FNP Final Exam III Latest 2024 Questions And Answers

FNP Final Exam III The following statements about the pathophysiology of OA are all true except: - ANS OA affects only bone and cartilage WHich statement or statements about OA is (are) not true? - ANS A) Although excessive weight may contribute to the development of OA, weight loss has NOT been shown to lead to improvement in symptoms or functionality. C) Strength training has not been shown to be helpful for patients with OA and is likely to exacerbate symptoms. Which statement about OA is not true? - ANS Patients with OA of the lower extremities should avoid tai chi as it has been shown to exacerbate lower extremity OA. New International Recommendations for diagnosis of myofascial pain syndrome from include: - ANS All of the above Which of the following statements are true regarding needle based interventions for myofascial pain syndrome? - ANS B & C B) Dry and wet needling appear to have similar benefits in the short term. C) Wet needling appears to have improved benefit in the medium-term vs dry needling, although the long-term significance of this are unknown. Which of the following statements are true regarding physical therapy interventions for myofascial pain syndrome? - ANS There is good evidence that the best outcomes are derived from the combination of individualized clinic therapies supported by active self-management techniques (exercise, stretching, relaxation). A 44-year-old male patient presents to your clinic for evaluation of persistent low back pain symptoms. He would like to discuss getting a magnetic resonance imaging scan and explore his treatment options. He has a prior history of intermittent low back pain with flares approximately twice per year for 10 years, but has had persistent daily symptoms for the past 6 months. He reports bilateral paraspinal pain that does not radiate past the buttocks. He has tried nonsteroidal antiinflammatory drugs, which provided some relief, but caused stomach discomfort, and he has completed a course of physical therapy without significant improvement. In your discussion of treatment options, all are reasonable approaches to include, except: - ANS Epidural steroid injection Your patient asks your opinion on mind-body techniques to help with pain management. Which of the following statements is consistent with current evidence? - ANS Behavioral therapies as a whole have shown improvements in functional status in patients with low back pain. Which of the follow statements about acupuncture are incorrect? - ANS The American College of Physicians (ACP) low back pain guidelines list acupuncture as a primary treatment option for acute low back pain. Out of the following listed choices, which one has the strongest association with chronic pain? - ANS Physiological factors Which of the following statements is correct regarding acupuncture treatments for neck pain? - ANS Overall, there is moderate evidence in favor of acupuncture for treatment of chronic neck pain when compared to sham acupuncture Which of the following is true regarding the evidence base for hands-on approach to the treatment of chronic neck pain? - ANS A multimodal, team-based approach that utilizes several modalities, including hands-on body work, often results in the most effective long-term pain relief. When managing chronic gouty arthritis, titrate urate-lowering therapies to achieve serum uric acid levels less than: - ANS 6 Lifestyle recommendations for gout should include all of the following except: - ANS Avoidance of all purine-rich foods Appropriate pharmacological treatments of acute gouty flairs include (choose all correct): - ANS a. Indomethacin b. Naproxen d. Prednisone f. Colchicine (low dose) A 43-year-old female working in janitorial services presents with pain and weakness in her right hand. She admits that symptoms have worsened over the past couple of years and now remain almost constant and have affected her ability to grip a mop and squeeze a spray bottle. She frequently awakens at night and has to "shake out" the pain and numbness she is experiencing. On physical exam there is decreased sensation to pinprick over the first through third phalanges and you note the right thenar eminence is much less robust than the left. Based of the condition in this patient? - ANS Refer patient for electrodiagnostic studies and to visit a hand surgeon. A 29-year-old female at the end of her second trimester is experiencing increasing discomfort of both hands. She states that pain and numbness are most noticeable while performing daily tasks around the house and washing dishes. After a thorough history and physical the most likely etiology is determined to be carpal tunnel syndrome (CTS). Which of the following management options would not be recommended for this patient - ANS Obtaining electrodiagnostic studies to evaluate the need for surgery. After determining a management plan, the patient wonders if there is anything aside from medications that she could take to help with her pain relief. Of note she also mentions she has had occasional nausea throughout her pregnancy. Which of the following would be an appropriate option for this patient? - ANS Suggest daily dosing of ginger capsules. The underlying progression of pathology of lateral and medial epicondylosis is currently viewed as: - ANS Acutely inflammatory and chronically degenerative Which of the following needle or injection-based therapies have for epicondylosis shown positive outcomes in randomized controlled trials? Select all that apply. - ANS a. Acupuncture b. Platelet rich plasma c. Prolotherapy d. ********All of the above ******* Current "best evidence" favors corticosteroid injections as standard of care for most cases of lateral and medical epicondylosis. - ANS False 1. When counseling a patient about the long-term effects of fibromyalgia syndrome, what is important to include in teaching? - ANS A multidisciplinary approach to treatment is most effective. 1. Which are symptoms associated with fibromyalgia? Select all that apply. - ANS Gastrointestinal complaints Musculoskeletal pain Non-restorative sleep 1. Which cause is implicated in patients with fibromyalgia syndrome (FMS)? - ANS Central nervous system dysfunction 1. A patient with gout and impaired renal function who uses urate-lowering therapy (ULT) is experiencing an acute gout flare involving one joint. What is the recommended treatment? - ANS Administration of intra-articular corticosteroid 1. A patient experiences a second gouty flare and the provider decides to begin urate-lowering therapy (ULT). How should this be prescribed? - ANS Start ULT in 5 weeks along with an anti-inflammatory drug 1. A post-menopausal female patient has a blood test that reveals hyperuricemia, although the patient has no symptoms of gout. What will the provider do? - ANS Ask the patient about medications and medical history 1. A patient with chronic hip pain cannot take NSAIDs and tells the provider that acetaminophen is minimally helpful. What might the provider recommend initially to improve pain relief? - ANS Capsaicin 1. An adult patient who has been taking high-dose corticosteroids reports a dull, aching pain in the groin and presents with a limp. What condition does the provider suspect, based on this history? - ANS Avascular necrosis of the femoral head 1. A patient reports the sudden onset of pain, redness, and swelling in one knee joint along with a no fever. The provider elicits exquisite pain with manipulation of the joint and notes no decrease in pain when the joint is at rest. Which is the likely cause of this arthritis? - ANS Bacterial infection 1. An adolescent patient reports pain and swelling in various joints on the right side that comes and goes and occurs in the knee, elbow, wrist, and ankle. A physical examination reveals tenosynovitis and a maculopapular rash. Which diagnostic tests will be most helpful in determining a diagnosis in this patient? - ANS Cultures of the urethra, pharynx, cervix, and rectum 1. A patient has marked swelling of a shoulder joint with erythema and severe pain. The provider suspects a bacterial cause. Which culture will be most helpful to determine the cause of these symptoms? - ANS Synovial fluid culture 1. A patient is diagnosed with osteoporosis. What is the recommended treatment once the diagnosis is made? - ANS Biphosphonate therapy 1. A patient has bone pain and laboratory testing reveals an elevated serum alkaline phosphatase (SAP). Which test can help distinguish Paget's from malignant bone disease? - ANS Bone radiograph 1. The primary care provider is assessing a 45-year-old postmenopausal woman who has a family history of osteoporosis. Which test will be most useful to screen for this disease in this patient? - ANS Bone densitometry of the hip and posteroanterior lumbar spine 1. A 45-year-old patient has mild osteoarthritis in both knees and asks about non-pharmacologic therapies. What will the provider recommend? - ANS Aerobic exercise 1. A patient who has osteoarthritis in the carpometacarpal joints of both thumbs asks about corticosteroid injections to treat symptoms. What will the provider tell this patient about this therapy? - ANS This treatment may cause a temporary increase in pain, warmth, and redness 1. A 50-year-old woman reports pain in one knee upon awakening each morning that goes away later in the morning. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the provider tell this patient? - ANS To take acetaminophen 1 gram three times daily for pain When choosing a fish oil supplement for treating depression one should select a product containing: - ANS A combination of EPA and DHA but with at least 60% EPA A Cochrane review of St. John's wort suggests that it is: - ANS d. As effective and better tolerated than serotonin specific reuptake inhibitors (SSRI) Which of the following supplements could be considered as addition to conventional treatment for depression? - ANS A) Vitamine D C. B Vitamin Complex E)***** A & C***** A patient presents with mild depression and anxiety in October. He reports lethargy and anhedonia but is not suicidal. His anxiety is predominantly work-related and he has trouble relaxing at night leading to a degree of insomnia. His summer was great. He knows he has seasonal affective disorder. He has begun taking St. John's wort. He reports this treatment is only partially helping his anxiety and he enquires regarding the availability of other supplements for the treatment of anxiety and insomnia. - ANS Kava Kava Of the following beverages, which is likely to have the highest amount of caffeine per equal volume? - ANS Regular cup of coffee A middle aged patient with Barrett's esophagitis, hypertension, and mild anxiety /depression expresses a wish to stop her Prozac treatment. In addition to lifestyle interventions including diet and exercise, she takes a proton pump inhibitor and an angiotensin converting enzyme inhibitor. You decide to start her on S-adenosylmethionine (SAMe). What following nutrient is important for maximizing the efficacy of SAMe? - ANS Vitamin B12 The best way to diagnose ADHD is by: - ANS Vanderbilt parent and teacher rating scales The best behavioral approach to ADHD is: - ANS Focus on strengths, goals, and SMART strategies including healthy habits in a healthy habitat to achieve goals The optimal amount of exercise for someone with ADHD is - ANS 30-60 minutes daily Which dietary supplements are most likely to be helpful for children with ADHD? - ANS Omega-3 fatty acids, iron, magnesium The current understanding of the relationship between autism and vaccines is most consistent with the following statement: - ANS There is strong and consistent evidence that there is no causal link between vaccines and autism. When treating children with pharmaceutical medications, such as stimulants, antipsychotics, and serotonin reuptake inhibitors, the best method for insuring a reliable response is: - ANS Decide with parent(s) the specific symptoms to be targeted and then initiating one medication at a time at a low dose before slowly tapering upward to reach the lowest effective dose. What strategies can be employed by mothers to decrease the risk of having a child with autism? - ANS Advise against What is the primary objective of the noise reduction approach to managing insomnia? - ANS Decreasing psychophysiological activation associated with hyperarousal What kind of disrupted temperature rhythm is commonly associated with sleep onset insomnia? - ANS A delayed circadian temperature rhythm New research suggests that insomnia patients who do not have access to behavioral sleep medicine specialists might effectively be treated in primary care by? - ANS A brief, single-session of stimulus control therapy Which formulation and administration of melatonin is indicated for sleep maintenance insomnia or early morning awakenings? - ANS Immediate release sublingual formulations administered at awakening Chronic PTSD is associated with an excess risk of: - ANS a. Suicidality b. Substance use disorders c. Coronary artery disease d. *****All of the above***** Which of the following is not part of the diagnostic criteria for PTSD? - ANS Disrupted interpersonal relationships Which of the following modalities has consistently not been found to be helpful in treating PTSD? - ANS Relaxation therapy Which of the following CAM modalities is the only one to have been evaluated among children or adolescents to treat PTSD in the U.S.? - ANS Exercise Which of the following psychotherapeutic modalities are considered empirically supported treatments (ESTs) for PTSD? - ANS a. Prolonged exposure (PE) therapy b. Eye movement desensitization and reprocessing (EMDR) c. Cognitive processing therapy (CPT) d. *****All of the above***** A 79-year-old woman is in an integrative medicine office for her family's concern of her losing memory. In the past few months she has left the stove on after cooking and gotten lost driving in her own neighborhood. During the visit, she is not able to recall three out of three objects on the Mini-Cog but her clock draw is normal. Patient's routine physical exam and blood work are unremarkable, including vitamin B12 level and thyroid function. In addition to comprehensive memory evaluation what else should be assessed at this time? - ANS Zinc/copper levels and C-reactive protein Of the following natural products which one has the best evidence to attempt to slow down Alzheimer disease progression? - ANS Huperzine A Of the following sentences select the best preventive recommendation for a patient with strong family history of Alzheimer disease. - ANS "Engage in physical and cognitive exercises daily or at least five times per week." Of the following conditions, please select the one that U.S. healthcare spends most money on: - ANS Dementia Out of the list of supplements and botanicals that follow, which one has the least evidence for treating the symptoms of migraine? - ANS Fish oil Biofeedback techniques may enhance effectiveness of preventive, abortive, and rescue migraine medications and have shown synergistic effects with some supplements and pharmaceuticals. However, what class of medications may interfere with biofeedback effectiveness? - ANS β-blockers Which of the following modalities have been found effective in the treatment of migraine, but not tension headaches? - ANS Spinal manipulation Which of the following have been proven safe and effective for migraine treatment in children and adolescents? - ANS a. Melatonin b. Coenzyme Q10 c. Fish oil d. *****All of the above**** Which type of diet has been shown to provide the best outcome for diabetic neuropathy patients? - ANS Plant-based Which herbal ingredient has been shown to lower oxidative-stress, provide neuroprotection, and lower pain through NF-kB, COX-2, and TNF, and improve complications from diabetes and neuropathy? - ANS Curcumin Which type of acupuncture is preferred to improve diabetic neuropathy symptoms? - ANS Neuroacupuncture (scalp) Which therapy is best at lowering blood glucose, improving immune functions, and increasing microcirculation, which may improve the penetration and increased efficacy of the medications used to treat peripheral neuropathy? - ANS Pulsed electromagnetic frequency (PEMF) Which one of these statements about multiple sclerosis (MS) is most valid? - ANS MS is a complex disorder characterized by axonal injury, inflammation, and demyelination. The pathological hallmark of MS is the presence of demyelinated plaques in the brain and spinal cord on MRI. Which of the following statements about the effect of lifestyle on MS is most valid? - ANS Yoga has been shown to improve mood and fatigue, and an 8-week mindfulness meditation class has been shown to improve quality of life, anxiety, depression, and fatigue among patients with MS. Which statement is the least valid regarding therapies for MS? - ANS Biotin is a water soluble B-vitamin that is thought to prevent both demyelination (by triggering myelin synthesis) and neurodegeneration (by replenishing ATP in hypoxic neurons). The recommended effective daily dose as a disease-modifying therapy for MS is 30 mcg daily, which approximates the adequate daily intake for adults. The following are all associated with an increased risk of developing Parkinson's disease except: - ANS Cigarette smoking Which of the following is not a common non-motor symptom in Parkinson's disease? - ANS Kidney stones Which of the following has the most evidence for slowing the progression of Parkinson's disease symptoms and disability? - ANS Exercise A proposed mechanism of addiction for all substances of abuse involves the sudden release of a neurotransmitter that is believed to cause a sense of euphoria and pleasure that is at the root of drug abuse. Which neurotransmitter is most responsible for this "reward pathway?" - ANS Dopamine Which pharmaceutical treatment can assist in preventing alcohol relapse by reducing the anxiety and sleep disturbances associated with alcohol craving? - ANS Acamprosate Which of the following is a traditional Chinese herb and has been used as an "antiinebriation" treatment for hundreds of years? - ANS Kudzu Which of the following modes of therapy has been found to be most effective in sustaining abstinence in alcoholism? - ANS Spiritual, 12-step programs 1. What are some common goals of neuropsychiatric evaluation? Select all that apply. - ANS To evaluate cognition when neuro-diagnostic tests are normal To help identify rehabilitation goals in brain-injured patients To monitor changes in symptoms over time 1. What is an important purpose of conducting an interview prior to beginning neuropsychological testing on an older adult suspected of having dementia? - ANS To assess the patient's ability to cooperate with the testing 1. A patient with a family history of amyotrophic lateral sclerosis (ALS) begins to have symptoms that include asymmetric weakness in the arms and difficulty walking. The neurologist recognizes these symptoms as characteristic of involvement of which portion of the nervous system? - ANS Lower motor neurons 1. The spouse of a patient newly-diagnosed with amyotrophic lateral sclerosis (ALS) asks about long-term care. What will the provider include when teaching the family about this disease? - ANS Preventing malnutrition is a key element in care. 1. Which symptoms may occur with Bell's palsy? Select all that apply. - ANS Alteration in taste Drooling Tinnitus 1. A 35-year-old patient reports suddenly experiencing an asymmetric smile along with drooping and tearing in one eye. The patient has a history of a recent viral illness, but is otherwise healthy. During the exam, the provider notes that there is unilateral full face paralysis on the right side. What is the initial intervention for this patient? - ANS Prescribe oral prednisolone 1. What is recommended to prevent ophthalmic complications in patients with Bell's palsy? - ANS Lubricating eye drops 1. A previously healthy 30-year-old patient is brought to the emergency department with signs of stroke. Diagnostic testing determines an ongoing ischemic cause. The patient's spouse reports that symptoms began approximately 2 hours prior to transport. What is the recommended treatment? - ANS Tissue plasminogen activator (tPA) administration 1. An elderly patient is brought to the emergency department after being found on the floor after a fall. The patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. The patient's blood pressure is 220/190 mm Hg. What is the likely treatment for this patient? - ANS Neurosurgical consultation 1. A patient exhibits visual field defect, ataxia, and dysarthria and complains of a mild headache. A family member reports that the symptoms began several hours prior. An examination reveals normal range of motion of the neck. What type of cerebrovascular event is most likely? - ANS Ischemic stroke 1. What are initial approaches when managing delirium in a hospitalized patient who is agitated and confused? Select all that apply. - ANS Attend to hydration and toileting needs Decrease stimulation Discontinue any non-essential medications 1. A previously lucid patient with early-stage Alzheimer's disease is hospitalized after a surgical procedure and exhibits distractibility and perceptual disturbances that occur only in the late afternoon. The patient has difficulty sleeping at night and instead sleeps much of the morning. What is the likely cause of these symptoms? - ANS Delirium 1. A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient's symptoms? - ANS Lewy body dementia 1. A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? - ANS Encourage activity and exercise 1. An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? - ANS Prescribe a trial of an antidepressant medication 1. A patient reports a recurrent sensation of spinning associated with nausea and vomiting. Which test will the provider order to confirm a diagnosis for this patient? - ANS The Hallpike-Dix positioning maneuver 1. An elderly patient reports sensations of being off balance when walking, but does not experience dizziness. The provider will refer this patient to which specialist for further evaluation? - ANS Neurologist 1. Which diagnostic test helps confirm a diagnosis of Guillain-Barre syndrome in a patient who is developing muscle weakness and paresthesias? - ANS Lumbar puncture 1. Which monitoring parameters are necessary when caring for a patient with Guillain-Barre syndrome? Select all that apply. - ANS Bladder scans Cardiac telemetry Fever Vital capacity measures 1. Following an upper respiratory infection, a patient begins to develop ataxia and distal paresthesias, along with oculomotor symptoms and double vision. Based on these presenting symptoms which type of GBS does this patient have? - ANS Miller Fisher syndrome (MFS) 1. A patient has recurrent cluster headaches and asks about abortive therapy. Which therapy is effective for a majority of patients with cluster headaches? - ANS Oxygen 1. A patient reports recurrent headaches occurring 1 or 2 times per month that generally occur with weather changes or when sleep patterns are disrupted and describes them as severe, with throbbing on one side of the head and sometimes accompanied by nausea. What is the recommended treatment for this type of headache? - ANS Rizatriptan 1. Which medications may be useful in treating tension-type headache? Select all that apply. - ANS Antiemetics Muscle relaxants NSAIDs 1. A provider suspects that a patient has bacterial meningitis. When should antibiotics be given? - ANS Prior to obtaining a CT scan or lumbar puncture 1. A patient is brought to the emergency department with fever, lethargy, and headache without meningeal signs. The examination reveals hypotension and lethargy and the examiner notes petechiae on the patient's trunk. What do these findings indicate? - ANS A poor prognosis 1. Which are common hyperkinetic movement disorders? Select all that apply. - ANS Dystonia Essential tremor Tourette's syndrome 1. A patient reports trembling of both hands causing difficulty performing tasks with the hands. The provider notes symmetric, rhythmic movements which are present at rest and no other neurological findings. A history reveals that the trembling decreases when the patient has a glass of wine with dinner. What is the initial action? - ANS Prescribing a beta blocker medication 1. A patient reports two episodes of visual disturbances and eye pain that lasted 1 to 2 days each about 2 months apart. Which diagnostic testing will the provider order initially? - ANS Magnetic resonance imaging 1. A patient diagnosed with multiple sclerosis and begins disease modulating therapy drugs. As part of the counseling about this therapy, the provider will tell the patient that this regimen will - ANS reduce the exacerbation rate. 1. A patient with Parkinson's disease (PD) has been taking carbidopa-levodopa (Sinemet) with good results, but develops increased dyskinesia. Which drug will be added to this patient's regimen to help control this symptom? - ANS Amantadine 1. A primary care provider suspects Parkinson's disease (PD) in a patient. Which tests may be performed to diagnose this disorder? - ANS Presence of 2 cardinal signs which improve with levodopa 1. What are common symptoms seen in patients with Parkinson's disease? Select all that apply. - ANS Bradykinesia Festination Rigidity 1. A patient who has a seizure disorder and who takes levetiracetam is brought to an emergency department with a seizure which has persisted for15 minutes and which immediately followed another 15 minute seizure. What is the priority action for this patient? - ANS Administer lorazepam and monitor cardiorespiratory status 1. A patient with a seizure disorder has seizures which begin with eye twitching and occasionally visual hallucinations. Which site in the brain is the seizure focus? - ANS Ocipital 1. Which drug is used to treat patients with focal epilepsy and complex partial seizures? - ANS Carbamazepine 1. A patient reports paroxysms of burning, shock-like pain on both sides of the face usually triggered by chewing or talking. The provider suspects trigeminal neuralgia. Based on these presenting symptoms, what testing is indicated? - ANS Magnetic resonance imaging 1. A patient with trigeminal neuralgia has tried several medication regimens to control pain without success. What is the next step in management for this condition? - ANS Referral to a neurosurgeon 1. A patient is diagnosed with trigeminal neuralgia and reports having paroxysms several times each day. What is the initial treatment for this patient? - ANS A high dose of carbamazepine with subsequent titration downward 1. A patient develops a gait disorder and the patient's spouse reports noticing recent personality changes. The provider suspects a brain lesion. Which evaluation is especially important in the initial physical examination? - ANS Examination of the optic fundi 1. Which is the preferred treatment for primary brain tumors? - ANS Surgical resection 1. A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake inhibitor medication. Six weeks later, the patient reports little relief from symptoms. What will the provider do next to manage this patient? - ANS Refer to a mental health provider 1. Which medication are useful in treating both obsessive-compulsive disorder and PTSD? Select all that apply. - ANS Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors Tricyclic antidepressants 1. A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? - ANS Headaches and bowel habits 1. A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of sadness and hopelessness and a feeling that the parent is still present, even to the point of hearing the parent's voice at times. What will the provider determine from these findings? - ANS These are normal grief responses. 1. A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient's symptoms? - ANS Begin treatment with lithium or lamotrigine 1. A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially? - ANS Perform a suicide risk assessment 1. A patient is brought to the emergency department who is experiencing disorientation, confusion, and fever. The patient describes visual and auditory hallucinations. The patient's spouse states that the patient had several drinks 12 hours prior to passing out. A blood alcohol level is 0.2%. What is the recommended treatment? - ANS Benzodiazepines 1. A college student is brought to the emergency department by a roommate who is concerned about symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects withdrawal from which substance? - ANS Opioids 1. A 17-year-old male is brought to the clinic by a parent who is concerned that the patient has become more isolated and withdrawn and expresses suspicions that his teachers hate him and want him to fail. What will the provider tell this parent? - ANS The adolescent should be evaluated by a psychiatrist. 1. A young male patient is reported to be more withdrawn from his peers than usual and has dropped out of college and quit his job within the last 5 months. The parent is concerned that the patient may have schizophrenia because a maternal uncle has the disease. What will the provider do next? - ANS Ask about the patient's speech and thinking patterns 1. Which are considered "negative" symptoms of schizophrenia? Select all that apply. - ANS Impaired self care Poor school performance Withdrawing from peers Based on Dr. Hans Selye's description of the body's response to chronic stress, the following is the initial phase of the general adaptation syndrome: - ANS Alarm A healthy 33-year-old woman presents to your clinic with concerns about persistent anxiety due to high stress levels at work. She is unable to change jobs at this time, does not want to use medications, and has a hard time sitting still. Which of the following relaxation practices would you avoid recommending? - ANS Autogenic training Which of the following would not typically be considered a key component of relaxation techniques? - ANS Clearing the mind True or False: It is important for someone to read a person's journaling to give feedback and help process the information. - ANS False Which of the following conditions have the best evidence for the therapeutic effects of journaling? - ANS Diabetes control All of the following are important in prescribing journaling except: - ANS Encouraging writing about stressful events, even if the individual does not feel ready to explore them The science and art of homeopathy - ANS Is a 200-year-old practice of medicine that utilizes microdoses of plants, minerals, and animal substances. The Law of Similars - ANS States that "likes cure likes," and is the underlying tenet of homeopathy. Homeopathic medicines - ANS a. Are made from plants, animals, minerals, and disease byproduct materials. b. Are diluted and potentized by succussion through a series of cycles. c. Are considered more potent with higher numbers of dilution and succession. d. *******All of the above.******** Which color/aspects of health are most commonly associated with the second chakra? - ANS Orange; emotional life and self-esteem Based on biofield therapy research, which of the following is true about what we know regarding the mechanism of action of these approaches? - ANS We do not yet know the mechanism of action for biofield therapies Biofield therapy research has been conducted most frequently for which common health issues? - ANS Pain and as an adjunctive treatment for people with cancer 1. 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? - ANS Polysomnography 1. Which medications are associated with weight gain? Select all that apply. - ANS Antidepressants Antihistamines Insulin analogs Seizure medications 1. 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? - ANS Stretching should be performed prior to activity 1. 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? - ANS Evaluate the patient for impaired glucose tolerance 1. The primary care provider is screening a patient using the CAGE criteria. What will the provider include in this assessment? Select all that apply. - ANS Number of times per week eaten in restaurants Sources of daily dairy intake Types of meats and proteins 1. A 50-year-old female patient has a blood pressure of 118/72 mm Hg, a negative family history for breast and ovarian cancer, a normal Pap smear 2 years prior, and a Framingham risk screening within normal limits. Which should be part of this patient's routine annual well-patient exams? - ANS Breast cancer screening and mammogram 1. 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? - ANS The trivalent influenza vaccine is indicated annually 1. A 60-year-old patient with a previous history of shingles asks about the herpes zoster vaccine. What will the provider recommend? - ANS A single dose of herpes zoster vaccine 1. A patient who has a history of working around asbestos and silica fibers is concerned about developing lung disease. The primary care provider determines that the patient has a previous history of asthma as a child and currently has frequent episodes of bronchitis. A physical examination is normal and pulmonary function tests and radiographs are negative. What action is correct? - ANS Refer the patient to an occupational health specialist 1. During a pre-placement screening for a person hired for a job requiring heavy lifting, a primary care provider notes that the new employee has environmental allergies, a history of GERD, recurrent eczema, a previous history of an ankle fracture, and normal lower back strength and flexibility. A urine drug screen is negative. What will be included in the report to the employer? Select all that apply. - ANS Lower back screening results Urine drug screening results 1. A female freshman college student tells the primary care provider at the student health center that she has a history of anorexia nervosa that has been well-controlled for several years. What will the provider recommend for this student? - ANS Stress management strategies 1. A female college student seeks information about emergency contraception. What is the most important part of the assessment of this patient? - ANS The female's sense of control in sexual situations 1. An international traveler plans to travel to Kenya in sub-Saharan Africa. Which is an important disease precaution for this person? - ANS Starting prophylactic doxycycline before travel 1. A patient returns home from travel in Africa and experiences chronic, non-bloody diarrhea. The patient reports frequent bloating and flatulence with a "rotten egg" smell. What is the treatment for this type of diarrhea? - ANS Metronidazole 1. A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccines? - ANS Requirements should be reviewed at least 6 to 8 weeks prior to travel. 1. Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? Select all that apply. - ANS Patient's age Patient's comorbidities Surgeon's preference Type of anesthetic agent planned 1. Which patient should have pulmonary function testing as part of the presurgical exam? - ANS A patient undergoing major intra-thoracic surgery 1. During a pre-participation sports physical, the examiner notes a difference in strength of the patient's radial and femoral pulses with the femoral pulses being weaker. What will the provider do? - ANS Refer the patient for a cardiologic exam 1. An overweight adolescent who takes metformin has type 2 diabetes with a HgA1c of 8.5% and asks about sports participation. What will the provider recommend? - ANS Referral to the endocrinologist for sports clearance 1. A high-school adolescent is being screened for fitness before participating in sports. The adolescent has a normal examination and the examiner notes S1 and S2 heart sounds without murmur, normal blood pressure, and equal pulses. The parent reports that the adolescent's father has a history or Wolff-Parkinson-White syndrome, which has been treated. What will the provider do? - ANS Refer the adolescent to a cardiologist 1. What is included in the mitigation phase of emergency management? - ANS Identification of risks 1. A primary care office develops a plan for what to do in case of a fire in the building. As part of the plan, two people are to take charge in case of this emergency. Which phase of emergency planning does this represent? - ANS Response 1. 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? - ANS Notify the patient's physician immediately 1. Which clinical findings are worrisome in a patient experiencing acute bronchospasm, requiring immediate treatment? Select all that apply. - ANS A silent chest after previously wheezing Decreasing blood pressure Presence of an urticarial rash 1. Which symptom in a patient with asthma indicates severe bronchospasm? - ANS Pausing to breathe while attempting to talk 1. A child with no previous history of asthma is brought to the emergency department with wheezing, stridor, and shortness of breath. When the child is started on oxygen and given a nebulized bronchodilator treatment, the treatment team notes a wheal and flare rash on the child's trunk. What medication will be given immediately? - ANS Intramuscular epinephrine 1. A man self-administers epinephrine using an Epi-Pen after experiencing a bee sting and developing angioedema and wheezing. What should the man do next? - ANS Obtain transport to an emergency department immediately 1. 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. - ANS CBC, BUN, electrolytes, and creatinine Coagulation studies Tetanus prophylaxis 1. 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? - ANS Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours 1. 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? - ANS Refer the patient to a cardiologist 1. 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? - ANS Epinephrine 1. Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, or defibrillation? - ANS Polymorphic ventricular tachycardia 1. Current American Heart Association (AHA) recommendations include: Select all that apply. - ANS A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths Using a ratio of 2 rescue breaths to 30 compressions 1. 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? - ANS Ventricular fibrillation 1. A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)? - ANS Assessment of gasping breaths or not breathing 1. What is true when considering activated charcoal for gastrointestinal decontamination to treat a toxic substance ingestion? - ANS It must be administered within 60 minutes of ingestion. 1. 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? - ANS Remove the patient's clothing and irrigate the skin for 15 to 30 minutes 1. 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. - ANS Flushed skin Hallucinations Mydriasis 1. What is true about electrical injuries? Select all that apply. - ANS Alternating current causes tetanic skeletal muscle contractions. Electrical injury causes more tissue necrosis in nerves than other tissues. Lightning is less lethal because the duration of electrical strike is short. 1. An adolescent male has an electrical injury from a high-voltage wire after climbing a tree. Which initial diagnostic test is necessary? - ANS 12-lead electrocardiogram 1. When performing diagnostic tests to determine which environmental allergens cause symptoms in an atopic patient, which aspects of scratch testing are preferable to other methods? Select all that apply. - ANS It has a lower potential for anaphylaxis.. It is safer. It produces more rapid results. 1. Which immunoglobulin is responsible for initiating the allergic cascade in susceptible individuals who are exposed to allergens? - ANS IgE 1. Which food allergies in children may be outgrown in the first decade of life? Select all that apply. - ANS Egg allergy Milk allergy 1. 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? - ANS Non-enhanced computed tomography of the head 1. A patient who sustained a head injury has a Glasgow Coma score of 14. The patient's spouse reported that the patient lost consciousness for approximately 7 minutes after falling down the stairs. A head CT does not reveal brain lesions. Which treatment is indicated? - ANS Admission to the hospital with a neurosurgical evaluation 1. A patient is brought to the emergency department after being hit in the head with a baseball. The patient is awake and talking, but is confused and disoriented and does not obey simple commands. The patient is able to point to the area of pain and opens eyes only when commanded to do so. Bystanders report a period of unconsciousness lasting almost 5 minutes. Which severity of traumatic brain injury is likely? - ANS Moderate 1. A young adult patient is being treated for hypertension and is noted to have a resting blood pressure of 135/88 mm Hg just after finishing a meal. After standing, the patient has a blood pressure of 115/70 mm Hg. What is the likely cause of this change in blood pressure? - ANS Antihypertensive medications 1. 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? - ANS Initiation of a fall risk protocol 1. 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. - ANS Crossing the legs when standing up Custom-fitted elastic stockings Increased physical activity 1. A patient who ingested a bottle of acetaminophen tablets is brought to the emergency department. Which treatment is indicated? - ANS N-acetylcysteine 1. Several groups of college students arrive in the emergency department reporting severe gastrointestinal symptoms after leaving a fraternity party. After stabilizing these patients, a priority for the emergency department personnel is to - ANS contact the fraternity to determine whether others are affected. 1. What is the first priority in emergency management of a biological terrorism attack? - ANS Containing the exposures 1. 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? - ANS In two weeks and then 3 to 6 months after the assault 1. During a health maintenance examination, 17-year-old female reports having been raped repeatedly at a college party during the previous semester and tells the practitioner that she did not seek help at the time. Which action is a priority for the primary care provider? - ANS Reporting the alleged assault to law enforcement 1. When beginning a health maintenance exam, the health care provider learns that an adult patient has been sexually assaulted the previous day. What is the initial responsibility of the provider? - ANS Refer the patient to the emergency department for a forensic examination 1. Which tests are indicated as part of the initial evaluation for women of childbearing age who report syncope? Select all that apply. - ANS 12-lead electrocardiogram Complete blood count Serum glucose testing 1. A healthy 20-year-old patient reports having had 1 or 2 episodes of syncope without loss of consciousness. Which is the most likely type of syncope in this patient? - ANS Reflex syncope 1. 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? - ANS Orthostatic blood pressures 1. 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. - ANS Apply warmed blankets Elevate the child's extremities Remove all clothing 1. A patient is brought to a clinic after fainting while working outdoors on a hot day. The patient has slurred speech and headache and has a temperature of 104° F. What will the provider do? - ANS Transport the patient to the emergency department 1. 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? - ANS Heat exhaustion What is the primary objective of the noise reduction approach to managing insomnia? - ANS Decreasing psychophysiological activation associated with hyperarousal What kind of disrupted temperature rhythm is commonly associated with sleep onset insomnia? - ANS A delayed circadian temperature rhythm New research suggests that insomnia patients who do not have access to behavioral sleep medicine specialists might effectively be treated in primary care by? - ANS A brief, single-session of sleep restriction therapy Which formulation and administration of melatonin is indicated for sleep maintenance insomnia or early morning awakenings? - ANS Immediate release sublingual formulations administered at awakening A proposed mechanism of addiction for all substances of abuse involves the sudden release of a neurotransmitter that is believed to cause a sense of euphoria and pleasure that is at the root of drug abuse. Which neurotransmitter is most responsible for this "reward pathway?" - ANS Dopamine Which pharmaceutical treatment can assist in preventing alcohol relapse by reducing the anxiety and sleep disturbances associated with alcohol craving? - ANS Acamprosate Which of the following is a traditional Chinese herb and has been used as an "antiinebriation" treatment for hundreds of years? - ANS Kudzu Which of the following modes of therapy has been found to be most effective in sustaining abstinence in alcoholism? - ANS Spiritual, 12-step programs 1. A scuba diver reports persistent nosebleeds after a diving trip. What is the treatment for this condition based on this history? - ANS Decongestant medications 1. A patient is brought to an emergency department after a diving accident and is receiving inhaled 100% oxygen. This is given in order to - ANS enhance oxygen delivery to ischemic tissues. 1. When evaluating a person who is interested in taking a scuba diving class, the practitioner will screen for which conditions? Select all that apply. - ANS Chronic sinusitis Diabetes mellitus Pressure equalizing ear tubes 1. A patient with chronic leg pain describes the pain as "stabbing" and "throbbing." This is characteristic of which type of pain? - ANS Somatic pain 1. A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal anti-inflammatory drugs. What will the provider prescribe for this patient? - ANS A selective serotonin reuptake inhibitor 1. A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to discomfort, along with a desire to quit working. What will the provider do? - ANS Consult with a social worker 1. A patient is seen in the clinic with complaints of constant fatigue. The patient's spouse reports that the patient moves and kicks the legs frequently during sleep. What treatment will the provider anticipate once a diagnosis of the underlying cause is confirmed? - ANS Iron and vitamin C supplements 1. Which are causes of physiologic fatigue? Select all that apply. - ANS Excessive alcohol use Irregular sleep habits Medication side effects A patient with poorly controlled diabetes mellitus has chronic fatigue symptoms. What is the most likely underlying cause of this patient's fatigue? - ANS Calorie depletion 1. A patient has a fever of unknown etiology and blood tests reveal elevated eosinophils. The patient has no history of asthma or allergies. What may be the cause of this fever? - ANS Parasites 1. Which patients with fever should generally be treated with antipyretics? Select all that apply. - ANS Children under the age of 5 years Patients with temperature greater than 41° C Those with underlying cardiovascular disease 1. A patient reports daily, recurrent fever associated with sweating, chills, and facial flushing, along with recent weight loss. What may this type of fever indicate? - ANS Tuberculosis or lymphoma 1. A 6-month-old infant is suspected of having an immune deficiency disorder. Which diagnostic tests may be included to evaluate this patient? Select all that apply. - ANS Blood, urine, sputum, and wound cultures ESR and CRP Metabolic profiles 1. A patient who has recurrent pneumococcal pneumonia and exhibits prolonged bleeding, easy bruising, and eczema. Which immunodeficiency disorder is likely in this patient? - ANS Wiskott-Aldrich syndrome (WAS) 1. A child has a primary immunodeficiency and the parent asks the provider about vaccines. What will the provider tell this patient? - ANS Some vaccines are contraindicated in those with T-cell involvement only 1. A child developed cervical lymphadenopathy after a scabies infestation. One node remains enlarged 6 months after the infestation, but has not increased in size. The physical examination reveals a non-tender, non-erythematous node. What will the provider tell the child's parents? - ANS This node is most likely benign. 1. An adolescent patient comes to the primary care provider because of a swollen lymph node which is warm, tender, and rapidly enlarging. Which initial action will the provider take? - ANS Obtain a complete blood count with differential 1. A 50-year-old patient presents with supraclavicular lymphadenopathy. Which action is correct? - ANS Consult with an oncologist for evaluation 1. A patient is diagnosed with mild restless leg syndrome which occasionally interferes with sleep. Which initial treatment will be helpful? - ANS Hot baths and exercise 1. Which patient would benefit from a polysomnography evaluation to assess a potential sleep disorder? - ANS A child with enlarged tonsils who has daytime sleepiness 1. A patient who has excessive daytime sleepiness tells the practitioner that he goes to bed and gets up at the same times each day but still wakes up tired. The spouse reports that the patient snores so much she has had to move to another bedroom. The patient is otherwise healthy and does not take any medications or drink alcohol. Which diagnostic test may be performed for this patient? - ANS Unattended out of center sleep testing (OCST) 1. What factors may contribute to weight loss from functional anorexia in older women? Select all that apply. - ANS Apathy Delayed gastric emptying Pain with elimination 1. Which non-pharmacologic intervention may be of most benefit in frail elders to restore physical function and improve appetite? - ANS Exercise 1. An elderly woman has marked decrease in muscle strength without weight loss. Which condition does the provider suspect in this patient? - ANS Sarcopenia 1. A patient is brought to the emergency department who is experiencing disorientation, confusion, and fever. The patient describes visual and auditory hallucinations. The patient's spouse states that the patient had several drinks 12 hours prior to passing out. A blood alcohol level is 0.2%. What is the recommended treatment? - ANS Benzodiazepines 1. A college student is brought to the emergency department by a roommate who is concerned about symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects withdrawal from which substance? - ANS Opioids Well-confirmed factors that increase breast cancer risk include: - ANS Nulliparity or older age at first birth A 54-year-old woman with breast cancer has had a lumpectomy with sentinel node biopsy on the right, standard chemotherapy and radiation. She now has swelling of the right hand and arm, and you diagnose lymphedema. Which of the following recommendations would you advise? - ANS Acupuncture You are caring for a 75-year-old African American patient with metastatic breast cancer involving the bone who lives in Wisconsin and it is springtime. You ask her what supplements she is taking, and she tells you none except for a multivitamin she takes irregularly. You examine the bottle she brings in, and it indicates 400 units of vitamin D3 in each tablet. What would be your best recommendation? - ANS Recommend a dose of vitamin D based on her 25-hydroxy-vitamin D level and check a calcium level. You are seeing a 56-year-old male smoker with a 34 pack-year history of smoking. Which of the following is false? - ANS You should get an annual CXR to screen for lung cancer. An 18-year-old female who has recently started smoking cigarettes comes to your office stating she likes it but realizes she should try to quit. She asks for more information. You give her information about cigarette smoking. Which of the following is true? - ANS a. You can refer her to , a site that has multiple resources and tools for people who are interested in smoking cessation information and aids to help them along their path. b. Lung cancer is the leading cause of cancer-related deaths in the United States, accounting for 26% of cancer-related deaths in women and 28% in men. c. Smoking cessation continues to be the most important factor in reducing the risk for lung cancer. d. ******All of the above****** A patient recently diagnosed with non-small cell lung cancer (NSCLC) wishes to use an integrative approach to their cancer treatment regimen. Which of the following would you recommend? - ANS a. Surgery to remove lung cancer may be an option for early stage NSCLC. If surgery can be done early, it provides the best chance to cure NSCLC. b. Massage therapy is an effective adjunct to cancer supportive care that can reduce anxiety, depression, and pain. c. A PET scan is more effective than CT in the distinction between benign and malignant lesions. d. Oral supplementation with EPA in patients with NSCLC significantly improves energy, protein intake, and body composition while decreasing fatigue, neuropathy, and loss of appetite. e. *******All of the above******* Which type of lung cancer is most commonly found in nonsmokers? - ANS Adenocarcinoma Which of the following is the strongest risk factor for developing prostate cancer? - ANS Age All of the following are important for a patient with prostate cancer to incorporate during treatment and into survivorship except: - ANS Normal BMI All of the following have evidence supporting a reduced risk of colon cancer except: - ANS Taking folic acid supplements You are seeing a 54-year-old man who just had a partial colectomy for stage 1 (localized) colon cancer last week. He is healing well, but asks you for suggestions to reduce his postoperative pain. What do you recommend to him? - ANS Teach him guided imagery Which of the following patients is at the highest risk for having colorectal cancer and requires more frequent screening? - ANS A 50-year-old woman whose father was diagnosed with colon cancer at age 50 Of the following therapies for pain, which one is not effective: - ANS Oral synthetic cannabis for neuropathic pain Anxiety is a challenging symptom in palliative care. Of the following therapies, which one is least likely to improve anxiety? - ANS Ginger You have a patient at the end of life who is discussing "visions" of seeing people in his room. He is alert, focused, and able to discuss this with you. You are concerned about hallucinations. - ANS Listen to patient for assessment of his cognitive function Which of the following categories contributes the largest part to health care's carbon emissions or carbon footprint? - ANS Building energy use Reducing the use of pharmaceuticals in health care would lead to all of the following except: - ANS Reduction in patient visits and hospitalizations Indirect health effects of climate change include all of the following except: - ANS Inhalation exposure to atmospheric levels of carbon dioxide Convincing evidence documents increased prevalence among members of economically disadvantaged populations for all but which of these health issues? - ANS Inflammatory bowel disease Which of the following is not a characteristic through which the social determinants of health (SDH) are thought to influence health status? - ANS The hygiene theory of disease development In a system based on fee-for-service payment, productivity, and financial sustainability, group medical visits should do which of the following to promote their success (choose all that apply)? - ANS Involve music Be scheduled consistently Be located conveniently to the population being served 1. Which type of bite is generally closed by delayed primary closure? Select all that apply. - ANS Bites to the hand Deep puncture wounds Wounds 8 hours old 1. A patient has been bitten by a dog and has sustained several puncture wounds near the thumb of one hand. The patie