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Question 1. 1. Which of the following best describes the pain associated with osteoarthritis? (Points : 2)
Constant, burning, and throbbing with an acute onset
Dull and primarily affected by eposure to cold and barometric pressure
Begins upon arising and after prolonged weight bearing and/or use of the joint
Begins in the morning and limits continued ambulation

Question 2. 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical eamination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: (Points : 2)
Recommending she increase her dietary intake of Calcium and Vitamin D
Ordering once a year bisphosphonate and a proton pump inhibitor
Participate in a fall prevention program
Dual-energy -ray (DEA) scan and updating immunizations

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Question 3. 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: (Points : 2)
Green leafy vegetables
Beer, sausage, fried seafood
Sugar
Gluten and bread items

Question 4. 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical eamination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: (Points : 2)
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Polymyalgia rheumatica

Question 5. 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical eamination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of: (Points : 2)
Osteoarthritis
Rheumatoid arthritis
Scleroderma
Sarcoidosis

Question 6. 6. Which of the following statements about osteoarthritis is true? (Points : 2)
It affects primarily weight-bearing joints
It is a systemic inflammatory illness
The metacarpal phalangeal joints are commonly involved
Prolonged morning stiffness is common

Question 7. 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): (Points : 2)
Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days
Doycycline 100 mg twice daily for 5 days
Prednisolone 35 mg four times a day for 5 days
Ice therapy

Question 8. 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical eamination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: (Points : 2)
Fibromyalgia
Sarcoidosis
Systemic lupus erythematosus
Rheumatoid arthritis

Question 9. 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? (Points : 2)
Beta blocker
ACE inhibitor
Statin medication
Metformin

Question 10. 10. A 20-year-old male construction worker is eperiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical eamination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? (Points : 2)
Joint infection
Chondromalacia patella
Prepatellar bursitis
All of the above

Question 11. 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical eamination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate: (Points : 2)

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