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A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (BP) at this visit is 168/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease?
A) It increases the chances of adverse effects to her health
B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic
C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics
D) None of the statements are true - ANSWER-B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic.
NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure by decreasing renal blood flow.
- All of the following are infections that affect mostly the labia and vagina except:
A) Bacterialvaginosis
B) Candidiasis
C) Trichomoniasis
D) Chlamydia trachomatis - ANSWER-D) Chlamydia trachomatis
Infections that commonly affect the labia and vagina include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity.
The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for:
A) Cholecystitis
B) Acute appendicitis
C) Inguinal hernia
D) Gastriculcer - ANSWER-B) Acute appendicitis.
Signs and symptoms of an acute abdomen include invol- untary guarding, rebound tenderness, boardlike abdomen, and a positive obtu- rator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his/her side with knees extended, or when pain occurs with active flexion of his/her thigh at the hip.
Treatment for mild preeclampsia includes all of the following except:
A) Bed rest except for bathroom privileges
B) Close monitoring of weight and blood pressure
degrees Fahrenheit, respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right lung. The total white blood cell count is 10,500/uL. What is the most likely diagnosis?
A) Streptococcal pneumonia
B) Mycoplasma pneumonia
C) Acute bronchitis
D) Legionnaires disease - ANSWER-B) Mycoplasma pneumonia
Mycoplasma pneumonia is the organism most com- monly seen in children and young adults. It is easily spread from droplets, from sneezing and coughing, in close proximity. Diagnosis is based on symptoms and x-ray results of infiltrates in lower lobes.
A 39-year-old migrant worker presents to the clinic 2.5 days after a purified protein derivative (PPD) test. What minimum size of induration would be considered posi- tive for this patient?
A) 3 mm B) 5 mm C) 10 mm D) 15 mm - ANSWER-C) 10 mm
The PPD is administered on the volar aspect of the lower arm and read 48 hours after the test is given. The PPD result must have induration and measure 10 mm or greater to be positive in a low-risk patient. Induration (firmness with palpation) must be present. If the site has erythema but no induration, result would be negative. Color is not important.
All of the following are correct statements regarding the role of the person named in a durable power of attorney except:
A) The agent's decisions are legally binding
B) The agent can make decisions in other areas of the patient's life such as financial
issues
C) The agent can decide for the patient who is on life support when that life support
can be terminated
D) The patient's spouse has a right to override the agent's decisions - ANSWER-D) The patient's spouse has a right to override the agent's decisions
The person named in a durable power of attorney (the agent) is designated by the patient to make all medical decisions, as well as any decisions regarding the patient's private affairs in the event that the patient becomes incompetent and unable to make his/her own decisions. No one has the ability to override the agent's decision.
All of the following are true statements regarding Munchausen syndrome except:
A) It is considered a mental illness
B) The patient has a medical illness that causes an anxiety reaction and denial
C) The patient fakes an illness in order to gain attention from health care providers
A) Perform a complete and thorough history
B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID
C) Give an injection of epinephrine 1:1000 intramuscularly stat
D) Call 911 - ANSWER-A) Perform a complete and thorough history
Prior to prescribing medications, a complete and thorough history must be performed to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency to require calling 911.
Which of the following findings is most likely in young primigravidas with pregnancy-induced hypertension?
A) Abdominal cramping and constipation
B) Edema of the face and the upper extremities
C) Shortness of breath
D) Dysuria and frequency - ANSWER-B) Edema of the face and the upper extremities
Common signs and symptoms of pregnancy-induced hypertension include edema of the face and the upper extremities, weight gain, blurred vision, elevated BP, proteinuria, and headaches.
Which of the following symptoms is associated with B12 deficiency anemia?
A) Spoon-shaped nails and pica
B) An abnormal neurological exam
C) A vegan diet
D) Tingling and numbness of both feet - ANSWER-D) Tingling and numbness of both feet
Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or numbness in fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia.
A second triple screen on a 35-year-old primigravida reveals abnormally low lev- els of the alpha fetoprotein and estriol and high levels of human chorionic gonad- otropin. Which of the following interventions is the best choice for this patient?
A) Order an ultrasound
B) Order a computed tomography (CT) scan of the abdomen
C) Order a 24-hour urine for protein clearance
D) Assess for a history of illicit drug or alcohol use - ANSWER-A) Order an ultrasound
Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be
When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis.
Kyphosis is a late sign of:
A) Old age
B) Osteopenia
C) Osteoporosis
D) Osteoarthritis - ANSWER-C) Osteoporosis
Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain.
A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be?
A) Normal
B) Higher than normal
C) Lower than normal
D) None of the above - ANSWER-B) Higher than normal
Alpha fetoprotein is produced in the fetal and maternal liver. Higher levels of alpha fetoprotein are commonly seen in multiple gestations due to the growing fetuses and enlargement of the livers.
Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis?
A) Calcium channel blocker
B) Angiotensin-converting enzyme (ACE) inhibitor
C) Beta-blocker
D) Diuretic - ANSWER-A) Calcium channel blocker
Calcium channel blockers act by blocking the cal- cium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones.
The Lachman maneuver is used to detect which of the following?
A) Knee instability
B) Nerve damage of the knee due to past knee injuries
C) The integrity of the patellar tendon
D) Tears on the meniscus of the knee - ANSWER-A) Knee instability
The Lachman maneuver is a test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament.
The acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. Although several of the conditions listed in the other answer options can also cause fetal problems, they are not included in the TORCH acronym.
Human papilloma virus (HPV) infection of the larynx has been associated with:
A) Laryngeal neoplasia
B) Esophageal stricture
C) Cervical cancer
D) Metaplasia of esophageal squamous cells - ANSWER-A) Laryngeal neoplasia
HPV infection of the larynx has been associated with laryngeal neoplasia; HPV infection of the cervix is associated with cervical cancer.
Mr. Brown is a 65-year-old carpenter complaining of morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam, the nurse notices the presence of Heberden's nodes. Which of the fol- lowing is most likely?
A) Osteoporosis
B) Rheumatoid arthritis
C) Degenerative joint disease
D) Reiter's syndrome - ANSWER-C) Degenerative joint disease
Heberden's nodes are commonly seen in degenerative joint disease. Heberden's nodes are bony nodules located on the distal interphalangeal joints (DIPs).
What does a positive posterior drawer sign in a 10-year-old soccer player signify?
A) An abnormal knee
B) Instability of the knee
C) A large amount of swelling on the knee
D) An injury of the meniscus - ANSWER-B) Instability of the knee
The drawer sign is performed on the knee or ankle to assess for knee instability. The affected knee will have more laxity when compared to the unaffected knee.
A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient?
A) Advise the mother that her pregnancy is progressing well
B) Order an ultrasound of the uterus
C) Refer her to an obstetrician for an amniocentesis
D) Recommend bed rest with bathroom privileges - ANSWER-A) Advise the mother that her pregnancy is progressing well
Serum creatinine is measured to evaluate renal function. Creatinine is the end product of creatine metabolism. Creatinine clearance is not affected by fluid or dietary intake of meat.
All of the following are false statements regarding acute gastritis except:
A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder
B) Chronic lack of dietary fiber is the main cause of the disorder
C) The screening test for the disorder is the barium swallow test
D) The gold standard to evaluate the disorder is a colonoscopy - ANSWER-C) The screening test for the disorder is the barium swallow test
The gold standard for diagnosing gastric disease is biopsy of gastric and/or duodenal tissue by upper endoscopy. Chronic use of NSAIDs disrupts the production of prostaglandins, which decreases blood supply and then breaks down the protective layer of the mucosa, which leads to gastric disease.
Signs and symptoms of depression include all of the following except:
A) Anhedonia and changes in appetite
B) Decreased energy and irritability
C) Apathy and low self-esteem
D) Apraxia and fatigue - ANSWER-D) Apraxia and fatigue
Apraxia is a disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so. Common signs of depression include anhedonia (loss of interest in activities that the patient finds pleasurable), unintentional weight loss or gain, fatigue, change in appetite, insomnia or hypersomnia, feelings of guilt and worthlessness, and recurrent thoughts of suicide.
Which of the following is an accurate description of eliciting for Murphy's sign?
A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle
B) Bend the patient's hips and knees at 90 degrees, then passively rotate hip exter- nally, then internally
C) Ask the patient to squat, then place the stethoscope on the apical area
D) Press into the abdomen deeply, then release it suddenly - ANSWER-A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle
Murphy's sign is positive if pain occurs when performing RUQ palpation while the patient takes a deep inspiration, causing the patient to abruptly stop the deep breath due to pain. As the liver is palpated, it will descend and push up against the inflamed gallbladder and cause sharp pain (cholecystitis).
A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except:
A) Hot flashes
B) Irregular menstrual periods
C) Severe vaginal atrophic changes
D) Cyclic mood swings - ANSWER-C) Severe vaginal atrophic changes
As women reach menopause, changes that may occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal changes, such as dryness and thinning, may also begin to occur
A 63-year-old patient with a 10-year history of poorly controlled hypertension presents with a cluster of physical exam findings. Which of the following indicate target organ damage commonly seen in hypertensive patients?
A) Pedal edema, hepatomegaly, and enlarged kidneys
B) Hepatomegaly, AV nicking, bibasilar crackles
C) Renal infection, S3, neuromuscular abnormalities
D) Glaucoma, jugular vein atrophy, heart failure - ANSWER-B) Hepatomegaly, AV nicking, bibasilar crackles
With long-term, uncontrolled hypertension, organ damage may occur. Organs commonly affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding, blindness), heart (heart dis- ease, left ventricular hypertrophy, MI, and/or CHF), and kidneys (renal failure, proteinuria).
A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion?
A) Vaginal bleeding and cramping are present, but the cervix remains closed
B) Vaginal bleeding and cramping are present along with a dilated cervix
C) The fetus and placenta are all expelled
D) The products of conception and the placenta remain inside the uterus along
with a dilated cervix - ANSWER-A) Vaginal bleeding and cramping are present, but the cervix remains closed
Threatened abortion is defined as vaginal bleeding and cramping with- out the presence of cervical dilation.
A 30-year-old female who is sexually active complains of a large amount of milk- like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely?
