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NSG 6430
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NSG6430_APEA_CARDIO
NSG6430_APEA_CARDIO Which mitral disorder results from redundancy of the mitral valve's leaflets? Mitral valve prolapse A child's resting heart rate i... [Show More] s expected to be between 60 and 100 beats per minute once he reaches: 10 years of age. A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably has: hypokalemia. Most hypertension in preadolescents and children is: secondary hypertension. Mr. Brown a 45-year-old African American male has the following lab values. What should the nurse practitioner do next? A thyroid stimulating hormone (TSH) level Which infant feeding behavior is least likely related to congenital heart disease (CHD)? Infants that burp frequently when feeding Besides hypertension, which risk factor most contributes to development of an abdominal aortic aneurysm? Cigarette smoking Which antibiotic should be used with caution if an older patient has cardiac conduction issues? Ciprofloxacin The usual clinical course of mitral valve prolapse: is benign. An 80-year-old patient with longstanding hypertension takes Monopril and HCTZ for hypertension. His most recent blood pressures are listed. What should be done about his blood pressure? Add a calcium channel blocker Drugs that target the renin- angiotensin-aldosterone system are particularly beneficial in patients who have: diabetic nephropathy Mr. Holbrook, a 75-year-old male, is a former smoker with a 30 pack-year history. He has come in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and has a near normal BMI. On examination, the patient is noted to have an absence of hair growth on his lower legs. Which statement is true regarding this patient? This might indicate disease in the lower extremities. Where would the murmur associated with mitral regurgitation best be auscultated? Mitral listening point Which patient could be expected to have the highest systolic blood pressure A 75-year-old male A 65-year-old male patient has the following lipid levels. What class of medications is preferred to normalize his lipid levels and reduce his risk of a cardiac event? HMG CoA reductase inhibitors Which patient is most likely to have mitral valve prolapse? A 30-year-old female with no cardiac history An older adult has renal insufficiency, hypertension, osteoarthritis, hypothyroidism, and varicose veins. Which medication should be avoided? NSAIDs A 75-year-old has isolated systolic hypertension. She started on amlodipine 4 weeks ago. She states that since then, she has developed urinary incontinence. What is the nurse practitioner's assessment? It is probably related to amlodipine. The most common arrhythmia resulting from valvular heart disease is: atrial fibrillation. A 42-year-old hypertensive patient was given a thiazide diuretic 4 weeks ago for treatment of primary hypertension. On his return visit today, he reports feeling weak and tired. What should the NP consider to evaluate the weakness and fatigue? Potassium level A medication that may produce exercise intolerance in a patient who has hypertension is: metoprolol. Which medication could potentially exacerbate heart failure (HF)? Naproxen A 77-year-old patient has had an increase in blood pressure since the last exam. The blood pressure readings are provided. If medication is to be started on this patient, what would be a good first choice? Calcium channel blocker A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI): 5th ICS, left of MCL Which class of medication is frequently used to improve long-term outcomes in patients with systolic dysfunction? ACE inhibitors The valve most commonly involved in chronic rheumatic heart disease is the mitral. The diagnosis of mitral valve prolapse can be confirmed by: echocardiography An immune response to Group A Streptococcal infections involving the heart is: rheumatic fever. A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of heart failure? Headache A 74-year-old patient has peripheral artery disease (PAD). Which item listed below is an important nonmodifiable risk factor for PAD? Diabetes Which of the following medications may have an unfavorable effect on a hypertensive patient's blood pressure? Naproxen Many factors can contribute to the risk of congenital heart disease. Which maternal disease carries a higher risk of transposition of the great vessels (TGA), ventricular septal defect (VSD), and hypertrophic cardiomyopathy? Diabetes A patient has shortness of breath. If heart failure is the etiology, which test demonstrates the highest sensitivity in diagnosing this? B type natriuretic peptide (BNP) A characteristic of an ACE inhibitor-induced cough is that it: usually begins within 2 weeks of starting therapy. A decrease in blood pressure can occur in men who take sildenafil (Viagra) and: any antihypertensive medication. Pharmacologic treatment for older adults with hypertension should be initiated: for any type of hypertension. Which item below represents the best choice of antihypertensive agents for the indicated patient? Lisinopril in a 35- year-old Caucasian male An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? Beta blocker A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: development of heart failure (HF). Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Losartan A common, early finding in patients who have chronic aortic regurgitation (AR) is: an hypertrophied left ventricle. Which medication listed below could potentially exacerbate heart failure in a susceptible patient? Metoprolol Which laboratory abnormality may be observed in a patient who takes lisinopril? Increased potassium level Benazepril should be discontinued immediately if: pregnancy occurs. How often should blood pressure be measured in a child who is 3 years old? It should be measured annually. Which test listed below may be used to exclude a secondary cause of hyperlipidemia in a patient who has elevated lipids? TSH An 80-year-old female who is otherwise well has the following blood pressure readings. How should she be managed pharmacologically Calcium channel blocker A patient taking an ACE inhibitor should avoid: potassium supplements. Mrs. Jones is an 85-year-old who has average blood pressures of 170/70 mmHg. Which agent would be a good starting medication to normalize her blood pressure? Amlodipine Pharmacologic treatment for children who have hypertension should be initiated for: diabetics with hypertension. A patient who has mitral valve prolapse (MVP) reports chest pain and frequent arrhythmias. In the absence of other underlying cardiac anomalies, the drug of choice to treat her symptoms is: metoprolol Which choice below characterizes a patient who has aortic regurgitation? Long asymptomatic period followed by exercise intolerance, then dyspnea at rest An 87-year-old has history of symptomatic heart failure. He presents today with lower extremity edema and mild shortness of breath with exertion. In addition to a diuretic for volume overload, what other medication should he receive today? ACE inhibitor A 91-year-old female with longstanding history of chronic heart failure has renal and liver studies that have slowly worsened over the past year. This probably indicates: target organ damage secondary to heart failure. A patient taking candesartan for treatment of hypertension should avoid: potassium supplements. Tables are used for determination of maximum blood pressure values for adolescents. How are these blood pressure values established for adolescents? Height percentile, gender, and age Three of the following medications warrant monitoring of potassium levels. Which one does NOT? Amlodipine A congenital heart abnormality often discovered during the newborn period is coarctation of the aorta. How is this assessed? By comparing upper and lower extremity blood pressures A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with rest. When specifically asked about the pain in his lower leg, he likely will report pain: in the calf muscle. The nurse practitioner is caring for an independent 74-year-old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medications should be part of her regimen unless there is a contraindication? ACE, ASA, beta blocker, and statin A 43-year-old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past 2 years. This murmur is probably: mitral stenosis. Which group of medications would be detrimental if used to treat a patient who has heart failure (HF)? Fosinopril, HCTZ, verapamil The lipid particle with the greatest atherogenic effect is: LDL A nurse practitioner has not increased the dosage of an antihypertensive medication even though the patient's blood pressure has remained >140/90 mmHg. This might be described as: clinical inertia Which choice below would be the best choice for an 80-year- old patient whose blood pressure is 172/72 mm Hg? Amlodipine A 28-year-old has a Grade 3 murmur. Which characteristic indicates a need for referral? A fixed split Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption? 70-year-old African American male According to the National Heart, Lung and Blood Institute, which characteristic listed below is a coronary heart disease (CHD) risk equivalent; that is, which risk factor places the patient at a CHD risk similar to a history of CHD? Diabetes mellitus You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now? INR of 8, no significant bleeding In order to reduce lipid levels, statins are most beneficial when taken in conjunction with diet and exercise. A 40-year-old African American patient has blood pressure readings of 175/100 mmHg and 170/102 mmHg. What is a reasonable plan of care for this patient today? Initiate 5 mg amlodipine daily (usual dose is 5-10 mg daily). An overweight 76-year-old female with a recent onset of diabetes has longstanding hypertension and hyperlipidemia. She has developed atrial fibrillation. The nurse practitioner knows that this patient is at risk for: heart failure (HF). Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided. The nurse practitioner should: stop the warfarin today and repeat the INR tomorrow. A 55-year-old male is obese, does not exercise, and has hyperlipidemia. His average blood pressure is 150/90 mmHg. How should he be managed today? Lifestyle modifications are appropriate A 75-year-old patient with longstanding hypertension takes a combination ACE inhibitor/thiazide diuretic and amlodipine daily. Today his diastolic blood pressure and heart rate are elevated. He has developed dyspnea on exertion and peripheral edema over the past several days. These symptoms likely demonstrate: development of heart failure. How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors? Annually A patient is diagnosed with mild heart failure (HF). What drug listed below would be a good choice for reducing morbidity and mortality long term? Metoprolol A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably: congenital Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases: more than 20 points within 3 minutes after rising A patient will be screened for hyperlipidemia via a serum specimen. He should be told: to fast for 12-14 hours. A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed? Add a drug from another class to the daily 25 mg hydrochlorothiazide. The major difference between varicose veins and arteriosclerosis is the: vessels affected. A patient taking atorvastatin for newly diagnosed dyslipidemia complains of fatigue, weakness, and muscle aches in his lower back, arms, and legs for the past three days. It has not improved with rest. How should this be evaluated? Stop the atorvastatin immediately. A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? Hydrochlorothiazide Mr. Daigle is an 80-year-old patient who takes warfarin for chronic atrial fibrillation. The nurse practitioner should: stop warfarin for the next two days and repeat the INR on day 3. Which study would be most helpful in evaluating the degree of hypertrophy of the atrium or ventricle? Echocardiography Which test below is most cost- effective to screen for abdominal aortic aneurysm? Abdominal ultrasound A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed? The child should be referred to cardiology. An independent 82-year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the NP approach his lipid elevation? Treatment is based on expected length of life The correlation between blood pressure and age greater than 60 years is that as age increases: diastolic blood pressure decreases. You have been asked to evaluate a heart murmur in a pregnant patient. Can a 3D echocardiogram be safely used to evaluate her? Yes, this is perfectly safe. Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern? 160/60 mmHg An ACE inhibitor is specifically indicated in patients who have: hypertension, diabetes with proteinuria, heart failure. An older adult who has hypertension also has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis? A thiazide diuretic Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about 1 week? Potassium level A patient taking an angiotensin receptor blocker (ARB) should avoid: potassium supplements. Classic symptoms of deep vein thrombosis (DVT) include: swelling, pain, and discoloration in lower extremity. A common side effect of thiazide diuretics is: erectile dysfunction. A 64-year-old male has been your patient for several years. He is a former smoker. He presents to your clinic with complaints of fatigue and "just not feeling well" for the last few days. His exam is normal. His blood pressure is well controlled. His medication list, most recent lipid panel, and today's vital signs are provided. What should be done next? Order a CBC, metabolic panel, TSH, and urine analysis. In older adults, the three most common ailments are: hearing loss, hypertension, arthritis. A patient with aortic stenosis has been asymptomatic for decades. On routine exam, he states that he has had some dizziness associated with activity but no chest pain or shortness of breath. The best course of action for the nurse practitioner is to: refer to cardiology. The carotid arteries are auscultated for bruits because this is indicative of generalized atherosclerosis. The most common indicator of end- organ damage in adolescents with hypertension is: left ventricular hypertrophy. A patient with mitral regurgitation (MR) has developed the most common arrhythmia associated with MR. The intervention most likely to prevent complications from this arrhythmia is: anticoagulation At what age should initial blood pressure screening take place? 3 years Risk assessment for dyslipidemia should begin at: 2 years Warfarin treatment is greatly influenced by a patient's food and medication intake. Which group listed can potentially decrease INR (International Normalized Ratio) in an outpatient who takes warfarin? Sucralfate and cholestyramine A 75-year-old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: shortness of breath and syncope A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to fosinopril? It is wet and worse with recumbence. A patient with hypertension has been diagnosed with gout. Which home medication may have contributed to this episode of gout? Furosemide . : : . . [Show Less]
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APEA_ GI_NSG6430
APEA_ GI_NSG6430 1. A patient with diarrhea is tested for C. difficile. How soon should the enzyme immunoassay (EIA) yield results? About 24 hours 2... [Show More] . Older adults frequently complain of constipation. Which medication listed below does NOT increase the likelihood of constipation in an older adult? Metformin 3. A 79-year-old with an appendicitis is unlikely to exhibit: initial WBC elevation. 4. A 10-year-old female presents with a 3-month history of abdominal pain. She has been diagnosed with recurrent abdominal pain. During the interview the nurse practitioner is likely to elicit a finding of: school absenteeism. 5. A patient with gall bladder disease has classic symptoms. Which symptom below is NOT classic of gallbladder disease? Pain that occurs when the stomach empties 6. A 24-year-old male has recently returned from a weekend camping trip with friends. He has ulcerative colitis and history of migraine headaches. He reports a 2-day history of headache, nausea, and vomiting with weakness. Which of the following is not part of the differential diagnosis? Exacerbation of ulcerative colitis 7. A 45-year-old patient has the following laboratory values. HBsAg positive; anti-HBc positive; anti-HBs negative. How should they be interpreted? The patient has hepatitis. 8. This patient has a positive hepatitis B surface antigen (HBsAg). Therefore, he has hepatitis B. A positive anti-HBc is found in patients who either have hepatitis now or who have had it. The surface antibody (anti-HBs) would be expected to be negative in a patient with positive surface antigen (HBsAg) because these two markers will not be positive at the same time. 9. What medication listed below could be used to increase appetite in an anorexic patient? Megestrol 10. A patient is in the clinic with a 36- hour history of diarrhea and moderate dehydration. Interventions should include: oral rehydration with an electrolyte replenishment solution. 11. A 56-year-old male patient has been diagnosed with an inguinal hernia. What symptom would make the nurse practitioner suspect an incarcerated hernia? PAIN 12. A patient asks for advice about a medication that will produce rapid relief if he is having heartburn symptoms. What should the nurse practitioner recommend? Calcium carbonate 13. A patient has a positive hepatitis B surface antibody. This means he: is immune to hepatitis B. 14. An 83-year-old patient is diagnosed with diverticulitis. Where is her pain typically located? Left lower quadrant 15. Many older adults have cachexia. What characterizes this? Illness and loss of muscle mass 16. Mrs. Lovely, an 84-year-old, complains of fecal incontinence. A likely cause is: constipation 17. A 40-year-old patient has the following laboratory values. How should they be interpreted? HBsAg negative; anti-HBs positive; anti-HBc negative. The patient has been immunized. 18. A 40-year-old patient has the following laboratory values. HbsAg negative; Anti-HBc positive; anti-HBs positive. How should they be interpreted? The patient had hepatitis. 19. A patient has hepatitis B. He probably has a predominance of: lymphocytes. 20. Which medication listed below can exacerbate the symptoms of GERD? Verapamil 21. Which description is more typical of a patient with acute cholecystitis? The patient is ill- appearing and febrile. 22. GERD (gastroesophageal reflux disease) and physiologic reflux have similar characteristics. However, physiologic reflux: rarely occurs at nighttime. 23. The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and: Shigella. 24. A 95-year-old male has lost muscle mass as he has aged. He does not have any underlying disease that has caused this loss. What is this termed? Sarcopenia 25. A 37-year-old has routine blood work performed during an annual exam. On exam he has a tender, enlarged liver. How should the nurse practitioner proceed? Order a hepatitis panel. 26. A 70-year-old patient states that he had some bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient? Anal fissure 27. A 70-year-old presents to the nurse practitioner’s office for a well exam today. What medication probably has no effect on screening for occult blood in the stool? Acetaminophen 28. Which symptom is INCONSISTENT with irritable bowel syndrome in older adults? Onset after 50 years of age 29. A 19-year-old female presents with a temp of 100.8°F and lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms? Renal stone 30. An 83-year-old patient is diagnosed with diverticulitis. The most common complaint is: left lower quadrant pain. 31. The relationship between duodenal ulcer disease and H. pylori infection is: very likely. 32. A 24-year-old female presents with pain and tenderness in the right lower abdominal quadrant. Her pelvic exam and urinalysis are within normal limits. Her WBC is elevated and her urine pregnancy test is negative. What is part of the differential diagnosis? Appendicitis 33. The most common reason that older adults develop peptic ulcer disease is: H. pylori infection. 34. Most patients who have acute hepatitis B infection: have varied clinical presentations. 35. A 26-year-old female presents with concerns about possible hepatitis C (HCV) infection. She admits to IV drug use 2 months ago and sharing needles with several other people. Initial laboratory studies have been completed. Anti-HCV reactive. How should this be managed? Order HCV RNA 36. A patient has been diagnosed with hepatitis B. The most common reported risk factor is: sexual exposure. 37. What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms? Calcium carbonate 38. Symptoms of uncomplicated reflux disease in older adults should be treated: with empiric treatment. 39. A 26-year-old female complains of pain at McBurney’s point. She feels nauseated. Her vital signs are provided. The most appropriate initial action by the NP is to: order a CBC and pregnancy test. 40. A 48-year-old patient has the following laboratory values. Anti-HCV reactive; HCV RNA detectable. How should they be interpreted? The patient has hepatitis C. 41. A 3-day-old full-term infant has a bilirubin level of 16 mg/dL. How should this be managed? Order phototherapy for the infant 42. A 6-week-old male infant is brought to the nurse practitioner because of vomiting. The mother describes vomiting after feeding and feeling a “knot” in his abdomen especially after he vomits. The child appears adequately nourished. What is the likely etiology? Pyloric stenosis 43. A patient has suspected peptic ulcer disease. Her symptoms occur a few hours after eating. She probably has a(n): duodenal ulcer. 44. Which patient has the least worrisome symptoms associated with his diarrhea? One with: moderate amounts of watery diarrhea. 45. A 5-year-old female’s playmate has been diagnosed with pinworms. The mother brings her child in for an exam. The 5 year-old denies rectal itching. How should the NP proceed? Perform the “scotch tape” test and look at the collection under the microscope. 46. A 35-year-old patient has the following laboratory values. HBsAg negative; anti-HBc negative; anti-HBs negative. How should they be interpreted? The patient should consider Hepatitis B immunization. 47. An 84-year-old presents with a stated involuntary weight loss. He states that he’s lost about 6 pounds in the last 6 or 8 weeks. What statement below is NOT part of the assessment? Evaluate his upper and lower extremity muscle mass. 48. Most patients who have acute hepatitis A infection: have a self-limited illness. 49. An older patient presents with left lower quadrant pain. If diverticulitis is suspected, how should the NP proceed? CT scan of abdomen 50. A 7-year-old male presents with encopresis. The NP might expect: constipation. 51. The initial step in the management of encopresis is: client and family education. 52. Choose the number on the image that most closely approximates the location of a direct inguinal hernia. 1 53. The most common place for indirect inguinal hernias to develop is: the internal inguinal ring. 54. What is the simplest screen for nutritional adequacy in elderly patients? Measure their weight 55. Which of the following is an appropriate initial intervention for gastroesophageal reflux disease (GERD) in an 8-week-old? Small, frequent thickened feedings 56. A 42-year-old patient was diagnosed with ulcerative colitis many years ago. What part of his routine health screenings should be stressed by the nurse practitioner? He should have a colonoscopy every 1-5 years. 57. A patient presents with complaints of bright red stools over the past week. This symptom could be consistent with: cancer of the sigmoid colon. 58. A 63-year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and “just not feeling well” for the last few days. His vital signs and exam are normal, but his liver enzymes are elevated. His hepatitis panel is negative for infectious hepatitis. What is the most likely cause of his elevated liver enzymes? Daily grapefruit consumption for the past 10 days 59. A 20-year-old female patient presents with tenderness at McBurney’s point. Appendicitis is considered. What laboratory test should be done initially to determine the etiology of this patient's abdominal pain? Serum pregnancy test 60. A patient has the following laboratory value. Anti-HAV IgG positive. What is the clinical interpretation? He has immunity to hepatitis A. 61. The most common place for indirect inguinal hernias to develop is:the internal inguinal ring. 62. What is the simplest screen for nutritional adequacy in elderly patients? Measure their weight 63. A 31-year-old patient is suspected of having hepatitis C. He reports possible exposure about a month ago. How should the nurse practitioner interpret his laboratory results? Anti-HCV nonreactive; HCV RNA not detectable. The patient does not have hepatitis C 64. A fecal occult blood test (FOBT) obtained during a rectal examination: is inadequate to screen for colorectal cancer. 65. A healthcare provider (“the HCP”) was stuck with a needle from a patient suspected to be infected with HIV (“the patient”). A rapid HIV test was performed on the patient and found to be positive. This means that: the HIV status of the patient requires further testing. 66. A 50-year-old with a history of consumption of 3-4 alcoholic drinks daily and weekend binges has elevated liver enzymes. Which set of enzymes is most representative of this patient? AST= 200, ALT= 75 67. Which imaging study of the abdomen would be LEAST helpful in diagnosing an acute appendicitis? X-ray 68. Hirschsprung's disease is characterized by: failure to pass meconium in the first 48 hours of life. 69. A mother of a 4-week-old infant visits your office. She states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the nurse practitioner assess? His abdomen for an olive shaped mass 70. Which choice contains three medications that should have liver function tests measured prior to initiation of the medications? Terbinafine, atorvastatin, simvastatin 71. A patient has been diagnosed with viral gastroenteritis. He has nausea and vomiting, and has started having lower abdominal cramps. What is the most effective intervention for him? Oral rehydration 72. A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are no other members of the household. How should his mother be managed? Perform the “scotch tape” test and look at the collection under the microscope. 73. An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is more indicative of a vitamin B12 deficiency? Macrocytosis 74. What is true regarding older adults who are overweight? Mortality in older adults related to overweight states declines over time. 75. Children with an inguinal hernia: have a history of an intermittent bulge in the groin. 76. An 85-year-old adult has chronic constipation. What is the most likely cause of her constipation? Medication- related 77. The relationship between colon polyps and colon cancer is that polyps: have a slow progression to colon cancer. 78. Which of the following is NOT a risk factor for developing hepatitis B? Consuming contaminated water 79. A patient has had right upper quadrant pain that has lasted for the past 3 days, but the pain has become acute in the past 12 hours. He has low-grade fever. Which lab test(s) will be elevated if he has pancreatitis? Serum amylase 80. An 85-year-old adult has chronic constipation. How should this be managed initially? Avoid all constipating medications/foods when possible 81. Which term does not characterize hemorrhoids? Carcinogenic 82. Choose the number on the image that most closely approximates the location of an indirect inguinal hernia. 4 83. A 43-year-old female patient reports a possible exposure to hepatitis C about 4 months ago. HBsAg negative; Anti-HBc Negative; Anti-HBs positive; anti-HCV nonreactive; HCV RNA not detectable. Which statement is true about this patient? The patient does not have hepatitis C, but has immunity to hepatitis B. 84. Which is NOT an effective strategy for helping older adults gain weight? Increase carbohydrate intake 85. A patient has received a prescriptions for metronidazole for treatment of C. difficile. What should be avoided in this patient? Alcohol 86. A patient has been diagnosed with hepatitis A. The most common reported risk factor is: international travel. 87. What choice below is most commonly associated with pancreatitis? Gallstones and alcohol abuse 88. The early signs and symptoms of appendicitis in an adult: are subtle. 89. The most common symptoms associated with gastroesophageal reflux disease (GERD) are heartburn and: regurgitation and dysphagia. 90. Which of the following symptoms is typical of GERD? Pyrosis 91. A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis is suspected because the pain radiates to the: right scapula area. 92. A patient with a suspected inguinal hernia should be examined: standing. 93. What medication may be used to treat GERD if a patient has tried over-the-counter ranitidine without benefit? Pantoprazole 94. The two tests that can indicate current infection with hepatitis B are: presence of hepatitis B surface antigen and IgM. 95. The most common cause of diarrhea in adults is: viral gastroenteritis. 96. A patient has elevated liver enzymes. What is the likely etiology of the elevation? Hepatitis 97. A patient has the following lab results. This means: more data is needed. 98. he has hepatitis C. 99. A 14 year-old male patient has an acute, painless groin swelling. Which tool would yield the most information to identify the etiology of the swelling? Ultrasound of the scrotum 100. A 15-year-old is about 10% below her ideal body weight. Laboratory studies were performed. Which complaint might be common in this patient? Dizziness with standing 101. A patient has the following lab values. HBsAg negative; anti-HBc negative; anti-HBs positive. This indicates that he: is immune to hepatitis B. 102. A patient has the following laboratory values. HBsAg Positive; IgM anti-HBc positive. What does this mean? He has acute hepatitis B 103. An inguinal hernia is palpated on a male patient by an examiner. Which word below best describes what the hernia feels like when touched by the examiner? Silky 104. A 20-year-old female patient presents with tenderness at McBurney’s point. What laboratory test supports a diagnosis of appendicitis? CBC with elevated white count 105. A patient has the following laboratory values. Anti-HAV IgM Negative; AntiHAV IgG negative. What does this mean? He has no immunity to hepatitis A [Show Less]
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APEA_ORTHO_NSG6430
APEA_ORTHO_NSG6430 1. Which joints are least commonly involved in osteoarthritis? Wrists 2. Which beverage below does not increase the risk of gout in a... [Show More] male who is prone to this condition? Wine 3. A nurse practitioner has successfully reduced a nursemaid’s elbow. How can the NP know that it was successful? Child moves the affected arm at the elbow 4. Which of the following is NOT true regarding cervical whiplash injury? Is identifiable on MRI or CT, but not X-ray. 5. A 79-year-old frail adult reports that she had a fall last week. She had no broken bones but is very sore. In evaluating this adult, what question is most important to ask? Have you had other falls this year? 6. A patient presents with right shoulder pain (7/10 on the pain scale) after an acute shoulder injury yesterday. He fell against a brick wall while working at his home. He reports pain that radiates into his upper arm. How should this be managed? Order an X-ray of the right shoulder 7. Management of a sprained ankle includes: rest, ice, compression, elevation. 8. A 49-year-old patient has osteoarthritis in the lumbar spine and hip. His hip X-ray demonstrates bone on bone. What can be done to resolve his complaints of pain in his hip? Acetaminophen and a referral to orthopedics 9. A young athlete is found to have a depression of the longitudinal arch of both feet. He complains of bilateral heel pain. The rest of his foot is normal and he has continued with his activities. What could be recommended for his heel pain? He needs some heel support in his shoes. 10. A patient cut himself on a fence post while working outside. He has not had a tetanus shot in more than 10 years. How long can he wait before getting the immunization and still prevent tetanus? 72 hours 11. An 80-year-old patient is very active but presents today with posterior hip pain for the past week. Which of the following is least likely part of the differential diagnosis? Osteoarthritis 12. The Ottawa ankle rules help the examiner determine when: X-rays are needed with a suspected ankle sprain. 13. A patient complains of pain in his right heel. Initially, it began with his first steps out of bed in the morning, but over the past few weeks he has heel pain throughout the day. What factor has contributed most to his worsening heel pain? Pes planus 14. Clubfoot: involves the foot and lower extremity. 15. A 45-year-old male who is in good health presents with complaints of pain in his left heel. He states that the first few steps out of bed in the morning are extremely painful. He has no history of trauma. What is the likely etiology of his pain? Plantar fasciitis 16. Which of the following is true about metatarsus adductus? Mild flexible metatarsus usually spontaneously corrects. 17. A 75-year-old patient has osteoarthritis and pain. Which of the following medications increases the risk of a GI-related ulceration? Celecoxib 18. Which diagnosis is the least likely cause of extrinsic shoulder pain? Gout 19. A 60-year-old has been on NSAIDs and hydrocodone for the past 48 hours for shoulder pain. He has complaints of blood on toilet tissue when wiping after a bowel movement this morning. What should be suspected? He could have hemorrhoids. 20. A characteristic of rheumatoid arthritis not typical in osteoarthritis is: symmetrical joint involvement. 21. A patient reports that her knee “locks” sometimes and feels like it will “give out.” She denies injury. She has no complaint about her other knee. What is her likely problem? Meniscal tear 22. An older adult had a total knee replacement (TKR) 10 months ago. He is doing well. He states that he is having a dental procedure performed in 1 week. What information should he be given regarding the knee replacement? He should not routinely receive an antibiotic prior to dental procedures. 23. Which patient below should be screened for osteoporosis? 60-year-old male with rheumatoid arthritis 24. The drop arm test is used to assess patients with suspected: rotator cuff injury. 25. A 14-year-old male client reports dull anterior knee pain, exacerbated by kneeling. What is the likely etiology? Osgood- Schlatter disease 26. A 75-year-old has pain from osteoarthritis in her right knee. What intervention is considered first line to treat her pain? Exercise 27. Bone mineral density screening in women older than 65 years is an example of: secondary prevention. 28. A 12-year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated? Perform Trendelenburg’s test in the office 29. An older adult with a complaint of shoulder pain has a positive “drop arm” test. What is his likely diagnosis? Torn rotator cuff 30. A 16-year-old complains that his knees hurt. His mother states that he has complained of knee pain for the past 2 weeks. He has a prominent tibial tubercle. What should be part of the differential diagnosis? Osgood– Schlatter disease 31. A 55-year-old male patient describes severe pain at the base of his left first toe. He is limping and says he can’t remember hurting his toe. Which symptom below suggests something other than gout? Fever 32. Which statement below best characterizes scoliosis in an adolescent? There can be unequal rib prominences or shoulder heights. 33. A 16-year-old male plays trumpet in the school marching band. He has had marching practice every day for the last week. Today he complains of pain in his left midfoot. The foot is neither swollen nor red. What is the most likely diagnosis in the differential? Stress fracture 34. A man fell off a 3-foot stepladder while working at home. He presents to your office with complaints of foot pain. He has point tenderness over the medial malleolus and swelling, but he is able to ambulate. How should this be managed? X-ray of the foot and ankle 35. A male patient who injured his back lifting a heavy object reports that he has low back pain. He is diagnosed with a lumbar strain. He is afraid to continue activities of daily living, especially walking, because he has pain with these activities. What statement below is true? Gradually increase activities of daily living and walking as tolerated. 36. A long distance runner is diagnosed with a tibial stress fracture. Which statement is true about the injury? Rest and an alternative activity are recommended. 37. A patient has suspected plantar fasciitis. The plantar fascia is best examined: with the great toe dorsiflexed. 38. An adolescent complains of knee pain. He is diagnosed with Osgood- Schlatter disease. What assessment finding is typical? Pain worsens with quadriceps contraction. 39. A positive Tinel’s test can be used to assess carpal tunnel syndrome. What other test can be used to assess for this? Phalen’s test 40. A 50-year-old patient reports acute pain in his lower back that started 2 weeks ago after working in his yard. The pain radiates into his right leg intermittently. He has been managing his pain with ibuprofen. There are no red flags in his history or on exam. When should consideration be given to imaging studies? At 4 weeks 41. A 70-year-old patient has had intermittent back pain secondary to a bulging disk for more than 3 years. In the last year, it is constant (pain scale is 2-3/10) and at times is sharp. She is not a surgical candidate. What class of medication would be a good choice for improvement of chronic pain in this patient? Gabapentin 42. A patient is at increased risk of osteopenia if she uses which form of birth control? Injectable progestin 43. A 65-year-old male is diagnosed with an initial episode of gout. It is likely that he: will have severe inflammation in a single joint. 44. An adolescent athlete has sprained his ankle. What instruction should be given to him regarding activity? He should be able to walk pain-free before he starts to run. 45. If plantar fasciitis is suspected in a patient, how is this diagnosed? Physical exam 46. An 8-year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? The NP should order a hip X- ray, CBC and ESR. 47. What should the nurse practitioner assess in an 80-year-old patient who reports a fall but does not have serious physical injury? Medications taken a few hours before the fall 48. A 60-year-old adult with an antalgic gait and complaints of hip pain is examined. He has trochanteric tenderness. What is the most common cause of this? Trochanteric bursitis 49. A 2-year-old was brought into the clinic by her mother who reports that she pulled her arms upward to pick her up and now the child won’t use her right arm. A nursemaid’s elbow is suspected. Which statement below is correct? Her arm is slightly flexed and held close to her body. 50. Which findings are most commonly associated with rheumatoid arthritis? Morning stiffness, positive rheumatoid antigen and antinuclear antibody 51. A patient who frequently has episodes of gout should avoid which groups of food? Roast beef with gravy, rice 52. A 60-year-old female presents with history of low back pain of recent origin. Her gait is antalgic and she reports loss of bladder function since the onset of back pain this morning. What should be done? Refer to the emergency department 53. What medication is recommended by the American College of Rheumatology as a first line agent for a patient who has been unsuccessful with nonpharmacologic interventions for osteoarthritis pain? Acetaminophen 54. What is the value of vitamin D supplementation in the diet of older adults? it decreases the risk of falls. 55. A 65-year-old female complains of left medial knee pain. She has been told that she has arthritis in this knee. Where would the pain be located? Medially, along the joint line 56. A 72-year-old patient complains of knee pain when she climbs stairs or walks long distances. Crepitus is palpable in the affected knee. What is the likely cause? Arthritis of the knee 57. A patient with sciatica is most likely to describe relief of symptoms with: side lying or standing. 58. A high purine diet can contribute to gouty arthritis. Which food listed below contributes most to a high purine diet? Beef 59. What is the most prevalent skeletal problem in the United States? Osteoarthritis 60. A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much”. When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? Acute lymphocytic leukemia (ALL) 61. A positive Trendelenburg’s test could be used to identify a child with: slipped capital femoral epiphysis. 62. A 75-year-old female who is otherwise healthy has mild osteoarthritis in her right knee. She complains of pain not relieved by acetaminophen 2000 mg daily. What should be done? Continue acetaminophen and order physical therapy 63. Ankle inversion is a common complaint from a patient with a: lateral ankle sprain. 64. A 66-year-old African American female has multiple risk factors for osteoporosis. Which choice listed below is NOT a risk factor for osteoporosis? Her race 65. Which factor listed below is NOT considered a risk factor for development of osteoporosis? Late menopause 66. When should functional rehabilitation occur once a patient has had an ankle or knee sprain? The day of the injury 67. Which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus (SLE)? Antinuclear antibody (ANA) 68. A male patient takes HCTZ daily for hypertension. He developed severe pain in his great toe yesterday. He was diagnosed with gout today and started on a medication. Which medication listed below would be contraindicated at this time? Allopurinol 69. What does a positive anterior drawer test demonstrate in a patient who has an injured knee? Instability of the anterior cruciate ligament 70. A 60-year-old patient who is otherwise healthy presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding? Swelling and pain to touch of the anterior knee 71. A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much”. When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What is the most important initial intervention? Complete blood count 72. A 75-year-old female who knits daily has a positive Finkelstein test. What is her likely diagnosis? De Quervain's tenosynovitis 73. An adolescent athlete has injured his ankle playing basketball. He has right ankle pain, ecchymosis, and significant edema, and he is unable to bear weight at the time of the clinical exam. Which diagnosis is least likely? Grade I sprain 74. When is Osgood-Schlatter disease most likely to produce symptoms? During a growth spurt 75. A 40-year-old complains of back pain after heavy lifting. This began 2 weeks ago. He has had little improvement in his pain. Which statement is true regarding plain X-rays in this patient? X-rays usually detect findings unrelated to symptoms. 76. A 70-year-old African American male complains of pain in his back and trunk. Cardiovascular disease is ruled out. Laboratory studies were obtained. A likely diagnosis is: multiple myeloma. 77. A 62-year-old female presents with atraumatic right knee pain. On exam, she has a mildly swollen right knee that is not warm or tender to touch. She has a negative McMurray test. An x-ray was obtained. How should the nurse practitioner interpret the results of this X-ray? Osteoarthritis 78. A college age basketball player landed awkwardly on his foot and ankle after jumping during a game yesterday. He states that he sprained his ankle. He complains of ankle pain and foot pain but is able to limp into the exam room. How should he be managed? Nonweightbearing until fracture is ruled out 79. Which symptom can be used to rule out a fracture? No symptom can rule out a fracture 80. Which statement below is true regarding NSAIDs for low back pain? They are associated with more side effects than acetaminophen. 81. Women are commonly screened for osteoporosis at age 65 years. How should screening for osteoporosis be managed in a male this age? They should be screened starting at age 65 if they have risk factors. 82. A 72-year-old patient complains of knee pain when she climbs stairs or walks long distances. Crepitus is palpable in the affected knee. What is the likely cause? Arthritis of the knee 83. The average age of pubertal growth spurt in North American boys is: 12 - 14 years. 84. [Show Less]
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NSG6430 Nancy Campbell Case Study
NSG6430 Nancy Campbell Case Study Patient is a 25-year-old female who is 65” tall and weighs 135 pounds. Chief complaint is painful urination a... [Show More] nd vaginal discharge. She recently had unprotected sex, does not use any barrier protection and is at high risk for sexual behavior. Dysuria, frequency and vaginal discharge began 3 days ago. Bimanual exam shows mucopurulent discharge from cervical os with an otherwise normal bimanual [Show Less]
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