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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
Answer: 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
Answer: 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
Answer: 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
Answer: 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
Answer: 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
Answer: B) Mycoplasma pneumonia