Chapter 3 HEALTH PROMOTION | Over 200 Complete Verified Questions and Answers for Test Prep

Chapter 3. Health Promotion MULTIPLE CHOICE 1. Which of the following is a primary prevention measure for a 76-year-old man newly diagnosed with a testosterone deficiency? A. Calcium supplem entation B. Testicular self-examination C. Bone density test D. Digital rectal examination ANS: A PTS: 1 2. Which of the following is an example of secondary prevention in a 50-year-old woman? A. Yearly mammogram B. Low animal-fat diet C. Use of seat belt D. Daily application of sunscreen ANS: A PTS: 1 3. Which of the following is an example of tertiary prevention in a patient with chronic renal failure? A. Fluid restriction B. Hemodialysis 4 days a week C. High-protein diet D. Maintenance of blood pressure at 120/80 ANS: B PTS: 1 4. Immunizations are an example of which type of prevention? A. Primary B. Secondary C. Tertiary D. Quaternary ANS: A PTS: 1 5. The nurse is speaking to a patient regarding endemic diseases. Which of these choices describes an endemic statistic? A. The typical incidence of influenza in a country B. The surprise outbreak of malaria in new regions C. Higher levels of Ebola in a country when compared to the previous year D. Abnormal outbreak of measles in pockets of a country ANS: A PTS: 1 6. The nurse is reviewing old and current trends in disease history. Which of these would be considered an example of a sporadic outbreak? A. The number of people diagnosed with rabies virus in 2017 B. The number of people diagnosed with chlamydia in Texas over a 1-month period C. The number influenza cases diagnosed from 1918 to 1919 D. The number of common cold cases diagnosed in Washington between October 2016 and March 2017 ANS: A PTS: 1 7. Which accurately defines incidence rate? A. The number of old cases of a disease at a point in time B. The number of cases of a disease at a point in time divided by the percentage of the population at a point in time C. The number of total cases of a disease total diagnosed at a point in time D. The number of new cases of a disease diagnosed at a point in time ANS: D PTS: 1 8. What describes a pandemic? A. An event more than epidemic magnitude affecting a single community or country over a long period of time B. An event of epidemic magnitude affecting a single community or country in a short period of time C. An event of epidemic magnitude affecting multiple communities and countries in a short period of time D. An event less than epidemic magnitude affecting multiple communities and countries over a long period of time ANS: C PTS: 1 9. Which test of health literacy can be completed quickly and provide results comparable to more time-consuming tests? A. Test of Functional Health Literacy in Adults (TOFHLA) B. Patient Health Questionnaire (PHQ-9) C. Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) D. Newest Vital Sign (NVS) ANS: D PTS: 1 10. The nurse is working with a 65-year-old patient who was recently diagnosed with hypertension. The patient is concerned about their optimal health with their new diagnosis. Which nursing action is necessary for health promotion with the patient? A. Discussing appropriate stress management techniques B. Sharing with the patient how to increase sodium consumption C. Discussing with the patient exercises that increase heart rate D. Emphasizing the importance of avoiding flu vaccinations ANS: A PTS: 1 Chapter 5. Evidence-Based Care MULTIPLE CHOICE 1. What is the goal of nursing research? A. Make decisions regarding nursing education based on published literature B. Determine topics that could develop nursing knowledge C. Gather information from published literature to make decisions about application to clinical practice D. Conduct studies to develop a body of nursing knowledge ANS: D PTS: 1 2. Which is the most important question to ask in evidence-based practice? A. What findings constitute evidence? B. How will the findings be used? C. Is this a randomized controlled trial? D. What theory is being utilized? ANS: B PTS: 1 3. Nursing research should be utilized by: A. Nurses at the bedside B. Advanced practice nurses C. Nurse researchers D. Nurses at all levels of practice ANS: D PTS: 1 4. A clinical guideline may be found useful if the guideline was: A. Published 2 years ago B. Created using one group C. Authored by a relatively unknown source D. Funded by an anonymous source ANS: A PTS: 1 5. Practice guidelines are designed to: A. Be inflexible B. Be utilized in every circumstance C. Provide a reference point for decision making D. Be created by a professional organization to guide the practice of a profession ANS: C PTS: 1 6. Which of the following is an example of determining whether a crucial element of a guideline is applicable to your patients? A. There are no intended specific patients in the guideline. B. You are a primary-care provider and the guidelines were written for primary-care providers. C. Your patients have a much lower prevalence of a condition than the patients in the guideline. D. You are a pediatric oncologist and the guidelines were written for geriatric specialists. ANS: B PTS: 1 7. Which of the following would be considered the research design for Level I evidence? A. Single, well-designed, randomized clinical trial B. Systematic review of randomized clinical trial studies C. Well-designed controlled trials without randomization D. Systematic reviews of descriptive or qualitative studies ANS: B PTS: 1 8. Which of the following would be considered the research design for Level II evidence? A. Single descriptive or qualitative study B. Well-designed case control or cohort studies C. Single, well-designed, randomized clinical trial D. Systematic review of randomized clinical trial studies ANS: C PTS: 1 9. Which of the following would be considered the research design for Level III evidence? A. Well-designed controlled trials without randomization B. Systematic reviews of descriptive or qualitative studies C. Systematic review of randomized clinical trial studies D. Opinion of authorities and expert committees ANS: A PTS: 1 10. Which of the following would be considered the research design for Level IV evidence? A. Single descriptive or qualitative study B. Opinion of authorities and expert committees C. Systematic review of randomized clinical trial studies D. Well-designed controlled trials without randomization ANS: D PTS: 1 11. Which of the following would be considered the research design for Level V evidence? A. Systematic review of randomized clinical trial studies B. Well-designed controlled trials without randomization C. Systematic reviews of descriptive or qualitative studies D. Single descriptive or qualitative study ANS: C PTS: 1 12. Which of the following would be considered the research design for Level VI evidence? A. Systematic reviews of descriptive or qualitative studies B. Opinion of authorities and expert committees C. Well-designed case control or cohort studies D. Single descriptive or qualitative study ANS: C PTS: 1 13. Which of the following would be considered the research design for Level VII evidence? A. Well-designed controlled trials without randomization B. Opinion of authorities and expert committees C. Well-designed case control or cohort studies D. Single descriptive or qualitative study ANS: B PTS: 1 Section 1. Neurological Problems MULTIPLE CHOICE 1. Which statement about confusion is true? A. Confusion is a disease process. B. Confusion is always temporary. C. Age is a reliable predictor of confusion. D. Polypharmacy is a major contributor to confusion in older adults. ANS: D PTS: 1 2. Which of the following indicates a diagnosis of dementia? A. Onset after an infection B. Abrupt onset over a week C. Difficulty with long-term memory D. Hard time finding words ANS: D PTS: 1 3. Which of the following aspects of the patient history is a hallmark of delirium? A. Patient has chronic kidney disease. B. Patient has had aphasia for a year. C. Patient has diabetes mellitus. D. Patient has been getting lost driving home. ANS: A PTS: 1 4. Which of the following may trigger migraines? A. Taking an ibuprofen for muscle pain B. A cup of coffee with regular sweetener C. A glass of merlot wine D. Drinking a cup of green tea ANS: C PTS: 1 5. Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear? A. Meclizine B. Diphenhydramine C. Diamox D. Promethazine ANS: C PTS: 1 6. The hallmark of an absence seizure is: A. No activity at all B. A blank stare C. Urine is usually voided involuntarily D. The attack usually lasts several minutes ANS: B PTS: 1 7. Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)? A. A teenage male B. A 65-year-old male C. A 25-year-old female D. A 60-year-old female ANS: C PTS: 1 8. Which of the following is a specific test to MS? A. Magnetic resonance imaging (MRI) B. Computed tomography (CT) scan C. A lumbar puncture D. There is no specific test ANS: D PTS: 1 9. Over the course of 3 years, a patient has had two MS flares. The patient’s primary complaints during the episodes are bilateral tingling and pain in their legs, depression, and numbness in their right hand with complete recovery in between occurrences. Which MS classification fits their disease process? A. Clinically isolated syndrome B. Relapsing-remitting C. Primary progressive D. Secondary progressive ANS: B PTS: 1 10. A patient with MS is complaining of new-onset “electric tingling” in both their arms. Which medication specifically treats these acute exacerbations? A. Lemtrada B. Aubagio C. Zanaflex D. Depo-Medrol ANS: D PTS: 1 11. Which of the following is a risk factor for developing Alzheimer’s disease? A. Having a master’s or doctoral degree B. Patient is a physician C. Patient has Down’s syndrome D. History of neurological disease ANS: C PTS: 1 12. Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis? A. Cholinesterase inhibitors B. Anxiolytics C. Antidepressants D. Atypical antipsychotics ANS: A PTS: 1 13. The health-care provider is treating a patient who was hit in the head with a frying pan. Which of the following should the provider suspect? A. Intraparenchymal hemorrhage B. Subdural hematoma C. Epidural hematoma D. Subarachnoid hematoma ANS: B PTS: 1 14. Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery? A. Epidural hematoma B. Subdural hematoma C. Subarachnoid hematoma D. Intraparenchymal hemorrhage ANS: A PTS: 1 15. Which of the following must be completed prior to administering TPA (tissue plasminogen activator)? A. Full-body MRI B. Head x-ray C. Head CT D. Head MRI ANS: C PTS: 1 16. Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing? A. CN V B. CN VII C. CN IX D. CN X ANS: A PTS: 1 17. Which of the following has been linked to a delay in treatment for stroke? A. Patient has stroke symptoms at work. B. Patient experiences stroke during the day. C. Patient lives with a family member. D. Patient calls their primary-care provider (PCP) instead of 911 at sign of stroke. ANS: D PTS: 1 18. When a patient has a carotid bruit, which of the following should the PCP gather from the patient history? A. History of hemophilia B. History of peripheral vascular occlusive disease C. History of seizure disorder D. History of sickle cell disease ANS: B PTS: 1 19. Which patient is more likely to have a cluster headache? A. A female in her reproductive years B. A 40-year-old African American male C. A 55-year-old female who drinks 10 cups of coffee daily D. A 45-year-old male awakened at night ANS: D PTS: 1 20. Which patient is most likely to have myasthenia gravis (MG)? A. A 75-year-old Caucasian woman B. A 31-year-old Hispanic woman C. A 55-year-old African American male D. A 10-year-old Middle Eastern male ANS: B PTS: 1 21. Inattention and a sleep–wake cycle disturbance are the hallmark symptoms of: A. Dementia B. Alzheimer’s disease C. Parkinson’s disease D. Delirium ANS: D PTS: 1 22. Which type of meningitis is more benign, self-limiting, and caused primarily by a virus? A. Purulent meningitis B. Chronic meningitis C. Aseptic meningitis D. Herpes meningitis ANS: C PTS: 1 23. A patient has been diagnosed with meningitis caused by a Streptococcus pneumoniae infection. Which of the following treatments would be appropriate? A. Cefotaxime B. Isoniazid C. Acyclovir D. Amphotericin ANS: A PTS: 1 24. Which of the following should be started promptly if viral encephalitis is suspected? A. Oral amoxicillin B. IV acyclovir C. IV ampicillin D. Oral acyclovir ANS: B PTS: 1 25. What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster? A. A stabbing pain on one small area of the body B. A vesicular skin lesion on one side of the body C. A pain that is worse upon awakening D. A lesion on the exterior ear canal ANS: B PTS: 1 26. Which patient is most likely to be diagnosed with Guillain-Barré syndrome? A. A 6-month-old infant B. A 30-year-old man C. A 72-year-old woman D. A 50-year-old man ANS: C PTS: 1 27. Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her? A. “Most patients have complete recovery in 3 to 6 months.” B. “Unfortunately, you’ll probably have a small amount of residual damage.” C. “Don’t worry, I’ll take care of everything.” D. “You may have a few more episodes over the course of your lifetime but no permanent damage.” ANS: A PTS: 1 28. A patient is presenting with chorea (dance-like movements). Which of the following diseases might the patient have? A. Dementia B. Parkinson’s disease C. Wilson’s disease D. Huntington’s disease ANS: D PTS: 1 29. Which of the following signs would a health-care provider expect to see in a patient with Parkinson-plus disorder? A. Resting tremor B. Bradykinesia C. Rigidity D. Postural instability ANS: D PTS: 1 30. Which of the following is a sign or symptom of a migraine? A. Light sensitivity B. Nonpulsatile pain C. Nasal stuffiness D. Bandlike pain ANS: A PTS: 1 31. Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis? A. Greater than 25% B. Greater than 50% C. Greater than 75% D. Only for 100% occlusion ANS: B PTS: 1 32. Which of the following activities is part of the functional activities questionnaire? A. Asking the patient to unravel a Rubik’s cube B. Determining if the patient can drive on the highway C. Asking the patient about a news event from the current week D. Seeing if the patient can keep his or her home clean ANS: C PTS: 1 33. About 90% of all headaches are: A. Tension B. Migraine C. Cluster D. Without pathological cause ANS: D PTS: 1 34. Which statement is true regarding driving and patients with a seizure disorder? A. Once diagnosed with a seizure disorder, patients must never drive again. B. After being seizure free for 6 months, patients may drive. C. Each state has different laws governing driving for individuals with a seizure disorder. D. These persons may drive but never alone. ANS: C PTS: 1 35. Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given IV once a month? A. Glatiramer acetate B. Natalizumab C. Fingolimod D. Glucocorticoids ANS: B PTS: 1 36. The “freezing phenomenon” is a cardinal feature of: A. Parkinson’s disease B. Alzheimer’s disease C. A cerebrovascular accident (CVA) D. Bell’s palsy ANS: A PTS: 1 37. A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as: A. Spinothalamic dysfunction B. Ratcheting C. Cogwheeling D. Hand tremors ANS: C PTS: 1 38. Which condition is characterized by the impaired ability to learn new information along with a cognitive disturbance in either language, function, or perception? A. Guillain-Barré syndrome B. Parkinson’s disease C. Alzheimer’s disease D. Delirium ANS: C PTS: 1 39. A score of 12 to 24 on this test indicates intermediate Alzheimer’s disease: A. SLUMS B. MoCA C. FAST D. MMSE ANS: D PTS: 1 40. IV thrombolytic therapy following an ischemic CVA should be given within how many hours of symptom onset? A. 1 hour B. 3 hours C. 6 hours D. 12 hours ANS: B PTS: 1 41. When administered at the beginning of an attack, oxygen therapy may help this kind of headache? A. Tension B. Migraine C. Cluster D. Stress ANS: C PTS: 1 Section 2. Skin Problems MULTIPLE CHOICE 1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause? A. “You must be under a lot of stress lately.” B. “It is hereditary. Did your father experience this also?” C. “The cause is unknown, but we suspect it is due to an immunological mechanism.” D. “We’ll have to do some tests.” ANS: C PTS: 1 2. Gillian presents with a sudden onset of 102°F fever, emesis, tingling in the hands and feet, fatigue, and weakness. What is the potential diagnosis of this presentation? A. Urticaria B. Toxic shock syndrome C. Scabies D. Pediculosis ANS: B PTS: 1 3. Which of the following describes a bulla? A. Results from a defect in the dermoepidermal junction B. Interfaces between the epidermis and the dermis C. A small crusty plaque D. A dime-sized purulent pustule on the buttocks ANS: A PTS: 1 4. An example of ecchymosis is: A. A hematoma B. A keloid C. A bruise D. A patch ANS: C PTS: 1 5. Francine presents with a total loss of skin color in patchy areas of her body. What are the potential causes? A. Zidovudine B. Chlorpromazine C. Vitiligo D. Addison’s disease ANS: C PTS: 1 6. When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval-to-round shapes. What do you suspect they are? A. Spores B. Leukocytes C. Pseudohyphae D. Epithelial cells ANS: A PTS: 1 7. Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is the most appropriate treatment? A. Terbinafine 250 mg once daily × 12 weeks B. Noxafil 100 mg oral suspension × 2 daily C. Griseofulvin 500 mg once daily × 2 to 4 weeks D. Metronidazole 2% cream 5 g intravaginally × 7 days ANS: D PTS: 1 8. Tinea unguium is also known as: A. Onychomycosis B. Tinea versicolor C. Tinea manuum D. Tinea corporis ANS: A PTS: 1 9. Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this? A. Bullous impetigo B. Staphylococcal scalded skin syndrome (SSSS) C. Nonbullous impetigo D. Ecthyma ANS: D PTS: 1 10. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria? A. Staphylococcus aureus B. Clostridium perfringens C. S. pyogenes D. Streptococcus ANS: B PTS: 1 11. When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? A. A piece of hair or a thread B. Hyphae C. Leukocytes D. Spores ANS: B PTS: 1 12. What should be the initial management for a new wart? A. Tretinoin cream B. Liquid nitrogen cryotherapy C. Salicylic acid D. Watchful waiting ANS: D PTS: 1 13. Stacy has a verruca plana and she is using tretinoin cream. Which of the following is true? A. It should be applied at bedtime over the entire area that is affected. B. It should be applied twice daily for 1 week. C. It is not normal to have a fine scaling when using this medication. D. It is not normal to have erythema when using this medication. ANS: A PTS: 1 14. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers? A. Necrotizing fasciitis B. Periorbital cellulitis C. Erysipelas D. “Flesh-eating” cellulitis ANS: C PTS: 1 15. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and discuss that: A. HPV 16 and 18 usually cause anogenital warts. B. Penetrative intercourse is necessary to transmit anogenital warts. C. Anogenital warts are transmitted genital to genital. D. OTC home-based cryotherapy is a good choice for treatment. ANS: C PTS: 1 16. Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him. Which would be a good choice? A. Betamethasone dipropionate 0.05% B. Hydrocortisone base 2.5% C. Halcinonide 0.1% D. Desonide 0.05% ANS: B PTS: 1 17. Harvey has a rubbery, smooth, round mass on his chest that is compressible and has a soft-to- very-firm texture. What do you diagnose this as? A. A lipoma B. A nevus C. A skin tag D. A possible adenoma ANS: A PTS: 1 18. Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using snip excision? A. Do not use lidocaine as it may potentiate bleeding. B. Pinch the skin taut together. C. Use gel foam to control bleeding. D. This should be performed by a dermatologist only. ANS: C PTS: 1 19. The “B” in the ABCDEs of assessing skin cancer represents: A. Biopsy B. Best practice C. Boundary D. Border irregularity ANS: D PTS: 1 20. Gary has been diagnosed with HSV-2 genital herpes and is wondering what to expect. Which of the following is a credible teaching point? A. HSV-1 genital herpes occurs more frequently than HSV-2 genital herpes. B. The HSV lesions will never occur near the initial infection site. C. Burning and tingling at the site of initial infection can signal recurrence. D. Each recurrent HSV infection will be worse than the initial infection. ANS: C PTS: 1 21. Eighty percent of men have noticeable hair loss by what age? A. 35 B. 50 C. 70 D. 85 ANS: D PTS: 1 22. Prevalence of psoriasis is highest in which group? A. Scandinavians B. African Americans C. Asians D. Native Americans ANS: A PTS: 1 23. The most common precancerous skin lesion found in Caucasians is: A. A skin tag B. Actinic keratosis C. A melanoma D. A basal cell lesion ANS: B PTS: 1 24. Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation. There is some edema involved. You suspect: A. Necrotizing fasciitis B. Kaposi’s sarcoma C. Cellulitis D. A diabetic ulcer ANS: C PTS: 1 25. Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition? A. There are round, hypopigmented macules on his back. B. Josh has red papules on his face. C. There are crusted plaques in Josh’s groin area. D. There are white streaks on his neck. ANS: A PTS: 1 26. Tori is on systemic antifungals for a bad tinea infection. You are aware that the antifungals may cause: A. Renal failure B. Skin discoloration C. Breathing difficulties D. Hepatotoxicity ANS: D PTS: 1 27. Which scalp problem can be caused by a fever and certain drugs? A. Telogen effluvium (TE) B. Trichotillomania C. Psoriasis D. Alopecia areata ANS: A PTS: 1 28. Which of the following is a strong risk factor associated with increased melanoma risk? A. Patient had a 15 mm nevus. B. Patient has a history of multiple blistering sunburns in their teenage years. C. Patient’s uncle had melanoma. D. Patient is of African American descent. ANS: B PTS: 1 29. Which statement is true regarding chloasma, the “mask of pregnancy”? A. It is caused by a decrease in the melanocyte-stimulating hormone during pregnancy. B. This condition only occurs on the face. C. Exposure to sunlight will even out the discoloration. D. It is caused by increased levels of estrogen and progesterone. ANS: D PTS: 1 30. A patient presents with xerosis. What do you tell the patient about this condition? A. Daily hot baths can help to soothe the skin. B. Using a strong deodorant can improve the condition. C. It can be a side effect of depigmentation creams. D. It is uncommon in the elderly. ANS: C PTS: 1 31. Which medication used for scabies is safe for children 2 months and older? A. Permethrin cream B. Lindane C. Crotamiton lotion and cream D. Ivermectin ANS: A PTS: 1 32. Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis? A. Keratosis pilaris B. Dennie’s sign C. Keratoconus D. Pityriasis alba ANS: B PTS: 1 33. Which of the following statements about performing cryosurgery for actinic keratosis is true? A. It is better to slightly overfreeze the area, so you only have to do it once. B. Using liquid nitrogen, freeze each lesion for at least 30 seconds. C. Every lesion should be biopsied after using liquid nitrogen. D. The “freeze balls” should be approximately one-and-a-half times as wide as they are deep. ANS: D PTS: 1 34. Gerald presents with a very dark color on his right pinkie finger. What is the health-care provider’s next care step? A. Referral to a dermatologist for a nail biopsy B. Watchful waiting C. Discussing that the condition is benign and the patient can ignore it D. Follow up in 2 weeks to see if there is any change ANS: A PTS: 1 35. Which statement regarding necrotizing fasciitis is true? A. The hallmark of this infection is its slow and steady progression. B. Once the border of the infection is “established,” it does not spread. C. This is a medical emergency and gangrene can develop. D. The lesion is most dangerous, because it is painless. ANS: C PTS: 1 36. When staging a malignant melanoma using Clark’s levels, which level extends into the papillary dermis? A. Level I B. Level II C. Level III D. Level IV ANS: C PTS: 1 37. Which of these patients is most likely to have acne and resultant scarring? A. A 15-year-old Caucasian male B. A 17-year-old Hispanic female C. A 20-year-old Asian female D. A 21-year-old African American male ANS: B PTS: 1 38. A 20-year-old Hispanic male presents with multiple noninflammatory comedones on his chest and back with four small papules on his right upper arm. Which diagnosis is accurate? A. Mild acne B. Moderate acne C. Severe acne D. Nodulocystic acne ANS: A PTS: 1 39. A 40-year-old woman presents with inflammatory papules on her face, facial flushing when she drinks a glass of wine, telangiectasias, and dry eyes. Which of the following conditions is the most likely diagnosis? A. Acne vulgaris B. Hot tub folliculitis C. Rosacea D. Perioral dermatitis ANS: C PTS: 1 40. Rachel is a patient complaining of a pruritic erythematous rash on her face and hands that became apparent this morning. Which of the following questions would help determine whether she has contact dermatitis? A. “Do you have a history of itchy rashes?” B. “Do you have any food allergies?” C. “Do you have a history of rosacea?” D. “Have you used any new face wash or soap?” ANS: D PTS: 1 41. A 70-year-old patient presents with a poorly defined, pink, scaling rash on his face and scalp. When he asks what he can expect from this condition, you say: A. “If your rash is itchy, the itching may be worse when you are hot and sweaty.” B. “This is probably a one-time rash and should not come back.” C. “This condition does not run in families, so your children are not at risk of developing it.” D. “This rash is most common in people that have poor hygiene, so you will have to shower at least once a day.” ANS: A PTS: 1 42. Janet has psoriasis that covers 25% of her body. Which of the following treatment options should be considered? A. Referral to plastic surgery B. Methotrexate 10 mg daily C. Anthralin 0.1% ointment applied once a day D. A surgical consult ANS: B PTS: 1 43. Heidi has a fingerlike, flesh-colored projection emanating from a broad base on her mouth. Which of the following is the most likely diagnosis? A. Plantar wart B. Flat wart C. Verruca vulgaris D. Digitate wart ANS: D PTS: 1 44. Maria had impetigo and is seeing her health-care provider for a follow-up visit. Which of the following teaching points should the provider discuss? A. Keeping fingernails short can prevent the spread of impetigo. B. Impetigo can be prevented in the future by wearing a face mask. C. If a patient has impetigo in the future, they should clean everything in their home with bleach. D. Impetigo is spread by blood, so the patient should avoid donating blood. ANS: A PTS: 1 45. Jill is a patient complaining of a “bumpy” rash on her neck that is nonpruritic. She was recently on a ski trip and went in a hot tub. What is the most likely diagnosis? A. HSV-2 B. Folliculitis C. Acne vulgaris D. Actinic keratosis ANS: B PTS: 1 46. Graham has a single furuncle on his buttocks with no surrounding cellulitis. What is the best treatment option? A. Systemic antibiotics B. Cold compress to the site C. Incision and drainage D. Watchful waiting ANS: C PTS: 1 47. Jack is complaining of an extremely pruritic lesion that is round to a half circle in his genital area. Which of the following is the most likely diagnosis? A. Tinea cruris B. Tinea pedis C. Tinea versicolor D. Tinea manuum ANS: A PTS: 1 48. Which of the following is true of scabies? A. Scabies is more common in the Caucasian population. B. Scabies is transmitted through blood. C. Scabies is not associated with hygiene. D. Scabies is transmitted through close personal contact. ANS: D PTS: 1 49. Which of the following is true of pediculosis? A. Pruritus occurs before the sensitivity to the head louse. B. Patients can be asymptomatic or cause few symptoms in the first 2 weeks following exposure. C. In a patient’s first infection, they will develop symptoms within 24 to 48 hours. D. It is transmitted through droplets. ANS: B PTS: 1 50. How might a rash appear on a patient with a darker skin tone? A. Dark brown B. Light pink C. Bright red D. Deep purple ANS: A PTS: 1 51. What of the following is the most common appearance of Paget’s disease? A. Poorly defined, red, raised plaque on one nipple B. Scattered white papules on the nipples bilaterally C. Oval-shaped, erythematous scaling plaque with sharp margins on one nipple D. Raised, silvery-white patches on the nipples bilaterally ANS: C Section 3. Eye Problems MULTIPLE CHOICE 1. An acutely presenting, erythematous, tender lump within the eyelid is called: A. Blepharitis B. Hordeolum C. Chalazion D. Iritis ANS: B PTS: 1 2. A granulomatous infection of a meibomian gland that presents as a painless swelling on the eyelid is called a: A. Iritis B. Chalazion C. Viral conjunctivitis D. Nuclear cataracts ANS: B PTS: 1 3. Billy presents with edematous and erythematous lid margins and closer visual inspection with a Wood’s lamp reveals scaling. Which of the following conditions could be the diagnosis? A. Hordeolum B. Chalazion C. Blepharitis D. Iritis ANS: C PTS: 1 4. Which of the following is true about epiphora? A. It is uncommon that it’s a response to dry eye. B. It will lead to decreased tearing. C. It is common in infants. D. It will lead to increased irritation. ANS: D PTS: 1 5. The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis? A. Viral conjunctivitis B. Keratoconjunctivitis C. Bacterial conjunctivitis D. Allergic conjunctivitis ANS: C PTS: 1 6. Which is appropriate patient education to provide regarding bacterial conjunctivitis? A. The patient should continue to go to his or her job as a day-care teacher. B. The patient should make sure to practice proper hand washing. C. The patient should touch his or her eyes to apply medication. D. The patient will be infectious for only 24 hours after diagnosis of bacterial conjunctivitis. ANS: B PTS: 1 7. What of the following in the patient’s history would lead the provider to diagnose a corneal abrasion? A. Patient’s mother had a corneal abrasion. B. Patient wears glasses. C. Patient complains, “I feel like something is in my right eye.” D. Patient complains, “My eyes feel so dry.” ANS: C PTS: 1 8. Which subtype of cataracts is characterized by significant nearsightedness and a slow indolent course? A. Nuclear cataracts B. Cortical cataracts C. Posterior cataracts D. Immature cataracts ANS: A PTS: 1 9. Which of the following produces a slow and painless visual field loss that usually begins peripherally? A. Posterior cataracts B. Open-angle glaucoma C. Immature cataracts D. Macular degeneration ANS: B PTS: 1 10. Which of the following is TRUE regarding dietary supplements and cataracts? A. High doses of vitamin E prevent the progression of cataracts. B. Low doses of vitamin C increase age-related cataract development. C. There is no evidence that concretely proves the benefit of high-dose vitamin E to prevent cataracts. D. Weekly lutein prevents the formation of cataracts. ANS: C PTS: 1 11. Which of the following contribute to the development of chronic open-angle glaucoma? A. Myopia B. Multiple sclerosis C. Hyperopia D. Small cornea ANS: A PTS: 1 12. A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma? A. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma. B. The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient. C. Physical diagnosis relies on gonioscopic evaluation of the angle by an ophthalmologist. D. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve. ANS: C PTS: 1 13. Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure? A. 0 to 7 mm Hg B. 12 to 22 mm Hg C. 22 to 40 mm Hg D. 40 to 80 mm Hg ANS: B PTS: 1 14. Which of the following education points is essential to provide to the patient with glaucoma? A. Their medication may have adverse effects. B. Only the patient can instill eye drops. C. Eye infections are common and are not a concern. D. Eye exams must happen monthly. ANS: A PTS: 1 15. With regards to the relationship between diabetes and diabetic retinopathy, which of the following is TRUE? A. Diabetic retinopathy only occurs in patients with type 1 diabetes. B. Diabetic retinopathy is always the first sign that a patient has diabetes. C. The longer the patient has had diabetes, the more likelihood that they will develop retinopathy. D. Diabetic retinopathy only occurs in patients with type 2 diabetes. ANS: C PTS: 1 16. As diabetic retinopathy progresses, the presence of “cotton wool” spots can be detected. “Cotton wool” spots refer to: A. Microvascular infarctions B. Blood vessel proliferation C. Venous beading D. Retinal hemorrhage ANS: A PTS: 1 17. Marie has diabetes mellitus with proliferative retinopathy. How often should she see her ophthalmologist? A. Monthly B. Every 2 months C. Every 3 to 4 months D. Annually ANS: C PTS: 1 18. Who of the following is a patient with risk factors for macular degeneration? A. 50-year-old African American male B. 65-year-old Caucasian female C. 40-year-old Asian man D. 90-year-old Hispanic female ANS: B PTS: 1 19. Sarah is a patient with a complaint of feeling like she has “sand in her eye.” Which is the most likely diagnosis? A. Cataracts (blurred vision, inability to see dim lights, halos) B. Diabetic retinopathy (floaters, can’t see colors-why might fall, microaneurysms, cotton wool spots) C. Macular degeneration D. Keratitis sicca (dry eyes) ANS: D PTS: 1 20. A patient was diagnosed with gradual floaters that the provider determined did not require treatment. What is a common complaint when a patient has benign floaters? A. “In my right eye I see little dots when I stare in the direction of the sun.” B. “In both eyes I see bright white dots that block my vision when I am in a black room.” C. “I can’t see in my left eye when I look into a bright room.” D. “When I am in a dark room a big white dot blocks my field of vision in my left eye.” ANS: A PTS: 1 21. A patient is complaining of seeing “flashing lights.” What is the provider’s next step? A. Send the patient to ophthalmology immediately to evaluate for macular degeneration. B. Tell the patient that it is normal to see flashing lights occasionally. C. Send the patient to ophthalmology immediately to evaluate for a retinal tear or detachment. D. Tell the patient that they can wait to be seen by ophthalmology for 1 month. ANS: C PTS: 1 22. Robin presents with tearing in her right eye that started this morning. What is the most likely cause in the provider’s differential diagnosis? A. Dry eye B. Foreign body in the eye C. Diabetic retinopathy D. Cataract ANS: B PTS: 1 23. Which of the following medications used in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape? A. Pilocarpine B. Timolol C. Brinzolamide D. Acetazolamide ANS: A PTS: 1 Chapter 82. Putting Caring Into Practice: Caring for Self MULTIPLE CHOICE 1. The World Health Organization defines self-care as: A. An important global activity for all health-care providers B. A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health C. Essential to efficacious advanced practice nursing practice D. An awareness by the Advanced Practice Registered Nurse (APRN) of their self- care behaviors as related to diet, activity, and mental attitude ANS: B PTS: 1 2. Nurse theorist Dorothea Orem defines self-care activities as: A. Attainment of professional self-development goals B. Ability to persevere through hardship C. Striving to attain balance and harmony in one’s life D. Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life ANS: D PTS: 1 3. Self-care and personal development are built into the standards of practice of: A. The American Holistic Nurses Association B. The American Nurses Association C. The American Association of Nurse Practitioners D. The American Academy of Nursing ANS: A PTS: 1 4. There are many pressures inherent in primary-care practice today for APRNs. These pressures include all of the following: A. Electronic medical record, the Affordable Care Act, and the implementation of socialized medicine B. Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants C. Uncertainty, the team approach to care, and the need for patient-centered care D. Availability of medical information on the Internet, educational programs for patients, and Medicare drug benefits ANS: B PTS: 1 5. A new era of health care leads to: A. Greater opportunity for independent practice, yet increased legal risk in accountability for patients B. Lowered reimbursement for all health-care services and providers C. Decrease in status for health-care providers D. No ability to individualize care ANS: A PTS: 1 6. Compassion fatigue is another side effect of today’s health-care delivery system. This term means: A. The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN. B. This happens over time related to the need to see increasing numbers of patients in busy primary-care practices. C. This may persist over time, even when the APRN transfers to a new and different setting. D. Patients’ problems and circumstances can be so overwhelming that the APRN needs to set severe boundaries to maintain safe function. ANS: A PTS: 1 7. Another term used, burn out, is differentiated by: A. Numbness of feelings leading to substance abuse B. How novice APRNs feel at the end of the day in primary care C. Feelings of aloneness, desperation, and despair D. A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale ANS: D PTS: 1 8. The following statement is TRUE: A. APRNs are often sensitive to patients’ deficiencies but not their own. B. APRNs always respond appropriately to patients, families, and team members. C. APRNs are well-equipped from their APRN educational programs to care for self. D. Re-licensure in some states mandates continuing education units in self-care. ANS: A PTS: 1 9. Emotional intelligence is defined as: A. Being highly attuned to the needs of others B. The ability to engage in self-care C. Being able to recognize and understand the meaning of emotions, and how they affect other people D. The holistic integration of self-care and self-development practices ANS: C PTS: 1 10. APRNs need to develop their own self-care management plans. Two key elements of self-care management plans are: A. Taking vacations and keeping up with new knowledge and developments in medicine B. Resilience and positive intentionality C. Family support and a healthy diet D. Being physically and emotionally “fit” ANS: B PTS: 1 11. The term resilience implies: A. Ability to look to a higher power to get you through a crisis B. Response to difficult and adverse circumstances through positively adjusting to stressors C. That the APRN can weather any emergency D. Learning to set appropriate boundaries ANS: B PTS: 1 12. Qualities associated with resilience include: A. Hope, self-efficacy, and positivity B. Stick-to-it-ness, belief in a higher power C. Education, self-regulation, and use of activity to decrease stress D. Ability to take vacations and the availability of support systems and a secure work environment ANS: A PTS: 1 13. Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no backup and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies? A. Patsy distanced Sue by listening to her as little as possible. B. Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining. C. Patsy spoke privately with their supervisor, Pamela, stating that she did not think Sue could be successful in this environment. D. Patsy requested that Sue be assigned to a different APRN for orientation. ANS: B PTS: 1 14. The qualities of resilience that Patsy demonstrated when responding to Sue include: A. Protecting her own positive attitude by lessening her contact with Sue, a negative person B. The ego strength to admit failure in her ability to orient Sue, a destructive person C. Protecting her organization by sharing Sue’s deficiencies with their supervisor D. Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her ANS: D PTS: 1 15. According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice? A. Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy B. Review of materials on primary care before going into the work environment to increase one’s confidence, leading to caring energy C. Travel to sacred places D. Helping the poor and homeless—volunteering at a domestic violence shelter, for example—in addition to one’s regular practice ANS: A PTS: 1 Section 4. Ear, Nose, and Throat Problems MULTIPLE CHOICE 1. Which of the following is an example of sensorineural hearing loss? A. Perforation of the tympanic membrane B. Otosclerosis C. Cholesteatoma D. Presbycusis ANS: D PTS: 1 2. The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient’s mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? A. Weber test B. Schwabach test C. Rinne test D. Auditory brainstem response (ABR) test ANS: C PTS: 1 3. A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition? A. Otitis media B. Ménière’s disease C. Tinnitus D. Otitis externa ANS: D PTS: 1 4. In which of the following scenarios would otitis media (OM) be considered chronic? A. Patient has had repeated episodes of acute OM followed by continuous or intermittent otorrhea lasting for more than 3 months. B. Patient has had severe pain and intermittent otorrhea lasting for 2 months. C. Patient has had repeated episodes of acute OM followed by continuous or intermittent otorrhea lasting for more than 1 month. D. Patient has had severe pain and continuous otorrhea lasting for 3 months. ANS: A PTS: 1 5. Which of the following is helpful in evaluating patients with otitis media with effusion? A. Lumbar puncture B. MRI C. Computed tomography (CT) scan D. Ultrasound ANS: C PTS: 1 6. Which of the following treatments is appropriate for a patient who has acute otitis media and has an allergy to penicillin? A. Augmentin 875 mg two times daily for 10 days B. Suprax 400 mg daily for 7 days C. Amoxicillin 500 mg every 8 hours for 10 days D. Zithromax (Azithgromycin)500 mg on day 1, and then 250 mg daily for 4 days ANS: D PTS: 1 7. Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis? A. IgA B. IgE C. IgG D. IgM ANS: B PTS: 1 8. Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? A. Vasomotor rhinitis B. Rhinitis medicamentosa C. Atrophic rhinitis D. Viral rhinitis ANS: A PTS: 1 9. Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than: A. 4 weeks B. 8 weeks C. 12 weeks D. 16 weeks ANS: C PTS: 1 10. Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected? A. Penicillin V B. Amoxicillin C. Levofloxacin D. Clindamycin ANS: C PTS: 1 11. Which of the following can prevent chronic sinusitis? A. Patients in the same household with sinusitis should all use the same nasal spray B. Treating respiratory infections after a week of symptoms C. Using a dehumidifier during sinusitis attacks D. Surgery to correct anatomical blockages of the sinus ostia ANS: D PTS: 1 12. Which type of stomatitis results in necrotic ulceration of the oral mucous membranes? A. Vincent’s stomatitis(ulcer of mouth) B. Allergic stomatitis(oral mucosal immunoflammatory d/o) C. Aphthous stomatitis (canker sore) D. Herpetic stomatitis ANS: A PTS: 1 13. Which type of stomatitis is caused by continual exposure to chewing tobacco? A. Aphthous stomatitis B. Herpetic stomatitis C. Nicotinic stomatitis D. Allergic stomatitis ANS: C PTS: 1 14. The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection? A. Herpes simplex virus type 2 B. HIV C. Pneumonia D. Syphilis ANS: B PTS: 1 15. Which of the following conditions leads to erythematous patches with bluish-white centers on the lingual and buccal mucosa (Koplik’s spots): A. Syphilis B. Roseola paramyxovirus infection (Measles) C. Parotitis D. HIV ANS: B PTS: 1 16. Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting from infection with which of the following pathogens? A. Coxsackievirus B. Cytomegalovirus C. Francisella tularensis D. Group A streptococcus-responsible for Strep thraost ANS: D PTS: 1 17. Which of the following is a disorder of infectious etiology? A. Tonsillitis B. Kawasaki’s syndrome C. Pharyngitis related to allergies D. Pemphigus ANS: A PTS: 1 18. A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause? A. Gonorrhea B. Mononucleosis C. Influenza D. Herpes zoster ANS: B PTS: 1 19. A patient presents with nonvesicular lesions that are 2 to 10 mm, symmetrical, and scattered on the oropharynx and mouth. What is their most likely diagnosis? A. Corynebacterium diphtheriae B. Primary syphilis C. Candida infection D. Secondary syphilis ANS: D PTS: 1 20. A patient presents to the clinician with a sore throat, fever of 100.7°F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be? A. The patient should be instructed to rest and increase fluid intake, as the infection is most likely viral and will resolve without antibiotic treatment. B. Because the patient does not have strep throat, the clinician should start broad- spectrum antibiotics in order to cover the offending pathogen. C. A throat culture should be performed to confirm the results of the rapid strep test. D. The patient should be treated with antibiotics for strep throat, as the rapid strep test is not very sensitive. ANS: C PTS: 1 21. Jean has acute otitis externa with fluid that is black and malodorous. Which of the following is responsible for the infection? A. Fungal infection B. Staphylococcus infection C. Pseudomonas infection D. Allergic reaction ANS: A PTS: 1 22. You have a patient who is a positive for strep on rapid antigen testing (rapid strep test). You order amoxicillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5°F in office). You also note significant lymphadenopathy, most notably in the posterior and anterior cervical chains, some hepatosplenomegaly, and a diffuse rash. You decide: A. To refer the patient B. That he is having an allergic response and needs to be changed to a macrolide antibiotic C. That his antibiotic dosage is not sufficient and should be changed D. That he possibly has mononucleosis concurrent with his strep infection ANS: D PTS: 1 23. Which of the following medications is safe to use when an adult patient has a perforated tympanic membrane? A. Chloroxylenol 1 mg, 4 to 5 drops in the affected ear three times per day for 7 days B. Floxin otic 10 drops in affected ear for 7 days C. Pramoxine HCL 10 mg, 4 to 5 drops in affected ear three times per day for 7 days D. Hydrocortisone 10 mg/mL, 3 drops in affected ear three times per day for 7 days ANS: B PTS: 1 24. Betty presents with tenderness on traction of the pinna in her right ear and when the provider places pressure on her right tragus, she expresses she is in pain. The clinician does not suspect a tympanic membrane rupture, but would like to make Betty more comfortable during the exam. Which of the following solutions should the clinician administer before attempting an examination? A. Normal saline B. Auralgan (Benzocaine Otic) C. Lidocaine D. Distilled water ANS: B PTS: 1 25. Which of the following is the form of external otitis in which bacterial infection extends from the auditory canal into the skull? A. Otitis media B. Otitis externa C. Necrotizing otitis D. Swimmer’s ear ANS: C PTS: 1 26. Though common as people age, what concerning disease can dysphonia(change in voice quality) be a cardinal sign for? A. Laryngeal cancer B. Viral infection C. Bronchitis D. Lung cancer ANS: A PTS: 1 27. A patient has dysphonia ×3 days as a result of a viral illness. Which of the following educational points is correct? A. As smoking has no effect on dysphonia, the patient can continue to smoke. B. The patient should continue to use their voice to exercise it. C. The patient should take cough medication with antihistamines. D. Make sure the patient has adequate fluid intake. ANS: D PTS: 1 28. A patient complains of dull and intermittent left-sided facial pain and left-sided headache that is worse in the morning. Which of the following diagnoses is most likely? A. Pharyngitis B. Temporomandibular disorder C. Temporomandibular joint disease D. Dysphonia ANS: B PTS: 1 29. A provider is examining a patient with temporomandibular joint disease (TMJ). Which of the following results would the provider expect from the exam? A. The mandibular opening is 40 mm. B. There are no sounds elicited from the exam. C. The mandible deviates to the left side. D. The patient is able to open the mouth without pain or sound. ANS: C PTS: 1 30. Which of the following medications for temporomandibular disorder has the warning that patients should NOT drive while taking it? A. Flexeril B. Naprosyn C. Tylenol D. Elavil ANS: A PTS: 1 31. What is the most common site of hemorrhage for epistaxis? A. Nasopharynx B. Nostril C. Posterior nasal cavity D. Little’s area ANS: D PTS: 1 32. What is the initial treatment for uncomplicated anterior epistaxis? A. Tilting the head back so the blood does not run out of the nose B. Applying firm and continuous pressure superior to the nasal alar cartilages for 10 to 15 minutes C. Applying firm and continuous pressure to the nostril for 5 minutes D. Letting the nose bleed clot and leaning the head forward ANS: B PTS: 1 33. A patient just had epistaxis and the provider is counseling them on what to do when they go home. Which of the following should be included? A. Make sure to talk during future nose bleeds to reassure the people around you. B. When nose bleeds occur, if you have blood in your mouth, spit it out. C. Avoid hot liquids after a nose bleed. D. With future nose bleeds, drinking lukewarm beverages helps blood clot. ANS: C PTS: 1 34. Peter presents with complaints of right hearing loss that has been getting worse and a congruent headache. What is the most likely diagnosis? A. Acoustic neuroma B. Presbycusis C. Ménière’s disease D. Sensorineural hearing loss ANS: A PTS: 1 35. Which of the following complementary therapies can help a patient with tinnitus? A. Increase salt intake B. Stop smoking C. Not listening to music D. Increase caffeine intake ANS: B PTS: 1 Section 5. Respiratory Problems MULTIPLE CHOICE 1. A chronic cough lasts longer than: A. 3 weeks B. 8 weeks C. 6 months D. 1 year ANS: B PTS: 1 2. You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex? A. Baker phenomenon B. Arnold reflex C. Cough reflex D. Tragus reflex ANS: B PTS: 1 3. Based on these patients’ histories, which of the following should receive fungal serology testing for their chronic cough? A. A patient with a history of sickle cell disease B. A patient with a history of multiple sclerosis C. A patient with a history of celiac disease D. A patient with a history of AIDS ANS: D PTS: 1 4. Which of these patients should be given a decongestant? A. Gerta, a 41-year-old female with GERD B. Christine, a 15-year-old female with pneumonia C. Dan, a 60-year-old male with allergic rhinitis D. Andy, a 26-year-old with cystic fibrosis ANS: C PTS: 1 5. Which of the following herbal supplements should be used cautiously in a patient with hypertension? A. Licorice B. Horehound C. Peppermint D. Jasmine ANS: A PTS: 1 6. A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: A. Metoprolol B. Clopidogrel C. Tadalafil D. Captopril ANS: D PTS: 1 7. Lisa is a 25-year-old Hispanic female experiencing chest tightness, a feeling of suffocation, and feels like she “can’t get air in.” She has no current history of heart or lung disease and did not exercise leading up to this attack. Which of the following is the most likely cause for this dyspnea? A. Severe chronic anemia B. Congestive heart failure C. Anxiety-related dyspnea D. Chronic obstructive pulmonary disease (COPD) ANS: C PTS: 1 8. Which of the following scales is useful to assess the degree of dyspnea with a score of 6 to 20? A. Borg scale B. Patient Health Questionnaire-9 scale C. Visual analog scale D. Global assessment of functioning scale ANS: A PTS: 1 9. Annie is a 30-year-old African American woman that complains of “coughing up blood.” What is a likely cause of her condition? A. Bronchogenic carcinoma B. Pulmonary embolus with infarction C. Mitral stenosis D. Bronchitis ANS: C PTS: 1 10. African American patients seem to have a negative reaction to which of the following asthma medications? A. Inhaled corticosteroids B. Long-term beta-agonist bronchodilators C. Leukotriene-receptor agonists D. Oral corticosteroids ANS: B PTS: 1 11. Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? A. Asthma B. Emphysema C. Chronic bronchitis D. Influenza ANS: C PTS: 1 12. You are using the CURB-65 clinical prediction tool to decide whether Latisha, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Which of the following risk factors would increase Latisha’s chance of CAP- associated mortality and complications? A. Temperature of 100°F B. Respiratory rate 22 breaths per minute C. Hemoglobin 9.5 g/dL D. History of diabetes mellitus ANS: D PTS: 1 13. Fredericka is a 40-year-old Hispanic female with a history of diabetes mellitus, hypertension, and HIV. She has a tuberculosis (TB) skin test. What is the smallest diameter of induration that would indicate a positive result? A. 2 mm B. 5 mm C. 8 mm D. 10 mm ANS: B PTS: 1 14. Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TST)? A. She is on a high-protein diet. B. She is an adolescent. C. She has been on a long-term corticosteroid therapy. D. She just got over a cold. ANS: C PTS: 1 15. Marci has been started on a TB regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically? A. Pyridoxine B. Thiamine C. Probiotic D. Phytonadione ANS: A PTS: 1 16. Which of the following patients is most likely to have squamous cell carcinoma? A. Janice, a 70-year-old female and is a nonsmoker B. Bill, a 65-year-old male with a 20-year history of smoking C. Sophie, a 30-year-old female with a family history of lung cancer D. David, a 90-year-old man whose brother passed away from lung cancer ANS: B PTS: 1 17. Amy has a history of lung cancer and is experiencing new-onset right side ptosis and miosis and says, “I’m so hot, but I’m not sweating.” Which of the following conditions can be attributed to her new-onset symptoms? A. Bell’s palsy B. Turner’s syndrome C. Murphy’s syndrome D. Horner’s syndrome ANS: D PTS: 1 18. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean? A. The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated. B. The cancer is in situ; it is spreading into the lymph nodes but the spread cannot be evaluated otherwise. C. The cancer is less than 3 cm in size and has not spread to the lymph nodes or other parts of the body. D. The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant spreading. ANS: C PTS: 1 19. Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do? A. Hand him literature about smoking cessation at every visit. B. Wait until he is ready to talk to you about quitting. C. Document in the record that he is not ready to quit. D. Continue to ask him at every visit if he is ready to quit. ANS: D PTS: 1 20. Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking? A. He should stop smoking today. B. He should stop smoking tomorrow. C. His quit date should be in 1 week. D. He will be ready to quit after the first 30 days. ANS: C PTS: 1 21. Which information should be included when you are teaching your patient about the use of nicotine gum? A. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa. B. Patients should not eat for 30 minutes prior to or during the use of the gum. C. Initially, 1 piece is chewed every 30 minutes while awake. D. Acidic foods and beverages should be encouraged during nicotine therapy. ANS: A PTS: 1 22. Which of these sputum strains would one use to test for a viral respiratory culture? A. Gram stain B. Direct fluorescent antibody stain C. Wright-Giemsa stain D. Acid-fast stain ANS: B PTS: 1 23. What is the first-line recommended treatment against Group A beta-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis? A. Penicillin B. Quinolone C. Cephalosporin D. Macrolide ANS: A PTS: 1 24. Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity? A. Mild intermittent B. Mild persistent C. Moderate persistent D. Severe persistent ANS: C PTS: 1 25. Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking? A. Inhaled corticosteroid B. Leukotriene-receptor antagonist C. Systemic corticosteroid D. Methylxanthines ANS: A PTS: 1 26. Your patient is on theophylline for his asthma. You want to maintain his serum levels between: A. 0 to 5 mcg/mL B. 5 to 10 mcg/mL C. 5 to 15 mcg/mL D. 10 to 20 mcg/mL ANS: C PTS: 1 27. George has COPD and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD? A. Stage 1 mild COPD B. Stage 2 moderate COPD C. Stage 3 severe COPD D. Stage 5 very severe COPD ANS: A PTS: 1 28. Most nosocomial pneumonias are caused by: A. Fungi B. Viruses C. Gram-negative bacteria D. Pneumococcal pneumonia ANS: C PTS: 1 29. Which of the following statements regarding TST is true? A. Tests should be read 48 hours after the injection. B. The size of the TST reaction has nothing to do with erythema but is based solely on induration. C. It is a type V T-cell-mediated immune response. D. The diameter of the induration is measured in centimeters. ANS: B PTS: 1 30. Which obstructive lung disease is classified as reversible? A. Asthma B. Chronic bronchitis C. Emphysema D. COPD ANS: A PTS: 1 31. Which of the following asthma medications should be used cautiously with geriatric patients? A. Atrovent B. Ventolin C. Singulair D. Asmanex ANS: B PTS: 1 32. Which statement about adenocarcinoma of the lung is accurate? A. It is the least common type of lung cancer, representing approximately 5% to 10% of cases. B. It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors. C. It is more common in men than in women and occurs almost entirely in cigarette smokers. D. It is aggressive, with rapid growth in primarily the liver and brain. ANS: B PTS: 1 33. Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors? A. He is a recovering alcoholic of 6 years. B. His collar size is 17 inches. C. He is the only person in his family who has this. D. He is extremely thin. ANS: B PTS: 1 34. What is the pressure needed for continuous positive air pressure (CPAP) to abolish apneas, snoring, and oxyhemoglobin desaturations in all positions and during REM sleep? A. 5 to 20 cm H2O B. 10 to 25 cm H2O C. 15 to 25 cm H2O D. 20 to 35 cm H2O ANS: A PTS: 1 35. What is a procedure that can be performed in the outpatient setting for a patient with obstructive sleep apnea? A. Mandibular advancement B. Laser-assisted uvulopalatoplasty C. Retrog