PSI 2022/2023 Questions and Answers Passed with 100% Which of the following statements regarding depression in the elderly is correct? ✔✔Depression can be induced by prescribed and over-the-cou... nter medications. An adolescent presents for a preparticipation athletic examination. In determining clearance for participation in sports, which of the following should be considered? ✔✔Characteristics of the sport Research studies indicate that erectile dysfunction in geriatric patients is a common complication in: ✔✔vascular disease. The nurse practitioner would suspect which of the following persons to be at the highest risk for Rocky Mountain spotted fever? ✔✔Your answer: A 40-year-old male who is living in a wooded area raising dogs When completing the INITIAL assessment for depression in geriatric adults, the nurse practitioner should evaluate: ✔✔mental status examination Which of the following constellations of symptoms, lasting more than 3 months, is MOST common in fibromyalgia? ✔✔Diffuse pain, sleep abnormality, fatigue A frail elderly male patient complains of difficulty with urination. The International Prostate Symptom Score can assist with decisions regarding the diagnosis of benign prostatic hyperplasia. Which symptom is consistent with the items on this scale? ✔✔Nocturia Which trimester of pregnancy is a woman with a fundal height measurement at the umbilicus? ✔✔2nd trimester A nurse practitioner considering referral of a frail elderly patient for hospice care understands that: ✔✔Your answer: documentation of limited life expectancy is a prerequisite. Urinary and bowel dysfunction, saddle anesthesia, and leg weakness or foot drop are signs of: ✔✔Your answer: cauda equina syndrome Which of the following is the MOST common risk factor for developing severe hyperbilirubinemia in the newborn? ✔✔Blood incompatibility with the mother Acute otitis media has which of the following characteristics? ✔✔Loss of ossicular landmarks on the tympanic membrane The most common skin cancer is: ✔✔basal cell carcinoma In a 19-year-old who presents with a sore throat and anterior cervical adenopathy, which causative agent would be suspected? ✔✔Group A beta-hemolytic Streptococcus Which of the following conditions exacerbate urinary incontinence? ✔✔Impacted stool and atrophic vaginitis An adult patient presents with a 2-day history of intermittent stabbing chest pain that worsens with deep breaths. The patient reports a nonproductive cough and no fever for several days, and denies trauma, palpitations, or GI symptoms. T = 98.7°F (37°C), P = 88, R = 20/min, BP = 90/60 mm Hg. O2 Sat = 97%. Lungs are clear to auscultation, and heart sounds are a normal S1 and S2 without murmurs, clicks, or rubs. Physical examination reveals localized chest wall tenderness at the costal margin. An EKG shows normal sinus rhythm. Chest X-ray is normal. The most likely diagnosis is: ✔✔costochondritis A geriatric patient who has a 40 pack-year smoking history complains of painful cramping in the leg muscles that occurs after walking for 20 minutes. After taking a complete history and performing a physical examination, a nurse practitioner decides that the most likely diagnosis is: ✔✔Intermittent claudification An adult male is seen for an initial visit. He denies tobacco, drug, or alcohol use. He has a sedentary lifestyle and no family history of diabetes. BP = 120/80, P = 76, and BMI = 31. Which of the following diabetes screening tests would a nurse practitioner order? ✔✔FPG Which of the following neurological signs are characteristic of the patient with Alzheimer's disease? ✔✔Your answer: Gait disorder and impaired stereognosis The best medication for a patient who complains of irritable bowel syndrome with cramping is ✔✔dicyclomine (Bentyl). Major causes of CKD are ✔✔Correct answer: amyloidosis and systemic lupus erythematosus Which of the following conditions is a risk factor for development of deep vein thromboembolism and pulmonary embolism? ✔✔Visceral malignancy Which of the following is associated with decreased risk of breast cancer? ✔✔Breast feeding A risk factor for postmenopausal osteoporosis is: ✔✔history of tobacco use. The sound intensity of a grade III/VI heart murmur is typically described as: ✔✔Medium intensity Which of the following is a common cause of acne? ✔✔Increase in androgens Which of the following conditions are associated with the development of type 2 diabetes mellitus? ✔✔Delivery of a neonate weighing 9 lb or greater An adult patient presents with a painless ulcer in the genital area and enlarged lymph nodes in the groin. The nurse practitioner suspects: ✔✔Syphilis An adult female patient presents to the emergency department for a sudden onset of severe lower abdominal pain. She describes the pain as stabbing. She denies nausea, vomiting, fever, or chills. The pain does not radiate. To confirm the diagnosis of an ectopic pregnancy, the nurse practitioner should order which imaging study? ✔✔US An elderly retired farmer presents with a dome-shaped, pearly, firm nodule with telangiectasia on the side of his nose. A nurse practitioner would recognize the nodule as a/an: ✔✔BCC An adult female presents complaining of an increase in a malodorous vaginal discharge that worsens after intercourse. Examination and testing reveal a vaginal pH of 5.5, presence of clue cells on the wet mount, and a positive whiff test. The most appropriate diagnosis is: ✔✔BV An adult male presents with intermittent retrosternal burning. He has gained 30 lb in the past year. Physical examination results are unremarkable and the EKG is normal. The most likely diagnosis is: ✔✔GER A pediatric patient presents with a painful, enlarged parotid gland. The most likely diagnosis is: ✔✔Mumps A late adolescent male presents with the complaint that his left breast appears larger than the right one. He had a recent 10-lb weight gain and admits to marijuana use. On examination, the area is diffuse and nontender. The primary diagnosis is: ✔✔Fatty gynecomastia A geriatric patient presents with a bump on the vulva, associated with pruritis and malodorous drainage. Examination reveals a raised, ulcerated lesion. The most likely diagnosis is ✔✔Vulvar cancer A geriatric female presents with tremors and a 20 lb weight loss over 2 months. A nurse practitioner's laboratory evaluation should include a: ✔✔TSH and free T4 An older adult female presents with severe pain. She reports malaise, and periodic itching and burning on her chest wall. Physical examination reveals a small area of hyperesthesia in a linear fashion. The most likely diagnosis is: ✔✔Herpes zoster An early adolescent patient who plays football presents to clinic after a football practice complaining of limping due to anterior left knee pain. The pain has gradually increased over the past 2 weeks but is relieved with rest. The patient denies any trauma, prior surgeries, or medical history. Physical examination reveals tenderness and swelling of the tibial tubercle and reproduction of pain with resisted knee extension. The history and physical examination findings are most consistent with a diagnosis of: ✔✔Osgood-Schlatter disease. An adult patient presents with complaints of nausea, fatigue, and myalgia. The patient reports a history of untreated hepatitis B 30 years ago. Which hepatitis B serology testing results would indicate that the patient has chronic hepatitis? ✔✔HBsAg = positive, IgM anti-HBc = negative A late adolescent football player presents to the urgent care with an acute knee injury. He heard a pop when his knee buckled. The nurse practitioner notes a positive anterior drawer test. The most likely diagnosis is injury to the: ✔✔ACL A geriatric male, who is a 30-packs a year smoker, presents with wheezing and dyspnea. His chest X-ray shows a flattened diaphragm and an increased retrosternal chest space. There are decreased vascular markings. The most likely diagnosis is: ✔✔COPD A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for: ✔✔Multiple myeloma A child presents with a reddened right eye. His mother states that he has been complaining of watering eyes with no purulent drainage. On examination, an enlarged preauricular node is identified. The nurse practitioner should suspect: ✔✔Viral conjunctivitis A pregnant adult patient is diagnosed with a chlamydial infection at 20 weeks of gestation. Which of the following is the most accurate method for confirming this diagnosis? ✔✔Nucleic acid amplification test (NAAT) of urine A geriatric female complains of problems with urination. She reports that whenever she feels the need to urinate, she is unable to "make it to the bathroom in time," and wets herself. Which type of incontinence is most likely? ✔✔Urge An elderly patient is diagnosed with acute gastritis. The patient stops taking naproxen (Aleve) and is started on famotidine (Pepcid), 40 mg h.s. Three weeks later, the patient complains that the anorexia, nausea, and epigastric pain and tenderness have NOT been relieved. Which diagnostic study should be ordered? ✔✔Testing for H Pylori Smoking marijuana leads to which of the following? ✔✔Increased heart rate A geriatric male patient is being followed for type 2 diabetes mellitus and hypertension. He also has a diagnosis of polycythemia vera and has regular phlebotomies to control this. Which of the following statements about this patient is true? ✔✔Your answer: He should avoid dietary iron supplements. A adult male with a body mass index (BMI) of 19 and continued gastroesophageal reflux disease (GERD) presents for follow-up visit after using over-the-counter famotidine (Pepcid) for six weeks. Which of the following is the best NEXT treatment option for this patient? ✔✔Prescribe PPI A geriatric male presents late in the day. The nurse practitioner suspects bacterial pneumonia, prescribes antibiotics, and sends the patient home. The next day, the patient returns, but has not improved. Which of the following findings would be an indication for hospital admission? ✔✔Confused mental status A geriatric female was diagnosed with hypothyroidism and started on levothyroxine (Synthroid), 25 μg 1 week ago. She feels tired and wishes to have her medicine increased. Which of the following is the BEST response? ✔✔"Your blood levels should be checked every 6 weeks, as it takes the body several weeks to adjust to the medication." Long-term management of a patient with stable COPD includes ✔✔Annual flu vaccine A confused elderly female presents for the first time accompanies by her daughter. The patient is taking glipizide-metformin (Metaglip), lisinopril (Zestril), glargine (Lantus), aspirin, and a multivitamin. Which of the following is the MOST likely cause of the patient's symptoms? ✔✔Hypoglycemia A nurse practitioner is assessing a 4-day-old newborn. The parents brought the patient into the clinic the day before for concerns regarding breastfeeding. The newborn was assessed as jaundiced with a bilirubin level of 12 mg/dL (elevated). The parents were instructed to increase breastfeeding and to return to the clinic today. Today's assessment shows the newborn continues with jaundice and the bilirubin level is now 15.2 mg/dL. The nurse practitioner should: ✔✔Phototherapy for infant An adult patient reports increasingly frequent migraines, especially upon rising in the morning. The headaches have been successfully managed in the past with acetaminophen (Tylenol) and isometheptene mucate (Midrin) p.r.n., and a neurological etiology has been ruled out. Of the following drugs, which would be recommended for prophylactic migraine management in this case? ✔✔Propranolol HCl (Inderal), 40 mg b.i.d. For a late adolescent with acquired hypothyroidism who has been stable, a follow-up evaluation should be performed every: ✔✔Every 6-12 months An elderly patient with type 2 diabetes mellitus has been well-controlled on glipizide and recently developed stage 1 hypertension. After 3 months of lifestyle therapy, the patient is still not at goal blood pressure. Which drug class would be the BEST choice? ✔✔ACE- I An adult male presents with general malaise and concerns about delayed ejaculation. His medication regimen consists of quinapril, 20 mg daily; paroxetine, 20 mg daily; loratadine, 10 mg daily; hydrochlorothiazide, 25 mg daily. The delayed ejaculation is most likely caused by the: ✔✔Paroxetine A geriatric male is diagnosed with stage II Parkinson's disease. Which of the following should be a first-line medication? ✔✔Levodopa-carbidopa (Sinemet) An early adolescent male presents with a history of low-grade fever, headache, and facial rash. Upon examination, the nurse practitioner finds red papular, vesicular lesions along the right side of his nose. Priority care for this patient should include ✔✔referral to an ophthalmologist today. An adult female presents at 7 weeks of gestation with bleeding and lower abdominal cramping. The nurse practitioner suspects imminent spontaneous abortion. The patient is Rh negative. When should RhoGAM be administered? ✔✔Within 72 hours A mother brings her 8-week-old to the clinic who has been inconsolably crying for the last 3 days. After completing a thorough physical exam with normal findings, which of the following diagnostic tests should the nurse practitioner order NEXT? ✔✔Urine culture An adult patient presents with a burning feeling in the eyes and crusty, inflamed eyelids. He is diagnosed with dry eye syndrome. The best treatment for this condition would include initiating: ✔✔Your answer: eyelid hygiene with baby shampoo and warm water. The preferred treatment for early syphilis is: ✔✔Your answer: benzathine penicillin G, 2.4 million units IM once. A late adolescent male goes to a clinic with a puncture wound after being bitten by a neighbor's cat. After irrigating the wound, the nurse practitioner should: ✔✔Your answer: prescribe amoxicillin-clavulanic acid (Augmentin). At a 6-month well-child visit, an infant weighs 12 lb (5.45 kg), compared to a birthweight of 6 lb (2.73 kg). The mother states breastfeeding is going well, but the infant frequently spits up afterward. The BEST management for the nurse practitioner is to ✔✔reassure the mom that the baby's weight gain is normal. A healthy early adolescent female presents for a clinic visit because of concern about her menses not having started yet. Examination reveals Tanner stage III - IV development and scant pubic hair. Which of the following is the most appropriate intervention? ✔✔Reassure, explaining that she will probably begin menses within the year; reassess in 6 months. For treatment of otitis media in a child who is allergic to penicillin, the antibiotic of choice is: ✔✔Cefdinir (Omnicef) Which of the following diagnoses in a late adolescent male necessitates an immediate referral for evaluation by a specialist? ✔✔Testicular torsion A late adolescent who has been taking loratadine (Claritin) for seasonal allergies is diagnosed with acute bacterial sinusitis. The patient is allergic to penicillins and sulfa drugs. Which of the following antibiotics should be prescribed? ✔✔Cefdinir (Omnicef) A 12-year-old child diagnosed with mild persistent asthma has a peak expiratory flow (PEF) of less than 80% of predicted. The most appropriate action would be to: ✔✔Add LABA to ICS A child with refractory retentive encopresis has been treated with a laxative protocol. What is the next step in this patient's treatment plan? ✔✔referral to a gastroenterologist. Solid foods can be introduced into an infant's diet at what age? ✔✔6 months Which of the following medications is prescribed for the treatment of pinworm? ✔✔Albendazole (Albenza) In a mass casualty situation with presumed anthrax exposure, the drug of choice for prophylaxis is: ✔✔doxycycline (Doryx). [Show More]
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