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NR 511 Final Exam
Questions and Answers
A 32 year old male patient presents to the clinic with a 2 day history of hoarseness, sore throat and dry cough. The NP diagnoses him with laryngititis. Which is the best treatment? a. bactrim b. supportive care c. amoxicillin d. levo b. supportive care Medicare part a covers which of the following services: a. outpt provider visits b. eye glasses and routine dental c. hospital services C. Hospital Services A 35 year old male uses high potency corticosteroid cream for dermatosis, he also currently has tinea corporis. Which should the clinician advise regarding the cream. a. "You must use this for an extended period of time for it to be effective." b. "It will work better if you occlude the area." c. "It may exacerbate your concurrent tinea corporis." d. "Be sure to use it daily." c. "It may exacerbate your concurrent tinea corporis." If a client uses a high- potency corticosteroid cream for a dermatosis, tell the client that it may exacerbate concurrent conditions such as tinea corporis and acne. Topical corticosteroids should not be used indiscriminately on all cutaneous eruptions. Topical corticosteroids should not be used for an extended period of time. The area should not be occluded. If a client uses a high-potency corticosteroid cream for a dermatosis, tell the client that it may exacerbate concurrent conditions such as tinea corporis and acne. Topical corticosteroids should not be used indiscriminately on all cutaneous eruptions.Intermittent therapy with high-potency agents, such as every other day, or 3 to 4 consecutive days per week, may be more effective and cause fewer adverse effects than continuous regimens. This is also true of lower potency corticosteroids.
a 21 year old male presents to the clinic with pruritic and emacerated skin in the groin area. Which is this? tinea cruris Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect?
- Epiglottitis
- Group A beta-hemolytic streptococcal pharyngitis
- Tonsillitis
- Diphtheria
- Epiglottitis (A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of epiglottitis) (Streptococcal pharyngitis presents with cervical adenitis, petechiae, a beefy-red uvula, and a tonsillar exudate) (A mild case of tonsillitis may appear to be only a slight sore throat. A more severe case would involve inflamed, swollen tonsils; a very sore throat; and a high fever) (Diphtheria starts with a sore throat, fever, headache, and nausea, and then progresses to patches of grayish or dirty-yellowish membranes in the throat that eventually grow into 1 membrane) Peptic ulcer disease symptom Burning/nawing you are assessing a first grader, and find that the tonsils are touching the uvula: 3 (Grade 1 indicates the tonsils are visible) (Grade 2 indicates the tonsils are halfway between the tonsillar pillars and the uvula) (Grade 3 indicates the tonsils are touching the uvula. Tonsils are enlarged to 2, 3, or 4 with an acute infection) (Grade 4 indicates the tonsils are touching each other) A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD?
- Order an endoscopy
- Order a Helicobacter pylori blood test
Which of the following medications is a treatment for alopecia? a. aspirin b. coumadin c. minoxidil d. oral contraceptive c. minoxidil Which of the following has/have not been linked to the use of isotretinoin?
- Elevated liver transaminases.
- Depression, psychosis, and suicidality.
- Benign intracranial hypertension.
- Pancreatitis.
- Pancreatitis. This is not an adverse effect of isotretinoin. You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with:
- Anxiety and panic attacks
- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
- Infection by Helicobacter pylori
- A family history of peptic ulcers
- Infection by Helicobacter pylori (About 90% of cases of peptic ulcers have been found to be caused by infection with the bacteria H pylori) (Stress-related conditions, such as anxiety and panic attacks, may contribute to and aggravate peptic ulcer disease) (Long-term use of NSAIDs may contribute to and aggravate peptic ulcer disease) (Research studies have been inconclusive regarding the hereditary factor for gastric and duodenal ulcers.) WHICH OF THE FOLLOWING PATIENTS SHOULD BE REFERRED TO AN ENT SPECIALIST? a. a 10 year old with OA and diminished hearing b. a 34 year old with OEM with mastoiditis c. an 18 yr old with OM two days ago and reports no Improvement d. a girl with tympanic rupture d Painless mass on eyelid chalazion
A 42 year old male has been diagnosed with h pylori gastritis which was confirmed by urea breath test. The clinician has given the patient a prescription for a standard 14 day triple therapy regimen. Which is correct regarding treatment? A. Repeat test 4 weeks after therapy completion B. Serological antibody test c. advise that follow up is not needed A. Repeat test 4 weeks after therapy completion What is the most common bacterial pathogen associated with acute otitis media?
- Streptococcus pneumonia
- Haemophilus influenza
- Streptococcus pyogenes
- Moraxella (Branhamella) catarrhalis
- Streptococcus pneumonia (This causes 40% to 50% of cases) Which of the following statements regarding the patient histories is true? a. OLDCART is the PMI b. Objective findings is reported in the ROS c. The HP is a detailed breakdown of the patients chief complaint d. objective findings are reported in the HPI C Which of the following is the least likely diagnosis for a patient with diarrhea? GERD A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step?
- Symptom management and reassurance that symptoms will resolve with time.
- Computed tomography (CT) of the head.
- Amoxicillin 80 to 90 mg/kg/d
- Augmentin 45 mg/kg/d
- Amoxicillin 80 to 90 mg/kg/d (This is the treatment of choice for acute otitis media) Which of the following patients should be referred to the ER? -A 40 yr old with corneal abrasion -a 9 yr old with lineal eyelid laceration
of this patient's right lower leg is warm, red, and painful. Although Justin may have diabetic neuropathy,
peripheral vascular disease, or a stasis ulcer, the information is not complete enough for you to suspect those conditions. The information and assessment data given fully support a diagnosis of cellulitis. Although Justin may have diabetic neuropathy, the information is not complete enough for you to suspect that condition. Although Justin may have peripheral vascular disease, the information is not complete enough for you to suspect that condition. Although Justin may have a stasis ulcer, the information is not complete enough for you to suspect that condition. Fever and rash on cheeks. Fifth disease; erythema infectiosum Your 24-year-old client whose varicella rash just erupted yesterday asks you when she can go back to work. What do you tell her?
- "Once all the vesicles are crusted over."
- "When the rash is entirely gone."
- "Once you have been on medication for at least forty-eight hours."
- "Now, as long as you stay away from children and pregnant women."
- "Once all the vesicles are crusted over." A client who has a varicella rash can return to work once all the vesicles are crusted over. Varicella is contagious 48 hours before the onset of the vesicular rash, during the rash formation (usually 4-5 days), and during the several days it takes the vesicles to dry up. The characteristic rash appears 2 to 3 weeks after exposure. Lee brings her 13-year-old son to your clinic. He has been complaining of a rash on the buttocks, anterior thighs, and posterolateral aspects of his upper arms. He tells you it is mildly pruritic and looks like "gooseflesh." On examination, the rash appears as small, pinpoint, follicular papules on a mildly erythematous base. You explain to Lee that the benign condition is likely to resolve by the time her son reaches adulthood, and it is known as:
- Comedones of acne.
- Molluscum contagiosum.
- Keratosis pilaris.
- Atopic dermatitis.
- Keratosis pilaris. The description and examination of this rash are consistent with keratosis pilaris, which most commonly appears on the cheeks, buttocks, anterior thighs, and posterolateral aspects of the upper arms.
- Comedones of acne. The distribution of comedones of acne is on the face, chest, and upper back.
- Molluscum contagiosum. Molluscum contagiosum involves waxy- appearing lesions with a central umbilication.
last year when he wore his jacket. The annular lesions are on his neck and both arms. They are
erythematous, sharply circumscribed, and both flat and elevated. His voice seems a little raspy, although he states that his breathing is normal. What is your first action?
- Order a short course of systemic corticosteroids.
- Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
- Start daily antihistamines.
- Tell Tom to get rid of his leather jacket. Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously. Tom has hives. Although all the actions are appropriate, the first step is to determine the need for 0.5 mL 1:1000 epinephrine subcutaneously. With Tom's neck involvement, it is most important to determine if respiratory distress is imminent; if it is, epinephrine must be administered. A patient is diagnosed with GERD, the clinician knows that she misunderstands the teaching when she says: stop smoking eat smaller meals have a snack before retiring for bed. have a snack before retiring for bed. The clinician is educating a 55 year old male about the warts on his hands; what should be included in on the teaching? Shaving the wart may improve TX is usually warts are caused by human papilloma virus warts are caused by human papilloma virus Buddy, age 13, presents with annular lesions with scaly borders and central clearing on his trunk. What do you suspect?
- Psoriasis.
- Erythema multiforme.
- Tinea corporis.
- Syphilis.
- Tinea corporis. Psoriasis, erythema multiforme, tinea corporis, and syphilis all have lesions with annular configurations. Tinea corporis (ringworm) has ring-shaped lesions with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.
- Psoriasis has annular lesions on the elbows, knees, scalp, and nails.
- Erythema multiforme has annular lesions that are mostly acral in distribution and are often associated with a recent herpes simplex
- Secondary syphilis lesions are usually on the palmar, plantar, and mucous membrane surfaces. Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke up this morning with a rash on his trunk. What is your first action?
- Prescribe systemic antihistamines
- Prescribe a short course of systemic steroids.
- Stop the amoxicillin.
- Continue the drug; having this reaction early in the course is normal.
- Stop the amoxicillin. If you suspect a drug reaction to amoxicillin, stop the amoxicillin. This reaction is not normal. If the patient is allergic to penicillin, treatment should be discontinued. Right eye pain, scratch on eye, what procedure should the clinician perform? Vision test Flurosine test ? What is true of a serum RAST? It helps diagnose it can be ordered as a general screening tool it measure igg and igm the test should only be performed by a board certified allergist Its prone to misinterpretation ? Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
- Prescribe nasal steroids and oral decongestants
- Prescribe antibiotic ear drops
- Prescribe systemic antibiotics
- Refer Max to an ear, nose, and throat specialist Prescribe nasal steroids and decongestants a patient presents to the clinic with a dry cough, non smoker, for 5 weeks. the cough increases at night, he reports episodes of heartburn after meals. what should the differential include?
GERD
A 59-Year-old male presents with a bright red spot which has been present on the white of his eye for 3 days. Denies pain or vision changes. No trauma conjunctival hemmorrhage hypem a abraisa n conjunctival hem. a 13 year old presents to the clinic complaining of severe left side sore throat and pain with swallowing for 1 day. upon exam, the patient appears uncomfortable and febrile. Cervical adenopathy is present on left side, difficulty opening and closing mouth. What should you do? Refer to the ER a 37 year old female presents for her annual visit. She mentions that her 13 year old daughter has had to recent infestions of lice. She asks what she can do to prevent this? After 2 days of no head lice, her bedding is lice free Client teaching is an integral part of successfully treating pediculosis. Which of the following statements would you incorporate into your teaching plan?
- "It's okay to resume sharing combs, headsets, and so on after being lice-free for one month."
- "Soak your combs and brushes in rubbing alcohol for eight hours."
- "Itching may continue for up to a week after successful treatment." Client education is essential when treating pediculosis.
- "Spraying of pesticides in the immediate environment is essential to prevent recurrence." "Itching may continue for up to a week after successful treatment." Client education is essential when treating pediculosis. Clients should be informed that itching may continue for up to a week after successful treatment because of the slow resolution of the inflammatory reaction caused by the lice infestation. Clients and parents should be instructed not to share hats, combs, scarves, headsets, towels, and bedding. Combs and brushes should be soaked in rubbing alcohol for 1 hour. Excessive decontamination of the environment is not necessary. Environmental spraying of pesticides is not effective and, therefore, is not recommended. Bedclothes and clothing should be washed in hot, soapy water
tenderness, and aside from the nighttime symptoms and dysphagia, she reports no symptoms with food or lack of food)
Danny, age 18, presents with a pruritic rash on his upper trunk and shoulders. You observe flat to slightly elevated brown papules and plaques that scale when they are rubbed. You also note areas of hypopigmentation. What is your initial diagnosis?
- Lentigo syndrome.
- Tinea versicolor.
- Localized brown macules.
- Ochronosis.
- Tinea versicolor. If a client presents with a pruritic rash on his upper trunk and shoulders and you observe areas of hypopigmentation and flat to slightly elevated brown papules and plaques that scale when they are rubbed, suspect tinea versicolor.
- Lentigines are macular tan to black lesions ranging from 1 mm to 1 cm in size. They do not increase in color with exposure to the sun. One or more lentigines are seen in normal individuals. Multiple ones need to be further assessed.
- Localized brown macules are freckles.
- Ochronosis is a condition with poorly circumscribed blue-black macules. Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is:
- Ciprofloxacin (Cipro)
- Azithromycin (Zithromax)
- Amoxicillin (Amoxil)
- Cephalexin (Keflex)
- Azithromycin (Zithromax) (Azithromycin is not a perfect option for treating otitis media; however, it is preferred for patients with severe penicillin allergy)
- Ciprofloxacin (Cipro) (Ciprofloxacin, a fluoroquinolone antibiotic, is not recommended for the treatment of acute otitis media)
- Amoxicillin (Amoxil) ( Amoxicillin is a penicillin-based antibiotic and should not be given to a patient with a penicillin allergy)
- Cephalexin (Keflex) (Cephalexin is a penicillin-based antibiotic and should not be given to a patient with a penicillin allergy) Red conjunctiva and dendrite appearance on the cornea HSV The term indemnity insurer refers to an insurer: In a health maintenance organization (HMO).
That pays for the medical care of the insured That pays health care providers on a per-visit, per-procedure basis. That pays for the medical care of the insured (The term indemnity insurer refers to an insurer that pays for the medical care of the insured but does not provide that care) a 25 year old male presents with abdominal cramping and diarrhea for 7 days. The clinician knows that stool samples are warranted in which of the following situations: Consuming sushi Antibiotic use in the last month Antibiotic use in the last month Which condition is not included in the atopic triad?
- Aspirin sensitivity
- Asthma
- Allergic Rhinitis
- Eczema Aspirin sensitivity Which of the following is the appropriate treatment for giardia quin.hydr. A 16 year old male presents to urgent care clinic with abdominal pain. The pain is constant and located in the periumbilical region shifting to the RLQ. N/V/D. Elevation in wbc and wbc in urine Appendicitis A Pancreatitis Gastroenteritis Rocky mountain fever Appendicitis a 12 year old male presents to your pediatric clinic with swimmers ear. what is the causative agent? stre
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