NSG 5003 FINAL EXAM 2 – QUESTION AND ANSWERS
1. It is important to not dilate the eye if ____ is suspected.
Cataract
Macular
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Acute closed-angle glaucoma
Chronic open-angle glaucoma
Question 2. 2. An 18-year-old female patient presents with repeated urinary tract infections. She has no risk factors in her history, and her physical examination is unremarkable. She also has a normal pelvic exam. Which of the following should be obtained if anatomic abnormalities are suspected?
Ultrasound of the kidneys
Intravenous pyelogram
Cystoscopy
Transvaginal ultrasound of the bladder
Question 3. 3. The pathophysiological hallmark of ACD is:
Depleted iron stores
Impaired ability to use iron stores
Chronic uncorrectable bleeding
Reduced intestinal absorption of iron
Question 4. 4. Which of the following is the most important question to ask during cardiovascular health history?
Number of offspring
Last physical exam
Sudden death of a family member
Use of caffeine
Question 5. 5. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:
Exercise-induced cough
Bronchiectasis
Alpha-1 deficiency
Pericarditis
Question 6. 6. Which of the following dermatological conditions results from reactivation of the dormant varicella virus?
Tinea versicolor
Seborrheic keratosis
Verruca
Herpes zoster
Question 7. 7. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is not a potential side effect of this procedure?
Urinary incontinence
Impotence
Dribbling urine
Selected low back pain
Question 8. 8. Presbycusis is the hearing impairment that is associated with:
Physiologic aging
Ménière’s disease
Cerumen impaction
Herpes zoster
Question 9. 9. Asymptomatic 1+ bacteriuria is found in a nursing home resident with an indwelling catheter. The nurse practitioner’s initial intervention includes:
Assessing resident’s cognitive status and last change of the catheter/bag
Prescribing prophylactic Bactrim 1 tablet at bedtime
Ordering a urine culture and sensitivity and prescribing empiric treatment until results obtained
Ordering an X-ray of the kidney, urine, and bladder
Question 10. 10. A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation?
Bacterium
Allergen
Virus
Fungi
Question 11. 11. The nurse practitioner is examining a 62-year-old female who has been complaining of lower abdominal pain. Upon auscultation, bowel sounds are high pitched and tinkling. Which of the following terms describes this finding?
Succession splash
Borborygmi
Tenesmus
Puddle sign
Question 12. 12. Which ethnic group has the highest incidence of prostate cancer?
Asians
Hispanics
African Americans
American Indians
Question 13. 13. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
Women with ischemic heart disease many times do not present with chest pain
Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction
Elderly patients have the most severe symptoms
A & B only
Question 14. 14. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included?
Weight reduction and rest 30 minutes after each meal in the supine position
Elevation of head of the bed 4-6 inches on blocks and weight reduction
Encouraged to wear restrictive clothing to add support for diaphragmatic breathing
Using oral mints to relieve gastric distress
Question 15. 15. Which lesions are typically located along the distribution of dermatome?
Scabies
Herpes zoster
Tinea
Dyshidrosis
Question 16. 16. Which of the following medications are commonly associated with the side effect of cough?
Beta blocker
Diuretic
ACE inhibitor
Calcium antagonist
Question 17. 17. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should:
Refer the patient for transrectal ultrasound guided prostate biopsy
Obtain an abdominal X-ray of kidneys, ureter, and bladder
Recognize this as a normal finding that requires periodic follow up
Obtain urine culture and sensitivity for prostatitis
Question 18. 18. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?
Femoral vein thrombosis
Femoral artery thrombus
Venous insufficiency
Musculoskeletal injury
Question 19. 19. The most common cause of eye redness is:
Conjunctivitis
Acute glaucoma
Head trauma
Corneal abrasion
Question 20. 20. The aging process causes what normal physiological changes in the heart?
The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis
Cardiology occurs along with prolapse of the mitral valve and regurgitation
Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves
Hypertrophy of the right ventricle
Question 21. 21. Ms. Smith, 37-year-old, comes to the clinic today complaining of dull, throbbing bilateral headaches almost every evening. You suspect she is experiencing:
cluster headaches
migraine headaches
tension headaches
benign intracranial hypertension
Question 22. 22. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is:
Peptic ulcer disease
Barrett’s esophagus
Esophageal varices
Pancreatitis
Question 23. 23. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?
Fever of 102
Infiltrates on chest X-ray
Pleural effusion on chest X-ray
Elevated white blood cell count
Question 24. 24. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider:
Diverticulitis
Colon cancer
Appendicitis
Peptic ulcer disease
Question 25. 25. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions?
Ménière’s disease
Benign paroxysmal positional vertigo
Transient ischemic attack (TIA)
Migraine
Question 26. 26. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion?
Fictional keratosis
Keratoacanthoma
Lichen planus
Leukoplakia
Question 27. 27. A cough is described as chronic if it has been present for:
2 weeks or more
8 weeks or more
3 months or more
6 months or more
Question 28. 28. The first assessment to complete related to the eyes is:
Eye lids
Visual acuity
Extraocular movements
Peripheral vision
Question 29. 29. The Mini-Cog is a short screening tool used to assess cognition. Which of the following statements pertaining to the test is a true statement?
The patient will be asked to repeat five words immediately following the directions by the practitioner.
The patient is asked to draw the hour and minute hands on a picture of an analog clock.
A score of 0-2 is a positive screen for dementia.
The patient is asked to recall five images from picture cards following the drawing of the clock hands.
Question 30. 30. A woman with an X-linked dominant disorder will:
Not be affected by the disorder herself
Transmit the disorder to 50% of her offspring (male or female)
Not transmit the disorder to her daughters
Transmit the disorder to only her daughters
Question 31. 31. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:
Legionnaires' disease
Malaria
Tuberculosis
Pneumonia
Question 32. 32. In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness?
History of prior red-eye episodes
Grossly visible corneal defect
Exophthalmos
Photophobia
Question 33. 33. The best evidence rating drugs to consider in a post myocardial infarction patient include:
ASA, ACE/ARB, beta-blocker, aldosterone blockade
ACE, ARB, Calcium channel blocker, ASA
Long-acting nitrates, warfarin, ACE, and ARB
ASA, clopidogrel, nitrates
Question 34. 34. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of:
Bacterial sinusitis
Allergic rhinitis
Drug abuse
Skull fracture
Question 35. 35. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
History of bright flash of light followed by significantly blurred vision
History of transient and painless monocular loss of vision
History of monocular severe eye pain, blurred vision, and ciliary flush
All of the above
Question 36. 36. Which symptom is more characteristic of Non-Cardiac chest pain?
Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm
Pain tends to occur with movement, stretching or palpation
Pain usually lasts less than 10 minutes and is relieved by nitroglycerine
Pain is aggravated by exertion or stress
Question 37. 37. Aortic regurgitation requires medical treatment for early signs of CHF with:
Beta blockers
ACE inhibitors
Surgery
Hospitalization
Question 38. 38. What test is used to confirm the diagnosis of appendicitis?
CBC
Flat plate of abdomen
Rectal exam
CT of abdomen with attention to appendix
Question 39. 39. The major impact of the physiological changes that occur with aging is:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
All of the above
Question 40. 40. A smooth round nodule with a pearly gray border and central induration best describes which skin lesion?
Seborrheic keratosis
Malignant melanoma
Herpes zoster
Basal cell carcinoma
Question 41. 41. A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with:
Inflammatory bowel disease
Irritable bowel syndrome
Giardiasis
Norovirus gastroenteritis
Question 42. 42. Which of the following disorders can cause urinary incontinence?
Cystocele
Overactive bladder
Uterine prolapse
All of the above
Question 43. 43. Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management?
Misoprostol (Cytotec)
Cimetidine (Tagamet)
Metronidazole (Flagyl)
Bismuth subsalicylate (Pepto bismol)
Question 44. 44. Which of the following details are NOT considered while staging asthma?
Nighttime awakenings
Long-acting beta agonist usage
Frequency of symptoms
Spirometry findings
Question 45. 45. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
50 x 2-pack years
100-pack years
50-year, 2-pack history
100-pack history
Question 46. 46. A clinical clue for suspected renal artery stenosis would be:
Decreased urine output
Development of resistant hypertension in a previously well-controlled patient
Retroperitoneal pain on the affected side
Rising BUN level with normal creatinine level
Question 47. 47. What is the most common valvular heart disease in the older adult?
Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis
Question 48. 48. The cytochrome p system involves enzymes that are generally:
Inhibited by drugs
Induced by drugs
Inhibited or induced by drugs
Associated with decreased liver perfusion
Question 49. 49. Which of the following is the most common cause of heartburn-type epigastric pain?
Decreased lower esophageal sphincter tone
Helicobacter pylori infection of stomach
Esophageal spasm
Peptic ulcer disease
Question 50. 50. A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in:
Appendicitis
Cholecystitis
Bowel Obstruction
Diverticulitis
Question 51. 51. A patient suffered a laceration of the shin three days ago, and today presents with a painful, warm, red swollen region around the area. The laceration has a purulent exudate. The clinician should recognize that the infected region is called:
Contact dermatitis
Folliculitis
Hidradenitis suppurativa
Cellulitis
Question 52. 52. A 62-year-old client presents with a complaint of fever, pain, and burning on urination. Difficulty urinating with dribbling has been increasing in the past few days. He has a feeling of pressure in his groin. On examination, his prostate is tender, boggy, and warm. A stat urinalysis reveals the presence of leukocytes and bacteria. He is allergic to sulfa drugs. His weight is 70 kg and his last serum creatinine was 1.0. While awaiting the culture and sensitivity, the nurse practitioner begins empiric treatment with which of the following?
Trimethoprim/sulfamethoxazole DS bid x 2 weeks
Ampicillin 250 mg PO Q day for 10 days
Nitrofurantoin 100 mg Q 12 hours for 7 days
Ciprofloxacin 500 mg Q 12 hours for 14 days
Question 53. 53. In teaching an older adult female client with end-stage renal disease her medication regimen, the nurse practitioner must include which of the following pieces of information in the treatment plan?
Report any changes in the color of her stool
Take iron supplement and elemental calcium with each meal
Take iron supplement before meals and the calcium after meals
Take calcium with a high phosphorus meal
Question 54. 54. 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 examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of:
Osteoarthritis
Rheumatoid arthritis
Scleroderma
Sarcoidosis
Question 55. 55. Whenever a patient presents with acute non-traumatic shoulder pain, the clinician should make sure to exclude a:
Cardiac origin of symptoms
Gastrointestinal condition
Cervical spine disorder
All of the above
Question 56. 56. A female patient presents to the clinic with complaints of a severe, throbbing, unilateral headache. She complains of seeing flashes of light prior to the headache. She complains of sound and light sensitivity as well as nausea. The clinician should recognize these as symptoms of:
Epilepsy with aura
Cluster headache
Migraine headache
Normal pressure hydrocephalus
Question 57. 57. The main focus of treatment of patients with ACD is:
Replenishing iron stores
Providing for adequate nutrition high in iron
Management of the underlying disorder
Administration of monthly vitamin B12 injections
Question 58. 58. The most common neurological cause of seizures in an older adult is:
Alzheimer’s disease
Multiple sclerosis
Stroke
Peripheral neuropathy
Question 59. 59. 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 examination 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:
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 X-ray (DEXA) scan and updating immunizations
Question 60. 60. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:
Thrush
Laryngeal cancer
Carotidynia
Thyroiditis
Question 61. 61. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an X-ray of the feet be ordered?
Yes, there is tenderness over the fifth metatarsal
No, there is not tenderness over the navicular bone
Yes, the patient cannot bear weight on the foot
A and C
Question 62. 62. When assessing a patient who complains of a tremor, the nurse practitioner must differentiate essential tremor from the tremor of Parkinson’s disease. Which of the following findings are consistent with essential tremor?
The handwriting is not affected by the tremor
The tremor occurs with purposeful movements
The tremor occurs at rest
The tremor gets worse with alcohol ingestion
Question 63. 63. Folliculitis is most commonly due to:
Contact dermatitis
Varicella zoster
Dermatophytes
Staphylococcal infection
Question 64. 64. What kind of lesions are caused by the herpes simplex virus?
Scales
Vesicles
Plaques
Urticaria
Question 65. 65. A 65-year-old male complains of a headache that feels “like a knife is cutting into his head.” He also reports feeling right-sided scalp and facial pain and “seeing double” at times. He has a history of hypertension and hyperlipidemia. His medications include beta blocker, statin drug, and an ACE inhibitor. On physical examination, you note palpable tenderness over the right side of the forehead. There are no neurological deficits. Vision is 20/20 with lenses. No weakness of extremities. CN II to XII are intact. The history corresponds to which of the following disorders?
Drug toxicity
Giant cell arteritis
Cluster headache
Migraine headache
Question 66. 66. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea?
Viral gastroenteritis
Staphylococcal food poisoning
Acute hepatitis A
E coli gastroenteritis
Question 67. 67. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be:
Symmetric joint space narrowing
Soft tissue swelling
Subluxations of the joints
Joint erosions
Question 68. 68. A common auscultatory finding in advanced CHF is:
Systolic ejection murmur
S3 gallop rhythm
Friction rub
Bradycardia
Question 69. 69. The three cardinal features of Parkinson’s disease are:
Essential tremor, postural rigidity, and infarcts of the basal ganglion
Bradykinesia, rigidity, and tremor
Shuffling gait, constipation, positional freezing.
Dementia, incontinence, and infarcts of the basal ganglion
Question 70. 70. In AR disorders, carriers have:
Two mutated genes; one from each parent that cause disease
A mutation on a sex chromosome that causes a disease
A single gene mutation that causes the disease
One copy of a gene mutation but not the disease
Question 71. 71. A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?
Arterial insufficiency
Femoral vein thrombus
Venous insufficiency
Peripheral neuropathy
Question 72. 72. Which of the following statements is true concerning anti-arrhythmic drugs?
Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile.
Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality.
Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.
Anti-arrhythmic therapy should be initiated in the hospital for all patients.
Question 73. 73. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:
Barrel-shaped chest
Clubbing
Pectus excavatum
Prolonged capillary refill
Question 74. 74. Which of the following is a common trigger of migraine headache?
Missed meals
Menses
Alcohol
All of the above
Question 75. 75. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon?
Straight leg raising sign
Lumbar herniated disc on X-ray
Loss of left sided patellar reflex
Urinary incontinence
Question 76. 76. The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in:
Pityriasis Rosea
Shingles
Psoriasis
Lymes Disease
Question 77. 77. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased
Question 78. 78. In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer?
Pain occurs on an empty stomach
Diffuse epigastric pain
Rarely associated with non-steroidal use
Occurs in patients under 40 years of age
Question 79. 79. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is:
Lower urinary tract infection
Nephrolithiasis
Hydronephrosis
Pyelonephritis
Question 80. 80. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition?
Inflammatory bowel disease
Irritable bowel syndrome
Giardiasis
Lactose intolerance
Question 81. 81. 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 examination, 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:
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Polymyalgia rheumatica
Question 82. 82. A 60-year-old female patient complains of pain in both hands that is worse in the morning. On physical examination, the thumb metacarpophalangeal joint is swollen on both hands. There is swelling of the proximal and distal interphalangeal joints bilaterally. These are typical signs of:
Osteoarthritis
Rheumatoid arthritis
Normal aging
Gouty arthritis
Question 83. 83. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner’s appropriate intervention is:
Digital rectal exam and send home with 3 hemoccult to return
Immediate referral to gastroenterologist and colonoscopy
Order a screening sigmoidoscopy
Order a colonoscopy and barium enema and refer based on results
Question 84. 84. During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with:
COPD
Pneumothorax
A normal finding
Pleural effusion
Question 85. 85. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle modifications and antacids, the patient continues to have occasional mild heartburn after occasional meals and at night. The most appropriate next action is:
Prokinetic agents
H2 antagonists
Proton pump inhibitors
Sucralfate
Question 86. 86. In order to provide a comprehensive genetic history of a patient, the NP should:
Ask patients to complete a family history worksheet
Seek out pathology reports related to the patient’s disorder
Interview family members regarding genetic disorders
All of the above [Show Less]