Buttaro: Primary Care, A Collaborative Practice, 5th Ed.

Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 1: The Evolving Landscape of Collaborative Practice Test Bank Multiple Choice 1. Which assessments of care providers are performed as part of the Value Based Purchasing initiative? Select all that apply. a. Appraising costs per case of care for Medicare patients b. Assessing patients’ satisfaction with hospital care c. Evaluating available evidence to guide clinical care guidelines d. Monitoring mortality rates of all patients with pneumonia e. Requiring advanced IT standards and minimum cash reserves ANS: A, B, D Value Based Purchasing looks at five domain areas of processes of care, including efficiency of care (cost per case), experience of care (patient satisfaction measures), and outcomes of care (mortality rates for certain conditions. Evaluation of evidence to guide clinical care is part of evidence-based practice. The requirements for IT standards and financial status are part of Accountable Care Organization standards. REF: Value Based Purchasing 2. What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? a. Associations with area hospitals b. Costs of ambulatory care c. Ease of access to care d. The ratio of providers to patients ANS: C As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care, walk-in settings and the ability to be seen within 30 minutes, and care that is close to home. Associations with hospitals, costs of care, and the ratio of providers to patients were not part of these results. REF: The New Look of Primary Care 3. A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? a. Bonuses based on achievement of benchmarksTest Bank 2 b. Care coordination for chronic diseases c. Standards for minimum cash reserves d. Strict requirements for financial reporting ANS: A A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality measures and expenditures. Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial reporting. REF: Accountable Care OrganizationsButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 2: Transitional Care Test Bank Multiple Choice 1. To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy? a. Mandates for communication among primary caregivers and hospitalists b. Penalties for failure to perform medication reconciliations at time of discharge c. Reduction of payments for patients readmitted within 30 days after discharge d. Requirements for written discharge instructions for patients and caregivers ANS: C As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service developed the Readmissions Reduction Program reducing payments for certain patients readmitted within 30 days of discharge. The CMS did not mandate communication, institute penalties for failure to perform medication reconciliations, or require written discharge instructions. REF: Transitional Care 2. According to Naylor’s transitional care model, which intervention has resulted in lower costs and fewer rehospitalizations in high-risk older patients? a. Coordination of post-hospital care by advanced practice nurses b. Frequent post-hospital clinic visits with a primary care provider c. Inclusion of extended family members in the outpatient plan of care d. Telephone follow up by the pharmacist to assess medication compliance ANS: A Naylor’s transitional care model provided evidence that high risk older patients who had posthospital care coordinated by an APN had reduced rehospitalization rates. It did not include clinic visits with a primary care provider, inclusion of extended family members in the plan of care, or telephone follow up by a pharmacist. REF: Transitional Care 3. Which approaches are among those recommended by the Agency for Healthcare Research and Quality to improve health literacy in patients? Select all that apply. a. Empowering patients and families b. Giving written handouts for all teachingTest Bank 2 c. Highlighting no more than 7 key points d. Repeating the instructions e. Supplementing teaching with visual aids ANS: A, D, E AHRQ recommends using clear, simple language, highlighting 3 to 5 key points, using pictures or visual aids, repeating the instructions, using Teach Back, and empowering patients. Written communication is not part of the recommendations. REF: Health LiteracyButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 3: Translating Research Into Clinical Practice Test Bank Multiple Choice 1. Which is the most appropriate research design for a Level III research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials ANS: B The experimental design is the most appropriate design for a Level III study. Epidemiological studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies. Randomized clinical trials are used for Level IV studies. REF: Level III Research/Experimental Design 2. What is the purpose of clinical research trials in the spectrum of translational research? a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the pre-clinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage. REF: Translational Science Spectrum 3. What is the purpose of Level II research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables ANS: CTest Bank 2 Level II research is concerned with describing the relationships among characteristics or variables. Level I research is conducted to define the characteristics of groups of patients. Level II research evaluates the nature of the relationships between variables. Level IV research is conducted to demonstrate the effectiveness of interventions or treatments. REF: Level II ResearchButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 4: The Patient, the Provider, and Primary Care: An Integrated Perspective Test Bank Multiple Choice 1. A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which medications, taken in conjunction with this medication, are of concern? a. Anticholinergic drugs b. Beta blocker medications c. Blood-thinning agents d. Narcotic analgesics ANS: C Glucosamine chondroitin can prolong bleeding if taken with other blood-thinning agents. It does not have anticholinergic effects, cardiac effects or analgesic effects. REF: Alternative Therapies for Common Chronic Conditions/Joint Pain 2. The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an important point to discuss with this patient about taking such supplements? a. Because they are not FDA approved, they are not safe b. Dietary supplements are safer than most prescription medications c. Many supplements lack clear clinical evidence of efficacy d. Supplements should not be taken with prescription medications ANS: C Many dietary supplements lack clinical evidence to support their use. Even though they are not FDA approved, federal law mandates that the products are safe and cannot make misleading claims about use. Supplements are not necessarily safer than prescription drugs. Supplements may be taken with prescription medications as long as the effects, side effects, and drug interactions are known. REF: Alternative Therapies for Common Chronic Conditions 3. Which dietary supplements have shown some effectiveness in reducing blood pressure in patients with hypertension? Select all that apply. a. Chromium picolinate b. Cinnamon c. CoQ10Test Bank 2 d. Garlic extract e. L-arginine ANS: C, D, E CoQ10, garlic extract, and L-arginine have demonstrated effectiveness in reducing blood pressure in some studies. Chromium picolinate and cinnamon have been studied for effects on glucose tolerance and fasting glucose. REF: Alternative Therapies for Common Chronic Conditions/Prehypertension and HypertensionButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 5: Population-Based Care for Primary Care Providers Test Bank Multiple Choice 1. Which are key components of the Patient-Centered Medical Home? Select all that apply. a. Access to care b. Comprehensive care c. Coordination of care d. Provision of care by a single provider e. Storage of medical records ANS: A, B, C The Patient-Centered Medical Home is a team-based approach to providing care that is accessible, comprehensive, coordinated, longitudinal and high quality. It is not provided by a single provider, but is managed as a team. The original concept had to do with where medical records are stored, but this is not the working definition today. REF: The Patient-Centered Medical Home 2. The chronic care model (CCM) was developed to manage patients with complicated chronic conditions because the traditional acute care model a. could not provide efficient and cost-effective chronic care. b. did not meet longitudinal health careneeds for this population. c. did not offer ambulatory care services for these patients. d. put patients and families at the center of care. ANS: B The chronic care model was developed based on the recognition that the traditional acute care model did not meet longitudinal health care needs of patients with chronic and complicated conditions, not because of inefficiencies or costs. The traditional model does include ambulatory care, but that is not the focus. The traditional model does not typically place patients at the center of care. REF: Chronic Care Model 3. What are functions of patient registries in the chronic care model? Select all that apply. a. Alerting providers to medication interactionsTest Bank 2 b. Identifying appropriate specialists for referral c. Recommending routine screenings d. Reminding providers about immunizations e. Transmitting clinical dataabout patients ANS: A, C, D, E Patient registries are used to help manage patients at risk and include alerting providers about medication interactions, recommending routine screenings, reminders for immunizations, and transmitting clinical data. They are not used to identify or recommend providers or specialists. REF: Chronic Care Model/Clinical Information SystemsButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 6: Health Literacy, Health Care Disparities, and Culturally Responsive Primary Care Test Bank Multiple Choice 1. A primary care provider administers the ―Newest Vital Sign‖ health literacy test to a patient newly diagnosed with a chronic disease. What information is gained by administering this test? a. Ability to calculate data, along with general knowledge about health b. Ease of using technology and understanding of graphic data c. Reading comprehension and reception of oral communication d. Understanding of and ability to discuss health care concerns ANS: A The ―Newest Vital Sign‖ tests asks patients to look at information on an ice cream container label and answer questions that evaluate ability to calculate caloric data and to grasp general knowledge about food allergies. It does not test understanding of technology or directly measure reading comprehension. It does not assess oral communication. The ―Ask Me 3‖ tool teaches patients to ask three primary questions about their health care and management. REF: Health Literacy Assessment 2. A female patient who is from the Middle East schedules an appointment in a primary care office. To provide culturally responsive care, what will the clinic personnel do when meeting this patient for the first time? a. Ensure that she is seen by a female provider b. Include a male family member in discussions about health care c. Inquire about the patient’s beliefs about health and treatment d. Research middle eastern cultural beliefs about health care ANS: C It is important not to make assumptions about beliefs and practices associated with health care and to ask the patient about these. While certain practices are common in some cultural and ethnic groups, assuming that all members of those groups follow those norms is not culturally responsive. REF: Address Cultural Variations Among Diverse Patient Groups 3. What is the main reason for using the REALM-SF instrument to evaluate health literacy? a. It assesses numeracy skills.Test Bank 2 b. It enhances patient-provider communication. c. It evaluates medical word recognition. d. It measures technology knowledge. ANS: C The REALM-SF is an easy and fast tool that measures medical word recognition. It does not evaluate numeracy. The ―Ask Me 3‖ tool enhances patient-provider communication. This tool does not evaluate understanding of technology. REF: Health Literacy AssessmentButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 7: Genetic Considerations in Primary Care Test Bank Multiple Choice 1. A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this patient, what is the best initial action? a. Ask if there is a family history of breast cancer b. Gather and record a three-generation pedigree c. Ordera genetic test for the breast cancer gene d. Recommend direct-to-consumer genetic testing ANS: B The three-generation pedigree is the best way to evaluate genetic risk. Asking about a family history is not a systematic risk assessment and doesn’t specify who in the family has the history or whether there is a pattern. Genetic testing and DTC genetic testing are not the initial actions when assessing genetic risk. REF: Gathering a Family History 2. A patient asks about direct-to-consumer (DTC) genetic testing. What will the provider tell the patient? a. It is not useful for identifying genetic diseases. b. Much of the information does not predict disease risk. c. The results are shared with the patient’s insurance company. d. The results must be interpreted by a provider. ANS: B DTC testing gives a lot of information, but much of it does not contribute to disease prediction, since mutations are not necessarily related to specific diseases. The tests are useful, but must be interpreted accurately. The results are confidential and do not have to be interpreted by a provider. REF: Direct-to-Consumer (DTC) Genetic TestingButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 8: Risk Management Test Bank Multiple Choice 1. What are some causes for failures or delays in diagnosing patients resulting in malpractice claims? Select all that apply. a. Failing to recognize a medication complication b. Failing to request appropriate consultations c. Improper performance of a treatment d. Notacting on diagnostic test results e. Ordering a wrong medication ANS: B, D Failing to obtain consultations when indicated or not acting on diagnostic test results can lead to diagnosis-related failures. Failing to recognize medication complications and ordering a wrong medication lead to medication prescribing allegations. Improper performance of a treatment can lead to treatment related malpractice claims. REF: Nurse Practitioner Malpractice Claims 2. What is an important part of patient care that can minimize the risk of a formal patient complaint even when a mistake is made? a. Ensuring informed consent for all procedures b. Maintaining effective patient communication c. Monitoring patient compliance and adherence d. Providing complete documentation of visits ANS: B Effective patient communication is key to building trust and rapport and ineffective communication is a predictor for malpractice claims. The other items are important aspects of care and may help the provider during the investigation of a claim, but do not minimize the risk. REF: Communication IssuesButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 9: Adolescent Issues Test Bank Multiple Choice 1. Which behavior is most characteristic of early adolescence? a. Arguing with parents and teachers b. Assimilating adult roles and thinking c. Exhibiting fatigue more frequently d. Experimenting with sex and risky behaviors ANS: A Early adolescents challenge authority, experience wide mood swings, reject the ideation of childhood, and can be argumentative and disobedient. Middle adolescents experience fatigue and begin experimenting with sex and risky behaviors. Late adolescents begin to assimilate adult roles. REF: Introduction 2. What is the initial sign of puberty in the adolescent male? a. Deepening of the voice b. Elongation of the penis c. Nocturnal emissions d. Testicular enlargement ANS: D Testicular enlargement is the initial sign of puberty in adolescent males. Penile growth and nocturnal emissions occur later as does deepening of the voice. REF: Physical Development 3. A parent reports that an adolescent child does well in school but seems to consistently make poor decisions about activities with friends. What will the practitioner recommend as an approach to help the adolescent make better decisions? a. Correcting the adolescent’s decisions and judgments b. Listening without making suggestions about choices c. Making decisions for the adolescent to provide guidance d. Providing factual information about appropriate behavior ANS: BTest Bank 2 Listening without correcting is the best approach to help adolescents learn to make good decisions. Correcting the decisions, making decisions for the adolescent, or giving information that is unsolicited are not recommended. REF: Cognitive DevelopmentButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 10: LGBTQ Patient Care Test Bank Multiple Choice 1. Which is the most important factor limiting access to health care for sexual and gender minorities? a. Lack of familial support for SGM members b. Laws prohibiting full marriage equality c. Risky coping behaviors among SGM members d. Social stigma about being in this population ANS: B Since most people get health insurance through their employer or their spouse s employer, states which do not allow full marriage equality limit access to health care for LGBTQ people. The other causes are important, but this is the leading cause. REF: Introduction 2. What is the medical diagnostic term used to identify transgender patients? a. Gender dysphoria b. Gender expression disorder c. Gender identity disorder d. Gender role unconformity ANS: A Gender dysphoria is the term used to identify transgender patients in order to justify the medical necessity of treatments for transgender patients. It replaces the previous ―gender identity disorder‖ designation. REF: Access to CareButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 11: Pregnancy and Prenatal Care Test Bank Multiple Choice 1. A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her electronic medical record? a. G4P:1113 b. G4P:1213 c. G5P:1113 d. G5P:1213 ANS: A Using the notation G (number of pregnancies), T (term deliveries), P (preterm deliveries), A (abortions – elective or spontaneous), L (living children), this patient is G4P:1113. She is in her fourth pregnancy, so is G4. She has had one delivery at 38 weeks or more, one delivery (of twins) at less than 36 weeks gestation, one spontaneous abortion, and has three living children. REF: Gravidity and Parity 2. A pregnant woman reports not having had any vaccinations as a child but requests vaccines during her pregnancy. Which vaccines may be given? Select all that apply. a. HPV b. Inactivated influenza c. Live, attenuated influenza d. MMR e. Tdap f. Varicella ANS: A, B, E Tdap is recommended to pregnant woman, optimally between 27 and 36 weeks gestation. Inactivated is strongly recommended and may be given at any point in the pregnancy. Hepatitis B is given to women at risk if needed. Live, attenuated influenza vaccine, MMR, and varicella vaccines are not recommended during pregnancy. REF: Health HistoryTest Bank 2 3. A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial screening exam reveals a blood pressure of 140/90 and a fasting blood glucose of 128 mg/dL. What will the practitioner do? a. Initiate insulin therapy b. Monitor blood pressure and fasting blood glucose closely c. Prescribe an antihypertensive medication d. Refer the patient to a high-risk pregnancy specialist ANS: B This woman, although she has no previous history of HTN or DM, is at elevated risk because of obesity. Her initial screening lab values are at the high end of normal, indicating potential development of gestational HTN and gestational DM. The initial response of the practitioner should be to monitor the patient closely and consider treatment at the first signs of development of these complications. Referral is warranted when these conditions become severe. REF: Hypertension/DiabetesButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 12:Lactation Guidance Test Bank Multiple Choice 1. An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother? a. To decrease the frequency of breastfeeding b. To supplement feedings with extra water c. To switch to formula until the bilirubin level drops d. To use a breast pump to increase her milk supply ANS: D Infants with suboptimal breastfeeding can have starvation jaundice and mothers should be encouraged to increase the frequency of breastfeeding and should be offered a breast pump to increase milk supply. It is not recommended to supplement with water or sugar water or to switch to formula. REF: Physiologic Jaundice 2. The mother of a 3-day-old newborn reports that her infant nurses every 4 hours during the day and sleeps 6 hours at night. What will the provider recommend? a. Awakening the baby every 3 hours to nurse b. Continuing this schedule until the infant is 6 months old c. Ensuring that her infant nurses for 15 to 20 minutes each time d. Pumping her breasts to maintain her milk supply ANS: A Newborn infants should nurse 8 to 12 times daily and mothers should be encouraged to awaken a sleepy baby to nurse every 3 hours or more often. The feedings will gradually space out as the infant is older. REF: The First Few Days 3. A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth, and breast tenderness. What will the provider recommend? a. Ice packs and decreased frequency of nursing b. Ice packsand increased frequency of nursing c. Warm packs and decreased frequency of nursing d. Warm packsand increased frequency of nursingTest Bank 2 ANS: D This mother has symptoms of mastitis. She should be encouraged to use warm packs for comfort and to increase the frequency of nursing to relieve the pressure. REF: MastitisButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 13: Aging and Common Geriatric Syndromes Test Bank Multiple Choice 1. When prescribing medications to an 80-year-old patient, the provider will a. begin with higher doses and decrease according to the patient’s response. b. consult the Beers list to help identify potentially problematic drugs. c. ensure that the patient does not take more than five concurrent medications. d. review all patient medications at the annual health maintenance visit. ANS: B The Beers list provides a list of potentially inappropriate medications in all patients age 65 and older and helps minimize drug-related problems in this age group. Older patients should be started on lower doses with gradual increase of doses depending on response and side effects. Patients who take five or more drugs are at increased risk for problems of polypharmacy, but many will need to take more than five drugs; providers must monitor their response more closely. Medications should be reviewed at all visits, not just annually. REF: Polypharmacy/Consequences of Polypharmacy/Management 2. An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused, according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital, and attends a book club with several friends once a month. What is the initial step in evaluating this patient? a. Obtain a CBC, serum electrolytes, BUN, and glucose b. Ordering a CBC, serum ferritin, and TIBC c. Referring the patient to a dietician for nutritional evaluation d. Referring the patient to a neurologist for evaluation for AD ANS: A Patients with weight loss, confusion, and lethargy are often dehydrated and this should be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leading an active life, so the likelihood that recent symptoms are related to AD, although this may be evaluated if dehydration is ruled out. Anemia would be a consideration when dehydration is ruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition or AD is present. REF: Dehydration/Pathophysiology/Clinical Presentation/Physical ExaminationTest Bank 2 3. The practitioner is establishing a plan for routine health maintenance for a new female client who is 80 years old. The client has never smoked and has been in good health. What will the practitioner include in routine care for this patient? Select all that apply. a. Annual hypertension screening b. Baseline abdominal aorta ultrasound c. Colonoscopy every 10 years d. One-time hepatitis B vaccine e. Pneumovax vaccine if not previously given f. Yearly influenza vaccine ANS: E, F For older clients a one-time pneumovax is given after age 65. Influenza vaccine should be given every year. Hypertension screening should be performed at each office visit, not just annually. An abdominal aorta US is performed once for every smoking male. Colonoscopy is performed every 10 years after age 50, but not after age 74. REF: Table 13-1: Recommended Screening and ImmunizationsButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 14: Palliative and End-of Life Care Test Bank Multiple Choice 1. A patient who is near death is exhibiting signs of agitation, anxiety, and intractable pain. When discussing palliative sedation with this patient’s family, what will be discussed? Select all that apply. a. The chance that refractory symptoms will be alleviated b. The fact that this is an intervention of last resort c. The likelihood that the patient will develop dependence on the drugs d. The need for informed consent from the patient and family e. The possibility that this measure may hasten death ANS: B, D, E Palliative sedation is used as a treatment of last resort for patients whose symptoms are intolerable or refractory. Patients, if possible, and family members must give informed consent. This treatment has the possibility of hastening death by inhibiting respirations. Symptoms will not be alleviated by using the measure. The chance of drug dependence is irrelevant in this situation. REF: Palliative Sedation for Management of Intractable Symptoms in Patients Near Death 2. When should palliative care be initiated by a primary care provider? a. After an ill patient asks for Hospice services b. As part of routine health maintenance c. When a patient is diagnosed with a serious disease d. When an interdisciplinary team is formed to manage a disease ANS: B Palliative care support begins with an understanding of a patient’s preferences and helping the patient to identify goals of care. Health care providers should initiate such discussions as a component of the initial history of adults regardless of age or health status. Palliative care services may be ordered when a patient is diagnosed with a serious disease; waiting until the patient asks for Hospice services or when an interdisciplinary team is formed increases the chances of providing end-of-life care that does not meet the patient’s needs. REF: Palliative Care/Advance Care Planning 3. When using the ―Five Wishes‖ approach to documenting patient preferences for end-of-life care, the provider will document which types of preferences?Test Bank 2 Select all that apply. a. A directive to avoid calling 911 at the time of death b. A specific list of treatments the patient does not want c. How much information to give various family members d. The level of sedation versus alertness the patient desires e. The people designated to make care decisions for the patient ANS: C, D, E The Five Wishes approach addresses the type of care a patient wants as a disease progresses and is less defensive than the traditional advance directive which indicates the type of care a patient does not want. Calling 911 may be done without requiring resuscitation if the patient has an appropriate advanced directive in place. REF: Advance Care PlanningButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 15: Obesity and Weight Management Test Bank Multiple Choice 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? a. Electrocardiography b. Gallbladder ultrasonography c. Mammography d. Polysomnography ANS: D Women with a neck circumference greater than 16 cm have an increased risk of obstructive sleep apnea and should have polysomnography to assess for this complication. The other tests may be necessary for obese patients, but are not specific to this finding. REF: Physical Examination/Diagnostics 2. Which medications are associated with weight gain? Select all that apply. a. Antibiotics b. Antidepressants c. Antihistamines d. Insulin analogs e. Seizure medications ANS: B, C, D, E Antidepressants, antihistamines, insulin and insulin analogs, and seizure medications are all associated with weight gain. Antibiotics are not associated with weight gain. REF: Pharmaceuticals Associated with Weight GainButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 16: Lifestyle Management Test Bank Multiple Choice 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? a. Begin with a 45 to 60 minute workout b. Include a 1 to 2 minute warm up before exercise c. Maintain a heart rate between 80 and 128 beats per minute d. Stretching should be performed prior to activity ANS: D The heart rate should be kept between 50% and 80% of the maximum heart rate (220 minus the patient’s age = 160), which is 80 to 128 beats per minute. Patients who are not conditioned should begin with a 20 minute workout; conditioned individuals may increase up to 60 minutes. The warm up should be 3 to 5 minutes and longer if it is cold. Stretching is performed after the activity when the muscles are warm. REF: Exercise 2. Routine screening blood tests at an annual physical exam reveal a fasting glucose level of 125 mg/dL and a hemoglobin A1C of 6.2%. What will the provider do, based on these results? a. Evaluate the patient for impaired glucose tolerance b. Reassure the patient that these are normal values c. Suggest that the patient begin an exercise program d. Tell the patient that these results indicate diabetes ANS: A The fasting blood glucose level is normal, but the HgA1C indicates impaired glucose tolerance. If the HgA1C were greater than 6.4%, the patient would be diagnosed with diabetes. Until the results are evaluated, suggestions for treatment are not indicated. REF: Diabetes 3. The primary care provider is screening a patient using the CAGE criteria. What will the provider include in this assessment? Select all that apply. a. Number of times per week eaten in restaurantsTest Bank 2 b. Sodium and sugar intake c. Sources of daily dairy intake d. Total number of servings of fruits and vegetables e. Types of meats and proteins ANS: A, C, E The CAGE questionnaire is designed to evaluate the intake of saturated fat and cholesterol, so the provider will ask about sources of dairy, the number of times eating foods not made at home, and the types of meats and proteins eaten. The questionnaire does not evaluate for sodium, sugar, fruits, or vegetables. REF: Box 16-1: Dietary CAGE Questions for Assessment of Intake of Saturated Fat and CholesterolButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 17: Routine Health Screening and Immunizations Test Bank Multiple Choice 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? a. Bone mineral density screening b. Breast cancer screening and mammogram c. Cervical cancer screening with a Pap test d. Lipid screening and cholesterol tests ANS: B The American Cancer Society recommends yearly mammogram at age 40. Bone mineral density screening begins at age 50 to 64, based on risk. Cervical cancer screening should be performed every 3 years unless there is increased risk. Lipid screening and cholesterol is performed annually if there is increased risk according to the Framingham guidelines. REF: Table 17-1: Screening Tests for Women/Table 17-4: Comparison of American Cancer Society and USPSTF Screening Guidelines for the Early Detection of Cancer in Asymptomatic Individuals 2. A 55-year-old patient who had influenza in the previous influenza season asks about the flu vaccine. What will the provider tell the patient? a. Having influenza vaccine confers lifetime immunity b. The FluMist vaccine may be used each year c. The Fluzone High-Dose vaccine is recommended d. The trivalent influenza vaccine is indicated annually ANS: D Because the strains of influenza vary from year to year, annual immunization with TIV is indicated for all persons. Lifetime immunity is not conferred with infection. The Flu Mist is used in persons 50 years of age and younger. The Fluzone High-Dose vaccine is used in patients older than 65 year. REF: Influenza Vaccine 3. A 60-year-old patient with a previous history of shingles asks about the herpes zoster vaccine. What will the provider recommend?Test Bank 2 a. A series of two herpes zoster vaccinations b. A single dose of herpes zoster vaccine c. No herpes zoster vaccine is necessary d. Prophylactic vaccination if exposed to chicken pox ANS: B All patients 50 years and older should have a single dose of herpes zoster vaccine regardless of previous herpes zoster infection. REF: Herpes Zoster VaccineButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 18: Principles of Occupational and Environmental Health in Primary Care Test Bank Multiple Choice 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? a. Reassure the patient about the normal findings b. Refer the patient to an occupational health specialist c. Request a workplace environmental assessment d. Suggest that the patient follow up with a pulmonologist ANS: B Patients with environmental exposure may not have symptoms or positive findings. Because this patient reports frequent bronchitis, this should be followed up with an occupational health specialist who can evaluate the degree of exposure and perform further testing. Normal findings are not necessarily reassuring. The occupational specialist may request an environmental assessment. Pulmonologists are not trained in occupational health. REF: Occupational Respiratory Diseases 2. 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. a. GERD history b. History of allergies and eczema c. History of ankle fracture d. Lower back screening results e. Urine drug screening results ANS: D, E Only findings related to the ability of the individual to perform position requirements for the job are included in the report. Other findings should not be included, even though they may need to be addressed. REF: Pre-Placement Health EvaluationButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 19: College Health Test Bank Multiple Choice 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? a. Dietary counseling b. Participation in sports c. Regular weight assessments d. Stress management strategies ANS: D Students with previous eating disorders may regress when stressed, so stress management is essential. Unless she begins to regress, dietary counseling is not indicated. Many who participate in sports will develop eating disorders in order to control weight. It is not necessary to evaluate weight regularly. REF: Eating Disorders and Weight Management 2. A female college student seeks information about emergency contraception. What is the most important part of the assessment of this patient? a. Cultural considerations for use of contraception b. Feelings of guilt about a possible pregnancy c. Possible concerns about confidentiality d. The female’s sense of control in sexual situations ANS: D Because college women are at greater risk for sexual violence and assault, a request for emergency contraception must be followed by an evaluation of possible rape or assault. The other considerations may be part of the assessment, but are not as important as determining whether a rape has occurred. REF: Reproductive, Substance, and Safety IssuesButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 20: Health Care of the International Traveler Test Bank Multiple Choice 1. An international traveler plans to travel to Kenya in sub-Saharan Africa. Which is an important disease precaution for this person? a. Carrying chloroquine to take as needed b. Starting prophylactic doxycycline before travel c. Taking precautions against Chikungunya fever d. Understanding how Ebola virus is transmitted ANS: B Malaria is a greater concern worldwide than Ebola virus and Chikungunya fever, although both are emerging diseases. Travelers should take antimalarial medications and, in this part of Africa, where there is widespread resistance to chloroquine, doxycycline is a better choice as prophylaxis. Even when chloroquine is appropriate, it must be taken prior to travel and not as needed. Chikungunya fever is a disease of the Western Hemisphere, especially in the Caribbean. Ebola virus is epidemic in western Africa and not in Kenya. REF: Introduction/Medications and Prescriptions/Malaria/4: Provider Toolbox for Travelers: Brochures, Vaccines, and Medications 2. 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? a. Azithromycin b. Ciprofloxacin c. Metronidazole d. Rifampin ANS: C This patient has symptoms characteristic of Giardia lamblia and should be treated with metronidazole. Azithromycin is given for Campylobacter infection, which is a bacterial cause. Ciprofloxacin is used for bacterial infections such as Salmonella or Shigella, which cause bloody diarrhea. Rifampin is used for non-invasive strains of E. coli. REF: Food and Water Precautions and Traveler’s Diarrhea 3. A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccines?Test Bank 2 a. Country-specific guidelines are provided by individual embassies. b. Malaria vaccine is the most important vaccine for worldwide travel. c. Requirements should be reviewed at least 6 to 8 weeks prior to travel. d. There are at least five required vaccines for entry into certain countries. ANS: C Patients seeking immunizations prior to international travel should have these reviewed at least 6 to 8 weeks prior so that antibody responses and completion of vaccine series may occur. Country-specific guidelines may be found on the CDC website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines that are required. REF: Immunizations/Medications and Prescriptions/MalariaButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 21: Presurgical Clearance Test Bank Multiple Choice 1. Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? Select all that apply. a. Patient’s age b. Patient’s comorbidities c. Previous surgeries d. Surgeon’s preference e. Type of anesthetic agent planned ANS: A, B, D, E The patient’s age and comorbidities, surgeon preference, and the type of anesthetic planned all determine which presurgical diagnostic tests will be performed. The patient’s previous surgeries do not determine presurgical testing. REF: Diagnostics 2. Which patient should have pulmonary function testing as part of the presurgical exam? a. A patient older than 60 years of age b. A patient undergoing major intra-thoracic surgery c. A patient with a history of pneumonia in the last 2 years d. A patient with diabetes and morbid obesity ANS: B Any patient undergoing major thoracic surgery should have pulmonary function testing. Age over 60 years, a history of pneumonia, and diabetes and obesity do not require pulmonary function testing unless there is comorbid COPD. REF: Table 21-1: Tests for Presurgical ClearanceButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 22: Preparticipation Sports Physical Test Bank Multiple Choice 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? a. Evaluate for orthostatic hypotension b. Obtain Doppler studies of lower extremity circulation c. Reassure the patient that this is a normal finding d. Refer the patient for a cardiologic exam ANS: D Differences in strength between radial and femoral pulses may indicate coarctation of the aorta and should be evaluated by a cardiologist. This finding does not indicate orthostatic hypotension. The likelihood of decreased circulation is low in a young athlete. REF: Physical Examination 2. 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? a. Losing weight prior to initiating sports participation b. Participation in strenuous sports to help with weight loss c. Referral to the endocrinologist for sports clearance d. Switching to insulin therapy prior to participation ANS: C Patients with poorly controlled diabetes should be referred to a specialist prior to clearance for sports participation. This patient has an elevated HgA1C, indicating poor control. The endocrinologist may suggest the other options, but the primary care provider should not clear this patient for participation in sports. REF: Medical Clearance 3. 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? a. Clear the adolescent to play sportsTest Bank 2 b. Perform an electrocardiogram c. Refer the adolescent to a cardiologist d. Tell the adolescent that sports are not allowed ANS: C A positive family history of Wolff-Parkinson-White syndrome requires physician consultation or referral before medical clearance can be given. The adolescent has a normal heart rate and physical exam, so the ECG may not yield significant or useful results. The examiner cannot clear the adolescent without consulting with a specialist. The adolescent may be cleared for sports by the specialist. REF: Medical ClearanceButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 23: Disaster/Emergency Preparedness and Response in Primary Care Test Bank Multiple Choice 1. What is included in the mitigation phase of emergency management? a. Debriefing and review b. Drills and exercises c. Identification of risks d. Use of Incident Command System ANS: C The mitigation phase involves identification of risks. Debriefing and review occurs during the recovery phase. Drills and exercises are part of the preparedness phase. Use of an Incident Command System is part of the response phase. REF: Preparing the Primary Care Office for Small-Scale Emergencies/Disasters 2. 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? a. Mitigation b. Preparedness c. Response d. Recovery ANS: C The response phase involves identification of those who will be in command in case of an emergency and identification of the roles of other personnel. The mitigation phase involves identification of risks. Debriefing and review occurs during the recovery phase. Drills and exercises are part of the preparedness phase. REF: Preparing the Primary Care Office for SmallScale Emergencies/DisastersButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 24: Acute Bronchospasm Test Bank Multiple Choice 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? a. Administer oxygen and continue to monitor the patient b. Contact the respiratory therapist to administer another treatment c. Notify the patient’s physician immediately d. Reassure the patient that the treatments will take effect soon ANS: C Patients with bronchospasm who have oxygen saturations less than 92% on room air and who fail to improve with nebulizer treatment given three times, need physician consultation. While oxygen administration and further nebulizer treatments may be indicated, it is incorrect to continue to monitor the patient without notifying the physician. REF: Acute Bronchospasm/Physician Consultation 2. Which clinical findings are worrisome in a patient experiencing acute bronchospasm, requiring immediate treatment? Select all that apply. a. A silent chest after previously wheezing b. Decreasing blood pressure c. Presence of an urticarial rash d. Pulsus paradoxus of 10 mm Hg e. Wheezing on both inspiration and expiration ANS: A, B, C A silent chest indicates severe spasm and is an ominous sign. Decreasing blood pressure and urticarial rash are present with anaphylaxis, which is a respiratory emergency requiring oxygen, diphenhydramine or epinephrine. A pulsus paradoxus greater than 25 mm Hg is worrisome. Wheezing on inspiration and expiration is a common finding and not necessarily an emergency. REF: Acute Bronchospasm/Physical Examination/Differential Diagnosis 3. Which symptom in a patient with asthma indicates severe bronchospasm?Test Bank 2 a. Breathlessness with minimal activity or eating b. Pausing to breathe while attempting to talk c. Repetitive, spasmodic coughing at night d. Wheezing after exposure to a trigger ANS: B Inability to speak a full sentence without pausing to breathe indicates severe bronchospasm. Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs of bronchospasm and do not necessarily indicate severe bronchospasm. REF: Acute Bronchospasm/Clinical PresentationButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 25: Anaphylaxis Test Bank Multiple Choice 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? a. Inhaled racemic epinephrine b. Intramuscular epinephrine c. Intravenous diphenhydramine d. Intravenous ranitidine ANS: B The patient has signs of anaphylaxis and should be given IM or SC epinephrine immediately as first-line therapy, with this repeated every 5 to 20 minutes as needed to prevent cardiovascular shock. Inhaled epinephrine is used for acute upper airway bronchospasm. Diphenhydramine and ranitidine are given as second-line treatment after epinephrine is administered or for mild, nonlife-threatening allergic reactions. REF: Anaphylaxis/Management 2. 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? a. Obtain transport to an emergency department immediately b. Repeat the epinephrine dose if needed and notify a physician of the episode c. Resume normal activity if symptom free after 30 to 60 minutes d. Take oral diphenhydramine and report any symptoms to a provider ANS: A The man has a history of anaphylaxis and experienced symptoms after contact with a trigger. The Epi-Pen should be used immediately, but does not prevent the need for follow up in an emergency department for close observation, since continued reaction to the allergen can occur for 6 to 8 hours. The epinephrine dose may be given if needed before emergency personnel arrive, but a second dose is not sufficient to prevent ongoing reaction to the allergen. REF: Anaphylaxis/Management/Education and Health PromotionButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 26: Bites and Stings Test Bank Multiple Choice 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. a. Airway management b. An acute abdominal series c. Antivenom therapy d. CBC, BUN, electrolytes, and creatinine e. Coagulation studies f. Tetanus prophylaxis ANS: D, E, F The spider is a brown recluse. If the patient exhibits systemic symptoms, laboratory workup, including CBC, BUN, creatinine, electrolytes, and coagulation studies should be performed. Tetanus prophylaxis is given. Airway management, an acute abdominal series, and antivenom therapy are used for black widow spider bites. REF: Spider Bites/Definition and Epidemiology/Diagnostics/Initial Stabilization and Management 2. A child experiences a snake bite while camping and is seen in the emergency department. The child’s parents are not able to identify the type of snake. An inspection of the site reveals two puncture wounds on the child’s arm with no swelling or erythema at the site. The child has normal vital signs. Which treatment is indicated? a. Administering antivenom and observing the child for 24 to 48 hours b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours c. Performing a type and cross match of the child’s blood d. Referral to a surgeon for incision and suction of the wound ANS: B The child does not have immediate symptoms of envenomation, since there is no swelling or erythema. Because symptoms may be delayed, and the type of snake is unknown, the child should be observed in an ED or hospital for 12 hours after providing wound care and tetanus prophylaxis. Antivenom is not indicated unless envenomation occurs. Type and cross match is done if envenomation is severe. Incision and suction of the sound is not recommended. REF:Test Bank 2 Reptile Bites and Scorpion Stings/Physical Examination/Diagnostics/Initial Stabilization and ManagementButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 27: Bradycardia and Tachycardia Test Bank Multiple Choice 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? a. Administer atenolol intravenously b. Admit to the hospital for urgent cardioversion c. Refer the patient to a cardiologist d. Transport the patient to the ED by ambulance ANS: C This patient has no history of serious heart disease and does not have symptoms of chest pressure, acute MI, or congestive heart failure and may be referred to a cardiologist for evaluation and treatment. Atenolol is given IV for patients who are unstable; the advanced life support treatment guidelines do not recommend treatment of tachycardia if the patient is stable. Urgent cardioversion is rarely needed if the heart rate is less than 150 beats per minute unless there are underlying heart conditions. It is not necessary to transport a stable patient to the ED. REF: Tachycardia/Initial Stabilization and Management 2. A patient who takes a beta blocker medication is in the emergency department with syncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35 beats per minute. Which medication may be used to stabilize this patient? a. Adenosine b. Amiodarone c. Atropine d. Epinephrine ANS: D Epinephrine is indicated if unstable bradycardia is caused by beta blockers. This patient is symptomatic and unstable and should be treated. Adenosine and amiodarone are used to treat tachycardia. Atropine is used for some types of bradycardia, but not when induced by beta blockers. REF: Bradycardia/Initial Stabilization and ManagementTest Bank 2 3. Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, or defibrillation? a. Atrial fibrillation b. Atrial flutter c. Monomorphic ventricular tachycardia d. Polymorphic ventricular tachycardia ANS: D Polymorphic ventricular tachycardia should be treated as ventricular fibrillation with unsynchronized shocks. The other arrhythmias are treated with synchronized cardioversion. REF: Box 27-1:Cardioversion and defibrillation of unstable patients with tachycardiaButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 28: Cardiac Arrest Test Bank Multiple Choice 1. Current American Heart Association (AHA) recommendations include: Select all that apply. a. A compression depth of 1½ inches or more on an adult b. A rate of 100 compressions per minute at a minimum c. Rescue breaths given during 2 seconds to allow full chest rise d. Untrained rescuers giving compressions without breaths e. Using a ratio of 2 rescue breaths to 30 compressions ANS: B, D, E The AHA recommends compression rates of at least 100 compressions per minute at a ratio of 2 breaths for every 30 compressions. Untrained rescuers are encouraged to provide chest compressions only. The depth of compressions in adults should be at least 2 inches. Rescue breaths are given over 1 second with full chest rise. REF: Cardiac Arrest/Physical Examination 2. The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia? a. Atrial fibrillation b. Atrial flutter c. Ventricular fibrillation d. Ventricular tachycardia ANS: C Most victims of cardiac arrest are in ventricular fibrillation, so the AHA considers early defibrillation the most effective treatment for adult victims of cardiac arrest. The other arrhythmias are not usually present in cardiac arrest and are treated with synchronized cardioversion REF: Cardiac Arrest/Initial Stabilization and Management 3. 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)? a. Assessment of gasping breaths or not breathing b. Determination of pulselessness or bradycardia c. Evaluation of peripheral perfusion and level of consciousnessTest Bank 2 d. Obtaining a history of previous myocardial infarction ANS: A The AHA recommends initiating CPR if the victim in not breathing or has gasping breaths. Determination of a pulse in an arrest situation can be problematic and the search for a pulse should not delay chest compressions if the patient is gasping for breath or not breathing. Evaluation of peripheral perfusion and LOC is not part of the initial assessment and not used to indicate the need for CPR. A medical history may be obtained after resuscitation is in progress. REF: Cardiac Arrest/Physical ExaminationButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 29: Chemical Exposure Test Bank Multiple Choice 1. What is true when considering activated charcoal for gastrointestinal decontamination to treat a toxic substance ingestion? a. It acts by enhancing gastric motility to reduce absorption. b. It is administered only through a nasogastric tube. c. It may be used when petroleum distillates are ingested. d. It must be administered within 60 minutes of ingestion. ANS: D Activated charcoal must be given within an hour after ingestion of the toxin. It absorbs ingested substances and reduces absorption and may cause bowel obstruction; it does not increase bowel motility. It may be given orally or by nasogastric tube. Because it is associated with vomiting, it should not be used when caustic substances, alcohols, and petroleum distillates are ingested. REF: Initial Stabilization and Management/Ingestions 2. A lawn maintenance worker is brought to the emergency department after an accident in which a large amount of pesticide was sprayed all over his clothing. He is able to relate the details of the accident to the emergency department personnel. What is the priority treatment on admission? a. Administer intravenous diphenhydramine and possibly epinephrine b. Contact the Poison Control center to ask about appropriate antidotes c. Place ona cardiorespiratory monitor and establish intravenous access d. Remove the patient’s clothing and irrigate the skin for 15 to 30 minutes ANS: D Most skin exposure to chemicals must be treated immediately with copious irrigation with water, so this is the initial priority in a stable patient. Since he is able to converse with staff, he is likely to be stable. If signs of anaphylaxis occur, diphenhydramine and epinephrine are indicated. The Poison Control center should be contacted, but this is not the priority. After irrigation to minimize exposure, other interventions, such as cardiorespiratory monitoring and IV access may be necessary. REF: Initial Stabilization and Management/Skin ExposureTest Bank 2 3. A child is brought to the emergency department because a grandparent suspects ingestion of a tricyclic antidepressant medication found in the bathroom. What symptoms will the ED professionals expect to observe if this is the case? Select all that apply. a. Excessive salivation b. Flushed skin c. Hallucinations d. Hypothermia e. Mydriasis f. Urinary frequency ANS: B, C, E Tricyclic antidepressants will cause anticholinergic effects, including flushing of the skin, hallucinations or psychosis, and mydriasis. These medications also cause dry mucous membranes, hyperthermia, and urinary retention. REF: Chemical Exposure/Clinical PresentationButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 30: Electrical Injuries Test Bank Multiple Choice 1. What is true about electrical injuries? Select all that apply. a. Alternating current causes tetanic skeletal muscle contractions. b. Direct current is more dangerous than alternating current. c. Electrical injury causes more tissue necrosis in nerves than other tissues. d. Lightning is less lethal because the duration of electrical strike is short. e. Low-voltage contact has no potential to be lethal. ANS: A, C, D Alternating current tends to be more lethal than direct current because it causes tetanic muscle contractions. Electrical injury affects nerves more than other tissues because nerve tissue has the least resistance to direct flow and is most easily damaged. Lightning, although it has a voltage of 10 million to 2 billion volts, has a short duration of contact. Alternating current is more dangerous than direct current. Low-voltage contact has the potential to be lethal. REF: Pathophysiology 2. An adolescent male has an electrical injury from a high-voltage wire after climbing a tree. Which initial diagnostic test is necessary? a. 12-lead electrocardiogram b. Cervical spine radiography c. Complete blood count and electrolytes d. Creatine kinase and myoglobin level ANS: A An early essential assessment in all patients with electrical injury is a 12-lead ECG to assess arrhythmias and conduction disturbances. The other labs are part of the initial workup, but not a priority over the ECG. A C-spine radiograph is done if cervical injury is suspected. REF: Physical Examination/DiagnosticsButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 31: Environmental Allergies Test Bank Multiple Choice 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. a. It has a lower potential for anaphylaxis. b. It is more sensitive. c. It is safer. d. It produces more rapid results. e. It requires a stepwise approach. ANS: A, C, D Scratch testing involves scratching the surface of the skin. This method has a lower potential for anaphylaxis, is safer, and has more rapid results. It is not as sensitive as the intradermal method, which requires a stepwise approach. REF: Environmental Allergies/Diagnostics 2. Which immunoglobulin is responsible for initiating the allergic cascade in susceptible individuals who are exposed to allergens? a. IgG b. IgA c. IgM d. IgE ANS: D While IgA, IgG, and IgM are produced to appropriately protect the body, circulating levels of IgE are responsible for the atopic reaction. REF: Environmental Allergies/Pathophysiology 3. Which food allergies in children may beoutgrown in the first decadeof life? Select all that apply. a. Egg allergy b. Fish allergy c. Milk allergy d. Nut allergyTest Bank 2 e. Shell fish allergy ANS: A, C Both egg and milk allergy may be outgrown within the first decade of life. Fish, nut, and shell fish allergies are more common in adults and have a higher incidence of lifetime allergy. REF: Food Allergies/Definition and EpidemiologyButtaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 32: Head Trauma Test Bank Multiple C