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1. Which of the following findings is assoc. D. Myxedema
with thyroid hypofunction? Myxedema or myxedema coma is seen
A. Graves Disease in patients with severe hypothyroidism. It
B. Eye Disorder refers to the skin changes (thickened skin)
C. Thyroid storm seen in chronic severe hypothyroidism. It is
D. Myxedema a medcial emergency with mortality rates
exceeding 20%. It is tx with very high doses
of thyroid hormone.
A thyroid storm occurs when there is the ex-
treme elevation of thyroid hormone. Thyroid
storm is life-threatening; if left untreated,
the mortality rate is about 90%. Call 911 if
suspected.
Graves Disease is associated with thyroid
hyperfunction
2. A 14 y/o boy is brought in by his mother, D. Celiac Disease
who reports that her son has been com- Celiac Disease is also known as celiac sprue
plaining for several months of recurrent Patients should avoid gluten, which causes
bloating, stomach upset and occasional malabsorption (diarrhea, gas, bloating, and
loose stools. She reports that he has diffi- abd pain). Foods to avoid are wheat, rye,
culty gaining wt. and is short for his age. and barley. Oats do not damage mucosa in
She has noticed that his symptoms wors- celiac disease. Antifiadins IgA and IgG are
en after eating large amounts of crack- elevated in almost all patients (90%)
ers, cookies, and bread. She denies seeing
blood in the boy's stool. Which of the fol-
lowing conditions is most likely?
A. Amebiasis
B. Malabsorption
C. Chron's
D. Celiac Disease
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3. A 67 y/o female patient presents with a 3 D. Amoxicillin -Clavulante(Augmentin)
day old cat bite that has become swollen, The patient present with symptoms asso-
reddened and painful to touch. The NP ciated with Pasteurella multocida, which is
notes there is purulent drng at the site of an anerobic gram-negative coccobacillus
the bite. Which medication will the nurse found in the oropharynx of healthy cats,
practitioner prescribe? dogs, and other animals. The dx of the
A. Gentamycin bacteria can be made with a gram stain
B Tetanus toxoid culture; however, a broad spectrum an-
C. Rabies prophylaxis tibiotic that targets Pasteurella, as well as
D. Amoxicillin -Clavulante(Augmentin) other gram-positive and gram neg bacte-
ria, is preferred for prescribed prophylax-
is. Amox-Clav is a recommended antibiotic
for prophylactic tx. Aminoglycosides such as
gentamycin have demonstrated poor activity
against P. multocida. Tetanus toxoids is nec-
essary only if the patient has received their
last tetanus vaccine greater than 5 years pri-
or. Rabies is unnecessary unless there is a
possibility of exposure after a risk assess-
ment.
4. A 14 year old girl with short stature, B. Karotype
swollen hands and feet, and a webbed
neck presents to the clinic. Upon assess-
ment she is found to be at Tanner stage
I. Which test will the NP order to confirm
diagnosis?
A. CT scan
B. Karotype
C. Prolactin level
D. Xray of the hand
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5. A 67 y/o woman with a 30 pack a year hx B. COPD
of smoking presents for a routine annual COPD is a progressive lung disease that in-
physical examination. She c/o being easily cludes emphysema and chronic bronchitis.
short of breath and is frequently fatigued. The most common risk factor is long-term
Physical examination reveals diminished cigarette smoke (80-90%). Another cause is
breath sound, hyprresonance, and hyper- alpha-1 trypsin deficiency and chronic fume
trophied respiratory accessory muscles. exposure. The three cardinal symptoms of
Her CBC reveals elevated HCT and her PFT COPD are dyspnea, chronic cough, and spu-
results show increased total lung capacity. tum production. The lungs are hyperinflat-
Which dx is most correct? ed which changes the shape of the chest
A. Bronchogenic carcinoma and diaphragm, making the mechanics of
B. COPD breathing more difficult Excess mucus and
C. Chronic bronchitis obstructed airflow from progressive thick-
D. CHF ening and stiffening of the airways finish
breath sound. COPD creates a high hemat-
ocrit percentage because of chronic hypox-
emia.
6. An elderly male presents to the clinic for D. Senile actinic keratosis
a routine physical examination. The NP Senile actinic keratosis is considered the
notes multiple rough, scaly patches on the most common precancerous lesion of squa-
patients forearms and face and back of his mous cell carcinoma in older adults. Actinic
ears. Which dx is most likely: keratosis is a rough, scaly patch on the skin
A. seborrheic keratosis that dev. from years of exposure to the sun.
B. Senile purpura It is most commonly found on the face,
C. Lentigines lips, ears, back of hands, forearms, scalp, or
D. Senile actinic keratosis neck. Sinle purpura presents as bright, pu-
ple-colored patches located on the forearms
and hands and are benightn. Lintigines,
also known as liver sparts are brown-colored
macules located on the hands and forearms
of older adults and are benign. Seborrheic
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keratoses are soft, wartlike benign lesions
that fequently appear on the back and trunk
of older adults.
7. The NP is assessing a 69 y/o male with a C. Hep C
hx of IV drug use as a young adult. He The CDC recommends Hep C screening in
presents with fatigue and nausea. Which adults born from 1945 through 1965. Hep
screening will the NP recommend for this C is transmitted by sharing needles and can
pt become a chronic infection. IV drug users
A. cxr and persons w/in this age group are con-
B. Urine specimen sidered high risk for Hep C. Given the hx, cxr,
C. Hep C ua , and electroencephalogram would not
D. Electroencephalogram be indicated.
8. The NP is performing an assessment of a 6 A. palmar grasp of objects
month old. What motor skills are expected B. sits up
at this age?
A. palmar grasp of objects
B. sits up
C. stands independently
D. moves from one piece of furniture to
another
E. feeds self without assistance
9. The Np is manging a stable middle-aged C. Quadrivalent inactivated influenza vaccine
adult with emphysema. In addition to rein- (QIV)
forcing smoking cessation and medication An older adult with a chronic respiratory dis-
schedules, which annual intervention will ease should receive an annual QIV, which is
the nurse practitioner recommend? appropriate to administer to patients six mo
A. Pneumococcal polysaccaride (PPSV23) and older. The LAIV is administered via nasal
B. Live attenuated influenza vaccine spray for patients aged 2 to 49. PPSV23 and
(LAIV) PCV13 are both for pneumococcal protec-