NSG 6440 Practice Test

NSG 6440 Practice Test The most cost-effective screening test for determining HIV status is which of the following? Western blot Enzyme-linked immunosorbent assay Venereal Disease Research Laboratory test Viral load - ANS Enzyme-linked immunosorbent assay Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process? Erythrocyte sedimentation rate White blood cell count Polymorphonuclear cells C-reactive protein (CRP) - ANS C-reactive protein (CRP) Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter? GABA Acetylcholine Dopamine Serotonin - ANS Dopamine Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is: Ecchymosis, edema, and erythema over the lateral epicondyle Pain at the elbow with resisted movements at the wrist and forearm Inability to supinate and pronate the arm Inability to flex or extend the elbow against resistance - ANS Pain at the elbow with resisted movements at the wrist and forearm Which of the following statements concerning the musculoskeletal examination is true? The uninvolved side should be examined initially and then compared to the involved side. The part of the body that is causing the patient pain should be examined first. When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient. - ANS The uninvolved side should be examined initially and then compared to the involved side. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain? Decreased C-reactive protein Hyperalbuminemia Morning stiffness Weight gain - ANS Morning stiffness Which causes the greatest percentage of mammalian bites? Dogs Cats Humans Rodents - ANS Dogs A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first? Transvaginal ultrasound Endometrial biopsy MRI Abdominal computed tomography scan - ANS Transvaginal ultrasound A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate? "Control of glucose will help postpone or delay complications." "Regularly checking blood sugar will help establish a routine." "Monitoring glucose will promote a sense of control." All of the above - ANS All of the above "Control of glucose will help postpone or delay complications." "Regularly checking blood sugar will help establish a routine." "Monitoring glucose will promote a sense of control." A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next? Serum calcium TSH Electrolytes Urine specific gravity - ANS TSH Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy? Insulin Metformin Glucotrol Precose - ANS Glucotrol During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious? An enlarged rubbery gland A hard irregular gland A tender gland A boggy gland - ANS An enlarged rubbery gland Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step? Remove the insect with tweezers. Immobilize the insect with 2% lidocaine. Sedate Eddie with diazepam. Shine a light in the ear for the insect to "find its way out." - ANS Immobilize the insect with 2% lidocaine. What is the most common cause of microcytic anemia? Anemia of chronic disease Sideroblastic anemia Iron-deficiency anemia Thalassemia - ANS Iron-deficiency anemia An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? Benign prostatic hyperplasia (BPH) Parkinson's disease Prostate cancer All of the above - ANS All of the above Early rheumatoid disease is characterized by: Pain and swelling in both small and large peripheral joints Rigid joints with diminished range of motion Joint swelling and immobility on rising A cardiac rub or pulmonary friction rub - ANS Joint swelling and immobility on rising A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do? Make an immediate referral for an orthopedic evaluation without further assessment. Tell her that it takes time for these bruises to improve, so she should be patient. Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint. Send her to the emergency room for reduction of this obvious wrist fracture. - ANS Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint. The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least: 1 month 3 months 6 months 12 months - ANS 6 months A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find? The scrotum will be dark. The scrotum will appear light pink or yellow. The scrotum will appear milky white. The internal structures will be clearly visible. - ANS The scrotum will appear light pink or yellow. According to Kübler-Ross, the stages of grief occur in which order? Anger, denial, depression, bargaining, acceptance Anger, denial, bargaining, acceptance, depression Denial, anger, depression, bargaining, acceptance Denial, anger, bargaining, depression, acceptance - ANS Denial, anger, bargaining, depression, acceptance Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate? A favorable prognostic trend Disease progression The need to be more aggressive with Reuben's medications The eradication of the HIV - ANS A favorable prognostic trend The exanthem of Lyme disease is: Erythema infectiosum Laterothoracic exanthem Erythema migrans Morbilli exanthem - ANS Erythema migrans You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: Articular Inflammatory Nonarticular A and B - ANS Articular What is the recommended daily calcium intake for adults over the age of 50 with low bone mass? 1,200 mg/day 1,000 mg/day 1,300 mg/day 1,500 mg/day - ANS 1,500 mg/day When assessing a woman for infertility, which of the following tests should be done first? Analysis of partner's sperm Magnetic resonance imaging (MRI) Hysterosalpingogram Estrogen level - ANS Analysis of partner's sperm Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact? Superficial burns Superficial partial-thickness burns Deep partial-thickness burns Full-thickness burns - ANS Deep partial-thickness burns A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? Human papillomavirus (HPV) Endometrial hyperplasia Vagismus Polycystic ovarian syndrome - ANS Human papillomavirus (HPV) As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin? Two Three Four Five - ANS 3 Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? Morning stiffness and limited mobility of the lumbar spine Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain Fever, chills, and elevated erythrocyte sedimentation rate Pathologic fractures, severe night pain, weight loss, and fatigue - ANS Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis Testosterone level Prostate-specific antigen Nocturnal penile tumescence and rigidity Prolactin level - ANS Testosterone level The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective? "I'll take my pill at least 30 minutes before breakfast." "I'll take my Glucotrol before bedtime." "It is important to take my medication right after I eat." "Since I only like to eat two meals a day, I can take the pill between my meals." - ANS "I'll take my pill at least 30 minutes before breakfast." In the United States, what is the second most common connective tissue disease and the most destructive to the joints? Osteoarthritis Systemic lupus erythematosus (SLE) Rheumatoid arthritis Sjögren's syndrome - ANS Rheumatoid arthritis The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety? Acetylcholine Gamma-aminobutyric acid (GABA) Dopamine Serotonin - ANS Gamma-aminobutyric acid (GABA) A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? Refer to a urologist immediately. Obtain a computed tomography (CT) scan. Instruct the patient to elevate the scrotum. Prescribe ibuprofen. - ANS Refer to a urologist immediately Which of the following medications can cause hyperglycemia? - ANS prednisone During treatment for anaphylaxis, what site is used for the initial injection of epinephrine? IV Abdomen Upper lateral thigh Deltoid - ANS Upper lateral thigh It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period? Before the initiation of treatment 1 to 2 weeks after the initiation of treatment When switching to a different medication 1 to 2 weeks after tapering off medications - ANS 1 to 2 weeks after the initiation of treatment What is the most common cause of secondary amenorrhea? Pregnancy Pituitary dysfunction Inadequate estrogen levels Genetic disorders - ANS Pregnancy Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration? Sertraline Fluoxetine Citoprolam Imipramine - ANS Fluoxetine The goals of the 15-minute hour approach include: Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning Emerge with a higher level of functioning and commitment to long-term psychotherapy Accept need for antidepressant therapy and psychiatric referral; share concerns with primary care clinician Improve family functioning and sexual performance as well as accept need for antidepressant medication - ANS Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? Valgus stress test McMurray circumduction test Lachman test Varus stress test - ANS McMurray circumduction test The cardinal subjective symptom of sickle cell crisis is which of the following? Pain Nausea Light-headedness Palpitations - ANS Pain A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea? Pelvic inflammatory disease Endometriosis Sexually transmitted infections Ovarian cyst - ANS Endometriosis Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue? Tick Brown recluse spider Wasp Stinging caterpillar - ANS Brown recluse spider Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? Gastrocnemius weakness A reduced or absent ankle reflex Numbness in the lateral foot Paresthesia of the perineum and buttocks - ANS Paresthesia of the perineum and buttocks A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? Pregnancy test Complete blood cell count Thyroid-stimulating hormone Urine dip for protein - ANS Pregnancy test A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin? Ketoacidosis Cirrhosis Hypoglycemic episodes All of the above - ANS All of the above The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagn=stic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants? SSRIs are more effective than TCAs. SSRIs take less time to work than TCAs. SSRIs have a more favorable side-effect profile than TCAs. SSRIs are not lethal in overdose. - ANS SSRIs are more effective than TCAs. Which type of bone marrow transplant is obtained from an identical twin? Autogenic Autologous Allogeneic Syngeneic - ANS Syngeneic Pink, cherry red tissues and skin may result from which type of poisoning? Arsenic Lead Carbon monoxide Strychnine - ANS Carbon monoxide Basic human needs are identified as: Autonomy and feeling valued by others Exhilaration and productivity Spirituality Career success and material rewards - ANS Autonomy and feeling valued by others The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient? Overweight Mild obesity Moderate obesity Morbid obesity - ANS Mild obesity A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self- examination (TSE). Which of the following should be included in the list of differential diagnoses? Testicular cancer Inguinal hernia Varicocele All of the above - ANS All of the above What is the treatment of choice for a patient diagnosed with testicular cancer? Radical orchidectomy Lumpectomy Radiation implants All of the above - ANS Radical orchidectomy Which method is used to remove heavy metals, such as lead, that are ingested as poisons? Chelation Dialysis Gastric lavage Bowel irrigation - ANS Chelation A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? "It is probably just a cyst because that is the most common breast mass." "We will order a mammogram and ultrasound to help establish a diagnosis." "We will go ahead and schedule you for a biopsy because that is the only way to know for sure." "Because your lump is painful, it is most likely not cancer." - ANS "We will order a mammogram and ultrasound to help establish a diagnosis." A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? Fluconazole Estrogen vaginal cream Metronidazole Doxycycline - ANS Fluconazole The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." "You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication." "You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain." "It is important to take NSAIDs on an empty stomach in order to increase absorption." - ANS "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? A sprain A strain A partial fracture A fracture - ANS A strain Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea? Heat cramps Heat syncope Heat exhaustion Heat stroke - ANS Heat stroke Which of the following may be used to evaluate a person's suicide risk? CAGE SANE SAD PERSONAS DIGFAST - ANS SAD PERSONAS One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure? Bone Synovium Tendons Fascia - ANS Synovium After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering? A viral syndrome Lyme disease Rocky Mountain spotted fever Relapsing fever - ANS Lyme disease A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease? Sinus bradycardia Atrial fibrillation Supraventricular tachycardia U waves - ANS Sinus bradycardia Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal? Pregnancy Estrogen level Progesterone level LH level - ANS Pregnancy After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies? - ANS normal A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment? - ANS Diet and exercise for 6-week trial Which of the following should be considered in a patient presenting with erectile dysfunction? Diabetes mellitus Hypertension Atherosclerosis All of the above - ANS All of the above Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. - ANS Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? Ceftriaxone Doxycycline Acyclovir Metronidazole - ANS Ceftriaxone Which of the following statements is true regarding the treatment of carpal tunnel syndrome? The goal of treatment is to prevent flexion and extension movements of the wrist. Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection. All of the above - ANS All of the above Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient? Elevated uric acid level Elevated blood urea nitrogen Decreased urine pH Decreased C-reactive protein - ANS Elevated uric acid level Which of the following data is indicative of testicular torsion? Absent cremasteric reflex Pain relieved on testicular elevation Testicle very low in the scrotum Swollen scrotum with "red dot sign" - ANS Absent cremasteric reflex A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes? Reduces postprandial blood glucose Reduces triglycerides and increases high-density lipoprotein (HDL) Reduces total cholesterol All of the above - ANS All of the above A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? Pregnancy test Pelvic ultrasound Endometrial biopsy Platelet count - ANS Pregnancy test What is the most common cause of generalized musculoskeletal pain in women ages 20 to 55? Chronic fatigue syndrome (CFS) Anemia Fibromyalgia syndrome (FMS) Sports-related injuries - ANS Fibromyalgia syndrome (FMS) If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do? Stop the warfarin for 1 week, and then repeat the INR. Withhold one or more days of anticoagulant therapy. Restart therapy at a lower dose immediately. The prothrombin time and INR should be reevaluated within 1 month of the dosage adjustments. - ANS Withhold one or more days of anticoagulant therapy. Restart therapy at a lower dose immediately. A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes? Pelvic inflammatory disease Oral contraceptive use for 15 years Early menarche Diet high in soy protein - ANS Pelvic inflammatory disease Which of the following statements concerning the treatment of fibromyalgia syndrome is true? There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible. Treatment is directed toward controlling discomfort, improving sleep, and maintaining function. Fibromyalgia syndrome can be difficult to manage, requiring a variety of approaches and multiple medications. All of the above - ANS All of the above The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis? Gram-positive cocci Gram-negative cocci Gram-positive bacillus Gram-negative bacillus - ANS Gram-negative bacillus Which household solution should be used to clean a bathroom if sharing with a friend who has HIV? 100% bleach 50% bleach and 50% vinegar Nine parts H2O to one part bleach The friend must have his or her own bathroom. - ANS Nine parts H2O to one part bleach Sandra is 42 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit? Acute lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia Chronic lymphocytic leukemia - ANS Acute myelogenous leukemia Which of the following is identified as an eating disorder in which a person craves food substitutes, such as clay, ice chips, and cotton, and is considered an objective finding associated with severe iron deficiency? Ferritin Porter's syndrome Hypochromasia Pica - ANS Pica The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit? High sensitivity thyroid-stimulating hormone (TSH) and free T4 Free T4 and serum calcium Free T3 and T4 TSH and thyroxin antibodies - ANS High sensitivity thyroid-stimulating hormone (TSH) and free T4 The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective? "As long as I don't need glasses, I don't have to worry about going blind." "I know I need to have my eyes checked every year." "My optometrist checks my eyes." "I will see my eye doctor when my vision gets blurry." - ANS "I know I need to have my eyes checked every year." Triggering factors for acute exacerbations of which of the following conditions include exposure to ultraviolet (UV)-B and UV-A rays? Rheumatoid arthritis Scleroderma SLE Sjögren's syndrome - ANS SLE Which of the following characteristics separates anaphylaxis from a vasovagal reaction? Bradycardia Extreme diaphoresis Severe bronchoconstriction Hypotension - ANS Severe bronchoconstriction Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician? "Complementary therapies should be considered only if surgical interventions are not successful." "I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition." "I would be happy to discuss all the treatment options available to you. Complement - ANS "I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy." One benefit of motivational interviewing (MI) is: It assumes that ambivalence is a normal part of the change process. It can be utilized during routine office visits. It is a therapeutic technique which is not necessarily time intensive. All are benefits of MI. - ANS All are benefits of MI. What percentage of burns is involved using the rule of nines if both front legs are burned? 9% 18% 24% 36% - ANS 18% Women are at the highest risk for developing postpartum depression for up to how long after childbirth? 2 weeks 1 month 3 months 6 months - ANS 6 months Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate? PEP should be started within hours of exposure. PEP should be started within 72 hours of exposure. Renal and hepatic function tests should be done 6 weeks after beginning PEP. PEP will prevent potential hepatitis C infection if present. - ANS PEP should be started within hours of exposure. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x- ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane's description of her injury. Which of the following clues in Diane's examination or history would alert the clinician to the need for obtaining radiographs? Inability to bear weight immediately after the injury Development of marked ankle swelling and discoloration after the injury Crepitation with palpation or movement of the ankle All of the above - ANS All of the above A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods? Rice Carrots Spinach Potatoes - ANS Spinach A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? CN II CN III CN IV CN V - ANS CN IV A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack? Pheochromocytoma Hyperthyroidism Cardiac arrhythmias All of the above - ANS All of the above Which test is used to confirm a diagnosis of epididymitis? Urinalysis Gram stain of urethral discharge Complete blood cell count with differential Ultrasound of the scrotum - ANS Ultrasound of the scrotum BATHEing the patient refers to: A technique used in primary care to get the patient to accept the need for psychological or psychiatric referral A technique used to facilitate cultural understanding A technique used to perform psychotherapy A technique that is a quick screen for psychiatric issues and interventions for psychological problems - ANS A technique that is a quick screen for psychiatric issues and interventions for psychological problems BATHEing the patient is an advanced practice nursing intervention that allows the practitioner to: Develop a therapeutic relationship without "owning" the patient's problem Conduct psychological counseling within the context of the primary care encounter Focus on the "process" and not the assessment Make the patient and family happier - ANS Develop a therapeutic relationship without "owning" the patient's problem Question 100.Question : A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses? Leiomyoma Pregnancy Ovarian cancer All of the above - ANS All of the above A useful maneuver test to confirm a cervical spine sprain/pain is: Spurling's Test Patrick's Test You Answered Obrien's Test Neer's Test - ANS Spurling's Test Acute low back pain does not warrant radiographic imaging unless there is evidence of neurological dysfunction. t f - ANS t The preferred imaging to determine the degree of spinal canal narrowing and facet arthroplasty resulting in nerve impingement is what? X-ray Magnetic resonance imaging Ultasound Computed tomography - ANS mri Which of the following is not a maneuver test to assess for lumbosacral pain? Straight leg raise Gaenslen's Hawkins Faber - ANS hawkins Cauda equina syndrome should prompt a yellow flag for the provider. t f - ANS f To determine whether the patient has normal thyroid function, the initial test should be _____. thyroglobulin antibodies thyroperoxidase antibodies TSH with reflex to FT4 TT3 - ANS TSH with reflex to FT4 Your patient is symptomatic with complains of fatigue, weight gain, constipation, and hair loss. The patient's labs return with a TSH of 7 and a normal FT4. Without considering a patient's weight (she refuses to get on the scale today), what dose of medication would you chose based on the lab values? Synthroid 75 mcg Synthroid 50 mcg Synthroid 25 mcg I would not medicate this patient. - ANS Synthroid 25 mcg A 70-year-old patient presents with a complaint of difficulty swallowing, tachycardia, sweating, and unintentional weight loss. Upon physical exam, the patient is found to have an enlarged thyroid that has an abnormal contour. Without any further testing, what diagnosis would you say is the most likely? Overt hypothyroidism Hashimoto's thyroiditis Subclinical hyperthyroidism Nodular goiter - ANS Nodular goiter intention tremor can be seen when the patient attempts voluntary movement. True False - ANS t Resting tremor can be seen when the arms are extended out in front of the patient. True False - ANS f Wilson's disease is a rare condition associated with lead poisoning. True False - ANS f congenital and due to excessive copper in the body In the primary care setting, patients with acute vertigo accompanied by headache and brainstem symptoms should be immediately sent to the ER to rule out stroke or hemorrhage. True False - ANS t Dizziness may be defined as _____. instablity. feeling faint. lightheadedness. all of the above. - ANS all of the above Cellulitis involve the deeper dermis while erysipelas involve the upper dermis. True fale - ANS t Cellulitis and erysipelas are almost always bilateral infections with the most common site of infection being the lower extremities. True False - ANS F These populations are most commonly affected by cellulitis and erysipelas. Cellulitis affects young children and older adults Cellulitis affects middle-age individuals and older adults. Erysipelas affects middle-age individuals and older adults Erysipelas affects children and middle-age adults. - ANS Cellulitis affects middle-age individuals and older adults. The vast majority of pathogens associated with cellulitis are from either streptococcal or _____ bacteria. In contrast, erysipelas almost always result from _____ bacteria Staphylococcus; Staphylococcus Morexella; Staphylococcus Morexella; Streptococcus Staphylococcus; Streptococcus - ANS Signs and symptoms include skin erythema, edema, warmth, and pain erysipelas cellulitis both - ANS both It is always nonpurulent erysipelas cellulitis both - ANS erysipelas It has an acute onset with fever and chills erysipelas cellulitis both - ANS erysipelas The lesions are raised above the level of surrounding skin with clear demarcation between involved and uninvolved tissue erysipelas cellulitis both - ANS erysipelas It might present lymphangitis and inflammation of regional lymph nodes erysipelas cellulitis both - ANS both Elevation of the affected area should be avoided because this can reduce perfusion to the affected area and reduce antibiotic effectiveness True False - ANS f What antibiotic should be added to amoxicillin if MRSA is suspected? Cephalexin Penicillin VK Bactrim DS Doxycycline - ANS Bactrim DS most frequently observed in adults. True False - ANS f Risk factors for community-associated methicillin-resistant S. aureus (CA-MRSA) include _____. poor hygiene HIV infection hemodialysis lack of dental care exercise intolerance - ANS poor hygiene HIV infection hemodialysis Experts recommend oral antibiotics for drained single abscess ≥2 cm. True False - ANS t Infection with this microbe characteristically develops rapidly following cat or dog bites with erythema, swelling, and intense pain evident as early as 12 to 24 hours after the bite. Staphylococcus Streptococcus Pasteurella multocida Eikenella - ANS Pasteurella multocida Aerobic and anaerobic blood cultures are warranted prior to antibiotic therapy in patients with an infected bite wound and signs of systemic infection. True False - ANS t Wound cultures should be obtained regardless of whether a bite is uninfected or not. True False - ANS f The laboratory requisition should note that an animal or human bite wound is the culture source because Eikenella corrodens and Pasteurella multocida are fastidious organisms. True False - ANS t Once the infection is established, HIV preferentially targets CD4+ T cells. This leads to _____. CD4+ T cell decline CD4 + T cell activation Chronic inflammation B and C - ANS CD4 + T cell activation Chronic inflammation The populations that are most at risk of contracting HIV are _____. Adolescents and adults aged 15 to 65 years Men who have sex with men and active injection drug users Homeless and sex workers Hemodialysis patients and those having sexual partners who are HIV-infected, bisexual, or injection drug users - ANS Men who have sex with men and active injection drug users Current recommendations on HIV screening include testing all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. t f - ANS t he following are fluids that can transmit HIV infection. Urine, feces, and blood Semen, vaginal fluid, and breast milk Saliva, breast milk, and peritoneal fluid Blood, pleural fluid, and urine - ANS Semen, vaginal fluid, and breast milk Who is more likely to contract HIV during sexual intercourse? Women are more likely than men during anal or vaginal sex. Men are more likely than women during anal or vaginal sex. Men are more likely than women during oral sex. Men are more likely than women during oral sex when the female partner has a very high viral load. - ANS Women are more likely than men during anal or vaginal sex. STIs decrease the likelihood of HIV transmission. True False - ANS f Keeping an infected partner's viral load low reduces the risk of transmission to an HIV-negative partner. t f - ANS t Most patients with acute HIV infection will exhibit signs and symptoms associated with acute retroviral syndrome. t f - ANS f The usual time from HIV exposure to the development of symptoms is _____ to _____ weeks. 1; 3 2; 4 3; 6 4; 8 - ANS 2,4 HIV differential diagnosis includes _____. syphilis, rubella, and varicella influenza, hepatitis, and cytomegalovirus toxoplasmosis, rheumatoid arthritis, and hypothyroidism strep, lupus, and chancre - ANS influenza, hepatitis, and cytomegalovirus Knowing that the current Health and Human Services Guidelines on the Treatment of HIV in Adults recommends to start HIV treatment immediately after the diagnosis, you proceed to _____. start your patient on a single tablet that contains three medications from at least two different classes refer your patient to an HIV medicine specialist or an infectious disease specialist start your patient on two NRTIs plus one NNRTI start your patient on two NRTIs plus one protease inhibitor - ANS refer your patient to an HIV medicine specialist or an infectious disease specialist