A patient is seen in a follow-up 12 weeks after being

QUESTION 1

A patient is seen in a follow-up 12 weeks after being started on levothyroxine, 75 mcg daily. Today the patient reports feeling well and offers no complaints. Vital signs are normal. Serum TSH is 5.7 mIU/L. The next step in the management of this patient is to:

A.     Tell the patient she is doing well and should continue her current medication with a f/u in 12 weeks

B.     Review with the patient her routine for taking her medication

C.     Increase the dose to 100 mcg/daily

D.     Order FT3 and FT4 studies

 

QUESTION 10

M.W. is an 18-year-old male who is being managed in the emergency department for an acute asthma exacerbation. He says that he has been using his maintenance inhalers as prescribed but caught a cold a few days ago and has been coughing a lot. Today when he checked his peak expiratory flow rate (PEFR) at home it was 49% and he knew he needed to come to the hospital. On arrival his PEFT was 51% and his saO2 on room air was 91%. He was put on nasal oxygen and given alternating albuterol and ipratroprium nebulizer treatments as well as 40 mg of prednisone p.o. After one hour he is reassessed and feels subjectively no better. His PEFR after one hour of emergency care is 41%. An arterial blood gas is drawn and pending. The AGACNP’s first priority is to:

A.        Prepare for intubation

B.        Admit the patient for management

C.       Order a chest radiograph

D.       Continue albuterol treatments for one more hour

 

QUESTION 13

A patient with pelvic inflammatory disease has not responded well to outpatient therapy and is admitted for higher level support. The AGACP expects that the patient’s admitting CBC will demonstrate leukocytosis with:

A.        Neutrophilia

B.        Lymphocytosis

C.       Esinophilia

D.       Monocytosis

 

QUESTION 21

Optimal pain management requires an accurate understanding of the physiology of pain. The AGACNP knows that a significant contributor to inflammatory pain is:

A.        Inductive prostaglandin release

B.        Neuropathy of nociceptors

C.       Mechanical stimuli

D.       Thermal stimuli

 

QUESTION 23

A 36-year-old female presents for evaluation of wheeze while exercising. She has no significant medical history and has always been very healthy. During review of systems she does admit to a general decrease in energy, lately, but nothing specific. Her cardiopulmonary exam is within normal limits and lungs are clear. Vital signs are: Temperature 97.4° F, pulse 66 b.p.m. respiratory rate 16 b.p.m., and blood pressure 98/56 mm Hg. Office spirometry demonstrates normal airflows and volumes. A basic metabolic panel is as follows: Na+ 130 mEq/L, K+ 5.5 mEq/L, Cl-100 mEq/L, CO2 25 mEq/L, glucose is 74 mg/L, BUN 15 mg/dL and creatinine 0.08 mg/dL. The AGACNP considers which of the following potential etiologies?

A.        Hypercortisolism

B.        Hypothyroidism

C.       Hypoadrenalism

D.       Hyperpituitarism

 

QUESTION 26

A 27-year-old female patient is newly diagnosed with herpes simplex virus (HSV) 2 following an initial outbreak. In teaching the patient about her disease process, the AGACP tells the patient that:

A.        Future outbreaks will be preceded by a prodrome

B.        She should encourage partner to wear a condom to prevent transmission

C.       The disease cannot be transmitted once vesicles have dried

D.       he will need maintenance medication to reduce the risk of outbreaks

 

QUESTION 33

Mrs. Knickerson is a 77-year-old female admitted for management of urinary tract infection. Her complete blood count reveals a white blood cell differential as follows: Total leukocyte count 57,000 cells/uL, neutrophils of 16%, lymphocytes 77%, monocytes 3%, eosinophils 3% basophils 1%. The AGACNP is suspicious for:

A.     Urosepsis

B.        Immunosuppression

C.       Drug-induced leukocytosis

D.       Chronic lymphocytic leukemia

 

QUESTION 40

A patient with septicemia is rapidly deteriorating. His blood pressure is now 78/50 mm Hg, pulse is 98 b.p.m. and respiratory rate is 24 b.p.m. The AGACP suspects which acid-base imbalance?

A.        Metabolic acidosis

B.        Metabolic alkalosis

C.       Respiratory acidosis

D.       Respiratory alkalosis

 

QUESTION 47

Lester is a 48-year-old male who is brought to the emergency room by ambulance. Neighbors found him lethargic and confused after an episode of binge drinking. IV fluid hydration was started. He perked up and was able to participate to some extent with history taking. Physical exam revealed an area of erythema on the upper inner aspect of the left thigh. Lester does not remember any trauma or injury, but the area is extremely painful to palpation and the painful region extends several centimeters proximal to the erythema. One hour later when all diagnostic studies are available—Lester says that the pain is markedly worse. Physical exam reveals that the original area of erythema is now almost purple, and there are two erythematous spots proximal to the original site. The AGACNP is suspicious for:

A.        Necrotizing fasciitis

B.        Brown recluse spider bite

C.       Staphylococcal cellulitis

D.       Coagulopathy

 

QUESTION 49

Mrs. Summer is a 63-year-old female who presents for colicky abdominal pain and distention. Her abdomen is very distended and she appears quite uncomfortable. Her vital signs are stable, but a metabolic panel suggests mild volume contraction. During her history Mrs. Summer admits she has not had a bowel movement in 15 days, and she is not sure when she last passed gas. The radiographic evaluation should begin with

A.        Ultrasound

B.        Plain film radiography

C.       CT scan

D.       MR angiography