Chapter 5: Symptoms and Syndromes
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Q1) Atypical presentation of acute coronary syndrome is:
A) Most common in Hispanic females
B) More common in men
C) Most common in African American men
D) More common in females
Q2) Drug-induced pruritus is distinguished because it:
A) Occurs soon after a new drug is taken
B) Usually is a generalized rash
C) May occur right after the drug is taken or months later
D) Usually involves localized circumscribed lesions
Q3) The term "geriatric syndrome" is best described as:
A) A condition that has multiple underlying factors and involves multiple systems
B) A condition that has a discreet etiology that is difficult to pinpoint
C) Significant progress has been made in understanding geriatric syndromes,especially falls and delirium
D) Therapeutic management of a geriatric syndrome can be accomplished once a specific diagnosis is made
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Chapter 6: Skin and Lymphatic Disorders
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Q1) A smooth round nodule with a pearly gray border and central induration best describes which skin lesion?
A) Seborrheic keratosis
B) Malignant melanoma
C) Herpes zoster
D) Basal cell carcinoma
Q2) A hyperkeratatotic nodule formed as the result of exposure of the foot to moisture from perspiration is called:
A) Hard corn
B) Tinea pedis
C) Soft corn
D) Plantar warts (verrucae)
Q3) Which of the following dermatological conditions results from reactivation of the dormant varicella virus?
A) Tinea versicolor
B) Seborrheic keratosis
C) Verruca
D) Herpes zoster
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Chapter 7: Head, neck, and Face Disorders
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Q1) One of the first-line treatments in patients with allergic rhinitis is the use of nasal corticosteroid sprays.What is the anticipated onset of symptom relief with the use of these medications?
A) Two weeks or more
B) Immediate
C) 1 to 2 days
D) A minimum of one week
Q2) Clinical findings in patients with nonproliferation retinopathy include:
A) Cotton wool spots
B) Microaneursyms
C) Deep hemorrhages
D) Neovascularization
Q3) Which of the following conditions is the leading cause of blindness in the United States?
A) Macular degeneration
B) Diabetic retinopathy
C) Glaucoma
D) Cataracts
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Chapter 8: Chest Disorders
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Q1) Aortic regurgitation requires medical treatment for early signs of CHF with:
A) Beta blockers
B) ACE inhibitors
C) Surgery
D) Hospitalization
Q2) Which test is the clinical standard for the assessment of aortic stenosis?
A) Cardiac catheterization
B) Stress test
C) Chest x-ray
D) Echocardiography
Q3) A key symptom of ischemic heart disease is chest pain.However,angina equivalents may include exertional dyspnea.Angina equivalents are important because:
A) Women with ischemic heart disease many times do not present with chest pain
B) Some patients may have no symptoms or atypical symptoms.Diagnosis may only be made at the time of an actual myocardial infarction
C) Elderly patients have the most severe symptoms
D) A & B only
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Chapter 9: Peripheral Vascular Disorders
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Q1) Home exercise programs for peripheral arterial disease focus on:
A) Walk until pain develops then stop
B) Walk through the pain then stop
C) Begin at a slow speed with 10 minutes a day and build up to 30 minutes
D) Walk through the pain,rest until it goes away,then resume walking
Q2) The most common cause of secondary lymphedema is:
A) Surgery
B) Cancer treatment
C) Infection
D) Trauma
Q3) The majority of abdominal aortic aneurysms are due to:
A) Trauma
B) Infection
C) Inflammation
D) Atherosclerosis
Q4) The initial treatment for symptomatic abdominal aortic aneurysm involves:
A) Emergency surgery
B) Aggressive blood pressure control
C) Watch-and-wait approach
D) Cardiology consult
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Chapter 10: Abdominal Disorders
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Q1) An obese middle-aged client presents with a month of nonproductive irritating cough without fever.He also reports occasional morning hoarseness.What should the differential include?
A) Atypical pneumonia
B) Peptic ulcer disease
C) Gastroesophageal reflux
D) Mononucleosis (Epstein-Barr)
Q2) In differentiating a gastric ulcer from a duodenal ulcer,you know that each type of ulcer can present with distinct signs and symptoms.Which of the following pieces of information from the patient's history is the least useful for you to determine that the patient has a duodenal ulcer?
A) Pain occurs on an empty stomach
B) Diffuse epigastric pain
C) Rarely associated with non-steroidal use
D) Occurs in patients under 40 years of age
Q3) A clinical clue for suspected renal artery stenosis would be:
A) Decreased urine output
B) Development of resistant hypertension in a previously well-controlled patient
C) Retroperitoneal pain on the affected side
D) Rising BUN level with normal creatinine level
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Chapter 11: Urological and Gynecological Disorders
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Q1) Mrs.Smith,a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia.She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid.Her mother had a hip fracture at 82 years of age.The patient's most recent mammogram was 5 years ago and no known family history of breast cancer.She is not taking any medications.Her physical examination is unremarkable except for findings consistent with atrophic vaginitis.You decide to begin topical hormone replacement therapy.Which of the following evaluations would be necessary prior to initiating hormone replacement therapy?
A) Mammogram
B) Endometrial biopsy
C) Bone mineral density measurement
D) Papanicolaou smear
Q2) A pelvic mass in a postmenopausal woman:
A) is most commonly due to uterine fibroids.
B) is always symptomatic.
C) is highly suspicious for ovarian cancer.
D) should be monitored over a period of time.
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Page 13
Chapter 12: Musculoskeletal Disorders
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Q1) The best method of verifying a diagnosis of gout in a joint is which of the following:
A) Radiographic examination of the joint with two views
B) Ultrasound
C) Palpation
D) Joint aspiration and polarized-light microscopy
Q2) You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA).Which of the following two symptoms are most indicative of GCA and PMR?
A) Jaw pain and heart murmur
B) Joint swelling and sudden loss of central vision bilaterally
C) Hoarseness and the total inability to grasp small objects
D) Scalp tenderness and aching in shoulder and pelvic girdle
Q3) When examining the spine of an older adult you notice a curvature with a sharp angle.This is referred to as a:
A) Gibbus
B) Scoliosis
C) Kyphosis
D) Lordosis
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Chapter 13: Central and Peripheral Nervous System Disorders
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Q1) When assessing an elderly client who reports a tremor,which assessment findings would be most reliable in identifying Parkinson's disease?
A) Any presence of tremor
B) Symptoms of slowed movement,unstable angina,and tremor
C) Resting tremor,slow unsteady gait,and cogwheel resistance
D) Cogwheel rigidity,bradykinesia,and amnesia
Q2) A 78-year-old man with Parkinson's disease is being cared for in a nursing home.The nurses observe that he coughs at mealtime;he has the ability to still feed himself with adaptive equipment.He has had no aspirations.Oral exam is normal,except during his swallowing assessment you note there is slight delayed elicitation.You assess that he has only mild dysphagia.You recommend which of the following as the next step in his care?
A) Consult gastroenterologist for g-tube decision
B) Consult speech pathologist for video fluoroscopy
C) Provide a trial of foods of differing consistency
D) Require that he is fed all his meals
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Page 15
Chapter 14: Endocrine, metabolic, and Nutritional Disorders
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Q1) A postmenopausal woman with osteoporosis is taking a bisphosphonate daily by mouth.What action information statement would indicate the patient understood the nurse practitioner's instructions regarding this medication?
A) Takes medication at bedtime with a full glass of water
B) Takes medication with a full glass of water when up in a.m.30 minutes prior to other food and medications
C) Takes medication when up in a.m.with a glass of orange juice to increase absorption
D) Takes medication sitting up and with a meal to avoid gastrointestinal distress
Q2) A 62-year-old female complains of fatigue and lack of energy.Constipation has increased and the patient has gained ten pounds in the past 3 months.Depression is denied although the patient reports a lack of interest in usual hobbies.Vital signs are within normal limits and the patient's skin is dry and cool.Which of the following must be included in the differential?
A) Hyperthyroidism
B) Hypothyroidism
C) Hyperparathyroidism
D) Grave's disease
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Chapter 15: Hematological and Immune System Disorders
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Q1) In the older adult,which group comprises the highest rate of HIV/AIDS?
A) African American women
B) African American men
C) Hispanic women
D) Hispanic men
Q2) You are prescribing oral iron therapy for a patient with IDA.In teaching your patient about iron therapy,all of the following instructions should be reviewed except:
A) Iron is best taken on an empty stomach one hour before meals
B) Meat,fish,poultry,beans,and green leafy vegetables are good dietary sources of iron
C) Adding vitamin D daily enhances absorption of iron
D) Common GI side effects of iron therapy include constipation,nausea,and black stools
Q3) The main focus of treatment of patients with ACD is:
A) Replenishing iron stores
B) Providing for adequate nutrition high in iron
C) Management of the underlying disorder
D) Administration of monthly vitamin B<sub>12</sub> injections
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Chapter 16: Psychological Disorders
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Q1) The majority of depressed older adults remain untreated because of:
A) Misdiagnosis
B) Social stigma
C) Environmental barriers
D) All of the above
Q2) The proposed mechanism by which diphenhydramine causes delirium is:
A) Serotinergic effects
B) Dopaminergic effects
C) Gabanergic effects
D) Anticholinergic effects
Q3) The justification for ordering a CBC,TSH,and serum B12 for a patient you suspect may have clinical depression is:
A) To determine the cause of sadness
B) Because of overlapping symptoms with anemia,thyroid dysfunction,and nutritional deficiencies
C) To differentiate between depression and metabolic disorders
D) To rule out vascular disease
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Chapter 17: Nutritional Support in the Older Adult
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Q1) Which of the following nutritional indicators is not an indication of poor nutritional status in an older person?
A) Albumin of <3.5 g/dl
B) Body mass index of 24
C) Total cholesterol <150 mg/dl
D) Loss of 5-10% body weight in 180 days
Q2) Patients at risk of Refeeding Syndrome include those with:
A) No food intake for more than 10 days
B) Chronic malnutrition
C) Dysphagia
D) All of the above
Q3) Feedings via PEG tube can safely begin hours after PEG tube placement,barring any contraindications.
A) 2 hours
B) 6 hours
C) 24 hours
D) 48 hours
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Chapter 18: Chronic Illness and the Advanced Practice
Registered Nurse Aprn
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Sample Questions
Q1) Inter-professional care is distinguished from other models of team-based care in that:
A) Independent providers share information
B) Expert advice is shared from one provider to another
C) Different disciplines work under one leader
D) Shared leadership and accountability is a primary focus
Q2) The legislation signed in March 2010 with provisions for addressing chronic disease was:
A) Accountable Care Organization Act
B) Independence at Home Act
C) Patient Protection and Affordable Care Act
D) Patient Centered Medical Home Act
Q3) Reported outcome measures for the Patient Centered Medical Home include all of the following except:
A) Emergency room use
B) Hospitalizations
C) Patient/family satisfaction
D) Number of primary care visits
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Chapter 19: Palliative Care and End-Of-Life Care
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Q1) Delirium is typically characterized by all of the following except:
A) Inattention
B) Hyperactive level of psychomotor activity
C) Disorganized thinking
D) Altered level of consciousness
Q2) Hospice care differs from palliative care in that:
A) It is not covered by insurance
B) Supports patients and families through both the dying and the bereavement process
C) It cannot be provided in the nursing home
D) The majority of those admitted to hospice die within 7 days
Q3) The first step in treating delirium is to:
A) Give low-dose Haldol if the patient has psychosis
B) Identify the cause
C) Provide reality orientation
D) Use side rails and/or wrist restraints to keep the patient safe
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