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NSG 6310 Exam 1_Cedarville University_Latest 2019_Score A+

NSG 6310 Exam 1 Sep 03 2019 Which patient should have pulmonary function testing as part of a presurgical clearance? a. a patient older than 60 years b. a patient with DM and morbid obesity c. a patient undergoing major intra-thoracic surgery d. a patient w a/hx of pneumonia in the last 2 years The chronic care model (CCM) was developed to manage patients with chronic diseases because the traditional acute care model: a. put patients and families at the center of care b. count not provide efficient and cost-effective chronic care c. did not meet longitudinal health care needs for this population d. did not offer ambulatory care services to these patients A female patient from the middle East schedules an appointment with you. In order to provide culturally responsive care, what will the clinic personnel do when meeting her? a. include a male family member in discussions about health care b. inquire about the patient's beliefs about health and treatment c. ensure that she is seen by a female provider d. research middle Eastern cultural beliefs about health care What is an important part of patient care that can minimize the risk of a formal mistake being made? a. ensuring informed consent for all procedures b. monitoring patient compliance and adherence c. providing complete documentation of visits d. maintaining effective patient communication A patient returns home from travel in Africa and experiences chronic, non-bloody diarrhea with frequent bloating and flatulence with a "rotten egg" smell. What is the treatment? a. Rifampin b. Azithromycin c. Ciprofloxacin d. Metronidazole What is the purpose of Level II research? a. to evaluate the nature of relationships between two variables b. to describe relationships among characteristics or variables c. to define characteristics of interest of groups of patients d. to demonstrate the effectiveness of an intervention or treatment According to Naylor's transitional care model, which intervention has resulted in a decrease in hospitalizations in high-risk older patients? a. coordination of post-hospital care by APRNs b. Telephone follow up by the pharmacist to assess medication compliance c. frequent post-hospital clinic visits with a PCP d. inclusion of extended family members in the outpatient plan of care Which are key components Which are key components of the Patient-Centered Medical Home? (Select all that apply.) a. Provision of care by a single provider b. Coordination of care c. Access to care d. Storage of medical records e. Comprehensive care Which medications are associated with weight gain? (Select all that apply.) a. Antihistamines b. Antidepressants c. Insulin analogs d. Seizure medications e. Antibiotics A 60-year-old patient who leads a sedentary lifestyle has expressed an interest in beginning an aerobic exercise program. What will the provider include when counseling this patient about this program? a. Include a 1 to 2 minute warm up before exercise b. Stretching should be performed prior to activity c. Maintain a heart rate between 80 and 128 beats per minute d. Begin with a 45 to 60 minute workout An international traveler plans to travel to Kenya in sub-Saharan Africa. Which is an important disease precaution for this person? a. Understanding how Ebola virus is transmitted b. Taking precautions against Chikungunya fever c. Starting prophylactic doxycycline before travel d. Carrying chloroquine to take as needed The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an important point to discuss with this patient about taking such supplements? a. Dietary supplements are safer than most prescription medications b. Because they are not FDA approved, they are not safe c. Supplements should not be taken with prescription medications d. Many supplements lack clear clinical evidence of efficacy A primary care provider administers the “Newest Vital Sign” health literacy test to a patient newly diagnosed with a chronic disease. What information is gained by administering this test? a. Ease of using technology and understanding of graphic data b. Ability to calculate data, along with general knowledge about health c. Understanding of and ability to discuss health care concerns d. Reading comprehension and reception of oral communication The primary care provider is screening a patient using the CAGE criteria. What will the provider include in this assessment? (Select all that apply.) a. Sources of daily dairy intake b. Total number of servings of fruits and vegetables c. Types of meats and proteins d. Number of times per week eaten in restaurants e. Sodium and sugar intake What are functions of patient registries in the chronic care model? (Select all that apply.) a. Transmitting clinical data about patients b. Alerting providers to medication interactions c. Identifying appropriate specialists for referral d. Reminding providers about immunizations e. Recommending routine screenings Which dietary supplements have shown some effectiveness in reducing blood pressure in patients with hypertension? (Select all that apply.) a. CoQ10 b. Cinnamon c. Chromium picolinate d. Garlic extract e. L-arginine Which approaches are among those recommended by the Agency for Healthcare Research and Quality to improve health literacy in patients? (Select all that apply.) a. Giving written handouts for all teaching b. Repeating the instructions c. Highlighting no more than 7 key points d. Supplementing teaching with visual aids e. Empowering patients and families What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? a. Costs of ambulatory care b. Associations with area hospitals c. The ratio of providers to patients d. Ease of access to care What is the main reason for using the REALM-SF instrument to evaluate health literacy? a. It assesses numeracy skills. b. It enhances patient-provider communication. c. It measures technology knowledge. d. It evaluates medical word recognition. Which is the most appropriate research design for a Level III research study? a. Qualitative studies b. Experimental design c. Randomized clinical trials d. Epidemiological studies A 60-year-old patient with a previous history of shingles asks about the herpes zoster vaccine. What will the provider recommend? a. No herpes zoster vaccine is necessary b. A series of two herpes zoster vaccinations c. A single dose of herpes zoster vaccine d. Prophylactic vaccination if exposed to chicken pox To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy? a. Requirements for written discharge instructions for patients and caregivers b. Mandates for communication among primary caregivers and hospitalists c. Reduction of payments for patients readmitted within 30 days after discharge d. Penalties for failure to perform medication reconciliations at time of discharge Which assessments of care providers are performed as part of the Value Based Purchasing initiative? (Select all that apply.) a. Assessing patients' satisfaction with hospital care b. Requiring advanced IT standards and minimum cash reserves c. Monitoring mortality rates of all patients with pneumonia d. Evaluating available evidence to guide clinical care guidelines e. Appraising costs per case of care for Medicare patients A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which medications, taken in conjunction with this medication, are of concern? a. Narcotic analgesics b. Blood-thinning agents c. Beta blocker medications d. Anticholinergic drugs A 55-year-old patient who had influenza in the previous influenza season asks about the flu vaccine. What will the provider tell the patient? a. The trivalent influenza vaccine is indicated annually b. The Fluzone High-Dose vaccine is recommended c. The FluMist vaccine may be used each year d. Having influenza vaccine confers lifetime immunity What are some causes for failures or delays in diagnosing patients resulting in malpractice claims? (Select all that apply.) a. Ordering a wrong medication b. Not acting on diagnostic test results c. Improper performance of a treatment d. Failing to recognize a medication complication e. Failing to request appropriate consultations Routine screening blood tests at an annual physical exam reveal a fasting glucose level of 125 mg/dL and a hemoglobin A1C of 6.2%. What will the provider do, based on these results? a. Evaluate the patient for impaired glucose tolerance b. Reassure the patient that these are normal values c. Suggest that the patient begin an exercise program d. Tell the patient that these results indicate diabetes Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? (Select all that apply.) a. Previous surgeries b. Type of anesthetic agent planned c. Patient’s comorbidities d. Patient’s age e. Surgeon’s preference What is the purpose of clinical research trials in the spectrum of translational research? a. Determination of the basis of disease and various treatment options b. Exploration of fundamental mechanisms of biology, disease, or behavior c. Examination of safety and effectiveness of various interventions d. Adoption of interventions and clinical practices into routine clinical care A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding? a. Polysomnography b. Mammography c. Electrocardiography d. Gallbladder ultrasonography A primary care provider administers the “Newest Vital Sign” health literacy test to a patient newly diagnosed with a chronic disease. What information is gained by administering this test? a. Understanding of and ability to discuss health care concerns b. Reading comprehension and reception of oral communication c. Ability to calculate data, along with general knowledge about health d. Ease of using technology and understanding of graphic data Which assessments of care providers are performed as part of the Value Based Purchasing initiative? (Select all that apply.) a. Assessing patients' satisfaction with hospital care b. Appraising costs per case of care for Medicare patients c. Requiring advanced IT standards and minimum cash reserves d. Evaluating available evidence to guide clinical care guidelines e. Monitoring mortality rates of all patients with pneumonia Which are key components of the Patient-Centered Medical Home? (Select all that apply.) a. Access to care b. Comprehensive care c. Provision of care by a single provider d. Storage of medical records e. Coordination of care A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? a. Standards for minimum cash reserves b. Strict requirements for financial reporting c. Care coordination for chronic disease d. Bonuses based on achievement of benchmarks A patient asks about direct-to-consumer (DTC) genetic testing. What will the provider tell the patient? a. The results must be interpreted by a provider. b. The results are shared with the patient’s insurance company. c. It is not useful for identifying genetic diseases. d. Much of the information does not predict disease risk. An elderly patient reports experiencing syncope each morning when getting out of bed. Which assessment will the health care provider perform first to evaluate this patient’s symptoms? a. Orthostatic blood pressures b. Fasting blood glucose c. Cardiac enzyme levels d. Electroencephalogram Which tests are indicated as part of the initial evaluation for women of childbearing age who report syncope? (Select all that apply.) a. Electroencephalogram b. 12-lead electrocardiogram c. Cardiac enzyme levels d. Serum glucose testing e. Complete blood count Which tests are indicated as part of the initial evaluation for women of childbearing age who report syncope? (Select all that apply.) a. Electroencephalogram b. 12-lead electrocardiogram c. Cardiac enzyme levels d. Serum glucose testing e. Complete blood count An older patient develops orthostatic hypotension secondary to an antihypertensive medication and asks what measures can be taken to minimize this condition. What will the provider recommend? (Select all that apply.) a. Custom-fitted elastic stockings b. Performing the Valsalva maneuver c. Discontinuation of the medication d. Crossing the legs when standing up e. Increased physical activity What is the first priority in emergency management of a biological terrorism attack? a. Basic life support b. Informing the public of the risk c. Containing the exposures d. Communication with authorities An elderly patient who has orthostatic hypotension secondary to antihypertensive medications is noted to have a drop in systolic blood pressure of 25 mm Hg. Which intervention is important for this patient? a. Close monitoring cardiorespiratory status b. Withholding antihypertensive medications c. Initiation of a fall risk protocol d. Administration of intravenous fluids Which symptom in a patient with asthma indicates severe bronchospasm? a. Wheezing after exposure to a trigger b. Repetitive, spasmodic coughing at night c. Pausing to breathe while attempting to talk d. Breathlessness with minimal activity or eating A patient who ingested a bottle of acetaminophen tablets is brought to the emergency department. Which treatment is indicated? a. N-acetylcysteine b. Naloxone c. Flumazenil d. Supportive care only A child experiences a snake bite while camping and is seen in the emergency department. The child’s parents are not able to identify the type of snake. An inspection of the site reveals two puncture wounds on the child’s arm with no swelling or erythema at the site. The child has normal vital signs. Which treatment is indicated? a. Referral to a surgeon for incision and suction of the wound b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours c. Performing a type and cross match of the child’s blood d. Administering antivenom and observing the child for 24 to 48 hours A patient who was sexually assaulted one month prior tells her provider that she is concerned about contracting HIV. When is it appropriate to perform testing? a. In two weeks and then 3 to 6 months after the assault b. Immediately and then every 6 months for the first year c. Three to 6 months after the assault d. Immediately with definitive results A patient with asthma has been given three bronchodilator treatments but continues to have wheezing and shortness of breath. The nurse caring for the patient notes an oxygen saturation of 90% on room air. What action is indicated? a. Reassure the patient that the treatments will take effect soon b. Contact the respiratory therapist to administer another treatment c. Notify the patient’s physician immediately d. Administer oxygen and continue to monitor the patient A lawn maintenance worker is brought to the emergency department after an accident in which a large amount of pesticide was sprayed all over his clothing. He is able to relate the details of the accident to the emergency department personnel. What is the priority treatment on admission? a. Contact the Poison Control center to ask about appropriate antidotes b. Remove the patient’s clothing and irrigate the skin for 15 to 30 minutes c. Place on a cardiorespiratory monitor and establish intravenous access d. Administer intravenous diphenhydramine and possibly epinephrine A patient who takes a beta blocker medication is in the emergency department with syncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35 beats per minute. Which medication may be used to stabilize this patient? a. Adenosine b. Atropine c. Amiodarone d. Epinephrine A patient is in the emergency department after sustaining a blow to the head in a motor vehicle accident. The patient’s Glasgow Coma score is 14 and the patient is drowsy. The patient has a small amount of blood in one external auditory canal. Which is a priority in diagnosing the extent of injury in this patient? a. Close monitoring of pulse, respiration, and oxygenation b. Non-enhanced computed tomography of the head c. Continued assessment of neurological status d. Magnetic resonance imaging of the head The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia? a. Ventricular tachycardia b. Atrial flutter c. Ventricular fibrillation d. Atrial fibrillation A patient reports heart palpitations but no other symptoms and has no prior history of cardiovascular disease. The clinic provider performs an electrocardiogram and notes atrial fibrillation and a heart rate of 120 beats per minute. Which is the initial course of action in treating this patient? a. Admit to the hospital for urgent cardioversion b. Refer the patient to a cardiologist c. Administer atenolol intravenously d. Transport the patient to the ED by ambulance A child is brought to the emergency department because a grandparent suspects ingestion of a tricyclic antidepressant medication found in the bathroom. What symptoms will the ED professionals expect to observe if this is the case? (Select all that apply.) a. Mydriasis b. Hallucinations c. Excessive salivation d. Hypothermia e. Urinary frequency f. Flushed skin What is included in the mitigation phase of emergency management? a. Drills and exercises b. Identification of risks c. Use of Incident Command System d. Debriefing and review A provider attending a soccer match on a hot day is assisting a player who feels hot and appears dehydrated, but who is alert and oriented. What does the provider suspect? a. Heat stroke b. Heat exhaustion c. Heat syncope d. Heat cramps A patient is seen in the emergency department after experiencing a spider bite. The spider is in a jar and is less than one inch in size, yellow-brown, and has a violin-shaped marking on its back. Depending on the patient’s symptoms, which treatments and diagnostic evaluations may be ordered? (Select all that apply.) a. CBC, BUN, electrolytes, and creatinine b. Airway management c. An acute abdominal series d. Tetanus prophylaxis e. Antivenom therapy f. Coagulation studies A child is brought to the emergency department after getting lost while camping on a cold, rainy day. The child is lethargic on admission. The cardiorespiratory monitor shows a normal heart rate and rhythm, a respiratory rate of 8 to 10 breaths per minute, and a normal blood pressure. The assessment reveals erythema and edema of the child’s hands and feet. What treatments are indicated? (Select all that apply.) a. Administer antibiotics b. Massage the hands and feet c. Apply warmed blankets d. Elevate the child’s extremities e. Remove all clothing A patient comes to the clinic after being splashed by boiling water while cooking. The patient has partial thickness burns on both forearms, the neck, and the chin. What will the provider do? a. Order a CBC, glucose, and electrolytes b. Perform a chest radiograph c. Clean and dress the burn wounds d. Refer the patient to the emergency department A patient reports generalized excessive sweating and states that night sweats are present. Which diagnostic test is a priority for this patient to determine the underlying cause? a. Thyroid function tests b. Purified protein derivative test c. Fasting blood glucose d. Blood pressure evaluation The provider is prescribing 5% permethrin cream for an adolescent patient who has scabies. What will the provider include in education for this patient? a. Itching 2 weeks after treatment indicates treatment failure. b. Stuffed animals and pillows should be placed in plastic bags for 1 week. c. The adolescent’s school friends should be treated. d. All household contacts will be treated only if symptomatic. A child is brought to a clinic with a sudden onset of rash after taking an antibiotic for 2 days. The provider notes all over wheals with pruritis, which the parent reports seem to come and go. Which action is correct? a. Reassure the parent that the rash will eventually subside b. Suggest trying cool compresses and tepid baths at home c. Prescribe an oral antihistamine and follow up in 1 to 2 days d. Admit the child to the hospital for treatment and observation Which types of medications are associated with urticarial type rashes? (Select all that apply.) a. Erythromycin b. NSAIDs c. Phenothiazines d. Penicillins e. ACE inhibitors A patient with well-localized vitiligo is referred to a dermatologist for treatment. What will the initial treatment be? a. Chemical depigmentation with mequinol b. Twice-daily application of a mid-potency steroid cream c. Narrow-band ultraviolet B light therapy d. Psoralens plus ultraviolet A light A patient with severe, recalcitrant psoriasis has tried topical medications, intralesional steroid injections, and phototherapy with ultraviolet B light without consistent improvement in symptoms. What is the next step in treating this patient? a. Etanercept b. Methotrexate c. Cyclosporine d. Oral retinoids When evaluating scalp lesions in a patient suspected of having tinea capitis, the provider uses a Wood’s lamp and is unable to elicit fluorescence. What is the significance of this finding? a. The patient is less likely to have tinea capitis. b. The patient may have tinea capitis. c. The patient is positive for tinea capitis. d. The patient does not have tinea capitis. When counseling a patient with rosacea about management of this condition, the provider may recommend (Select all that apply.) a. eliminating spicy foods. b. avoiding oil-based products. c. avoiding makeup. d. using topical antibiotics. e. applying a topical steroid. f. exposing the skin to sun. A patient is taking a sulfonamide antibiotic and develops a rash that begins peeling. Which type of rash is suspected? a. Erythema multiforme b. Wheal and flare c. Stevens-Johnson d. Urticaria A patient describes a wheal and flare type rash that recurs frequently with hives that appear and then fade within an hour. The provider notes that the patient demonstrates a wheal and flare reaction when the skin is stroked with a pen. What will the provider ask the patient to help determine the cause of this rash? a. If there is a family history of thyroid autoimmunity disease b. If the patient takes any medications, such as NSAIDs regularly c. Whether the patient is exposed to cold or water prior to the rash d. Whether the patient is experiencing gastrointestinal discomfort When collecting a specimen to determine a diagnosis of tinea corporis, the provider will scrape which portion of the lesion? a. The area of central clearing b. The active, leading border c. The papular lesions d. The erythematous plaque A patient with a purulent skin and soft tissue infection (SSTI). A history reveals a previous MRSA infection in a family member. The clinician performs an incision and drainage of the lesion and sends a sample to the lab for culture. What is the next step in treating this patient? a. Wait for culture results before ordering an antibiotic b. Begin treatment with amoxicillin-clavulanate c. Apply moist heat until symptoms resolve d. Prescribe oral clindamycin Which type of office surgical procedure warrants sterile technique? a. Scissor excision b. Punch biopsy c. Shave biopsy d. Curettage A patient with a soft corn develops an infection without surrounding erythema or edema. Which treatments are recommended? (Select all that apply.) a. Sanding with a pumice stone b. Topical mupirocin c. Twice-daily warm soaks d. Salicylic acid patch e. Oral erythromycin An older patient experiences a herpes zoster outbreak and asks the provider if she is contagious because she is going to be around her grandchild who is too young to be immunized for varicella. What will the provider tell her? a. Contagion is possible until all of her lesions are crusted. b. As long as her lesions are covered, there is no risk of transmission. c. Varicella zoster and herpes zoster are different infections. d. An antiviral medication will prevent transmission to others. Which treatment is most important in long-term management of stasis dermatitis? a. “Active” dressing application b. Massage therapy c. Systemic antibiotics d. Compression therapy A provider is prescribing a topical dermatologic medication for a patient who has open lesions on a hairy area of the body. Which vehicle type will the provider choose when prescribing this medication? a. Ointment b. Gel c. Cream d. Powder When recommending ongoing treatment for a patient who has recurrent intertrigo, what will the provider suggest? (Select all that apply.) a. Burow’s solution compresses b. Cornstarch application c. Aluminum sulfate solution d. Nystatin cream e. Topical steroid cream Which type of bite is generally closed by delayed primary closure? (Select all that apply.) a. Wounds 8 hours old b. Deep puncture wounds c. Dog bites on an arm d. Bites to the face e. Bites to the hand A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient’s vital signs are normal. What is the most likely diagnosis for this patient? a. Chronic sinusitis b. Acute sinusitis c. Viral rhinitis d. Allergic rhinitis A provider examines a patient who has chronic nasal obstruction, respiratory tract symptoms, and generalized malaise. An examination of the nasal mucosa reveals ulceration of the nasal septum. What is the most important action when caring for this patient? a. Performing laboratory tests b. Obtaining a chest radiograph c. Administering prednisone d. Referring to a specialist A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend for this patient? a. Daily intranasal steroids b. Consultation for immunotherapy c. Oral decongestants as needed d. Oral antihistamines each morning A young child has a pale, whitish discoloration behind the tympanic membrane ™. The provider notes no scarring on the TM and no retraction of the pars flaccida. The parent states that the child has never had an ear infection. What do these findings most likely represent? a. Primary acquired cholesteatoma b. Chronic cholesteatoma c. Congenital cholesteatoma d. Secondary acquired cholesteatoma A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention at this time? a. Apply ice to the injured site to prevent airway occlusion b. Immobilize the child’s head and neck and call 911 c. Place nasal packing in both nares to stop the bleeding d. Turn the child’s head to the side to prevent aspiration of blood A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient’s tympanic membrane. What is the initial action? a. Irrigate the canal with normal saline b. Use a curette to attempt to dislodge the mass c. Prescribe a ceruminolytic agent for that ear d. Ask the patient about previous problems with that ear A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? a. Acute otitis externa b. Otitis media with effusion c. Acute otitis media d. Chronic otitis externa A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient? a. Intranasal steroids b. Intranasal cromolyn c. Oral antihistamines d. Antihistamine spray A patient with allergic conjunctivitis who has been using a topical antihistamine-vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms? a. Determine the duration of treatment with this medication b. Refer the patient to an ophthalmologist for further care c. Consider prescribing a topical mast cell stabilizer d. Prescribe a non-sedating oral antihistamine A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider? a. Recommend oral antiseptic rinses and follow up in one week b. Perform an incision and drainage of the edematous tissue c. Refer to an oral surgeon for emergency surgery d. Prescribe amoxicillin and refer to a dentist in 2 to 3 days A patient is diagnoses with peritonsillar abscess and will be hospitalized for intravenous antibiotics. What additional treatment will be required? a. Intubation to protect the airway b. Needle aspiration of the abscess c. Systemic corticosteroid administration d. Tonsillectomy and adenoidectomy Which physical examination finding suggests viral rather than bacterial parotitis? a. Unilateral edema of parotid glands b. Enlargement and pain of affected glands c. Gradual reduction in saliva production d. Clear discharge from Stensen’s duct A child has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment? a. Warm compresses and massage of the lesion b. Systemic antibiotics c. Surgical incision and drainage d. Referral to an ophthalmologist An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul-smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the primary care provider do? a. Refer the patient to an otolaryngologist b. Prescribe empiric oral antibiotics c. Evaluate for possible epiglottitis d. Perform a rapid strep and throat culture An elderly patient has a permanent loss of the sense of smell and diminished taste. What will be included in teaching this patient about managing these symptoms? (Select all that apply.) a. Eating regular meals at scheduled times b. Using gas rather than electrical appliances c. The importance of installing smoke detectors d. Avoiding perfumes and perfumed soaps e. Putting dates on food in the refrigerator A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single laceration away from the iris that involves the anterior but not the posterior segment. What is the prognosis for this injury? a. Blindness is likely with this type of eye injury b. Massive hemorrhage and loss of intraocular contents is likely c. Retinal detachment is almost certain to occur d. Because the posterior segment is not involved, the prognosis is good A patient is in the emergency department with unilateral epistaxis that continues to bleed after 15 minutes of pressure on the anterior septum and application of a topical nasal decongestant. The provider is unable to visualize the site of the bleeding. What is the next measure for this patient? a. Electrocautery b. Chemical cautery c. Nasal packing d. Petrolatum ointment A patient has been taking amoxicillin for treatment of a dental abscess. In a follow-up visit, the provider notes edema of the eyelids and conjunctivae. What is the next action? a. Prescribe amoxicillin clavulanate for 10 to 14 days b. Suggest using warm compresses to the eyes for comfort c. Recommend follow up with a dentist in 2 to 3 days d. Hospitalize the patient for an endodontist consultation Correct A patient who has a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated? a. Artificial tears and cool compresses b. Antihistamine-vasoconstrictor drops c. Topical corticosteroid drops d. Topical antibiotic eye drops A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion? a. Hordeolum b. Chalazion c. Meibomian d. Blepharitis Which are potential complications of chronic or recurrent sinusitis? (Select all that apply.) a. Osteomyelitis b. Allergic rhinitis c. Meningitis d. Asthma e. Orbital infection A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup. The provider notes that the patient has dry skin in the ear canal. Which preparation is FDA approved for this use? a. Liquid docusate sodium b. Hydrogen peroxide c. Carbamide peroxide d. Mineral oil A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis? a. Spontaneous horizontal nystagmus b. Facial palsy and vertigo c. Vertigo with changes in head position d. Fluctuating hearing loss and tinnitus A child sustains an ocular injury in which a shard of glass from a bottle penetrated into the eye wall. The emergency department provider notes that the shard has remained in the eye. Which best describes this type of injury? a. Intraocular foreign body b. Perforating eye injury c. Ruptured globe injury d. Penetrating eye injury A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o’clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What will the provider tell the patient about this lesion? a. Visine may be used for symptomatic relief b. UVB eye protection is especially important c. Spontaneous bleeding is likely d. Artificial tear drops are contraindicated During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding? a. Ocular disease requiring referral b. Normal physiologic variant c. Potential vision loss in one eye d. Potential infection in the “red” eye A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most likely treatment for this condition? a. Prescribe ophthalmic antibiotic drops b. Refer to an ophthalmologist c. Order lubricating drops or ointments d. Reassure the patient that this will resolve An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications? a. Metronidazole b. Dexamethasone c. Chloramphenicol d. Clindamycin Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media? (Select all that apply.) a. Level of cooperation b. Tugging on ears c. Difficulty sleeping d. Poor hearing e. Appetite Which are risk factors for developing otitis externa? (Select all that apply.) a. Having underlying diabetes mellitus b. Vigorous external canal hygiene c. Cooler, low-humidity environments d. Exposure to someone with otitis externa e. Use of ear plugs and hearing aids A patient has an initial episode otitis external associated with swimming. The patient’s ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered? a. Neomycin b. Fluconazole c. Vinegar and alcohol d. Cipro HC During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion? a. Immediate surgery is recommended. b. This is most likely malignant. c. It is benign and will not need intervention. d. A biopsy should be performed. A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step? a. Irrigation of the eye with normal saline b. Application of topical fluorescein dye c. Administration of antibiotic eye drops d. Instillation of cyclopegic eye drops A patient has gingival inflammation with several areas of ulceration and a small amount of purulent discharge. What is required to diagnose this condition? a. Tzanck smear b. Microscopic exam of oral scrapings c. Physical examination d. Culture and sensitivity A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding? a. Impedance audiometry b. Speech reception test c. Tympanogram d. Pure tone audiogram A patient reports chronic nasal obstruction and recurrent epistaxis. Which type of nasal mass is likely? a. Nasal polyp b. Squamous cell carcinoma c. Paranasal lymphoma d. Inverted papilloma What are factors associated with acute suppurative parotitis? (Select all that apply.) a. Radiotherapy b. Allergies c. Anticholinergic medications d. Hypervolemia e. Diabetes mellitus A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year. The child’s parent asks the provider if the child needs a tonsillectomy. What will the provider tell this parent? a. Tonsillectomy is recommended based on this child’s history. b. Current recommendations do not support tonsillectomy for this child. c. The child should have radiographic studies to evaluate the need for tonsillectomy. d. If there is one more episode in the next 6 months, a tonsillectomy is necessary. The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient? a. Administer empiric intravenous antibiotics and steroids b. Have the child lie down and administer high-flow, humidified oxygen c. Perform a thorough examination of the oropharynx d. Obtain an immediate consultation with an otolaryngologist A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient? a. Audiogram and MRI b. Auditory brainstem testing c. Electrocochleography d. Vestibular testing A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next?a. Prescribe an antibiotic b. Refer to a cardiologist c. Recommend an NSAIDd. Order a chest radiograph A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient?a. Blood cultures b. Spirometry c. Arterial blood gases d. Ventilation/perfusion scan When following a patient with sarcoidosis over time, which diagnostic test is useful to help monitor the progression of the disease?a. Erythrocyte sedimentation rate b. Pulmonary function test c. Chest radiographs d. Radionucleotide scanning A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend?a. Coming to the clinic for evaluation b. Taking an oral corticosteroid c. Going to the emergency department d. Administering two more doses of albuterol A young adult patient develops a cough persisting longer than 2 months. The provider orders pulmonary function tests and a chest radiograph, which are normal. The patient denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough?a. 24-hour esophageal pH monitoringb. Tuberculosis testing c. Sputum culture d. Methacholine challenge test A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient’s pneumonia?a. Tuberculosis b. S. pneumoniae c. Mycoplasma d. A virus A patient with pulmonary arterial hypertension (PAH) has increased dyspnea with activity. Which drug may be prescribed to manage this on an outpatient basis?a. Bosentanb. Epoprostenol c. Trepostinil d. An inhaled prostanoid A patient with stage 1 sarcoidosis who is taking a nonsteroidal anti-inflammatory medication to treat joint discomfort develops mild dyspnea and cough. Which medication will be added to treat this symptom?a. An oral corticosteroid b. A beta-adrenergic medication c. An antimalarial agent d. An antimalarial agent A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient reports improvement in symptoms. What is the next action in treating this patient?a. Refer the patient to a gastroenterologist b. Order esophageal pH monitoring c. Schedule an upper endoscopy d. Continue the proton pump inhibitor Which test is most diagnostic for chronic obstructive pulmonary disease?a. COPD Assessment Test b. Spirometry for FVC and FEV1c. Forced expiratory time maneuver d. Lung radiograph When screening for metastatic cancer in a patient with lung cancer, the provider will assess for (Select all that apply.)a. increased cough. b. complaints of headache. c. unexplained weight gain. d. low hematocrit. e. lymph nodes greater than 1 cm. A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially?a. Spirometry b. Computerized tomography c. Chest radiograph d. Complete blood count A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings?a. Pulmonary infection b. Pulmonary embolus c. Hepatic disease d. Congestive heart failure A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism?a. Electrocardiogram b. D-dimer c. Arterial blood gases d. CT angiography Which method of treatment is used for traumatic pneumothorax?a. Needle aspiration of the pneumothorax b. Observation for spontaneous resolution c. Tube thoracostomy d. Placement of a small-bore catheter A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated?a. Fiberoptic bronchoscopy b. Coagulation studies c. Computerized tomography d. Needle biopsy A patient with increased left-sided heart pressure will have which type of pulmonary hypertension?a. Group 5 b. Group 4 c. Group 3 d. Group 2 A patient who has dyspnea and chest pain along with occasional chills and night sweats has a chest that shows bilateral hilar lymphadenopathy and pulmonary infiltrates. The provider suspects which classification of sarcoidosis?a. Stage 2 b. Stage 1 c. Stage 4 d. Stage 3 Which clinical sign is especially worrisome in a patient with a pulmonary embolism?a. Dyspnea b. Hypotension c. Abnormal lung sounds d. Tachycardia A patient with chronic obstructive pulmonary disease and reports daily symptoms of dyspnea and cough. Which medication will the prescriber order?a. Ipratropium bromide b. Pirbuterol acetate c. Theophylline d. Salmeterol xinafoate

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