TEST BANK FOR ADVANCED PRACTICE NURSING IN THE CARE OF OLDER ADULTS 2ND EDITION BY KENNEDY-MALONE (Answer Key at the end of each chapter)

TEST BANK FOR ADVANCED PRACTICE NURSING IN THE CARE OF OLDER ADULTS 2ND EDITION BY KENNEDY-MALONE (Answer KChapter 1. Changes With Aging Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The major impact of the physiological changes that occur with aging is: A. Reduced physiological reserve B. Reduced homeostatic mechanisms C. Impaired immunological response D. All of the above 2. The strongest evidence regarding normal physiological aging is available through: A. Randomized controlled clinical trials B. Cross-sectional studies C. Longitudinal studies D. Case-control studies 3. All of the following statements are true about laboratory values in older adults except: A. Reference ranges are preferable B. Abnormal findings are often due to physiological aging C. Normal ranges may not be applicable for older adults D. Reference values are not necessarily acceptable values 4. Biochemical individuality is best described as: A. Each individual’s variation is often much greater than that of a larger group B. The unique biochemical profile of a selected population C. The truly “normal” individual—falling within average range D. Each individual’s variation is often much smaller than that of a larger group 5. Polypharmacy is best described as taking: A. More than nine medications per day B. More than five medications per day C. Even a single medication if there is not a clear indication for its use D. When a drug is given to treat the side effect of another drug 6. Pharmacokinetic changes with aging are reflective of: A. What the drug does to the body B. What the body does to the drug C. The effect at the site of action and the time and intensity of the drug D. D. The side effects commonly associated with the drug 7. All the following statements are false about drug absorption except: A. Antacids increase the bioavailability of digitalis B. Gastric acidity decreases with age C. Anticholinergics increase colonic motility 1 | P a g eD. Underlying chronic disease has little impact on drug absorption 8. All of the following statements are true about drug distribution in the elderly except: A. Drugs distributed in water have lower concentration B. Drugs distributed in fat have less intense, more prolonged effect C. Drugs highly protein bound have greater potential to cause an adverse drug reaction D. The fastest way to deliver a drug to the action site is by inhalation 9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: A. Less obesity rates than women B. Prostate enlargement C. Testosterone D. Less estrogen than women 10. The cytochrome p system involves enzymes that are generally: A. Inhibited by drugs B. Induced by drugs C. Inhibited or induced by drugs D. Associated with decreased liver perfusion 11. A statement not shown to be true about pharmacodynamics changes with aging is: A. Decreased sensitivity to oral anticoagulants B. Enhanced sensitivity to central nervous system drugs C. Drug responsiveness can be influenced by patient activity level D. There is a decreased sensitivity to beta blockers 12. Atypical presentation of disease in the elderly is reflected by all the following except: A. Infection without fever B. Depression without dysphoric mood C. Myocardial infarction with chest pain and diaphoresis D. Cardiac manifestations of thyroid disease 13. Functional abilities are best assessed by: A. Self-report of function B. Observed assessment of function C. A comprehensive head-to-toe examination D. Family report of function 5. ANS: C 6. ANS: B 7. ANS: D MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: C 3. ANS: B 4. ANS: D 8. ANS: A 9. ANS: C 10. ANS: C 2 | P a g e PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 111. ANS: A 12. ANS: C 13. ANS: B PTS: 1 PTS: 1 PTS: 1 Chapter 2. Health Promotion Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The leading cause of death in elderly travelers worldwide is: A.Cardiovascular disease B.Infection s C.Accident s D.Malaria 2. Which of the following should be avoided in countries where food and water precautions are to be observed? A. Hot coffee B. Bottled water C. Salad buffet D. Unpeeled bananas 3. What insect precautions are not necessary to prevent insect-borne diseases in the tropics? A. Using 100% DEET on the skin to prevent bites B. Treating clothes with permethrin C. Covering up exposed skin to lessen biting surface D. Taking malaria pills as directed for areas at risk for malaria 4. An example of secondary prevention you could recommend/order for older adults would be to: A. Check for fecal occult blood B. Wear seat belts in the car C. Provide foot care for a diabetic patient D. Administer a tetanus shot 5. Ali is a 72-year-old man who recently came to the U.S. from Nigeria. He reports having BCG (bacille Calmette-Guerin) vaccination as a child. Which of the following is correct regarding a tuberculin skin test? A. It should not be done at all. B. It should be read as smaller than it really is. C. Vaccination history is irrelevant; read as usual. D. It should be read as larger than it really is. 6. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? A. Pulmonary edema B. Heart failure C. Pulmonary embolism D. Pneumonia 3 | P a g e7. Ivan W. is a 65-year-old man who is new to your practice. He has a history of COPD, CAD, hypertension, and type 2 diabetes mellitus. He has had no immunizations since his discharge from the military at age 25. Childhood diseases included chickenpox, measles, mumps, and “German measles.” He presents for a disease management visit. Which of the following immunizations would you recommend for Ivan? A. MMR, influenza, pneumococcal, Zostavax B. Influenza, pneumococcal, PPD, Hepatitis B C. Tdap, pneumococcal, influenza, Zostavax D. Hepatitis B, influenza, pneumococcal, Hepatitis A 8. Leo L. is a 62-year-old African American male who comes for an initial visit to your practice. Personal health history includes smoking 1 pack/day since age 11, consuming a case of beer (24 bottles) every weekend, and working as an assembler (sedentary job) for the past 10 years. Family history in first-degree relatives includes hypertension, high cholesterol, heart attack, and type 2 diabetes mellitus. Leo’s BMI is 32; BP today is 130/86. You order a fasting glucose, lipid profile, and return visit for BP check. This is an example of: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Health profiling 9. A local chapter of a nurse practitioner organization has begun planning a community- based screening for hypertension at a local congregate living facility. This population was selected on the basis of: A. A predicted decreased incidence of high blood pressure in this population B. A recognized element of high risk within this group C. Readily available treatment measures D. Achieving an administrative goal for the congregate living facility 10. Performing range of motion exercises on a client who has had a stroke is an example of which level of prevention? A. Primary prevention B. Tertiary prevention C. Secondary prevention D. Rehabilitation prevention 11. The nurse practitioner demonstrates an understanding of primary prevention of falling among the elderly through which management plan? A. Evaluate a need for assistive devices for ambulation after the client has been injured from a fall. B. Provide resources to correct hazards contributing to falls in the home environment. C. Reinforce the need to use prescribed eyeglasses to prevent further injury from falls. 4 | P a g eD. Provide information about medications, side effects, and interactions. 12. An example of an active strategy of health promotion for an individual to accomplish would be: A. Maintaining clean water in the local environment B. Introducing fluoride into the water C. Beginning a stress management program D. Maintaining a sanitary sewage system 13. You are working with an older male adult with a long history of alcohol abuse and a 30-year history of smoking. In recommending an intervention for this client, your responsibility is to: A. Make the individual abandon his own health practices and follow your recommendations B. Register the patient for a local intervention program and secure payments C. Promote positive change in lifestyle choices D. Identify the barriers that the client will encounter 14. The four main domains of clinical preventive services that the practitioner will provide are: A. Counseling interventions, screening tests, immunizations, and chemoprophylaxis B. Counseling intervention, screening tests, immunizations, and education C. Counseling interventions, transportation, screening tests, and immunizations D. Screening tests, brief psychotherapy, immunizations, and chemoprophylaxis 15. Which organism that can be prevented by immunization is most often responsible for an infectious “outbreak” in the nursing home setting? A. Haemophilus influenza B. Streptococcus C. Influenza A D. Mycobacterium tuberculosis 16. What is the appropriate method for tuberculosis screening of an older adult entering a nursing home? A. 5 tuberculin units intramuscular PPD injection and if negative repeat with same dose one week later B. 5 tuberculin units intradermal PPD injection and if negative repeat with same dose one week later C. Chest x-ray at the same time of PPD testing D. 5 tuberculin units intradermal PPD injection and if positive repeat same dose in one week MULTIPLE CHOICE 1.ANS: C PTS: 1 2.ANS: C PTS: 1 3.ANS: A 4.ANS: A 5 | P a g e PTS: 1 PTS: 1 5.ANS: C PTS: 1 6.ANS: C PTS: 1 7.ANS: C PTS: 1 8.ANS: B PTS: 19.ANS: B PTS: 1 13.ANS: C PTS: 1 10.ANS: B 11.ANS: D PTS: 1 PTS: 1 12.ANS: C PTS: 1 14.ANS: A PTS: 1 15.ANS: C PTS: 1 16.ANS: B PTS: 1 Chapter 3. Exercise in Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Exercise recommended for older adults should include activities that: A. Conserve energy B. Restrict flexibility C. Strengthen muscles D. Are anaerobic in nature 2. Preferred amount of exercise for older adults is: A. 10 minutes of physical activity each morning B. 30 minutes per day of aerobic activity five times a week C. Any increase in physical activity over a sedentary lifestyle D. 60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weight training five times a week 3. Which of the following medical conditions is not considered restrictive for engaging in physical activity? A. A.Unstable angina B. Dehydration C. Depression D. Uncontrolled tachycardia 4. The best recommendation for a patient who states they have no equipment to exercise would be: A. Sign a contract for a year’s membership to a local gym B. Borrow free weights from grandchildren C. Have a personal trainer come to the home three times a week D. Improvise with recommended objects at home that can be used 5. When the nurse practitioner recommends exercise for a sedentary older adult, which of the following pieces of advice should be considered for all types of exercise? A. Only use equipment recommended by physical trainers B. Start low and go slow C. Only group exercise is beneficial to someone who has not been active in a long A. time D. Focus only on one type of exercise for the first few months 6 | P a g e1. ANS: C PTS: 1 2. ANS: D PTS: 1 3. ANS: C PTS: 1 4. ANS: D PTS: 1 5. ANS: B PTS: 1 Chapter 4. Comprehensive Geriatric Assessment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The evidence reflects that comprehensive geriatric assessment should be conducted: A. On all individuals 65 and older B. On all individuals 75 and older C. By an inter-disciplinary team of professionals D. Targeting the vulnerable and frail elderly 2. Evidence-based geriatric assessment instruments available to the clinician: A. Are largely screening instruments to detect a condition B. Largely do not exist and if they do they have limited clinical utility C. Include screening, evaluation, and measurement instruments in multiple domains D. Have applicability in the outpatient but not the inpatient setting 3. When interviewing the older adult with a suspected dementia, it is most important that: A. Mental status be evaluated first in order to determine if the patient is a reliable historian B. The examiner use short simple questions and recognize non-verbal signs of discomfort C. Postpone the mental status evaluation for the following visit and establish a rapport first D. The clinician get in contact with a family member to obtain the history 4. Which is not considered a dimension of symptomatology? A. Onset B. Physical signs C. Location D. Absence of associated symptoms 5. The best approach to taking the health history is to: A. Start with an open-ended question B. Start with the review of systems C. Focus on the chief complaint D. Complete the history before conducting the examination 6. A review of the evidence relative to screening of the elderly reveals the highest evidence rating for: A. Vision screening B. Mammography screening C. Hearing screening D. Dementia screening 7 | P a g e7. Assessment of vital signs in the elderly reflect: A. Errors in blood pressure measurement are rare with automated recording devices B. Shortness of breath in the elderly is rare in the older, deconditioned, and immobile patient C. Older adults prefer a 0-10 pain rating scale D. Older adults could be septic with a temperature within normal limits 8. What statement is true about nutrition intake in the elderly? A. Deficiencies in protein intake are common with aging. B. Malnutrition is the most common nutritional disorder among the elderly living in the community. C. Increased caloric consumption is needed as one ages. D. The serum albumin is a good reflection of protein stores. 9. What is reflective of functional decline in older adults? A. Functional decline is synonymous with advanced age. B. Some individuals die of “old age” but have maintained an active and healthy lifestyle. C. Instrumental activities of daily living are preserved longer than activities of daily living. D. It is always possible to prevent functional deterioration. 10. The leading cause of traumatic death in the elderly is due to: A. Motor vehicle accidents B. Pedestrian injuries C. Falls D. Burns 11. Timing of the get-and-go test enhances its sensitivity. The process should take less than: A. Thirty seconds B. Sixteen seconds C. Sixty seconds D. Ten seconds 12. A validated tool for assessing cognitive function specific to dementia is: A. Mini-cog B. Confusion assessment method C. Yesavage GDS scale D. NuDesc 13. The medical outcome study short form 36 remains the gold standard of quality of life instruments. It measures: A. Mental and social domains B. Social domain C. Physical, mental, and social domains D. Physical domain MULTIPLE 8 | P a g eCHOICE 1. ANS: D PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: C PTS: 1 11. ANS: B PTS: 1 12. ANS: A PTS: 1 13. ANS: C PTS: 1 Chapter 5. Symptoms and Syndromes Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The term “geriatric syndrome” is best described as: A. A condition that has multiple underlying factors and involves multiple systems B. A condition that has a discreet etiology that is difficult to pinpoint C. Significant progress has been made in understanding geriatric syndromes, especially falls and delirium D. Therapeutic management of a geriatric syndrome can be accomplished once a specific diagnosis is made 2. The anal wink reflex is used to test: A. Rectal prolapse B. Sensation and pudental nerve function C. Baseline and squeeze sphincter tone D. Fissures and fistulas 3. Atypical presentation of acute coronary syndrome is: A. Most common in Hispanic females B. More common in men C. Most common in African American men D. More common in females 4. What disease can mimic and often co-exists with myocardial infarctions in elders with coronary artery disease? 9 | P a g eA. Hypertension B. Esophageal disease C. Diabetic gastroparesis D. Vascular disease 5. Thoracic aortic dissection presents typically as: A. Sharp stabbing pain in the mid thorax B. Pleuretic chest pain and dyspnea C. Severe retrosternal chest pain that radiates to the back and both arms D. Unilateral pleuretic chest pain and dyspnea 6. Medications known to contribute to constipation include all of the following except: A. Stimulant laxatives B. Anticholinergic drugs C. Broad-spectrum antibiotics D. Iron 7. Bordetella pertussis is best characterized by: A. Sub-acute cough lasting greater than two weeks B. Acute cough associated with a coryzal symptom C. Chronic cough with post-nasal drip D. Non-productive acute cough 8. The routine testing of tuberculosis should occur in all of the following vulnerable populations except: A. Nursing home residents B. Prison inmates C. Hospitalized elderly D. Immune-compromised patients 9. Which of the following statements about fluid balance in the elderly is false? A. Total body water decreases with age. B. Thirst response decreases as a person ages. C. African Americans have higher rates of dehydration than white Americans. D. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly. 10. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the differential is: A. Performance on the Mini Mental Status Exam B. The Confusion Assessment is negative C. Rapid change and fluctuating course of cognitive function D. The presence of behavioral symptoms with cognitive impairment 11. Presbystasis is best described as: A. Impairment in vestibular apparatus that causes dizziness B. Age-related disequilibrium of unknown pathology characterized by a gradual 10 | P a g eonset of difficulty walking C. The loss of high frequency tones with aging that can impair sensation D. A disorder of the inner ear characterized by vertigo 12. If dizziness has a predictable pattern associated with it, the clinician should first consider: A. Hypoglycemia B. Psychogenic etiology C. Cardiovascular cause D. Neurogenic cause 13. All of the following are considered as contributors to dysphagia except: A. Anticholinergics B. Drugs that increase reflux symptoms C. Inadequate intake of fluids with medications and meals D. Smooth muscle relaxants 14. Evidence shows that the most important predictor of a fall is: A. Prior history of a fall B. Cognitive impairment C. Gait and balance disturbance D. Proximal muscle weakness 15. The most cost-effective interventions used to prevent falls are: A. Use of sitters B. Use of alarms (bed, chair, monitors) C. Tai Chi exercises D. Home modifications and vitamin D supplements 16. Chronic fatigue syndrome is best described as: A. Fatigue that is constant, lasting more than three months B. Fatigue lasting longer than six months and not relieved by rest C. Fatigue that waxes and wanes over a period of three months D. Total exhaustion with inability to get out of bed 17. Which form of headache is bilateral? A. Cluster B. Tension C. Migraine D. Acute angle closure glaucoma 18. Microscopic hematuria is defined as: A. Twenty or more RBCs on a urine sample B. Three or more RBCs on a urine sample C. Twenty or more RBCs on three or more samples of urine D. Three or more RBCs on three or more samples of urine 11 | P a g e19. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except: A. Male sex B. Smoking history C. Over age 40 D. Childhood asthma 20. Recent weight loss is defined as: A. loss of >10 pounds over the past 3-6 months B. loss of >2 pounds a week C. 5% weight loss in three months D. 10% weight loss in one year 21. The most common cause of disability in the elderly is due to: A. Diabetes B. Arthritis C. Heart disease D. Chronic obstructive pulmonary disease 22. Lipedema is best described as: A. Bilateral accumulation of interstitial fluid B. Bilateral distribution of fat in the lower extremities C. Fluid retention caused by a compromised lymphatic system D. Lipid molecules that break down and cause fluid retention 23. Drug-induced pruritus is distinguished because it: A. Occurs soon after a new drug is taken B. Usually is a generalized rash C. May occur right after the drug is taken or months later D. Usually involves localized circumscribed lesions 24. A form of syncope that is more common in the elderly than younger adults is: A. Vasovagal B. Carotid sinus sensitivity C. Orthostatic hypotension D. Arrhythmias 25. All of the following statements about tremor are true except: A. The most common tremor is the Parkinson tremor B. Most individuals with tremor do not seek medical attention C. Psychogenic tremor is uncommon D. Tremor is more prevalent in whites than blacks 26. Overflow incontinence is usually associated with: A. Loss of urine that occurs with urgency B. Cognitive impairment 12 | P a g eC. Weak pelvic floor muscles D. Bladder outlet obstruction 27. Wandering is best described as: A. Aimless excessive ambulatory behavior B. B. Purposeful excessive ambulatory behavior C. C. Risk-seeking behavior in the cognitively impaired D. D. A result of boredom in those with dementia MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: B PTS: 1 3. ANS: D PTS: 1 4. ANS: B PTS: 1 5. ANS: C PTS: 1 6. ANS: C PTS: 1 7. ANS: A PTS: 1 8. ANS: C PTS: 1 9. ANS: D PTS: 1 10. ANS: C 11. ANS: B 12. ANS: A 13. ANS: D 14. ANS: A PTS: 1 PTS: 1 PTS: 1 PTS: 1 PTS: 1 Chapter 6. Skin and Lymphatic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? A. Tinea versicolor B. Seborrheic keratosis C. Verruca D. Herpes zoster 2. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon 13 | P a g e 15. ANS: D PTS: 1 16. ANS: B PTS: 1 17. ANS: B PTS: 1 18. ANS: D PTS: 1 19. ANS: D PTS: 1 20. ANS: A PTS: 1 21. ANS: B PTS: 1 22. ANS: B PTS: 1 23. ANS: C PTS: 1 24. ANS: C PTS: 1 25. ANS: A PTS: 1 26. ANS: D PTS: 1 27. ANS: B PTS: 1examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that: A. All symptoms should disappear within three days B. Oral medications can dramatically reduce the duration and intensity of his symptoms C. He has chickenpox and can be contagious to his grandchildren D. He has a sexually transmitted disease 3. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C. Perform a biopsy or refer to a dermatologist. D. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away. 4. The immunofluorescent antibody (IFA) is a laboratory test used to diagnose which of the following disorders? A. Tinea versicolor B. Herpes zoster C. Squamous cell carcinoma D. Human papilloma virus 5. A wound with drainage and foul odor should be cleansed with: A. Normal saline B. Hydrogen peroxide C. 20% acetic acid D. Betadine 6. A full-thickness pressure ulcer is partially covered with eschar and the surrounding tissue is reddened. Which of the following is the most appropriate treatment for this condition? A. Apply an occlusive dressing B. Debride mechanically or chemically C. Saline moistened gauze dressings D. Vacuum-assisted wound closure 7. In examining the skin of your nursing home patient, you note a “stained glass” brownish mark on the face. Which of the following lesions best describes a stained glass brownish mark? A. Actinic keratosis B. Seborrhea keratosis C. Lentigo maligna D. Superficial spreading malignant melanoma 8. Patients who have an underlying tinea infection to the cellulitis should also be treated with which one of the following? 14 | P a g eA. An anti-fungal medication B. Topical steroids C. Oral steroids D. Zinc oxide 9. Identify the type of malignant melanoma that is associated with the Hutchinson’s sign of the cuticle of the finger. A. Lentigo maligna B. Acral lentiginous C. Nodular D. Superficial spreading malignant melanoma 10. A smooth round nodule with a pearly gray border and central induration best describe which skin lesion? A. Seborrheic keratosis B. Malignant melanoma C. Herpes zoster D. Basal cell carcinoma 11. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? A. Cellulitis is two times more common in women B. Facial cellulitis is more common in people >55 C. There is low incidence of cellulitis in patients with diabetes D. Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency 12. An 82-year-old female has a “pimple” on his nose that occasionally bleeds and may have increased in size in the past year. The lesion is a 0.7-cm, dome-shaped, umbilicated papule with pearly translucence. There is also a hemorrhagic crust covering the central portion. Which of the following is the most likely diagnosis? A. Squamous cell carcinoma B. Basal cell carcinoma C. Keratoacanthoma D. Sebaceous hyperplasia 13. Which of the following is generally not a first-line treatment for post herpetic neuralgia? A. Intrathecal methylprednisolone B. Gabapentin C. 5% lidocaine patch D. Topical capsaicin 14. A nursing home resident with a Stage 4 pressure ulcer that extends to the muscle layer and has significant undermining with heavy exudate should be treated with: A. Dry gauze dressings 15 | P a g eB. Duoderm C. Chemical debridement D. Calcium alginate dressings 15. Which of the following descriptions accurately documents cellulitis? A. Cool, erythematous, shiny hairless extremity with decreased pulse B. Scattered, erythematous ring-like lesions with clear centers C. Clearly demarcated, raised erythematous area of face D. Diffusely inflamed skin that is warm and tender to palpation 16. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with: A. Melanoma B. Basal cell carcinoma C. Leukoplakia D. Senile lentigines 17. Which of the following descriptions best illustrates assessment findings consistent with tinea capitis? A. Circular erythematous patches with papular, scaly annular borders and clear centers B. Inflamed scaly dry patches with broken hairs C. Web lesions with erythema and scaling borders D. Scaly pruritic erythematous lesions on inguinal creases 18. A hyperkeratotic nodule formed as the result of exposure of the foot to moisture from perspiration is called: A. Hard corn B. Tinea pedis C. Soft corn D. Plantar warts (verrucae) 19. A 64-year-old male presents with an exacerbation of psoriasis. His social history includes 50- year two packs a day of cigarettes and a six-pack a week of beer. He states he had a recent sore throat, which he attributes to minding his young grandson. He reports that until recently the pruritis was only minimal. His BMI is 37. Which of the following factors most likely contributed to the acute presentation of psoriasis? A. Alcohol abuse B. Smoking C. Streptococcal infection D. Obesity 20. Treatment of complicated cellulitis of the lower extremity resulting from an anaerobe requires all of the following except: A. Extended antibiotic medication lasting at least 7-10 days 16 | P a g eB. Topical antifungal medication C. Inquiry when last tetanus toxoid booster was given D. Elevation of limb and consideration of compression bandaging MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: B PTS: 1 3. ANS: C PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: B PTS: 1 7. ANS: C PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: D PTS: 1 11. ANS: B PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: D PTS: 1 15. ANS: D PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: C PTS: 1 19. ANS: C PTS: 1 20. ANS: B PTS: 1 Chapter 7. Head, Neck, and Face Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? A. Bacterium B. Allergen C. Virus D. Fungi 2. One of the first-line treatments in patients with allergic rhinitis is the use of nasal corticosteroid sprays. What is the anticipated onset of symptom relief with the use of these medications? A. Two weeks or more B. Immediate C. 1 to 2 days D. A minimum of one week 3. The nurse practitioner knows that antihistamines work primarily through which of the following mechanisms? A. Vasodilatation B. Blocking leukotriene effects 17 | P a g eC. Inhibiting histamine receptor sites D. Vasoconstriction 4. Cromolyn sodium may also be used in the treatment of allergic rhinitis. What is the mechanism of action of this medication? A. Mast cell stabilization B. Blocking the effects of IgE C. Leukotriene inhibition D. Histamine blockade 5. Patients that have atopic disorders are mediated by the production of IGE will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? A. Sinus pain, increased vascular permeability, and bronchodilation B. Bronchospasm, vascular permeability, and vasodilatation C. Contraction of smooth muscle decreased vascular permeability and vasoconstriction D. Vasodilatation, bronchodilation, and increased vascular permeability 6. Which of the following maneuvers is used to induce symptoms of benign paroxysmal positional vertigo? A. The Fukuda stepping test B. The Dix-Hallpike maneuver C. Forced hyperventilation D. The head thrust test 7. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? A. Ménière’s disease B. Benign paroxysmal positional vertigo C. TIA D. Migraine 8. Sensory impairment (vision and hearing) in the elderly is associated with: A. Impaired quality of life B. Decreased function C. Increased mortality D. All of the above 9. Which of the following conditions is the leading cause of blindness in the United States? A. Macular degeneration B. Diabetic retinopathy C. Glaucoma D. Cataracts 10. A slightly elevated elastic tissue deposit in the conjunctiva that may extend to the 18 | P a g ecornea but does not cover it is known as a: A. Pterygium B. Pinguecula C. Xanthelsma D. Limbal nodule 11. A nonmodifiable risk factor for the development of cataracts is: A. Long-term exposure to ultraviolet B radiation B. High alcohol intake C. Strong family history D. Diabetes mellitus 12. Causes of sensorineural hearing loss include: A. Ototoxicity B. Ménière’s disease C. Otosclerosis D. Inner ear fistula 13. Clinical findings in patients with nonproliferation retinopathy include: A. Cotton wool spots B. Microaneursyms C. Deep hemorrhages D. Neovascularization 14. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? A. Fictional keratosis B. Keratoacanthoma C. Lichen planus D. Leukoplakia 15. A gross screening for hearing is the whisper tests. Which cranial nerve is being tested when the nurse practitioner conducts this test? A. Cranial nerve V B. Cranial nerve VII C. Cranial nerve VIII D. Cranial nerve IV MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: C PTS: 1 19 | P a g e 9. ANS: B PTS: 1 10. ANS: B PTS: 13. ANS: C PTS: 1 4. ANS: A PTS: 1 5. ANS: B PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: D PTS: 1 11. ANS: C PTS: 1 12. ANS: C PTS: 1 13. ANS: B PTS: 1 14. ANS: D PTS: 1 15. ANS: C PTS: 1 Chapter 8. Chest Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. In mitral stenosis, p waves may suggest: A. Left atrial enlargement B. Right atrial enlargement C. Left ventricle enlargement D. Right ventricle enlargement 2. Aortic regurgitation requires medical treatment for early signs of CHF with: A. Beta blockers B. ACE inhibitors C. Surgery D. Hospitalization 3. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: A. Women with ischemic heart disease many times do not present with chest pain B. Some patients may have no symptoms or atypical symptoms. Diagnosis may only be made at the time of an actual myocardial infarction C. Elderly patients have the most severe symptoms D. A & B only 4. The best evidence rating drugs to consider in a post myocardial infarction patient include: A. ASA, ACE/ARB, beta-blocker, aldosterone blockade B. Ace, ARB, Calcium channel blocker, ASA C. Long-acting nitrates, warfarin, ACE, and ARB D. ASA, clopidogrel, nitrates 5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST-segment abnormalities. Your plan may include: A. Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging 20 | P a g eey at the end of each chapter)