Midterm Exam: NR511/ NR 511 (Latest 2024/ 2025 Update) Differential Diagnosis & Primary Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain

Midterm Exam: NR511/ NR 511 (Latest
2024/ 2025 Update) Differential Diagnosis &
Primary Care Review| Questions and
Verified Answers| 100% Correct |Grade A –
Chamberlain
Q: Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical.
During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of
the tongue that you suspect to be cancerous. You document your finding as
Answer:
A white, painless, firm, ulcerated lesion with indurated borders
Q: Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin
within these oval patches of hair loss is very smooth. Ta- pered hairs that resemble exclamation
points are seen at the margin of a patch of hair loss. Based on these findings, you suspect
Maryann has
Answer:
Alopecia areata The findings are consistent with alopecia areata, ie, nonscarring hair loss
of rapid onset,
the pattern of which is most commonly sharply defined round or oval patches.
Q: Which of the following is not a complication of group a strep
hemolytic anemia glomerular nephritis
Answer:
Q: Which of the following is an example of conductive hearing loss?

Answer:
Serous
OM
Q: Medical coding is the process of submitting and following up on claims made to the payer in
order
Answer:
Coding is done in order to process demographic, insurance, … number as shown on insured’s ID
card for the payer to whom the claim is being submitted.
Q: Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on
his leather jacket. He recalls having a slightly similar rash 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?
Answer:
Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
Q: Which of the following is a non systemic non scarring cause of alopeciaAnswer:
alopecia areata
Q: a clinician diagnoses an 18 year old female with extensive poison ivy on the face, neck and
eye, what are the
best treatment options?
corticosteroids antihistamine prednisone
Answer:

Q: WHICH OF THE FOLLOWING PATIENTS SHOULD BE REFERRED TO AN ENT
SPECIALIST?
Answer:
d. a girl with tympanic rupture
Q: Which of the following medications is a treatment for alopecia
Answer:
minoxidil
Q: A screening test identified correctly identified 80 individuals who did not have colon cancer
out of 100 individuals that were known to be free of the disease (true negatives). Thus, the test
failed to recognize 20 individuals who did not have colon cancer. What is the specificity of the
screening test?
Answer:
80%
Q: The OLDCARTS Mnemonic is best used in which part of the chart note.
Answer:
–
History of present illness. (HPI)
Q: Three elements needed to determine the level of complexity including risk, diagnosis and…
Answer:
Data

Q: Which of the following is a subjective finding?
Answer:
SOB Pain
Q: Which of the following demonstrates an objective finding?
Answer:
Respiratory rate
Q: Which of the following statements regarding the patient histories is true?-
Answer:
c. The HP is a detailed breakdown of the patients chief complaint
Q: -Which of the following statements does not belong in the past medical history portion of
your chart note?
Answer:
Your patient had lab work done at their last appointment; CBC was normal
Q: In relation to writing a patient encounter note, the acronym SOAP stands for which of the
following?
Answer:
Subjective, objective, assessment, plan
Q: BILLING
Q: What must you do as an advanced practice registered nurse (APRN) before billing for visits?
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what is the sensitivity of the Prostate Specific Antigen (PSA) for detecting prostate cancer?

men with prostate cancer

men with positive PSA

160

men with negative PSA

40

total

200

The correct answer is 160/200. Sensitivity is the proportion of patients with the disease that have a positive result; it is the number of true positives divided by the total number of patients who have the disease.

A diagnostic test is used in a sample of 1000 patients. 500 of these patients have the disease, while 500 do not. Of those 500 patients without the disease, 30 test positive, and 470 test negative. What is the specificity of the test?
The correct answer is 470/500.

Specificity is the proportion of patients who test negative out of the total number of patients who do not have the disease; it is the number of true negatives overall negatives. In this example, 500/1000 patients have the disease. Of those 500 patients without the disease, 30 test positive, and 470 test negative.

The Positive Predictive Value (PPV) of a test refers to which of the following?
the proportion of patients with a positive test who have the disease.

Which of the following depends on the prevalence of the disease?
positive predictive value.

Predictive values depend on the prevalence of disease in the population whereas sensitivity and specificity are intrinsic properties of the test. Reliability refers to the consistency or stability of a measure.

A low pretest probability of disease may lead to which of the following?
low positive predictive value and more false-positive results.

Positive predictive value increases with prevalence; therefore, a low prevalence value yields a low positive predictive value and implies a high false-positive rate. Negative predictive value decreases with prevalence, and sensitivity and specificity do not vary with prevalence.

If you strongly suspect that a patient is positive for a specific condition but tests negative, the negative result may be:
false-negative test results due to a low negative predictive value.

At the individual level, your clinical suspicion is equivalent to pre-test probability and high prevalence at the population level. Negative predictive value is inversely correlated with prevalence; therefore, your clinical suspicion translates to a low negative predictive value, suggesting a false-negative test result.

Which test(s) provide data relevant to the chief complaint: Fever

CBC

Check CBC with differential for neutrophil shift in suspected infection

Which test(s) provide data relevant to the chief complaint: Unexplained bruising

CBC

Check platelet count

Which test(s) provide data relevant to the chief complaint: Fatigue

Both CBC and CMP

Check RBC, Hgb and Hct for anemia, CMP for potential liver or kidney abnormalities​

Which test(s) provide data relevant to the chief complaint: Cardiac dysrhythmias​

CMP

Monitor electrolytes for abnormalities​

Which test(s) provide data relevant to the chief complaint: Unexplained weight loss

Both CBC and CMP

Check WBC for inflammation or possible cancer, CMP for glucose, liver or kidney abnormalities​

Which test(s) provide data relevant to the chief complaint: Edema

CMP

Check for kidney function

What is SNAPPS?
Summarize the history and findings

Narrow the differential diagnosis to two or three possibilities

Analyze the differential by comparing and contrasting the possibilities

Probe the preceptor by asking questions about alternative approaches or uncertainties

Plan the management of the client’s health issues

Select an issue from the case for self-directed learning

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

Which of the following is the appropriate treatment for giardia
quin.hydr.

Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as:
A white, painless, firm, ulcerated lesion with indurated borders

Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin within these oval patches of hair loss is very smooth. Tapered hairs that resemble exclamation points are seen at the margin of a patch of hair loss. Based on these findings, you suspect Maryann has:
Alopecia areata The findings are consistent with alopecia areata, ie, nonscarring hair loss of rapid onset,
the pattern of which is most commonly sharply defined round or oval patches.

Which of the following is not a complication of group a strep

hemolytic anemia
glomerular nephritis

Which of the following is an example of conductive hearing loss?
Serous OM

Medical coding is the process of submitting and following up on claims made to the payer in order
Coding is done in order to process demographic, insurance, … number as shown on insured’s ID card for the payer to whom the claim is being submitted.

Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his leather jacket. He recalls having a slightly similar rash 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?
Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.

Which of the following is a non systemic non scarring cause of alopecia
alopecia areata

a clinician diagnoses an 18 year old female with extensive poison ivy on the face, neck and eye, what are the
best treatment options?

corticosteroids
antihistamine
prednisone

WHICH OF THE FOLLOWING PATIENTS SHOULD BE REFERRED TO AN ENT SPECIALIST?
d. a girl with tympanic rupture

Which of the following medications is a treatment for alopecia
minoxidil

A screening test identified correctly identified 80 individuals who did not have colon cancer out of 100 individuals that were known to be free of the disease (true negatives). Thus, the test failed to recognize 20 individuals who did not have colon cancer. What is the specificity of the screening test?
80%

HPI

….

The OLDCARTS Mnemonic is best used in which part of the chart note.
History of present illness. (HPI)

Three elements needed to determine the level of complexity including risk, diagnosis and…
Data

Which of the following is a subjective finding?
SOB
Pain

Which of the following demonstrates an objective finding?
Respiratory rate

Which of the following statements regarding the patient histories is true?
c. The HP is a detailed breakdown of the patients chief complaint

-Which of the following statements does not belong in the past medical history portion of your chart note?
Your patient had lab work done at their last appointment; CBC was normal

In relation to writing a patient encounter note, the acronym SOAP stands for which of the following?
Subjective, objective, assessment, plan

BILLING

What must you do as an advanced practice registered nurse (APRN) before billing for visits?
Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer

Which of the following statements about Medicaid is true?
Medicaid is a program for the indigent financed jointly by the federal and state governments

Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. What does this mean?
The HMO reimburses the provider a predetermined fee per client per month based on the client’s age and sex

AHRQ (Agency for Healthcare Research and Quality) was established to..
Produce evidence to make healthcare more accessible and affordable.
improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

What is an Accountable Care Organization (ACO)?
A group of providers and suppliers who come together voluntarily to give coordinated, high-quality care to Medicare patients

The Affordable Care Act (ACA) which passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health insurance exchange is to:
Create an online marketplace for the sale and purchase of health insurance for consumers

Medicare

Medicare part A covers which of the following services:

C. Hospital Services

How do Most clients on traditional Medicare cover their out-of-pocket expenses?
Acquiring a secondary insurance plan.

Which part of Medicare covers outpatient services?
Medicare Part B.

The term indemnity insurer refers to an insurer:
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)

Which of the following is true regarding the payment of nurse practitioners by the Centers for Medicare and Medicaid Services (CMS)
NPs are reimbursed at 85% of the physician fee.

Which of the following in his example of a third-party payer?
Veterans administration.

SKIN INFECTIONS

…

A 69 YEAR old female is complaining of dry skin, what should the clinician advise
Bathe or shower with lukewarm water and use a mild soap or skin cleanser. If a client is complaining of dry skin, the client should use tepid water and a mild cleansing cream or soap.

You’re teaching Mitch, age 18, about his tinea pedis. You know he doesn’t understand your directions when he tells you which of the following?
False “I should wear rubber shoes in the shower to prevent transmission to others.” true May return

a 21 year old male presents to the clinic with pruritic and emacerated skin in the groin area. Which is this?
tinea cruris

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.
It may exacerbate your concurrent tinea corporis

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?
Tinea versicolor.

A 45-year-old client with a history of a total thyroidectomy comes to the office concerned with a rash. That has developed around a new tracheostomy site. Upon exam, the NP notes a papular rash. With satellite lesions surrounding the stoma. What does this indicate?
A fungal infection

Buddy, age 13, presents with annular lesions with scaly borders and central clearing on his trunk. What do
you suspect?
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

Which of the following medications are commonly used to treat onychomycosis (fungal infection of the nail)?

Terbinafine

47 year old male patient with diabetes presents with a rash on his penis. Based on hx alone, the clinician knows the patient is at risk for?
Candida

Candidias may occur in many parts of the body. In the penis it is known as
candida balantis

Rash initially started on her abdomen as a solid itchy round patch, which developed to arms and back of legs
pityriasis rosea

Michael, a 25-year-old military reservist, presents to your clinic for a rash that began on his chest and has since developed into smaller lesions that are more concentrated on the lower abdomen and pubic area. In obtaining a history of the present illness, he reports that he had an upper respiratory infection 1 month before the rash developed. He tells you it started with 1 large oval-shaped lesion on his left chest, and 1 to 2 weeks later he developed numerous smaller lesions on the lower abdomen and groin. It has been 2 weeks since the smaller lesions developed, and he tells you he is concerned that the rash isn’t improving. As you examine the patient, you note that the lesions are salmon-colored and have a thin collarette of scale within them. The original lesion is still present. You suspect Michael has:
Pityriasis rosea. Pityriasis rosea is a common, self
-limiting, usually asymptomatic eruption with a distinct
initial lesion. This “herald patch,” which appears suddenly and without symptoms, usually is on the chest or
back. Secondary lesions appear 1 to 2 weeks later while the herald patch remains.

Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael?
Swish and swallow the medication.” (When ordering nystatin (Mycostatin) for an oral fungal infection, tell
the client to swish the medication in the mouth to coat all the lesions and then to swallow it

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.

A client suffers a laceration of the Shin 3 days ago, and today presents with a painful, warm, red, swollen region around the area. The laceration has purulent exudate. What is the appropriate diagnosis for this client?
Cellulitis.

Which of the following is the most common? Causative pathogen for folliculitis.
Staphylococcus.

Which of the following information about Nonpharmacologic management should be included in parent teaching for a child with impetigo?
The goal is to debris the lesions and expose the skin surface where bacteria may be present.

A parent of a school age child reports spreading red, crusty rash on the face. The NP diagnosis the client with bulbous impetigo. Which of the following additional findings was most likely found on the assessment of a child?
Sore Throat?

A client has a tender, firm, nodular cyst lesion on his scalp that produces a cheesy discharge with foul odor. What is the most likely diagnosis?
Epidermal inclusion cyst

What is the most appropriate prescription for 29 year old female diagnosed with Urticaria?
Antihistamines

A 19-year-old with a rash recently underwent surgery of humoral head fraction and develops rash after PT/OT. What can it be?
contact dermatitis

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

Which condition is not included in the atopic triad?

Aspirin sensitivity

• Asthma
• Allergic Rhinitis
• Eczema
  Aspirin sensitivity

Which of the following is true regarding atopic dermatitis?
The client complaints of itching before the rash appears.

Where is a rash most likely to appear in children with atopic dermatitis.
Antecubital fossa.

Which of the following should be included in the teaching plan for a client with acne?
Wash the face gently at least twice a day with an antibacterial soap.

Which of the following is essential when considering prescribing a local retinoid for acne vulgaris?
Retnoids are not recommended for use in pregnancy unless otherwise stated

The NP is treating a 17 year old for acne. What teaching should be provided?
Sunscreen should be used with all acne medications.

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:
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.

Which of the following clients is best candidate for oral antibiotic treatment for acne?
Clients at risk for pigmentation changes or scarring.

Clients with severe nodulocystic acne.

Clients. who want quick relief from inflammatory acne.

All of the choices are correct.

which of the following is the mainstay treatment for rosacea?
Metronidazole cream (0.75-1%)

Which of the following should be included in the teaching plan for a client with rosacea?
Identify circumstances that trigger a rosacea flare up.

Apply sunscreen with a sun protection factor of 15.

Protect the face from cold air and wind.

All choices are correct

which of the following individuals is most at risk for developing seborrheic keratosis?
Older white women.

which of the following is true about seborrhea ketatosis?
It presents as superficial epithelial growths that originate from the horny layer of the epidermis.

Which of the following is an appropriate differential diagnosis for seborrhea keratosis.
Benign pigmented naevi.

Pigmented basal cell carcinoma.

Malignant Melanoma.

All choices are correct.

A 67 year old male client presents to the clinic with several lesions that appear to be actinic keratosis. Which of the following statements is true?
Sun exposure increases the characteristics of the actinic keratosis Lesions.

A 55-year-old landscaper presents to your primary care office complaining of a small skin lesion on his face. The patient states the lesion causes no pain or other symptoms. On physical exam, you notice a small (3 mm) papule that is flesh-colored and irregular. To palpation, the lesion feels hard and like sandpaper. What type of malignancy is this patient at risk for given the appearance of this lesion
Squamous Cell Carcinoma. The lesion described is an actinic keratosis, which is a premalignant lesion that
can progress to squamous cell carcinoma

A 70 year old female patient mentions she was just diagnosed with actinic keratosis… what should be said to
her
Actinic keratoses are wartlike growths on the skin that occur in middle-aged or older adults and are caused

by excessive exposure to the sun. Actinic keratosis is distributed on sun-exposed areas, such as the face,

head, neck, and dorsum of the hands, and appears as a poorly circumscribed, pink to red, slightly scaly

lesion

A client presents to the office with a complaint of skin irritation, redness, and tenderness on the back of his
neck. Examination reveals a rubbery., smooth, and round mass of tissue Fat is compressible and has a soft texture. What
is the most likely diagnosis?
Lipoma

Which of the following is the best systemic treatment for common scabies refactoring to topical treatment?
Ivermectin.

Which of the following is true regarding scabies
A diagnosis is almost never made until hypersensitivity occurs.

The classic scabby skin lesion is a 1-2mm Red crust.

The lesions are usually located in the areas of many hair follicles.

The lesions become less visible with treatment.

Which the following is the best way to differentiate between pediculosis (lice) And dandruff.
lice nits cement firmly in place on the hair shaft

An 11 year old is diagnosed with Pediculosis. And treatment is prescribed. What teaching is essential before the child and parent leave the office.
Expect itching to continue for up to a week after successful treatment.

A client presents with a complaint of swollen nodes under his arm. The area is tender, and the node has increased in size over the past few days. Which of the following should be included in the differential diagnosis?
Hidradenitis suppurotiva

The clinician is educating a 55 year old male about the warts on his hands; what should be included in on the teaching?
warts are caused by human papilloma virus

A rash that looks like the patient was slapped on the cheeks of the face is the hallmark characteristic for which disease?
erythema infectiosum

A 4-year-old presents to the clinic with his mother complaining of an itchy rash, mostly between his fingers. The rash has been present for days and has been getting worse. The patient recently started at a new day care. On physical exam, the patient is afebrile and has multiple small (1-2 mm) red papules in sets of 3 located in the web spaces between his fingers. He also has signs of excoriation. What is the treatment for this problem?
Permethrin lotion for the patient and family members

A 25-year-old male presents to urgent care complaining of genital pruritus. On physical exam, the patient has small, erythematous, excoriated papules in his pubic hair. No mites are identified. There is no penile discharge, and the patient has no constitutional symptoms. He is sexually active but wears condoms during all sexual experiences. What is the most likely diagnosis?
pediculosis –This is a common presentation of genital lice

Which of the following patients does not have an increased risk of candida infection?
A patient with a history of coronary artery disease

A 20-year-old presents to the office in the summer complaining of chest discoloration. He is a lifeguard and has been out in the sun without a shirt on for extended periods of time. His physical exam shows small, flat, circular, hypopigmented macules on his chest that he states are mildly pruritic. What is the treatment of choice for this diagnosis?
selenium sulfide shampoo

A 3-year-old patient presents to the office with her mother. She has recently started in day care. Her mother noted slight perioral erythema on the right side of the patient’s mouth last night before bed. The patient awoke today with 3 small, superficial, honey-colored vesicles in the location of the erythema. The patient has no surrounding erythema presently. She had no difficulty eating this morning and is active and energetic and does not appear lethargic or fatigued. She is afebrile. How would you treat this child?
local debridement and mupirocin for 5 days

A 22-year-old college student presents to the urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions?
Pseudomonas aeruginosa

A 27-year-old presents to the primary care office complaining of a perioral rash. The patient noticed burning around her lips a couple of days ago that quickly went away. She awoke from sleep yesterday and noticed a group of vesicles with erythematous bases where the burning had been before. There is no burning today. She is afebrile and has no difficulty eating or swallowing. What test would confirm her diagnosis?
Tzanck smear.

The “herald patch” is present in almost all cases of:
pityriasis rosea

Your patient accidentally cut his cheek while shaving 3 days ago. Today, the region is warm, erythematous, swollen, and has the appearance of an orange peel. There is a serous exudate coming from the wound. This is most likely due to:
cellulitis

EYE DISORDERS

…

which of the following are major characteristics of filiform/digitate warts?
They are easily treated but reoccur

Red conjunctiva and dendrite appearance on the cornea
HSV- may include oral acyclovir

Mother brings in 3 year old with red eye, and then it went to both eyes, goes to day care
viral conjunctivitis (Adenovirus) Any pre-auricular lymph node involvement is viral

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
-a 20 year old male with a non tender lump of eyelid
-a 31 yr old with mild subconjunctival hemmorhage
corneal abrasion

A 16-year-old client presents to the office with redness of the right eye. After diagnosing bacterial conjunctivitis. The NP should prescribe:
Gentamicin. Sulfate.0.03% ophthalmic

A 72-year-old client is experiencing a gradual blurring of the vision in both eyes, not associated with any pain. The NP. Suspects. The client is experiencing.
Cataracts

which is the most appropriate diagnosis for client who describes painless, blurry vision and being bothered by glare in response to bright lights and when driving at night.
Cataracts. age related

Blepharitis caused by
Staphylococcus

The NP has been treating a client for Staphylococcal blepharitis with bacitracin 0.5% Ointment. The client reports that the symptoms have not improved. What is the most appropriate change to the treatment plan?
Discontinue the bacitracin ointment and prescribe a quinolone Antibacterial ointment.

Painless mass on eyelid
chalazion

Which of the following individuals is at most risk for developing epiphora (Excessive, tearing.)?
A 76-year-old with Type 2 diabetes.

Which of the following is the appropriate treatment for epiphora (excessive tearing) due to trauma or infection
Topical antibiotics (Do not use anesthetic drops)

A 68 year old client reports a bright red spot located on the sclera of the right eye for five days. The client denies any trauma to the eye or headaches. His past medical history is unremarkable except for chronic Constipation treated with laxative as needed. Which of the following is the most likely diagnosis?
Subconjunctival hemorrhage

Self-care for dry eyes includes which of the following?
Wear goggles when swimming.

Use a preservative free artificial tears preparation.

Take frequent rest periods from computer and handheld electronic devices.

All choices are correct.

In addition to a slit lamp examination, what other diagnostic tests should be performed to diagnose dry eyes?
Schirmer test (test Visual acuity.)

Right eye pain, scratch on eye, what procedure should the clinician perform?
Flurosine test

What is the most likely diagnosis for a client who presents with localized eye tenderness, redness at the margin of the eyelid, and internal swelling?
Hordeolum (stye)

Ear, Nose and Throat Disorders

…

Which statement by the client indicates that additional teaching is needed for a client with acute sinusitis?
I can take acetaminophen to treat my discomfort.

I will drink a lot of juice and other fluids to stay well hydrated.

I can use my nasal decongestant spray until the congestion is all gone.

I will watch for changes in nasal secretions, or sputum that I cough up

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected?
Maxillary sinus

A 35-year-old client presents to the office with an upper respiratory infection for the last 10 days. Which of the following accompanying symptoms would confirm a diagnosis of sinusitis?
Facial pain and headache.

Otitis externa:
A classic sign of acute otitis externa is tenderness on traction of the pinna and/or pain on applying pressure over the tragus. There is typically an erythematous ear canal, and usually a history of recent swimming; important to dry out the ear

Acute otitis media:
ear infection; Diagnosis of acute otitis media is made by otoscopic examination. The tympanic membrane will appear red and bulging with or without visible effusion. Light reflex is usually diminished or absent. Mobility is decreased (not increased). The external auditory canal is red and erythematous; healthy pediatric clients with mild symptoms and no day-care attendance and no antibiotics within the past 90 days, the standard Amoxicillin dose is: 40-45 mg/kg/day PO in two divided doses for 10 days

should be seen for follow-up in 48 to 72 hours if symptoms have not resolved. Otherwise, a follow-up appointment may be scheduled several days after the completion of pharmacotherapy

•Impact of AOM on speech and language
-A change in hearing threshold greater than 25 dB and has speech and language delays would indicate more aggressive treatment is needed. Referral may be necessary

What is the standard dose of antibiotic for a healthy child with mild symptoms of otitis media who has no antibiotics in the past 90 days?
Amoxicillin 80-90 mg/kg/day po in 2 divided doses for 10 days

A 10-year-old client was prescribed amoxicillin for otitis media. The FNP receives a call. From the parents
that the client has developed a rash on the trunk. What is the most appropriate next activity by the FNP?
Stop the medication.

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:
Azithromycin (Zithromax) (Azithromycin is not a perfect option for treating otitis media; however, it
is
preferred for patients with severe penicillin allergy)

A 16-year-old client presents to the clinic with right ear pain for two days following participating in high
school swim meet. The eardrum demonstrates tenderness with traction of the pinna and tragus pain, when pressure is
applied. The ear canal is red and swollen to the point that the tympanic membrane cannot be visualized. Which of the
following is the most likely diagnosis?
Otitis externa. (swimmers ear)

What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral?
There is a change in the child’s hearing threshold to greater than 25 dB

which of the following is a differential diagnosis for conductive hearing loss?
Otitis externa

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?
Amoxicillin 80 to 90 mg/kg/d (This is the treatment of choice for acute otitis media)

A four-year-old child, complaints of right ear pain for three days that was resolved with acetaminophen. The pain was accompanied by fevers of 101.4. Over the last two nights. The child had a nonproductive cough for seven
days prior to the ear pain. The child attends daycare five days per week. The physical exam findings include. (-) Tenderness with tugging The Oracle of the ear; the tympanic membranes is erythematous and full on inspection and
immobile with pneumatic otoscopy; (-) drainage from the ear; (-) Mastoid tenderness. What is the appropriate next step?
Amoxicillin, 80 to 90 MG./Hg/day

a 12-year-old male presents to your pediatric clinic with swimmers ear (Otitis Externa). what is the causative agent?
Pseudomonas

What is the most common bacterial pathogen associated with acute otitis media?
Streptococcus pneumonia (This causes 40% to 50% of cases)

A parent of a 7-year-old child being treated for acute otitis media calls the office, after 48 hours of initiating treatment, to report that the child’s symptoms are still present. Which of the following is the NP’s best action?
Continue watchful waiting as the antibiotics have not had time to be effective.

Schedule a follow-up visit.

which of the following should the NP assess in a client diagnosed with open angle glaucoma?
Degree of vision loss

A 35 year old client presents to the office with right ear pain. The client recently flew back from vacation, and the NP diagnosis barotrauma to the right ear. What is the appropriate management plan?
Prescribe nasal steroids and oral decongestants.

Conductive hearing loss

•In conductive hearing loss, bone conduction is greater than air conduction, so the patient will report the bone conduction sound longer than the air conduction sound. Serous otitis media can result in conductive hearing loss. Produces a high-frequency hearing loss that is bilateral and symmetrical

Cerumen impaction

is the cause of a conductive hearing loss; differential diagnosis would be otitis externa

In the Weber test

•a vibrating tuning fork is placed on the top of the head equidistant from the patient’s ears. In the normal patient, the Weber tuning fork sound is heard equally loud in both ears. In a patient with conductive hearing loss the Weber tuning fork sound is heard louder in “bad” ear. In sensorineural hearing loss, the tuning fork is heard louder in the “good” ear.

A 72-year-old client presents with a sudden sense of sensorineural hearing loss. What is the most appropriate next action by the NP?
Refer to an otorhinolaryngologist

Which of the following Bedside tests can be performed to differentiate conductive from sensory neural hearing loss.
Sachabach test

What is the safest drug to prescribe for a 6 year old with a perforated and tempanic membrane?
Ciproloxin 0.3% and dexamethasone 0.1%

When performing an exam in the office setting to determine the cause of a clients hearing loss. Which test should be completed first?
Weber test.

Abnormal weber test finding
With conductive hearing loss

Which of the following is a characteristic finding associated with conductive hearing loss
Bone conduction is greater than air conduction (Rinne test)

Which of the following is not a cause of conductive hearing loss
Presbycusis (This is a cause of sensorineural hearing loss)

Which of the following is associated with presbycusis?
High frequency loss

Which of the following is a differential diagnosis for sensorineural hearing loss?
Meniere’s disease.

An 86-year-old client with poor hearing refuses to wear his hearing aid. Other than possible hearing aid malfunction, What is the most likely reason for not wearing the hearing aid?
Cerumen impaction.

Meniere syndrome
+
The symptomatic triad of episodic vertigo, __________and hearing loss occurring
secondary to other inner ear disorders
Tinnitus

which of the following is differential diagnosis for ear pain?
Cervical lymphadenopathy

A complete blood count (CBC) may identify which of the following as a cause of tinnitus.
Anemia.

A 55-year-old client presents to the office complaining of bilateral, high-pitched tinnitus. What is the best assessment to complete at this time?
Assessment of the client’s blood pressure.

Which of the following is associated with severe tinnitus?
Hypertension

Which of the following should the NP recommend to a client experiencing tinnitus?
Play background music during the daytime and before sleep.

A client complaints of fever, fatigue. And pharyngitis. On Physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered?
Monospot.

Strep test.

Throat culture.

All choices are correct.

A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most
likely diagnosis?
Mononucleosis (This presentation could be a viral pharyngitis; however, with posterior cervical
lymphadenitis, you would suspect mononucleosis

which of the following clinical findings is most significant when diagnosing mononucleosis?
Tender posterior cervical lymph node.

A 14 year old child is brought to the office by the parent with a complaint of sore throat., difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, in a temperature of 102. No pharyngeal edema or
cough is noted. What is the most likely diagnosis?
Epiglottitis

It is commonly caused by bacterial infection with Haemophilus influenzae type B (Hib) but can also be caused by other bacteria or viruses. Prompt medical attention is necessary in suspected cases of epiglottitis to ensure airway management

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
(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)

A client has a positive rapid strep test. Knowing nothing else, how likely is it that the client has strep pharyngitis?
The correct answer is cannot be determined from this information.

Without a pre-test probability the test result cannot be interpreted accurately.

Nasal discharge of green yellow mucus, pharyngitis, and otitis media commonly indicates which of the following diagnosis
Bacterial infection

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?
b. supportive care

You are assessing a first grader, and find that the tonsils are touching the uvula:
Grade 3 indicates the tonsils are touching the uvula. Tonsils are enlarged to 2, 3, or 4 with an acute

infection

(Grade 1 indicates the tonsils are visible)(Grade 2 indicates the tonsils are halfway between the tonsillar pillars and the uvula)

Allergic rhinitis is considered a type 1 hypersensitivity mediated by which of the following immunoglobulins
IGE

The ‘atopic triad” Includes asthma, eczema and which of the following?
Allergic rhinitis

Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis?
Allergic rhinitis (The symptoms of hay fever, also called allergic rhinitis, are similar to those of viral rhinitis

but usually persist and are seasonal in nature. When assessing the nasal mucosa, you will observe that the

turbinates are usually pale or violaceous because of venous engorgement)

(with viral rhinitis, the turbinates are typically erythematous) (With nasal polyps, there are usually yellowish,

boggy masses of hypertrophic mucosa)

A client comes into the clinic complaining of watering. Nasal drainage. Nasal congestion, and mouth Breathing. What is the most likely diagnosis?
Viral rhinitis.

A picture of pink eye

which of the following can be used to assist in sound clinical decision making?
Algorithm pushed in a peer reviewed journal article.

Clinical practice guidelines.

Evidence based research.

All answers are correct.

Which of the following statements regarding the client history is true?
History of present illness (HPI) Is a detailed breakdown of the client’s chief complaint.

What is the indication of a diagnostic study with high sensitivity?
High percentage of persons with the given condition will have an abnormal result

A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions?
Pseudomonas aeruginosa

A 10-year-old male presents to the office with his mother with complaints of itchy and red eyes for 1 day. He reports watery drainage in both eyes, associated with repetitive itching. He has no fever or constitutional symptoms. The patient has a sibling that just started day care recently. Upon examination, vision is 20/20 OU with glasses. He has mild to moderate conjunctival hyperemia with bilateral preauricular lymph nodes that are inflamed. What is the patient’s diagnosis?
Viral conjunctivitis.

A 25-year-old male presents with “bleeding in my eye” for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient’s sclera of the right eye only and takes up less than 50% of the eye. The patient’s remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment?
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks

Henry, 64 years old, is having difficulty getting rid of a corneal infection. He asks why. How do you respond?
Because the cornea doesn’t have a blood supply, an infection can’t be fought off as usual.

A rash that looks like the patient was slapped on the cheeks of the face is the hallmark characteristic for which disease?
Erythema infectiosum (fifth disease)

You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include:
Supportive measures and lubricating drops (artificial tears).

Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is:
A ciliary flush.–

ciliary flush present in iritis. Photophobia is not usually present in conjunctivitis, but it is always present with iritis.

Photophobia occurs with corneal inflammation, iritis, and angle-closure glaucoma

Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect:
Iritis.

Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “sunken in.” What do you suspect?
Normal age-related changes

Which of the following patients does not have an increased risk of Candida infection?

A patient with a history of coronary artery disease