NSG 6440/ NSG6440 Exam Practice Questions With 100% Correct Answers - Latest Update 2023/2024 (GRADED)

A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout c. Osteoarthritis (OA) d. Osteoporosis Explanation: Rheumatoid arthritis is characterized by several joint deformities, usually bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not. RA and OA are chronic conditions. Gout is characterized by acute exacerbations related to a defect in purine metabolism, increased uric acid production, or decreased uric acid excretion. 18) A 7-year old female patient presents with severe injuries that are inconsistent with the explanation given for them. The nurse practitioner questions the mother about abuse. She admits that her husband, the child’s father, beat the child. How should the nurse practitioner proceed? a. Inform the mother that the abuse must be reported to child protection authorities. b. Counsel the mother that if it happens again it will be reported to child protection service. c. Ask the child what she did to cause the punishment 5 d. Refer the family to the National Domestic Violence hotline. Explanation: An awareness of all the unique presentations of child abuse, subjective or objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as broken bones, burns, and bruises, may be as a result of an intentional injury from physical abuse or from an unintentional injury as a result of neglect. Both must be considered. Repeated visits to the emergency department, frequent or suspicious injuries, or bilateral or multiple healing fractures are often indicators of physical abuse. Once the diagnosis of child abuse has been made, the primary role of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing abuse, it’s critical to report it—and to continue reporting each separate incidence if it continues to recur. 19) A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the legs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? a. Intussusception b. Volvulus c. Crohn’s disease d. Foreign body in the GI tract explanation:Intussusception is one of the most common causes of abdominal obstruction in children prior 2 years of age; is best described as a portion of the intestine which telescopes into a more distal intestinal segment. The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient may pull up his knees with crying. The patient may develop vomiting with bilious emesis. Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test. Enemas is considered the first line of treatment prior surgery. Volvulus occurs more frequently in middle-aged and elderly men. Cronos’s is most often diagnosed between 13 – 30 years of age. 20) A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is a. Thyrotoxicosis b. Menopausal vasomotor instability c. Alcohol or another drug withdrawal d. New onset type 2 diabetes mellitus Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaints of insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may 6 be caused by thyroxine excess, menopausal instability, or withdrawal from alcohol or other drugs of addiction. 21) Which of the following indicated need for further evaluation? a. A 7 y/o girl with vaginal bleeding b. A 7 years old girl with no true pubic hair c. A 12 years old boy with sparse, slightly pigmented pubic hair d. A 12-year-old girl with breast buds explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternal estrogen leaving the infant’s uterine lining. Vaginal bleeding after the first few weeks of life and before puberty is considered abnormal. Early vaginal bleeding can indicate trauma, foreign bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps, precocious puberty, or sexual abuse. 22) A young couple is being seen by the NP for preconception counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do now to “make the baby as healthy as possible”. Which of the following should the NP encourage to decrease the chance of neural tube defect in the fetus? a. Maternal alpha-fetoprotein level b. Folic acid 0.4 mg daily c. Rubella vaccine today d. Vitamin E 400 IU daily Explanation: Supplementation with folic acid decreases the development of neural tube defects, such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure. Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks’ gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent tube defects. 23) A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? a. Refer to a cardiologist as soon as possible b. Prescribe long-acting nitroglycerin c. Order treadmill stress test d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours Explanation: The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery). 24) A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: a. Infection proximal to the nodes b. A possible cancer diagnosis c. Shorty nodes, a common normal variant in children d. An infectious process distal to the nodes explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be asses carefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest 7 inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection. 25) The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the NP do next? a. Send the infant for x-ray of the hips b. Send the infant for ultrasound of the hips c. Perform Ortolani and Barlow test d. Examine the infant for unequal arm length Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. Xray studies are not useful before 3 months-of-age because the femoral head has not completely ossified. 26) A very active 35 years old male has painful hemorrhoid, but he does not want hemorrhoidal surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select food that are: a. Low in fiber such as milk and other dairy products b. High in simple carbohydrates such as white bread and mashed potatoes c. High in fiber such as bran, complex carbohydrates and fresh fruit d. High protein such a meat, poultry and fish Explanation: Hemorrhoid disease is the most common reason patients seek evaluation by a colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with medical management or office-based procedures. Patients should benefit from minimizing straining and avoiding constipation. Bulking of the stool facilitates this and can be accomplished by increasing dietary fiber and fluid intake. Stool softeners may also be used. 27) Correct instructions to give new parent who are transporting their newborn infant is a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20 lbs. b. The infant car set may be secured in the back or front seat, but must rear-facing c. The infant car seat may be front facing when the infant is 1 year old d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight 20 lbs. Explanation: The American Academy of Pediatrics (AAP) recommends that infants and toddlers ride in a rear-facing seat until they are 2 years old or until they have reached the maximum weight and height limits recommended by the manufacturer 28) A 13 y/o pt. complains that he fell while running during football practice. Now his knee hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is TRUE about this test? a. An audible or palpated “click” is positive for a torn meniscus b. A various stress is applied to the flexed knee c. The straight leg is internally rotated with the patient supine and flat d. The knee is grasped with the examiner’s fingers placed laterally. Explanation: Mac Murray’s test is conducted while the patient is in the supine position. The NP places the distal hand on the foot and raises the knee slowly, keeping the foot and knee externally 8 rotated with the proximal hand resting on the join line. The knee is flexed and then quickly straightened. If an audible or palpable click occurs during the this test, the outcome is positive for medial meniscal injury. 29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia Explanation:Hydrocele is common in newborns and usually disappears without treatment within the first year. Older men can develop hydroceles, sometimes due to inflammation or injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound may be needed to diagnose the condition. 30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this information, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. 31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to. a) Refer for surgical interventions such as partial or complete fundoplication. b) Refer for endoscopy, namometry, and/or PH testing c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications. d) Review proper proton pump inhibitor dosing time and adherence with the patient. Explanation: poor adherence is an importance cause of inadequate acid suppression and refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and superficially timing in relation to meals, should be sought first alarm features such as iron deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need for further diagnostic testing. Diagnostic testing procedures should proceed any surgical intervention like fundoplication. 32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT a. Moderate weight bearing exercise 3 times per week b. 1200 – 1500 mg calcium daily c. Avoidance of alcoholic beverages d. Weight loss 9 Explanation: the recommended calcium intake is 1,200 mg – 1500 mg a day. Regular weightbearing and muscle-strengthening exercise reduce the risk of falls and fractures. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. However, alcohol intake of more than two drinks per day for women or three drinks a day for men may be detrimental to bone health, increases the risk of falling and requires further evaluation for possible alcoholism. In addition, Risk factors for osteoporosis include age greater than 65, white or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen deficiency including premature menopause. 33) According to Erickson, the developmental task of the elderly adult is: a. Intimacy VS isolation b. Ego integrity VS despair c. Industry VS self-doubt d. Trust Vs mistrust explanation: 34) Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: a. Improved insulin sensitivity b. Increased glucose uptake and utilization by the cells c. Increase lean muscle mass’ d. Improved lipid profile Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes management. The ADA recommends that people with diabetes perform at least 30 minutes, 5 10 days/wk of a moderate-intensity aerobic physical activity. The ADA also encourages people with type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications to reach target blood glucose goals. Regular exercise may also help reduce triglyceride and low-density lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk for hypoglycemia when they increase physical activity. 35) A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media because the a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly b. Tympanic membrane is retracted against boy landmarks c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dulls and immobile. d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact Explanation: Serous otitis media typically presents with a flat or bulging and tympanic membrane with a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be immobile and retracted against the bony landmarks when the eustachian tube is swollen or congested as with the common cold or allergies. Narrowing of the external canal with erythema and extreme tenderness of the canal wall is indicative of otitis externa. 36) The NP should instruct the mother of an infant with thrush to: a. Take oral nystatin since she is breastfeeding b. Stop breast feeding until the thrush has resolved c. administer antifungal What medication would be best to relieve symptomatic wheezing in a patient who has asthma? Short-acting bronchodilator Explanation: The most rapid relief for this patient will be achieved by nebulizing a short-acting bronchodilator, termed a “rescue” medication. Relief can be achieved in 1-5 minutes. Longacting bronchodilators usually take 15-20 minutes to achieve bronchodilation. Methylxanthines are not usually used for relief of asthma symptoms. 180) Strabismus is observed in a 13-month-old child. The most appropriate action for the NP to take is to: Refer the patient to an ophthalmologist Explanation: Any ocular deviation seen beyond 6 months-of-age is considered abnormal and the patient should be referred to an ophthalmologist for evaluation. 45 181) Which of the following findings would raise the NP suspicious of bulimia in a 17-yearold female? Scar on her knuckles Explanation: Scars on the knuckles from induced vomiting are often found on persons with bulimia nervosa. Hypokalemia may be present. Persons with anorexia nervosa are commonly emaciated, but those with bulimia nervosa are usually normal weight. Frequent vomiting causes erosion of dental enamel. 182) A new patient presents to the NP clinic stating she wants a second opinion. She started propylthiouracil (PTU) 75mg 3 times a day a week ago as therapy for newly diagnosed Grave’s disease. She still feels irritable and jittery. How should the NP respond? Inform the patient that improvement requires 2-3 weeks Explanation: Because anti-thyroid drugs block the synthesis of thyroid hormone, but do not interrupt the release of stored hormone, clinical improvement is delayed for 2 to 3 weeks. A euthyroid state can usually be expected in 4 to 6 weeks. 183) Health Maintenance Organization (HMOs) and Preferred Provider Organizations (PPOs) are: Managed care systems Explanation: Managed care systems are intended to integrate delivery of health care with financing of health care. This is typically done through a series of contracts with health care providers, diagnostic groups, and other support services. 184) Which of the following is a microcytic hypochromic anemia? Iron deficiency anemia Explanation: Iron deficiency anemia is a microcytic and hypochromic anemia. Folic acid is a macrocytic normochromic anemia. Pernicious (vitamin B-12 deficiency) anemia is a macrocytic, megaloblastic, and normochromic anemia. The anemia of chronic disease is normocytic and normochromic. 185) Which drug class is associated with elevated serum lipid levels? Thiazide diuretics Explanation: Thiazide diuretics given in a higher dose are associated with elevated serum lipids and glucose. In lower doses, these elevations are less likely. 186) A 16-year-old presents for a sports physical for football. The NP auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP? Refer this patient to a cardiologist Explanation: A diastolic murmur is ALWAYS considered abnormal, even if not accompanied by any physical symptoms. Diastolic murmurs tend to be soft (I-III/IV are common) because the heart is resting during diastole. This patient should not be allowed to practice football until he is evaluated by a cardiologist. He will need an echocardiogram as part of initial treatment. 46 187) The NP is performing a routine assessment of a 47-year-old female who wants to lose weight. She has truncal obesity with relatively slender forearms and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the NP diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT: Cardiac arrhythmias Explanation: Common features of Syndrome X include truncal obesity, HDL equal to or less than 35, triglycerides equal to or greater than 250, hyperinsulinemia, insulin resistance, and HTN. Cardiac pathology is not part of the clinical presentation of Syndrome X. 188) Which of the following is NOT a form of diaper dermatitis? Acrodermatitis enteropathica Explanation: Diaper rash collectively can encompass one or several dermatoses. There are many types: friction, irritation, allergic, atopic, seborrheic, and candida. Typically, candida infections are beefy red with satellite lesions. Acrodermatitis enteropathica is a dermatitis due to zinc deficiency. 189) Which of the following diseases is NOT acquired trans placentally? Tuberculosis Explanation: Tuberculosis is not transmitted trans placentally but may be transmitted in the early newborn period if the mother has active untreated disease. Rubeola, toxoplasmosis, and varicella are all transmitted trans placentally and have teratogenic potential. 190) A 2-week-old infant presents with projectile vomiting, weight loss, dehydration, constipation, and history of insatiable appetite. An olive-shape mass is palpable to the right of the epigastrium. The NP, suspecting pyloric stenosis, refers the infant for an upper GI series. The expected finding is: The “string sign” indicating a narrow and elongated pyloric canal Explanation: Pyloric stenosis is due to a hypertrophied pyloric muscle. It is diagnosed by clinical signs and symptoms along with narrowing and elongation of the pyloric canal (evidenced by upper GI series as the classic “string sign”). Intervention is correction of fluid and electrolyte imbalances followed by surgical repair. 191) Which of the following is an example of secondary prevention? Annual mammography for women age 40 years and older Explanation: Secondary prevention consists of early diagnosis and treatment of a disease that is already present. 192) An 80-year-old Caucasian female has heart failure (FH). Which symptom below is an early indication of failure? Weight gain Explanation: Early signs of HF include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascites, frothy sputum, and hypotension. 47 193) A patient presents to the NP with complaints of diarrhea and malaise which started at 2:00 am the morning of the visit. After history and examination, the nurse practitioner advises the patient that the problem should be self-limiting. If the diarrhea does not resolve, when should the NP advise the pt to return? 3 days Explanation: Diarrhea without systemic symptoms and fever should resolve in 3 days. If does not, laboratory studies and further testing may be necessary to identify the causative organism. 194) A mother presents with a 3-year-old who has croup. The plan for home care would appropriately include: a cool mist vaporizer Explanation: Cool mist helps reduce inflammation and swelling as well as loosen secretions. Warm mist and hot steam aggravate pulmonary inflammation and swelling. 195) An early sign of multiple sclerosis (MS) is: Acute monocular vision loss Explanation: Acute monocular vision loss may be seen in 15% to 20% of patients with MS. Memory loss and personality changes appear later in the course of the disease. Loss of consciousness is not usually associated with MS. 196) The mother of a 6-month-old infant asks about the use of an infant walker. The most appropriate response is to: Discourage the use of walkers and encourage parental holding and floor play Explanation: Baby walkers are a significant cause of injuries in young children. Their use should be discouraged, and parental holding and floor play should be encouraged instead. 197) Which of the following is LEAST likely to be the cause of ophthalmia neonatorum? Hemophilus influenza Explanation: Bacterial conjunctivitis caused by H. influenza is most likely to present in preschoolers and teenagers. All the other choices are likely causing of ophthalmia neonatorum, a form of conjunctivitis in the newborn period. Silver nitrate reaction is the causative factor in 10% of neonates. 198) An 18-year-old female applying for college admission presents to the health clinic because evidence of rubella vaccination is required for admission. She says, “I don’t remember ever getting that shot.” She has negative serologic evidence of rubella antibody. The NP should: Administer the vaccination after a negative pregnancy test and advise the patient that she must not get pregnant for 28 days. Explanation: Administration of rubella vaccination during pregnancy is absolutely contraindicated because of the possible teratogenic effects of rubella on the developing fetus. The earlier in the pregnancy the fetus is exposed, the greater the potential for congenital anomalies. Regardless of the actual time of gestational development in which the fetus is exposed, the infant may be chronically ill. 48 199) A 19-year-old sexually active female is being counseled by the NP about contraception. The NP is accurate when she tells the patient that a diaphragm: Increases the incidence of UTI Explanation: Use of a diaphragm for contraception is associated with an increased incidence of UTI. The arching spring type is easier to properly place than the flat spring type. The diaphragm can be inserted up to 6 hours before intercourse. The risk of contracting a sexually transmitted disease is decreased with diaphragm use. 200) A 2-week-old infant is brought to the NP clinic after a difficult delivery. The mother says the infant fusses when handled or picked up. On physical examination, the NP notes decreased movement of the right arm during the Moro reflex, and crepitus on palpation of the right clavicle. The diagnosis is fracture of the clavicle. The recommended management is: Instructions to the parents to handle the neonate gently. Explanation: A frequent complication of a difficult birth is fracture of the clavicle. Neonates generally require only gentle handling of the arm and shoulder for 3 to 5 weeks. Older children may require a sling. X-rays are not usually necessary. 201) A 4-year-old presents to the clinic with circumoral pallor and an intense red eruption on both cheeks which appeared last night. The child has low grade fever but no other symptoms. What is the most likely diagnosis? Fifth disease Explanation: The eruptive rash of Fifth disease appears on the cheeks and forehead and looks like the child has been slapped; hence, the name, “slapped cheek” disease. This is a viral infection that stars on the face, but by the next day appears as a maculopapular rash on the extremities. It finally spreads to the trunk and distal extremities leaving a lace-like appearance. A prodrome with malaise and fever occurs occasionally. 202) The most effective intervention (s) to prevent stroke is (are): Smoking cessation and treatment of hypertension Explanation: According to the U.S. Preventive Services Task Force, the most important modifiable risk factors for stroke are hypertension and smoking. Improved treatment of hypertension has resulted in greater than 50% age-adjusted reduction in stroke. 203) A 30-years-old female has varicose veins. These are: Usually diagnosed on clinical presentation Explanation: Varicose veins are not congenital, but are due to development of faulty valves, usually at the saphenofemoral junction. They are more common during and after pregnancy. Women become symptomatic during menses. No special diagnostic studies are needed to diagnose varicose veins; they are evident by inspection. However, diagnostic studies are conducted prior to any surgical treatments. 204) A 3-year-old has worn a new pair of plastic sandals at the beach. When her mother takes them off, she notices that the straps of the sandals have left red marks and the child complains of itching and burning in the area of redness. What is the most likely diagnosis and how should the nurse practitioner manage the problem? Contact dermatitis; the mother should not allow the child to wear theses sandals again. 49 Explanation: This is a case of classic contact dermatitis. When the skin is exposed to an irritant, the stratum corneum is disrupted, the underlying epidermis is injured, and an inflammatory reaction ensues. Plastic is a common precipitant of this kind of reaction. The child should avoid exposure to known skin irritants. 205) Which of the following is NOT a symptom of irritable bowel syndrome? Weight loss Explanation: Irritable bowel syndrome (IBS) is characterized by cramping abdominal pain with painful constipation and /or diarrhea. Bleeding, fever, weight loss, and persistent severe pain are indicative of other problems. 206) After a thorough examination, a 2-month-old infant is diagnosed with infantile colic. What should be included in the initial education of the mother about this condition? Instruct the mother on appropriate feeding techniques. Then reinforce efforts to claim and comfort the infant. Explanation: There is no “cure” for infantile colic. The situation can only be managed until it resolves on its own. Effective management includes appropriate feeding technique, calming strategies, and patient support. Dicyclomine (Antispas), hyoscyamine (Lesvin), and simethicone (Mylicon) have indications for treatment of infantile colic. 207) Of the following signs and symptoms of heart failure (HF), the earliest clinical manifestation is: Weight gain Explanation: The earliest and most sensitive clinical indicator of HF is weight gain. A patient with HF should be instructed to weigh himself daily to note changes in his weight. The best time of day to weigh is early morning. The other clinical manifestations listed will present after the weight gain. Another early, clinical manifestation of CHF not listed above is fatigue. 208) After a thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome. Which of the following initial treatment plans is currently considered most effective? A low-fat, tyramine-free, caffeine free, high fiber diet, along with a daily diary, and attention to psychosocial factors Explanation: Irritable bowel syndrome can be diagnosed with careful history and physical examination, along with complete blood count (CBC) to assess for anemia, and a biochemical profile and urinalysis, for general information. Invasive procedures should be avoided unless age or family history indicates risk. A low-fat, tyramine free, caffeine free diet, along with a daily diary and stress reduction are mainstays of therapy. Unresponsive patients should be referred to a gastroenterologist. Selective serotonin reuptake inhibitors (SSRI) may worsen symptoms by their excitatory effect on the bowel. 209) A 2-week old African American male infant has ecchymotic-like marks over his lower back and upper buttocks. The most appropriate intervention is to: Reassure the infant’s mother that this is a normal finding 50 Explanation: Mongolian spots are normal variants in non-Caucasian infants (particularly African American and Asian infants). They appear as “bruised” areas on the lower back and buttocks and usually fade spontaneously. 210) An elderly patient is taking an effective dose of doxepin (Sinequan) for treatment of agitated depression with insomnia. Constipation has become a significant problem, even though the patient has been vigilant about maintaining adequate hydration and uses bulk laxatives frequently. Which of the following is the course of action most likely to be successful? Stop the doxepin and initiate trazodone (Desyrel) Explanation: Fluoxetine tends to contribute to insomnia. A daily enema may cause fluid and electrolyte imbalance. Trazodone is a good alternative. It is a sedating antidepressant with properties similar to doxepin, but without anticholinergic effects. Constipation often accompanies depression and should be treated. 211) Which of the following is NOT true about Carpal Tunnel Syndrome? Phalen’s and Tinel’s signs are negative Explanation: Phalen’s and Tinel’s signs are positive and diagnostic of Carpal Tunnel Syndrome. Another hallmark feature is nighttime awakening with symptoms. Symptoms follow the distribution of the median nerve which innervates the first 3 fingers and the thumb-side half of the 4th finger. There is no involvement of the 5th finger. 212) A 17-year-old female presents with painful vesicular lesions on her vulva. Which of the following would be the most definitive diagnostic test? Tzanck prep Explanation: Tzanck prep is the only test in this which is diagnostic for herpes simplex. KOH prep is used to diagnose candida and bacterial vaginosis. Gram stain is used to help distinguish Gram positive and Gram-negative organisms. The Papanicolaou (Pap) smear is used to screen for cervical dysplasia and cancer. 213) Which of the following findings are usually associated with atopic dermatitis in infants? Positive family history Explanation: Atopic dermatitis is a familial disorder with unknown etiology. It is intensely pruritic. In infants it presents on the cheeks, forehead, scalp, trunk or extremities. It is often associated with asthma and allergy. 214) Today, a patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. In order to best assess the adequacy of supplementation, the NP would appropriately order a follow-up: b. Hemoglobin level 1 one month Explanation: One month after iron supplementation, a hemoglobin or hematocrit should be measured to assess response to therapy. If this value is not increased in 1 month, consideration must be given to other sources of iron loss like GI or menstrual bleeding. The serum ferritin level, an indicator of tissue iron stores, should be increased and near normal after 4-6 months of supplementation. The reticulocyte count wound be expected to increase be 10 days or less but would not specifically assess the effects of iron supplementation. 51 215) Appropriate nutritional guidance for the pregnant patient is: b. Increase caloric intake by 300 Cal/day and add iron and folic acid supplementation Explanation: Recommendation during pregnancy include well-balanced and nutritious meals and snacks, an additional 300 calories per day, and supplemental folic acid, iron and calcium. 216) An 8-month-old male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma but say “he has always bruised easily.” The most likely diagnosis is: A type of hemophilia Explanation: Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times. 217) At 3 years old female with palpable right upper quadrant abdominal mass, anemia, and fever is been evaluated for wilms tumor. Which of the following diagnostic test would be the most useful a) intravenous polygram b) flat an erect xray of the abdomen c) abdominal ultrasound d) Voiding sistourethrogram Explanation: Abdominal ultrasound gives the best information about extensiveness of the tumor. Flat and erect x-rays of the abdomen may show linear calcifications, but are not as helpful as ultrasound. Intravenous pyelogram is rarely useful and voiding cystourethrogram is not indicated in the evaluation of Wilms' tumor. 218) Which class of drugs increases a patient's risk of developing rhabdomyolysis ? a) anti hypertensives b) thiazide diuretics c) the statin d) anticoagulant Explanation: The higher the dose of statins, the higher the risk of rhabdomyolysis becomes. The risk also increases if certain drugs — including cyclosporine (Sandimmune) and gemfibrozil (Lopid) — are taken in combination with statins. An overdose of aspirin or diuretics may cause an electrolyte imbalance and muscle injury. Alcohol and illegal drugs such as amphetamines, opiates, ecstasy, and LSD can also cause muscle injury. Trauma to the muscles, such as a crushing injury, electrical shock, or severe burns, can cause rhabdomyolysis. 219) When, in childhood, do the frontal sinus is usually present? a) 2 to 3 years b) 4 to 6 years c) 10 to 11 years d) Birth 52 Explanation: frontal sinuses usually appear as early as 5 to 6 years of age but they may be asymmetrical or absent. Infants are born with ethmoid sinuses. Sphenoid sinuses may be identified radiographically by 9 years of age. 220) Which of the following is an example of Piaget’s concrete logical operation? a) A 4 years old child insist that a bowl of clay has more ones it is shaped into a snake b) a 5 years old child demonstrate their ability to read a paragraph to decode the words c) a 7 years old maintains that a bowl of clay wait the same amount after it has been shaped into a snake d) an 8 years old child must recalculate basic mathematic facts each time he attempts to solve a word problem Explanation: This period spans the time of middle childhood—it begins around age 7 and continues until approximately age 11—and is characterized by the development of logical thought. Conservation is the understanding that something stays the same in quantity even though its appearance change 221) A 23 years old college student present to the campus health clinic with a generalized rash on the trunk deletions are oriented in a Christmas tree pattern and are mildly pruritic. she describes around ringworm that that appeared about one week ago coma but now how has disappeared. What is this patient's diagnosis and how should be treated? a) Tinea corporis: treat with a topical antifungal cream for 10 to 14 days b) secondary syphilis: treat with penicillin c) viral exanthem: not specific treatment is needed except rest and fluids d) Pityriasis rosea: treat with a topical anti pruritic Explanation: Pityriasis rosea is a self-limited, inflammatory disorder of the skin possibly caused by human herpesvirus types 6, 7, or 8 or drugs. An initial 2- to 10-cm herald patch is followed by centripetal eruption of oval papules and plaques with a slightly raised and scaly border, typically appearing along skin lines. Diagnose based on clinical appearance and distribution. Treat with antipruritic drugs as needed and possibly topical corticosteroids and/or sunlight. Pityriasis rosea during the first 15 wk of pregnancy is associated with premature birth or fetal demise. Pregnant women should be offered antiviral therapy, even though this has not proved to reduce obstetric complications. Definition of Viral Exanthem: Viral exanthema is a widespread skin rash triggered by a viral infection. These rashes are more common in children than adults. 222) The nurse practitioner is caring for a 19 years old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate initial treatment for this patient is: a) intramuscular iron dextran b) a daily oral multi vitamin with iron c) oral ferrous sulfate d) increase intake of dietary iron Explanation: With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed but may be required in 53 the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. 223) The initial management of an adult with hypertension should include: evaluation for underlying causes explanation: approximately 5% of patients with hypertension in the US half secondary hypertension coma that is, it is secondary to something. Patient history, physical exam, and laboratory tests should be completed to identify patients who might have underlying causes (secondary hypertension ). underlying causes include some forms of renal disease, medications (oral contraceptives), adrenal hypertension, Acromegaly and hypercalcemia . 224) Which of the following statements about medication in a 45 years old patient with diabetes is correct? daily aspirin therapy should be recommended for the secondary prevention of a cardiovascular disease. Explanation: daily aspirin therapy for the secondary prevention of cardiovascular disease is recommended for patients with diabetes. The use of as the primary prevention, specially in low risk patients, is not routinely recommended. ACE inhibitors are especially beneficial right after albuminurea is present. Even if blood pressure is normal, an ace inhibitor may be used for renoprotection. The initiation of statin the dependent on cardiovascular risk or the presence of cardiovascular disease. ACE inhibitors may not be required with all patients with d…. 225) A 25 years old female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexu