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In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic - correct answer (a) normochromic normocytic A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis - correct answer (a) asthma A patient has hyperactive reflexes of the lower extremities. The adult- gerontology primary care nurse practitioner assesses for ankle clonus by: (a) firmly applying a low-pitched tuning fork to the lateral malleolus.
(b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. - correct answer (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. A 70-year-old, female patient is having her yearly evaluation. The adult- gerontology primary care nurse practitioner gives which physical examination finding the highest priority for immediate treatment? (a) Atrophy of vaginal rugae. (b) Cystocele present. (c) Palpable ovary. (d) Pessary in place. - correct answer (c) Palpable ovary. The adult-gerontology primary care nurse practitioner reminds a 16- year-old, male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is
(a) concludes that the study proves the hypothesis. (b) excludes the discussion section, because the conclusion contains this information. (c) recommends incorporating the results directly into clinical practice. (d) uses the methodology section to support the validity of the study. - correct answer (d) uses the methodology section to support the validity of the study. A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information.
(c) informs the child that he or she must come to the clinic to discuss the parent's case. (d) tells the child that the nurse practitioner can discuss the information only with the patient. - correct answer (d) tells the child that the nurse practitioner can discuss the information only with the patient. The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: (a) evaluate standards, risks, benefits, and outcomes. (b) identify how to anticipate and resolve similar future situations. (c) investigate the need for disciplinary action. (d) obtain agreement of all parties with a chosen solution. - correct answer (a) evaluate standards, risks, benefits, and outcomes. To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: (a) charges a fee for patients who arrive late to clinic appointments.
(a) contacts the patient's adult child. (b) queries the other staff members. (c) relies on the patient's self-report. (d) waits until the patient's chart is available. - correct answer (a) contacts the patient's adult child. The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: (a) extroverted patient raising his or her grandchildren. (b) introverted patient who does not speak in the group. (c) personable patient who lives with his or her children. (d) worried patient whose son is serving in military conflict. - correct answer (d) worried patient whose son is serving in military conflict.
The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: (a) advise the patient to stop smoking. (b) prescribe bupropion (Zyban). (c) raise the issue of smoking cessation at the next visit. (d) recommend that the patient select a low nicotine cigarette. - correct answer (a) advise the patient to stop smoking. The adult-gerontology primary care nurse practitioner plans to provide smoking cessation education at a community center to older adults and their families. The nurse practitioner designs the program based on knowledge that older adult smokers: (a) are likely to be optimistic about their ability to quit. (b) are more likely to be successful at quitting than younger smokers.
(c) D-dimer assay. (d) Spirometry study. - correct answer (b) Brain natriuretic peptide test. Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult- gerontology primary care nurse practitioner obtain? (a) Liver function studies. (b) Platelet count. (c) Renal function studies. (d) White blood cell count. - correct answer (a) Liver function studies. A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? (a) Antibody. (b) Enzyme-linked immunosorbent assay. (c) Immune globulin G.
(d) Surface antigen. - correct answer (d) Surface antigen. For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness. The adult- gerontology primary care nurse practitioner anticipates that laboratory tests will show that the patient's: (a) T4 level decreased, and TSH level increased. (b) T4 level increased, and TSH level decreased. (c) T4 level increased, and TSH level is unchanged. (d) T4 level is unchanged, and TSH level decreased. - correct answer (a) T4 level decreased, and TSH level increased. A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two months but reports feeling well. The patient's problems include depression, tobacco abuse, obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor), and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which THREE actions? (a) Adds a probiotic.
(c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen. - correct answer Strongest evidence: (c) a systematic review ...then: (b) a consensus statement Weakest evidence: (a) a case report What factors does the adult-gerontology primary care nurse practitioner need to consider when discussing advanced care planning with a patient? (a) Autonomy and patient safety are rarely competitive considerations. (b) Decisions regarding a health care representative are a family group decision. (c) Family members are not integral components in care planning. (d) Trust and rapport with patients are key to patient satisfaction in decisions for care. - correct answer (d) Trust and rapport with patients are key to patient satisfaction in decisions for care.
The adult-gerontology primary care nurse practitioner working in an urban community health center recognizes that asthma-related health issues commonly result in higher morbidity and mortality for persons with: (a) alcohol dependency. (b) lower socioeconomic status. (c) persistent social isolation. (d) recent immigrant status. - correct answer (b) lower socioeconomic status. During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm) over the past year. She has not reached menarche. Her mother is concerned because the patient's sister reached menarche at age 11 and the mother reached menarche at age
- Examination reveals that the patient's breasts are enlarged, with the areolae forming a mound above the general contour of each breast, and that the left breast is larger than the right. Axillary hair is absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult female. These findings are consistent with a diagnosis of: (a) hypothyroidism.
(a) daughter, because she might file a lawsuit over unsatisfactory care. (b) daughter, because the patient is occasionally confused and incapable of granting informed consent. (c) nursing home administration, which may choose to support either the patient or the daughter. (d) patient, who has given informed consent. - correct answer (d) patient, who has given informed consent. A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: (a) amoxicillin (Amoxil). (b) doxycycline (Vibramycin). (c) erythromycin (E-Mycin). (d) trimethoprim-sulfamethoxazole (Bactrim). - correct answer (c) erythromycin (E-Mycin).
A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip. Examination reveals a well- developed patient in no acute distress who is afebrile and has respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse practitioner orders: (a) a chest x-ray. (b) a lung perfusion scan. (c) over-the-counter treatments for symptomatic relief. (d) pulmonary function tests. - correct answer (a) a chest x-ray. An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The nurse practitioner explains that phobias differ from other anxiety disorders in that phobias: (a) are innate and can be prevented. (b) are related to specific trigger experiences.
(a) assessment with a split lamp. (b) examination with an otoscope. (c) immediate referral to an ophthalmologist. (d) treatment with several ophthalmologic agents. - correct answer (c) immediate referral to an ophthalmologist. A 45-year-old patient with diabetes comes to the clinic for an annual appointment. The patient declines a parenteral influenza vaccination because a friend "came down with the flu after receiving the vaccination." The adult nurse practitioner explains that the vaccination is: (a) a polysaccharide, so it may cause a mild case of influenza. (b) activated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza. (d) live attenuated, so it may cause a mild case of influenza. - correct answer (c) inactivated, and this is unable to cause influenza.
An institutional review board rejects an adult nurse practitioner's research proposal on the grounds that the: (a) chosen statistics were not optimal to meet research objectives. (b) literature review was insufficient to develop the research question. (c) proposed budget did not cover the cost of the study. (d) subject's rights were not clearly protected. - correct answer (d) subject's rights were not clearly protected. A patient informs an adult nurse practitioner, "I want to stop smoking." The nurse practitioner responds: (a) "Do you have any ideas about how you would like to quit smoking?" (b) "Does your health insurance cover smoking cessation?" (c) "I will develop a plan for you to stop smoking."
