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NURS 552-1 Primary Health Care
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Which of the following best describes asthma? A. Intermittent airway inflammation with occasional bronchospasm B. A disease of bronchospasm that leads to airway inflammation C. Chronic airway inflammation with superimposed bronchospasm D. Relatively fixed airway constriction - ANSWER -C. Chronic airway inflammation with superimposed bronchospasm The patient you are evaluating is having an asthma flare. You have assessed that his condition is appropriate for office treatment. You expect to find the following on physical exam: A. Tripod posture B. Inspiratory crackles C. Increased vocal fremitus D. Hyperresonance on thoracic percussion - ANSWER -D. Hyperresonance on thoracic percussion A 44-year-old man has a long-standing history of moderate persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff twice a day, and the use of albuterol one to two times a week as needed for wheezing. Three days ago, he developed a sore throat, clear nasal discharge, body aches, and a cough with a small amount of white sputum production. In the past 24 hours, he has had intermittent wheezing that necessitated the use of albuterol, two puffs, every 3 hours, which produced partial relief. Your next most appropriate action is to obtain a: A. Chest radiograph B. Measurement of oxygen saturation (SaO2) C. Spirometry measurement
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D. Sputum smear for WBCs - ANSWER -C. Spirometry measurement You examine Jane, a 24-year-old woman who has an acute asthma flare following a 3-day history of upper respiratory tract symptoms (clear nasal drainage, dry cough, no fever). She has a history of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PED). She is using budesonide (Pulmicort) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home, her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 second (FEV1) is 65% of predicted. Her medication regimen should be adjusted to include: A. Oral theophylline B. Inhale salmeterol (Serevent) via MDI C. Oral prednisone D. Oral montelukast (Singulair) For Jane in the previous question, the NP also considers prescribing: A. A 10-day course of oral amoxicillin B. A 5-day course of oral azithromycin C. A 14-day course of levofloxacin D. No antimicrobial therapy - ANSWER -C. Oral prednisone D. No antimicrobial therapy Which of the following describes a PEF meter? A. Should only be used in the presence of a medical professional B. Provides convenient method to check expiratory air flow at home C. Is as accurate as spirometry
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The cornerstone of moderate persistent asthma controller drug therapy is the use of: A. Oral theophylline B. Inhaled mast cell stabilizers C. Inhaled SABAs D. ICSs - ANSWER -D. ICSs Sharon is a 29-year-old woman with moderate persistent asthma. She has a prescription for an ICS that she does not use, stating, "I'm finding that the albuterol works better." Currently she uses about two albuterol metered-dose inhalers per month, "that keeps my cough and wheeze under control." She is requesting a prescription refill. You consider that: A. Her asthma is well controlled, and albuterol use can continue B. Excessive albuterol use is a risk factor for asthma death C. Her asthma is not well controlled, and salmeterol (Serevent) should be added to relieve bronchospasm and reduce her albuterol use D. Her asthma has better control with albuterol than ICSs - ANSWER -B. Excessive albuterol use is a risk factor for asthma death In the treatment of asthma, an LTM should be used as a: A. Controller to prevent bronchospasm B. Controller to inhibit inflammatory responses C. Reliever to treat acute bronchospasm D. Reliever to treat inflammation - ANSWER -B. Controller to inhibit inflammatory responses Which of the following is not a risk for asthma death? A. Hospitalization or an emergency department visit for asthma in the past month
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B. Current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids C. Difficulty perceiving airflow obstruction or its severity D. Rural residence - ANSWER -D. Rural residence An 18-year-old high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate action is to: A. Write the note because gym class participation could trigger asthma symptoms B. Excuse him from outdoor activities only to avoid pollen exposure C. Assess his level of asthma control and make changes in his treatment plan if needed so he can participate D. Write a note excusing him from gym until his follow-up examination in 2 months - ANSWER -C. Assess his level of asthma control and make changes in his treatment plan if needed so he can participate You see a 34-year-old man with moderate persistent asthma who has an asthma flare, and a regimen of oral prednisone is prescribed for 7 days. Which of the following is true? A. A taper is needed for prednisone therapy lasting longer than 4 days B. A taper is not needed if the prednisone regimen is usually for 14 days or less C. A taper is not needed regardless of duration of prednisone therapy D. A taper is needed if the patient is taking concomitant ICSs - ANSWER -B. A taper is not needed if the prednisone regimen is usually for 14 days or less After ICS is initiated, improvement in control is usually seen: A. On the first day of use B. Within 2 to 8 days C. In about 3 to 4 weeks D. In about 1 to 2 months - ANSWER -B. Within 2 to 8 days
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D. Wheezing with and without associated respiratory infections - ANSWER -C. A congested cough that is worse during the day Which of the following best describes the mechanism of action of SABAs? A. Reducer of inflammation B. Inhibition of secretions C. Modification of leukotriene action D. Smooth muscle relaxation - ANSWER -D. Smooth muscle relaxation Regarding the use of LABAs, which of the following is false? A. LABAs enhance the anti-inflammatory action of corticosteroids B. Use of LABAs is associated with an increase in the risk of asthma death C. Adding a LABA to an ICS can be considered to enhance asthma control D. LABAs should not be used as monotherapy to relieve bronchospasms in asthma - ANSWER -B. Use of LABAs is associated with an increase in the risk of asthma death Which of the following is the therapeutic objective of using inhaled SAMA? A. As an anti-inflammatory B. To increase vagal tone in the airway C. As a bronchodilator D. As a mucolytic - ANSWER -C. As a bronchodilator Which of the following is true regarding the use of systemic corticosteroids in the treatment of asthma? A. Frequent short bursts are preferred over daily ICSs
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B. The OCS should be started at days 3 to 4 of the asthma flare for optimal effect C. The oral route is preferred over parenteral therapy in most patients D. The adult dose to treat an asthma flare should not exceed the equivalent of prednisone 40 mg daily - ANSWER - C. The oral route is preferred over parenteral therapy in most patients Concerning LABA use, the NP realizes that LABAs: A. Are recommended as a first-line therapy in mild intermittent asthma B. Have a significantly different pharmacodynamic profile when compared with SABAs C. Have the most rapid onset of action across the drug class D. Should be added to therapy only when ICS use does not provide adequate asthma control - ANSWER -D. Should be added to therapy only when ICS use does not provide adequate asthma control Which of the following statements is false regarding the use of biologics in the management of asthma? A. Their use is recommended for patients with mild persistent asthma to prevent asthma flares B. The medications are administered via IV infusion C. Labetolol indications are generally for patients with asthma that is poorly controlled despite active standard treatment D. Special evaluation is required prior to its use, and ongoing monitoring is needed during use - ANSWER -A. Their use is recommended for patients with mild persistent asthma to prevent asthma flares Immunotherapy is recommended for use in patients: A. With well-controlled asthma and infrequent exacerbations B. With allergic-based asthma C. With moderate persistent asthma who are intolerant of ICSs D. With poorly controlled asthma demonstrated by SABA use multiple times per day - ANSWER -B. With allergic- based asthma
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A. For 7 days B. For 2 to 4 weeks C. For 3 months D. Indefinitely - ANSWER -B. For 2 to 4 weeks For a patient presenting with an acute exacerbation, the goals of treatment include all of the following except: A. Restore lung function to baseline B. Relieve airflow obstruction C. Address underlying inflammation D. Relieve hypoxemia - ANSWER -A. Restore lung function to baseline A peak flow meter is used for patients who have: A. Chronic bronchitis B. Emphysema C. Pneumonia D. Asthma - ANSWER -D. Asthma A patient is diagnosed with new onset asthma. Which question is most important to ask when deciding on medication management? A. Do you smoke? B. How severe are your symptoms? C. How often do your symptoms occur? D. Do you ever wheeze? - ANSWER -C. How often do your symptoms occur?
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A patient with asthma should use his rescue inhaler "minimally," according to the National Asthma Education and Prevention Program: Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma from 2007. How often is "minimally"? A. Once monthly B. Once weekly C. Not more than twice weekly D. Not more than once daily - ANSWER -C. Not more than twice weekly A patient with asthma uses one puff twice daily of an inhaled steroid and has an albuterol inhaler for PRN use. He requests a refill on his albuterol inhaler. His last prescription was filled 5 weeks ago. What action by the NP is appropriate? A. Refill with albuterol only B. Prescribe a longer acting bronchodilator, continue the steroid C. Increase the dose of the inhaled steroid, refill the albuterol D. Prescribe a long-acting bronchodilator and increase the steroid - ANSWER -C. Increase the dose of the inhaled steroid, refill the albuterol Ms. Levine is a 48-year-old woman with HTN and depression, taking an oral angiotensin-converting enzyme (ACE) inhibitor and sertraline, presenting with a sudden left-sided headache that is most painful in and behind her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, with ciliary flush, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: A. Unilateral herpetic conjunctivitis B. Open-angle glaucoma (OAG) C. Angle-closure glaucoma D. Anterior uveitis - ANSWER -C. Angle-closure glaucoma In caring for Ms. Levine, the most appropriate next action is:
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C. To initiate treatment with a corticosteroid ophthalmic solution D. Immediate referral to an ophthalmologist - ANSWER -D. Immediate referral to an ophthalmologist A 29-year-old woman presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were "stuck together" this morning when she awoke. Examination reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU), and purulent eye discharge on the right only. This presentation is most consistent with: A. Suppurative or bacterial conjunctivitis B. Viral conjunctivitis C. Allergic conjunctivitis D. Mechanical injury - ANSWER -A. Suppurative or bacterial conjunctivitis A 39-year-old man presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by: A. A bacterium B. A virus C. An allergen D. An injury - ANSWER -C. An allergen Common causative organisms of acute suppurative or bacterial conjunctivitis include all of the following except: A. S aureus B. H influenzae C. S pneumoniae D. Pseudomonas aeruginosa - ANSWER -D. Pseudomonas aeruginosa
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Keeping in mind patterns of bacterial resistance, currently recommended treatment options in suppurative or bacterial conjunctivitis include an ophthalmological preparation containing: A. Tobramycin B. Levofloxacin C. Gentamicin D. Azithromycin - ANSWER -B. Levofloxacin Treatment options in acute and recurrent allergic conjunctivitis include all of the following except: A. Cromolyn ophthalmic drops B. Oral antihistamines C. Ophthalmological antihistamines D. Corticosteroid ophthalmic drops - ANSWER -D. Corticosteroid ophthalmic drops The most common virological cause of conjunctivitis is: A. Coronavirus B. Adenovirus C. Rhinovirus D. Human papillomavirus - ANSWER -B. Adenovirus Treatment of viral conjunctivitis can include: A. Moxifloxacin ophthalmic drops B. Polymyxin B ophthalmic drops C. Oral acyclovir D. Cool artificial tear solution - ANSWER -D. Cool artificial tear solution
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A. when she becomes sexually active B. at age 21 C. during her first pregnancy D. before birth control is prescribed - ANSWER -B. At age 21 Appropriate screening for a 70 yo female includes: Select one: A. vision and hearing B. bone density C. colonoscopy D. all of the above - ANSWER -D. All of the above Which of the following is usually viewed as the most cost-effective form of healthcare? Select one: A. primary prevention B. secondary prevention C. tertiary prevention D. cancer reduction measures - ANSWER -A. Primary prevention A 67 yo patient with COPD presents an immunization record that reflects having received the pneumococcal immunization when she was 60 years old. What statement reflects the current standard of practice? Select one: A. She should be revaccinated today. B. She should receive Pneumovax every 8 years. C. She should get vaccinated with Prevnar 13 for additional protection
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D. She does not need the vaccine. - ANSWER -C. She should get vaccinated with Prevnar 13 for additional protection All of the following statements are true regarding domestic abuse except: Select one: A. there is no delay in seeking medical treatment B. the pattern of injuries is inconsistent with the history reported C. injuries are usually in the central area of the body instead of extremities D. pregnant women have a higher risk of domestic abuse - ANSWER -A. There is no delay in seeking medical treatment Bone mineral density screening in women older than 65 years old is an example of: Select one: A. primary prevention B. secondary prevention C. tertiary prevention D. none of the above - ANSWER -B. secondary prevention A patient cut himself on a fence post working outside. He has not had a tetanus shot in more than 10 years. How long can he wait before getting one? Select one: A. 24 hours B. 48 hours C. 72 hours D. 5 days - ANSWER -C. 72 hours Which individuals does the USPSTF recommend screening for depression?
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A. fever, phyaryngitis, lymphadenopathy. B. fatigue, pharyngitis, fever. C. splenomegaly, fever, body aches. D. tonsillar exudates, lymphadenopathy, headache. - ANSWER -A. fever, phyaryngitis, lymphadenopathy A medication which should be avoided in patients with mononucleosis is: Select one: A. azithromycin. B. ampicillin. C. acetaminophen. D. topical lidocaine. - ANSWER -B. ampicillin An older adult has cerumen impaction in both ears. His hearing is diminished. This type of hearing loss is: Select one: A. sensorineural. B. conductive. C. presbycusis. D. cholesteatoma. - ANSWER -B. conductive Which statement about otitis media with effusion (OME) is correct? Select one: A. OME usually needs treatment with antibiotics. B. OME can precede or follow otitis media. C. Otitis media is far more common than OME. D. Otitis media and OME are usually associated with fever. - ANSWER -B. OME can precede or follow otitis media
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Atrophic macular degeneration is the leading cause of blindness in the elderly in the U.S. Which of the following statements is correct? Select one: A. it is a slow or sudden painless loss of central vision B. it is a slow or sudden painless loss of peripheral vision C. it is an occlusion of the central retinal vein causing degeneration of the macular area D. it is commonly caused by diabetic retinopathy - ANSWER -A. it is a slow or sudden painless loss of central vision A patient with fever and pharyngitis has a negative rapid strept test. A preliminary throat culture sent to the laboratory reveals "normal flora after 24 hours". The patient: Select one: A. probably has Strept and should be treated. B. probably has some bacterial pathogen. C. has a pharyngitis of undetermined etiology. D. should be treated with penicillin based on symptoms. - ANSWER -C. has a pharyngitis of undetermined etiology A patient is diagnosed with allergic rhinitis. Which symptom below is NOT associated with allergic rhinitis? Select one: A. Paroxysmal sneezing B. Rhinorrhea C. Nasal congestion D. Facial pain - ANSWER -D. Facial pain How would you grade tonsils that touch the uvula?
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