NR 511 Week 8 Final Exam

04 August 2024

Question 1: The most cost-effective screening test for determining HIV status is which of the following?

  • Correct Answer: Enzyme-linked immunosorbent assay (ELISA). Explanation: ELISA is the preferred initial screening method for HIV due to its high sensitivity and cost-effectiveness.

Question 2: Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?

  • Correct Answer: C-reactive protein (CRP). Explanation: CRP levels rise in response to inflammation, making it a useful marker for monitoring the severity of inflammatory diseases.

Question 3: Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?

  • Correct Answer: Dopamine. Explanation: Cocaine increases dopamine levels in the brain by inhibiting its reuptake, which leads to stimulation and euphoric effects.

Question 4: Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:

  • Correct Answer: Pain at the elbow with resisted movements at the wrist and forearm. Explanation: Lateral epicondylitis is characterized by pain during resisted wrist extension and forearm movements due to inflammation of the extensor tendons.

Question 5: Which of the following statements concerning the musculoskeletal examination is true?

  • Correct Answer: The uninvolved side should be examined initially and then compared to the involved side. Explanation: Comparing the uninvolved side with the involved side helps identify abnormalities and assess the extent of the injury.

Question 6: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

  • Correct Answer: Morning stiffness. Explanation: Morning stiffness that improves with activity is a hallmark of inflammatory conditions like rheumatoid arthritis.

Question 7: Which causes the greatest percentage of mammalian bites?

  • Correct Answer: Dogs. Explanation: Dog bites are the most common type of mammalian bite injuries, especially in domestic environments.

Question 8: A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?

  • Correct Answer: Transvaginal ultrasound. Explanation: Transvaginal ultrasound is the first-line imaging test for evaluating pelvic masses, especially when a large mass is detected.

Question 9: A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?

  • Correct Answer: “Control of glucose will help postpone or delay complications.” Explanation: Regular monitoring of blood glucose levels is essential in preventing complications associated with diabetes, even when the patient feels well.

Question 10: A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?

  • Correct Answer: TSH (Thyroid Stimulating Hormone). Explanation: TSH is the most sensitive test for diagnosing hypothyroidism, which matches the patient’s symptoms.

Question 11: Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?

  • Correct Answer: Glucotrol (Glipizide). Explanation: Glipizide is a sulfonylurea and is generally avoided during pregnancy due to potential risks to the fetus.

Question 12: During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

  • Correct Answer: A hard irregular gland. Explanation: A hard and irregular prostate gland on examination is highly suspicious for prostate cancer.

Question 13: Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step?

  • Correct Answer: Immobilize the insect with 2% lidocaine. Explanation: Lidocaine is used to immobilize the insect, preventing further injury before removal.

Question 14: What is the most common cause of microcytic anemia?

  • Correct Answer: Iron-deficiency anemia. Explanation: Iron-deficiency anemia is the most common cause of microcytic anemia, particularly in women and children.

Question 15: An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?

  • Correct Answer: All of the above (Benign prostatic hyperplasia (BPH), Prostate cancer, Parkinson’s disease). Explanation: All these conditions can contribute to urinary symptoms in older men and should be considered.

Question 16: Early rheumatoid disease is characterized by:

  • Correct Answer: Pain and swelling in both small and large peripheral joints. Explanation: Rheumatoid arthritis typically affects both small and large joints symmetrically in its early stages.

Question 17: A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?

  • Correct Answer: Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint. Explanation: An x-ray is necessary to rule out a fracture, and a splint should be applied to immobilize the wrist and reduce pain.

Question 18: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:

  • Correct Answer: 6 months. Explanation: Generalized anxiety disorder is diagnosed when excessive worry occurs more days than not for at least 6 months.

Question 19: A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

  • Correct Answer: The scrotum will appear light pink or yellow. Explanation: A hydrocele typically transilluminates, appearing light pink or yellow due to fluid accumulation.

Question 20: According to Kübler-Ross, the stages of grief occur in which order?

  • Correct Answer: Denial, anger, bargaining, depression, acceptance. Explanation: Kübler-Ross’s model of grief outlines these stages as the emotional responses individuals go through when facing loss.

Question 21: Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?

  • Correct Answer: A favorable prognostic trend. Explanation: A decreasing viral load suggests that the patient is responding well to antiretroviral therapy and has a favorable prognosis.

Question 22: The exanthem of Lyme disease is:

  • Correct Answer: Erythema migrans. Explanation: Erythema migrans is the characteristic rash associated with Lyme disease, often resembling a “bull’s-eye.”

Question 23: You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:

  • Correct Answer: Articular. Explanation: Crepitus and limited ROM typically indicate an articular problem, such as arthritis or joint effusion.

Question 24: What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?

  • Correct Answer: 1,200 mg/day. Explanation: Adequate calcium intake is important for maintaining bone health, particularly in older adults.

Question 25: When assessing a woman for infertility, which of the following tests should be done first?

  • Correct Answer: Analysis of partner’s sperm. Explanation: Male factor infertility should be assessed early in the evaluation process, often starting with a sperm analysis.

Question 26: Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

  • Correct Answer: Deep partial-thickness burns. Explanation: Deep partial-thickness burns affect the dermis extensively but leave some epidermal structures intact, allowing for potential regeneration.

Question 27: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?

  • Correct Answer: Human papillomavirus (HPV). Explanation: Given the patient’s history, she is at increased risk for HPV, which is associated with cervical dysplasia and cancer.

Question 28: As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin?

  • Correct Answer: Three. Explanation: Hematocrit is roughly three times the hemoglobin value, providing a quick estimate of the red blood cell concentration.

Question 29: Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

  • Correct Answer: Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain. Explanation: Radicular pain extending below the knee suggests nerve root compression, which is consistent with a herniated disc.

Question 30: A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?

  • Correct Answer: Testosterone level. Explanation: Low testosterone levels can be a cause of decreased libido and should be measured to assess hormonal status.

Question 31: The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?

  • Correct Answer: “I’ll take my pill at least 30 minutes before breakfast.” Explanation: Glipizide should be taken before meals to maximize its effectiveness in controlling blood sugar levels.

Question 32: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

  • Correct Answer: Rheumatoid arthritis. Explanation: Rheumatoid arthritis is a common and particularly destructive autoimmune disease affecting connective tissue and joints.

Question 33: The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?

  • Correct Answer: Gamma-aminobutyric acid (GABA). Explanation: Benzodiazepines enhance the effect of GABA, an inhibitory neurotransmitter, thereby reducing anxiety.

Question 34: A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?

  • Correct Answer: Refer to a urologist immediately. Explanation: Testicular torsion is a surgical emergency requiring immediate referral to prevent testicular loss.

Question 35: Which of the following medications can cause hyperglycemia?

  • Correct Answer: Prednisone. Explanation: Prednisone, a corticosteroid, can induce hyperglycemia by increasing glucose production and reducing insulin sensitivity.

Question 36: During treatment for anaphylaxis, what site is used for the initial injection of epinephrine?

  • Correct Answer: Upper lateral thigh. Explanation: The upper lateral thigh is recommended for epinephrine administration because it provides rapid absorption.

Question 37: It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?

  • Correct Answer: 1 to 2 weeks after the initiation of treatment. Explanation: Patients are at higher risk of increased depression and suicidal thoughts when starting new medications, so close monitoring during this period is critical.

Question 38: What is the most common cause of secondary amenorrhea?

  • Correct Answer: Pregnancy. Explanation: Pregnancy is the most common cause of secondary amenorrhea and should be ruled out first in any evaluation.

Question 39: Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration?

  • Correct Answer: Fluoxetine. Explanation: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is the only FDA-approved drug for treating bulimia nervosa.

Question 40: The goals of the 15-minute hour approach include:

  • Correct Answer: Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning. Explanation: The 15-minute hour approach focuses on short, goal-oriented therapy sessions to quickly address and mitigate issues while improving patient functioning.

Question 41: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

  • Correct Answer: McMurray circumduction test. Explanation: The McMurray test is used to detect meniscal tears. A “pop” or click during the maneuver is indicative of a tear.

Question 42: The cardinal subjective symptom of sickle cell crisis is which of the following?

  • Correct Answer: Pain. Explanation: Pain is the most common and debilitating symptom of a sickle cell crisis, resulting from vaso-occlusive events.

Question 43: A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?

  • Correct Answer: Endometriosis. Explanation: Endometriosis is a common cause of dysmenorrhea, characterized by the presence of endometrial tissue outside the uterus.

Question 44: Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?

  • Correct Answer: Brown recluse spider. Explanation: The brown recluse spider’s venom can cause significant tissue necrosis and hemolysis, leading to severe local and systemic effects.

Question 45: Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

  • Correct Answer: Paresthesia of the perineum and buttocks. Explanation: Paresthesia in the perineal area, known as “saddle anesthesia,” is a hallmark symptom of cauda equina syndrome, a surgical emergency.

Question 46: A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?

  • Correct Answer: Pregnancy test. Explanation: It is essential to confirm that the patient is not pregnant before initiating oral contraceptive therapy.

Question 47: A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?

  • Correct Answer: Cirrhosis. Explanation: Metformin is contraindicated in patients with liver disease, including cirrhosis, due to the risk of lactic acidosis.

Question 48: The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?

  • Correct Answer: SSRIs take less time to work than TCAs. Explanation: Both SSRIs and TCAs generally take several weeks to become effective. SSRIs are favored for their better side effect profile and lower risk of toxicity in overdose.

Question 49: Which type of bone marrow transplant is obtained from an identical twin?

  • Correct Answer: Syngeneic. Explanation: A syngeneic bone marrow transplant is one in which the donor is an identical twin of the recipient, ensuring complete histocompatibility.

Question 50: Pink, cherry-red tissues and skin may result from which type of poisoning?

  • Correct Answer: Carbon monoxide. Explanation: Carbon monoxide poisoning causes a characteristic pink or cherry-red coloration of the skin due to carboxyhemoglobin formation.

Question 51: Basic human needs are identified as:

  • Correct Answer: Autonomy and feeling valued by others. Explanation: Autonomy and being valued are considered basic psychological needs that contribute to overall well-being.

Question 52: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

  • Correct Answer: Overweight. Explanation: A person with a BMI in the range of 25 to 29.9 is classified as overweight, which is likely the case for someone of this height and weight.

Question 53: A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses?

  • Correct Answer: All of the above (Testicular cancer, Inguinal hernia, Varicocele). Explanation: All these conditions can present with a hard testicular lump and should be considered in the differential diagnosis.

Question 54: What is the treatment of choice for a patient diagnosed with testicular cancer?

  • Correct Answer: Radical orchidectomy. Explanation: Radical orchidectomy, the surgical removal of the affected testicle, is the primary treatment for testicular cancer.

Question 55: Which method is used to remove heavy metals, such as lead, that are ingested as poisons?

  • Correct Answer: Chelation. Explanation: Chelation therapy involves the administration of chelating agents to bind heavy metals in the bloodstream, facilitating their excretion.

Question 56: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

  • Correct Answer: “We will order a mammogram and ultrasound to help establish a diagnosis.” Explanation: Imaging studies, such as a mammogram and ultrasound, are essential for evaluating a breast mass and guiding further management.

Question 57: A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?

  • Correct Answer: Fluconazole. Explanation: The presence of hyphae suggests a fungal infection, such as candidiasis, which is treated with antifungal agents like fluconazole.

Question 58: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?

  • Correct Answer: “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.” Explanation: NSAIDs can cause GI side effects, so it is important to use the lowest effective dose to minimize the risk of complications.

Question 59: A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury?

  • Correct Answer: A strain. Explanation: A strain typically results from overuse or excessive force affecting muscles or tendons, unlike sprains which involve ligaments.

Question 60: Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea?

  • Correct Answer: Heat stroke. Explanation: Heat stroke is a severe form of heat-related illness characterized by a high core body temperature, mental status changes, and lack of sweating, requiring immediate medical attention.

Question 61: Which of the following may be used to evaluate a person’s suicide risk?

  • Correct Answer: SAD PERSONS. Explanation: The SAD PERSONS scale is a tool used to assess suicide risk based on various factors such as sex, age, depression, previous attempts, and more.

Question 62: One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?

  • Correct Answer: Synovium. Explanation: The synovium is an articular structure, as it lines the joints and produces synovial fluid, playing a crucial role in joint health.

Question 63: After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering?

  • Correct Answer: Lyme disease. Explanation: The expanding rash suggests erythema migrans, a characteristic sign of Lyme disease, which is transmitted by ticks.

Question 64: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?

  • Correct Answer: Sinus bradycardia. Explanation: Hypothyroidism often leads to sinus bradycardia due to the reduced metabolic rate and decreased sympathetic activity.

Question 65: Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal?

  • Correct Answer: LH level. Explanation: Luteinizing hormone (LH) levels rise during perimenopause, and measuring LH can help confirm the diagnosis.

Question 66: After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?

  • Correct Answer: Normal TSH. Explanation: Successful Synthroid (levothyroxine) therapy should normalize TSH levels in patients with hypothyroidism.

Question 67: A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?

  • Correct Answer: Diet, exercise, and oral medication. Explanation: Initial treatment for type 2 diabetes typically involves lifestyle modifications (diet and exercise) combined with oral hypoglycemic agents.

Question 68: Which of the following should be considered in a patient presenting with erectile dysfunction?

  • Correct Answer: All of the above (Diabetes mellitus, Hypertension, Atherosclerosis). Explanation: Erectile dysfunction can be caused by various conditions, including diabetes, hypertension, and atherosclerosis, which all affect blood flow.

Question 69: Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?

  • Correct Answer: Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. Explanation: Carpal tunnel syndrome has a genetic component, meaning family members may be at increased risk.

Question 70: A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?

  • Correct Answer: Ceftriaxone. Explanation: Ceftriaxone is the recommended antibiotic for treating gonorrhea, often administered as a single intramuscular injection.

Question 71: Which of the following statements is true regarding the treatment of carpal tunnel syndrome?

  • Correct Answer: The goal of treatment is to prevent flexion and extension movements of the wrist. Explanation: Preventing repetitive wrist movements is key to managing carpal tunnel syndrome, as these movements can aggravate symptoms.

Question 72: Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?

  • Correct Answer: Elevated uric acid level. Explanation: Acute gout is associated with elevated serum uric acid levels, which can lead to the formation of urate crystals in joints.

Question 73: Which of the following data is indicative of testicular torsion?

  • Correct Answer: Absent cremasteric reflex. Explanation: The absence of the cremasteric reflex is a key clinical sign of testicular torsion, a urological emergency.

Question 74: A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?

  • Correct Answer: All of the above (Reduces postprandial blood glucose, Reduces triglycerides and increases high-density lipoprotein (HDL), Reduces total cholesterol). Explanation: Exercise has multiple benefits for patients with type 2 diabetes, including improving blood glucose levels, lipid profile, and overall cardiovascular health.

Question 75: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

  • Correct Answer: Pregnancy test. Explanation: A pregnancy test should always be the first priority when evaluating a woman with irregular vaginal bleeding to rule out pregnancy-related complications.

Question 76: What is the most common cause of generalized musculoskeletal pain in women ages 20 to 55?

  • Correct Answer: Fibromyalgia syndrome (FMS). Explanation: Fibromyalgia is a common cause of widespread musculoskeletal pain in women, particularly in this age group.

Question 77: If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do?

  • Correct Answer: Withhold one or more days of anticoagulant therapy. Explanation: Withholding warfarin temporarily is a common approach to managing elevated INR levels to reduce the risk of bleeding.

Question 78: A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes?

  • Correct Answer: Pelvic inflammatory disease. Explanation: Pelvic inflammatory disease (PID) is a significant cause of infertility due to scarring and blockage of the fallopian tubes.

Question 79: Which of the following statements concerning the treatment of fibromyalgia syndrome is true?

  • Correct Answer: All of the above (There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible. Treatment is directed toward controlling discomfort, improving sleep, and maintaining function. Fibromyalgia syndrome can be difficult to manage, requiring a variety of approaches and multiple medications). Explanation: Managing fibromyalgia involves a multifaceted approach to control symptoms, improve quality of life, and address associated conditions.

Question 80: The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis?

  • Correct Answer: Gram-negative bacillus. Explanation: Gram-negative bacilli, such as Escherichia coli, are the most common pathogens in acute prostatitis, requiring appropriate antibiotic coverage.

Question 81: Which household solution should be used to clean a bathroom if sharing with a friend who has HIV?

  • Correct Answer: Nine parts H2O to one part bleach. Explanation: A diluted bleach solution is effective for disinfecting surfaces and reducing the risk of HIV transmission.

Question 82: Sandra is 42 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit?

  • Correct Answer: Acute myelogenous leukemia (AML). Explanation: AML often presents with bone and joint pain due to the rapid proliferation of abnormal myeloid cells in the bone marrow.

Question 83: Which of the following is identified as an eating disorder in which a person craves food substitutes, such as clay, ice chips, and cotton, and is considered an objective finding associated with severe iron deficiency?

  • Correct Answer: Pica. Explanation: Pica is an eating disorder characterized by the consumption of non-nutritive substances and is often associated with iron deficiency anemia.

Question 84: The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?

  • Correct Answer: High sensitivity thyroid-stimulating hormone (TSH) and free T4. Explanation: TSH and free T4 are critical in diagnosing hyperthyroidism, with TSH typically being suppressed and free T4 elevated.

Question 85: The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?

  • Correct Answer: “I know I need to have my eyes checked every year.” Explanation: Annual eye exams are crucial for patients with type 1 diabetes to monitor for diabetic retinopathy and other complications.

Question 86: Triggering factors for acute exacerbations of which of the following conditions include exposure to ultraviolet (UV)-B and UV-A rays?

  • Correct Answer: SLE (Systemic Lupus Erythematosus). Explanation: UV exposure can trigger exacerbations of SLE, an autoimmune disease that affects multiple organs.

Question 87: Which of the following characteristics separates anaphylaxis from a vasovagal reaction?

  • Correct Answer: Severe bronchoconstriction. Explanation: Severe bronchoconstriction is a hallmark of anaphylaxis, a life-threatening allergic reaction, whereas vasovagal reactions typically involve bradycardia and hypotension without bronchoconstriction.

Question 88: Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?

  • Correct Answer: “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy.” Explanation: Complementary therapies can be effective in managing osteoarthritis symptoms when used alongside conventional treatments.

Question 89: One benefit of motivational interviewing (MI) is:

  • Correct Answer: All are benefits of MI (It assumes that ambivalence is a normal part of the change process. It can be utilized during routine office visits. It is a therapeutic technique which is not necessarily time-intensive). Explanation: Motivational interviewing is a flexible, patient-centered counseling approach that can be integrated into routine clinical practice.

Question 90: What percentage of burns is involved using the rule of nines if both front legs are burned?

  • Correct Answer: 18%. Explanation: The rule of nines assigns 9% to each leg’s anterior surface, totaling 18% for both front legs.

Question 91: Women are at the highest risk for developing postpartum depression for up to how long after childbirth?

  • Correct Answer: 6 months. Explanation: The risk of postpartum depression is highest within the first six months after childbirth, though it can develop later.

Question 92: Which statement about HIV post-exposure prophylaxis (PEP) for healthcare workers is the most accurate?

  • Correct Answer: PEP should be started within hours of exposure. Explanation: Prompt initiation of PEP, ideally within hours, is critical for reducing the risk of HIV infection after exposure.

Question 93: The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?

  • Correct Answer: All of the above (Inability to bear weight immediately after the injury, Development of marked ankle swelling and discoloration after the injury, Crepitation with palpation or movement of the ankle). Explanation: These signs indicate a more severe injury, warranting radiographs to rule out fractures.

Question 94: A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods?

  • Correct Answer: Spinach. Explanation: Spinach is high in purines, which can exacerbate gout by increasing uric acid levels.

Question 95: A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve?

  • Correct Answer: CN IV (Trochlear nerve). Explanation: The trochlear nerve controls the superior oblique muscle, which is responsible for downward gaze. Injury to this nerve can cause diplopia and difficulty looking down.

Question 96: A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack?

  • Correct Answer: All of the above (Pheochromocytoma, Hyperthyroidism, Cardiac arrhythmias). Explanation: These conditions can present with symptoms similar to panic attacks and should be ruled out before diagnosing panic disorder.

Question 97: Which test is used to confirm a diagnosis of epididymitis?

  • Correct Answer: Ultrasound of the scrotum. Explanation: Scrotal ultrasound is the preferred imaging modality for diagnosing epididymitis, as it can distinguish it from other causes of scrotal pain.

Question 98: BATHEing the patient refers to:

  • Correct Answer: A technique that is a quick screen for psychiatric issues and interventions for psychological problems. Explanation: BATHE is an acronym used in primary care to quickly assess and address a patient’s emotional and mental health.

Question 99: BATHEing the patient is an advanced practice nursing intervention that allows the practitioner to:

  • Correct Answer: Develop a therapeutic relationship without “owning” the patient’s problem. Explanation: The BATHE technique facilitates a supportive therapeutic relationship while encouraging patient autonomy and responsibility.

Question 100: A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses?

  • Correct Answer: All of the above (Leiomyoma, Pregnancy, Ovarian cancer). Explanation: These conditions can cause abnormal uterine bleeding and dyspareunia, and should be considered in the differential diagnosis.