You are the nurse practitioner caring for Martha, a 47-yearold accountant. You have made a diagnosis of acute sinusitis
based on Martha's history and
... [Show More] the fact that she complains of
pain behind her eye. Which sinuses are affected?
1.Maxillary.
2.Ethmoid.
3.Frontal.
4.Sphenoid - ...ANSWER...ethmoid
Rationale: With ethmoid sinus problems, the pain is felt
behind the eye and high on the nose
A 25-year-old client who plays in a band complains that he
finds it difficult to understand his fellow musicians at the
end of a night of performing, a problem that is compounded
by the noisy environment of the club. These symptoms are
most characteristic of which of the following?
1.Sensorineural loss.
2.Conductive loss.
3.Tinnitus.
4.Vertigo. - ...ANSWER...sensorineural hearing loss
Rationale: Sensorineural loss comes from exposure to loud
noises, inner ear infections, tumors, congenital and familial
disorders, and aging. The results of the Weber and Rinne
tests will assist in the diagnosis
Mandy, 44, was given a diagnosis of flu 1 day ago and
wants to start on the "new flu medicine" right away. What
do you tell her?
1."The medication is effective only if started within the first
72 hours after symptoms begin."
2."If you treat a cold, it goes away in 7 days; if you don't
treat it, it goes away in 1 week."
3."The medicine has not proven its effectiveness."
4. "I'll start you on oseltamivir (Tamiflu) today. It may
shorten the course of the disease and perhaps lessen the
severity of your symptoms." - ...ANSWER..."I'll start you on
oseltamivir (Tamiflu) today. It may shorten the course of the
disease and perhaps lessen the severity of your symptoms.
Rationale: Two antiviral drugs, oseltamivir (Tamiflu), a pill
taken by mouth, and zanamivir (Relenza), an inhaled
medication, are particularly effective against the influenza
viruses that cause the flu. If the virus causing the flu is type
A influenza, the client may benefit from either one of these
drugs
Marjorie, age 37, has asthma and has been told she has nasal
polyps. What do you tell her about them?
1.Nasal polyps are usually precancerous.
2.Nasal polyps are benign growths.
3.The majority of nasal polyps are neoplastic.
4.They are probably inflamed turbinates, not polyps,
because polyps are infrequent in clients with asthma. -
...ANSWER...Nasal polyps are benign growths
Rationale: Nasal polyps are benign growths that occur
frequently in clients with sinus problems, asthma, and
allergic rhinitis. Polyps are neither neoplastic growths nor
precancerous, but they do have the potential to affect the
flow of air through the nasal passages. Clients who have
asthma and have nasal polyps may have an associated
allergy to aspirin, a syndrome that is referred to as Samter
triad
Nystatin (Mycostatin) is ordered for Michael, a 56-year-old
banker who has an oral fungal infection. What instructions
for taking the medication do you give Michael?
1."Dilute the oral medication with one tablespoon of water
for easier digestion."
2."Take the medication with meals so that it's absorbed
better."
3."Swish and swallow the medication."
4."Apply the medication only to the lesions. -
...ANSWER..."Swish and swallow the medication."
Rationale: When ordering nystatin (Mycostatin) for an oral
fungal infection, tell the client to swish the medication in the
mouth to coat all the lesions and then to swallow it.
Erica, age 39, has a sudden onset of shivering, sweating,
headache, aching in the orbits, and general malaise and
misery. Her temperature is 102°F. The nurse practitioner
diagnosed her with influenza (flu). What is your next course
of action?
1.Order amoxicillin (Amoxil) 500 mg every 12 hours for 7
days.
2.Prescribe rest, fluids, acetaminophen (Tylenol), and
possibly a decongestant and an antitussive.
3.Order a complete blood count (CBC).
4.Consult with your collaborating physician -
...ANSWER...Prescribe rest, fluids, acetaminophen
(Tylenol), and possibly a decongestant and an antitussive.
Rationale: Management of flu is generally symptomatic and
includes rest, fluids, acetaminophen (Tylenol), and possibly
a decongestant and an antitussive. The client should be
advised to call or return to the clinic in 4 days if symptoms
are not improving
April, age 50, presents with soft, raised, yellow plaques on
her eyelids at the inner canthi. She is concerned that they
may be cancerous skin lesions. You tell her that they are
probably:
1.Xanthelasmas.
2.Pingueculae.
3.The result of arcus senilis.
4.Actinic keratoses - ...ANSWER...xanthelasmas
Rationale: Xanthelasmas are soft, raised, yellow plaques on
the eyelids at the inner canthi. They appear frequently in
women, in their 50s. Xanthelasmas occur with both high and
normal lipid levels and have no pathological significance
Which manifestation is noted with carbon monoxide
poisoning?
1.Circumoral pallor of the lips.
2.Cherry-red lips.
3.Cyanosis of the lips.
4.Pale pink lips - ...ANSWER...cherry-red lips
Rationale: Cherry-red lips are a manifestation of carbon
monoxide poisoning. They also occur with ketoacidosis or
acidosis from aspirin poisoning
The most common cause of a white pupil (leukokoria or
leukocoria) in a newborn is:
1.A congenital cataract.
2.Retinoblastoma.
3.Persistent hyperplastic primary vitreous.
4.Retinal detachment - ...ANSWER...congenital cataract
Rationale: The most common cause of a white pupil
(leukokoria or leukocoria) in a newborn is a congenital
cataract. The incidence may be as high as 1 in every 500 to
1000 live births, and there is usually a family history. Some
infants require no treatment; however, in other cases surgery
may be performed during the first few weeks of life
Ellen, a 56-year-old social worker, is seen by the nurse
practitioner for complaints of fever; left-sided facial pain;
moderate amounts of purulent, malodorous nasal discharge;
and pain and headache when bending forward. The
symptoms have been occurring for approximately 6 days.
On physical assessment, there is marked redness and
swelling of the nasal passages and tenderness/pain on
palpation over the cheekbones. The nurse practitioner should
suspect:
1.Dental abscess.
2.Acute rhinosinusitis.
3.Chronic rhinosinusitis.
4.Nasal tumor - ...ANSWER...Acute rhinosinusitis
Rationale: The client is exhibiting classic characteristics of
acute rhinosinusitis
Jill, a 34-year-old bank teller, presents with symptoms of
hay fever. She complains of nasal congestion, runny nose
with clear mucus, and itchy nose and eyes. On physical
assessment, you observe that she has pale nasal turbinates.
What is your diagnosis?
1.Allergic rhinitis.
2.Viral rhinitis.
3.Nasal polyps.
4.Nasal vestibulitis from folliculitis - ...ANSWER...Allergic
rhinitis
Rationale: The symptoms of hay fever, also called allergic
rhinitis, are similar to those of viral rhinitis but usually
persist and are seasonal in nature. When assessing the nasal
mucosa, you will observe that the turbinates are usually pale
or violaceous because of venous engorgement
Which of the following is not a cause of conductive hearing
loss?
1.Presbycusis.
2.Cerumen impaction.
3.Otitis media.
4.Otosclerosis - ...ANSWER...Presbycusis
Rationale: This is a cause of sensorineural hearing loss
Alexandra, age 34, was treated with oral antibiotics 2 weeks
ago for a urinary tract infection. She is seen in the office
today for a follow-up visit. On physical examination, the
nurse practitioner notices that she has some painless, white,
slightly raised patches in her mouth. This is probably caused
by:
1.Herpes simplex.
2.Aphthous ulcers.
3.Candidiasis.
4.Oral cancer. - ...ANSWER...candidiasis
Rationale:
Painless, white, slightly raised patches in a client's mouth
are probably caused by candidiasis (thrush)
Kevin, a 56-year-old lawyer, has throbbing pain in the left
eye, an irregular pupil shape, marked photophobia, and
redness around the iris. What is your initial diagnosis?
1.Conjunctivitis.
2.Iritis.
3.Subconjunctival hemorrhage.
4.Acute glaucoma. - ...ANSWER...iritis
Rationale: If a client has throbbing pain in the eye, an
irregular pupil shape, marked photophobia, and redness (a
deep, dull, red halo or ciliary flush) around the iris and/or
cornea, suspect iritis. An immediate referral is warranted.
The client may also have blurred vision [Show Less]