Quiz 13-2 – Flashcard
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1. A 46 year old woman asks about the need for surgery, since she was recently diagnosed with Crohn's disease. Indications for surgical interventions in Crohn's disease would include all but which of the following? A. Intestinal obstruction B. Free perforation C. Ileum-ascending colon fistula D. Enterovaginal fistula
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C. Ileum-ascending colon fistula Fistulas are always an indication for surgery but fistulas between the intestine and vagina cause significant symptoms and would warrant surgical intervention. An ileum-ascending colon fistula is very common in Crohn's yet rarely symptomatic.
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2. A 24 year old man presents to the emergency room with abdominal pain and fevers. A CT scan of the abdomen reveals inflammation of the terminal ileum. He is referred to a gastroenterologist, where he is diagnosed with Crohn's disease. Regarding the risk for complications from this disease, which of the following statements is true? A. The occurrence of toxic megacolon is common. B. Perforation occurs in about 25% of patients with similar disease. C. This patient would be at no increased risk for developing cancer of the colon. D. Fistulas between the colon and segments of the intestine, bladder, vagina, urethra and skin may develop.
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D. Fistulas between the colon and segments of the intestine, bladder, vagina, urethra and skin may develop. Fistulas are a common complication of those diagnosed with Chrohn's disease. Perforation occurs in only about 5% of patients. Toxic megacolon can occur but is not common.
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3. Crohn's disease is most common for which age groups? A. Late teens through twenties and fifties through seventies. B. Mid thirties through fifties. C. There is not definitive age frame in which most diagnoses have been established. D. Sixties and older.
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A. Late teens through twenties and fifties through seventies. The most common age frame is diagnosis before the age of 30 with another high occurence between 50-70.
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4. A newly diagnosed 28 year old woman questions her CRNP while visiting her gastroenterologist regarding the risk for her children having Crohn's disease. Which would be the best response to this question? A. There have been no findings in research that show there is any genetic component of Crohn's disease. B. The exact cause of Crohn's disease is uncertain but there have been multiple genes associated with increased incidence of Crohn's disease. The most common gene being associated with Crohn's disease is NOD2. C. It has been determined that because you have been diagnosed Crohn's disease, your children will certainly have the disease. D. Crohn's disease has a hereditary component but there have been little research findings that support any exact genes to link with Crohn's disease.
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B. The exact cause of Crohn's disease is uncertain but there have been multiple genes associated with increased incidence of Crohn's disease. The most common gene being associated with Crohn's disease is NOD2. NOD2 has been found to have a strong correlation with Crohn's disease and the genetic components attributed with Crohn's disease.
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5. A 30 year old female patient who presented to physician with minimal rectal bleeding, abdominal pain with frequent liquid stools is found with a colonoscopy to have lesions confined to the transverse and descending colon. Crohn's disease is suspected and a biopsy is performed. Which of the following statements is true about this patient? A. The inflammatory process is likely to be confined to the mucosa and submucosa. B. The inflammatory reaction is likely to be continuous. C. Superficial as opposed to linear ulcerations can be expected. D. Noncaseating granulomas can be expected in up to 50% of patients with transmural inflammation noted.
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D. Noncaseating granulomas can be expected in up to 50% of patients with transmural inflammation noted. Crohn's colitis is characterized by linear mucosal ulcerations, discontinuous (skip) lesions, a transmural inflammatory process, and noncaseating granulomas in up to 50% of patients.
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6. Extrinsic asthma is caused by a hypersensitivity reaction to which of the following? A. Dust mite allergens and animal danders B. Exercise C. Chemicals D. Respiratory tract infections
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A. Dust mite allergens and animal danders
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7. The early (acute) phase of an extrinsic asthma attack can be reversed by? A. Corticosteroids B. Bronchodilators C. Magnesium sulfate D. Leukotriene modifiers
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B. Bronchodilators
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8. Intrinsic asthma can be caused from all of these except? A. Exercise B. GERD C. Chemicals D. The immune system
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D. The immune system
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9. What term is used to categorize an acute asthma attack of such severity that it is considered a medical emergency because it can lead to respiratory failure and death? A. Status asthmaticus B. Severe persistent asthma C. Moderate persistent asthma D. Mild intermittent asthma
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A. Status asthmaticus
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10. Severe (refractory) asthma... A. is a common disorder B. is acute and easy to treat C. is persistent and often requires continuous high doses of corticosteroids D. does not place people at an increased risk for fatal or near fatal asthma
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C. is persistent and often requires continuous high doses of corticosteroids
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11. Which of the following symptoms is most specific to colon cancer? A. Nausea and jaundice B. Abdominal pain and hematochezia C. Epigastric pain and vomiting D. Heartburn and dysphagia
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B. Abdominal pain and hematochezia
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12. Risk of developing cancer is increased with which of the following gastrointestinal disorders? A. Duodenal ulcers B. Diverticulosis C. Ulcerative colitis D. Dumping syndrome
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C. Ulcerative colitis
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13. Which of the following factors are known causes of ulcerative colitis? A. Genetic predisposition B. Autoimmune injury C. Inflammation D. All of the above
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D. All of the above
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14. All of the following are characteristics of ulcerative colitis except: A. Iron deficiency anemia. B. The presence of "skip" lesions. C. Diarrhea. D. An increased risk of colon cancer.
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B. The presence of "skip" lesions.
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15. Which of the following risk factors increases a person's chance of developing esophageal cancer? A. Smoking B. Alcohol C. Gastroesophageal reflux D. All of the above
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D. All of the above
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16. What is the most common cause of acute mesenteric (vascular) insufficiency? A. Emboli B. Heart failure C. Ileus D. Anemia
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A. Emboli
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17. Which of the following nutritional disorders is characterized by consumption of large amounts of food (binging) followed by self-induced vomiting and/or the use of laxatives (purging)? A. Obesity B. Anorexia nervosa C. Bulimia nervosa D. Kwashiorkor
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C. Bulimia nervosa
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18. Appendictis usually presents with pain that manifests in which abdominal quadrant? A. Right upper B. Right lower C. Left upper D. Left lower
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B. Right lower
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19. Diverticulosis can be related to which of the following dietary problems? A. Lactose deficiency B. Diet high in refined foods C. Iron deficiency D. High fiber intake
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B. Diet high in refined foods
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20. Diverticula are: A. Ulcers that form in the colon. B. Outpouchings of the colon's mucosa. C. Perforations of the colon wall. D. Areas where the colon wall is hypertrophied.
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B. Outpouchings of the colon's mucosa.
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21. Common characteristics of Chron disease include which of the following? A. Significant blood loss in diarrhea B. Gastroesophageal reflux C. Vitamin B12 deficiency D. Mucosal erosions of the rectum
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C. Vitamin B12 deficiency
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22. Which of the following disorders is characterized by the inability to digest all nutrients? A. Pancreatic insufficiency B. Gluten-sensitive enteropathy C. Bile salt deficiency D. Lactase deficiency
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A. Pancreatic insufficiency
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23. Which of the following disorders is characterized by night blindness, osteopathy, and clotting disorders? A. Post-gastrectomy syndrome B. Gluten-sensitive enteropathy C. Bile salt deficiency D. Lactase deficiency
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C. Bile salt deficiency
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24. Gastrectomy surgery commonly leads to a vitamin B12 deficiency anemia because: A. Vitamin B12 is absorbed in the stomach. B. Decreased HCl production affects vitamin B12 absorption. C. Pepsin is required for the conversion of vitamin B12 into its active form. D. Decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum.
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D. Decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum.
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25. Severe trauma can result in stress ulcers that often first manifest with: A. Abdominal pain. B. Peritonitis. C. Severe bleeding. D. Dumping syndrome.
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C. Severe bleeding.
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26. Gastric ulcers are characterized by: A. Increased acid secretion. B. Regurgitation of bile. C. Pain with eating. D. Bloody diarrhea.
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C. Pain with eating.
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27. Which type of ulcer is a stress ulcer that is associated with burn injuries? A) Addison B) Cushing C) Curling D) Retroperitoneal
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C) Curling
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28. In addition to NSAID use, possible risk factors for peptic ulcer disease include all of the following except: A) smoking. B) alcoholism. C) psychological stress. D) female gender
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D) female gender
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29. Non-steroidal anti-inflammatory agents (NSAIDS) cause peptic ulcer by: A) Decreasing gastric bicarbonate production. B) Accelerating the proton pump in parietal cells. C) Inhibiting mucosal prostaglandin synthesis. D) Reducing mucosal blood flow
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C) Inhibiting mucosal prostaglandin synthesis
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30. How does a chronic infection with Helicobacter pylori (H. pylori) lead to duodenal ulcers? A) Chronic inflammation inhibits the proton pumps in the gastric lining. B) Presence of bacteria in the stomach causes the pyloric sphincter to open prematurely, releasing acid into the duodenum. C) H. pylori inhibits prostaglandins, leading to decreased mucus production. D) H. pylori produces substances that are toxic to the duodenal mucosa.
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D) H. pylori produces substances that are toxic to the duodenal mucosa.
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31. Individuals with chronic gastritis are at risk for developing which of the following problems? A) Gastric cancer B) Achlorhydria C) Gastrointestinal bleeding D) All of the above
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D) All of the above
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32. The most common cause of chronic gastritis is: A) Viral infection B) Bacterial infection C) Parasitic infection D) Fungal infection
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B) Bacterial infection
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33. The classic symptoms of a small bowel obstruction are: A) Nausea, dyspnea, and mid-back pain B) Vomiting, severe abdominal pain, and abdominal distension C) Constipation, pelvic pain, and dysuria D) Fever, heartburn, and diaphoresis
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B) Vomiting, severe abdominal pain, and abdominal distension
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34. Intestinal obstruction can lead to all of the following complications except: A) Hepatic failure B) Dehydration C) Peritonitis D) Perforation
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A) Hepatic failure
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35. Paralytic ileus often occurs after: A) Gastroesophageal reflux resolves B) Abdominal surgery C) Pregnancy D) Vomiting
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B) Abdominal surgery
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36. A hiatal hernia is a protrusion of the _____ through the ______.
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stomach; diaphragm
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37. Complications associated with gastroesophageal reflux disease (GERD) include which of the following? A) Esophageal ulcerations B) Esophageal cancer C) Esophageal strictures D) All of the above
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D) All of the above
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38. Common causes of constipation include all of the following except: A) Inadequate fluid intake B) Laxative use C) A low-fiber diet D) Medications
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B) Laxative use
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39. Which of the following disorders can result in lower gastrointestinal bleeding? A) Mallory-Weiss tear B) Peptic ulcers C) Cancer D) Hernia
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C) Cancer
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40. Which of the following conditions is a complication of gastrointestinal bleeding? A) Iron deficiency anemia B) Polyps C) Hypertension D) Ascites
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A) Iron deficiency anemia
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41. The presence of digested dark blood in the stool is called: A) Melena. B) Hematochezia. C) Hematemesis. D) Occult bleeding
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A) Melena.
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42. Which of the following conditions can cause dysphagia? A) Hiatal hernia B) Achalasia C) Gastroesophageal reflux D) All of the above
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D) All of the above
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43. Reflux esophagitis is defined as: A) The autoimmune destruction of the esophageal lining B) Dysplasia of the epithelial lining of the esophagus C) A congenital anomaly of the esophagus D) An inflammatory response to gastroesophageal reflux
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D) An inflammatory response to gastroesophageal reflux
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44. Common manifestations of gastroesophageal reflux disease (GERD) include: A) Nausea, vomiting, and weight loss B) Diarrhea, abdominal cramping, and fever C) Heartburn, dysphagia, and pain within one hour of eating D) Back pain, ascites, and anorexia
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C) Heartburn, dysphagia, and pain within one hour of eating
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45. As a NP working in a doctor's office, you begin to listen to your patient's chief complaint of upper back pain. This 62 y/o male begins to describe his pain as sharp and tearing which began earlier today after carrying a load of firewood. Unrelieved with analgesics, he decided to make the first available appointment and seek medical attention. After careful assessment and review of his medical history which includes uncontrolled hypertension, smoking and diabetes. Your physical assessment reveals: new diastolic murmur, pulses are present but weaker on the side, the patient begins to complaint of lightheadedness, you decide to? A. Send the patient home and tell him to apply heat to the area B. Send him home with a prescription for a MRI of the thorax C. Call 911, because after assessing the patient you suspect an aneurysm with a high suspicion of dissection D. Tell him he should go the emergency room
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C. Call 911, because after assessing the patient you suspect an aneurysm with a high suspicion of dissection
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46. During your clinical rotation in obstetrics, it is your understanding that women are at higher risk for aortic aneurysm because...? A. During pregnancy women have a lower cardiac output state and hyperdynamic state B. During pregnancy women have a lower cardiac output state and have a hypodynamic state and a lower heart rate. C. Their hyperdynamic state puts them at greater risk; estrogen inhibits collagen and elastin production. D. Increase production of collagen and elastin weaken the walls of the aorta.
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C. Their hyperdynamic state puts them at greater risk; estrogen inhibits collagen and elastin production.
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47. A 56 y/o man with a 3.5 cm abdominal aortic aneurysm was released from the hospital and now has his two week follow up appointment. As a CRNP, how do you expect that this patient will be monitored? A. The patient will be on antihypertensive medications. B. The patient will be placed on antihypertensive medications and will have yearly CT. C. If the patient remains asymptomatic, he will receive imaging studies every 36 months. D. The patient will have a MRI every six months.
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C. If the patient remains asymptomatic, he will receive imaging studies every 36 months.
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48. How do dissecting aneurysms differ from fusiforms aneurysms? A. Dissecting aneurysms occur in a small section of the aorta. B. There is no difference between dissecting and fusiform aneurysms they are synonymous. C. Fusiforms aneurysms are aneurysms in which the entire circumference of the vessel is distended while a dissection is a tear in the intimal layer of the vessel. D. Fusiforms aneurysms only occur at the arch of the aorta while dissections occur anywhere in the aorta.
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C. Fusiforms aneurysms are aneurysms in which the entire circumference of the vessel is distended while a dissection is a tear in the intimal layer of the vessel.
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49. What are the three main risk factors associated with aneurysms? A. Atherosclerosis, syphilis, familial. B. Hypertension, degeneration, congenital defects. C. Atherosclerosis, hypertension, degeneration. D. Marfan's syndrome, familial, hypertension.
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C. Atherosclerosis, hypertension, degeneration.
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50. TRUE/ FALSE: Berry aneurysms are small out pouching that is formed in the ascending aorta.
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FALSE
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51. TRUE/FALSE: Foam cells are a result of macrophages and smooth muscle cells engulfing the lipid.
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TRUE
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52. A 29 year old female presents to the hospital complaining of generalized weakness with progressive change in metal status, polyuria, and polydipsia. Her laboratory values indicated a blood glucose level 373 mg/dL, a serum ketone level of 7 mEq/L, and a serum bicarbonate level of 12 mEq/L. Which of the following conditions is she most likely to be diagnosed with? A. Type 2 diabetes mellitus B. Diabetic Ketoacidosis C. Type 1 diabetes mellitus D. Panceatitis
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B. Diabetic Ketoacidosis
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53. Which one of the following patients is at a higher risk of developing gestational diabetes during pregnancy? A. A 20 year old Caucasian female with BMI <25% expecting her first child, whose husband has a family history of diabetes. B. A 33 year old Native American female expecting her second child with a previous history of giving birth to a heavy-for-date infant. C. A 36 year old Asian American female expecting her fourth child with a fasting plasma glucose (FPG) of 119 mg/dL and no previous history of macrosomia. D. A 18 year old Caucasian female with a history of obesity, family history of type 2 diabetes, and FPG of 130 mg/dL.
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D. A 18 year old Caucasian female with a history of obesity, family history of type 2 diabetes, and FPG of 130 mg/dL.
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54. Which of the following fetal complications are associated with gestational diabetes? A. Macrosomia and postnatal hypocalcemmia B. Postnatal hyperbilirubimia and difficulty feeding C. Neurotubal defects and esophageal atresia D. Hypoglycemia and cleft lip
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A. Macrosomia and postnatal hypocalcemmia
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55. A 37 year old diabetic male has been complaining of generalized malaise accompanied by polydipsia. Upon initial physical assessment it was noted that the patient was obtunded, but able to maintain his airway, had very dry scaly skin and dry mucous membranes. His laboratory values indicated a blood glucose level of 1100 mg/dL, with a serum bicarbonate level of 20 mEq/L, and an anion gap of 12 mEq/L. According to his laboratory values, which of the following condition he most likely to be diagnosed with, A. Diabetic Ketoacidosis B. Hemachromatosis C. Cushing Syndrome D. Hyperosmolar Hyperglycemic State
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D. Hyperosmolar Hyperglycemic State
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56. A 56 year old male has been diagnosed with an anterior pituitary adenoma and has been experiencing increased glucose levels. Upon further evaluation it was noted that the pt had increased cortisol levels, normal growth hormone levels, and no family history of diabetes mellitus. Which one of the following conditions is most likely associated with the patient's glucose intolerance? A. Pancreatitis B. Hemochromatosis C. Cushing Syndrome D. Acromegaly
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C. Cushing Syndrome
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57. In the pathology of pneumococcal pneumonia, what occurs in the gray hepatization stage? A. The alveolar exudates is removed and the lungs return to normal B. Macrophages phagocytose the red blood cells and other cellular debris, leaving the lungs firm and less congested C. Capillary congestion leads to a massive outpouring of polymorphonuclear leukocytes and red blood cells, leaving the lungs red D. The alveoli become filled with rich edema fluid containing numerous organisms
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B. Macrophages phagocytose the red blood cells and other cellular debris, leaving the lungs firm and less congested
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58. True/False: Atypical pneumonias are caused by viral and mycoplasma infections that involve the alveolar septum and the interstitium of the lung.
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TRUE
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59. True/False: Typical pneumonias result from infection by bacteria that multiply extracellularly in the alveoli and cause inflammation and exudation of fluid into the air-filled spaces of the alveoli.
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TRUE
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60. __________ is the most common cause of bacterial pneumonia A. S. pneumoniae B. Pseudomonas aeruginosa C. S. aureus D. Escherichia coli
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A. S. pneumoniae
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61. True/False: Atypical pneumonias are characterized by patchy involvement of the lung, largely confined to the alveolar septum and pulmonary interstitium.
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TRUE
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62. A fifty year old Caucasian male comes to the Emergency Room with complaints of increasing weakness in his upper legs. He also has complaints of a cough and hoarseness over the last several months. During the work up process, a CT scan was done and noted a small mass on his left upper lobe. What can the leg weakness be contributed to? A. Generalized weakness caused by the tumor in his lung B. Fatigue caused by his chronic cough C. Eaton- Lambert Syndrome caused by the antibodies from the neurosecretory granules
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C. Eaton- Lambert Syndrome caused by the antibodies from the neurosecretory granules
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63. A 60 year female comes to see her Family Nurse Practitioner in regards to her recent onset of fatigue, cough and dyspnea. What of the following information would be most useful in her clinical history? A. Husband has a 20 pack per year smoking history. B. Patient and husband cook frequently on a charcoal grill C. Patient has a significant environmental allergy history
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A. Husband has a 20 pack per year smoking history.
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64. A patient recently has been diagnosed with lung cancer. She has had many complications including metastasis to her brain and bones. She also now developed Cushing Syndrome. What is most likely the cause of this? A. Intrathoracic effects from tumor B. A Paraneoplastic Syndrome caused by neursecretory granules C. Metastasis to the brain D. Not related to the lung cancer
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B. A Paraneoplastic Syndrome caused by neursecretory granules
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65. A patient is the office and expresses concerns about lung cancer. Both her mother and father had a smoking history while growing up and she is a current smoker. What statement would be the best when discussing lung cancer with this patient? A. You are a higher risk to develop lung cancer because your parents were smokers and you have been exposed to secondhand smoke. B. Smoking cessation would be beneficial to you. You have been exposed to second smoke and continuing to smoke causes irritation to the tissue lining of your lungs. C. You do not need to be concerned because there is no risk factors associated to smoking and lung cancer. D. You should quit smoking.
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B. Smoking cessation would be beneficial to you. You have been exposed to second smoke and continuing to smoke causes irritation to the tissue lining of your lungs.
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66. A 55 year nonsmoker female has been diagnosed with lung cancer. The lung cancer originates in the glandular tissue of the left lower lobe. Which type of lung cancer is this patient most likely suffering from? A. Small Cell Lung Cancer B. Large Cell Carcinoma C. Squamous Cell Carcinoma D. Adenocarcinoma
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D. Adenocarcinoma
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67. Your 65-year-old female patient was recently diagnosed with osteoarthritis asks you how she developed this condition. The best response reflecting the development of the disease is the following: A. "This condition will go away after a course of steroids." B. "This is an auto-immune disease that some people develop due to their genetics." C. "Destructive granulation tissue called pannus makes your joints swollen and difficult to move, particularly in the morning." D. "This condition is caused by continual wear and tear on joints and slowly progresses over years and years, peaking in advanced age."
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D. "This condition is caused by continual wear and tear on joints and slowly progresses over years and years, peaking in advanced age."
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68. When providing an educational workshop to the community, a nurse practitioner is discussing modifiable/lifestyle risk factors for osteoarthritis. Which of the following is not a modifiable risk factor for developing osteoarthritis? A. Obesity/overweight B. Occupation with repetitive joint stress C. Family history D. Nutritionally poor diet
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C. Family history
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69. Which of the following is not a laboratory test you would order to assist in diagnosis of rheumatoid arthritis? A. CBC B. CRP C. ESR D. Anti-CCP antibody
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A. CBC
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70. Which of the following statements is true about osteoarthritis? A. It is a systemic disease. B. It is characterized by remissions and exacerbations. C. It has a slow progression over years. D. There is usually symmetric involvement of joints.
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C. It has a slow progression over years.
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71. Your client with a history of gout asks you what he can do to reduce gouty arthritis flare-ups. Which of these statements regarding diet and nutrition would be appropriate to teach to your client? A. "You should eat more seafood to reduce your uric acid levels." B. "You should consider a healthier diet aimed at weight reduction and blood pressure." C. "Alcohol intake has no influence on your gout." D. "Consuming poultry has shown to contribute to gouty arthritis."
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B. "You should consider a healthier diet aimed at weight reduction and blood pressure."
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72. True/False: Some patients with severe osteoarthritis may require surgical intervention.
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TRUE
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73. True/False: Osteophyte formation is characteristic of rheumatoid arthritis.
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FALSE
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74. True/False: Radiograph studies are not helpful in diagnosing arthritis.
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FALSE
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75. True/False: Certain forms of arthritis can develop after an infection
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TRUE
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76. True/False: Synovial fluid facilitates joint motion by decreasing friction.
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TRUE
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77. A 29 y/o male patient arrives at the doctor's office complaining of shortness of breath, blurred vision, and anxiety upon examination you find his blood pressure reading is 200/110 you suspect he may be exhibiting signs of malignant hypertension based on your knowledge of this condition what additional symptoms may you find on your physical exam? A. Abnormal heart sounds, fluid in the lungs, retinal bleeding, swelling of the legs and feet B. Ataxia, tremors of the hands, and convulsions C. No other symptoms as malignant hypertension is often asymptomatic other than an extremely elevated blood pressure reading D. Abnormal lung sounds, blurred vision, tremors, and abdominal pain
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A. Abnormal heart sounds, fluid in the lungs, retinal bleeding, swelling of the legs and feet
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78. A 40 y/o obese female has been seeing the nurse for blood pressure checks over the past two months her blood pressure has been consistently recorded as a systolic pressure between 144-150 and her diastolic pressure has been recorded between 90-94 at this time the doctor has diagnosed her with essential hypertension other than her being overweight what factors may have contributed to her developing hypertension? A. Age, eating a low fat low cholesterol diet, walking twenty minutes per day. B. Smoking a pack of cigarettes a week, a diet high in cholesterol and saturated fat, and a sedentary life style C. Drinking 1-2 alcoholic beverages a month, eating a diet rich in fruits and vegetables, performing a low impact aerobic routine 3 times per week D. No family history of HTN, working a high pressure job, eating a diet of lean cut meats.
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B. Smoking a pack of cigarettes a week, a diet high in cholesterol and saturated fat, and a sedentary life style
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79. Where is the blood pressure the highest? A. Arteries B. Capillaries C. Veins
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A. Arteries
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80. True/False: Once symptoms of hypertension are present they are usually related to effects on other organs such as the kidneys, heart, eyes, and blood vessels.
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TRUE
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81. True/False: When primary hypertension is diagnosed other tests such as X-rays and labs are generally done to exclude secondary hypertension and determine the presence or extent of target organ damage.
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TRUE
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82. When reviewing lab results in a patient who has hypertension what values would be suspect of kidney impairment? A. Elevated WBC's, decreased RBC's B. Hypercalcemia, elevated magnesium C. Elevated urea nitrogen, elevated serum creatinine D. Elevated RBC's, elevated sedimentation rate
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C. Elevated urea nitrogen, elevated serum creatinine
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83. Congenital hypothyroidism can be caused by exposure to high levels of A. Testosterone B. Prolactin C. Estrogen D. Iodine E. Calcitonin
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D. Iodine
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84. The hypothalamus regulates the secretion of thyroid hormones by its production of: A. Thyroid Stimulating Hormone (TSH) B. Thyroglobulin C. Thyrotropin-Releasing Factor (TRF) D. Thyroid Binding Globulin (TBG)
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C. Thyrotropin-Releasing Factor (TRF)
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85. True/False: Hashimoto Thyroiditis often temporarily presents with tachycardia, anxiety, and sweating.
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TRUE
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86. A 75 year old female, who fractured her hip after slipping outside on the ice, arrives in the Emergency department. The patient is alert and oriented and denies any injury to other sites. Her medical history is significant for hypercholesteremia, osteoarthritis, hypothyroidism, obesity, and hypertension. Her pain is managed with analgesics as she awaits further laboratory results and surgical intervention. During subsequent assessments, it took considerable stimulus to arouse her. Additionally, when her family arrives, they make note of her puffy face and eyes, difference in her speech, due to what appears to be enlargement of her tongue. These symptoms are indicative of: A. Stroke B. Allergic reaction to analgesics C. Myxedema D. Subdural hematoma E. Thyroid Storm
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C. Myxedema
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87. In the case of the patient mentioned above, one would expect the following lab results: A. Elevated ammonia levels B. Elevated TSH levels C. Decreased TSH levels D. Decreased WBCs
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B. Elevated TSH levels
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88. What is the most commonly reported notifiable STD in the United States? A. Human Papillomavirus (HPV) B. Chlamydia C. Herpes Simplex Virus (HSV) D. Gonorrhea
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B. Chlamydia
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89. The pathogenesis of chlamydia includes which of the following? A. The reticulate body becomes an elementary body. B. The reticulate body enters vaginal cells. C. The elementary body enters the endocervical cells to replicate. D. There is no permanent damage to the cells which are invaded.
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C. The elementary body enters the endocervical cells to replicate.
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90. All of the following statements are true of C. trachomatis except: A. C. trachomatis is an obligatory intracellular organism. B. C. trachomatis organisms survive by replication that results in death of the cell they enter. C. The life cycle of C. trachomatis is 6 hours. D. The elementary body is the infectious particle of C. trachomatis.
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C. The life cycle of C. trachomatis is 6 hours.
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91. Chlamydia causes mucosal infection of which type of cell? A. Columnar B. Squamous C. Glandular D. Keratinized
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A. Columnar
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92. If symptomatic in men, the most common symptom of C. trachomatis infection is: A. Scrotal pain B. Penile pain C. Urethral discharge D. Reiter's syndrome
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C. Urethral discharge
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93. Which of the following is true regarding chlamydial infection in men? A. Epididymitis is a complication of untreated C. trachomatis infection. B. Epididymitis is always the result of a sexually transmitted infection. C. Men almost always experience symptoms. D. Chlamydial urethritis (or NGU) can be reliably distinguished clinically from gonococcal urethritis by its association with a clear urethral discharge (in contrast to gonorrhea's thicker yellow discharge).
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A. Epididymitis is a complication of untreated C. trachomatis infection.
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94. Which of the following is NOT one of the characteristic symptoms of Reiter's syndrome? A. Prostatitis B. Urethritis C. Conjunctivitis D. Oligoarthritis
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A. Prostatitis
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95. Complications of untreated chlamydial infection in women include all of the following except: A. Perihepatitis B. Salpingitis C. Endometritis D. Gastritis
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D. Gastritis
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96. The laboratory test for C. trachomatis with the highest sensitivity is: NAAT (nucleic acid amplification test) A. Culture B. DFA (MicroTrak) C. EIA (Chlamydiazyme)
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A. Culture
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97. The CDC-recommended treatment of choice for uncomplicated genital chlamydial infection is: A. Amoxicillin 500 mg orally 3 times a day for 7 days B. Tetracycline 250 mg orally 4 times a day for 7 days C. Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days D. Erythromycin 250 mg orally 4 times a day for 14 days
answer
C. Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days
question
98. Patients and their partners who undergo the recommended treatment should wait how long before resuming intercourse? A. 3 days B. 7 days C. 10 days D. 14 days
answer
B. 7 days
question
99. A 50 year old woman enters your doctors' office with complaints of a fever of 103* for two days, chills, and states, "I have the worst headache of my life." She has a positive Kernig's sign and has negative strep and influenza screens. What is your first step with this patient? A. Keep discussing history with the patient B. Ask the patient if she has been around sickened individuals. C. Ask the patient regarding her occupation. D. Complete a lumbar puncture and define the infection.
answer
D. Complete a lumbar puncture and define the infection.
question
100. True/False: The Kernig's sign is a flexion of the neck inducing painful flexion of hips and knees.
answer
FALSE
question
101. True/False: It is important to identify the exact bacteria and location it is present for accurate treatment of meningitis.
answer
TRUE
question
102. True/False: Viral Meningitis is the more severe and easiest to diagnose and treat form of this type of disease.
answer
FALSE
question
103. An 18 year old male is completing his physical examination for college. What state would indicate a need for further teaching and understanding of meningitis? A. I should obtain a lumbar puncture by a physician if I get the worst headache ever. B. I shouldn't get a vaccine for meningitis prevention. C. I will take a first aid kit packed with necessities if I get a common cold. D. I will followup with my school nurse if I don't feel well.
answer
B. I shouldn't get a vaccine for meningitis prevention.
question
104. Which two heart valves are most commonly affected by disease? A. Aortic and Pulmonic Valve B. Aortic and Tricuspid Valve C. Pulmonic and Tricuspid Valve D. Aortic and Mitral (Bicuspid) Valve
answer
D. Aortic and Mitral (Bicuspid) Valve
question
105. True/False: Regurgitation is characterized by the narrowing of the valve orifice and failure of the valve leaflets to open normally.
answer
FALSE
question
106. What diagnostic tool is commonly utilized to assess valvular characteristics? A. Chest Xray B. Echocardiogram C. Open Heart Surgery D. Cardiac Catheterization
answer
B. Echocardiogram
question
107. After Mr. Smith's initial visit to your office for c/o angina, fatigue, DOE and syncopal episodes, his echocardiogram shows an aortic valve mean gradient of 68mmHg and aortic valve area of 0.7cm2. Based upon the patient's symptoms and clinical data, what expected treatment do you foresee for Mr. Smith? A. Repeat echocardiographs every 6 months B. No indication for further follow up C. Open Heart Surgery for valve replacement/repair D. Placement on anticoagulation therapy for thrombus prevention
answer
C. Open Heart Surgery for valve replacement/repair
question
108. What is the single greatest risk factor regarding the development of valvular heart disease? A. Age B. Gender C. Auto-immune disease D. Lower Respiratory Infection
answer
A. Age
question
109. A patient comes into your office complaining of joint pain, fatigue and has a red skin rash spreading from a central point on her abdomen. You suspect Lyme and explain to her that Lyme Disease is caused by: A. A virus similar to the flu virus B. A unique type of bacteria called a spirochete C. The bacteria Staphylococcus Aureus D. An unknown organism
answer
B. A unique type of bacteria called a spirochete
question
110. The organism that causes Lyme Disease is most often found in the saliva of the tick in the ________ phase because it is most active at this time in its life cycle. A. Adult B. Nymph C. Larva D. All phases are equal carriers of the organism
answer
B. Nymph
question
111. The patient from question 1 tests positive for Lyme using the initial ELISA test. The next step for you to take is to: A. Call her and tell her she has Lyme Disease and needs to start on antibiotics ASAP. B. Rerun the ELISA test to make sure you did not get a false positive. C. Do nothing - this test is very inaccurate and there is no effective treatment for Lyme anyway. D. Perform a Western Blot test with the sample to verify the positive result.
answer
D. Perform a Western Blot test with the sample to verify the positive result.
question
112. The most common months to be infected with Lyme Disease are.... A. May through September B. October through February C. March through June D. December through March
answer
A. May through September
question
113. A patient has confirmed Lyme and is asking you what you recommend for treatment. He has no rash, but has had swollen/painful joints and migraine headaches for 6 months. You determine that he is in the late stage of Lyme and decide to: A. Prescribe Doxycycline for 14 days duration B. Prescribe Penicillin for 21 days duration. C. Admit him to the hospital since this is an emergent situation. D. Prescribe oral Keflex, set up an appointment for re-evaluation and continue treating until his symptoms are gone.
answer
D. Prescribe oral Keflex, set up an appointment for re-evaluation and continue treating until his symptoms are gone.
question
114. True/False: The incidence of prostate cancer is most common in elderly Asian men.
answer
FALSE
question
115. True/False: PSA is a glycoprotein secreted into the cytoplasm of benign and malignant prostatic cells.
answer
TRUE
question
116. True/False: Androgens play an important role in the development of prostate cancer.
answer
TRUE
question
117. True/False: Most prostate cancers are fast growing adenocarcinomas.
answer
FALSE
question
118. True/False: Prostate cancer is confirmed through PSA & DRE testing.
answer
FALSE
question
119. A 69-year old man complains of difficulty starting urination, hesitancy, frequency and nocturia. He denies any hematuria or pain. A DRE reveals a palpable mass near the rectum. Further testing reveals a PSA level of 5. A needle biopsy was performed and according to the Gleason grading system the tumor was assigned a score of 4. Based on the above information what TNM stage would be most likely? A. T1 -Nonpalpable, found on Histological exam B. T2 -Palpable mass, remain in prostate C. T3- Extends into seminal vesicles D. T4- Invades surrounding tissues
answer
B. T2 -Palpable mass, remain in prostate
question
120. Mrs. Jones is a 78 year old woman with heart failure who is comfortable at rest but experiences severe dyspnea and palpitations when she walks from her chair to the kitchen. According to the NYHA Functional Classification for chronic heart failure, she would be considered: A. Class 1 B. Class 2 C. Class 3 D. Class 4
answer
C. Class 3
question
121. Clinical exam findings significant for acute heart failure include all of the following except: A. Weight loss B. Lower extremity edema C. Dyspnea D. Increased fatigue
answer
A. Weight loss
question
122. The role of the NP in the care of the heart failure patient includes all of the following EXCEPT: A. Assess the patient for unusual fatigue or increased shortness of breath during activities of daily living (ADL)s B. Obtain vital sign and weight measurement C. Reassure the patient that increased shortness of breath and frothy sputum is normal for their condition D. Assess changes in mental status
answer
C. Reassure the patient that increased shortness of breath and frothy sputum is normal for their condition
question
123. Mrs. Jones has just returned from the hospital after treatment for acute heart failure exacerbation. She is followed in the out-patient HF clinic. Which of the following is the guideline recommendation for weight monitoring? A. Daily weights B. Monthly weights C. Weight measurement at clinic visits only D. Weight measurement is not necessary in treatment of HF patients
answer
A. Daily weights
question
124. Mr. Weimann is an 86 year old man with heart failure and osteoarthritis in both hips and knees resulting in significant pain which limits his mobility and ADLs. Given his heart failure diagnosis, pain management options include all of the following except: A. Ibuprofen B. Ice packs C. Acetaminophen D. Range of motion
answer
A. Ibuprofen
question
125. Mrs. Smith is preparing to be discharged to her home after a short stay for treatment of acute heart failure. Her doctor told her she has to weigh herself every day. She is confused about why she needs to weigh herself so often. Your best response is: A. Weight gain is an early sign of fluid overload. Fluid overload makes the heart work harder and is an early sign of heart failure. B. Frequent weights are necessary as a measure of nutritional status since good nutrition is important for heart health. C. Frequent weights are only necessary if you are in the hospital. D. Measuring your weight allows you to change your heart medication if you think you need to
answer
A. Weight gain is an early sign of fluid overload. Fluid overload makes the heart work harder and is an early sign of heart failure.
question
126. Which of the following of heart failure patient complaints could be safely addresses via phone assessment? A. Non-compliance with dietary restrictions for a period of 7 days B. Weight gain of 2 pound within 5 days C. Persistent cough and increased SOB on exertion and at rest D. Decreased functional capacity and difficulty performing ADL's E. Near syncopal episode with ICD therapy
answer
B. Weight gain of 2 pound within 5 days
question
127. Which of the following is a proven surgical approach that can be used in NYHA class IV heart failure refractory to medical management? A. Heart valve replacement B. Myectomy C. Ventricular assist device D. Dor procedure E. All of the above
answer
E. All of the above
question
128. True/False: For the majority of patients, the major causes of heart failure are coronary artery disease, hypertension and dilated or hypertrophic cardiomyopathy.
answer
TRUE
question
129. True/False: HF is the number 2 reason for hospitalization in patients over 65 years of age.
answer
FALSE
question
130. Over what number BMI is a patient considered obese?
answer
30
question
131. Name one of the hormones involved in the pathophysiology of obesity.
answer
GHRELIN LEPTIN ADIPONECTIN
question
132. What are some disorders / diseases associated with obesity?
answer
DIABETES HEART DISEASE STROKE HYPERTENSION GALLSTONES COLON CA OA SLEEP APNEA
question
133. True/False: obesity has a singular well understood cause.
answer
FALSE
question
134. True/False: diabetes is only slightly correlated with obesity.
answer
FALSE
question
135. True/False: Hypertension, smoking, and diabetes do not cause greater risk for stroke.
answer
FALSE
question
136. True/False: Ischemic stroke occurs when there is bleeding within the brain.
answer
FALSE
question
137. You are seeing a 75y.o. woman who presents to your office with c/o slurred speech, left side facial droop, slight left sided weakness. She admits that she hasn't been taking her meds for hypertension due to the cost so she "spreads them out" to make them last. When using the mnemonic FAST what should you be assessing? A. Frequent complaints, Argumentative, Somatic complaints, Tired. B. Forgetful, Anxious, Somnolent, Time symptoms started. C. Facial droop, Arm drift, Speech difficulties, Time last seen normal. D. Flight of ideas, auditory hallucinations, Sore throat, Time they last took their meds.
answer
C. Facial droop, Arm drift, Speech difficulties, Time last seen normal.
question
138. For a patient exhibiting stroke symptoms what is some basic information you'd want to know? A. EKG, Vital Signs including Pulse Ox., Blood Glucose level B. Angiography, Trans Cranial Doppler, Drug Screen C. MRI, EMG, TPA therapy
answer
A. EKG, Vital Signs including Pulse Ox., Blood Glucose level
question
139. What is the truest statement about stroke? A. Not many people have life altering disabilities from stroke B. More men than women suffer stroke C. There isn't a big incidence of stroke in the United States D. On average someone dies every 4 minutes from stroke.
answer
D. On average someone dies every 4 minutes from stroke.
question
140. What are the types of bladder cancer? A. Squamous cell B. Urothelial carcinoma C. Adenocarcinoma D. All of the above
answer
D. All of the above
question
141. Treatment for bladder cancer involves which of the following: A. Radiotherapy B. Resection C. Chemotherapy D. All of the above
answer
D. All of the above
question
142. True/False: Bladder cancer results from a genetic alteration in normal bladder epithelium.
answer
TRUE
question
143. True/False: One of the risk factors of bladder cancer is alcoholism.
answer
FALSE
question
144. Metastasis of bladder cancer involves which of the following sites: A. lymph lodes, liver, bones, & lungs B. pancreas & liver C. liver & lungs D. none of the above
answer
A. lymph lodes, liver, bones, & lungs
question
145. All of the following are characteristics of the common cold except: A. Children are the main reservoir of the common cold and the primary route of transmission is through self inoculation of the nose and eyes after contact with infected secretions B.The common cold is caused by over 200 types of viruses, the most common being the Rhinovirus. C. Common cold viruses undergo antigenic shift and drift to evade host defenses D. The common cold is usually self limiting and is not susceptible to antibiotics
answer
C. Common cold viruses undergo antigenic shift and drift to evade host defenses
question
146. Which of the following patients is most likely to have a cold? A. A patient who has had a gradual onset of symptoms including a sore throat, runny nose and sneezing B. A patient who has experienced an abrupt onset of fever higher than 101 for 3-4 days C. A patent experiencing severe aches and pains, malaise, headache and chills. D. A patient who has nausea vomiting and diarrhea
answer
A. A patient who has had a gradual onset of symptoms including a sore throat, runny nose and sneezing
question
147. All of the following are characteristics of the influenza virus except? A. The virus has 2 different surface glycoproteins B. The virus replicates well at 33-35°C in the upper respiratory tract only C. There is a vaccine that offers protection against various influenza viruses D. The virus is primarily transmitted through respiratory droplets
answer
B. The virus replicates well at 33-35°C in the upper respiratory tract only
question
148. Which of the following varieties of influenza can cause pandemics with significant mortalities in affected young people? A. Influenza A B. Influenza B C. Influenza C D. All of the above
answer
A. Influenza A
question
149. All of the following are true concerning the flu vaccine except? A. Vaccine mismatch can occur due to antigenic drift B. The Live Attenuated Influenza Vaccine contains a cold adapted virus that replicates at 25°C in the nasopharynx C. Even though the Trivalent inactivated influenza vaccine contains killed viruses this vaccine can still cause influenza infection in some patients D. The Trivalent inactivate vaccine is recommended for high risk groups
answer
C. Even though the Trivalent inactivated influenza vaccine contains killed viruses this vaccine can still cause influenza infection in some patients
question
150. A 54 year old patient recently diagnosed with colorectal cancer is inquiring about chance of her children developing colorectal cancer. The response that best answers this question is: A. There is no familial component of colorectal cancer; there is no increased risk associated with familial history. B. Your son is more at risk for developing colorectal cancer than your daughter. C. While there is a familial component of colorectal cancer, only 5% of new cases are linked to a first -degree familial history. D. If any of your children were to develop colorectal cancer,
answer
C. While there is a familial component of colorectal cancer, only 5% of new cases are linked to a first -degree familial history.
question
151. Which individual is most at risk for developing colorectal cancer? A. A 45 year old woman whose first colonoscopy revealed a small colorectal polyp. B. A 58 year old male who has Chrohn's disease and consumes a high-fat, low-fiber diet. C. An otherwise healthy 65 year old whose mother developed colon cancer at the age of 58. D. A 56 year old male who has a history of prostate cancer.
answer
B. A 58 year old male who has Chrohn's disease and consumes a high-fat, low-fiber diet.
question
152. Which best describes the two-hit hypothesis in regards to colorectal cancer? A. The development of more than 2 polyps is associated with an increased risk of developing colorectal cancer. B. The development of colorectal cancer begins with a genetic mutation which places the individual at risk, followed by an exposure or event that causes mutation, resulting in a homozygous mutant allele C. P53 gene dysfunction and a kras mutation must both occur, which results in increased
answer
B. The development of colorectal cancer begins with a genetic mutation which places the individual at risk, followed by an exposure or event that causes mutation, resulting in a homozygous mutant allele
question
153. Which blood test is typically used to monitor the effectiveness of treatment in colorectal cancer? A. CBC B. CMP with LFT's C. CEA D. CA 27.29
answer
C. CEA
question
154. Signs and symptoms of colorectal cancer include all but which of the following: A. Dysphagia B. Weight loss C. Lower abdominal pain or tendernes D. Change in bowel habits or appearance in stool
answer
A. Dysphagia
question
155. A 45 year old male presents for routine evaluation. Upon review of his ECG tracing, the Nurse Practitioner notices that his heart rhythm is sinus bradycardia at 55 bpm. The patient denies any SOB, activity intolerance, or dizziness. He admits that he regularly exercises and maintains a frequent jogging regimen averaging approximately 1 mile 3 times a week. He has a family history of coronary artery disease and MI and himself has hypertension and GERD. The best course of action is to: A. Counsel the patient on the need for a pacemaker B. Review his medications and consider substituting any AV nodal blocking agents with another class of medication and set him up for routine evaluations and ECG monitoring. C. Increase his beta-blocker to optimize his blood pressure. D. Set him up for cardiac catheterization to evaluate for coronary artery disease.
answer
B. Review his medications and consider substituting any AV nodal blocking agents with another class of medication and set him up for routine evaluations and ECG monitoring.
question
156. True/False: Ventricular arrhythmias have a higher mortality rate than atrial arrhythmias.
answer
TRUE
question
157. True/False: Atrial fibrillation slightly increases risk for stroke therefore most patients do not require anti-coagulation therapy, especially if they exhibit only paroxysmal Afib.
answer
FALSE
question
158. A 35 yr old female presents with a concern of "palpitations." Upon exam the Nurse Practitioner notices that her ECG tracing shows sinus tachycardia at 120 bpm. The patient has a medical history that includes hypertension, diabetes, and hypothyroidism. The Nurse Practitioner's best action is to: A. Prescribe a beta-blocker to treat her tachycardia. B. Obtain a physical history that includes assessment for infection and blood work that includes an electrolyte panel, glucose level, CBC, and thyroid studies. C. Set the patient up for sinus node ablation. D. Prescribe Ativan to treat her anxiety.
answer
B. Obtain a physical history that includes assessment for infection and blood work that includes an electrolyte panel, glucose level, CBC, and thyroid studies.
question
159. True/False: A 70 year old male patient presents to the office and is found to have new onset Atrial Fibrillation. Before treating this patient, the healthcare provider should consider whether a rate control strategy or a rhythm control strategy would likely be most beneficial for this patient.
answer
TRUE
question
160. What is the gold standard operative approach for the surgical management of an individual with ulcerative colitis and colonic dysplasia and polyps? A. Temporary diversion above the point of disease. B. Proctocolectomy with permanent end ileostomy C. Restorative proctocolectomy with ileal pouch and anal anastomosis. D. Loop transverse colostomy allowing the bowel to rest and heal.
answer
B. Proctocolectomy with permanent end ileostomy
question
161. This statement made by the patient with a new diagnosis of ulcerative colitis is evidence to the nurse practitioner that further education is necessary. A. I should contact my health care provider if I experience severe rectal bleeding B. I will take some Aleve if my back pain starts to act-up C. Reducing my daily stress will help me manage my symptoms D. I should reduce the amount of alcohol I consume on a daily basis.
answer
B. I will take some Aleve if my back pain starts to act-up
question
162. The best response when a patient asks the nurse practitioner about the length of time she will have to take high doses of prednisone is. A. You will have to remain on high doses of corticosteroids for the rest of your life. B. You can use over the counter medications like NASIDs for your headache if you are in remission. C. Corticosteroids will be the best choice to put your moderate ulcerative colitis into remission D. Once you're ulcerative colitis symptoms are controlled and the inflammatory process is in remission we will reevaluate your medical plan of care.
answer
D. Once you're ulcerative colitis symptoms are controlled and the inflammatory process is in remission we will reevaluate your medical plan of care.
question
163. True/False: The rectum is always involved in ulcerative colitis.
answer
TRUE
question
164. Which statement made by an individual who has had ulcerative colitis for 10 years indicates to the nurse practitioner that further education is necessary? A. I will make sure to ask my children if they experience any unusual bowel movements B. I am really glad that I don't have to go through that colon prep procedure for another five years. C. I should really think about quitting smoking. D. I should really think about losing 50 lbs.
answer
B. I am really glad that I don't have to go through that colon prep procedure for another five years.
question
165. What are the 2 main causes of pancreatitis, attributing to approximately 80-90% of all cases? A. Hereditary disease & abdominal trauma B. Abdominal trauma & biliary tract disease C. Biliary tract disease & alcohol use D. Alcohol use & medications
answer
C. Biliary tract disease & alcohol use
question
166. What is the most common symptom of acute pancreatitis? A. Nausea B. Tachycardia C. Fever D. Pain
answer
D. Pain
question
167. True/False: The pancreas always returns to its normal state after an attack of acute pancreatitis.
answer
TRUE
question
168. True/False: After an attack of acute pancreatitis has resolved, patients may resume alcohol intake in moderation.
answer
FALSE
question
169. Which complication cannot be identified and treated with an ERCP? A. Gallstones B. Jaundice C. Pseudocysts D. Narrowing or obstruction of the pancreatic or bile duct.
answer
B. Jaundice
question
170. Which lab results may be up to three times the normal limit during an attack of pancreatitis? A. WBC and potassium B. Glucose and lactate C. Amylase and lipase D. Calcium and platelets
answer
C. Amylase and lipase
