Signs and symptoms commonly associated with fibromyalgia include all of the following except: a. b. c. d.

Chronic fatigue Migraine headaches Irritable bowel syndrome Hyperglycemia

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Suspect malignancy in patients with low back pain who present with: a. b. c. d. Pain unrelieved by rest Age over 50 years old History of prior malignancy All of the above

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All the following statements about serotonin-selective reuptake inhibitors (SSRIs) are true except: a. b. c. d. SSRIs can be effective in the treatment of depression, anxiety, OCD, and panic attacks. Noticeable improvement in symptoms occurs within the first 5 days of treatment. Common side-effects of SSRIs include nausea, headache, insomnia, and nervousness. Sexual side-effects such as anorgasmia and erectile dysfunction are common.

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A 59 year old smoker complains of gradual onset of shortness of breath. He smokes two packs per day and denies chest pain, sputum production, or weight loss. After appropriate testing, the NP suspect early COPD. What initial treatment should be started? a. b. c. d. Begin a bronchodilator or anticholinergic per MDI Avoid starting treatment and schedule for a second chest xray examination Have patient record peak flow measurements for 2 weeks then return to clinic. Consult a pulmonologist.

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A 22 year old is treated for suspected asthma. After treatment with bronchodilators and inhaled steroids, she is not showing improvement. What follow-up is most appropriate for the NP? a. b. c. d. Refer the client to a pulmonologist or allergist Reevaluate the client's condition in 1 month Assure client that no evaluation is needed because symptoms are due to hyperventilation Inform the client to return if her symptoms worsen

Rationale Which of the following is NOT a risk factor for COPD? a. Age b. Inhaled irritant and noxious agents c. Heredity

d. Heart Failure Rationale

One of the main benefits of the angiotensin II receptor blockers (ARBs) is that: a. b. c. d. ARBs ARBs ARBs ARBs are less likely to cause cough. do not cause hypotension. cost less than ACE inhibitors. have had many randomized controlled trials to test their efficacy.

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The NP is evaluating an 85 year old female who is "not feeling well." She has a history of CAD and CHF. Her current medications include digoxin 0.25 mg qd, HCTZ 50 mg bid, K+10 mEq daily, and nitroglycerin transdermal patches. She complains of nausea without vomiting and denies chest pain or shortness of breath. BP 130/86, P 76, R 18, and T 97.9F. She has no peripheral edema. What are the FIRST diagnostic tests that the NP should order for this patient? a. b. c. d. Stat EKG and white blood cell count Arterial blood gases Serial cardiac enzymes now and every 6 hours X 2 Serum digoxin and potassium levels.

Rationale Which of the following is true in patients who appear to have resistant hypertension? a. b. c. d. Step the patient up on a three-drug regimen that includes a diuretic. The NP can continue to adjust medications for up to 6 months without consultation. Add a sedative/hypnotic drug and instruct the patient to take it prior to the next appointment. By definition, patients with resistant hypertension are noncompliant.

Rationale The main difference between systolic dysfunction and diastolic dysfunction in CHF is: a. Diastolic dysfunction is related to abnormal filling of the left ventricle whereas systolic dysfunction is related to abnormal ventricular contraction. b. Systolic dysfunction does not affect preload. c. No difference, they the same cardiac condition. d. Diastolic dysfunction is associated with increased compliance of the left ventricle. Rationale Common characteristics associated with batterers include: a. b. c. d. High need for control Tendency to blame others Violence in the family of origin All of the above

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The most important sign/symptom that supports the diagnosis of Asthma is: a. b. c. d. Presence of sputum production Reversible airflow obstruction Fatigue Family history of asthma

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Complaints commonly heard from patients with CHF seen in primary care settings include: a. b. c. d. Nocturia Exercise intolerance Chronic nonproductive cough All of the above.

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The following statements are appropriate when educating a patient about his gout except: a. b. c. d. Gout is a genetic defect Gout is due either to an increased production of uric acid or a decreased excretion of uric acid Persons with gout benefit from taking salicylate-containing medication daily Serum uric acid levels > 7 support a diagnosis of gout

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Based on the diagnosis of chronic bronchitis, the NP expects the patient to have: a. b. c. d. Chest pain on exertion Cough present for 2 or more weeks Hemoptysis Chronic cough with sputum production

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Which of the following are goals of treatment for COPD? a. b. c. d. reducing airway inflammation reversing hypoxia reduce airway obstruction all of the above

Rationale An 80 year old woman has been on a serotonin-selective retuptake inhibitor (SSRI) to treat depression for the last 6 months. She was just hospitalized for 24 hours following a fall. It was noted that the SSRI was not given during hospitalization but was restarted last evening. She presents today with her son who reports that her mother has had episodes of confusion and flu-like symptoms in the last 24 hours. Based on her history, which of the following would be the MOST likely cause of her new symptoms?

a. b. c. d.

Sundowning Withdrawal from the SSRI SSRI toxicity Viral gastroenteritis

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