NRNP 6531 / NRNP6531 Advanced Primary Care of Adults Midterm / Final Exam Quiz Bank Rated A |Questions and Answers | Latest 2022/2023
1. When you
... [Show More] elicit a painful Finkelstein ' s sign, you are testing for
A. carpal tunnel syndrome.
B. bursitis of the shoulder.
C. de Quervain ' s tenosynovitis.
D. tennis elbow.
Rationale:
Pain elicited when the Finkelstein ' s test is performed indicates de Quervain ' s tenosynovitis at the base of the thumb.
2. Alexander, age 18, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What do you tell him?
A. " Use continuous heat for the first 12 hours, then use heat or cold to your own preference. "
B. " Use continuous cold for the first 12 hours, then use heat or cold to your own preference. "
C. " Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. "
D. " Alternate between cold and heat for 20 minutes each for the first 24 - 48 hours. "
Rationale:
Tell a client who has sprained his ankle to apply cold for 20 minutes, then take it off for 30 – 45 minutes, and repeat that procedure for the first 24 - 48 hours while awake
3. In analyzing synovial fluid, a yellow-green color may indicate which of the following?
A. Trauma
B. Gout
C. A bacterial infection
D. Rheumatoid arthritis
Rationale:
Synovial fluid that is turbid and yellow-green on analysis indicates an inflammation, such as one that occurs in rheumatoid arthritis
4. To diagnose fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender-point sites, which would include
A. the occiput, low cervical, trapezius, and supraspinatus.
B. the proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints of the hands, and the metatarsophalangeal (MTP) and PIP joints of the foot.
C. the facet joints of the cervical, thoracic, and lumbar spine.
D. the radial and ulnar styloids and the medial and lateral malleoli.
Rationale:
To diagnose fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender-point sites, including the occiput, low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and knee
5. Trevor, age 4, has an apparent hypertrophy of the calf muscles, which seem doughy on palpation. His mother is concerned because Trevor is unable to raise himself from the floor without bracing his knees with his hands. What do you suspect?
A. Duchenne muscular dystrophy
B. Cerebral palsy
C. Legg-Calv é -Perthes disease
D. Multiple sclerosis
Rationale:
Duchenne muscular dystrophy, inherited in a sex linked recessive pattern, afflicts boys, with the onset usually occurring around ages 3 - 5. The inability of the child to raise himself without supporting his knees because of weakness beginning primarily in the calf muscles, quadriceps, and hip extensor muscles is characteristic.
6. Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to
A. refer her to a hand surgeon.
B. take a more complete history.
C. try neutral position wrist splinting and order an oral NSAID.
D. order a nerve conduction study such as an electromyography (EMG).
Rationale:
For the client who has just been given a diagnosis of carpal tunnel syndrome, your next step is to try neutral position wrist splinting and order an oral NSAID
7. Carol, age 62, has swollen, bony proximal interphalangeal joints. You describe these as
A. Heberden ' s nodes.
B. Bouchard ' s nodes.
C. Osler ' s nodes.
D. Murphy ' s nodes.
Rationale:
Swollen, bony proximal interphalangeal joints are Bouchard ' s nodes. Bony enlargements of the distal interphalangeal joints are Heberden ' s nodes
8. Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?
A. " Caffeine has no effect on osteoporosis. "
B. " A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly. "
C. " Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix. "
D. " Caffeine increases bone resorption. "
Rationale:
The effect of caffeine in causing osteoporosis is controversial, but it is postulated to result from caffeine ' s diuretic effect that causes calcium to be excreted more rapidly
9. You suspect adolescent idiopathic scoliosis in Victoria, age 15, who is in her growth spurt. You perform the Adams forward-bending test and note a right-sided rib hump. What is this indicative of?
A. Right lumbar shifting
B. Right thoracic curvature
C. Right truncal shift
D. Spondylolysis
Rationale:
When you have a client bend forward to assess the spine (the Adams forward-bending test) and you note a right-sided rib hump, this is indicative of a right thoracic curve
10. Joan, age 76, has been given a diagnosis of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. You have educated her about the importance of increasing calcium and vitamin D in her diet and starting a low impact weight bearing exercise program. You are also going to start her on medial management. Joan asks you about a drug called a " SERM " that she has heard has been shown in studies to prevent vertebral fractures. Which of the following pharmacological therapies for osteoporosis is classified as a selective estrogen receptor modulator (SERM)?
A. Alendronate
B. Risedronate
C. Salmon calcitonin
D. Raloxifene
Rationale:
Raloxifene is a selective estrogen receptor modulator. Intranasal salmon calcitonin has been shown effective for pain management of osteoporotic fracture, but data on fracture incidence with this treatment is not available
11. Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis
A. develops when loss of bone matrix (resorption) occurs more rapidly than new bone growth (deposition).
B. is a degenerative joint disease characterized by degeneration and loss of articular cartilage in synovial joints.
C. is a chronic, systemic inflammatory disorder characterized by persistent synovitis of multiple joints.
D. is a metabolic bone disorder characterized by inadequate mineralization of bone matrix.
Rationale:
Osteoporosis develops when bone resorption occurs more rapidly than bone deposition. Osteoarthritis is a degenerative joint disease characterized by degeneration and loss of articular cartilage in synovial joints
12. A Baker ' s cyst is
A. an inflammation of the bursa.
B. a form of tendinitis.
C. the buildup of synovial fluid behind the knee.
D. the result of a " swollen " ligament.
Rationale:
A Baker ' s cyst, also called popliteal cyst, is the buildup of synovial fluid behind the knee. It usually results from inflammation resulting from knee arthritis or a cartilage (especially meniscal) tear and consists of local pain, inability to extend the knee, and symptoms related to compression of surrounding structures
13. When teaching Alice, age 67, to use a cane because of osteoarthritis of her left knee, an important point to stress is to tell her to [Show Less]