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i. Signs and symptoms and management of musculoskeletal sprains/strains/dislocations 16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. is an injury th 16- Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use continuous heat for the first 12 hours and then use heat or cold to your own preference.” B. “Use continuous cold for the first 12 hours and then use heat or cold to your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45 minutes; repeat this for the first 24 to 48 hours while awake.” D. “Alternate between cold and heat for 20 minutes each for the first 24 to 48 hours.” 16-69 Ankylosis is defined as A. muscle shortening. B. joint stiffness. C. malposition of a joint. D. dislocation of a joint. 16-108 Jill, age 49, has recently begun a rigorous weight- lifting regimen. She presents to the primary care office with a shoulder dislocation. Which of the following clinical manifestations lead the nurse practitioner to suspect an anterior shoulder dislocation over a posterior dislocation? A. Inability to shrug the shoulder B. Absence of pain C. Inability to rotate the shoulder externally D. Shortening of the arm 16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the
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practitioner places the infant supine, flexes the knees by holding the thumbs on the inner mid- thighs, with fingers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver. 16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her many sports activities. The nurse practitioner thinks that the patient was probably never taught about health promotion and maintenance regarding physical activity. What information should be included in patient teaching? A. “After an activity, if any part hurts, apply ice for 20 minutes.” B. “You must first get in shape with a rigorous schedule of weight training, and then you can participate in any activity once you are physically fi t.” C. “After any strenuous activity, you must completely rest your muscles before beginning your next activity.” D. “Stretching and warm- up exercises are an important part of any exercise routine.” 16-27 Upon assessment, the nurse practitioner notes unilateral back pain that had an acute onset and increases when standing and bending. A straight- leg test is negative. The most likely differential diagnosis is A. herniated nucleus pulposus. B. muscle strain. C. osteoarthritis. D. spondylolisthesis. 16-67 June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back and muscles without sciatica, and it is aggravated by sitting,
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spinal fracture 16-14 Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age- related change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis 16-90 What disorder affects older individuals, particularly women, and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, weight loss, sweats, and low- grade fever? A. Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica D. Reiter’s syndrome iii. Recognition and immediate management of cauda equina syndrome 16-11 The most common cause of cauda equina syndrome is A. fracture. B. hematoma. C. lumbar intervertebral disk herniation. D. space- occupying lesion. 16-60 Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? A. Order physical therapy B. Order a lumbar/sacral x- ray C. Order extensive lab work D. Refer to a neurosurgeon 16-72 Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the
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cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological compromise D. Spinal fracture iv. Maneuvers and expected findings with joint pain (knee, shoulder, wrist, etc.) Chap 16 16-24 To aid in the diagnosis of meniscus damage, which test should a nurse practitioner perform? A. The bulge test B. The Lachman test C. The drawer test D. Apley’s compression test 16-35 You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the A. lateral meniscus. B. cruciate ligament. C. medial meniscus. D. collateral ligament. 16-29 The straight leg–raising maneuver can be used to diagnose A. nerve root compression. B. a fractured hip. C. an anterior cruciate ligament tear. D. tendinitis. 16-96 What is the name of the test used to assess for nerve- root compression? A. The Apley scratch test B. The drop arm test C. Finkelstein’s test D. Spurling’s maneuver 16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the practitioner places the infant supine, flexes the knees by holding the thumbs on the inner mid- thighs, with fingers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver. v. Initial assessment of FOOSH injury in correlation to anatomical location of radial head bone 16-39 Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You know this probably indicates a(n) A. ulnar styloid fracture. B. scaphoid fracture. C. hamate fracture. D. radial head fracture.
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16-16 Which of the following is NOT a management principal for an acute musculoskeletal injury that does not require emergent treatment? A. RICE B. NSAIDs or acetaminophen C. Imaging studies D. Skeletal muscle relaxants. 16-86 James, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given a diagnosis of Osgood-Schlatter disease and asks you about his treatment options. The nurse practitioner should tell him that the initial treatment is A. relative rest; he could benefit t from hamstring, heel cord, and quadricep stretching exercises. B. immobilization: a long- leg knee immobilizer is recommended. C. surgical intervention: removal of the bony fragments is necessary. D. bedrest for 1 week. 16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her many sports activities. The nurse practitioner thinks that the patient was probably never taught about health promotion and maintenance regarding physical activity. What information should be included in patient teaching? A. “After an activity, if any part hurts, apply ice for 20 minutes.” B. “You must first get in shape with a rigorous schedule of weight training, and then you can participate in any activity once you are physically fi t.” C. “After any strenuous activity, you must completely rest your muscles before beginning your next activity.” D. “Stretching and warm- up exercises are an important part of any exercise routine.”. 16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. is an injury that does not result in joint instability. 16-98 Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use continuous heat for the first 12 hours and then use heat or cold to your own preference.” B. “Use continuous cold for the first 12 hours and then use heat or cold to
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your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45 minutes; repeat this for the first 24 to 48 hours while awake.” D. “Alternate between cold and heat for 20 minutes each for the first 24 to 48 hours.” viii. Osteopenia 6- 87 Shelley, 65 years old, sees you for the first time. She has demonstrated osteopenia on a bone density test, and you have prescribed the appropriate medication for her. What additional lifestyle changes should you counsel for this client? A. She should begin a rigorous swimming program to actively build bone. B. She should cut down on coffee, but tea is okay. C. She needs to take a multivitamin every day. D. She should begin weight training. 12- 51 Marisa, age 42, has celiac disease. She is prone to osteopenia bone disease because of impaired calcium absorption because of A. increased calcium absorption by the small intestine. B. increased absorption of the fat-soluble vitamin D. C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. D. decreased magnesium absorption.
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16-89 Which of the following is a modifiable risk factor for osteoporosis? A. Low alcohol intake B. Low caffeine intake C. Smoking D. Excessive exercise 16-121 Bone mineral density (BMD) testing is recommended by the National Osteoporosis Foundation for which of the following client populations to assess whether they are at high risk for osteoporosis? A. All women age 65 and older regardless of risk factors B. All men age 65 and older regardless of risk factors C. All women in their 30s for a baseline D. All women of menopausal age. 72 Jill is perimenopausal and asks you about the relationship between exercise and preventing osteoporosis. You tell her that A. exercise has no effect; she should take calcium supplements. B. weight-bearing exercise prevents bone mass loss. C. all types of exercise assist in preventing osteoporosis. D. since she was very athletic during her formative years, her bones will maintain their bone mass. ix. Assessment and management of gout. 8-40 Eric, age 52, has gout. What do you suggest? A. Using salicylates for an acute attack B. Limiting consumption of purine-rich foods C. Testing his uric acid level every 6 months D. Decreasing fluid intake
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8-92 Gouty pain in the great toe is A. toe gout. B. hyperuricemia of the toe. Podagra 16-82 The nurse practitioner is considering a diagnosis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout in a 72- year- old man who presents with complaints of pain and stiffness in his wrists and knees. The most useful diagnostic test to assist in confirming this diagnosis would be CPPD disease (pseudo gout) may appear clinically like gouty arthritis. 16-118 Gout is caused by urate crystals being deposited in certain joints leading to acute pain, erythema, and edema. Gout typically occurs most often in the joint of the A. foot. B. wrist. C. elbow. D. finger. 17- 24 Which of the following medications can increase uric acid and lead to an acute gouty attack? A. HCTZ B. Beta blockers C. Calcium channel blocker D. ACE inhibitors Medication management for acute vs. chronic gout A uricosuric such as Probenecid, with the addition of the anti-inflammatory colchicine, is indicated for chronic gouty arthritis. 17-4 What is the medication of choice for an initial acute attack of gout? A. An NSAID 16 -2 Colchicine may be used to terminate an acute attack of gouty arthritis as well as to prevent recurrent episodes. The mechanism of action is to A. interrupt the cycle of urate crystal deposition and inflammatory response. B. increase serum uric acid levels. C. potentiate the excretion of uric acid. D. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid. 16-7 Bursitis is an inflammatory process that may be caused by infection, trauma, repetitive movement disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is from which of the following? Staph aureus x. Dietary restrictions for gout 6- 96 You are teaching a client about his gout. Which of the following should you include in your teaching? A. Once gout is treated, there is no danger of permanent damage. B. Diet and alcohol consumption may remain the same. C. Drink at least 1 quart of fluid
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17-13 Hyperthyroidism is seen in which of the following lab results? A. Increased TSH and decreased free T4 B. Decreased TSH and decreased free T4 C. Decreased TSH and increased free T4 D. Increased TSH and increased free T 17-27 Mr. Reynolds is on the antithyroid drug methimazole (Tapazole), so you make it a point to check his A. HbA1c. B. CBC and liver transaminases. C. uric acid level. D. total T4. 17-44 After establishing clinical and biochemical euthyroidism after a thyroidectomy, you should perform a measurement of the serum thyroid stimulating hormone (TSH) level every A. 3 month. B. 6 months. C. 1 year. D. 2 years. 17-46 The major risk factor for development of thyroid cancer is A. inadequate iodine intake. B. presence of a goiter. C. exposure to radiation. D. smoking. 17- 69 The thyroid-stimulating hormone (TSH) test measures the A. total serum level of thyroxine. B. serum level of T 3 and T 4. C. pituitary’s response to peripheral levels of thyroid hormone. D. combined serum levels of T 3 and T 4. 17-76 Four clients present with an undetectable TSH level and a normal free T indicating subclinical hyperthyroidism. Which client should be treated? A. The client over the age of 50 B. The client with bradycardia C. The client with cardiovascular disease D. The client with a thyroid bruit 17- 80 You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has A. elevated serum phosphate levels. B. elevated serum calcium levels. C. decreased neuromuscular irritability. D. increased bone resorption, as implied by her bone density test. 17- 89 Why is parathyroid hormone secretion increased during pregnancy? A. To meet the increased stress demands on the mother B. To meet the increased requirements for calcium and vitamin D for fetal skeletal growth C. To help prevent neural tube defects in the fetus D. To help promote neurological g 7- 92 Which of the following medications should not be used by a client who has a history of medullary thyroid cancer? A. Sitagliptin (Januvia) B. Metformin (Glucophage) C. Liraglutide (Victoza) D. Canagliflozin (Invokana)
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17-115 Which is the only treatment option that is curative for primary hyperparathyroidism (PHPT)? A. Type II calcimimetic cinacalcet B. Hormone therapy C. Parathyroidectomy D. Bisphosphonates xiii. Risk factors for Hashimoto's & Grave’s disease 9-58 Which of the following signs of thyroid dysfunction in a 49-year-old patient is a sign of hyperthyroidism? A. Slow pulse B. Decreased systolic BP C. Exophthalmos D. Dry, coarse, cool skin 17-5 Marsha, age 24, is preparing for radioactive iodine therapy for her Graves’ disease. Which test must she undergo first? A. Beta human chorionic gonadotropin B. Basal metabolism rate C. Lithium level D. Serum calcium 17-17 Which of the following can increase the ocular manifestations of Graves’ disease? A. Pregnancy B. Hypertension C. Smoking D. Hyperlipidemia 17-36 Which of the following statements is true regarding the epidemiology of Graves’ disease? A. It is more common in males. B. The diagnosis is most made during the early teenage years. C. It is the most common autoimmune disease in the United States. D. It is more common in African Americans.
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caused this? A. An intake of more calories than are expended B. Polycystic ovary disease C. Her antihypertensive medications D. Her sedentary lifestyle xv. Macrocytic vs microcytic vs normocytic anemia (causes, symptoms, testing) 18 -8 Sherri’s blood work returns with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? A. Order a serum iron and total iron binding capacity (TIBC) B. Order a serum ferritin C. Order a serum folate level D. Order a serum iron, TIBC, and serum ferritin level 18 -33 Macrocytic normochromic anemias are caused by A. acute blood loss. B. an infection or tumor. C. a nutritional deficiency of iron. D. a deficiency of folic acid. 18- 40 Mrs. Bartley, age 58, presents with complaints of unsteady gait and numbness and tingling in her fingers. Her laboratory values show increased MCV, normal MCHC, and normal hemoglobin. Which of the following laboratory test results would you also expect? A. Decreased B 12 , normal folate, and increased reticulocyte count B. Normal B 12 , decreased folate, and decreased red cell distribution width C. Decreased B 12 , normal folate, and decreased reticulocyte count D. Decreased B 12 , increased reticulocyte count, and increased MCH
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18-94 Your client, Shirley, has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis? A. Iron-deficiency anemia B. Hemolytic anemias C. Lead poisoning D. Liver disease xvi. X-linked disorders in African American males 18-84 Which of the following is an X-linked recessive disorder commonly seen in African American males? A. Sickle cell anemia B. Glucose-6-phosphate dehydrogenase deficiency C. Pyruvate kinase deficiency D. Bernard-Soulier syndrome xvii. Signs and symptoms of splenic sequestration 18-5 Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to A. vomiting and diarrhea. B. decreased mental acuity. C. abdominal pain, pallor, and tachycardia. D. abdominal pain and vomiting. xviii. Most accurate diagnostic testing for sickle cell anemia 18-5 Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to A. vomiting and diarrhea. B. decreased mental acuity. C. abdominal pain, pallor, and tachycardia. D. abdominal pain and vomiting. 18-2 Sickle cell anemia affects African Americans. Approximately 1 in 400 African Americans in the United States has sickle cell disease (SCD). Advances in treatment have been made, but life expectancy is still limited. The mean survival time for men with the disease is approximately A. 24 years. B. 34 years. C. 42 years. D. 52 years. 18-11 Jimmy, age 6 months, is newly diagnosed with sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? A. Tell the parents that Jimmy will not be immunized because of his diagnosis. B. Tell the parents that Jimmy should not go to day care. C. Immunize Jimmy with diphtheria, tetanus, and pertussis; Hemophilus influenzae type b (HIB); hepatitis B (HBV); and poliomyelitis vaccines. D. Immunize Jimmy with measles, mumps, a 18-22 Which of the following situations might precipitate a sickle cell crisis in an infant?
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18-88 Hemolytic anemia may be an inherited condition. Which of the following is not an inherited condition related to hemolytic anemia? A. Hereditary spherocytosis B. Pernicious anemia C. Glucose-6-phosphate dehydrogenase deficiency D. Sickle cell anemia 18-95 Sickle cell anemia is an autosomal recessive disorder caused by the hemoglobin S gene. An abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical manifestations and becomes a chronic multisystem disease, with death from organ failure, usually between ages 40 and 50. The hemoglobin S gene is carried by A. approximately 4% of the U.S. population. B. approximately 8% of African Americans. C. approximately 4% of Latinos. D. approximately 12% of Native Americans. xix. Patient education for iron supplementation administration to improve efficacy 18-70 Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? A. Obtain a lead level B. Instruct Tina’s parents to increase the amount of milk in her diet C. Start Tina on ferrous sulfate (Feosol) and check the CBC in 6 weeks D. Recheck the CBC on this visit. 98 Food sources rich in iron include A. potatoes; bananas; and green, leafy vegetables. B. enriched grain cereals, cabbage, and sweet potatoes. C. liver, red meats, prunes, apples, and raisins. D. enriched grain cereals, strawberries, watermelon, and honeydew melons. 18-57 Sandra, age 19, is pregnant. She is complaining of breathlessness, tiredness, weakness, and is pale. After diagnosing anemia, you order medication and tell her to take it A. only with meals because it can be irritating to the stomach. B. in the morning if she experiences morning sickness. C. 1 hour before eating or between meals. D. at bedtime. xx. Risks, diagnosis, and treatment of hematological disorders 18-36 You have a new client, Robert, age 67, who presents with a generalized lymphadenopathy. You know that this is indicative of A. disseminated malignancy, particularly of the hematological system. B. cancer of the liver. C. Sjögren’s syndrome. D.
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pancreatic cancer. 18-51 Systemic lupus erythematosus (SLE) is diagnosed based on A. positive antinuclear antibody (ANA), malar rash, and photosensitivity. B. positive ANA, weight loss, and night sweats. C. negative ANA, photosensitivity, and renal disease. D. leukopenia, negative ANA, and photosensitivity. 18-91 Mandy, age 18, has infectious mononucleosis. What might you expect her blood work to reflect? A. Thrombocytopenia and elevated transaminase B. Elevated white blood cells (WBCs) C. Decreased WBCs D. Decreased serum globulins xxi. Common types of leukemia 6-39 Which of the following conditions, which may be detected by a complete blood count, has sufficient prevalence to make early detection beneficial? A. Anemia B. Leukocytosis C. Thrombocytopenia D. Leukemia 10- 60 Which of the following individuals most likely will have a false-negative reaction to the Mantoux test? A. Marvin, age 57 B. Jane, who is on a short course of corticosteroid therapy for an acute exacerbation of asthma C. Jerry, who has lymphoid leukemia D. Mary, who recently was exposed to someone coughing
