FINAL NURSING EXAM REVIEW 2022
QUESTIONS AND ANSWERS
1. Which assessments of care providers are performed as part of the Value Based
Purchasing
... [Show More] initiative?
Select all that apply.
a. Appraising costs per case of care for Medicare patients
b. Assessing patients' satisfaction with hospital care
c. Evaluating available evidence to guide clinical care guidelines
d. Monitoring mortality rates of all patients with pneumonia
e. Requiring advanced IT standards and minimum cash reserves - ANS: A, B, D
Value Based Purchasing looks at five domain areas of processes of care, including
efficiency of care (cost per case), experience of care (patient satisfaction measures),
and outcomes of care (mortality rates for certain conditions. Evaluation of evidence
to guide clinical care is part of evidence-based practice. The requirements for IT
standards and financial status are part of Accountable Care Organization standards.
2. What was an important finding of the Advisory Board survey of 2014 about
primary care preferences of patients?
a. Associations with area hospitals
b. Costs of ambulatory care
c. Ease of access to care
d. The ratio of providers to patients - ANS: C
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7
access to care, walk-in settings and the ability to be seen within 30 minutes, and
care that is close to home. Associations with hospitals, costs of care, and the ratio of
providers to patients were not part of these results.
3. A small, rural hospital is part of an Accountable Care Organization (ACO) and is
designated as a Level 1 ACO. What is part of this designation?
a. Bonuses based on achievement of benchmarks
b. Care coordination for chronic diseases
c. Standards for minimum cash reserves
d. Strict requirements for financial reporting - ANS: A
A Level 1 ACO has the least amount of financial risk and requirements, but receives
shared savings bonuses based on achievement of benchmarks for quality measures
and expenditures. Care coordination and minimum cash reserves standards are part
of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial
reporting.
1. To reduce adverse events associated with care transitions, the Centers for
Medicare and Medicaid
Service have implemented which policy?
a. Mandates for communication among primary caregivers and hospitalists
b. Penalties for failure to perform medication reconciliations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after discharge
d. Requirements for written discharge instructions for patients and caregivers - ANS:
C
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid
Service developed
the Readmissions Reduction Program reducing payments for certain patients
readmitted within 30 days of discharge. The CMS did not mandate communication,
institute penalties for failure to perform medication reconciliations, or require written
discharge instructions.
2. According to Naylor's transitional care model, which intervention has resulted in
lower costs and
fewer rehospitalizations in high-risk older patients?
a. Coordination of post-hospital care by advanced practice nurses
b. Frequent post-hospital clinic visits with a primary care provider
c. Inclusion of extended family members in the outpatient plan of care
d. Telephone follow up by the pharmacist to assess medication compliance - ANS: A
Naylor's transitional care model provided evidence that high risk older patients who
had post-hospital
care coordinated by an APN had reduced rehospitalization rates. It did not include
clinic visits with a
primary care provider, inclusion of extended family members in the plan of care, or
telephone follow up
by a pharmacist.
3. Which approaches are among those recommended by the Agency for Healthcare
Research and
Quality to improve health literacy in patients?
Select all that apply.
a. Empowering patients and families
b. Giving written handouts for all teaching
c. Highlighting no more than 7 key points
d. Repeating the instructions
e. Supplementing teaching with visual aids - ANS: A, D, E
AHRQ recommends using clear, simple language, highlighting 3 to 5 key points,
using pictures or visual
aids, repeating the instructions, using Teach Back, and empowering patients. Written
communication is
not part of the recommendations.
1. Which is the most appropriate research design for a Level III research study?
a. Epidemiological studies
b. Experimental design
c. Qualitative studies
d. Randomized clinical trials - ANS: B
The experimental design is the most appropriate design for a Level III study.
Epidemiological studies are appropriate for Level II studies. Qualitative designs are
useful for Level I studies. Randomized clinical trials are used for Level IV studies.
2. What is the purpose of clinical research trials in the spectrum of translational
research?
a. Adoption of interventions and clinical practices into routine clinical care
b. Determination of the basis of disease and various treatment options
c. Examination of safety and effectiveness of various interventions
d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS: C
Clinical research trials are concerned with determining the safety and effectiveness
of interventions. Adoption of interventions and practices is part of clinical
implementation. Determination of the basis of disease and treatment options is part
of the pre-clinical research phase. Exploration of the fundamental mechanisms of
biology, disease, or behavior is part of the basic research stage.
3. What is the purpose of Level II research?
a. To define characteristics of interest of groups of patients
b. To demonstrate the effectiveness of an intervention or treatment
c. To describe relationships among characteristics or variables
d. To evaluate the nature of relationships between two variables - ANS: C
Level II research is concerned with describing the relationships among
characteristics or variables. Level I research is conducted to define the
characteristics of groups of patients. Level II research evaluates the nature of the
relationships between variables. Level IV research is conducted to demonstrate the
effectiveness of interventions or treatments.
1. A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which
medications, taken
in conjunction with this medication, are of concern?
a. Anticholinergic drugs
b. Beta blocker medications
c. Blood-thinning agents
d. Narcotic analgesics - ANS: C
Glucosamine chondroitin can prolong bleeding if taken with other blood-thinning
agents. It does not have anticholinergic effects, cardiac effects or analgesic effects.
2. The provider learns that a patient is taking herbal supplements for a variety of
reasons. What is an important point to discuss with this patient about taking such
supplements?
a. Because they are not FDA approved, they are not safe
b. Dietary supplements are safer than most prescription medications
c. Many supplements lack clear clinical evidence of efficacy
d. Supplements should not be taken with prescription medications - ANS: C
Many dietary supplements lack clinical evidence to support their use. Even though
they are not FDA approved, federal law mandates that the products are safe and
cannot make misleading claims about use. Supplements are not necessarily safer
than prescription drugs. Supplements may be taken with prescription medications as
long as the effects, side effects, and drug interactions are known.
3. Which dietary supplements have shown some effectiveness in reducing blood
pressure in patients
with hypertension?
Select all that apply.
a. Chromium picolinate
b. Cinnamon
c. CoQ10
d. Garlic extract
e. L-arginine - ANS: C, D, E
CoQ10, garlic extract, and L-arginine have demonstrated effectiveness in reducing
blood pressure in some studies. Chromium picolinate and cinnamon have been
studied for effects on glucose tolerance and fasting glucose.
1. Which are key components of the Patient-Centered Medical Home?
Select all that apply.
a. Access to care
b. Comprehensive care
c. Coordination of care
d. Provision of care by a single provider
e. Storage of medical records - ANS: A, B, C
The Patient-Centered Medical Home is a team-based approach to providing care
that is accessible, comprehensive, coordinated, longitudinal and high quality. It is not
provided by a single provider, but is managed as a team. The original concept had to
do with where medical records are stored, but this is not the working definition today.
2. The chronic care model (CCM) was developed to manage patients with
complicated chronic
conditions because the traditional acute care model
a. could not provide efficient and cost-effective chronic care.
b. did not meet longitudinal health care needs for this population.
c. did not offer ambulatory care services for these patients.
d. put patients and families at the center of care. - ANS: B
The chronic care model was developed based on the recognition that the traditional
acute care model did not meet longitudinal health care needs of patients with chronic
and complicated conditions, not because of inefficiencies or costs. The traditional
model does include ambulatory care, but that is not the focus. The traditional model
does not typically place patients at the center of care.
3. What are functions of patient registries in the chronic care model?
Select all that apply.
a. Alerting providers to medication interactions
b. Identifying appropriate specialists for referral
c. Recommending routine screenings
d. Reminding providers about immunizations
e. Transmitting clinical data about patients - ANS: A, C, D, E
Patient registries are used to help manage patients at risk and include alerting
providers about medication interactions, recommending routine screenings,
reminders for immunizations, and transmitting clinical dat
a. They are not used to identify or recommend providers or specialists.
1. A primary care provider administers the "Newest Vital Sign" health literacy test to
a patient newly diagnosed with a chronic disease. What information is gained by
administering this test?
a. Ability to calculate data, along with general knowledge about health
b. Ease of using technology and understanding of graphic data
c. Reading comprehension and reception of oral communication
d. Understanding of and ability to discuss health care concerns - ANS: A
The "Newest Vital Sign" tests asks patients to look at information on an ice cream
container label and answer questions that evaluate ability to calculate caloric data
and to grasp general knowledge about food allergies. It does not test understanding
of technology or directly measure reading comprehension. It does not assess oral
communication. The "Ask Me 3" tool teaches patients to ask three primary questions
about
their health care and management.
2. A female patient who is from the Middle East schedules an appointment in a
primary care office. To provide culturally responsive care, what will the clinic
personnel do when meeting this patient for the first time?
a. Ensure that she is seen by a female provider
b. Include a male family member in discussions about health care
c. Inquire about the patient's beliefs about health and treatment
d. Research middle eastern cultural beliefs about health care - ANS: C
It is important not to make assumptions about beliefs and practices associated with
health care and to ask the patient about these. While certain practices are common
in some cultural and ethnic groups, assuming that all members of those groups
follow those norms is not culturally responsive.
3. What is the main reason for using the REALM-SF instrument to evaluate health
literacy?
a. It assesses numeracy skills.
b. It enhances patient-provider communication.
c. It evaluates medical word recognition.
d. It measures technology knowledge. - ANS: C
The REALM-SF is an easy and fast tool that measures medical word recognition. It
does not evaluate numeracy. The "Ask Me 3" tool enhances patient-provider
communication. This tool does not evaluate understanding of technology.
1. A patient expresses concern that she is at risk for breast cancer. To best assess
the risk for this patient,
what is the best initial action?
a. Ask if there is a family history of breast cancer
b. Gather and record a three-generation pedigree
c. Order a genetic test for the breast cancer gene
d. Recommend direct-to-consumer genetic testing - ANS: B
The three-generation pedigree is the best way to evaluate genetic risk. Asking about
a family history is not a systematic risk assessment and doesn't specify who in the
family has the history or whether there is a pattern. Genetic testing and DTC genetic
testing are not the initial actions when assessing genetic risk.
2. A patient asks about direct-to-consumer (DTC) genetic testing. What will the
provider tell the patient?
a. It is not useful for identifying genetic diseases.
b. Much of the information does not predict disease risk.
c. The results are shared with the patient's insurance company.
d. The results must be interpreted by a provider. - ANS: B
DTC testing gives a lot of information, but much of it does not contribute to disease
prediction, since mutations are not necessarily related to specific diseases. The tests
are useful, but must be interpreted accurately. The results are confidential and do
not have to be interpreted by a provider.
1. What are some causes for failures or delays in diagnosing patients resulting in
malpractice claims?
Select all that apply.
a. Failing to recognize a medication complication
b. Failing to request appropriate consultations
c. Improper performance of a treatment
d. Not acting on diagnostic test results
e. Ordering a wrong medication - ANS: B, D
Failing to obtain consultations when indicated or not acting on diagnostic test results
can lead to diagnosis-related failures. Failing to recognize medication complications
and ordering a wrong
medication lead to medication prescribing allegations. Improper performance of a
treatment can lead to treatment related malpractice claims.
2. What is an important part of patient care that can minimize the risk of a formal
patient complaint even
when a mistake is made?
a. Ensuring informed consent for all procedures
b. Maintaining effective patient communication
c. Monitoring patient compliance and adherence
d. Providing complete documentation of visits - ANS: B
Effective patient communication is key to building trust and rapport and ineffective
communication is a predictor for malpractice claims. The other items are important
aspects of care and may help the provider during the investigation of a claim, but do
not minimize the risk.
1. A woman who is obese has a neck circumference of 16.5 cm. Which test is
necessary to assess for complications of obesity in this patient based on this finding?
a. Electrocardiography
b. Gallbladder ultrasonography
c. Mammography
d. Polysomnography - ANS: D
Women with a neck circumference greater than 16 cm have an increased risk of
obstructive sleep apnea and should have polysomnography to assess for this
complication. The other tests may be necessary for obese patients, but are not
specific to this finding.
2. Which medications are associated with weight gain?
Select all that apply.
a. Antibiotics
b. Antidepressants
c. Antihistamines
d. Insulin analogs
e. Seizure medications - ANS: B, C, D, E
Antidepressants, antihistamines, insulin and insulin analogs, and seizure
medications are all associated with weight gain. Antibiotics are not associated with
weight gain.
1. A 60-year-old patient who leads a sedentary lifestyle has expressed an interest in
beginning an aerobic exercise program. What will the provider include when
counseling this patient about this program?
a. Begin with a 45 to 60 minute workout
b. Include a 1 to 2 minute warm up before exercise
c. Maintain a heart rate between 80 and 128 beats per minute
d. Stretching should be performed prior to activity - ANS: D
The heart rate should be kept between 50% and 80% of the maximum heart rate
(220 minus the patient's age = 160), which is 80 to 128 beats per minute. Patients
who are not conditioned should begin with a 20 minute workout; conditioned
individuals may increase up to 60 minutes. The warm up should be 3 to 5 minutes
and longer if it is cold. Stretching is performed after the activity when the muscles are
warm.
2. Routine screening blood tests at an annual physical exam reveal a fasting glucose
level of 125 mg/dL and a hemoglobin A1C of 6.2%. What will the provider do, based
on these results?
a. Evaluate the patient for impaired glucose tolerance
b. Reassure the patient that these are normal values
c. Suggest that the patient begin an exercise program
d. Tell the patient that these results indicate diabetes - ANS: A
The fasting blood glucose level is normal, but the HgA1C indicates impaired glucose
tolerance. If the HgA1C were greater than 6.4%, the patient would be diagnosed with
diabetes. Until the results are evaluated, suggestions for treatment are not indicated.
3. The primary care provider is screening a patient using the CAGE criteri
a. What will the provider include in this assessment? Select all that apply.
a. Number of times per week eaten in restaurants
b. Sodium and sugar intake
c. Sources of daily dairy intake
d. Total number of servings of fruits and vegetables
e. Types of meats and proteins - ANS: A, C, E
The CAGE questionnaire is designed to evaluate the intake of saturated fat and
cholesterol, so the provider will ask about sources of dairy, the number of times
eating foods not made at home, and the types of meats and proteins eaten. The
questionnaire does not evaluate for sodium, sugar, fruits, or vegetables.
1. A 50-year-old female patient has a blood pressure of 118/72 mm Hg, a negative
family history for breast and ovarian cancer, a normal Pap smear 2 years prior, and a
Framingham risk screening within normal limits. Which should be part of this
patient's routine annual well-patient exams?
a. Bone mineral density screening
b. Breast cancer screening and mammogram
c. Cervical cancer screening with a Pap test
d. Lipid screening and cholesterol tests - ANS: B
The American Cancer Society recommends yearly mammogram at age 40. Bone
mineral density
screening begins at age 50 to 64, based on risk. Cervical cancer screening should
be performed every 3 years unless there is increased risk. Lipid screening and
cholesterol is performed annually if there is increased risk according to the
Framingham guidelines.
2. A 55-year-old patient who had influenza in the previous influenza season asks
about the flu vaccine.
What will the provider tell the patient?
a. Having influenza vaccine confers lifetime immunity
b. The FluMist vaccine may be used each year
c. The Fluzone High-Dose vaccine is recommended
d. The trivalent influenza vaccine is indicated annually - ANS: D
Because the strains of influenza vary from year to year, annual immunization with
TIV is indicated for all persons. Lifetime immunity is not conferred with infection. The
Flu Mist is used in persons 50 years of age and younger. The Fluzone High-Dose
vaccine is used in patients older than 65 year.
3. A 60-year-old patient with a previous history of shingles asks about the herpes
zoster vaccine. What will the provider recommend?
a. A series of two herpes zoster vaccinations
b. A single dose of herpes zoster vaccine
c. No herpes zoster vaccine is necessary
d. Prophylactic vaccination if exposed to chicken pox - ANS: B
All patients 50 years and older should have a single dose of herpes zoster vaccine
regardless of previous herpes zoster infection.
1. A patient who has a history of working around asbestos and silica fibers is
concerned about
developing lung disease. The primary care provider determines that the patient has a
previous history of asthma as a child and currently has frequent episodes of
bronchitis. A physical examination is normal and pulmonary function tests and
radiographs are negative. What action is correct?
a. Reassure the patient about the normal findings
b. Refer the patient to an occupational health specialist
c. Request a workplace environmental assessment
d. Suggest that the patient follow up with a pulmonologist - ANS: B
Patients with environmental exposure may not have symptoms or positive findings.
Because this patient reports frequent bronchitis, this should be followed up with an
occupational health specialist who can
evaluate the degree of exposure and perform further testing. Normal findings are not
necessarily reassuring. The occupational specialist may request an environmental
assessment. Pulmonologists are not trained in occupational health.
2. During a pre-placement screening for a person hired for a job requiring heavy
lifting, a primary care provider notes that the new employee has environmental
allergies, a history of GERD, recurrent eczema, a previous history of an ankle
fracture, and normal lower back strength and flexibility. A urine drug screen is
negative. What will be included in the report to the employer?
Select all that apply.
a. GERD history
b. History of allergies and eczema
c. History of ankle fracture
d. Lower back screening results
e. Urine drug screening results - ANS: D, E
Only findings related to the ability of the individual to perform position requirements
for the job are included in the report. Other findings should not be included, even
though they may need to be addressed.
1. A female freshman college student tells the primary care provider at the student
health center that she has a history of anorexia nervosa that has been wellcontrolled for several years. What will the provider recommend for this student?
a. Dietary counseling
b. Participation in sports
c. Regular weight assessments
d. Stress management strategies - ANS: D
Students with previous eating disorders may regress when stressed, so stress
management is essential. Unless she begins to regress, dietary counseling is not
indicated. Many who participate in sports will develop eating disorders in order to
control weight. It is not necessary to evaluate weight regularly.
2. A female college student seeks information about emergency contraception. What
is the most important part of the assessment of this patient?
a. Cultural considerations for use of contraception
b. Feelings of guilt about a possible pregnancy
c. Possible concerns about confidentiality
d. The female's sense of control in sexual situations - ANS: D
Because college women are at greater risk for sexual violence and assault, a
request for emergency contraception must be followed by an evaluation of possible
rape or assault. The other considerations may be part of the assessment, but are not
as important as determining whether a rape has occurred.
1. An international traveler plans to travel to Kenya in sub-Saharan Afric
a. Which is an important disease precaution for this person?
a. Carrying chloroquine to take as needed
b. Starting prophylactic doxycycline before travel
c. Taking precautions against Chikungunya fever
d. Understanding how Ebola virus is transmitted - ANS: B
Malaria is a greater concern worldwide than Ebola virus and Chikungunya fever,
although both are emerging diseases. Travelers should take antimalarial medications
and, in this part of Africa, where there is widespread resistance to chloroquine,
doxycycline is a better choice as prophylaxis. Even when chloroquine is appropriate,
it must be taken prior to travel and not as needed. Chikungunya fever is a disease of
the Western Hemisphere, especially in the Caribbean. Ebola virus is epidemic in
western Africa and not in Keny
a.
2. A patient returns home from travel in Africa and experiences chronic, non-bloody
diarrhe
a. The patient reports frequent bloating and flatulence with a "rotten egg" smell.
What is the treatment for this type of diarrhea?
a. Azithromycin
b. Ciprofloxacin
c. Metronidazole
d. Rifampin - ANS: C
This patient has symptoms characteristic of Giardia lamblia and should be treated
with metronidazole. Azithromycin is given for Campylobacter infection, which is a
bacterial cause. Ciprofloxacin is used for bacterial infections such as Salmonella or
Shigella, which cause bloody diarrhe
a. Rifampin is used for non-invasive strains of E. coli. REF: Food and Water
Precautions and Traveler's Diarrhea
3. A patient who is planning international travel to a developing country asks the
provider about vaccinations. Which is true about pre-travel vaccines?
a. Country-specific guidelines are provided by individual embassies.
b. Malaria vaccine is the most important vaccine for worldwide travel.
c. Requirements should be reviewed at least 6 to 8 weeks prior to travel.
d. There are at least five required vaccines for entry into certain countries. - ANS: C
Patients seeking immunizations prior to international travel should have these
reviewed at least 6 to 8 weeks prior so that antibody responses and completion of
vaccine series may occur. Country-specific guidelines may be found on the CDC
website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs.
There are only two vaccines that are required.
1. Which factors determine which diagnostic tests should be performed in a
presurgical clearance evaluation?
Select all that apply.
a. Patient's age
b. Patient's comorbidities
c. Previous surgeries
d. Surgeon's preference
e. Type of anesthetic agent planned - ANS: A, B, D, E
The patient's age and comorbidities, surgeon preference, and the type of anesthetic
planned all determine which presurgical diagnostic tests will be performed. The
patient's previous surgeries do not determine presurgical testing.
2. Which patient should have pulmonary function testing as part of the presurgical
exam?
a. A patient older than 60 years of age
b. A patient undergoing major intra-thoracic surgery
c. A patient with a history of pneumonia in the last 2 years
d. A patient with diabetes and morbid obesity - ANS: B
Any patient undergoing major thoracic surgery should have pulmonary function
testing. Age over 60 years, a history of pneumonia, and diabetes and obesity do not
require pulmonary function testing unless there is comorbid COPD.
1. During a pre-participation sports physical, the examiner notes a difference in
strength of the patient's radial and femoral pulses with the femoral pulses being
weaker. What will the provider do?
a. Evaluate for orthostatic hypotension
b. Obtain Doppler studies of lower extremity circulation
c. Reassure the patient that this is a normal finding
d. Refer the patient for a cardiologic exam - ANS: D
Differences in strength between radial and femoral pulses may indicate coarctation
of the aorta and should be evaluated by a cardiologist. This finding does not indicate
orthostatic hypotension. The likelihood of decreased circulation is low in a young
athlete.
2. An overweight adolescent who takes metformin has type 2 diabetes with a HgA1c
of 8.5% and asks about sports participation. What will the provider recommend?
a. Losing weight prior to initiating sports participation
b. Participation in strenuous sports to help with weight loss
c. Referral to the endocrinologist for sports clearance
d. Switching to insulin therapy prior to participation - ANS: C
Patients with poorly controlled diabetes should be referred to a specialist prior to
clearance for sports participation. This patient has an elevated HgA1C, indicating
poor control. The endocrinologist may suggest the other options, but the primary
care provider should not clear this patient for participation in sports.
3. A high-school adolescent is being screened for fitness before participating in
sports. The adolescent has a normal examination and the examiner notes S1 and S2
heart sounds without murmur, normal blood pressure, and equal pulses. The parent
reports that the adolescent's father has a history or Wolff-Parkinson-White
syndrome, which has been treated. What will the provider do?
CONTINUES.... [Show Less]