Question XX. (2 XXX): XXX primary XXXX NP XXXXXXXXXX an inhaled XXXXXXXXXXXXXX for a XXXXXXX XXX has XXXXXX. The XXXXX-XXXXX payer XXX XXXX patient XXXXXX coverage XXX the brand that XXXXX in the XXXXXXXX strength the NP prescribes. XXX NP should:
a. XXXXXXX pharmaceutical company XXXXXXX of XXX XXXXXXXXXX XXX XXX patient. b. inform the patient XXXX the drug must XX paid for out XX pocket because it XX XXX covered. c. order XXX closest formulary-XXXXXXXX approximation of XXX XXXX and XXXXXXX effectiveness. d. write a XXXXXX XX medical necessity to the insurer XX XXXXXXX the need for XXXX particular medication.
Question XX. (2 XXX): A patient XXXX primary XXXXXXXXXXXXXXXXXXXX is XXXXXX an HMG-CoA reductase XXXXXXXXX. XXX of the XXXXXXX’s XXXXXXXX XXXX XXXX normal. XX a 6-month XXXXXX-XX visit, XXX XXXXXXX XXXXXXX occasional headache. X lipid XXXXXXX XXXXXXX a decrease XX XX% in the patient’s LDL XXXXXXXXXXX. The NP should:
a. order LFTs. b. order XX-MM tests. c. XXXXXXXX decreasing XXX XXXX XX XXX XXXXXXXXXX. d. XXXXXXXX the XXXXXXX that this XXXX effect is common.
XXXXXXXX 27. (X pts): X patient XXX takes a XXXXXXXX XXXXXXXX will XXXXX XXXXXX an XXX XXXXXXXXX. The primary care XX should counsel the patient XX:
a. XXXXXX XXXXXXXX XXX XXXXXXXXX of XXXXXX, which may occur with XXXXX XXXXX. b. take XXXX when getting out XX XXX or a chair XXXXX XXX first dose of XXX XXX XXXXXXXXX. c. discuss XXXXXX an XXXXXXXXX dose of XXX XXXXXXXX XXXXXXXX XXXX XXX cardiologist. d. minimize XXXXX intake for several days when beginning therapy XXXX the XXX XXXXXXXXX.
Question 28. (X pts): A thin XX-XXXX-old XXXXX who XXX XXXXXXXX XXX a hysterectomy XXXXX XXX XXXXXXX XXXX XX XXX is XXXXXX frequent hot XXXXXXX and vaginal XXXXXXX. A recent XXXX XXXXXXX study XXXXX early XXXXXXXXXX. XXX woman’s XXXXXX XXX CHD. She has XX family history of breast cancer. The XX should prescribe:
a. estrogen-only XX XXX. b. estrogen-XXXX HT in 5 XXXXX. c. XXXXXXXX-XXXXXXXXXXXX HT now. d. XXXXXXXX-progesterone XX in X years.
Question XX. (X XXX): A patient who XXXX begin XXXXX nitroglycerin XXX angina asks the primary XXXX XX how the XXXXXXXXXX works XX relieve XXXX. XXX NP XXXXXX tell XXX patient XXXX XXXXXXXXXXXXX acts to:
a. XXXXXXXX XXXXXXXXXXXX lesions. b. XXXXX XXXXXXXX XXXXXX XXXXXX. c. prevent XXXXXXXXXXXXX release. d. XXXXXX C-XXXXXXXX XXXXXXX XXXXXX.
XXXXXXXX XX. (2 pts): A XXXXXXX is in the clinic XXXXXXXXXXX of nausea and XXXXXXXX XXXX has lasted X to 3 days. The XXXXXXX XXX XXX oral mucous membranes, a blood XXXXXXXX of 90/56 mm XX, a pulse of XX XXXXX per minute, XXX a temperature XX XX.X° X. XXX primary care NP XXXXX a capillary XXXXXX XX XXXXXXX than X XXXXXXX. XXX NP XXXXXX:
a. XXXXXX a complete blood count XXX XXXXX electrolytes. b. XXXXXXXXX a rectal antiemetic medication. c. admit XX the XXXXXXXX for XXXXXXXXXXX (IV) XXXXXXXXXXX. d. encourage the XXXXXXX to XXXX small, frequent sips of Gatorade.
XXXXXXXX 31. (X XXX): X XXXXXXX who has XXXXXX XXXXXXXXX XXX who takes nonsteroidal XXXXXXXXXXXXXXXX drugs (NSAIDs) XXXXX XXXXXXXX a duodenal XXXXX. The patient XXX XXXXX a XXXXXXXXXXXXXX-2 XXXXXXXXX NSAID in XXX past XXX XXXXXX XXXX it is not as XXXXXXXXX as XXX current XXXXX. The primary care XXXXX XXXXXXXXXXXX (XX) should:
a. prescribe cimetidine (XXXXXXX). b. XXXXXXXXX omeprazole (Prilosec). c. XXXXX XXX patient XXXXX a XXXXX XXXX. d. XXXXXX XXX XXXXX XX a XXXXXXXXXXXXXX.
XXXXXXXX 32. (X pts): X XXXXXXX who XXX XXXXXX angina and uses sublingual nitroglycerin XXXXXXX XX in the clinic XXX XXXXXX XXXXXX XXXXX pain. XXX XXXXXXX XXXX XX XXXXXXXXXXX a nitroglycerin tablet and XXXXXXXXX XXX XXXXXXX to lie XXXX. XXX NP’s XXXX action XXXXXX be XX:
a. obtain an XXXXXXXXXXXXXXXXX. b. administer oxygen at 2 L/XXXXXX. c. give XXX mg of XXXXXXXX XXXXXXX. d. call XXX.
XXXXXXXX 33. (X pts): A primary XXXX NP sees a XXXXXXX who XX XXXXX treated for heart XXXXXXX with digoxin, a loop diuretic, XXX an XXX inhibitor. The patient reports XXXXXX XXXXXX. The XX notes a heart rate of XX beats XXX XXXXXX XXX a XXXXX pressure XX 100/60 XX XX. The XX should:
a. decrease the XXXX of the diuretic to XXXXXXX further XXXXXXXXXXX. b. obtain a XXXXX XXXXXXXXX level to assess for XXXXXXXXXXXX. c. XXXX XXX XXX inhibitor XXXXX the XXXXXXX's blood pressure XXXXXXXXXX. d. obtain a digoxin level before XXX patient takes the XXXX XXXX of XXXXXXX.
XXXXXXXX 34. (X pts): X patient XXX XX XXXXXX an XXXX XXXXXXXXXXXXX is in XXX XXXXXX in the late afternoon XXX reports having missed the XXXXXXX XXXX XX the medication because the XXXXXXXXXXXX was not XXXXXXXX. The XXXXXXX care NP XXXXXX XXXXXXX this XXXXXXX to:
a. avoid XXXXX that are XXXX in vitamin K for XXXXXXX XXXX. b. take a double dose of XXX medication the next morning. c. refill the XXXXXXXXXXXX XXX XXXX today's XXXX XXXXXXXXXXX. d. skip XXXXX's XXXX XXX XXXXXX a XXXXXXX dosing XXXXXXXX in XXX morning.
XXXXXXXX XX. (2 pts): X primary XXXX XX XXX prescribed XXXXXXXXXXX XXX a XXXXXXX who XX XXXXX. XXX patient XXXXX 10 XX in the first XXXXX XXX reports XXXX XXX XXXX XXXX XXX XXXX XX be XXXXXXXXXXX appetite XX much XX before. XXX NP XXXXXX:
a. discontinue XXX phentermine. b. XXXXXXXX the dose XX XXXXXXXXXXX. c. continue the XXXXXXXXXXX XX the same XXXX. d. change to a XXXXXXXXXXX of phentermine XXX XXXXXXXXXX.
XXXXXXXX 36. (2 pts): A 45-year-XXX XXXXXXX XXX XXX a positive XXXXXX history but XX personal XXXXXXX of XXXXXXXX artery XXXXXXX XX seen by XXX primary care NP XXX a XXXXXXXX examination. The XXXXXXX has a body XXXX XXXXX XX XX and a blood XXXXXXXX of XXX/78 XX XX. XXXXXXXXXX tests reveal low-density lipoprotein, 110 XX/dL; high-XXXXXXX lipoprotein, 70 XX/dL; and XXXXXXXXXXXXX, 120 XX/dL. XXX patient XXXX not smoke XXX has a sedentary XXXXXXXXX. The XX should XXXXXXXXX:
a. 30 XXXXXXX of aerobic exercise XXXXX. b. XXXXXX XX XX XXX mg of XXXXXXX daily. c. beginning therapy with a XXXXXX medication. d. XXXXXXXX a thiazide diuretic to treat hypertension.
XXXXXXXX XX. (X XXX): X XXXXXXX XXX heart XXXXXXX. X recent XXXXXXXXXXXXXX XXXXXXX XXXXXXXXX XXXXXXXXXX XX XXX XXXX ventricle XXX poor XXXXXXXXXXX filling. The XXXXXXX takes XXX-XXXX XXXXXXXXXX and an ACE XXXXXXXXX. The primary XXXX XX XXXX the patient for a routine physical examination and notes a heart XXXX of XX beats per XXXXXX and a blood XXXXXXXX XX XXX/XX XX Hg. The NP XXXXXX:
a. order XXXXX XXXXXXXXXXXX. b. XXXXXX XXXXX function tests. c. consider prescribing a B-blocker. d. call XXX XXXXXXX's XXXXXXXXXXXX to discuss adding digoxin to XXX XXXXXXX's regimen.
XXXXXXXX 38. (2 XXX): A XXXXXXX takes an XXXXXXXXXXXXX XXX an occasional XXXXXXXXXXXXX medication XX treat XXX. XXX XXXXXXX comes to the XXXXXX XXX XXXXXXX having XXX XXXXX, difficulty urinating, and XXXX XXXXXXXX XXXXXXXXXXXX. The primary care XX XXXXX a heart rate XX 92 XXXXX XXX XXXXXX. The NP should:
a. prescribe a TCA. b. discontinue the antidiarrheal medication. c. encourage XXX patient XX increase XXXXX intake. d. XXXXX XXX XXXX XX the antispasmodic medication.
Question XX. (X pts): X XXXXXXX who has had XXXX XX five liquid XXXXXX XXX day XXX X days is XXXX XX XXX primary care XX. XXX XXXXXXX asks about medications XX XXXX XXX XXXXXXXX. XXX XX XXXXX the XXXXXXX that antidiarrheal XXXXXXXXXXX XXX:
a. not curative XXX may prolong the XXXXXXX. b. XXXXXX in cases XX XXXXX infection XXXX elevated temperature. c. most beneficial when XXXXXXXX persist XXXXXX than X weeks. d. XXXXXX when other XXXXXXXX, such XX XXXXXXXXXXXX, develop.
Question 40. (X pts): A XXXXXXX XXX has angina is taking XXXXXXXXXXXXX and XXXX-acting XXXXXXXXXX. The primary XXXX NP notes a persistent blood pressure XX XX/XX mm Hg at XXXXXXX follow-up visits. The patient XXXXXXX XXXXXXXXXXXXXXX associated with XXXXXXXX up. XXX NP should XXXXXXX with the XXXXXXX’s cardiologist about XXXXXXXX the medication XX:
a. amlodipine (Norvasc). b. isradipine (DynaCirc). c. XXXXXXXXX XXX (Calan). d. short-XXXXXX XXXXXXXXXX (Procardia).
Question XX. (2 XXX): X patient who XXX XXXX XXXXXX XXXXXXX X.25 XX XXXXX XXX 6 XXXXXX XXXXXXX XXXX it XX not XXXXXXX XX XXXX XX it XXX XXXXXXXXX. XXX XXXXXXX care XX should:
a. XXXXXXXXX a reduced XXXXXXXXX intake. b. XXXXXXXX the XXXX XX XXXXXXX to X.5 XX daily. c. XXXX XXX next XXXX XX digoxin and obtain a serum digoxin XXXXX. d. contact XXX XXXXXXX's pharmacy to XXX XX generic digoxin was dispensed.
Question XX. (2 pts): X patient XX XXXXXX XXXXXXXXXXXXXX and comes XX XXX XXXXXX complaining XX XXXXXXXX and tingling of the XXXXX XXX XXXX. XXX XXXXXXX care NP XXXXX a heart rate of 62 XXXXX XXX XXXXXX and a XXXXX XXXXXXXX XX 100/XX mm XX. The XX XXXXXX:
a. obtain a serum XXXX XXXXX. b. order an XXXXXXXXXXXXXXXXX (XXX) XXX serum electrolytes. c. XXXXXX the XXXXXXXXXX to a thiazide XXXXXXXX. d. XXXXXXXX XXX XXXXXXX about potassium XXXXXX.
Question 43. (X pts): XXX XXXXXXX care nurse XXXXXXXXXXXX (NP) sees a patient in XXX clinic who has a blood pressure of XXX/85 XX Hg. The patient’s XXXXXXXXXX XXXXX XXXXXX high-density lipoprotein, XX mg/XX; XXXXXXXXXXXXX, XXX mg/dL; XXX XXXXXXX XXXXXX glucose, XXX XX/XX. The XX XXXXXXXXXX a body XXXX XXXXX XX XX. The XXXXXXX XXX a positive family XXXXXXX XXX cardiovascular XXXXXXX. XXX XX should:
a. prescribe a thiazide diuretic. b. consider treatment with an XXXXXXXXXXX-converting XXXXXX XXXXXXXXX. c. reassure the XXXXXXX XXXX XXXXX XXXXXXXX are XXXXXX. d. counsel XXX XXXXXXX about dietary and XXXXXXXXX XXXXXXX.
Question 44. (X XXX): A XXXXXXX XXX has primary hyperlipidemia XXX XXX XXXXX XXXXXXXXXXXX (XXXXXXX) XXXXXXXXX XX have XXX XXXXXXXXXXX of 140 mg/dL after X months of therapy. XXX XXXXXXX XXXX NP XXXXXXXXX XXX dose XXXX 10 mg XXXXX XX 20 mg XXXXX. The XXXXXXX reports headache XXX dizziness a XXX weeks after the dose XXXXXXXX. The XX XXXXXX:
a. XXXXXXXXX supplements of omega-X XXXXX XXXX XXX atorvastatin.
b. change XXX XXXXXXXXXXXX XXXX to XX XX XXXXX XXXXX.
c. add XXXXXXXXX (XXXXX) XXX XXXXX the XXXXXXXXXXXX to XX mg daily.
d. XXXXXX the patient’s XXXXXXXXXX to cholestyramine
Question 45. (X XXX): XXX primary care XX XX seeing a XXXXXXX for a hospital follow-XX XXXXX XXX XXXXXXX XXX XXX a XXXXX myocardial infarction. XXX XXXXXXX has a XXXX XX the prescribed medications XXX tells the XX XXXX “no XXX XXXXXXXXX anything XXXXX XXXX.” XXX XX’s XXXXXXX XXXXXXXX should be to:
a. ask XXX XXXXXXX XX describe the XXXXXXXXXX XXXXXXX. b. ask the XXXXXXX XX make a XXXX XX XXXXXXXXX about the medications. c. XXXXXXXXX what the patient understands XXXXX coronary artery XXXXXXX. d. XXXX the XXXXXXX information about drug effects XXX any XXXXXXX XXXXXXXXX.
Question 46. (X XXX): A XXXXXXX XXXX XX XXXX a X-year-old XXXXX XXX XX XXXXXXXX XXXXX. XXX child XXX an elevated XXXXXXXXXX A1c XXX increased XXXXX XXXXXX. Both of the child’s parents XXX overweight but not obese, and XXXX tell the NP XXXX they see XXXXXXX wrong with their child. They both state that it XX XXXXXXXXX to refuse their child’s requests XXX soda or ice cream. The NP XXXXXX:
a. XXXXXXX XXXX XXXX XXXX XXX child diet XXXX and XXX-XXX frozen yogurt. b. XXXXXXXXXX XXX respect the parents' beliefs XXXXX XXXXX child's XXXX-XXXXX. c. initiate a dialogue XXXX the parents about the XXXXXXXXXXXX of the XXXXX's laboratory XXXXXX. d. suggest XXXXXX XXXXXXXXXX to XXXXXXX ways XX improve parenting XXXXXX and limits.
Question 47. (2 XXX): X XXXXXXX XXXX XX XX developing a handout to give XX XXXXXXXX who XXXX XXXXX self-administering XXXXXXX. XXXX XXXXXXXXXX this XXXXXXX, the XX XXXXXX:
a. provide XXXXXXXX XXXXXXXXXXXX XX each XXXX in the process XX injecting XXXXXXX. b. use XXXXXXX XXXXXXX terminology XXXX describing XXXXXXX self-XXXXXXXXXXXXXX. c. XXXXXXX XX much XXXXXXX XXXXXXXXXXX as XXXXXXXX XXXXX insulin XXXXXXXXXXXXXX. d. address XXX or two XXXXXXXXXXX objectives that describe what XXX XXXXXXX will learn.
Question XX. (2 XXX): X XXXXXXX reports XXXXXX XXXXXXXXXX acute constipation XXXX large, hard stools XXX XXXX XXX XXXX XXX primary XXXX XX about medication to treat this XXXXXXXXX. The XX XXXXXX XXXX XXX patient XXXXXX XXXX mL of water daily; XXXX XXXXXX, XXXXXXXXXX, XXX XXXX; XXX exercises XXXXXXXXX. XXX NP XXXXXX XXXXXXXXX:
a. a daily XXXX laxative. b. long-XXXX docusate sodium. c. a saline laxative as needed. d. glycerin suppositories XX needed.
XXXXXXXX XX. (X pts): A XXXXXXX XXX XXX heart XXXXXXX has been treated XXXX furosemide XXX an XXX inhibitor. The XXXXXXX’s cardiologist XXX added digoxin to the patient’s XXXXXXXXXX regimen. XXX XXXXXXX care NP who XXXXX XXX XXXX XXXXXXX XXXXXX expect XX XXXXXXX:
a. serum electrolytes. b. blood glucose XXXXXX. c. XXXXX thyroid levels. d. complete blood XXXXXX (XXXX).
Question XX. (X XXX): X 55-XXXX-old woman XXX XXX XXX menstrual XXXXXXX for 5 XXXXX and tells the primary care nurse practitioner (NP) that XXX is having increasingly frequent XXXXXXXXX XXXXXXXX. She XXX XX XXXXXX XXXXXXX or XXXX factors for XXXXXXXX XXXXX disease (CHD) or breast cancer XXX is XXXXXXXXX XXXXX XXXXX side effects XX hormone XXXXXXX (XX). The XX should:
a. XXXX her XXXX XXXXXXXX HT XXX XXX XXXXXX her XXXX of XXXXXX XXXXXX. b. advise a XXXXX course of HT XXX XXXX may XXXXXXXX her risk XXX XXX. c. tell her that XX XXXX XXX help control her XXXXXXXX during postmenopause. d. recommend herbal XXXXXXXXXXX for her XXXXXXXX to XXXXX XX side effects.
Question XX. (X XXX): X XXXXXXX XXXX NP is XXXXXXXXXX a XXXXXXXX XXXXXX history on a new XXXXXXX. The XXXXXXX reports XXXXXX XXXXXXXX every day. The NP should:
a. XXX the patient XX bring XXX XXXXXXX bottles to XXX clinic XXXXXXXXXXX. b. XXXXXXXXX natural vitamin products over XXXXXXXXX XXXXXXX products. c. reassure XXX XXXXXXX that vitamins that XXX high in folic XXXX XXX safe to XXXX. d. XXXX the patient that some vitamins, such XX vitamin X, XXX XXXX in large XXXXX.
XXXXXXXX XX. (X XXX): An XX-year-old patient XXXX a primary care NP about OTC XXXXXXXX XXX XXXXXXXXXX heartburn. The XX XXXXX XXXX XXX XXXXXXX has a normal complete blood count and normal electrolytes and a XXXXXX XXXXXXXXX in XXXXXXXXXX XXXXXX. XXX XX XXXXXX XXXXXXXXX:
a. calcium carbonate (Tums). b. aluminum XXXXXXXXX (XXXXXXXX). c. sodium XXXXXXXXXXX (XXXX-XXXXXXX). d. XXXXXXXXX XXXXXXXXX (XXXX XX Magnesia).
Question XX. (X XXX): X 50-year-old XXXXX XXXX a family XXXXXXX of CHD XX experiencing XXXXXXXXXX hot XXXXXXX and XX XXXXXX XXXXXXX every 3 to 4 months. XXX XXXX the XXXXXXX care XX about HT XX relieve her symptoms. XXX XX should:
a. XXXXXXXXX estrogen-XXXX XXXXXXX. b. initiate oral contraceptive XXXXX XXX. c. discuss XXXXX bioidentical HT. d. XXXX XX XXX estrogen-progesterone therapy XXXX menopause XXXXXX.
Question XX. (2 pts): X XXXXXXX XXX has XXXXXX cancer has XXXX XXXXXX toremifene XXX X XXXXX. She tells her primary XXXX XX XXXX she XXXXXX her XXXXX has grown XXXXXX. The NP XXXXXX:
a. XXXXXXXX her XXX a XXXXXX ultrasound. b. reassure her that this XX common XXX will XXXXXXX. c. XXXX her XXX XXX need an increased dose of XXXX XXXXXXXXXX. d. XXXXXXX her oncologist XX XXXXXXX adding XXXXXXX XXXXXXXXXX.
XXXXXXXX XX. (X pts): X XXXXXXX XXXXXXX having XXXXXXXX XX XXXXXXXXX, nausea, XXX XXXXXXXXXXXXXXX and XXXXXXXXX a sensation of XXX room XXXXXXXX XXXX these occur. The XXXXXXX care XX will XXXXX XXX patient to a XXXXXXXXXX XXX, XXXXX diagnostic XXXXXXX, XX likely to XXXXXXXXX:
a. meclizine.
b. ondansetron.
c. XXXXXXXXXXX.
d. XXXXXXXXXXXXXX
Question 56. (X XXX): The primary care NP XXXX a XXXXXXX XXX XXX a XXXXXXX XX XXXXXXXXXXXX and alcoholism. The XXXXXXX is not taking XXX medications. XXX NP auscultates crackles in XXXX XXXXX XXX XXXXXXXX the XXXXX 2 cm XXXXX XXX costal margin. XXXXXXXXXX tests show an elevated XXXXXXXXXX XXXXX. XXX NP will XXXXX XXXX XXXXXXX to a cardiologist and should XXXXXXXXX:
a. XXXXXXXXX metered-XXXX XXXXXXX. b. XXXXXXXXXX (XXXXX). c. XXXXXXXXXXXXXX (Aldactone). d. XXXXXXXXXXXXXX (XXXXXXXXX).
Question 57. (2 XXX): X XXXXXXXXXXXXXX XXXXX tells XXX XXXXXXX care XX XXXX she XX having hot XXXXXXX and increasingly XXXXXX mood XXXXXX. XXX woman has XXX a XXXXXXXXXXXX. XXX XX should prescribe:
a. estrogen-only HT. b. low-dose XXXX XXXXXXXXXXXXX XXXXXXX. c. XXXXXXXXX serotonin reuptake XXXXXXXXX therapy XXXXX menopause begins. d. estrogen-XXXXXXXXXXXX XX.
XXXXXXXX XX. (X pts): X XXXXXXX care NP prescribes a COCP for a woman who XX taking them for the XXXXX time. XXXXX XXXXXXXX, XXX XXXXX XXXXXX XXXXXXXXX XXXXX the XXXX for using a XXXXXX form of XXXXXXXXXXXXX XX she:
a. XX XXXXXX vomiting or XXXXXXXX. b. delays XXXXXX a XXXX by 5 or X XXXXX. c. takes nonsteroidal XXXXXXXXXXXXXXXX XXXXX XXXXXXX XXXX in a row. d. has recurrent XXXXXXXXX or insomnia.
XXXXXXXX 59. (2 XXX): A patient who XXX XXX a XXX XXXXX of AF XXX XXX XXXXX will XXXXXXX cardioversion XXXX XXX. The XXXXXXX XXXX XX XXXX XXXXXX the XXXXXXXXXXXX XX:
a. XXXX clopidogrel after XXXXXXXXXXXXX cardioversion. b. administer cardioversion without XXXXX anticoagulants. c. give warfarin XXX XXXXXXX XXXXXX attempting cardioversion. d. XXXX XXX-dose aspirin before XXXXXXXXXXXXX XXXXXXXXXXXXX.
Question XX. (X pts): X XXXXXXX in the XXXXXX XXXXXXX frequent XXXXXXXX XX XXXXXXXX, abdominal XXXX, XXX loose XXXXXX XX the XXXXXXX XXXX XXXXX XXXXXXXXXXXX (XX). An important question the NP should ask about XXX XXXXXXXXX pain XX:
a. XXX XXXXXXXX of XXX pain to XXXXXX. b. XXXX XXXX of day XXX XXXX XXXXXX. c. XXXXXXX XXX pain XX XXXXX or diffuse. d. XXX age of XXX XXXXXXX XXXX XXX pain XXXXX.