Pharmacotherapy for Hematologic Disorders

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In the 1970s, the average lifespan for patients diagnosed with sickle cell disease was 14 years. Today, the average lifespan has increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for many other hematologic disorders such as hemophilia and cancer continue to improve as well. This can be attributed to advancements in medical care—specifically drug therapy and treatment. When managing drug therapies for patients, it is essential to continuously examine current treatments and evaluate the impact of patient factors on drug effectiveness. To prepare for your role as an advanced practice nurse, you must become familiar with common drug treatments for various hematologic disorders seen in clinical settings.

To prepare:

Select one of the following hematologic disorders: anemia, hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or white blood cell disorders. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.

Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

With these thoughts in mind:

By Day 3

Post a description of the hematologic disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

Social Determinants of Health

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Answer one of the following questions:

· Increasingly, health policymakers are becoming aware of the social determinants of health and the role they play in prevention disease and promoting health and wellness. In the “Frameworks for Action in Policy and Politics” chapter, examine Box 1-1 (Political Aspects of the Social Determinants of Health) and Figure 1-6 (The Who, What, Where, When, and Why of Nursing’s Policy Influence). Then compare these with the story about Lilian Wald’s work in New York City. Reflect on the “what” of Wald’s strategies. In your opinion, which did she use effectively?

Looking further at the “what” in Figure 1-6 and answer any one of the following questions:

o Discuss at least three competencies/strategies that you have used effectively.

o Identify three competencies/strategies that you don’t currently use and discuss how you might incorporate them into your advocacy toolbox.

Review the four recommendations in the IOM report The Future of Nursing: Leading Change, Advancing Health and find your state’s action coalition(https://campaignforaction.org/our-network/state-action-coalitions/)USE THIS LINK OR WEBSITE TO ACCES THE STATE’S ACTION

· . Discuss your state’s action coalition’s work as it aligns with these four recommendations. Is each recommendation being addressed? Based on your analysis of the website, how would you describe your state’s progress toward meeting the IOM recommendations?APA FORMAT AND REFERENCES NEEDED.

Evidenced Based Research

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Details:

Before making a case for an evidence-based project, it is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness.

Develop an analysis of 250 words from the results, addressing your organization’s readiness level, possible project barriers and facilitators, as well as how to integrate clinical inquiry.

Make sure to include the rationale for the survey categories scores that were significantly high and low, incorporating details and/or examples. Also explain how to integrate clinical inquiry into the organization, providing strategies that strengthen the organizations weaker areas.

Submit a summary of your results. The actual survey results do not need to be included.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, revise “Section A: Organizational Culture and Readiness Assessment” for your final paper submission. This will be a continuous process throughout the course for each section.

My Sister's Keeper: Movie Presentation

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In this assignment, you will be creating a PowerPoint presentation based on the application of the functional health assessment of a movie character. To complete this assignment, choose a movie from the following list and identify a character from the movie on whom you would like to do a health assessment. If you wish to use a character from a movie not included on the following list, get the approval of your instructor.

Films:

Away From Her

Lorenzo’s Oil

Mask

My Sister’s Keeper

Philadelphia

Rain Man

Steel Magnolias

Stepmom

The Elephant Man

The Mighty

The Tic Code

Directions:

Create a PowerPoint presentation of 10-12 slides using the template “Movie Character Presentation.”

Provide an introduction and background overview of the movie character (client).

Assess the client using the “Functional Health Pattern Assessment.”

Based on your “observations” and thoughts, document your assessment, providing examples from the movie.

Describe any observed or potential cultural, geographic, religious, ethnic, or spiritual considerations of this client.

Describe two normal health patterns of the client as well as two abnormal health patterns that you observe, and provide examples.

Develop an appropriate nursing diagnosis for the client based on your assessment.

Identify and describe three interventions for the client: health promotion, health prevention, and maintenance.

Identify at least two possible resources or community services to which you would refer this client and provide rationale for your choices.

In addition to submitting the presentation to the instructor, post your assignment to the Movie Character Health Assessment Presentation Main Forum as directed by instructor. Respond to other students’ posts in a manner that initiates or contributes to discussion. Each person should make at least three substantive comments.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation 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 not required to submit this assignment to LopesWrite.

NRS-434VN-R-MovieCharacterPresentationSamplePPT-Student.pptx

Best Nursing Practices

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Assignment 1: Application – Best Practices

For over 20 years, the Women’s Health Initiative (WHI) study has conducted research trials to examine factors that impact risks and development of conditions that impact women such as heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Health care providers use results from these trials to develop guidelines for delivering care to patients. In your role in clinical settings, you must be familiar with these guidelines, and you must be aware that through clinical practice, guidelines frequently evolve and change. Often, what is considered a best practice today might not be a best practice in the future. For this Assignment, you compare guidelines outlined in the WHI study to current best practices for assessing and managing conditions.

By Day 7 of Week 11

To Prepare:

Review the Women’s Health Initiative website in this week’s Learning Resources. Select one disorder presented in this study.

Locate a research article focused on women’s health issue that you have learned about on the Women’s Health Initiative project. Be sure that the research article you select is from a reputable source.

Discuss the best practices presented in the article about the health issue. Explain if there are any differences in the literature about best practices about health issue.

Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research.

To Complete:

Write a 2- to 3-page paper that addresses the following:

Describe the disorder you selected from the Women’s Health Initiative study.

Explain the current best practices for assessing and managing this disorder as suggested in the research article you selected.

Compare the best practices presented in the WHI study to the current best practices presented in the article. Explain how the differences in best practices might impact women’s health.

Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research.

ANA’s Definition Of Nursing

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Part one:

Discussion Question:

Henderson believed nurses have the responsibility to assess the needs of the individual patient, help individuals meet their health needs, and provide an environment in which the individual can perform activities unaided. What is an opportunity in your nursing practice that would benefit from application of Henderson’s theory? How does this align with the ANA’s definition of nursing? Provide at least one evidenced-based research article to support this recommendation.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length.

Part two:

Assignment:

This week you will create a two-part Power Point to discuss the following:

Part one:

Peplau was the first nursing theorist to identify the nurse–patient relationship as being central to all nursing care. Peplau valued knowledge, believing that the nurse must possess extensive knowledge about the potential problems that emerge during a nurse–patient interaction. Peplau’s theoretical work on the nurse–patient relationship continues to be essential to nursing practice.

Describe the phases of the Nurse-Patient relationship as defined by Peplau. Align your presentation regarding the use of Peplau’s theory with a current practice example.

Part two:

Provide a discussion of Orem’s Self-Care Deficit Theory. Identify and explain the three related parts? Identify a current nursing practice example where Orem’s theory would be relevant. Use at least one evidenced-based research article to support your practice example. The PowerPoint should include at least 3 outside references and the textbook. It should include title and reference slides and be 14-20 slides.

Sociology

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Explain Charles Horton Cooley’s concept of “the Looking-Glass Self.” Then apply the concept of “the looking-glass self” to describe hypothetically how a person who has an eating disorder could have been influenced by others.
According to your text, parents of different social classes socialize children differently. For example, middle-class parents are more likely to stress independence and self-direction, whereas working-class parents prioritize obedience to external authority. Research shows that such socialization through families potentially reproduce inequality. Do you agree or disagree? Substantiate your argument with at least 2-3 examples from academic sources.
Define what an ‘ascribed status’, an ‘achieved status’, and a ‘master status’ are. Describe some ascribed statuses, achieved statuses, and a master status from your life. How do these statuses make you feel? Examine the positives and negatives of these statuses? How did the example you gave become to be your master status? Is the master status within your control to change, or is it a matter of others’ perceptions?
What is ‘Social construction of Reality?’ Provide a couple of examples either from your life or those found in the society to elucidate the concept well.
Pick either Erving Goffman’s “Dramaturgical Theory” or Harold Garfinkel’s “Ethnomethodology” & ‘Breaching Experiments’ and explain it in detail. Provide 2 detailed examples to substantiate the theory you choose to explain.

Reflective Analysis

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Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.

Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:

What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

Rubric:

1
Unsatisfactory
0.00%

2
Less than Satisfactory
65.00%

3
Satisfactory
75.00%

4
Good
85.00%

5
Excellent
100.00%

70.0 %Content

20.0 %Explains the Administrative Role of a Health Care Organization Regarding Oversight of Risk Management Policies and Ensuring Compliance With Managed Care Organization (MCO) Standards

Not included.

An explanation of the administrative role of a health care organization regarding oversight of risk management policies and ensuring compliance with MCO standards is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.

An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, but minimal detail or support is provided for one or more components.

An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, and is incorporated in full. The submission encompasses essential details and provides appropriate support.

An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

20.0 %Discussion Regarding Assessment of the Value Provided to an Organization That Stems From the Following Aspects of a Typical MCO: Regulatory Statutes, Inclusive of Conflict Resolution and Risk Management Strategies From the Employer/Employee Perspective and Patient Conflict Circumstances

Not included.

A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.

A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present, but minimal detail or support is provided for one or more components.

A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and incorporated in full. The submission encompasses essential details and provides appropriate support.

A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

20.0 %Describes MCO Responsibilities Pertaining to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) Focus on Fraud, Waste, and Abuse Laws

Not included.

A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.

A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present, but minimal detail or support is provided for one or more components.

A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and incorporated in full. The submission encompasses essential details and provides appropriate support.

A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

10.0 %Discussion Addresses Course Content and Learning

A discussion that addresses course content and learning is not provided.

A discussion addressing course content and learning is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.

A discussion addressing course content and learning is present, but minimal detail or support is provided for one or more components.

A discussion addressing course content and learning is present and incorporated in full. The submission encompasses essential details and provides appropriate support.

A discussion addressing course content and learning is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

20.0 %Organization and Effectiveness

7.0 %Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

8.0 %Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

Writer is clearly in command of standard, written, academic English.

10.0 %Format

5.0 %Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately, or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Diseases, Illnesses, And Disorders

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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.

Diseases Illnesses And Disorders

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Question 1. 1. Which of the following best describes the pain associated with osteoarthritis? (Points : 2)

Constant, burning, and throbbing with an acute onset

Dull and primarily affected by eposure to cold and barometric pressure

Begins upon arising and after prolonged weight bearing and/or use of the joint

Begins in the morning and limits continued ambulation

Question 2. 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical eamination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: (Points : 2)

Recommending she increase her dietary intake of Calcium and Vitamin D

Ordering once a year bisphosphonate and a proton pump inhibitor

Participate in a fall prevention program

Dual-energy -ray (DEA) scan and updating immunizations

Question 3. 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: (Points : 2)

Green leafy vegetables

Beer, sausage, fried seafood

Sugar

Gluten and bread items

Question 4. 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical eamination, the patient has no swelling or decreased range of motion in any of the joints.She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: (Points : 2)

Osteoarthritis

Rheumatoid arthritis

Fibromyalgia

Polymyalgia rheumatica

Question 5. 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical eamination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of: (Points : 2)

Osteoarthritis

Rheumatoid arthritis

Scleroderma

Sarcoidosis

Question 6. 6. Which of the following statements about osteoarthritis is true? (Points : 2)

It affects primarily weight-bearing joints

It is a systemic inflammatory illness

The metacarpal phalangeal joints are commonly involved

Prolonged morning stiffness is common

Question 7. 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): (Points : 2)

Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days

Doycycline 100 mg twice daily for 5 days

Prednisolone 35 mg four times a day for 5 days

Ice therapy

Question 8. 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical eamination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: (Points : 2)

Fibromyalgia

Sarcoidosis

Systemic lupus erythematosus

Rheumatoid arthritis

Question 9. 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? (Points : 2)

Beta blocker

ACE inhibitor

Statin medication

Metformin

Question 10. 10. A 20-year-old male construction worker is eperiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical eamination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? (Points : 2)

Joint infection

Chondromalacia patella

Prepatellar bursitis

All of the above

Question 11. 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical eamination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate: (Points : 2)

Knee ligament injury

Osgood-Schlatter disease

Prepatellar bursitis

Chondromalacia patella

Question 12. 12. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical eamination, the patient has diminished ability to dorsifle the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon? (Points : 2)

Straight leg raising sign

Lumbar herniated disc on -ray

Loss of left sided patellar refle

Urinary incontinence

Question 13. 13. Your patient is a 43-year-old female golfer who complains of arm pain. On physical eamination, there is point tenderness on the elbow and pain when the patient is asked to fle the wrist against the clinician’s resistance. These are typical signs of: (Points : 2)

Carpal tunnel syndrome

Osteoarthritis of the wrist

Epicondylitis

Cervical osteoarthritis

Question 14. 14. Which of the following describes the pathology of De Quervain’s tenosynovitis? (Points : 2)

Irritation of a tendon located on the radial side of the wrist, near the thumb

Impingement of the median nerve, causing pain in the palm and fingers

Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist

Ulnar nerve compression at the olecranon process

Question 15. 15. What is the most common cause of hip pain in older adults? (Points : 2)

Osteoporosis

Osteoarthritis

Trauma due to fall

Trochanteric bursitis

Question 16. 16. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical eamination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness ecept at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an -ray of the feet be ordered? (Points : 2)

Yes, there is tenderness over the fifth metatarsal

No, there is not tenderness over the navicular bone

Yes, the patient cannot bear weight on the foot

A and C

Question 17. 17. 38-year-old Asian male, Mr. Chen, with past medical history significant for prehypertension who has recently taken up softball presents with three to five weeks of shoulder pain when throwing overhead. Ice minimally alleviates pain. Medications: Naproen minimally alleviates shoulder pain. Allergies: Penicillin-associated rash. Family history: Brother has rheumatoid arthritis.

Which of the following musculoskeletal causes of shoulder pain would merit urgent diagnosis and management? (Points : 2)

Adhesive capsulitis

Septic subacromial bursitis

Impingement of the supraspinatus tendon

Calcific tendinopathy

Question 18. 18. If Mr. Chen had restricted passive as well as active ROM of the shoulder, what problems involving the shoulder might you consider? (Points : 2)

Adhesive capsulitis

Rotator cuff tear

Tendinopathy of the long head of the biceps

Rotator cuff impingment

Question 19. 19. What is the essential dynamic stabilizer of the shoulder joint? (Points : 2)

Labrum

Rotator muscle group

Glenohumeral ligaments

Teres major muscle

Question 20. 20. Given Mr. Chen’s repetitive overhead activities, some injury to his rotator cuff muscle group is most likely. Of the following eam findings, which one would not support the diagnosis of rotator cuff tendinopathy? (Points : 2)

Positive Apley’s Scratch test

Weakness and pain with empty can testing

Limited active ROM

Inability to raise arm above his head

Question 1.

  1. Your patient has been using chewing tobacco for 10 years. On physical eamination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: (Points : 2) Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome

Question 2.

  1. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? (Points : 2) Colon cancer in family member at age 70 Breast cancer in family member at age 75 Myocardial infarction in family member at age 35 All of the above

Question 3.

  1. The pathophysiological hallmark of ACD is: (Points : 2) Depleted iron stores Impaired ability to use iron stores Chronic uncorrectable bleeding Reduced intestinal absorption of iron

Question 4.

  1. It is important to not dilate the eye if __ is suspected. (Points : 2) Cataract Macular degeneration Acute closed-angle glaucoma Chronic open-angle glaucoma

Question 5.

  1. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: (Points : 2) 50 2-pack years 100-pack years 50-year, 2-pack history 100-pack history

Question 6.

  1. When teaching a group of older adults regarding prevention of gastroesophageal reflu disease symptoms, the nurse practitioner will include which of the following instructions? (Points : 2) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. Sit up for an hour after taking any medication and restrict fluid intake. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal.

Question 7.

  1. A 56-year-old male complains of anoreia, changes in bowel habits, etreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical eamination is unremarkable. It is important for the clinician to recognize the importance of: (Points : 2) CBC with differential Stool culture and sensitivity Abdominal -ray Colonoscopy

Question 8.

  1. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by eercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? (Points : 2) Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris

Question 9.

  1. A common auscultatory finding in advanced CHF is: (Points : 2) Systolic ejection murmur S3 gallop rhythm Friction rub Bradycardia

Question 10.

  1. Which of the following symptoms is common with acute otitis media? (Points : 2) Bulging tympanic membrane Bright light refle of tympanic membrane Increased tympanic membrane mobility All of the above

Question 11.

  1. Rheumatic heart disease is a complication that can arise from which type of infection? (Points : 2) Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae

Question 12.

  1. In eamining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? (Points : 2) Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia

Question 13.

  1. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon eamination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: (Points : 2) Mitral Valve Prolapse Referred Pain from Cholecystitis Pericarditis Pulmonary Embolus

Question 14.

  1. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? (Points : 2) History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above

Question 15.

  1. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2) It is highly contagious and a mask should be worn at home. Treatment regimen is multiple lifetime medications. Treatment regimen is multiple medications taken daily for a few weeks. Treatment regimen is complicated and is not indicated unless the patient is symptomatic.

Question 16.

  1. The best evidence rating drugs to consider in a post myocardial infarction patient include: (Points : 2) ASA, ACE/ARB, beta-blocker, aldosterone blockade ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates

Question 17.

  1. The most common cause of eye redness is: (Points : 2) Conjunctivitis Acute glaucoma Head trauma Corneal abrasion

Question 18.

  1. A specific eam used to evaluate the gall bladder is: (Points : 2) Psoas sign Obturator sign Cullens sign Murphy’s sign

Question 19.

  1. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical eamination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: (Points : 2) Mallory-Weiss tear Esophageal varices Gastric ulcer Colon cancer

Question 20.

  1. Which of the following is not a contributing factor to the development of esophagitis in older adults? (Points : 2) Increased gastric emptying time Regular ingestion of NSAIDs Decreased salivation Fungal infections such as Candida

Question 21.

  1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? (Points : 2) Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis

Question 22.

  1. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical eamination, you note ascites and caput medusa. A likely cause for the hematemesis is: (Points : 2) Peptic ulcer disease Barrett’s esophagus Esophageal varices Pancreatitis

Question 23.

  1. Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. (Points : 2) Acute pancreatitis Duodenal ulcer Biliary colic Cholecystitis

Question 24.

  1. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? (Points : 2) Acute MI GERD Pneumonia Angina

Question 25.

  1. In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? (Points : 2) Serum iron Total iron binding capacity Transferrin saturation Serum ferritin

Question 26.

  1. If it has been determined a patient has esophageal reflu, you should tell them: (Points : 2) They probably have a hiatal hernia causing reflu They probably need surgery They should avoid all fruit juices Smoking, alcohol, and caffeine can aggravate their problem

Question 27.

  1. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? (Points : 2) Computed tomography (CT) scan Chest -ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan

Question 28.

  1. 2. (*There are multiple questions on this eam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.

When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? (Points : 2)

Abdominal upright and flat plate -ray

Abdominal MRI

Abdominal CT scan with contrast

Abdominal ultrasound

Question 29.

  1. Emphysematous changes in the lungs produce the following characteristic in COPD patients? (Points : 2) Asymmetric chest epansion Increased lateral diameter Increased anterior-posterior diameter Pectus ecavatum

Question 30.

  1. (*There are multiple questions on this eam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? (Points : 2) Trial of ursodiol ‘Watchful waiting’ Surgical consult HIDA scan

Question 31.

  1. A 26-year-old, non-smoker, male presented to your clinic with SOB with eertion. This could be due to: (Points : 2) Eercise-induced cough Bronchiectasis Alpha-1 deficiency Pericarditis

Question 32.

  1. (*There are multiple questions on this eam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? (Points : 2) Abdominal plain films Liver function tests Amylase/lipase Urinalysis

Question 33.

  1. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On eamination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: (Points : 2) Digital rectal eamination Endoscopy Pelvic eamination Urinalysis

Question 34.

  1. A nurse practitioner reports that your patient’s abdominal -ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: (Points : 2) Appendicitis Cholecystitis Bowel Obstruction Diverticulitis

Question 35.

  1. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to eclude the possibility of: (Points : 2) Thrush Laryngeal cancer Carotidynia Thyroiditis

Question 36.

  1. Functional abilities are best assessed by: (Points : 2) Self-report of function Observed assessment of function A comprehensive head-to-toe eamination Family report of function

Question 37.

  1. Essential parts of a health history include all of the following ecept: (Points : 2) Chief complaint History of the present illness Current vital signs All of the above are essential history components

Question 38.

  1. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: (Points : 2) Acoustic neuroma Cerumen impaction Otitis media Ménière’s disease

Question 39.

  1. Upon assessment of respiratory ecursion, the clinician notes asymmetric epansion of the chest. One side epands greater than the other. This could be due to: (Points : 2) Pneumothora Pleural effusion Pneumonia Pulmonary embolism

Question 40.

  1. When interpreting laboratory data, you would epect to see the following in a patient with Anemia of Chronic Disease (ACD): (Points : 2) Hemoglobin <12 g/dl, MCV decreased, MCH decreased Hemoglobin >12 g/dl, MCV increased, MCH increased Hemoglobin <12 g/dl, MCV normal, MCH normal Hemoglobin >12 g/dl, MCV decreased, MCH increased