Codina Test 1 - 50

1. 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (BP) at this visit is 168/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease?. A) It increases the chances of adverse effects to her health. B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic. C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics. D) None of the statements are true.

2. All of the following are infections that affect mostly the labia and vagina,except: A) Bacterial vaginosis. B) Candidiasis. C) Trichomoniasis. D) Chlamydia trachomatis.

3. The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: A) Cholecystitis. B) Acute appendicitis. C) Inguinal hernia. D) Gastric ulcer.

4. Treatment for mild preeclampsia includes all of the following, except: A) Bed rest except for bathroom privileges. B) Close monitoring of weight and blood pressure. C) Close follow-up of urinary protein, serum creatinine, and platelet count. D) A prescription of methyldopa (Aldomet) to control blood pressure.

5. All of the following services is covered under Medicare Part A except: A) Inpatient hospitalizations. B) Medicines administered to a patient while hospitalized. C) Nursing home care. D) Surgeons.

6. A 28-year-old student is seen in the school health clinic with complaints of a hacking cough that is productive of small amounts of sputum and a runny nose. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right lung. The total white blood cell count is 10,500/uL. What is the most likely diagnosis?. A) Streptococcal pneumonia. B) Mycoplasma pneumonia. C) Acute bronchitis. D) Legionnaires disease.

7. A39-year-old migrant worker presents to the clinic 2. 5 days after a purified protein derivative (PPD) test. What minimum size of indurations would be considered positive for this patient?. A) 3 mm. B) 5 mm. C) 10 mm. D) 15 mm.

8. All of the following are correct statements regarding the role of the person named in a durable power of attorney except: A) The agent's decisions are legally binding. B) The agent can make decisions in other areas of the patient’s life such as financial issues. C) The agent can decide for the patient who is on life support when that life support can be terminated. D) The patient’s spouse has a right to override the agent's decisions.

9. All of the following are true statements regarding Munchausen syndrome except: A) It is considered a mental illness. B) The patient has a medical illness that causes an anxiety reaction and denial. C) The patient fakes an illness in order to gain attention from health care providers. D) The patient has an inconsistent medical history along with a past history of frequent hospitalizations.

10. Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema?. A) Calcium channel blockers. B) Angiotensin-converting enzyme (ACE) inhibitors. C) Beta-blockers. D) Diuretics.

11. A 30-year-old chef complains of pruritic hives over her chest and arms but denies difficulty swallowing or breathing. She reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate?. A) Perform a complete and thorough history. B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID. C) Give an injection of epinephrine 1:1000 intramuscularly stat. D) Call 911.

12. Which of the following findings is most likely in young primigravida with pregnancy-induced hypertension?. A) Abdominal cramping and constipation. B) Edema of the face and the upper extremities. C) Shortness of breath. D) Dysuria and frequency.

13. Which of the following symptoms is associated with B12 deficiency anemia?. A) Spoon-shaped nails and pica. B) An abnormal neurological exam. C) A vegan diet. D) Tingling and numbness of both feet.

14. A second triple screen on a 35-year-old primigravida reveals abnormally low levels of the alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient?. A) Order an ultrasound. B) Order a computed tomography (CT) scan of the abdomen. C) Order a 24-hour urine for protein clearance. D) Assess for a history of illicit drug or alcohol use.

15. All of the following are true statements about diverticula except: A) Diverticula are located in the colon. B) A low-fiber diet is associated with the condition. C) Most diverticula in the colon are infected with gram-negative bacteria. D) Supplementing with fiber such as psyllium (Metamucil) is recommended.

16. Patients who are diagnosed with gonorrhea should also be treated for which of the following infections?. A) Chancroid. B) Chlamydia trachomatis. C) Herpes genitals. D) PID (pelvic inflammatory disease).

17. Kyphosis is a late sign of: A) Old age. B) Osteopenia. C) Osteoporosis. D) Osteoarthritis.

18. A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be?. A) Normal. B) Higher than normal. C) Lower than normal. D) None of the above.

19. Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis?. A) Calcium channel blocker. B) Angiotensin-converting enzyme (ACE) inhibitor. C) Beta-blocker. D) Diuretic.

20. The Lachman maneuver is used to detect which of the following?. A) Knee instability. B) Nerve damage of the knee due to past knee injuries. C) The integrity of the patellar tendon. D) Tears on the meniscus of the knee.

21. When an adolescent male’s penis grows more in length than width, at which of the following Tanner stages is he classified?. A) Tanner Stage II. B) Tanner Stage III. C) Tanner Stage IV. D) Tanner Stage V.

22. Fetal TORCH infections can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation. The acronym TORCH stands for: A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. B) Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster. C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities. D) Toxins, other infections, roseola, candidiasis, and head abnormalities.

23. Human papilloma virus (HPV) infection of the larynx has been associated with: A) Laryngeal neoplasia. B) Esophageal stricture. C) Cervical cancer. D) Metaplasia of esophageal squamous cells.

24. Mr. Brown is a 65-year-old carpenter complaining of morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam, the nurse notices the presence of Heberden’s nodes. Which of the following is most likely?. A) Osteoporosis. B) Rheumatoid arthritis. C) Degenerative joint disease. D) Reiter’s syndrome.

25. What do a positive posterior drawer sign in a 10-year-old soccer player signify?. A) An abnormal knee. B) Instability of the knee. C) A large amount of swelling on the knee. D) An injury of the meniscus.

26. A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient?. A) Advise the mother that her pregnancy is progressing well. B) Order an ultrasound of the uterus. C) Refer her to an obstetrician for an amniocentesis. D) Recommend bed rest with bathroom privileges.

27. A multigravida who is at 34 weeks of gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fundus is: A) Midway between the umbilicus and the lower ribs. B) At the level of the umbilicus. C) From 33 to 35 cm. D) From 32 to 34 cm.

28. Which of the following laboratory tests is used in primary care to evaluate renal function?. A) Electrolyte panel. B) Creatinine. C) Alkaline phosphatase. D) Blood urea nitrogen (BUN) to creatinine ratio.

29. All of the following are false statements regarding acute gastritis except:. A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder. B) Chronic lack of dietary fiber is the main cause of the disorder. C) The screening test for the disorder is the barium swallow test. D) The gold standard to evaluate the disorder is a colonoscopy.

30. Signs and symptoms of depression include all of the following except: A) Anhedonia and changes in appetite. B) Decreased energy and irritability. C) Apathy and low self-esteem. D) Apraxia and fatigue.

31. Which of the following is an accurate description of eliciting for Murphy’s sign?. A) Upon deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle. B) Bend the patient’s hips and knees at 90 degrees, then passively rotate hip externally, then internally. C) Ask the patient to squat, then place the stethoscope on the apical area. D) Press into the abdomen deeply, then release it suddenly.

32. A 28-year-old multipara who is at 32 weeks of gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely?. A) Placenta abruption. B) Placenta previa. C) Acute cervicitis. D) Molar pregnancy (hydatidiform mole).

33. Epidemiologic studies show that Hashimoto’s disease occurs most commonly in: A) Middle-aged to older women. B) Smokers. C) Obese individuals. D) Older men.

34. A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: A) Hot flashes. B) Irregular menstrual periods. C) Severe vaginal atrophic changes. D) Cyclic mood swings.

35. A 63-year-old patient with a 10-year history of poorly controlled hypertension presents with a cluster of physical exam findings. Which of the following indicate target organ damage commonly seen in hypertensive patients?. A) Pedal edema, hepatomegaly, and enlarged kidneys. B) Hepatomegaly, AV nicking, bibasilar crackles. C) Renal infection, S3, neuromuscular abnormalities. D) Glaucoma, jugular vein atrophy, heart failure.

36. A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion?. A) Vaginal bleeding and cramping are present, but the cervix remains closed. B) Vaginal bleeding and cramping are present along with a dilated cervix. C) The fetus and placenta are all expelled. D) The products of conception and the placenta remain inside the uterus along with a dilated cervix.

37. A 30-year-old female who is sexually active complains of a large amount of milk like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely?. A) Trichomonas infection. B) Bacterial vaginosis. C) Candidal infection. D) A normal finding.

38. The Pap smear result on a 20-year-old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action?. A) The NP needs to do cervical cultures to verify the presence of gonorrhea. B) Prescribe metronidazole vaginal cream for the patient over the phone. C) Call the patient and tell her she needs a repeat Pap smear in 6 months. D) Advise the patient to use a Betadine douche at bedtime x 3 days.

39. While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient’s labia. The patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described?. A) Chronic scabies infection. B) Lichen sclerosus. C) Chronic candidal vaginitis. D) A physiologic variant found in some older women.

40. The heart sound S2 is caused by: A) Closure of the atrioventricular valves. B) Closure of the semilunar valves. C) Opening of the atrioventricular valves. D) Opening of the semilunar valves.

41. A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas?. A) Between the umbilicus and the suprapubic bone. B) Just rising above the suprapubic bone. C) Between the suprapubic bone and the xiphoid process. D) Between the umbilicus and the xiphoid process.

42. All of the following are covered under Medicare Part B except: A) Persons age 65 years or older. B) Durable medical equipment. C) Mammograms annually starting at age 50. D) Anesthesiologist’s services.

43. All of the following patients are at higher risk for suicide except: A) A 66-year-old White male whose wife of 40 years recently died. B) A high school student with a history of bipolar disorder. C) A depressed 45-year-old female with family history of suicide. D) A 17-year-old teen who has only 1 close friend in school.

44. A 70-year-old male patient complains of a bright red spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on is Bayer aspirin 1 tablet a day. Which of the following is most likely?. A) Corneal abrasion. B) Acute bacterial conjunctivitis. C) Acute uveitis. D) Subconjunctival hemorrhage.

45. Which of the following is appropriate follow-up for this 70-year-old patient?. A) Referral to an optometrist. B) Referral to an ophthalmologist. C) Advise the patient that it is a benign condition and will resolve spontaneously. D) Prescribe an ophthalmic antibiotic solution.

46. Jason, an 8-year-old with type 1 diabetes, is being seen for a 3-day history of frequency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially?. A) Urine for culture and sensitivity. B) 24-hour urine for protein and creatinine clearance. C) 24-hour urine for microalbumin. D) An intravenous pyelogram.

47. The best test for diagnosing congenital glaucoma is which of the following?. A) Fluorescein staining. B) Tonometry. C) Snellen vision exam. D) The refractive index.

48. Rocky Mountain spotted fever is caused by the bite of the: A) Mosquito. B) Tick. C) Insect. D) Flea.

49. All of the following are false statements about atopic dermatitis except: A) Contact with cold objects may exacerbate the condition. B) It does not have a linear distribution. C) It is associated with bullae. D) The lesions have vesicles that are full of serous exudates.

50. A mother brings in her 4-year-old daughter who just started attending preschool. She tells the nurse practitioner that her child is complaining of burning and itching in both eyes along with a runny nose. During the physical exam, the child’s eyes appear injected bilaterally. The throat is red and her inferior nasal turbinate are swollen. Which of the following is most likely?. A) Herpes keratitis. B) Corneal ulcer. C) Viral conjunctivitis. D) Bacterial conjunctivitis.