A 59 year old patients tells the nurse practitioner that he thinks he must
have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked.
A patient tells the nurse practitioner that she has had abdominal pain for the past week. What would be the best response by the nurse practitioner?
A) We'll talk more about that later in the interview."
B) "Have you ever had any children?"
C) "What have you had to eat in the last 4 hours?"
D) "Can you point to where it hurts?"
A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the following would be an appropriate response by the nurse to her statement?
A) "How does your family react to your pain?"
B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating."
D) "How would you say the pain affects your ability to do your daily activities?"
In recording the childhood illnesses of a patient who denies having had any, which of the following notes by the nurse would be most accurate?
A) Patient denies usual childhood illnesses.
B) Patient states he was a "very healthy" child.
C) Patient states sister had measles, but he didn't.
D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio.
A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information?
A) "Are you allergic to any other drugs?"
B) "How often have you received penicillin?"
C) "I'll write your allergy on your chart so you won't receive any."
D) "Please describe what happens to you when you take penicillin."
The nurse is taking a family history. Important diseases or problems to ask the patient about include:
A) emphysema.
B) head trauma.
C) mental illness.
D) fractured bones.
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to?
A) Chief complaint
B) Present illness
C) Personal and social history
D) Review of systems
Which of the following statements represents subjective data obtained from the patient regarding his skin?
A) Skin appears dry.
B) No obvious lesions
C) Denies color change
D) Lesion noted lateral aspect right arm
The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999."
A) Medical
B) Surgical
C) Obstetrics/gynecology
D) Psychiatric
During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse practitioner knows that this occurs because of a decrease in:
A) pigmentation
B) thyroid stimulating hormone
C) phagocytes
D) fungacytes
You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution
You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this?
A) macule
B) papule
C) vesicle
D) spider angioma
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter with damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?
A) Insect bites
B) Wheals, urticaria, or hives
C) Psoriasis
D) Purpura
Ethel is a 68 year old Caucasian female who is new to your area. She shows you multiple brown colored, flat lesions on her face, chest, and hands that have been present for years. You respond that these are likely:
A) solar lentigos
B) melanomas
C) keloids
D) fissures
A 27 year old female patient has three furuncles connected around a hair follicle. You use the following term in your charting:
A) nodules
B) carbuncle
C) macules
D) bulla
A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings?
A) Eczema
B) Pityriasis rosea
C) Psoriasis
D) Tinea infection
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview?
A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story.
B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport.
C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan.
D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.
A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely?
A) CN IX lesion on the left
B) CN X lesion on the left
C) CN IX lesion on the right
D) CN X lesion on the right
When performing posterior palpation of the thyroid gland, you should do all fo the following, EXCEPT:
A) Have the patient tip his or her head forward and slightly to the side.
B) Place your index fingers above the cricoid cartilage.
C) Palpate between the sternocleidomastoid muscle and the trachea for the lobes of the thyroid.
D) Move your fingers laterally to palpate for the thyroid lobes.
You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is NOT a component of guided questioning?
A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer.
B) Offering the patient multiple choices in order to clarify the character of the urinary symptoms she is experiencing.
C) Asking her to tell you what she means when she states that she has a urinary tract infection.
D) Directed questioning starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer.
Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?
A) Allow the patient to speak uninterrupted for the duration of the appointment.
B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.
Which of the following will help to optimize success from a pediatric examination?
A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc.
B) Being very orderly, so as not to miss a portion of the examination.
C) Using firmness throughout your examination, letting the child know you are in charge.
D) Making sure to place the infant on the table during the examination while Mom watches close by.
A patient has come in for an examination and states, "I have this spot in front of my ear lobe here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his:
A) occipital node
B) thyroid gland
C) parotid gland
D) none of the above
All of the following are a common or concerning symptom in a health history for a respiratory assessment EXCEPT?
A) palpitations
B) blood-streaked sputum
C) chest pain
D) snoring
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion
The nurse practitioner is performing an eye examination using the ophthalmoscope. Which component is NOT part of the ophthalmoscope?
A) lens disc
B) aperature
C) indicator of diopters
D) speculum
A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage
The nurse practitioner is reviewing for a class in age-related changes in the eye. Which of these physiological changes is responsible for presbyopia?
A) degeneration of the cornea
B) decreased adaptation to darkness
C) decreased distance vision abilities
D) loss of lens elasticity
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem?
A) You are an alcoholic, aren't you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
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