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A 15-year-old patient returns for contraceptive services 2 weeks after a diagnosis of trichomonas
vaginitis and treatment with 2 g of metronidazole (Flagyl). She reports that discharge and itching are
gone, but she is urinating frequently, accompanied with a lot of burning. The patient has not resumed
sexual activity and has menstruated since her last visit. Examination reveals mild suprapubic tenderness,
no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which
diagnostic test should be performed immediately?
Microscopic examination of urine
A 50-year-old male presents with a chief complaint of malaise. Further questioning reveals that his
primary concern is delayed ejaculation. He is currently taking the following medications: atenolol
(Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and
hydrochlorothiazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be:
paroxetine (Paxil).
During development of a treatment plan for an 84-year-old patient with hypothyroidism, the nurse
practitioner must keep in mind the possibility of the worsening of:
osteoporosis.
A 4-year-old girl with a history of recurrent urinary tract infections returns for follow-up after diagnosis
of the most recent infection. During the physical examination, the 4-year-old tells the nurse practitioner
that her brother (age 9) lies on top of her and rubs his penis near her pubic area. After completing the
physical examination, the nurse practitioner must:
report suspicions to the appropriate child protective services agency.
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,A 2-year-old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed
manipulation, the best indication of successful treatment is that:
the child quickly begins to use the affected arm.
Which of the following is the most serious outcome of Barrett's esophagus?
Esophageal adenocarcinoma
The follow-up examination of a 12-month-old treated 2 weeks ago for bilateral otitis media reveals a
normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and
decreased mobility. An appropriate plan should include a:
follow-up evaluation of the ears in 2 months.
A 68-year-old female presents with a new onset of left-sided throbbing headache. She has noticed some
spots in her visual fields that come and go. She is being treated with an NSAID for arthritis.
Sedimentation rate is elevated, but all other laboratory values are within normal limits. The headache is
most likely due to:
Your answer: temporal arteritis.
A 39-year-old patient was diagnosed with acute bronchitis in the emergency department and treated
with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a
smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of
101.2°F (39.4°C) and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse
practitioner should encourage smoking cessation and prescribe:
Your answer: a macrolide antibio
Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV
infection?
CD4 count and viral load
A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates
normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the
following is the most appropriate intervention to aid in the diagnosis of this case?
Ultrasound
A 3-year-old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The
patient lives with several relatives, including a grandmother who also has a cough. Which of the
following diagnostic tests would be most appropriate for the patient?
Sputum culture
Which of the following best describes psoriatic lesions in an elderly patient?
Red, sharply defined plaques with silvery scales
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,A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease.
The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta
blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom
would be most indicative of hypoglycemia in this patient?
Sweating
An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily,
and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To
evaluate his memory, which of the following tests should the nurse practitioner choose?
Folstein Mini-Mental State Examination
Which of the following is the leading cause of cancer-related deaths in the majority of women?
Lung cancer
Which of the following findings is typically a sign of acute appendicitis?
Rebound tenderness at McBurney's point
A patient with macular degeneration has difficulty seeing objects:
In the center of the visual field.
To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient:
the meaning of a common proverb.
During an employment physical examination of a 21-year-old female, bruising around the areolae on the
breasts is noted. An appropriate health history for these findings should include all of the following
EXCEPT:
socioeconomic status.
The best laboratory test to distinguish iron deficiency anemia from other anemias is:
serum ferritin level.
A 17-year-old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the
most appropriate diagnostic tests to order would be:
follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone
(TSH).
Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma
because it indicates:
whether a patient has reversible airway obstruction.
An 88-year-old patient presents with right-sided weakness after being unable to rise unassisted
following a fall to the bathroom floor. History includes aphasia and noncompliance with a hypertension
medication regimen. What is the most likely diagnosis?
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, Left-sided stroke
29-year-old male with noncomplicated Chlamydia infection may exhibit:
no remarkable clinical symptoms.
To assess spinal function at the S1 level, which deep tendon reflex should be tested?
Achilles
An 18-year-old college student presents for an athletic physical. When asked about current medications,
she mentions that she takes "some herb" she bought at a health food store for migraines and menstrual
cramps. Which of the following herbal remedies has been commonly used for these conditions?
Feverfew
An 88-year-old patient has had a gradual onset of hearing loss in the left ear. Examination shows a large
accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse
practitioner would expect the Weber test to:
lateralize to the left.
Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis?
Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and
many white blood cells
Which of the following would be most appropriate to perform in the initial evaluation of a patient with
symptoms of acute prostatitis?
Urinalysis and urine culture
A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder
exacerbated by movement. The patient reports that he participated in extensive house painting 24
hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis
is present. What is the next step that should be taken in order to make a diagnosis?
Palpate structures around the shoulder.
Assessment findings that would support a diagnosis of mitral regurgitation include:
Loud, high-pitched pansystolic murmur.
Which of the following gastrointestinal changes is associated with normal aging?
Decreased production of gastric acid
Which of the following signs/symptoms are often associated with headaches due to an intracranial
tumor?
Pain worse in supine position; focal neurological signs
Which of the following is NOT an indication of preeclampsia?
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