Download Test Set-2 - Teddie Joe Snodgrass

ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
1. Elevated sedimentation rate, positive antinuclear antibody, elevated C-reactive protein, and a
“butterfly” rash across the cheeks and bridge of the nose are most likely indicative of:
antinuclear
a. Systemic lupus erythematosus
b. Psoriatic giant cell arteritis
c. Giant cell arteritis
d. Myasthenia gravis.
No single laboratory test can diagnose systemic lupus erythematosus, and early symptoms may be
vague, varied, and intermittent. Patients present with rashes, specifically a “butterfly” rash across
the bridge of the nose. Arthralgias, anemia, edema, and photosensitivity are among a myriad of
symptoms.
2. You suspect that your 82-year-old patient has decreased gastric acid secretion. This may cause:
a. Calcium malabsorption
b. Anemia of chronic disease
c. Iron deficiency anemia
d. Pernicious anemia
Pernicious anemia is an autoimmune condition linked to heredity. Onset is usually after age 40
years. It is characterized by macrocytic anemia, low serum B12 level, atrophic gastritis,
achlorhydria, and an autoimmune disease such as immunoglobulin A.
3. An 82-year-old patient presents complaining of constipation for the past 2 months. The patient
denies any gastrointestinal symptoms, and his examination is unremarkable. What conservative
treatment should be initiated?
a. Bowel stimulants such as sodium phosphate (Fleet enema)
b. Magnesium salts (milk of magnesia)
c. Bowel lubricants such as mineral oil
d. Bulking agents such as polycarbophil (FiberCon)
Bulk-forming agents are safe in the treatment of constipation, increasing the stool bulk with
minimal adverse effects. Bowel stimulants and bowel lubricants are indicated for short-term use
only and may bind with fat-soluble vitamins and decrease the absorption of some medications.
Magnesium salts causes several drug interactions and are contraindicated with patients with renal
impairment. Patient instructions should stress the importance of drinking adequate amounts of
water and other fluids in conjunction with bulking agents.
4. Mr. M., a 42-year-old male, presents with sudden onset, severe mid-epigastric pain with
associated nausea and vomiting. He admits to a history of alcohol abuse. His labs reveal
elevated lipase and amylase levels. You suspect:
a. Cholecystitis
b. Acute pancreatitis
c. Gastritis
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
d. Acute Appendicitis
A sudden onset of severe epigastric pain, nausea, and vomiting accompanied by elevated lipase
and amylase levels is consistent with acute pancreatitis. The patient with a history of alcohol
abuse is at high risk for developing pancreatitis.
5. Mrs. C., age 78, presents with recent facial drooping, left-sided weakness, and aphasia. Her
treatment will depend on the following diagnostic test:
a. Serum troponin level
b. MRI of the brain
c. Angiogram
d. CT of the head
A CT scan must be immediately performed to determine whether the patient is likely having an
ischemic or hemorrhagic stroke. This will determine if the patient will require immediate
thrombolytic therapy. Survival is improved if intervention is introduced within 3 hours of the
onset of symptoms. An MRI and an angiogram are both not immediate diagnostic tools, and
serum troponin is the cardiac marker for myocardial infarctions.
6. Dana, age 26, has been diagnosed with asthma, and her peak flow meter reading is in the yellow
zone. This indicates the following:
a. She is at 80-100% of her personal best peak flow measurement.
b. She should seek medical help immediately.
c. Her asthma is under control.
d. Her asthma is getting worse, and she should use her quick-relief medication.
The yellow zone of the peak flow meter indicates that the patient is within 50-79% of her optimal
best and that her asthma is getting worse.
7. A lifestyle risk factor for developing breast cancer is:
a. Participating in contact sports.
b. Being a smoker.
c. Being overweight.
d. Low-fat diet.
Being overweight is a risk factor for developing breast cancer after menopause. There is a direct
link between elevated estradiol levels, obesity, and breast cancer.
8. You assess Cullen’s sign in you 72-year-old patient who fell down a flight of eight stairs. Cullen’s
sign is indicative of:
a. Appendicitis
b. Pancreatitis
c. Ventral hernia
d. Intra-abdominal bleeding
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
Intra-abdominal bleeding may track toward the skin and present as bruising around the umbilicus.
The appearance of such a pattern of bruising is Cullen’s sign.
9. All elderly patients with epistaxis should be referred to an ENT specialist:
a. Whenever anterior packing is used.
b. When posterior bleeding is visualized.
c. With every bleeding episode.
d. For silver nitrate cauterization.
Most epistaxis is self-limiting ad can be treated in primary care. Referral to an ENT specialist is
indicated when posterior bleeding is visualized, anterior packing is difficult to place, and there is
bleeding into the throat.
10. The Gardasil vaccine is indicated to prevent the incidence of the human papillomavirus (HPV).
The series of vaccines is currently indicated for which age?
a. 6-12 years
b. 26-50 years
c. All ages
d. 9-26 years
The prevalence of HPV is in the 15-to-25-year-old age group. The Gardasil vaccine is indicated for
ages 9-26 at present.
11. The preferred treatment for mild persistent asthma consists of:
a. High-dose inhaled steroid.
b. Oral corticosteroid.
c. Low-acting beta-agonist.
d. Low-dose inhaled steroid.
The preferred treatment for mild persistent asthma is a low-dose inhaled steroid. Intermittent
asthma is treated with short-acting bronchodilators. Treatment for moderate persistent asthma
includes inhaled corticosteroids and long-acting bronchodilators. Treatment for severe asthma
includes long-acting bronchodilators and inhaled corticosteroids and may include oral
corticosteroids.
12. Treatment for the patient with peptic ulcer disease caused by Helicobacter pylori (H. pylori)
includes:
a. Lansoprazole, amoxicillin, and clarithromycin (Prevpac)
b. Maalox 30 cc before meals.
c. Omeprazole (Prilosec).
d. Clarithromycin (Biaxin).
When treating H. pylori, a combination of proton-pump inhibitor and two antibiotics is indicated
for eradication therapy.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
13. A 76-year-old man is being treated with timolol eyedrops for glaucoma. What oral medication
that he is taking would cause you concern?
a. Ranitidine (Zantac) for GERD
b. Atenolol (Tenormin) for hypertension
c. Aspirin for myocardial infarction prevention
d. Alprazolam (Xanax) for anxiety
Atenolol is a beta blocker. Timolol is a beta-adrenergic blocker. The combination may cause or
worsen cardiac conditions such as chronic heart failure, reactive airway diseases, and delirium.
14. The NP examines a 62-year-old woman with rhinorrhea for the past 2 weeks, frontal headache,
halitosis, and facial pain and dizziness when bending over. The practitioner suspects:
a. Acute sinusitis
b. Allergic rhinitis
c. Migraine headache.
d. Acute nasopharyngitis.
Acute sinusitis presents with facial pressure, tenderness, and dizziness that worsen when bending
forward. It may also include a headache and halitosis. Upper respiratory infections resolve in 7
days and do not exhibit facial pain and pressure. Migraine headaches will not present with
rhinorrhea or sinus tenderness.
15. Ken, age 36, presents with painful swallowing, sore throat, fever, and swollen glands. On exam,
he has a fever of 101⁰F, exudative posterior pharyngitis, and anterior cervical lymphadenopathy.
You suspect that he has the following:
a. Infectious mononucleosis.
b. Acute epiglottitis
c. Acute suppurative pharyngitis
d. Viral influenza
Acute suppurative pharyngitis is a bacterial infection with symptoms of painful swallowing, sore
throat, fever, swollen glands, exudative posterior pharyngitis, and anterior cervical
lymphadenopathy. Epiglottitis incidence in adults is rare. Patient does exhibit stridor, hoarseness,
trismus, or drooling. Mononucleosis can be considered if a bacterial infection is not diagnosed.
16. An adult male presents with a sore throat, difficulty swallowing, and mouth pain. You observe
white curd-like plaques in the mouth and on the tongue and pharynx. What course of treatment
would you prescribe?
a. Refer to an ENT specialist for evaluation
b. Prescribe amoxicillin 500 mg by mouth three times a day for 10 days.
c. Recommend consuming only clear liquids for few days
d. Prescribe antifungal medication and encourage HIV screening
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
Sore throat, difficulty swallowing, and mouth pain with white curd-like plaques in the mouth and
on the tongue and pharynx are indicative of candidiasis and require antifungal, not antibacterial,
medication. These symptoms could be signs of HIV.
17. The pathogen that most commonly causes community-acquired pneumonia (CAP) in the elderly
is:
a. Pneumococcus.
b. Mycoplasma pneumonia.
c. Haemophilus influenzae.
d. Moraxella catarrhalis
Pneumococcus is the predominant pathogen CAP in the elderly population. Mycoplasma
pneumonia is common in those aged 35-50, and Haemophilus influenzae is common in smokers.
18. Legal authority over advanced practice nursing practice in under the auspices of:
a. State board of nursing
b. Certification authorities
c. Federal laws
d. The American Medical Association
Each state’s board of nursing defines NP roles and governs practice regulations for safe and
competent advanced practice registered nurses.
19. Ann, age 68, presents with a 3-day history of nausea, vomiting, cramping, diffuse abdominal
pain, and watery diarrhea. You suspect:
a. Ulcerative colitis.
b. Cholecystitis.
c. Gastroenteritis.
d. Appendicitis.
Gastroenteritis is self-limiting with a normal physical exam. Pain is commonly diffuse in nature,
with possible hyperactive bowel sounds. Care is supportive and caution must be taken in the
elderly to avoid dehydration.
Differential:
Appendicitis – (RLQ) right lower quadrant pain
Cholecystitis – (RUQ) right upper quadrant pain, usually after a fatty meal.
Colitis – mild pain in the lower quadrant, with bloody diarrhea.
20. A 58-year-old female has been diagnosed with GERD, and the NP is providing the patient with
instructions regarding condition-specific lifestyle changes. These include:
a. Avoiding all milk products.
b. Avoiding eating meals late at night.
c. Avoiding foods high in fiber.
d. Avoiding acetaminophen (Tylenol).
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
Eating meals late at night and then lying down afterwards increases the likelihood of gastric
reflux. Acetaminophen is not usually a medication that triggers GERD. Milk products and food high
in fiber are not common triggers for GERD.
21. A 78-year-old woman has early bilateral senile cataracts. Which of the following situations
would most likely pose the greatest difficulty?
a. Reading the newspaper.
b. Reading road signs while driving
c. Following extraocular movements
d. Distinguishing between primary colors
Reading the newspaper could be made easier by increasing the light in the room and using
stronger prescription glasses. Distinguishing between primary colors is a problem, but reading
road signs while driving would pose the greatest difficulty because size of print and amount of
light cannot be adjusted.
22. An elderly patient presents with bloody diarrhea, flatulence, and fever. Laboratory results show
leukocytosis. Your diagnosis is:
a. Duodenal ulcer.
b. Irritable bowel syndrome
c. Liver cirrhosis.
d. Diverticulitis.
Leukocytosis is due to colon inflammation and infection. Irritable bowel syndrome can be
diagnosed based on severity of abdominal pain, bowel habits, alternating diarrhea and
constipation, flatulence, abdominal pain, and distention. Duodenal ulcer symptoms range from
none to burning epigastric pain, nausea, and vomiting.
23. The primary care provider’s responsibility to his/her patient:
a. Is the coordination of his/her patient’s care.
b. Dictates care of his/her patient that is provided by specialist.
c. May involve disregarding hospital protocol not sited to his/her patient’s care.
d. Is relinquished when a patient is referred to another provider.
The primary care provider’s responsibility to his or her patient is to ensure quality of care and
practice competency, as outlined by the American Association of Colleges of Nursing and the
National Organization of Nurse Practitioners, in the core competencies for NP practice.
24. A 27-year-old female presents with complaints of urgency, frequency, and dysuria of 28 hours
duration. She denies fever, chills, hematuria, flank pain, vaginal discharge, or previous UTI. She
is not sexually active, takes no meds, and has no significant past medical history. Physical exam
reveals slight suprapubic tenderness. No costovertebral angle tenderness. Urine dipstick is
positive for nitrates, large bacteria, and many white blood cells. She is diagnosed with a UTI.
What bacteria is the most common cause of UTIs?
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
a.
b.
c.
d.
11 Jan 2014
Staphylococcus aureus
Proteus mirabilis
Staphylococcus epidermidis
Escherichia coli (E. coli)
In the healthy adult population, E. coli is the most common causative agent for urinary tract
infections. Staph infection would only occur as contaminants from lack of asepsis with urological
procedures. Proteus is uncommon in the healthy young adult patient.
25. Which of the following is true about mitral valve prolapse?
a. It commonly causes premature death.
b. It is related to rheumatic fever.
c. Maneuvers that decrease volume is the heart will make the click inaudible.
d. Many people have asymptomatic mitral valve prolapse.
Mitral valve prolapse is a systolic murmur that is usually benign in nature.
26. A patient presents with chest pain unrelieved by nitroglycerine, and EKG changes were noted in
transport. The immediate treatment for this patient would include:
a. Clopidogrel (Plavix), pacemaker, amiodorone (Cordorone), and oxygen.
b. Oxygen, heparin, serum cardiac enzymes, and clopidogrel (Plavix).
c. Aspirin, heparin, oxygen, and serum brain natriuretic peptide (BNP).
d. Morphine, oxygen, nitroglycerine, and aspirin (MONA).
Nitroglycerine is indicated to dilate the coronary arteries, oxygen and morphine decrease cardiac
consumption, and aspirin prevents platelet aggregation.
27. Prescribing NPs should be aware of the difference between the schedules of controlled
substances. Which of the following about Schedule I-IV drugs is accurate?
a. Schedule III drugs have more potential for abuse than do substances in Schedules II or
IV, and abuse may lead to high physical and/or psychological dependence.
b. Schedule IV drugs have a high potential for abuse but are accepted for medical use
under strict medical supervision.
c. Schedule II drugs have a high potential for abuse, which may lead to severe
psychological or physical dependence.
d. Schedule I drugs have no currently accepted medical use in the United States but are
safe for use under medical supervision.
Because Schedule II drugs have a high potential for abuse, which may lead to severe psychological
or physical dependence, NPs need to have knowledge about federal regulations and be well
versed in laws regarding prescribing controlled substances in their own state.
28. The NP who suspects a patient has temporal arteritis knows that blood results will show:
a. Elevated sedimentation rate
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
b. Decrease calcium.
c. Decreased white blood cells.
d. Elevated potassium.
Elevated sedimentation rate indicates inflammation in the body and can be an indicator of giant
cell arteritis.
29. What cancer is associated with Epstein-Barr virus?
a. Prostate cancer
b. Leukemia
c. Burkitt’s lymphoma (BL)
d. Ovarian cancer
BL is an aggressive non-Hodgkin lymphoma associated with Epstein-Barr virus that initially
presents as a tumor in the jaw. Each year, it affects approximately 1,200 people in the United
States. Fifty-nine percent of all people affected are adults. Incidences of BL in immunosuppressed
patients is high, with 30-40% associated with HIV infection.
30. Which of the following is consistent with the visual problems associated with macular
degeneration?
a. Peripheral vision loss
b. Blurring of near vision
c. Loss of central vision field
d. Difficulty with distant vision
Conditions that affect the macula (a portion of the retina of the eye) affect central vision most.
31. Pyelonephritis is differentiated from cystitis by which of the following clinical presentations?
a. Dysuria and suprapubic tenderness
b. Fever, flank pain, and nausea
c. Hematuria and urgency
d. Frequency and burning
Pyelonephritis is a serious systemic urinary tract infection that includes symptoms that are
systemic, such as fever, nausea, and flank pain.
32. A 60-year-old male reports large amounts of bloody urine on three occasions over the past
month. He denies frequency, urgency, fever chills, or pain. A urine dipstick test is negative. He
takes vitamin E, Tenormin, and Tums. Subsequent evaluation should include:
a. Intravenous pyelogram (IVP)
b. Cystoscopy.
c. Blood urea nitrogen/creatinine.
d. Urinalysis and urine culture and sensitivity.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
Blood urea nitrogen/creatinine measures the amount of nitrogen present in the blood and how
well the kidneys are functioning. Based on the results, a need for more invasive procedures will be
considered. Cystoscopy is an invasive examination for visualization of the lining of the bladder to
evaluate where the bleeding may be occurring. An IVP is an invasive examination of the Kidneys,
bladder, ureters, and urethra used to identify diseases and structure of the urinary tract. A
urinalysis evaluates physical, chemical, and microscopic aspects of urine to identify disease. A
urinalysis and a urine culture and sensitivity test identify organisms in the urinary tract and the
antibiotics to which they are sensitive.
33. A 28-year-old female patient presents with a several-month history of bloody diarrhea. You
would suspect the following:
a. Diverticulosis.
b. Ulcerative colitis.
c. Colon cancer.
d. Crohn’s disease.
Given the age of the patient, one would suspect ulcerative colitis because bloody diarrhea is the
hallmark sign of the disease. Crohn’s disease patients present with nonbloody diarrhea and
systemic symptoms. Diverticulosis is a chronic disease, and bloody diarrhea is uncommon. The
probability of this patient having colon cancer is how; however, further history and diagnostics
should be obtained.
34. When prescribing medications for an elderly patient, NPs must remember that dosing may need
to be altered because:
a. Liver function increases with age, so bioavailability of medications is decreased.
b. The elderly have greater fat stores, so bioavailability of fat-soluble medications is
decreased.
c. Plasma levels may reflect aging effects of decreased drug clearance or impaired
absorption.
d. Vitamin supplements are more completely absorbed.
Plasma levels may reflect aging effects of decreased drug clearance or impaired absorption in
elderly who have compromised kidney or liver function as well as altered metabolism resulting
from increased fat stores, decreased lean tissue, and decreased hydration, all of which alter
absorption, metabolism, distribution, and excretion of medications.
35. The diagnosis of AIDS is made with a:
a. Liver immunoassay test.
b. CD4 count.
c. Viral load test.
d. Viral resistance test.
A CD4 count less than 200 cells/mmᶾ is an indicator for a diagnosis of AIDS. A healthy person’s CD4
count ranges from 500 to 1,200 cells/mmᶾ.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
36. A 27-year-old woman presents with a painless “pimple” on her right eyelid. Examination reveals
a 2 mm pustule on the lateral border of the right eyelid margin. This is most consistent with:
a. A hordeolum.
b. A chalazion.
c. Blepharitis.
d. Periorbital cellulitis.
A hordeolum, or stye, is an acute infection in the secretory glands of the eyelid that forms a
tender, nodular lump, usually in the eyelid. A chalazion is a granulomatous infection of the
Meibomian gland that forms a usually nontender lump in the eyelid. Blepharitis may involve both
the eyelid and glands, and is not localized. Periorbital cellulitis is a serious cellulitis that involves
the entire eye.
37. Chlamydia is the most common bacterial sexually transmitted disease in the United States. This
condition is treated with the following medication:
a. Amoxicillin (Amoxil).
b. Levofloxacin (Levaquin).
c. Nitrofurantoin (Macrobid).
d. Azithromycin (Zithromax).
The drug of choice for treatment of chlamydia trachomatis is azithromycin given as a onetime
dose.
38. A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril
(Capoten). Before administration of the medication, the NP will check the patient’s:
a. Phosphate levels.
b. Creatinine levels.
c. Glucose levels.
d. Potassium levels.
Angiotensin-converting enzyme inhibitors are frequently used in patients with CKD because they
delay the progression of the CKD, but they cause potassium retention; therefore, careful
monitoring of potassium levels in needed in patients who are at risk for hyperkalemia. The other
laboratory values would also be monitored in patients with CKD but would not impact whether
the captopril were given or not.
39. Which statement by the NP when explaining the purpose of positive end-expiratory pressure
(PEEP) to the family members of a patient with ARDS (acute respiratory distress syndrome) is
correct?
a. PEEP prevents the lung air sacs from collapsing during exhalation.
b. PEEP allows the ventilator to deliver 100% oxygen to the lungs.
c. PEEP will prevent fibrosis of the lung from occurring.
d. PEEP will push more air into the lungs during inhalation.
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Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation.
PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or
change the fraction of inspired oxygen (FiO2) delivered to the patient.
40. Mr. G., age 72, has been diagnosed with heart failure and recently has not been able to walk to
the grocery store without getting short of breath. According to the New York Heart Association
classifications for heart failure, Mr. G.’s present symptoms would classify him as:
a. New York Heart Association heart failure Class II.
b. New York Heart Association heart failure Class III.
c. New York Heart Association heart failure Class IV.
d. New York Heart Association heart failure Class I.
According to the New York Heart Association classifications, Mr. G. would be classified as Class III
because he is experiencing marked limitation in physical activity and his ordinary activities lead to
symptoms. These heart failure classifications determine the type of treatment a heart failure
patient will receive based on the severity of the heart failure.
41. Primary treatment of giant cell arteritis starts with:
a. Prednisone (Deltasone).
b. Furosemide (Lasix)
c. Propanolol (Inderal)
d. Doxycycline (Doryx)
Steroid therapy has an anti-inflammatory effect. Early treatment with steroids is important to
prevent vision loss or stoke.
42. Signs of left-sided heart failure include:
a. Jugular venous distention
b. Pulmonary crackles
c. Organomegaly.
d. Peripheral edema
Left-sided heart failure presents with respiratory symptoms, and right-sided heart failure presents
systemically, such as with organomegaly, jugular venous distention, and peripheral edema.
43. The first line of medication treatment for an elderly patient with hypertension would be the
following:
a. Hydrochlorothiazide (Hydrodiuril).
b. Amlodipine (Norvasc).
c. Furosemide (Lasix).
d. Doxazosin (Cardura).
According to the National Institutes of Health hypertension guidelines from the Seventh Report of
the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood
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Adult-Gerontological Primary Care NP Questions – Set 2
11 Jan 2014
Pressure, thiazide diuretics are the first line of hypertension treatment in elderly patients. There is
less incidence of syncope and adverse effects.
44. A 21-year-old African-American college quarterback presents for a sports physical. On cardiac
exam, you auscultate a systolic II/VI murmur that decreases in intensity and duration with
inspiration, squatting, and supine leg elevation and becomes louder with the Valsalva maneuver.
You suspect that the murmur may be a result of:
a. Mitral regurgitation
b. Pulmonic stenosis
c. Obstructive hypertrophic cardiomyopathy (HCM).
d. Aortic stenosis
A murmur due HCM will increase in intensity with any maneuver that decreases the volume of
blood in the left ventricle (such as standing abruptly or the strain phase of a Valsalva maneuver).
An important clue to suspecting HCM based on initial auscultation is to have the patient perform
the squatting maneuver. The systolic murmur should become noticeably lower when the patient
is squatting and should increase when the patient is standing.
45. The family member of a patient who has suffered massive abdominal trauma in an automobile
accident asks the NP why the patient is receiving famotidine (Pepcid). The NP will explain that
the medication will:
a. Lower the chance of Helicobacter pylori (H. pylori) infection.
b. Decrease the risk for nausea and vomiting.
c. Inhibit the development of stress ulcers.
d. Prevent aspiration of gastric contents.
Famotidine is administered to prevent the development of physiologic stress ulcers, which are
associated with a major physiologic insult such as massive trauma. Famotidine does not decrease
nausea or vomiting, prevent aspiration, or prevent H. pylori infection.
46. The patient has acute pancreatitis, with seven of the diagnostic criteria from Ranson’s criteria. In
order to plan care, the clinician understands that this criteria score has which of the following
meanings?
a. An increased chance of recurrence
b. A high probability of developing sepsis
c. A 7% chance of the disease becoming chronic
d. A high mortality rate.
Ranson’s criteria are a predictor of mortality within the first 48 hours of developing acute
pancreatitis. Age; hemodynamic status; lab values such as glucose, liver enzymes, white blood cell
count, and serum calcium; and renal function are included in the criteria to determine mortality.
47. A 17-year-old presents with pain and swelling in his left testis. Pain began suddenly and is rated
8/10. He denies dysuria, frequency, urgency, urethral discharge, fever, and chills. He has no
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Adult-Gerontological Primary Care NP Questions – Set 2
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significant past medical history. He denies sexual activity. Physical exam reveals very painful
testis that is significantly higher in the scrotum than the right. The most likely diagnosis is:
a. Gonorrhea
b. Epididymitis
c. Testicular malignancy
d. Testicular torsion
With testicular torsion, the pain is severe and sudden. This indicates a urologic emergency, and an
urologist should be consulted immediately. The pain with epididymitis is gradual and less severe.
48. The pneumonia severity index is a tool to determine the need for hospitalization of patients
with pneumonia. It includes which of the following predictors?
a. Over the age 40, with a comorbid condition
b. Respiratory rate greater than 20 breaths per minute.
c. Patients ability for self-care
d. Systolic blood pressure less than 120 mm/Hg
The pneumonia index identifies the following predictors for hospitalization: over age 50 with a
comorbid state, altered mental status, respiratory rate greater than 30, systolic blood pressure <
90, and patient’s ability for self-care.
49. Mr. G., a 67-year-old patient, is starting on lisinopril (Prinivil) for hypertension. He should be
instructed that the most common adverse effect of this medication is:
a. Dry cough
b. Syncope
c. Peripheral edema
d. Hypokalemia
Lisinopril, an ACE inhibitor, prevents the conversion of angiotensin I to angiotensin II to decrease
renin, thereby reducing BP. This occurs in the lungs, which frequently causes a dry, hacking cough.
ACE inhibitors cause hyperkalemia and do not cause peripheral edema or syncope.
50. A 68-year-old female complains of occasional urinary incontinence over the past 8-12 months
when she sneezes or coughs. She denies frequency, loss of bowel control, fever, chills, or pain.
Pelvic exam reveals a small introitus, smooth vaginal mucosa, and small cervix and uterus. What
type of incontinence does she have?
a. Stress
b. Urge
c. Overflow
d. Functional
Stress incontinence occurs when there is loss of support of vesicle neck, and proximal urethra
increases abdominal pressure. When the proximal urethra not against pelvic bone, pressure
overcomes the sphincter.
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51. A 56-year-old male patient presents with a sudden onset of acute right upper quadrant pain.
The NP suspect acute pancreatitis. The most specific lab test to determine this diagnosis is:
a. Serum amylase
b. Serum liver panel
c. Serum glucose
d. Serum lipase
Serum lipase biomarker is more specific than is amylase, appears earlier in the disease process,
and stays elevated longer than does serum amylase. Serum amylase and liver panel may elevate
with acute pancreatitis and may elevate with other condtions.
52. An increase in red blood cell distribution width (RDW) and low mean corpuscular volume (MCV)
are early indicators of:
a. Vitamin B12 deficiency
b. Folate deficiency
c. Thalassemia major.
d. Iron deficiency anemia
Iron deficiency anemia is a microcytic anemia that is diagnosed via a complete blood count that
shows increased RDW, low serum hemoglobin and hematocrit, decreased MCV and mean
corpuscular hemoglobin, decreased total iron-binding capacity, and low serum ferritin.
53. What should be considered in all clients with adult-onset asthma or in clients with asthma that
worsens in adulthood?
a. A suppressed immune system
b. Occupational asthma
c. Concurrent chronic obstructive pulmonary disease
d. Another immunologic disease
Asthma patients do not have COPD. However, if asthma is left untreated, chronic inflammation of
the respiratory tract associated with asthma can cause airway obstruction to become fixed and
result in abnormal airflow between asthma attacks, referred to as lung remodeling. Asthma
patients with fixed airway obstruction are considered to have COPD.
54. Both acute and chronic asthma are characterized primarily by:
a. Thinning of the epithelial basement membrane
b. Airway obstruction
c. Diminution of bronchial smooth muscle
d. Airway inflammation
Asthma is best described as a chronic disease that involves inflammation of the pulmonary
airways and bronchial hyperresponsiveness that results in the clinical expression of a lower airway
obstruction that usually is reversible. Physiologically, bronchial hyperresponsiveness is
documented by decreased bronchial airflow after bronchoprovocation with methacholine or
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histamine. Other triggers that provoke airway obstruction include cold air, exercise, viral upper
respiratory infection, cigarette smoke, and respiratory allergens.
55. Pat, a 32-year-old male, presents with a cough worsening at night, occasional fever, substernal
pain, and scant white mucus production for the past week. What diagnosis would be suspected?
a. Bronchitis
b. Pneumonia
c. Rhinorrhea
d. Tuberculosis
Bronchitis commonly last approximately 7-14 days, with nonproductive cough worsening at night.
56. The patient is diagnosed with acute renal failure (ARF). Which of the following information
obtained from the history should alert the provider that this is a case of prerenal azotemia?
a. Recent heat stroke
b. Recent infection where gentamicin was used in treatment (intrarenal)
c. Nephrolithiasis (postrenal)
d. Recent Foley catheterization
Acute renal failure that is prerenal in nature can be reversed if the cause is corrected. Gentamicin
is nephrotoxic and causes intrarenal ARF and both nephrolithiasis and a recent Foley
catheterization are postrenal causes of ARF. Both intrarenal and postrenal causations can result in
permanent renal damage.
57. A 21-year-old woman is scheduled for an open mitral valve commissurotomy for treatment of
mitral stenosis. When explaining the advantage of valve repair instead of valve replacement to
the patient, the NP will include the information that:
a. Biologic replacement valves require the use of lifelong immunosuppressive drugs.
b. No antibiotic prophylaxis to prevent endocarditis is needed after valve repair.
c. Long-term anticoagulation is necessary after mechanical valve replacement.
d. Mechanical mitral valves require replacement about every 5 years.
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would
restrict decisions about career and childbearing in this patient. Mechanical valves are durable and
typically last longer than 10 years. Patients require prophylactic antibiotics when having invasive
procedures after either valve repair or replacement. Biologic valves do not activate the immune
system, so immunosuppressive therapy is not needed.
58. Marvin, age 56, has developed sudden conjunctival redness that occurred during a strenuous
coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to:
a. Instruct him to rest his eyes and avoid further eye strain.
b. Order oral antibiotics.
c. Refer him immediately to an ophthalmologist.
d. Consult with your collaborating physician.
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There is no treatment for this condition other than avoiding eye strain and instructing patients to
observe that bleeding does not extend to the iris, which is then an emergency. Extra caution
should be taken for patients on anticoagulant therapy. The blood usually is reabsorbed within 2
weeks.
59. Non-cardioselective beta blockers as antihypertensives are contraindicated for clients with:
a. COPD, angina pectoris, and type I diabetes mellitus.
b. CAD, atrial fibrillation, and renal insufficiency.
c. Acute heart failure, diabetes mellitus, and bronchial asthma.
d. Myocardial infarction, type II diabetes mellitus, and COPD.
Non-cardioselective beta blockers block both beta 1 and beta 2 receptors, causing bradycardia and
leading to worsening failure, bronchospasm, and masked hypoglycemia in diabetics already on
antihyperglycemics.
60. Discriminating between symptoms of occlusive arterial disease and other disorders requires a
careful history. Which symptom is noted with occlusive arterial disease?
a. Redness and pronounced superficial veins
b. Pain occurring in the calves or thighs when walking, with relief obtained when
standing still
c. Severe pain at rest that requires the client to raise the legs in the air to obtain relief
d. Pain when standing that is not relieved by sitting or lying down
Intermittent claudication, pain occurring when walking and relieved when standing still, is an
early symptom of arterial disease. Pain unrelieved by sitting, severe pain when raising one’s legs,
and venous redness are indications of venous disease.
61. A definitive diagnosis of prostate cancer is best accomplished by:
a. An ultrasound
b. A biopsy
c. A CT of the abdomen.
d. A prostatic surface antigen (PSA) level
The most definitive diagnostic test to rule out prostate cancer is a biopsy. PSA level is a reliable
screening tool but is not a definitive tool for diagnosing prostate cancer.
62. The most common cause of sensorineural hearing loss in the older adult is:
a. Tympanic membrane sclerosis and scarring.
b. Presbycusis
c. Otosclerosis
d. Trauma
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Presbycusis is a gradual decrease in cochlear function, causing sensorineural hearing loss with age.
Trauma, otosclerosis, and tympanic membrane sclerosis and scarring result in conductive hearing
loss.
63. The preferred treatment of choice for beta-lactamase coverage of otitis media is:
a. Azithromycin (Zithromax).
b. Amoxicillin and potassium clavulanate (Augmentin)
c. Amoxicillin (Amoxil)
d. Erythromycin (Neomycin)
Augmentin is the preferred drug of choice because the clavulanate is a beta-lactamase that
prevents inactivation of amoxicillin.
64. If results from the first and second HIV tests do not agree, the next test to perform is:
a. HIV viral load testing
b. HIV-1 RNA test (nucleic acid amplification test, or NAAT)
c. Opportunistic infections.
d. CD4 count
The NAAT detects HIV, not the antibodies, and has the potential to identify people with acute HIV
infection earlier. HIV viral load testing monitors HIV infection over time. CD4 count is a blood test
to determine how well the immune system is working in people who have been diagnosed with
HIV.
65. Associated pathophysiology in clients with chronic bronchitis includes:
a. Decreased permeability of the pulmonary epithelium
b. Permanent alveolar damage
c. Dysfunctional respiratory tract cilia
d. Decreased numbers of neutrophils and macrophages
Chronic bronchitis causes dysfunctional cilia, resulting in poor mucus clearance, increased number
of neutrophils and macrophages and increased permeability of the pulmonary epithelium.
Emphysema causes alveolar damage.
66. According to the National Institutes of Health Adult Treatment Panel III (ATP III) guidelines, to
reduce risks of cardiovascular disease, the goal level of serum LDL should be:
a. 150-170 mg/dL.
b. Less than 100 mg/dL.
c. Less than 130 mg/dL.
d. 130-150 mg/dL.
According to the ATP III, cardiovascular risk factors are significantly reduced when serum LDL
levels are below 100 mg/dL.
67. Which is true of peptic ulcer disease in the elderly?
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a.
b.
c.
d.
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Perforation is rare.
Duodenal ulcers are common in the elderly.
Weight loss and anorexia are often the only symptoms.
Smoking does not increase the risk.
Weight loss and anorexia are often the only symptoms in geriatric practice. Anorexia and
malnutrition frequently represent alarm symptoms. Smoking facilitates ulcer formation. Duodenal
ulcers are less common in the elderly. The increased risk of severe complications (hemorrhage ad
gastric perforation) in this population is likely to mask important early symptomatic signs, which
makes peptic ulcer disease treatment difficult in the elderly.
68. Mrs. S., age 42, is complaining of chronic nasal congestion. She states that he is always blowing
her nose and has chronic redness around her nose from using tissues. She is also taking
Lopressor 25 mg orally twice a day. Your examination concludes that Mrs. S. has allergic rhinitis.
Based on this information, which of the following would you avoid prescribing for Mrs. S.?
a. Montelukast (Singulair)
b. Pseudoephedrine (Sudafed)
c. Cetirizine (Zyrtec)
d. Loratadine (Claritin)
Pseudoephedrine is a sympathetic stimulant and is contraindicated in patients with hypertension.
69. The class of antihypertensive medications that might best treat hypertension and voiding
difficulties for men with benign prostatic hypertrophy (BPH) is:
a. ACE inhibitors
b. Beta blockers
c. Alpha blockers
d. Calcium channel blockers
Alpha blockers as opposed to beta blockers will relax the smooth muscle of the bladder and allow
the symptoms of BPH to improve by taking pressure off the enlarged prostate. ACE inhibitors and
calcium channel blockers have no direct effect on the bladder muscle.
70. The advantage of using a ThinPrep specimen for cervical cancer screening is that:
a. There is no significant difference than traditional testing.
b. A sample may be obtained from menstruating patients.
c. It reduces the number of inadequate specimens.
d. It is more comfortable for the patient during the pelvic exam.
ThinPrep testing has proven to reduce the number of inadequate specimens and removes any
confounding mucus, blood, or debris from the specimen. Pap smears should be performed on the
non-menstruating patient.
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71. Jill, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta2-agonist daily.
Her exacerbations affect her activities, and they occur at least twice weekly and may last for a
couple of days. She is affected more than once weekly during the night with an exacerbation.
Which of the following describes her asthma?
a. Moderate persistent
b. Severe persistent
c. Mild persistent
d. Intermittent
People suffering from moderate persistent asthma have daily asthma symptoms and nighttime
symptoms more than once a week. Asthma attacks may affect the daily activities of people with
this type of asthma.
72. Harry, age 67, comes to your office with waxing and waning ischemic symptoms over the past
few weeks. He also reports an increase in angina at rest, and you note transient ST changes on
his electrocardiogram. This presentation leads you to believe that he is experiencing:
a. Myocardial infarction (MI).
b. Ischemic stroke.
c. Stable angina.
d. Unstable angina.
Unstable angina is defined as newly diagnosed angina or worsening angina unrelieved by
nitroglycerin. It is unlikely to be an MI or stroke, because it has been evolving over weeks, but
should be ruled out in a workup.
73. A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be
reviewed by the NP. Which medication being used by the patient indicates that patient teaching
is required?
a. Multivitamin with iron
b. Acetaminophen (Tylenol) 650 mg
c. Calcium phosphate (PhosLo)
d. Milk of magnesia 30 mL
Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter
products containing magnesium. The other medications are appropriate for a patient with CKD.
74. Which statement is true regarding HIV testing among older adults?
a. Primary care providers always address sex with their older patients.
b. HIV testing among older adults is often performed in later stages of HIV infection.
c. Older adults are at less risk for HIV and STDs.
d. Older adults do not participate in risky health behaviors.
HIV testing among older adults is often performed in later stages of HIV because often older
adults do not present with clearly defined symptoms, and symptoms are often attributed to aging.
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75. The etiology of COPD is predominantly:
a. Occupation.
b. Smoking.
c. Age.
d. Genetics
Eighty-two percent of chronic obstructive pulmonary disease is attributed to smoking.
76. Folate deficiency anemia is an anemia of:
a. Macrocytic, normochromic.
b. Microcytic, hyperchromic.
c. Normocytic, microchromic.
d. Microcytic, normochromic.
A complete blood count reveals macrocytosis, low hemoglobin and folic acid, and decreased
folate levels. Folate deficiency is common in alcoholism, hemolytic anemia, folate-poor diet, and
pregnancy, and with medications like phenytoin (Dilantin), methotrexate, and barbiturate.
77. Evidenced-based practice relates to:
a. Clinical decisions that are supported by valid and relevant research.
b. Clinical decisions that are rooted in previous practice.
c. Clinical decision protocols formulated by health facilities.
d. Clinical decisions that are mandated by physicians who oversee clinical practice.
Clinical decisions that are supported by valid and relevant research are best practice in nursing
and other disciplines.
78. A 68-year-old man has a long history of COPD and is admitted to the hospital with cor
pulmonale. Which clinical manifestation noted by the NP is consistent with the cor pulmonale
diagnosis?
a. Audible crackles at both lung bases
b. High systemic blood pressure
c. Loud murmur at the mitral area
d. 3+ edema in the lower extremities
Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein
distension, organomegaly, and peripheral edema. The other clinical manifestations may occur in
the patient with other complications of COPD but are not indicators of cor pulmonale.
79. A patient in the outpatient clinic has positive serologic testing for anti-HCV (anti-Hepatic C
virus). Which action by the NP is appropriate?
a. Schedule the patient for HCV genotype testing
b. Tell the patient that HCV will resolve in 2-4 months
c. Instruct the patient on self-administration of interferon
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d. Administer immune globulin and the HCV vaccine
Genotyping of HCV has an important role in managing treatment and is done before drug therapy
with interferon or other medications is started. HCV has a high percentage of conversion to the
chronic state, so the nurse should not tell the patient that the HCV will resolve in 2-4 months.
Immune globulin or vaccine is not available for HCV.
80. A patient with a non-ST segment elevation myocardial infarction is receiving heparin. What is
the purpose of the heparin?
a. Heparin will dissolve the clot that is blocking blood flow to the heart.
b. Heparin will prevent the development of clots in the coronary arteries.
c. Coronary artery plaque size and adherence are decreased with heparin.
d. Platelet aggregation is enhanced by IV heparin infusion.
Heparin does not dissolve the clot but rather prevents future clots. Heparin binds to antithrombin
III, catalyzing inactivation of thrombin and other clotting factors. Other medications, such as
Aspirin and clopidogrel (Plavix), are indicated to prevent platelet aggregation.
81. A patient presents with excessive bruising, petechial rash, bleeding gums, and frequent
nosebleeds. Lab results that show decreased platelets, normal prothrombin time (PT) and partial
thromboplastin time (PTT), and antiplatelet antibodies indicate that she has:
a. Thalassemia major.
b. Pernicious anemia.
c. Disseminated intravascular coagulopathy.
d. Idiopathic thrombocytopenic purpura (ITP).
ITP is an autoimmune response that develops antibodies against the body’s platelets, resulting in
low platelet levels and bleeding tendencies. Prothrombin time decreases in response to the
depleted platelets. A positive test for antiplatelet antibodies indicates antibodies for the platelets
and is indicative of ITP. However, a negative test rules out only an immune etiology for ITP.
82. Judy, age 67, complains of a sudden onset of impaired vision, severe right eye pain, vomiting,
and a headache. You diagnose the following condition and refer her for urgent treatment:
a. Cataracts.
b. Presbyopia.
c. Acute closed-angle glaucoma.
d. Retinal detachment.
These symptoms are consistent with acute closed-angle glaucoma, which is an emergency.
Patients with cataracts have gradual decreased vision and see with opacity and cloudiness. With
macular degeneration, there is decreased central vision and gradual presbyopia. In retinal
detachment, patients have limited pain and see a sudden onset of a white floater.
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83. Hormone replacement therapy for the treatment of the symptoms of menopause is
contraindicated in which of the following conditions?
a. Breast cancer
b. Asthma
c. Hypothyroidism
d. Osteoarthritis
Hormone replacement therapy has been contributory to secondary ovarian cancer in patients
with a prior history of breast cancer. It is also contraindicated in hypertension and any
thromboembolic condition.
84. Prior to starting a patient with elevated LDL levels on statins, it is imperative to obtain:
a. Serum electrolytes
b. Serum liver enzymes
c. Serum blood urea nitrogen/creatinine levels
d. An EKG
Statin medications inhibit the cholesterol in the liver, causing the liver enzymes to elevate.
Baseline and quarterly levels need to be monitored during this treatment.
85. Discussing a patient’s case with family members could be considered:
a. Truth in caring.
b. A breach in confidentiality.
c. In the best interest of the patient.
d. A therapeutic relationship.
A breach in confidentiality is the release of any information to individuals not directly involved in
the care of a patient. Breaches in confidentiality include such actions as speaking to family
members about a patient’s case, releasing information without prior written permission, leaving a
message on an answering machine, discussing a patient in public places, leaving patient records in
view of others, providing patients’ names to vendors, and discarding unshredded records.
86. Bacterial endocarditis prophylaxis is recommended in which of the following
conditions/situations?
a. Mitral valve prolapse
b. Surgical repair of atrial septal defect
c. Cardiac pacemakers and internal defibrillators
d. Prosthetic heart valves
Patients with prosthetic valves are considered high risk for developing bacteria endocarditis.
Cardiac pacemakers, internal defibrillators, mitral valve prolapse, and surgical repair of atrial
septal defect are considered moderate risks.
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87. Terry is a 25-year-old nurse who presents to you for her annual physical exam. Her previous
tuberculin skin test, one year ago, was negative. A PPD repeated this year shows a 14 mm
induration. Terry is asymptomatic, and the results of her chest X-ray are negative. The most
appropriate management at this time would be:
a. Prescribe isoniazid for 6-12 months.
b. Prescribe rifampin for 6-12 months.
c. Repeat the tuberculin skin test in 6 months.
d. Repeat the chest X-ray yearly.
According to CDC protocol, positive tuberculin skin tests are to be treated with at least 6 months
of isoniazid.
88. You suspect that your 60-year-old patient has a gastric ulcer. You would expect the patient to
present with which of the following symptoms?
a. Pain that worsens with eating.
b. Worsening symptoms while lying down at bedtime.
c. Burning retrosternal discomfort.
d. Pain that is relieved by eating.
Older adults age 55 to 70 have a higher incidence of gastric ulcers. Gastric ulcers present with pain
that worsens with eating, while patients with duodenal ulcers present with pain that is relieved by
eating. A patient with GERD experiences burning retrosternal discomfort that worsen while
recumbent after eating a late meal.
89. Joan, a 32-year-old female, presents to the office with symptoms of vertigo with associated
nausea, abrupt roaring tinnitus, fullness in the ear, and sensorineural hearing loss. The NP
suspects Meniere’s disease, which can best be validated by performing the following diagnostic
test:
a. Phalen test.
b. Stereognosis test.
c. Tilt test.
d. Dix-Hallpike maneuver.
The Dix-Hallpike maneuver is a diagnostic test specific to diagnosing vertigo. The Dix-Hallpike
maneuver is a diagnostic test used to evaluate vestibular function in patients with vertigo or
hearing loss. It consists of a quick position change from sitting to lying, with the neck
hyperextended, and then back to sitting. A positive response will show nystagmus and help
formulate a diagnosis.
90. A patient with a history of peptic ulcer presents to the walk-in clinic with severe upper
abdominal pain, diaphoresis, and a very firm abdomen. Which action should be taken first?
a. Order pain medication
b. Obtain vital signs
c. Listen for bowel sounds
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d. Order an antacid
The patient’s symptoms suggest acute perforation, and the nurse should assess for signs of
hypovolemic shock. Administration of antacids would be contraindicated because any material in
the stomach would increase the spillage into the peritoneal cavity. The nurse practitioner should
assess the bowel sounds but not immediately. Pain medication would not be indicated because it
may mask the symptoms of the perforation.
91. What is your response to a postmastectomy patient who asks when she can have her blood
pressure taken and blood drawn from the arm of her operative side?
a. “If lymphedema does not develop in the first year, then you can have your blood
pressure taken and blood drawn from the arm of your operative side.”
b. “You should never permit blood pressure to be taken or blood to be drawn from the
arm of your operative side again.”
c. “Ten years postoperative is the benchmark for resuming blood pressure taken and
blood drawn from the arm of your operative side.”
d. “You always can have blood pressure taken and blood drawn from the arm of your
operative side.”
This is an appropriate answer for women who had a mastectomy involving the removal of the
breast, chest muscle, and axillary lymph nodes that increase the risk for lymphedema.
92. A patient is admitted with an abrupt onset of jaundice, nausea and vomiting, hepatomegaly, and
abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which
question from the NP is most appropriate?
a. “Have you been around anyone with jaundice?”
b. “Do you use any prescription or OTC drugs?”
c. “Is there any history of IV drug use?”
d. “Are you taking corticosteroids for any reason?”
The patient’s symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms
suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen
(Tylenol). Exposure to a jaundiced individual and a history of IV drug use are risk factors for viral
hepatitis. Corticosteroid use does not cause the symptoms listed.
93. Specialized cells that are attacked by HIV, are replicated, and result in a weakened immune
system are called:
a. Helper D cells.
b. Helper T cells.
c. Cytotoxic C cells.
d. Cytotoxic T cells.
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Helper T cells (CD4 cells) are the host cells that allow for HIV replication. Once they are infected
and damaged by HIV, the presence of fewer functioning CD4 cells results in increased vulnerability
for opportunistic infections.
94. A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the
patient’s illness, the NP would expect serologic testing to reveal:
a. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
b. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
c. Anti-hepatitis B core immunoglobulin M (anti-HBC IgM).
d. B surface antigen (HBsAg).
Hepatitis A is transmitted through the oral-fecal route, and anti-HAV IgM appears during the acute
phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV
IgG would indicate past infection and lifelong immunity.
95. When assessing a 74-year-old female patient, a systolic murmur is heard at the second
intercostal space at the right sternal border. This would indicate the presence of the following
murmur:
a. Pulmonic stenosis.
b. Aortic stenosis
c. Mitral regurgitation.
d. Tricuspid regurgitation.
The aortic valve is located at the second intercostal space in the right sternal border, and aortic
stenosis is a systolic murmur.
96. A Schilling test is performed to identify which type of anemia?
a. Anemia of chronic disease
b. Pernicious anemia
c. Thalassemia minor
d. Iron deficiency anemia
Pernicious anemia is a B12 deficiency resulting from a lack of intrinsic factor in the parietal cells of
the stomach lining that interferes with absorption of B12. The Schilling test measures the amount
of B12 voided over a 24-hour period after a dose of radioactive B12. Malabsorption is indicated if
less than 10% is excreted over 24 hours.
97. Julie, age 18, presents with a several-week history of a sore throat, swollen cervical lymph
nodes, and hoarseness despite completing two courses of antibiotics. You suspect the following:
a. Acute tonsillitis.
b. Infectious mononucleosis.
c. Patient is immunocompromised and needs a workup.
d. Streptococcus infection.
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Most strep infections and tonsillitis are successfully treated with antibiotics. If the symptoms
persist, viral etiology should be considered, particularly because of the patient’s age. A monospot,
CBC, and Epstein-Barr virus titers should be performed.
98. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant pain,
nausea, and vomiting. You suspect:
a. Appendicitis.
b. Crohn’s disease.
c. Cholecystitis.
d. Irritable bowel syndrome.
Acute acalculous Cholecystitis is characterized by fever, nausea and vomiting, right upper
quadrant abdominal pain, and inspiratory arrest on palpation of the right upper quadrant
(Murphy’s sign) Appendicitis, Crohn’s disease and irritable bowel syndrome typically present in
the lower abdomen.
99. The NP caring for an older adult with an acute infection realizes that immune response is less
effective due to:
a. Poorly described signs and symptoms.
b. Inability to relate symptoms effectively.
c. Slowed disease progression.
d. Decreased production of T cells that regulate immune response.
A decrease in the production of T cells is related to the physiological changes to the immune
system that occur with age.
100.
a.
b.
c.
d.
The treatment of the first episode of the herpes simplex virus includes:
Famciclovir (Famvir) 250 mg three times a day for 7-10 days.
Famciclovir (Famvir) 125 mg twice daily for 5 days.
Amoxicillin (Amoxil) 500 mg twice daily for 7-10 days.
No treatment.
The treatment of first-time herpes simplex includes an antiviral medication for 7-10 days. The
correct dose of Famciclovir is 250 mg three times a day. The 125 mg dosage of Famciclovir is
indicated for recurrence of herpes simplex. Antibiotics will not be effective in treating viral
infections.
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