A 13 year old obese (BMI greater than 95%) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent
... [Show More] horseplay with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative Drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and knee flexion causing external hip rotation. Based on the above scenario, the NP should suspect:
a. a left meniscal tear.
b. a left ACL tear
c. a slipped capital femoral epiphysis
d. osgood-schlatter disease. - correct answer C.
Colchicine may be used to terminate an acute attack of gouty arthritis as well as prevent recurrent episodes. The mechanism of action is to:
a. interrupt the cycle of urate crystal deposition and inflammatory response.
b. increase serum uric acid levels.
c. potentiate the excretion of uric acid.
d. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid. - correct answer A.
Cass, age 67, tells the NP that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows that it is cause by urate crystals that "get stuck in the joint and cause pain". Joan is on HcTz for management of her hypertension. The NP should suspect a diagnosis of:
a. septic arthritis
b. gout.
c. rheumatoid arthritis.
d. Charcot neuro-osteoarthropathy - correct answer B.
Treatment of choice for polymyalgia rheumatica (PMR) is:
a. acetaminophen or NSAIDS
b. low dose steroids.
c. tricyclic antidepressants.
d. antibiotics - correct answer B.
Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct?
a. integumentary effects involve swelling, erythema, and warmth at the involved site.
b. there is a low grade fever with intermittent chills
c. musculoskeletal effects include tenderness of the entire leg.
d. cardiovascular effects include bradycardia. - correct answer A.
Matthew, age 52, is a chef who just severed two of his fingers with a meat cutter. You would recommend that he:
a. wrap the severed fingers tightly in a dry towel for transport to the emergency department with him.
b. leave the severed fingers at the scene because fingers cannot be reattached.
c. immediately freeze the severed fingers for reattachment in the near future.
d. pack the fingers in a saline-soaked dressing and seal in a plastic bag. - correct answer D.
Bursitis is an inflammatory process that may be caused by infection, trauma, repetitive motion disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is from which of the following:
a. Mycobacterium tuberculosis
b. Candida
c. Staphylococcus aureus.
d. streptococcus - correct answer C.
When a provider elicits a painful Finkelstein's sign he or she is testing for:
a. carpal tunnel syndrone
b. bursitis of the shoulder.
c. de Quervain's tenosynovitis
d. tennis elbow. - correct answer C.
Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome?
a. musculoskeletal pain
b. difficulty sleeping
c. depression
d. fatigue - correct answer A.
A coccygeal fracture is treated with:
a. traction
b. surgical repair
c. analgesia and by use of a donut cushion when sitting
d. prolonged bedrest for 6 weeks. - correct answer C.
The most common cause of cauda equina syndrome is:
a. fracture
b. hematoma
c. lumbar intervertebral disk herniation.
d. space occupying lesion. - correct answer C.
If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured using:
a. Phalen's test
b. skeletometry
c. The Thomas test
d. a goniometer. - correct answer D.
Management of fibromyalgia would include:
a. giving psychotropic drugs, such as amitriptyline (Elavil), in a low dose at bedtime.
b. instructing clients to keep as busy as possible to keep their minds off the symptoms.
c. using high doses of NSAIDS.
d. avoiding exercise. - correct answer A.
Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change?
a. Lordosis
b. Dorsal kyphosis
c. Scoliosis
d. Kyphoscoliosis - correct answer B.
When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The NP is trying to differentiate between a sprain and a strain. A sprain:
a. is an injury to the ligaments that attach to bones in a joint.
b. is an injury to the tendons that attach to the muscles in a joint.
c. is an injury resulting in extensive tears of the muscles.
d. is an injury that does not result in joint instability. - correct answer A.
Which of the following is NOT a management principle for an acute musculoskeletal injury that does not require emergent treatment?
a. RICE
b. NSAIDS or acetaminophen
c. Imaging studies.
d. skeletal muscle relaxants. - correct answer C.
The valgus stress test, Varus stress test, Lachman test, and Thumb test are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the NP choose to assess the ACL, which is the most commonly involved structure in severe knee injury?
a. Valgus stress test
b. Varus stress test
c. Lachman test
d. Thumb sign - correct answer C.
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 occurs more rapidly than new bone growth.
b. is a degenerative joint disease characterized by loss of cartilage in certain joints.
c. is a chronic inflammatory disorder that affects multiple joints.
d. is a bone disorder that has to do with inadequate mineralization of bones. - correct answer A.
A clinical manifestation of symmetric neurogenic pain may indicate:
a. radiculopathy
b. reflex sympathetic dystrophy
c. entrapment neuropathy
d. peripheral neuropathy. - correct answer D.
Mike, age 42, a golf pro, has had chronic back pain for many years. His work-up reveals that it is not the result of a degenerative disk problem. His back "goes out" about twice per year, and he is out of work for about a week each time. Which of the following should the NP advise him to do:
a. consider changing careers to a less physical job
b. begin a planned exercise program to strengthen back muscles
c. make an appointment with a neurosurgeon for a surgical consultation.
d. start on a daily low-dose narcotic to take away the pain. - correct answer B.
Anna, age 42, is pregnant and was just given a diagnosis of carpal tunnel syndrome. She is worried that this will affect her in caring for the baby. What do you tell her to do?
a. don't worry; we'll find a brace that is very malleable.
b. after childbirth, your carpal tunnel syndrome may resolve.
c. if we do surgery now, you'll be recovered by the time the baby arrives.
d. you should prepare yourself for the probability of being unable to care for your baby. - correct answer B.
In a client with osteomyelitis, you would expect levels of:
a. serum calcium to be elevated.
b. akaline phosphatase to be elevated.
c. creatinine excretion to be elevated.
d. serum phosphorous to be elevated. - correct answer B.
Janine, age 69, has a class III case of rheumatoid arthritis. According to the American Rheumatism Association, her function would be:
a. adequate for normal activities despite a handicap of discomfort or limited motion of one or more joints.
b. largely or wholly incapacitated, bedridden, or confined to a wheelchair, permitting little or no self-care.
c. completely able to carry on all usual duties without handicaps.
d. adequate to perform only few or none of the duties of usual occupation or self-care. - correct answer D.
To aid in the diagnosis of meniscus damage, which test should a nurse practitioner perform?
a. the bulge test
b. the Lachman test
c. the drawer test.
d. Apley's compression test. - correct answer D.
Mickey, age 18, is on a chemotherapeutic antibiotic for a musculoskeletal neoplasm. Which drug do you think he is taking?
a. Cyclophosphamide (Cytoxan)
b. Doxorubicin (Adriamycin)
c. Methotrexate (Rheumatrex)
d. Cisplatin (Platinol) - correct answer B.
Stan, age 34, fractured his femur when his horse tripped over a jump. With this type of injury, you know that Stan is at risk for fat emboli. Early assessment findings for this complication include:
a. fever, tachycardia, rapid respirations, and neurological manifestations.
b. neurological manifestations, temperature elevation, bradycardia, and pallor
c. hostility; combativeness, paresthesia, and absent peripheral pulses.
d. lethargy, hypothermia, paresthesia, and absent peripheral pulses. - correct answer A.
Upon assessment, the NP notes unilateral back pain that had an acute onset and increases when standing and bending. A straight leg test is negative. The most likely differential diagnosis is:
a. herniated nucleus pulposus.
b. muscle strain
c. osteoarthritis
d. spondylolisthesis - correct answer A. **I believe this is an error. I believe the correct answer is B.
Which test is routinely recommended for a preparticipation sports physical?
a. a CBC
b. a CXR
c. an ECG
d. A snellen test. - correct answer D.
The straight-leg-raising maneuver can be used to diagnose:
a. nerve root compression
b. a fractured hip
c. an anterior cruciate ligament tear
d. tendinitis. - correct answer A.
A 55 year old patient presents with complaints of paresthesias into the lateral lower arm, thumb, and middle finger. The most commonly involved nerve roots that cause the related symptoms are c6-c7. The most likely differential diagnosis would be:
a. brachial plexus neuritis
b. cervical radiculopathy
c. peripheral polyneuropathy
d. thoracic outlet syndrome - correct answer B.
Which of the following can assist in the diagnosis of myasthenia gravis?
a. repetitive nerve stimulation
b. the presence of cogwheel rigidity
c. Chvostek's sign
d. Trousseau's sign - correct answer A.
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. - correct answer B.
The NP has just completed a work-up on Michael, age 13, and confirmed Osgood-Schlatter disease. The initial management would be to:
a. refer to orthopedics for early surgical correction.
b. recommend physical therapy for quadricep strengthening exercises
c. advise him to temporarily discontinue all sports activities until his growth plates have completely fused.
d. tell Michael that he can resume his usual activities immediately without concern and should begin aggressive exercises to increase muscle bulk and strength. - correct answer B.
For an adult patient with a knee injury, the NP orders an NSAID to be taken on a routine basis for the next two weeks. Patient teaching should include which of the following:
a. you may take the medication on an empty stomach as long as you eat within 2 to 3 hours of taking it
b. If one pill does not seem to help, you can double the dose for subsequent doses.
c. If you notice nausea/vomiting or black or bloody stools, take the next dose with a glass of milk or a full meal.
d. if you have additional pain, an occasional acetaminophen is permitted in between the usual doses of the NSAID. - correct answer D.
You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the:
a. lateral meniscus
b. cruciate ligament
c. medial meniscus
d. collateral ligament. - correct answer B.
Carol, age 62, has swollen, bony proximal interphalangeal joints. The NP describes these as:
a. heberden's nodes
b. bouchard's nodes
c. osler's nodes
d. murphy's nodes - correct answer B.
Sean, a factory line worker, has osteoarthritis of the right hand. According to the American college of rheumatology (ACR), the guidelines for pharmacological treatment include:
a. acetaminophen, tramadol, and intra-articular corticosteroid injections
b. oral NSAIDS, Tramadol, and articular corticosteroid injections
c. acetaminophen, topical capsaicin, and topical NSAIDS
d. topical capsaicin, topical NSAIDS, and oral NSAIDS. - correct answer B. **This answer is not correct.
Guidelines recommend:
"We conditionally recommend that health professionals
should use one or more of the following:
Topical capsaicin
Topical NSAIDs, including trolamine salicylate [Show Less]