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,1. During a breast exam of a 30-year-old nulliparous female, the
nurse practitioner palpates several rubbery mobile areas of breast
tissue. They are slightly tender to palpation. Both breasts have
symmetrical findings. There are no skin changes or any nipple
discharge. The patient is expecting her menstrual period in 5 days.
Which of the following would you recommend?
A) Referral to a gynecologist for further evaluation
B) Tell her to return 1 week after her period so her breasts can be rechecked
C) Advise the patient to return in 6 months to have her breasts rechecked
D) Schedule the patient for a mammogram
B)Tell her to return 1 week after her periods so her breasts can be
rechecked
Prior to having menses, women will experience breast changes of tenderness
with palpation, with symmetrical soft, mobile areas of breast tissue that are
benign. Her symptoms should improve after her menses and repeating the
exam in 1 week would be recommended.
2. When evaluating the blood pressure on both the arms and legs of
an infant who has a diagnosis of coarctation of the aorta, which of
the following is the correct finding?
A) The blood pressure is higher in the arms than in the legs
B) Only the diastolic blood pressure is higher in the legs than in the arms
C) The blood pressure is higher in the legs than the arms
D) The blood pressure is lower in both arms than in the legs
A) The blood pressure is higher in the arms than in the legs
In coarctation of the aorta, blood pressure is higher in the arms than in the
legs due to the narrowing in the aorta. Blood pressure must rise to get
adequate blood flow to the lower extremities; therefore, the blood pressure
above the coarctation rises to compensate for this.
3. Which of the following should you expect to find on a wet-mount
slide of a patient diagnosed with bacterial vaginosis?
,A) Tzanck cells
B) A large amount of leukocytes and epithelial cells
C) A large amount of bacteria coating the squamous cells and very few
leukocytes
D) Epithelial cells and a small amount of blood
108
C) A large amount of bacteria coating the squamous cells and very
few leukocytes
Results of the wet mount for bacterial vaginosis include bacteria coating the
squamous cells (clue cells) and very few leukocytes or RBCs
4. A 40-year-old woman is in the office complaining of palpitations
and some light headedness for the past 6 months. These are
random episodes. The nurse practitioner notices a mid-systolic click
with a late systolic murmur that is best heard in the apical area
during auscultation of the chest. The NP would suspect:
A) Atrial fibrillation
B) Sinus arrhythmia
C) Mitral stenosis
D) Mitral valve prolapse
D) Mitral valve prolapse
Mitral valve prolapse occurs when the mitral valve does not close all the way,
causing a late systolic murmur heard best in the apical area during
auscultation of the chest. Symptoms patients may experience at times
include palpitations and dizziness.
5. Your 35-year-old patient is being worked up for microscopic
hematuria. All of the following are differential diagnoses of
microscopic hematuria except:
A) Kidney stones
B) Bladder cancer
C) Acute pyelonephritis
D) Renal stenosis
D) Renal stenosis
, Renal stenosis is a narrowing of the renal artery. No blood would be noted on
exam. Evidence of blood in the urine can be seen with kidney stones, bladder
cancer, and acute pyelonephritis.
6. During a routine physical exam of an elderly woman, a triangular
thickening of the bulbar conjunctiva on the temporal side is noted to
be encroaching on the cornea. She denies any eye pain or visual
changes. Which of the following is most likely?
A) Corneal arcus
B) Pterygium
C) Pinguecula
D) Chalazion
B) Pterygium
Pterygium is a triangular growth on the white part of the eye that also
extends onto the cornea. Corneal arcus is a ring around the edge of the
cornea. Chalazion is a stye in the eye that may cause pain and swelling.
Pinguecula is a benign growth on the conjuctiva caused by the degeneration
of its collagen fibers. Thick, yellow fibers may be seen.
7. Mr. Jones, who has been on pravastatin (Pravachol) 20 mg at
bedtime for the past few months, complains of lately feeling
extremely fatigued. The patient also noticed that his urine has been
a darker color during the past 2 weeks. Which of the following is the
best treatment plan to follow?
A) Discontinue his pravastatin and order a liver function profile
B) Continue the pravastatin but on half the dose
C) Schedule him for a complete physical exam
D) Schedule him for a liver function profile
A) Discontinue his pravastatin and order a liver function profile
Side effects of statin drugs include myalgia, fatigue, and elevated liver
enzymes. Routine labs should include liver enzymes to assess the effects on
the liver.
8. Jane, a young primigravida, reports to you that she is starting to
feel the baby's movements in her uterus. This is considered to be
which of the following?