Fitzgerald Review 2
Which of the following is not an expected finding for a patient with Meniere's disease?
A positive Romberg test
An abnormal Rinne test
Lateralization during the Weber test
Hearing loss - Answer-An abnormal Rinne test
An abnormal Rinne test. The Weber and Rinne tests are physical examination techniques to assess for
the presence of a conductive and/or sensorineural hearing loss and findings can be suggestive of
Meniere's disease. In Meniere's disease, the Weber test shows lateralization to the unaffected ear. The
Rinne test is usually normal (i.e., air conductance exceeds bone conductance). The Romberg test is
positive, with the patient showing difficulty staying balanced when standing with eyes closed.
The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman who reports a
progressive worsening of her hearing in both ears. The NP removes a large amount of cerumen from the
patient's ears with stated resolution of her hearing problem. Her hearing loss was likely of what nature?
Sensory
Sensorineural
Conductive
Neural - Answer-Conductive
,Conductive. In this situation, the hearing loss was due to obstruction with cerumen in the external ear
canal. Another common reason for conductive hearing loss includes middle ear effusion. Sensorineural
loss is the most common form of progressive, high-frequency hearing loss due to presbycusis or aging.
Sensorineural hearing loss can have many causes and results in the gradual loss of sound receptors and
nerve endings. Conductive hearing loss is usually temporary while sensorineural hearing loss is
permanent.
A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet therapy with low-
dose aspirin and clopidogrel. He complains about intermittent headaches and says his friend mentioned
about the use of feverfew. You caution the patient that feverfew can be associated with:
Hypertension.
Increased bleeding risk.
QTc prolongation.
Ventricular arrhythmia. - Answer-Increased bleeding risk.
Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family and the
supplement is derived from the leaves of the plant. Feverfew is used for migraine and other types of
headaches, as well as dizziness, rheumatoid arthritis, fever, and abdominal pain, among other
conditions. Its mechanisms of action include inhibiting platelet aggregation, exhibiting anti-
prostaglandin effects, and decreasing serotonin release. Due to its antiplatelet effect, there is an
increased risk of bleeding with use of feverfew and should be used with caution or avoided altogether
with concomitant antiplatelet therapy, such as aspirin and/or clopidogrel.
The most important component of the initial assessment of an asthma exacerbation includes a(n):
SaO2.
Objective measurement of lung function.
Chest X-ray.
Arterial blood gases. - Answer-Objective measurement of lung function.
,Objective measurement of lung function. Asthma exacerbations, characterized by a decrease in peak
expiratory flow, are identified by spirometric assessment, which is the most important and immediate
indicator. After the exacerbation is managed, a comprehensive health history will contribute to the
holistic chronic management. Arterial blood gases and SaO2 can be indicated later in the assessment if
the patient continues to deteriorate despite initial interventions. A chest radiograph is usually
unchanged in an asthma exacerbation and is not part of the initial assessment.
Which of the following statements about migraine headache is most accurate?
The pain is described as pulsating.
Migraines are more common in men than women.
Migraine with aura is more common than without aura.
The pain is typically bilateral. - Answer-The pain is described as pulsating.
The pain is described as pulsating. Migraine headache is one of the three most common primary
headache syndromes, and may occur with or without aura; migraine without aura is the more common
type. Migraine is most common in women of childbearing age. The pain is typically described as
unilateral and pulsating.
Risk factors for urinary tract infection in a 62-year-old woman can include each of the following except:
Uterine prolapse.
Renal stones.
Diabetes mellitus.
Well-controlled hypertension. - Answer-Well-controlled hypertension.
Well-controlled hypertension. UTIs occur more frequently in women than men and the frequency
increases with age. UTI rates are higher in postmenopausal women due to decreased estrogen that can
impact the vaginal flora, as well as the presence of uterine prolapse that can cause incomplete bladder
emptying. Comorbid chronic medical conditions, such as diabetes, can also increase UTI risk. The
presence of renal or kidney stones can also increase risk of infection. Well-controlled hypertension is not
a substantial risk factor for UTI.
, A 27-year-old woman presents complaining of pain on her upper thighs related to spilled hot coffee on
her lap. Physical examination reveals a burn site that is red, dry and blanches briefly with pressure but
without blisters. The NP categorizes this burn as:
First degree.
Second degree.
Third degree.
Fourth degree. - Answer-First degree.
First degree. A first degree burn is a superficial burn that affects only the epidermis. The appearance of
first degree burns is a burn site that is red, painful, dry, and without blisters. A second degree burn can
involve the upper layers of papillary dermis (superficial partial thickness) or deeper layers of the dermis
(deep partial thickness). These burns appear red, blistered, and can be swollen. A third degree burn can
involve the dermis and underlying fat and can appear white or charred.
You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit his blood
pressure is 185/110 mm Hg but does not report any symptoms. Auscultation will likely reveal:
S3 heart sound heard during early diastole
S3 heart sound heard during late diastole
S4 heart sound heard during early diastole
S4 heart sound heard during late diastole - Answer-S4 heart sound heard during late diastole
S4 heart sound heard during late diastole. The S4 sound is the sound heard when a stiff, non-compliant
ventricular wall is being subjected to a sudden increase in pressure that occurs during atrial contraction.
At the end of diastole, the atria contracts, ejecting its final contents into the ventricle just before the
mitral valve closes. A stiff, non-compliant ventricle vibrates in response to this pressure and creates the
end-diastolic sound known as an S4. The S4 sound is a marker of poor diastolic function and is most
often found in poorly-controlled hypertension or recurrent myocardial ischemia. The S4 heart sound
Which of the following is not an expected finding for a patient with Meniere's disease?
A positive Romberg test
An abnormal Rinne test
Lateralization during the Weber test
Hearing loss - Answer-An abnormal Rinne test
An abnormal Rinne test. The Weber and Rinne tests are physical examination techniques to assess for
the presence of a conductive and/or sensorineural hearing loss and findings can be suggestive of
Meniere's disease. In Meniere's disease, the Weber test shows lateralization to the unaffected ear. The
Rinne test is usually normal (i.e., air conductance exceeds bone conductance). The Romberg test is
positive, with the patient showing difficulty staying balanced when standing with eyes closed.
The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman who reports a
progressive worsening of her hearing in both ears. The NP removes a large amount of cerumen from the
patient's ears with stated resolution of her hearing problem. Her hearing loss was likely of what nature?
Sensory
Sensorineural
Conductive
Neural - Answer-Conductive
,Conductive. In this situation, the hearing loss was due to obstruction with cerumen in the external ear
canal. Another common reason for conductive hearing loss includes middle ear effusion. Sensorineural
loss is the most common form of progressive, high-frequency hearing loss due to presbycusis or aging.
Sensorineural hearing loss can have many causes and results in the gradual loss of sound receptors and
nerve endings. Conductive hearing loss is usually temporary while sensorineural hearing loss is
permanent.
A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet therapy with low-
dose aspirin and clopidogrel. He complains about intermittent headaches and says his friend mentioned
about the use of feverfew. You caution the patient that feverfew can be associated with:
Hypertension.
Increased bleeding risk.
QTc prolongation.
Ventricular arrhythmia. - Answer-Increased bleeding risk.
Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family and the
supplement is derived from the leaves of the plant. Feverfew is used for migraine and other types of
headaches, as well as dizziness, rheumatoid arthritis, fever, and abdominal pain, among other
conditions. Its mechanisms of action include inhibiting platelet aggregation, exhibiting anti-
prostaglandin effects, and decreasing serotonin release. Due to its antiplatelet effect, there is an
increased risk of bleeding with use of feverfew and should be used with caution or avoided altogether
with concomitant antiplatelet therapy, such as aspirin and/or clopidogrel.
The most important component of the initial assessment of an asthma exacerbation includes a(n):
SaO2.
Objective measurement of lung function.
Chest X-ray.
Arterial blood gases. - Answer-Objective measurement of lung function.
,Objective measurement of lung function. Asthma exacerbations, characterized by a decrease in peak
expiratory flow, are identified by spirometric assessment, which is the most important and immediate
indicator. After the exacerbation is managed, a comprehensive health history will contribute to the
holistic chronic management. Arterial blood gases and SaO2 can be indicated later in the assessment if
the patient continues to deteriorate despite initial interventions. A chest radiograph is usually
unchanged in an asthma exacerbation and is not part of the initial assessment.
Which of the following statements about migraine headache is most accurate?
The pain is described as pulsating.
Migraines are more common in men than women.
Migraine with aura is more common than without aura.
The pain is typically bilateral. - Answer-The pain is described as pulsating.
The pain is described as pulsating. Migraine headache is one of the three most common primary
headache syndromes, and may occur with or without aura; migraine without aura is the more common
type. Migraine is most common in women of childbearing age. The pain is typically described as
unilateral and pulsating.
Risk factors for urinary tract infection in a 62-year-old woman can include each of the following except:
Uterine prolapse.
Renal stones.
Diabetes mellitus.
Well-controlled hypertension. - Answer-Well-controlled hypertension.
Well-controlled hypertension. UTIs occur more frequently in women than men and the frequency
increases with age. UTI rates are higher in postmenopausal women due to decreased estrogen that can
impact the vaginal flora, as well as the presence of uterine prolapse that can cause incomplete bladder
emptying. Comorbid chronic medical conditions, such as diabetes, can also increase UTI risk. The
presence of renal or kidney stones can also increase risk of infection. Well-controlled hypertension is not
a substantial risk factor for UTI.
, A 27-year-old woman presents complaining of pain on her upper thighs related to spilled hot coffee on
her lap. Physical examination reveals a burn site that is red, dry and blanches briefly with pressure but
without blisters. The NP categorizes this burn as:
First degree.
Second degree.
Third degree.
Fourth degree. - Answer-First degree.
First degree. A first degree burn is a superficial burn that affects only the epidermis. The appearance of
first degree burns is a burn site that is red, painful, dry, and without blisters. A second degree burn can
involve the upper layers of papillary dermis (superficial partial thickness) or deeper layers of the dermis
(deep partial thickness). These burns appear red, blistered, and can be swollen. A third degree burn can
involve the dermis and underlying fat and can appear white or charred.
You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit his blood
pressure is 185/110 mm Hg but does not report any symptoms. Auscultation will likely reveal:
S3 heart sound heard during early diastole
S3 heart sound heard during late diastole
S4 heart sound heard during early diastole
S4 heart sound heard during late diastole - Answer-S4 heart sound heard during late diastole
S4 heart sound heard during late diastole. The S4 sound is the sound heard when a stiff, non-compliant
ventricular wall is being subjected to a sudden increase in pressure that occurs during atrial contraction.
At the end of diastole, the atria contracts, ejecting its final contents into the ventricle just before the
mitral valve closes. A stiff, non-compliant ventricle vibrates in response to this pressure and creates the
end-diastolic sound known as an S4. The S4 sound is a marker of poor diastolic function and is most
often found in poorly-controlled hypertension or recurrent myocardial ischemia. The S4 heart sound
