✔B) 5 mm To perform the Mantoux test, a dose of 5 tuberculin units in 0.1 mL solution is injected intradermally into the forearm and read 48 to 72 hours later. Results are measured by the size of the induration, not ery- thema. Standard results of 10 mm or less are considered negative for a low- risk population. For a high-risk population, such as a recent exposure, 5 mm of induration or greater is a positive result. In small children with acquired immunodeficiency syndrome (AIDS), which of the following vaccines is contraindicated? A) Diphtheria and tetanus (Td) B) Hepatitis B and mumps C) Varicella D) Td and oral polio - ✔✔C) Varicella The data regarding efficacy of the varicella vaccine are insufficient; therefore, varicella vaccine is contraindicated in HIV-infected individuals. A 44-year-old female who is undergoing treatment for infertility complains of not having a menstrual period for a few months. The night before, she started spotting and is now having cramp-type pains in her pelvic area. Her blood pressure (BP) is 160/80, the pulse rate is 110, and she is afebrile. Her labs reveal a mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is found above the symphy- sis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? A) Inevitable abortion B) Threatened abortion C) Incomplete abortion D) Acute pelvic inflammatory disease - ✔✔A) Inevitable abortion Inevitable abortion is defined as vaginal bleeding with pain and cervical dilation and/or effacement. Threatened abortion is defined as vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion is moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping or contractions. Acute pelvic inflammatory disease is a sudden onset of inflammation and pain that affects the pelvic area, cervix, uterus, and ovaries, which is caused by infection. A 14-year-old female who is sexually active is brought in by her mother for an immunization update. According to the mother, her daughter had 1 dose of hepatitis B vaccine. Which of the following vaccines would you administer at this visit? A) Td and hepatitis B B) DTaP (diphtheria, tetanus, acellular pertussis) and hepatitis B C) Hepatitis B only D) MMR (measles, mumps, rubella) and Td - ✔✔A) Td and hepatitis B The CDC recommends Td and hepatitis B for 14-year-old females. It is recommended for her to continue the hepatitis series, which includes a total of 3 injections. An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy? A) She can be vaccinated at any time in her pregnancy B) During the second trimester C) During the third trimester D) During the postpartum period - ✔✔D)During the post partum period Rubella should be administered to the woman during the postpartum period. Rubella is contraindicated during pregnancy. Medicare Part B will pay for all of the following services except: A) Outpatient physician visits that are medically necessary B) Durable medical equipment C) Outpatient laboratory and radiology tests D) Eyeglasses and routine dental care - ✔✔D) Eyeglasses and routine dental care Medicare Part B covers: 1) outpatient physician visits, labs, x-rays; 2) durable medical equipment; 3) mammograms/ colonoscopy after age 50 years annually; and 4) rehabilitation. Which of the following is used to screen for color blindness in a 7-year-old boy? A) Snellen chart B) Ishihara chart C) Cover/uncover test D) Red reflex - ✔✔B) Ishihara chart The Ishihara chart is used for screening for color blindness. A 67-year-old retired clerk presents with complaints of shortness of breath and weight gain over a 2-week period. A nonproductive cough accompanies her symptoms. The lung exam is positive for fine crackles in the lower lobes with no wheezing. The exam is positive for egophony. Which of the following conditions is most likely? A) Acute exacerbation of asthma B) Left-heart failure C) Right-heart failure D) Chronic obstructive pulmonary disease - ✔✔B) Left-heart failure Signs and symptoms of left-heart failure include tachypnea, labored breathing, and rales or crackles in the lower bases of the lungs, which can develop into pulmonary edema. Which of the following drugs is most likely to relieve the patient's symptoms? A) Atenolol (Tenormin) B) Trimethoprim/sulfamethoxazole (Bactrim DS) C) Furosemide (Lasix) D) Hydrocodone/guaifenesin syrup (Hycotuss) - ✔✔C) Furosemide (Lasix) Lasix would be used to help remove the extra fluid load. A patient has recently been diagnosed with migraine headache with aura. She wants advice on what she should eliminate from her diet to reduce her risk of headaches. The best response is to advise this patient to avoid: A) Foods with aspartame (Equal) because they can trigger migraines B) Foods with monosodium glutamate because they promote diuresis C) Foods with garlic because they promote hypertension D) Foods with nitrates because they do not induce flushing - ✔✔A) Foods with aspartame (Equal) because they can trigger migraines Dietary triggers for migraine headaches include foods that contain aspartame, tyramine, nitrites, MSG, and/or red wine. These foods are thought to cause a change in the blood vessels and increased blood flow to the brain. A patient with a history of mitral valve prolapse (MVP) is requesting prophylaxis before her dental surgery. Which of the following would you prescribe this patient? A) Amoxicillin a half hour before and 2 hours after the procedure B) Amoxicillin 1 hour before the procedure C) Amoxicillin 1 hour before and 3 hours after the procedure D) Prophylaxis is not recommended for this patient - ✔✔D) Prophylaxis is not recommended for this patient The American Heart Association does not recommend routine antibiotic prophylaxis prior to dental procedures except for patients who are at high risk for bacterial endocarditis (a prosthetic cardiac valve, previous history of bacterial endocarditis, congenital heart defects, etc.). Koplik's spots are associated with: A) Poxvirus infections B) Measles C) Kawasaki's disease D) Reye's syndrome - ✔✔B) Measles Signs and symptoms of the measles include fever over 101°F, coryza, cough, conjunctivitis, rash, and Koplik's spots on buccal mucosa. Stella, a new mother, complains to you that she has been feeling irritable and jittery almost daily for the past few months. She complains of frequent palpitations and more frequent bowel movements along with weight loss. Her BP is 160/70, her pulse is 110, and she is afebrile. All of the following conditions should be considered in the differential diagnosis for this patient except: A) Mitral regurgitation B) Graves' disease C) Generalized anxiety disorder D) Illicit drug use - ✔✔A) Mitral regurgitation Signs and symptoms of mitral regurgitation do not include frequent bowel movements with weight loss. An elderly patient with a productive cough and fever is diagnosed with pneumonia. All of the following organisms are capable of causing community-acquired pneumonia except: A) Haemophilus influenzae B) Mycoplasma pneumoniae C) Treponema pallidum D) Streptococcus pneumoniae - ✔✔C) Treponema pallidum Treponema pallidum is a gram-negative spirochete bacterium that causes syphilis Human chorionic gonadotropin (hCG) is produced by the: A) Placenta B) Hypothalamus C) Anterior pituitary D) Ovaries - ✔✔A) Placenta HCG is produced by the placenta. The majority of serum alpha fetoprotein is produced by the: A) Fetal liver B) Mother's liver C) Placenta D) Fetal neural tube - ✔✔A) Fetal liver Serum alpha fetoprotein is produced by the fetal liver. Stella works in the housekeeping department of a hospital. She presents to the employee health clinic with a complaint of a needlestick to her left thumb. The needle was in one of the garbage bags from the emergency room. The patient had a little bleeding that stopped spontaneously. Which of the following is the next step? A) Order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible B) Recommend a tetanus booster in 1 week C) Offer the patient hepatitis B immunoglobulin D) Order a chest x-ray - ✔✔A) Order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible Employee health clinic protocols for needlesticks recommend ordering an ELISA test as soon as possible to establish baseline blood work for the employee. An elderly woman has been on digoxin (Lanoxin) for 10 years. Her electrocardio- graph (EKG) is showing a new onset of atrial fibrillation. Her pulse is 64/min. She denies syncope and dizziness. Which of the following interventions is most appropriate? A) Order an electrolyte panel and a digoxin level B) Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel C) Order a serum digoxin level and decrease her digoxin dose by half while waiting for results D) Discontinue the digoxin and order another 12-lead EKG - ✔✔B) Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel Obtaining baseline blood work to evaluate for causes of new- onset atrial fibrillation is recommended prior to decreasing or stopping medications. Thyroid disease is a common cause of new-onset atrial fibrillation. You note the following result on a routine urinalysis of a 37-year-old primigravida who is at 30 weeks of gestation. Leukocyte = trace, nitrite = negative, protein = 2 +, blood = negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A) HELLP syndrome B) Pregnancy-induced hypertension (preeclampsia) C) Eclampsia of pregnancy D) Primary hypertension - ✔✔B) Pregnancy-induced hypertension (preeclampsia) The classic triad of symptoms of preeclampsia includes hypertension, edema (weight gain), and proteinuria. The nurse practitioner who suspects that one of her hypertensive patients has Cushing's syndrome would expect to find which of the following laboratory results? A) Hyponatremia B) Hypoglycemia C) Elevated serum cortisol levels D) Decreased urine 17-ketosteroids - ✔✔C) Elevated serum cortisol levels Elevated serum cortisol levels are seen with Cushing's syndrome. The first teeth to erupt during infancy are which of the following? A) First molars B) Second molars C) Incisors D) Canines - ✔✔C) Incisors The incisors are the first teeth to erupt during infancy. The positive signs of pregnancy include: A) Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner B) Palpation of the fetus and a positive quantitative serum pregnancy test C) Fetal heart tones and a positive quantitative serum pregnancy test D) Fetal heart tones and feeling of movement of the baby by the mother - ✔✔A) Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner Presumptive signs of pregnancy are symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/vomiting, fatigue, and increased urinary frequency. Probable signs of pregnancy are signs detected by the examiner, such as an enlarged uterus. Positive signs of pregnancy are direct evidence of pregnancy such as audible fetal heart tones or cardiac activity on ultrasound. Chadwick's sign is characterized by: A) Softening of the cervix B) Blue coloration of the cervix and vagina C) Softening of the uterine isthmus D) Nausea and vomiting during the first trimester of pregnancy - ✔✔B) Blue coloration of the cervix and vagina Chadwick's sign is defined as a bluish discoloration of the cervix and vagina. These changes are caused by the increased vascularity and congestion in the pelvic area during pregnancy. A college student has recently been informed that he has an HPV (human papilloma virus) infection on the shaft of his penis. Which of the following may reveal subclinical lesions on the penile skin? A) Perform a KOH (potassium hydroxide) exam B) Scrape off some of the affected skin and send it for a culture and sensitivity C) Apply acetic acid to the penile shaft and look for acetowhite changes D) Order a serum herpes virus titer - ✔✔C)Apply acetic acid to the penile shaft and look for acetowhite changes Lesions of HPV infection will turn white with application of acetic acid. Carol M. is a 40-year-old bank teller who has recently been diagnosed with obsessive-compulsive disorder by her therapist. Her symptoms would include: A) Ritualistic behaviors that the patient feels compelled to repeat B) Attempts to ignore or suppress the repetitive behaviors, which increase anxiety C) Frequent intrusive and repetitive thoughts and impulses D) All of the above - ✔✔D) All of the above Signs and symptoms of obsessive-compulsive disorder include ritualistic behaviors that are repeated, increased anxiety with attempting to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses. Which of the following medications is indicated for the treatment ofobsessive-compulsive disorder? A) Paroxetine (Paxil CR) B) Haldoperidol (Haldol) C) Lorazepam (Xanax) D) Imipramine (Elavil - ✔✔A) Paroxetine (Paxil CR) Antidepressants are the most common medications used for OCD. Those antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft). You would advise an 18-year-old female student who has been given a booster dose of MMR at the college health clinic that: A) She might have a low-grade fever during the first 24 to 48 hours B) She should not get pregnant within the next 4 weeks C) Her arm will be very sore on the injection site for 24 to 48 hours D) Her arm will have some induration on the injection site in 24to48hours - ✔✔B) She should not get pregnant within the next 4 weeks MMR should not be administered to women known to be pregnant. In addition, women should be counseled to avoid becoming pregnant for 28 days following vaccination. Jean, a 68-year-old female, is suspected of having Alzheimer's disease. Which of the following is the best initial method for assessing the condition? A) Computed tomography scan of the brain B) Mini Mental Status Exam C) Obtain the history from the patient, friends, and family members D) EEG (electroencephalography) - ✔✔B) Mini Mental Status Exam Begin with administering the MMSE for a baseline assessment, followed by taking a history from the patient and others. A 55-year-old woman who has type 2 diabetes is concerned about her kidneys. She has a history of 3 urinary tract infections within the past 8 months. She denies dysuria and frequency at this visit. Which of the following is the best initial course to follow? A) Recheck the patient's urine and order a urine for culture and sensitivity B) Order an IVP (intravenous pyelogram) C) Advise the patient to follow up with a urologist D) Evaluate the patient for a possible kidney infection - ✔✔A) Recheck the patient's urine and order a urine for culture and sensitivity A urinary tract infection is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria (more than 7 WBCs/mL) in a symptomatic patient A nurse practitioner is giving dietary counseling to a male alcoholic who has recently been diagnosed with folic acid deficiency anemia. Which of the following foods should the nurse practitioner recommend to this patient? A) Tomatoes, oranges, and bananas B) Cheese, yogurt, and milk C) Lettuce, beef, and dairy products D) Spinach, liver, and whole wheat bread - ✔✔D) Spinach, liver, and whole wheat bread Foods that are higher in folic acid include spinach, liver, and whole wheat bread. The ELISA and Western Blot tests are both used to test for HIV. Which of the following statements is correct? A) It is a test to detect viral RNA B) A positive ELISA screening does not mean the person has HIV infection C) It is a test to detect viruses D) It is a diagnostic test for the AIDS virus - ✔✔B)A positive ELISA screening does not mean the person has HIV infection The ELISA test is always followed by a Western blot test to confirm diagnosis. Hegar's sign is considered a: A) Positive sign of pregnancy B) Probable sign of pregnancy C) Presumptive sign of pregnancy D) Problem in pregnancy - ✔✔B) Probable sign of pregnancy Hegar's sign is softening of the lower portion of the uterus and is considered a probable sign of pregnancy. When palpating a woman who is at 20 weeks of gestation, the nurse practitioner should be able to feel the uterine fundus at what level? A) Just rising above the level of the pubic symphysis B) Between the pubic symphysis and the umbilicus C) At the level of the umbilicus D) Above the level of the umbilicus - ✔✔C) At the level of the umbilicus Uterine growth at 12 weeks gestation, palpable just above the symphysis pubis; 20 weeks gestation, at the level of the umbilicus; after this, measurements in cm should approximately equal weeks of gestation. A 67-year-old female with a 50 pack/year history of smoking presents for a routine annual physical examination. She complains of being easily short of breath and is frequently fatigued. Physical examination reveals diminished breath sounds, hyperresonance, and hypertrophied respiratory accessory muscles. Her CBC results reveal that her hematocrit level is slightly elevated. Her pulmonary function test (PFT) results show increased total lung capacity. What is the most likely diagnosis for this patient? A) Bronchogenic carcinoma B) COPD (chronic obstructive pulmonary disease) C) Chronic bronchitis D) Congestive heart failure - ✔✔B) COPD (chronic obstructive pulmonary disease) Common complaints and signs/symptoms of COPD include shortness of breath, fatigue, chronic cough, wheezing, difficulty performing tasks and speaking, pursed-lip breathing, digital clubbing, diminished breath sounds, use of accessory muscles, and polycythemia due to chronic hypoxia. Pulmonary function tests/ spirometry include forced expira- tory volume, forced vital capacity, and FEV1/FVC ratios. Your patient of 10 years, Mrs. Leman, is concerned about her most recent diagnosis. She was told by her dermatologist that she has an advanced case of actinic keratosis. Which of the following is the best explanation for this patient? A) It is a benign condition B) It is a precancerous lesion and should be followed up with her dermatologist C) Apply hydrocortisone cream 1% BID for 2 weeks and most of it will go away D) It is important for her to follow up with an oncologist - ✔✔B) It is a precancerous lesion and should be followed up with her dermatologist Actinic keratosis is a small, raised skin lesion from having been in the sun for a long period of time. Some actinic keratoses may develop into skin cancer; therefore, further evaluation is needed to determine if removal is required. Patient confidentiality is breached when: A) Medical information is given to a spouse B) Records are subpoenaed C) Reports are sent to the Public Health Department D) Records are released to insurance companies - ✔✔A) Medical information is given to a spouse Patient confidentiality is breached when medical information is given to a spouse or any other individual without consent of the patient. A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered: A) Positive signs of pregnancy B) Probable signs of pregnancy C) Presumptive signs of pregnancy D) Possible signs of pregnancy - ✔✔C) Presumptive signs of pregnancy Presumptive signs of pregnancy are symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/ vomiting, fatigue, and increased urinary frequency. A 55-year-old male patient describes to you an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when [Show More]

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