18 Oct A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

 

                Yes

 

                No

 

Question 2A typical description of a tension headache is:

 

                Periorbital pain, sudden onset, often explosive in quality, and associated with nasal stuffiness, lacrimation, red eye, and nausea.

 

                Bilateral, occipital, or frontal tightness or fullness, with waves of aching pain.

 

                Hemicranial pain that is accompanied by vomiting and photophobia.

 

                Steadily worsening pain that interrupts sleep, is exacerbated by orthostatic changes, and may be preceded by nausea and vomiting.

 

Question 3A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:

 

                Primary hyperparathyroidism is treated with Vitamin D restriction

 

                Primary hyperparathyroidism is treated with parathyroidectomy

 

                Primary hyperparathyroidism is treated with daily magnesium

 

                Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

 

Question 4At what age is screening most likely to detect scoliosis?

 

                4 to 6 years

 

                8 to 10 years

 

                12 to 14 years

 

                18 to 20 years

 

Question 5Potential side effects of levofloxacin include which of the following?

 

                Confusion

 

                Hypoglycemia

 

                Achilles tendon rupture

 

All of the above

 

Question 6What intervention does the American College of Rheumatology recommend as first line therapy for osteoarthritis?

 

                Extensive diagnostic work-up

 

                NSAIDs at therapeutic doses

 

                Early joint replacement

 

                Exercise and weight loss

 

Question 7A patient has just been diagnosed with Bell’s palsy. He is understandably upset and has questions about the prognosis. You response should be:

 

                Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard

 

                Unfortunately there is no cure but you have a mild case

 

                The condition is self-limiting and most likely complete recovery will occur

 

                With suppressive drug therapy you can minimize the symptoms

 

Question 8 Which of the following patients most warrants screening for hypothyroidism?

 

                A young adult female with postpartum depression lasting 2 weeks.

 

A patient taking thyroid replacement preparation.

 

                A 40 year old male with unexplained tremors.

 

                An elderly female with recent onset of mental dysfunction.

 

Question 9Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?

 

                Apples

 

                Peppermint

 

                Cucumbers

 

                Popsicles

 

Question 10Diagnostic evaluation of hypothyroidism reveals:

 

                Elevated TSH and decreased T4

 

                Decreased TSH and increased T4

 

                Decreased TSH and decreased T3

 

Elevated TSH and increased T4

 

Question 11The most accurate measure of diabetes control is:

 

                Avoidance of micro- and macro-vascular complications.

 

                Insulin sensitivity.

 

                Early morning glucose levels.

 

                HgbA1c

 

Question 12 The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is:

 

                Rest from activities which may further stress the bone.

 

                Daily passive range of motion exercises.

 

                Continuation of the patient’s routine physical activities.

 

                Application of ice after activity.

 

Question 13The most effective treatment of non-infectious bursitis includes:

 

                Systemic antibiotic therapy effective against penicillin resistant Staphylococcus areus.

 

                Rest, an intra-articular corticosteroid injection, and a concomitant oral NSAID.

 

                A tapering regimen of oral corticosteroid therapy.

 

                Frequent active range of joint motion.

 

Question 14Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?

 

                “Caffeine has not effect on osteoporosis.”

 

                “A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”

 

                “Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.”

 

                “Caffeine increase bone resorption.”

 

Question 15Diagnostic evaluation for urinary calculi includes:

 

                Urinalysis and culture

 

                Non contrast CT

 

                Serum calcium

 

                All of the above

 

Question 16A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition?

 

                Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am.

 

                Instruct the child’s parents on physical activities to help weight loss.

 

                Increase the evening insulin dose and check CBG at 2:00 am.

 

                Refer the child for instruction on a strict diabetic diet.

 

Question 17A 65 year old patient complains of recurrent bilateral temporal headaches, malaise, muscle aches, and low grade fever. The headache is described as superficial tenderness rather than deep pain. Giant cell arteritis is suspected. Appropriate treatment is:

 

                Refer for temporal artery biopsy and initiation of oral prednisone.

 

                Aspirin or acetaminophen every 4 hours as needed for pain and fever.

 

                A daily β-blocker such as propranolol.

 

                CT scan of the head and lumbar puncture for CSF evaluation.

 

Question 18The physiological explanation of syncope is:

 

                Accelerated venous return and increased stroke volume resulting in deactivation of the parasympathetic nervous system.

 

                A cycle of inappropriate vasodilation, bradycardia, and hypotension.

 

                A sudden rise in blood pressure due to overly efficient vasoconstriction.

 

                Emotional stress resulting in hypertension, tachycardia, and increased venous return.

 

Question 19Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse?

 

                “What was it you did to make him angry?”

 

                “You must seek refuge immediately.”

 

                “I am concerned about your safety.”

 

                “I am going to call a shelter for you.”

 

Question 20The primary goals of treatment for patients with alcohol abuse disorder are:

 

                Reduction in withdrawal symptoms and reduction in desire for alcohol

 

                Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol

 

                Abstinence or reduction in use, relapse prevention, and rehabilitation

 

                Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment

 

Question 21A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient’s TSH?

 

                1 week

 

                2 weeks

 

                4 weeks

 

                8 weeks

 

Question 22Which history is commonly found in a patient with glomerulonephritis?

 

                Beta-hemolytic strep infection

 

                Frequent urinary tract infections

 

                Kidney  stones

 

                Hypotension

 

Question 23 Risk factors for prostate cancer include all of the following except:

 

                Family history

 

                Benign prostatic hypertrophy

 

                African American race

 

                Age

 

Question 24The treatment of choice for chronic bacterial prostatitis (CBP) is:

 

                Erythromycin 4 times daily for 7 to 10 days

 

                Doxycycline twice daily for 7 to 10 days

 

                A fluoroquinolone daily for 3 weeks to 4 months

 

                Bactrim DS daily for 4 to 16 weeks

 

Question 25The cardinal sign of infectious arthritis is:

 

                Affected joint is painful at rest, with movement and weight bearing

 

                Rapid onset that wakes the patient during the night

 

                Long history of severe pain with associated joint swelling

 

                None of the above

 

Question 26Which factors are associated with high risk for foot complications in a patient with diabetes mellitus?

 

1.            Obesity

 

2.            Abnormal nails

 

3.            Abnormal gait

 

4.            Poorly controlled lipids

 

                1, 2, 3

 

                2, 3, 4

 

                2, 3

 

                1, 4

 

Question 27What diabetic complications result from hyperglycemia?

 

1.            Retinopathy

 

2.            Hypertension resistant to treatment

 

3.            Peripheral neuropathy

 

4.            Accelerated atherogenesis

 

                1, 2, 3

 

                2, 3, 4

 

                1, 3, 4

 

                1, 2, 4

 

Question 28The correct treatment for ankle sprain during the first 48 hours after injury includes:

 

                Alternating heat and ice, and ankle exercises.

 

                Resistive ankle exercises, ankle support, and pain relief.

 

                Rest, elevation, compression, ice and pain relief.

 

                Referral to an orthopedist after x-rays to rule out fracture.

 

Question 29Which patient would benefit most from screening for type 2 diabetes?

 

                A 30 year old female with unintended weight loss.

 

                A 25 year old male with family history of type 1 diabetes

 

                An obese female with recurrent vaginitis

 

                A 50 year oldhyperlipidemic male

 

Question 30Major depression occurs most often in which of the following conditions?

 

                Myocardial infarction

 

                  Parkinson’s disease

 

                  Stroke

 

                Alzheimer’s disease

 

Question 31Which drug category contains the drugs that are the first line Gold standard therapy for COPD?

 

                Corticosteroids

 

                Inhaled beta-2 agonist bronchodilators

 

                Inhaled anticholinergic bronchodilators

 

                Xanthines

 

Question 32A thymectomy is usually recommended in the early treatment of which disease?

 

                  Parkinson’s disease

 

                Multiple sclerosis

 

                  Myasthenia gravis

 

                Huntington’s chorea

 

Question 33Urine cultures should be obtained for which of the following patients?

 

                Suspected urinary tract infection in pregnancy

 

                Febrile patients

 

                Young men

 

                All of the above

 

Question 34Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?

 

                Start him on an ACE Inhibitor

 

                Start him on a diuretic

 

                Have him monitor his blood pressure at home

 

                Try nonpharmacological methods and have him monitor his blood pressure at home

 

Question 35Diagnostic radiological studies are indicated for low back pain:

 

                Routinely after 3 weeks of low back pain symptoms.

 

                To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain.

 

                When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection.

 

                As a part of a pre-employment physical when heavy lifting is included in the job description.

 

Question 36Which of the following accounts for half of the bladder tumors among men and one-third in women?

 

                Cigarette smoke, both active and passive inhalation

 

                Chemicals from plastic and rubber

 

                Chronic use of phenacetin-containing analgesic agents

 

                Working long hours and not voiding often

 

Question 37Which of the following is the most common causative organism of nongonococcal urethritis?

 

                Chlamydia trachomatis

 

                Ureaplasmaurealyticum

 

                Mycoplasma hominis

 

                Trichonomas vaginalis

 

Question 38A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is:

 

 Consult with a physician

 

A 14 day course of ciprofloxacin

 

 To obtain blood cultures from separate site

 

Obtain urine cultures, CBC, and initiate antibiotic therapy

 

Question 39The most common cause of elevated liver function tests is:

 

                Hepatitis

 

                Biliary tract obstruction

 

                Chronic alcohol abuse

 

                A drug-induced injury

 

Question 40A nurse practitioner diagnoses a 60 year old male with balanitis. Which disease is commonly associated with balanitis?

 

                Congestive heart failure (CHF)

 

                Dyslipidemia

 

                Erectile dysfunction (ED)

 

                Diabetes mellitus (DM)

 

Question 41Legal authority for advanced practice nursing rests with:

 

                The Health Care Financing Administration

 

                Federal statutes

 

                State laws and regulations

 

                Certifying bodies

 

Question 42 A patient taking levothyroxine is being over-replaced. What condition is he at risk for?

 

                Osteoporosis

 

                Constipation

 

                Depression

 

                Exopthalmia

 

Question 43A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is:

 

                Gout

 

                Epicondylitis

 

                Osteoarthritis

 

  Lyme disease

 

Question 44A positive drawer sign supports a diagnosis of:

 

 Sciatica

 

 Cruciate ligament injury

 

 Meniscal injury

 

 Patellar ligament injury

 

Question 45Sam, age 42, has had persistent proteinuria on the previous two office visits. Which action is warranted next?

 

                Order and intravenous pyelogram

 

                Admit Sam to the hospital

 

                Schedule extensive blood work

 

                Have Sam collect one urine specimen on first arising and then another 2 hours later

 

Question 46What is the first step in the treatment of uric acid kidney stones?

 

                Encouraging hydration

 

                Alkalinizing the urine

 

                Prescribing allopurinol

 

                Reducing protein intake

 

Question 47Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:

 

                HbA1C

 

                2-hour 75 gram oral glucose tolerance test

 

                C-peptide level

 

                A and B

 

                All of the above

 

Question 48An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is:

 

                Trauma

 

                Tight shoes

 

                Arthritis flare

 

                Hydrochlorothiazide

 

Question 49A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?

 

                Prescribe an alpha adrenergic blocker

 

                Recommend saw palmetto

 

 Prescribe an antibiotic

 

                Refer to urology

 

Question 50An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects?

 

                Weight gain

 

                Fracture risk

 

                Hypoglycemia

 

                Weight loss

 

Question 51Deficiency of which nutritional source usually presents with an insidious onset of paresthesias of the hands and feet that are usually painful?

 

                Thiamine

 

                Vitamin B12

 

                Folic acid

 

                Vitamin K

 

Question 52Which is the most common cause of end-stage renal disease in the United States?

 

                Diabetic nephropathy

 

                Chronic renal failure secondary to vascular disorders

 

                Acute tubular necrosis

 

                Kidney trauma

 

Question 53Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?

 

                Hypertriglyceridemia and low high-density lipoprotein (HDL)

 

                Gestational diabetes and polycystic ovarian syndrome

 

                Hispanic, African-American, Native-American, and Pacific Islander ethnicity

 

                Postprandial hypoglycemia

 

Question 54A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?

 

                Obtain a thorough history and physical, and check serum cortisol and ACTH levels.

 

                Obtain a diet history and check CBC and FBS.

 

                Provide nutritional guidance and have the patient return in 1 month.

 

                Consult home health for intravenous administration of fluids and electrolytes.

 

Question 55A patient exhibits extrapyramidal side effects of antipsychotic medications. Which of the following symptoms would lead you to look for another diagnosis?

 

                Akathisia

 

                Dystonia

 

                Parkinsonism

 

                Hallucinations

 

Question 56The most commonly recommended method for prostate cancer screening in a 55 year old male is:

 

                Digital rectal examination (DRE) plus prostate specific antigen (PSA)

 

                Prostate specific antigen (PSA) alone

 

                Transrectal ultrasound (TRUS) alone

 

                Prostate specific antigen (PSA) and transrectal ultrasound (TRUS)

 

Question 57Diagnostic confirmation of acute leukemia is based on:

 

                Bone marrow aspiration and biopsy

 

                Pancytopenia

 

                Hyperuricemia

 

                All of the above

 

Question 58Risk factors for Addison’s disease include which of the following?

 

 Tuberculosis

 

 Autoimmune disease

 

 AIDS

 

 All of the above

 

Question 59Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?

 

                Doxycycline 100 mg qd

 

                Nitrofurantoin 100 mg qd

 

                Bactrim DS qd

 

                Erythromycin qd

 

Question 60What information should patients with diabetes and their families receive about hypoglycemia?

 

                Hypoglycemia is a rare complication.

 

                Hypoglycemia requires professional medical treatment.

 

                Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly.

 

                Hypoglycemia occurs only as a result of insulin overdose.