PART 1:

John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal congestion that worsens at night. He states that he has a history of asthma, eczema and allergies to pollen. There is also one other person on the football team that has similar symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F.

Write a differential of at least three (3) possible items from the most likely to less likely. For each disease include information about the epidemiology, pathophysiology and briefly argue why this disease fits the presentation and why it might not fit the presentation.

PART 2:

A patient has been admitted into the emergency room that was in the passenger side of a car that collided with another car head on. The patient is pale, barely conscious and has a weak and thready pulse. An IV is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team fights to keep the patient alive they have to remove the spleen. Blood is given but it has been mistyped. A transfusion reaction occurs.

Describe the type of hypersensitivity reaction that has occurred and discuss the molecular pathophysiology of the specific type of hypersensitive reaction you have chosen.

In the event that this patient survived the car accident and the transfusion reaction which organs are most likely to be damaged and why?

PART 3:

A 44-year-old patient presents with lump in the chest of approximately 2 cm in diameter. There is a slight dimple over the location of the lump and when the lump is manipulated it seems to be attached to the surrounding tissue. A lumpectomy is performed and the mass is sent to pathology. The pathology report comes back and the mass is confirmed to be an estrogen receptor negative, a progesterone receptor negative and a her2/neu receptor positive breast cancer.

• What are some of the risk factors for breast cancer?

• What tumor suppressor genes are associated with breast cancer?

• What tumor oncogenes are associated with breast cancer?

• Compare and contrast tumor suppressor genes from oncogenes?

NR 507 Week No. 1 Quiz:

1. Which statement about vaccines is true? (Points : 2)
2. Which statement is true about fungal infections? (Points : 2)
3. What is the role of reverse transcriptase in HIV infection? (Points : 2)
4. What of the following remains a significant cause of morbidity and mortality worldwide? (Points : 2)
5. Once they have penetrated the first line of defense, which microorganisms do neutrophils actively attack, engulf, and destroy by phagocytosis? (Points : 2)
6. After sexual transmission of HIV, a person can be infected yet seronegative for _ months. (Points : 2)
7. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2)
8. Hypersensitivity is best defined as a(n) (Points : 2)
9. A person with type O blood is likely to have high titers of anti-_ antibodies. (Points : 2)
10. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction? (Points : 2)
11. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? (Points : 2)
12. In a type II hypersensitivity reaction, when soluble antigens from infectious agents enter circulation, tissue damage is a result of (Points : 2)
13. In which primary immune deficiency is there a partial to complete absence of T-cell immunity? (Points : 2)
14. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2)
15. What effect does estrogen have on lymphocytes? (Points : 2)
16. Which hormone increases the formation of glucose from amino
17. During a stress response, increased anxiety, vigilance, and arousal is prompted by (Points : 2)
18. Which cytokine is involved in producing cachexia syndrome? (Points : 2)
19. Which of the viruses below are oncogenic DNA viruses? (Points : 2)
20. By what process does the ras gene convert from a proto-oncogene to an oncogene? (Points : 2)
21. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-) in cell metastasis? (Points : 2)
22. Many cancers create a mutation of ras. What is ras? (Points : 2)
23. In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes? (Points : 2)
24. Tobacco smoking is associated with cancers of all of the following except (Points : 2)
25. What percentage of children with cancer can be cured? (Points : 2)

. Which one of the following statements accurately represents the practice known as unbundling?

A. Combination codes are assigned separately in ICD-10-CM. B. Codes that should be grouped into one code are broken into separate codes to maximize physician reimbursement. C. ICD-10-PCS codes are broken into separate codes for congruent assignment. D. Codes listed as separate procedures are assigned individually.

1. Placing a catheter into the aorta or directly into an artery or vein is called A. brachiocephalic manipulation. B. third order placement. C. selective catheter placement. D. nonselective catheter placement.
2. What ICD-10-CM code would be assigned for a patient with acute tubule-interstitial nephritis? A. L50.0 B. Z02.6 C. N10 D. B96.2
3. The suffix -sis means A. inflammation. B. drooping. C. condition. D. process.
4. The concept of meaningful use pertains to A. medical office protocol and document organization. B. electronic health record implementation. C. resource management in the inpatient setting. D. categorization of patient information.
5. In what CPT code range is Surgical Pathology found? A. 88400–80499 B. 88000–80299 C. 88300–88309 D. 88515–88598
6. According to the CMS National Physician Fee Schedule, what is the conversion factor for basic life support mileage? A. $32.4726 B. $34.5741 C. $28.8457 D. $36.0666
7. A patient who was involved in a motor vehicle accident is taken to the hospital by ambulance and admitted to the hospital in critical care. The physician sees the patient for 74 minutes in critical care. The physician leaves to attend to other patients in the ICU and the NICU of the same hospital. Five hours later, the physician returns to the patient and continues to treat the patient in critical care for an additional 30 minutes. The patient spends a total of 104 minutes in critical care. What codes are assigned? A. 99291, 99292 B. 99292, 99293 C. 99291, 99291 D. 99292, 99292, 99293
8. The prefix endo- means A. beneath. B. outside of. C. adjacent to. D. within.
9. What is the CPT code for a three-view x-ray of the mandible? A. 70200 B. 70100 C. 70150 D. 70240
10. Rules of evidence control the A. amount of evidence that may be admitted during a civil trial. B. processes and procedures for question and answer sessions. C. documents that can be considered during jury trial. D. length of criminal court proceedings, but not civil court proceedings.
11. The ampulla, isthmus, interstitium, and fimbria are examples of A. implantation sites of ectopic pregnancy. B. incision sites for pacemaker insertion. C. membranes in the abdomen. D. bones in the ankle.
12. Code J9165 is assigned for intravenous diethylstilbestrol diphosphate. According to the code description, what dosage was administered? A. 20 mg B. 50 mg C. Up to 0.5 mg D. 250 mg
13. Members of the uniformed services, their families and survivors, and retired members and their families qualify for A. TRICARE. B. OIG Recovery. C. Medicare. D. Medicaid.
14. A patient comes to the emergency room complaining of abdominal pain. She was previously diagnosed with type I diabetes. She also complains of watery eyes, congestion, pressure in the sinuses, and difficulty breathing. Her final diagnoses are right lower quadrant abdominal pain, type I diabetes, acute sinusitis, and asthma. What CPT and ICD-10-CM codes are assigned? A. 99222, R18.91, E16.9, J01.91, J45.919 B. 99221, R17.41, E17.9, J01.90, J45.909 C. 99221, R10.31, E10.9, J01.90, J45.909 D. 99223, R14.31, E15.9, J01.90, J45.929
15. Under HIPAA, health care facilities must A. follow up with patients who repeatedly miss scheduled appointments for mandatory services. B. keep records of patients who refill prescriptions more than once within a three-month timeframe. C. maintain a clean, safe working environment. D. choose a privacy officer in accordance with HIPAA policies and procedures.
16. What is the ICD-10-CM code for unspecified acute pericarditis? A. I30.89 B. I30.9 C. I30 D. I30.79
17. What is the full code description for 25515? A. Open treatment of radial shaft fracture, includes internal fixation, when performed B. Closed treatment of ulnar shaft fracture; without manipulation C. Closed treatment of radial shaft fracture; without manipulation D. Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex
18. Which of the following anatomical locations would contain the diaphysis? A. Metatarsal B. Diaphragm C. Septum D. Tibia
19. A patient recently became eligible for health insurance through her employer. Her health insurance is considered to be an 80-20 policy. Under the terms of an 80-20 policy, the insurer pays 80 percent and the insured pays 20 percent of expenses. This 80-20 policy is an example of A. coinsurance. B. prospective payment. C. capitation. D. case management.
20. The Outpatient Prospective Payment System (OPPS) pays A. an established rate for outpatient services in specific hospitals. B. a percentage of the national average for the same surgery performed in a different geographic location. C. 65% of the schedule C rate for all surgeries. D. subsidies to contain health care costs in rural facilities.
21. The study of disease is called A. physiology. B. pathology. C. urology. D. neurology.
22. Superficial injuries such as abrasions or contusions are A. not coded when associated with more severe injuries of the same site. B. queried to determine if the injuries are confined to the same site. C. coded when associated with more severe injuries of the same site. D. coded only when debridement is performed.
23. Another name for XXY syndrome is A. Turner’s syndrome. B. Cooley’s anemia. C. Klinefelter syndrome. D. Huntington’s chorea.
24. The method that physicians use to bill for each service or visit individually rather than on a pre-paid basis is called A. fee-for-service. B. capitation. C. pre-paid care. D. managed care.
25. A physician has a meeting with a pharmaceutical sales representative. During the course of the conversation, the physician reveals the diagnosis and past family, medical, and social history of a patient currently being treated with one of the medications that the sales representative is selling. In this situation, the doctor could be sued for A. invasion of privacy. B. malfeasance. C. undue harm and fraud. D. malice.
26. A patient is prescribed a medication that narrows the blood vessels and raises her blood pressure. The medication is most likely a A. tranquilizer. B. cardiogenic. C. vasoconstrictor. D. cardiotonic
27. Physicians typically refer to anatomical locations using directional terms, which are often A. paired in opposites. B. used primarily by chiropractors. C. used to describe surgical incisions. D. referenced horizontally.
28. The study of tissue disease using macroscopic or microscopic analysis is called A. immunology. B. histopathology. C. cytopathology. D. microbiology.
29. A physician obtains cells from the bone marrow cavity using a needle and a syringe. How would this procedure be coded? A. 36575 B. 37328 C. 38220 D. 35092
30. What is Medicare Part D? A. The component of Medicare Part A that covers outpatient surgeries B. Add-on coverage for prescription drugs provided through insurance companies approved by Medicare C. Supplemental coverage for war veterans and their dependents D. Add-on coverage for dental procedures
31. A female patient is seen for her annual gynecological examination. During the examination, the physician performs a test to detect cervical cancer. This test is called a/an A. immunoassay test. B. Pap smear. C. carcinoembryonic antigen test. D. mycobacterial culture.
32. A physician is called to the intensive care unit for a patient with second-degree burns sustained on 55% of his body while cooking in the kitchen where he works. The physician sees the patient in the critical care unit for two hours, leaves the unit, and returns later the same day to provide an additional hour of critical care. What ICD-10-CM and CPT codes would be assigned? A. L91.8, 99291 × 2, 99292 × 4 B. R53.81, 99291, 99293 × 5 C. Z30.09, 99293, 99294 × 2 D. T31.50, 99291, 99292 × 4
33. A change in the tissues and cells within a specific area on or in the body is called a A. lesion. B. cyst. C. neoplasm. D. tumor.
34. Information about a patient can becan be released for research under the terms of HIPAA, only if A. the patient signs an authorization immediately upon admission. B. the research is critical for technological development. C. the patient has authorized the release and only a limited amount of information is released. D. researchers obtain authorization from the admitting physician.
35. A patient is diagnosed with breast cancer and undergoes a partial mastectomy. What CPT code would be assigned? A. 19305 B. 19307 C. 19304 D. 19301
36. To conform to the HIPAA Privacy Rule, which of the following safeguards must be maintained in health care facilities? A. Immunization and injection safeguards B. Reasonable administrative, technical, and physical safeguards C. ICD-7 provisional safeguards D. Hazardous waste protection safeguards
37. A patient sustains a fracture of the femur while playing football in a nearby park. What ICD-10-CM code would be assigned? A. S72.001A B. S72.009A C. S72.003A D. S49.006A
38. According to the guidelines for medical records outlined in the Health Insurance Portability and Accountability Act (HIPAA), patients A. have the right to have errors reviewed by a hospital administrator. B. have the right to correct errors in identification data only. C. have the right to have errors in their medical records corrected. D. do not have the right to have errors corrected, as the data has been previously verified by the physician.
39. Modifier -23 indicates that A. two surgeons performed a procedure. B. a procedure was performed bilaterally. C. a physician reviewed and interpreted a radiology procedure. D. the patient received general anesthesia for a procedure that would ordinarily be performed with local or no anesthesia.
40. The Health Insurance Portability and Accountability Act (HIPAA) was created for the purpose of A. streamlining claims processing and reducing paperwork through electronic transmission. B. stabilizing administrative costs and productivity. C. decreasing employee turnover and reducing the volume of new hire paperwork. D. modifying legal and ethical issues surrounding medical records retention.
41. A patient is seen in the emergency room complaining of abdominal pain in the left lower quadrant. It’s determined that the patient is experiencing inflammation of the pancreas, which is also called A. pancreaticoduodonal arcade. B. pancreatitis. C. pancreatolysis. D. pancreatonia.
42. A 55-year-old patient was injured while working as a carpenter on a construction site. While framing the roof of a two-story house, he fell and hit his head. He was diagnosed with a concussion to the left side of his head, and underwent a right frontal parietal craniotomy with removal of a subdural hematoma. During the patient’s period of recovery, he was given a medication that resulted in a rash on his abdomen. The physician conducted an expanded problem focused history and exam, with straightforward medical decision making. What CPT code(s) should be assigned? A. 99251 B. 99252 C. 99292, 99291 D. 99253
43. Taking certain steps to protect PHI from being accidentally released to individuals who don’t need to know the information is called the A. minimum necessary standard. B. privacy management statute. C. health information guardianship guideline. D. information provision standard.
44. The main term represents the most basic aspect of a disease or condition. For example, the main term of a diagnosis involving a broken arm is A. broken. B. break. C. fracture. D. arm.
45. Performing a daily check for viruses and malware is one of the A. requirements of the Help Desk. B. routine aspects of software maintenance. C. sensible guidelines for Internet use in health care facilities. D. functions of HIM encoders.
46. A coder overhears a confidential statement made outside of the court, and then, when called to testify, repeats the statement as being truth. This is an example of A. cross-examination. B. hearsay. C. speculation. D. a direct quote.
47. A patient receives two venous pressure clamps for hemodialysis. What HCPCS Level II code is assigned? A. A4751 B. A4751 × 2 C. A4918 × 2 D. A4918
48. The process of removing tissue for histopathology is called A. shaving. B. debridement. C. excision. D. biopsy.
49. A coder would assign modifier -53 to report A. dental procedures. B. repeat procedures. C. anesthesia administration. D. procedures cancelled due to the patient’s condition.
50. Alternative dispute resolution (ADR) allows A. resolving medical malpractice suits by submitting pretrial depositions. B. lawyer-to-lawyer mediation during trial recess. C. mediating disputes with a judge in the presence of the bailiff. D. litigants to resolve disputes prior to or after the start of litigation.
51. Code range 99231–99233 pertains to A. initial hospital care. B. subsequent hospital care. C. consultation services. D. hospital discharge services.
52. A patient comes to the emergency room complaining of abdominal pain, nausea, and intractable vomiting. Unable to pinpoint the source of the patient’s complaints, the physician decides to admit the patient to the hospital. After conducting a complete history and examination, the patient’s final diagnosis is determined to be chronic duodenal ulcer. The patient remains hospitalized for three days. The physician sees the patient on the day of discharge. What ICD-10 and CPT codes are assigned? A. 99234, N17.9 B. 99223, I48.91 C. 99238, K26.7 D. 99291, D63.1
53. The specific guidelines that constitute a valid release of information under the HIPAA Privacy Rule are described as A. OIG specifications. B. E/M levels. C. considerations in relation to risk management. D. core elements.
54. The suffix –centesis means A. abnormal condition. B. calculus or stone. C. a surgical puncture for fluid removal. D. separation, breakdown, destruction.
55. The code for an ESWL would be found in the A. Urinary and Male Genital Systems of CPT. B. Chemotherapy section of HCPCS. C. Digestive System of CPT. D. Cardiovascular System of CPT.
56. A female patient is diagnosed with breast cancer of the lower-inner quadrant of the right breast. The patient undergoes a modified radical mastectomy of the right breast in an attempt to circumvent the spread of the cancer to any secondary anatomical sites. The procedure was performed in three stages. In addition to the radical mastectomy, the physician also performed a right breast biopsy to treat the breast tumor in the lower-inner quadrant. What ICD-10-CM and CPT codes are assigned? A. 19307-58-RT, 19101-59-RT, C50.311 B. 15852-58, Z48.01 C. 11602, 15240, C50.312 D. 19307-RT, 19101-RT, C50.211
57. A patient comes to the ambulatory surgery center for a fusion of the cervical spine. Prior to the beginning of the surgery, the patient suffers an allergic reaction to the anesthesia shortly after it’s administered. Because of this reaction, the surgery is not performed. What code would be assigned as the first-listed diagnosis? A. The observation code B. The reason that the surgery was scheduled to be performed C. The allergy code D. The anesthesia administration
58. Anti-inflammatory drugs applied to the skin to relieve skin disorders are called A. topical corticosteroids. B. antiseptics. C. keratolytics. D. astringents.
59. The _ nerve sends visual data to the occipital lobe of the brain. A. abducens B. trochlear C. optic D. oculomotor
60. The root word OBSTETR/O means A. pregnancy. B. cesarean. C. midwife. D. birth.
61. The root word ENTER/O means A. tooth. B. stomach. C. intestine. D. secretion.
62. What code would be assigned for gastropathy? A. K29.7 B. K41.31 C. K31.9 D. K41.2
63. A patient comes to the physician’s office complaining of neck irritation. The physician examines her neck and notes that she has a 15 cm neck scar. Upon further examination, the physician notes that the neck scar requires extensive debridement and retention sutures. The physician performs a dermabrasion to treat the neck scar and then closes the complex wound with the sutures. What ICD-10 and CPT codes are assigned? A. 13132, 13133 × 2, L90.5 B. 13132, 13133 × 3, H81.09, L92.9 C. 13133-51, 13131-79, L60.0 D. 13132, L76.82
64. The bulbourethral gland is found in the _ system. A. neurological B. cardiovascular C. male genital D. female genital
65. A tethered health record allows patients to A. restructure insurance copayments. B. use a secure portal to access their own records. C. compare their health records to the records of patients with similar diagnoses. D. amend the diagnoses listed in the health record.
66. A patient is diagnosed with lymphocytic lymphoma. Another patient is seen several weeks later and is diagnosed with histiocytic lymphoma. Both of these diagnoses are examples of _ lymphoma. A. basic B. Hodgkin’s C. non-Hodgkin’s D. Burkitt’s
67. A patient receives a blood glucose monitor. What HCPCS Level II code would be assigned? A. E0976 B. E0607 C. E0562 D. E4752
68. A good compliance program in the health care setting includes A. HHS surveillance. B. regular tracking and monitoring of coding activities. C. meetings with compliance officers. D. regular audit consultations with trustees of the AAPC.
69. A patient with numerous symptoms is seen in the laboratory for a general health panel to gauge her overall physical well-being. What CPT code would be assigned for a general health panel? A. 80051 B. 82136 C. 84135 D. 80050
70. Code 71030-TC indicates a/an A. complete chest x-ray, four views, technical component only. B. incomplete chest x-ray, two views, technical and professional component. C. complete chest x-ray, two views, technical component only. D. incomplete chest x-ray, three views, technical and professional component
71. If patients choose to obtain copies of their medical records, under the terms of HIPAA, providers can A. also fulfill requests for prescription data. B. reschedule office visits to allow time to update medical records. C. complete employee paperwork. D. charge a reasonable fee for providing copies of those records.
72. A patient comes to the clinic complaining of fever, diarrhea, nausea, and vomiting. The patient is diagnosed with salmonella meningitis. What ICD-10-CM code would be assigned? A. A23.24 B. A02.21 C. A05.26 D. A07.21
73. A patient comes to the emergency room complaining of right knee pain. He states that he was playing baseball the previous evening and accidentally fell when sliding into first base. The physician obtains an expanded problem focused history and examination, as well as a two-view x-ray of the right knee. The physician reviews the x-ray, as well as the notes in the medical record, and renders a diagnosis of osteoarthritis of the knee. The physician performs a patellofemoral arthroplasty to repair the knee. What ICD-10-CM and CPT codes are assigned? A. 27477, M17.12 B. 27506-RT, N17.11 C. 27477-RT, D17.39 D. 27447-RT, M17.11
74. Provision of security against a hurt, loss, or damage with specific cash payments is called A. copayment. B. protection. C. indemnity. D. secured loss.
75. HCPCS modifier –E2 indicates that the patient had a surgical procedure performed on the A. lower left eyelid. B. upper left eyelid. C. upper right eyelid. D. lower right eyelid.
76. When is code 58120 assigned? A. The code is assigned for permanent pacemaker insertion. B. The code has been deleted and cannot be assigned. C. The code is assigned for a patient undergoing dilatation and curettage. D. The code is assigned as an add-on code.
77. Epithelial tissue that secretes its products directly into the bloodstream is made of A. extracellular matrix. B. endocrine gland cells. C. endoplasmic reticulum. D. columnar epithelial cells.
78. Which of the following modifiers would be assigned for a moribund patient? A. P4 B. P1 C. P5 D. P3
79. The anatomical location of the calyx is the A. spine. B. brain. C. arm. D. kidney.
80. Which one of the following requirements is outlined in the guidelines established in HIPAA’s Privacy Rule? A. Hospital administrators must encrypt data within older data files. B. Physicians must not disclose patient information to consulting physicians. C. Patients must receive notice if their information will be used or disclosed to third parties. D. Managers must secure medical records immediately following patient admission.
81. The I-10 helps coders classify patient A. morbidity and mortality. B. management information. C. evaluation files. D. reimbursement data.
82. During a routine examination, a male patient is diagnosed with an elevated PSA. The physician performs a biopsy of the prostate with a rectal ultrasound to pinpoint the source of the problem. Which CPT and ICD-10-CM codes would be assigned? A. 55725, 76000-26, R93.6 B. 55700, 76872-26, R97.2 C. 55734, 73200-26, R97.2 D. 55720, 74000-26, R97.3
83. Health care practitioners must maintain records of privacy policy practices and procedures for A. 20 years. B. 10 months. C. 2 years. D. 6 years.
84. A patient comes to the emergency department of a rural hospital. He complaints of problems sleeping, foot swelling, and insomnia. After a detailed review of the patient’s history and a detailed examination, the patient is diagnosed with chronic renal insufficiency, nephrotic syndrome, and anemia, based on the values listed in his blood test. The patient undergoes a biopsy of the left and right kidneys under physician guidance. A CT scan is also used for guidance and needle placement. A follow-up CT scan with physician review and interpretation is also performed. What ICD-10 and CPT codes are assigned? A. 50500-73, 51200-LT, C79.2, C61 B. 50200-RT-LT, 50310-RT, 51252-26, E46, N18.9, N04.9 C. 51000, 50310-59-LT, J90, Z90.12, E85.4 D. 50200-50, 50200-59-RT, 77012.26, N18.9, N04.9, D64.9
85. Data stored in a health care facility must A. comply with HIPAA rules and must be maintained securely. B. adhere to OIG policies and procedures. C. be organized in accordance with state standards for electronic data interchange. D. conform to the physician’s expectations for data storage.
86. Health care practitioners who submit fraudulent bills to increase reimbursement may A. be blacklisted according to geographic location. B. be listed in the Coding Directory of Fraudulent Billing published annually by the Department of Health and Human Services. C. be reported to the Office of the Attorney General. D. face financial penalties or, in some cases, imprisonment.
87. Which of the following anesthesia modifiers indicates a normal, healthy patient? A. P3 B. P1 C. P4 D. P2
88. When coding burns, coders should A. classify all burns as acute burns. B. assign separate codes for each burn site. C. assign the code for third-degree burns. D. assign the code for chronic burns.
89. A 65-year-old patient is admitted to the hospital for 48 hours to receive treatment from her physician. This patient would be covered under A. Medicare Part D. B. Medicare Part A. C. Medicare Part B. D. Medicare Part C.
90. A patient comes to the clinic complaining of ongoing headaches. The headaches began one week prior and have persisted ever since. A lumbar spinal tap is performed to pinpoint the source of the patient’s headaches. What CPT and ICD-10-CM codes are assigned? A. 62270, G44.1 B. 62270, G74.3 C. 62141, G46.8 D. 62272, G46.9
91. What code would be assigned for a tube pericardiostomy? A. 33210 B. 33026 C. 33015 D. 33050
92. What is the code description for 65101-LT? A. Removal of ocular implant performed laterally B. Fine needle aspiration of orbital contents on the left third of the orbit C. Biopsy of cornea performed on the lower third of the cornea D. Enucleation of eye, without implant, performed on the left side of the body
93. Another name for diazepam is A. Flexeril. B. Valium. C. Norflex. D. Myolastan.
94. The gatekeeper concept refers to the operation of A. prospective payment organizations. B. retrospective payment organizations. C. ambulatory payment surgery centers. D. health maintenance organizations.
95. The CPT code for thrombolysis is A. 93000. B. 92975. C. 92920. D. 93797.
96. According to HIPAA, a patient’s information may be released for A. paternity testing. B. research. C. determining premiums based on a patient’s past medical history. D. transferring electronic medical records to remote locations.
97. Which of the following statements is true of the Affordable Care Act? A. It includes a provision for military service members who served in Afghanistan. B. It requires health care facilities to maintain health records for at least 10 years. C. It makes it mandatory for patients to carry health insurance. D. It offers parents supplementary coverage for dependents with chronic illness
98. A patient is seen in the physician’s office after the results of an earlier mammogram demonstrated microcalcification in the right breast as well as a breast lesion. The lesion is excised using needle localization. The patient’s final diagnosis is fibrosclerosis of the right breast. What CPT and ICD-10-CM codes are assigned? A. 19120-RT, L10.11 B. 19125-RT, N60.31 C. 19126-LT, M25.1 D. 19123-RT, H16.11
99. A coder would assign a Q code as a temporary code for A. holistic treatments for spinal procedures. B. durable medical equipment only. C. procedures or services only. D. procedures, services, and supplies
100. Which of the following forms is used to bill outpatient charges? A. HCFA-1350 or CMS-650 B. HCFA-1400 or CMS-1540 C. AMA-14 or UCF-1250 D. CMS-1500 or UCF-1500.
101. During a routine examination, a patient indicates that she is taking an antihypertensive medication that causes her kidneys to excrete more urine. These antihypertensive medications are called A. calcium-channel blockers. B. anticoagulants. C. beta blockers. D. diuretics.
102. A patient comes to the emergency room complaining of postnasal drip, frequent nosebleeds, headaches, and difficulty breathing. She is diagnosed with a deviated nasal septum, hypertrophy of the turbinate, and inflammation of the ethmoid sinuses. The physician performs an endoscopic ethmoidectomy of the left nasal sinus, septoplasty, and turbinate excision. What ICD-10-CM and CPT codes are assigned? A. 31255, 30520, 30130, J34.2, J34.3, J32.2 B. 31255-LT, 30520-51, 30130-51, J34.2, J34.3, J32.2 C. 31230, 30520, J34.2, J34.3, J32.2 D. 31230-51, 30520-LT, J34.2
103. A physician is analyzing specific organs in a particular region of the patient’s body. In her notes, she refers to the transverse or cross-sectional plane, which divides the body A. inferiorly. B. vertically. C. horizontally. D. bilaterally.
104. A patient comes to the emergency room after having dinner at a restaurant, where she began to experience chest tightness during the meal. She is seen for a cardiology consultation in the outpatient setting for a diagnosis of chest tightness. Which CPT and ICD-10-CM codes would be assigned? A. 99245, R07.89 B. 99244, R07.59 C. 99242, R17.52 D. 99243, R25.96
105. Providers that receive reimbursement after health care services have been provided are being compensated under the _ system. A. prospective payment B. retrospective payment C. capitation D. UCR
106. The regulations in HIPAA apply to three groups of individual and corporate entities, each involved in electronic medical records transfer. These groups are collectively referred to as A. health care administrators. B. covered entities. C. provisional health care data collectors. D. protected personnel.
107. The largest salivary glands are called the _ glands. A. amylase B. parotid C. sublingual D. submandibular
108. Which modifier indicates a staged or related procedure performed during the postoperative period? A. -59 B. -57 C. -58 D. -54
109. The voluntary program that’s financed through a combination of payments from general federal revenues and premiums paid by beneficiaries who elect to participate is called A. CHAMPVA. B. Medicare Part B. C. Medicaid. D. TRICARE.
110. What is the full code description for 33536? A. Repair of postinfarction ventricular septal defect, with or without myocardial resection B. Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts C. Repair of double outlet right ventricle with intraventricular tunnel repair D. Closure of atrioventricular valve (mitral or tricuspid) by suture or patch
111. Categorically needy and medically needy patients may qualify for A. Medicaid. B. CHAMPVA. C. Champus. D. Medicare Advantage
112. ICD-10-CM code S50.351A indicates that the patient has a superficial foreign body of the right elbow. The A indicates that A. code S50.351A should be assigned to page 1 of the medical record, but not subsequent pages. B. this is the patient’s first encounter. C. this is the patient’s second encounter for the same original diagnosis. D. code S50.351A should be sequenced before secondary codes.
113. The foramen ovale is found in which anatomical location? A. Fibula B. Heart C. Pancreas D. Liver
114. A new patient is seen in a clinic for complaints of shortness of breath, fever, difficulty swallowing, runny nose, and cough. The physician performs a detailed history, detailed examination, and medical decision making of low complexity. The physician also obtains a chest x-ray and lab workup. Based on the results of the diagnostic tests, the physician renders a diagnosis of upper respiratory tract infection and lymphadenopathy. What ICD-10 and CPT codes are assigned? A. 99203, J06.9, R59.0 B. 99202, D63.1, J45.909 C. 99213, R06.82, F10.229 D. 99215, M19.011, R13.10
115. A patient has a disorder in which the bone marrow produces an overabundance of white blood cells. What is this disorder called? A. Leukemia B. Hemophilia C. Coagulation D. Septicemia
116. A patient is diagnosed with acne. What ICD-10-CM code would be assigned? A. L74.2 B. L72.3 C. L70.0 D. L73.1
117. A coder assigns a HCPCS Level II code to a patient’s medical record. The code description reads as follows: Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape. Based on this description, which HCPCS Level II code was assigned? A. B4072 B. B4125 C. B4034 D. B4278
118. The Health Insurance Portability and Accountability Act (HIPAA) standards were developed to A. ensure that coders could easily access each medical record. B. determine the structure of insurance carrier payments for health care practitioners. C. protect patient confidentiality when health information is transferred electronically. D. define XLTM standards for health records management.
119. Another name for third-party contractors who have access to medical information is A. business associates. B. insurance administrators. C. healthcare vendors. D. covered entities.
120. Bones inside the nose are called A. maxillae. B. turbinates. C. ethmoids. D. septal mucosa.
121. The atrioventricular (tricuspid) valve is located in the A. fibula. B. lung. C. heart. D. brain.
122. Another term for disease evolution is A. exacerbation. B. remission. C. pathogenesis. D. morphology.
123. The vitreous humor can be found in the A. ear. B. tongue. C. nose. D. eye.
124. The codes for pacemakers and implantable defibrillators would be found in what section of CPT? A. 33202–33273 B. 33200–33205 C. 33437–33537 D. 33533–33799
125. The HIPAA Privacy Rule indicates that A. practitioners should disclose only the minimum amount of health information necessary for the purpose of the disclosure. B. physicians may release medical information at their own discretion. C. restrictions on information disclosure exist only for patients with life-threatening illnesses. D. the level of information disclosure permitted is based on the nature of the procedure.
126. The abbreviation INH indicates what route of drug administration? A. Inhaled and intrathecal administration B. Inhaled and intravenous administration C. Intrathecal injection D. Inhalant solution
127. A patient comes to the clinic complaining of nausea, vomiting, fever, dizziness, and intermittent confusion. The physician conducts a detailed history and examination and reviews the patient’s lab results. The patient is diagnosed with pyelonephritis and is scheduled for an ultrasound to review the state of the kidneys and other organs. What CPT and ICD-10-CM codes are assigned? A. 76775-TC, N15 B. 76775-26, N10 C. 73256-TC, M11 D. 71010-26, B12
128. What happens when HIPAA rules conflict with state law? A. Conflicting state rules are overridden by federal law. B. The interpretation of HIPAA rules is left to the physician’s discretion. C. State laws overrule federal law. D. The Supreme Court’s decision becomes final in binding arbitration
129. Which of the following statements is true of the olfactory nerve? A. It’s susceptible to erosion due to Peyronie’s disease. B. It’s located in the mitral valve and helps to circulate blood throughout the heart. C. It conveys the fluid from lymph glands to other areas of the body. D. It’s found in the nose and allows the senses to detect and distinguish odors.
130. The first step in EHR implementation is A. structuring the timeline for EHR implementation. B. analyzing the content of the traditional medical record. C. conducting an assessment of the goals, needs, and financial stability of the health care practice. D. reviewing the list of established patients currently being seen in the practice.
131. The outcome of delivery code should be A. omitted from the maternal record for stillborn delivery. B. assigned to the newborn record only. C. assigned to the maternal record when a delivery occurs. D. assigned to both the maternal and newborn records.
132. A patient is seen in the office for complaints of dizziness and insomnia. The physician records a chronological description of specific elements of the patient’s condition. This chronological description is called the A. history of present illness. B. examination. C. review of systems. D. chief complaint.
133. What is the CPT code description for 64483? A. Injection(s) anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level B. Injection, anesthetic agent, sphenopalatine ganglion C. Injection(s) anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, multiple levels D. Transforaminal epidural injection under ultrasound guidance
134. Releasing genetic information is forbidden under the terms of HIPAA because it may A. allow immediate family members to have access to a patient’s medical records. B. require physicians to fulfill contractual obligations for treatments provided in ambulatory surgery centers. C. indicate susceptibility to a future illness, without the patient actually being diagnosed with the condition. D. not be successfully transmitted to all health care facilities.
135. Prescribing combination drugs that contain multiple medications to cut down on the number of pills

patients take on a daily basis

A. compounds the drugs’ effectiveness. B. increases the likelihood of compliance. C. decreases the frequency of drug interactions. D. supports good body function.

1. A patient who has paralysis of all four limbs is called A. quadriplegic. B. paraplegic. C. tetraplegic. D. hemiplegic.
2. Which of the following is true about HIPAA national standards? A. The national standards apply to any electronic data interchange. B. The national standards apply only to data exchange within a specified geographical region. C. The national standards do not apply to surgical procedures in the inpatient setting. D. The national standards do not apply to data exchanged within a claim clearinghouse.
3. A patient undergoes an appendectomy and later returns to the operating room for a related procedure the same day. Which modifier should be assigned to the CPT code? A. -51 B. -AA C. -78 D. -76
4. The portion of health insurance that an insured pays before he or she is entitled to receive benefits from an insurance plan is called the A. deductible. B. OPPS reimbursement. C. capitation. D. coinsurance.
5. A patient is seen in follow-up two weeks after undergoing cholecystectomy. During the follow-up examination, the physician notes that the abdominal wound has not yet healed. The patient undergoes a split-thickness autograft due to a nonhealing left lower abdominal wound that’s 10 square centimeters. Which CPT and ICD-10-CM codes would be assigned? A. 15350, L52.64 B. 15250, L34.74 C. 15200, L85.64 D. 15100, L76.82
6. The Female Genital System subsection covers which CPT code range? A. 56203–56303 B. 56607–56809 C. 56300–56499 D. 56405–58999
7. What ICD-10-CM code would be assigned for unilateral primary osteoarthritis of the right hip? A. M16.12 B. M16.30 C. M16.11 D. M16.10
8. Which of the following anatomical locations would contain the superior vena cava? A. Hip B. Nose C. Lungs D. Heart
9. A patient receives an injection of nandrolone decanoate. What HCPCS Level II code would be assigned? A. J2323 B. J3530 C. J2320 D. J2300
10. The suffix –stasis means A. breakdown. B. stopping and controlling. C. kinetic. D. flow.
11. A patient undergoes a sigmoidoscopy. The coder would assign CPT code A. 45852. B. 45330. C. 45397. D. 45919.

Details:

In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.

Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.

In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale.

In 400-500 words, respond to the following: How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care?

In 200-250 words, respond to the following: How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

This benchmark assignment assesses the following competencies:

BS Nursing (RN to BSN)

5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

Question

Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?

Moist and smooth

Moist and rough

Dry and smooth

Dry and rough

Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

Tenderness

Cool temperature

Ecchymosis

Nodules

Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?

Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatica

Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases?

Rheumatoid arthritis

Degenerative joint disease

Psoriatic arthritis

Septic arthritis

Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:

Contact dermatitis

Impetigo

Larva migrans

Scabies

Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis?

Obesity

Late menopause

Having an aunt with osteoporosis

Delayed menarche

Question 8. Question : Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

Conclude that these are lesions she has had for a long time.

Wait for her to mention them before asking further questions.

Ask how she acquired them.

Conduct the visit as usual for the patient.

Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?

: Age over 50

Pain at night

Pain lasting more than 1 month or not responding to therapy

Pain that is bilateral

Question 10. Question : The Phalen’s test is used to evaluate:

Inflammation of the median nerve

Rheumatoid arthritis

Degenerative joint changes

Chronic tenosynovitis

1. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?

The presence of bowel sounds in the scrotum

Being unable to palpate superior to the mass

A positive transillumination test

Normal thickness of the skin of the scrotum

Question 2. Question : You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?

Refer to urology

Recheck in six months

Tell the parent the testicle is absent but that this should not affect fertility

Attempt to bring down the testis from the inguinal canal

Question 3. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?

Internal hemorrhoid

Prostate cancer

Anorectal cancer

Rectal polyp

Question 4. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can’t even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup.

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 5. Question : Which is true of prostate cancer?

It is commonly lethal.

It is one of the less common forms of cancer.

Family history does not appear to be a risk factor.

Ethnicity is a risk factor.

Question 6. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?

Phimosis

Paraphimosis

Balanitis

Balanoposthitis

Question 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn’t sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have?

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 8. Question : The most common cause of cancer deaths in males is:

Lung cancer

Prostate cancer

Colon cancer

Skin cancer

Question 9. Question : Important techniques in performing the rectal examination include which of the following?

Lubrication

Waiting for the sphincter to relax

Explaining what the patient should expect with each step before it occurs

All of the above

Question 10. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?

Decreased testosterone levels

Psychological issues

Abnormal hypogastric arterial circulation

Impaired neural innervation

Question 1. Which of the following is true of human papilloma virus (HPV) infection?

Pap smear is a relatively ineffective screening method.

It commonly resolves spontaneously in one to two years.

It is the second most common STI in the United States.

HPV infections cause a small but important number of cervical cancers.

Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer?

Beginning at the nipple, make an ever-enlarging spiral.

Divide the breast into quadrants and inspect each systematically.

Examine in lines resembling the back and forth pattern of mowing a lawn.

Beginning at the nipple, palpate vertically in a stripe pattern.

Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?

Breast cancer

Imbalance of hormones of puberty

Drug use

Question 4. Question : Which of the following represents metrorrhagia?

Fewer than 21 days between menses

Excessive flow

Infrequent bleeding

Bleeding between periods

Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose?

Herpes zoster infections

Yeast infections

Herpes simplex infections

Viral infections

Question 6. Question : Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?

This is most likely due to lack of lubrication.

This is most likely due to atrophic vaginitis.

This is most likely due to pressure on an ovary.

Psychosocial reasons may cause this condition.

Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?

Breast tissue

Fibrocystic disease

Breast cancer

Lymph node

Question 8. Question : Which of the following is true regarding breast self-examination?

It has been shown to reduce mortality from breast cancer.

It is recommended unanimously by organizations making screening recommendations.

A high proportion of breast masses are detected by breast self-examination.

The undue fear caused by finding a mass justifies omitting instruction in breast self-examination.

Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have?

Peau d’orange

Acanthosis nigricans

Hidradenitis suppurativa

Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy?

They no longer require breast examination.

They should be examined carefully along the surgical scar for masses.

Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer.

Women with breast reconstruction over their mastectomy site no longer require examination.

Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric ischemia

Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

Acute appendicitis

Acute mechanical intestinal obstruction

Acute cholecystitis

Mesenteric ischemia

Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?

His spleen is definitely enlarged and further workup is warranted.

His spleen is possibly enlarged and close attention should be paid to further examination.

His spleen is possibly enlarged and further workup is warranted.

His spleen is definitely normal.

Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?

Aortic insufficiency

Hyperthyroidism

Arterial emboli

Early “warm” septic shock

Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.

What is the best choice for the cause of her constipation?

Large bowel obstruction

Irritable bowel syndrome

Rectal cancer

Hypothyroidism

Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

Intermittent claudication

Chest pressure with exertion

Shortness of breath

Knee pain

Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?

Thigh

Knee

Calf

Ankle

Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

Femoral pulse, popliteal pulse

Dorsalis pedis pulse, posterior tibial pulse

Carotid pulse

Radial pulse, brachial pulse

Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?

It is a splenic rub.

It is a variant of bowel noise.

It represents borborygmi.

It is a vascular noise.

Question 1.A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:

heart failure.

aortic stenosis.

pulmonary edema.

mitral regurgitation.

Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 4. Question : A patient tells the nurse practitioner that he is very nervous, that he is nauseated, and that he “feels hot.” This type of data would be:

objective.

reflective.

subjective.

introspective

Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help:

the examiner feel more comfortable and gain control of the situation.

build rapport and increase the patient’s confidence in the examiner.

the patient understand his or her disease process and treatment modalities.

the patient identify questions about his or her disease and potential areas of patient education.

Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule):

is tender.

is mobile and not hard.

disappears when the patient smiles.

is hard and fixed to the surrounding structures.

Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has:

Cushing’s syndrome.

Parkinson’s syndrome.

Bell’s palsy.

had a cerebrovascular accident (stroke).

Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the:

hyoid.

vagus.

tragus.

mandible.

Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates:

constipation.

air-filled areas.

the presence of a tumor.

the presence of dense organs.

Question 10. Question : A patient tells the nurse that he is allergic to penicillin. What would be the nurse practitioner’s best response to this information?

“Are you allergic to any other drugs?”

“How often have you received penicillin?”

“I’ll write your allergy on your chart so you won’t receive any.”

“Please describe what happens to you when you take penicillin.”

Question 11. Question : A patient’s thyroid is enlarged, and the nurse practitioner is preparing to auscultate the thyroid for the presence of a bruit. A bruit is a:

low gurgling sound best heard with the diaphragm of the stethoscope.

loud, whooshing, blowing sound best heard with the bell of the stethoscope.

soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.

high-pitched tinkling sound best heard with the diaphragm of the stethoscope.

Question 12. Question : After completing an initial assessment on a patient, the nurse practitioner has documented that his respirations are eupneic and his pulse is 58. This type of data would be:

objective.

reflective.

subjective.

introspective.

Question 13. Question : A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse?

“Can you point to where it hurts?”

“We’ll talk more about that later in the interview.”

“What have you had to eat in the last 24 hours?”

“Have you ever had any surgeries on your abdomen?”

Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with:

bronchitis.

a pneumothorax.

acute pneumonia.

an asthmatic attack.

Question 15. Question : The inspection phase of the physical assessment:

yields little information.

takes time and reveals a surprising amount of information.

may be somewhat uncomfortable for the expert practitioner.

requires a quick glance at the patient’s body systems before proceeding on with palpation.

Question 16. Question : The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse practitioner?

“It is unusual for a small child to have frequent ear infections unless there is something else wrong.”

“We need to check the immune system of your son to see why he is having so many ear infections.”

“Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”

“Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”

Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation?

Palpating the thorax of an infant

Palpating the kidneys and uterus

Assessing pulsations and vibrations

Assessing the presence of tenderness and pain

Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the:

database.

admitting data.

financial statement.

discharge summary.

Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should:

have the parent remove all clothing except the diaper on a boy.

instruct the parent to feed the infant immediately before the exam.

encourage the infant to suck on a pacifier during the abdominal exam.

ask the parent to briefly leave the room when assessing the infant’s vital signs.

Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is:

hydrocephalus.

craniosynostosis.

cephalhematoma.

caput succedaneum.

Question 21. Question : When examining an infant, the nurse practitioner should examine which area first?

Ear

Nose

Throat

Abdomen

Question 22. Question : When preparing to examine a 6-year-old child, which action is most appropriate?

Start with the thorax, abdomen, and genitalia before examining the head.

Avoid talking about the equipment being used because it may increase the child’s anxiety.

Keep in mind that a child this age will have a sense of modesty.

Have the child undress from the waist up.

Question 23. Question : The nurse practitioner is assessing a patient’s skin during an office visit. What is the best technique to use to best assess the patient’s skin temperature?

Use the fingertips because they’re more sensitive to small changes in temperature.

Use the dorsal surface of the hand because the skin is thinner than on the palms.

Use the ulnar portion of the hand because there is increased blood supply that enhances temperature sensitivity.

Use the palmar surface of the hand because it is most sensitive to temperature variations because of increased nerve supply in this area.

Question 24. Question : Percussion notes heard during the abdominal assessment may include:

flatness, resonance, and dullness.

resonance, dullness, and tympany.

tympany, hyperresonance, and dullness.

resonance, hyperresonance, and flatness.

Question 25. Question : The nurse practitioner is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?

Hypertension

Streptococcus infections

History of constipation and frequent laxative use

Frequent use of nonsteroidal anti-inflammatory drugs

Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?

Ethnicity

Alcohol intake

Gender

Asthma

Question 2. Question : You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Upright

Upright, but leaning forward

Supine

Left lateral decubitus

Question 3. Question : You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?

Normal

Prehypertension

Stage 1 hypertension

Stage 2 hypertension

Question 4. Question : How should you determine whether a murmur is systolic or diastolic?

Palpate the carotid pulse.

Palpate the radial pulse.

Judge the relative length of systole and diastole by auscultation.

Correlate the murmur with a bedside heart monitor.

Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s age group for an AMI?

Chest pain

Syncope

Pain radiating into the left arm

Pain radiating into the jaw

Question 6. Question : On examination, you find a bounding carotid pulse on a 62-year-old patient. Which murmur should you suspect?

Mitral valve prolapse

Pulmonic stenosis

Tricuspid insufficiency

Aortic insufficiency

Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?

Hyperthyroidism

Anemia

Fever

Hypertension

Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:

Kidney failure

Congestive heart failure

Angiotensin-converting enzyme (ACE) inhibitor induced coughing

Thyroid disease

Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?

Asking the patient to hold their breath.

Asking the patient in the next bed to turn down the TV.

Checking your stethoscope for air leaks.

All of the above.

Question 10. Question : You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?

Emphysema

Asthma exacerbation

Severe left heart failure

Cardiac tamponade

Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?

Asthma

COPD

Bronchiectasis

Heart failure

Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.

Pneumonia

COPD

Pleural pain

Left-sided heart failure

Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?

Percuss the lower border of the liver.

Measure the span of the liver.

Order a hepatitis panel.

Obtain an ultrasound of the liver.

Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?

Bronchitis

Costochondritis

Pericarditis

Angina pectoris

Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?

Bronchitis

Simple asthma

Cystic fibrosis

Heart failure

Question 6. Question : Is the following information subjective or objective? Mr. Mazz has shortness of breath that has persisted for the past ten days; it is worse with activity and relieved by rest.

Subjective

Objective

Question 7. Question : All of the following are implicated in causing chronic cough except:

Chronic bronchitis

Allergic rhinitis

Acute viral upper respiratory infection

Gastroesophageal reflux disease

Question 8. Question : A mother brings her infant to you because of a “rattle” in his chest with breathing. Which of the following would you hear if there is a problem in the upper airway?

Different sounds from the nose and the chest

Asymmetric sounds

Inspiratory sounds

Sounds louder in the lower chest

Question 9. Question : Which of the following is consistent with good percussion technique?

Allow all of the fingers to touch the chest while performing percussion.

Maintain a stiff wrist and hand.

Leave the plexor finger on the pleximeter after each strike.

Strike the pleximeter over the distal interphalangeal joint.

Question 2.

A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts?

Prolactin

Oxytocin

Estrogen

Follicle-stimulating hormone

Progesterone

Question 4.

A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns?

“There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually goes down slightly.”

“All things considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer.”

“HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear.”

“There’s in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer.”

Question 5.

After a long and frustrating course of constant vaginal pain, a 38-year-old woman has been diagnosed with generalized vulvodynia by her nurse practitioner. What treatment plan is her nurse practitioner most likely to propose?

Alternative herbal therapies coupled with antifungal medications

Antidepressant and antiepileptic medications

Lifestyle modifications aimed at accommodating and managing neuropathic pain

Narcotic analgesia and nonsteroidal anti-inflammatory medications

Question 6.

Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female?

The woman’s ovaries are not producing new ova.

The woman’s ovaries do not synthesize or secrete luteinizing hormone (LH).

The epithelium covering the woman’s ovaries is broken during the time of ovulation.

The woman’s ovaries are not producing progesterone

Question 9.

A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman’s most likely treatment and prognosis?

Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.

Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection.

Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

Question 13.

A 71-year-old man has visited his nurse practitioner for a check-up, during which the nurse practitioner has initiated a discussion about the patient’s sexual function. Which of the following phenomena would the nurse practitioner most likely consider a pathological rather than an age-related change?

The presence of relative or absolute hypogonadism

A decrease in the size and firmness of the patient’s testes

Cessation of FSH production

A decrease in the force of the man’s ejaculation

Question 15.

A 57-year-old woman who has been diagnosed with atrophic vaginitis has expressed her surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond?

“The lower levels of estrogen since you’ve begun menopause make your vagina prone to infection.”

“Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause.”

“This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past.”

“The exact cause of this problem isn’t known, but it can usually be resolved with a diet high in probiotic bacteria.”

Question 17.

A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior?

Human chorionic gonadotropin will be produced, preventing luteal regression.

The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy.

The corpus luteum will atrophy and be replaced by corpus albicans.

The basal layer of the endometrium will be sloughed in preparation for implantation.

Question 21.

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the patient from infecting others in the future. Which of the following statements by the patient demonstrates the best understanding of his health problem?

“Either me or a partner could end up with an eye infection from chlamydia that could make us blind.”

“Even though I couldn’t end up sterile, a woman that I give it to certainly could.”

“Each of the three stages of the disease seems to be worse than the previous one.”

“Even if I spread it to someone else, there’s a good chance she won’t have any symptoms or know she has it.”

Question 25.

A 40-year-old male patient with multiple health problems has been diagnosed with a testosterone deficiency. Which of the following assessment findings would his care provider attribute to an etiology other than this deficiency?

The patient has a voice that is unusually high in pitch.

The patient has long-standing anemia and low red cell counts.

The patient has a history of susceptibility to upper respiratory infections.

The patient has a low muscle mass as a proportion of total body weight.

Question 27.

A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The patient has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The patient has a 40-pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a ß-adrenergic blocking medication. During the nurse’s assessment, the man notes that he has been unable to maintain his erection in recent months. Which of the following aspects of the man’s health problems and treatments would the nurse identify as NOT being contributing to his erectile dysfunction (ED)?

His antihypertensive medications

His use of bronchodilators

His hypertension

His ischemic heart disease

His smoking history

His age

Question 28.

Which of the following statements best captures an aspect of normal spermatogenesis?

Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.

Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.

Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.

Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.

Question 29.

A 39-year-old male patient has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis?

Normal levels of free testosterone; low levels of total testosterone

Low free testosterone, LH, and FSH levels

Low levels of GnRH

Low testosterone levels; normal levels of LH and FSH