PSI Exam With Correct Answers

PSI Exam With Correct Answers Which of the following laboratory tests should a nurse practitioner order when the suspected diagnosis is temporal arteritis? - ANS Erythrocyte sedimentation rate (ESR) A 17-year-old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: - ANS follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH). To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: - ANS the meaning of a common proverb. To assess spinal function at the S1 level, which deep tendon reflex should be tested? - ANS Achilles Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? - ANS Pain worse in supine position; focal neurological signs Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? - ANS CD4 count and viral load A 3-year-old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? - ANS Sputum culture Which of the following best describes psoriatic lesions in an elderly patient? - ANS Red, sharply defined plaques with silvery scales A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? - ANS Palpate structures around the shoulder. A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? - ANS Ultrasound A 29-year-old male with noncomplicated Chlamydia infection may exhibit: - ANS no remarkable clinical symptoms. An 88-year-old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with a hypertension medication regimen. What is the most likely diagnosis? - ANS Left-sided stroke A patient with macular degeneration has difficulty seeing objects: - ANS in the center of the visual field. Which of the following is the leading cause of cancer-related deaths in the majority of women? - ANS Lung Cancer Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? - ANS Urinalysis and urine culture Which of the following gastrointestinal changes is associated with normal aging? - ANS Decreased production of gastric acid Which of the following is NOT an indication of preeclampsia? - ANS Gluosuria Assessment findings that would support a diagnosis of mitral regurgitation include: - ANS loud, high-pitched pansystolic murmur. An 18-year-old college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some herb" she bought at a health food store for migraines and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? - ANS Feverfew An 88-year-old patient has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: - ANS lateralize to the left During an employment physical examination of a 21-year-old female, bruising around the areolae on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: - ANS socioeconomic status Which of the following findings is typically a sign of acute appendicitis? - ANS Rebound tenderness at McBurney's point The best laboratory test to distinguish iron deficiency anemia from other anemias is: - ANS serum ferritin level A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? - ANS sweating An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? - ANS Folstein Mini-Mental State Examination Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? - ANS Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white blood cells Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: - ANS whether a patient has reversible airway obstruction. A 32-year-old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? - ANS Rheumatoid arthritis A 47-year-old patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient does not currently take any medications. The most likely differential diagnoses would include: - ANS gastritis and peptic ulcer disease. A 2-month-old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (non-beet-red) macular rash in the diaper area, sparing the inguinal folds. No satellite lesions are noted. The infant's diaper rash is most likely caused by: - ANS contact dermatitis. A nurse practitioner is evaluating a 40-year-old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat chest X-ray is normal. Which of the following tests should the nurse practitioner perform next? - ANS Helical CT pulmonary angiography A 65-year-old male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical examination, the patient is tachycardic, positive for jugular venous distention, and positive for S3, with a systolic murmur. Chest X-ray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: - ANS heat failure Trigeminal neuralgia manifests itself primarily with: - ANS electric-shock-like unilateral facial pain. Which of the following criteria differentiates a TIA from a stroke? - ANS Absence of residual symptoms A 20-year-old male presents with a 1-month history of a "bump on my testicle." He reports being sexually active, with frequent episodes of unprotected intercourse with multiple partners. Which condition should be suspected? - ANS Cancer of the testicles A 65-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? - ANS Polymyalgia rheumatica An 85-year-old patient relates that on the way to an annual physical examination, the patient suffered a sudden loss of vision in the right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." The most likely diagnosis is: - ANS retinal detachment. A 70-year-old male presents with paresthesia of the lower extremities. On examination, the patient appears pale and shows a decreased vibratory sense. Laboratory tests reveal elevated indirect bilirubin; Hct = 30%; mean corpuscular volume (MCV) = 120 µm3 [normal = 87-103 µm3]. The most likely diagnosis is: - ANS pernicious anemia A 14-year-old patient who fell on an outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on X-ray. The most likely working diagnosis is: - ANS radial head fracture A 72-year-old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3:00 A.M., is reluctant to go out although she has family members living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: - ANS depression, unresolved grief, and hypothyroidism. A 66-year-old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 × 4. The patient should be evaluated for: - ANS HIV infection A 17-year-old female has never had her menses. She is at Tanner stage III of sexual development. Her physical examination is completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? - ANS Primary amenorrhea According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than: - ANS 126 mg/dL. A 38-year-old male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: - ANS testicular torsion. A 10-month-old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papules with an erythematous base on the buccal mucosa. What does this suggest? - ANS Measles The parent of a 13-year-old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that the development of fever may: - ANS lower the seizure threshold. After a 3-week camping trip, an 11-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: - ANS doxycycline (Doryx). An 18-year-old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? - ANS Amoxicillin-Clavulanate (Augmentin) A 40-year-old male presents with a 2-week history of rectal pain and itching. He reports a past history of constipation and finding spots of bright red blood on toilet paper several times a week. Rectal examination reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. Which of the following actions should the nurse practitioner take? - ANS Prescribe bulk-forming agents and hydrocortisone suppositories. A nurse practitioner is suturing a simple laceration on an 11-year-old patient. The use of lidocaine with epinephrine is contraindicated in all of the following areas EXCEPT the: - ANS scalp A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? - ANS Providing reassurance Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: - ANS oxygen A routine laboratory assessment of a 12-year-old patient with a family history of thalassemia and anemia reveals Tanner stage II presentation and Hct = 35%. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? - ANS Hemoglobin electrophoresis A common rule to follow when prescribing many medications for the elderly is to: - ANS start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. Which of the following would be an appropriate alternative to erythromycin therapy in an 18-year-old patient with Mycoplasma pneumoniae infection? - ANS Azithromycin (Zithromax) A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100°F (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: - ANS clear liquids and oral antibiotics. The most common bacteria responsible for pneumonia in older adults residing in the community is: - ANS Streptococcus pneumoniae. Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? - ANS Angiotensin-converting enzyme (ACE) inhibitors An 18-month-old child presents with a bulging, immobile tympanic membrane; T = 103°F (39.4°C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: - ANS reevaluate the patient in 10 days. The management of choice for polymyalgia rheumatica includes: - ANS prednisone. Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? - ANS Gentamicin ophthalmic (Genoptic) A patient with type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: - ANS the Somogyi effect. A 14-year-old male with bronchitis is being treated with fluids and expectorants. He returns to the clinic with a fever of 103°F (39.4°C), right pleuritic chest pain, and green sputum. Which of the following examination results would be expected? - ANS Right lower lobe crackles The follow-up examination of a 12-month-old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include a: - ANS follow-up evaluation of the ears in 2 months. A 50-year-old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorothiazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: - ANS paroxetine (Paxil). A 68-year-old female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other laboratory values are within normal limits. The headache is most likely due to: - ANS temporal arteritis. Which of the following is the most serious outcome of Barrett's esophagus? - ANS Esophageal adenocarcinoma A 39-year-old patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of 101.2°F (39.4°C) and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse practitioner should encourage smoking cessation and prescribe: - ANS a macrolide antibiotic. A 15-year-old patient returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2 g of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with a lot of burning. The patient has not resumed sexual activity and has menstruated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? - ANS Microscopic examination of urine A nurse practitioner orders pulmonary rehabilitation for a 75-year-old with COPD. Expected outcomes of this program include all of the following EXCEPT: - ANS increased lung capacity. A 4-year-old girl with a history of recurrent urinary tract infections returns for follow-up after diagnosis of the most recent infection. During the physical examination, the 4-year-old tells the nurse practitioner that her brother (age 9) lies on top of her and rubs his penis near her pubic area. After completing the physical examination, the nurse practitioner must: - ANS report suspicions to the appropriate child protective services agency. A 2-year-old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed manipulation, the best indication of successful treatment is that: - ANS the child quickly begins to use the affected arm. A 67-year-old patient with type 2 diabetes mellitus, congestive heart failure (CHF), and mild coronary artery disease is currently taking digoxin, 0.25 mg daily; hydrochlorothiazide, 25 mg daily; metformin, 500 mg daily; glipizide, 10 mg daily; and atorvastatin (Lipitor), 20 mg h.s. Which of the following is an accurate statement regarding this regimen? - ANS The hydrochlorothiazide will predispose the patient to digoxin toxicity. During development of a treatment plan for an 84-year-old patient with hypothyroidism, the nurse practitioner must keep in mind the possibility of the worsening of: - ANS osteoporosis. Initial therapy for a 3-week-old infant with uncomplicated symptoms of gastroesophageal reflux disease includes which of the following positions and change in diet? - ANS Smaller, more frequent feedings while holding infant