NURS 6531 COMBINED MIDTERM AND FINAL REVIEW
QUESTIONS AND ANSWERS 2022
A health care provider in a clinic finds a patient in a room, unresponsive and
... [Show More] pale.
Which sign should be used to identify the need to initiate cardiopulmonary
resuscitation (CPR)?
Evaluation of peripheral perfusion and level of consciousness
Obtaining a history of previous myocardial infarction
Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - Correct Answer-Assessment of
gasping breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic
hypertension reports blurred vision and shortness of breath. The provider notes a
blood pressure of 185/115. What is the recommended action for this patient?
Increase the dose of the thiazide medication
Add a beta blocker to the patient's regimen
Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - Correct Answer-Admit to the hospital for
evaluation and treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause
of these symptoms?
Atrial fibrillation
Anemia
Extrasystole
Paroxysmal attacks - Correct Answer-Atrial fibrillation
A patient has a cardiac murmur that peaks in midsystole and is best heard along the
left sternal border. The provider determines that the murmur decreases in intensity
when the patient changes from standing to squatting and increases in intensity with
the Valsalva maneuver. Which cause will the provider suspect for this murmur?
Aortic stenosis
Tricuspid regurgitation
Hypertrophic cardiomyopathy
Mitral valve prolapse - Correct Answer-Hypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute STsegment elevation MI (STEMI). The nearest hospital that can perform percutaneous
coronary intervention (PCI) is 3 hours away. What is the initial treatment for this
patient?
Give the patient an oral beta blocker
Transfer to the PCI-capable institution
Administer heparin
Initiate fibrinolytic treatment - Correct Answer-Initiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic
cardiovascular disease are those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - Correct Answer-previous
myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only
relieves after sitting for 30 minutes or more. What the does provider suspect as the
cause for these symptoms?
Buerger's disease
Cauda equina syndrome
Diabetic neuropathy
Peripheral arterial disease - Correct Answer-Cauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.)
Oral contraceptives
Isometic excercises
NSAIDS
Sleep apnea
Increased salt intake - Correct Answer-Oral contraceptives
NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health
maintenance exam, the provider notes an apical systolic murmur and a midsystolic
click on auscultation. The patient denies chest pain, syncope, or palpitations. What
will the provider do?
Reassure the patient that these findings are expected
Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - Correct AnswerConsult with cardiology to determine appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an
exam, the provider notes a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease
Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - Correct Answer-US of the mass to determine size
A patient is brought to an emergency department with symptoms of acute STsegment elevations MI (STEMI). The nearest hospital that can perform percutaneous
coronary intervention (PCI) is 3 hours away. What is the initial treatment for this
patient?
Give the patient an oral beta blocker
Initiate fibrinolytic treatment
Administer heparin
Transfer to the PCI-capable institution - Correct Answer-Initiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient
denies headaches, palpitations, snoring, muscle weakness, and nocturia and does
not take any medications. What will the provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - Correct Answer-Order urinalysis, CBC, BUN and
creatinine
A patient is diagnosed with PAD and elects to not have angioplasty after an
angiogram reveals partial obstruction in lower extremity arteries. What will the
provider recommend to help with relief of symptoms in this patient?
Statin therapy with clopidogrel
Walking to the point of pain each day
Daily aspirin therapy to prevent clotting
Walking slowly for 15 to 20 minutes twice daily - Correct Answer-Walking to the point
of pain each day
An adult patient reports frequent episodes of syncope and lightheadedness. The
provider notes a heart rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down
Evaluate the patient's orthostatic vital signs
Reassure the patient that the symptoms are non-cardiac in origin - Correct AnswerEvaluate the patient's orthostatic vital signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest
outside of a hospital setting because most victims have which arrhythmia?
Atrial flutter
Ventricular fibrillation
Atrial fibrillation
Ventricular tachycardia - Correct Answer-Ventricular fibrillation
A child with a history of asthma is brought to the clinic with a rapid heart rate. A
cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies
transport to take the child to the child emergency department. What initial
intervention may be attempted in the clinic?
Administration of intravenous adenosine
Using a vagal maneuver or carotid massage
Providing a loading dose of digoxin
Giving a beta blocker - Correct Answer-Using a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that
apply.)
Using a ratio of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - Correct AnswerUsing a ratio of 2 rescue breaths to 30 compressions
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not
relieved by rest. The provider administers a nitroglycerin tablet which does not
relieve the discomfort. What is the next action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist
Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - Correct Answer-Give the patient a beta
blocker medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient
has poorly-controlled hypertension, and decompensated heart failure. What is the
recommendation for treatment for this patient?
No intervention is necessary for this patient
Immediate open surgical repair of the aneurysm
Endovascular stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - Correct Answer-Serial
ultrasonographic surveillance of the aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum
calcium are consistent with a diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - Correct
Answer-Inappropriate secretion of PTH along with hypercalcemia
A patient who is obese has recurrent urinary tract infections and reports feeling tired
most of the time. What initial diagnostic test will the provider order in the clinic at this
visit?
Hemoglobin A1C
Random serum glucose
C-peptide level
Thyroid studies - Correct Answer-Hemoglobin A1C
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal
TSH is 0.3-4)
0.2 uIU/L
4.2 uIU/L
0.4 uIU/L
2.4 uIU/L - Correct Answer-0.2 uIU/L
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms
has the following laboratory values: decreased TSH, increased T3, and increased T4
and free T4. A pregnancy test is negative. What is the initial treatment for this
patient?
Radioiodine therapy
Surgical resection of the thyroid gland
Beta blocker medications
Thionamide therapy - Correct Answer-Beta blocker medications
A 40-year-old patient with primary hyperparathyroidism has increased serum calcium
0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended
treatment for this patient?
Avoidance of weight bearing exercises
Annual monitoring of calcium, creatinine, and bone density
Decreasing calcium and Vitamin D intake until values normal
Parathyroidectomy - Correct Answer-Annual monitoring of calcium, creatinine, and
bone density
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate
thyroid nodules for potential malignancy, which test is performed?
Serum calcitonin
Radionucleotide imaging
Serum TSH level
Thyroid ultrasound - Correct Answer-Thyroid ultrasound
Which laboratory values representing parathyroid hormone (PTH) and serum
calcium are consistent with a diagnosis of primary hyperparathyroidism?
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Appropriately increased PTH and low or normal serum calcium - Correct AnswerInappropriate secretion of PTH along with hypercalcemia
What is important about increased PAI-1 levels in patients with metabolic syndrome?
They cause increased insulin resistance.
They predispose patients to dyslipidemia.
They lower the risk of hypertension.
They increase the risk of arterial thrombosis. - Correct Answer-They increase the risk
of arterial thrombosis.
A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria.
Which initial action by the primary care provider is indicated for management of this
patient?
Consulting with a nephrologist
Prescribing an antihypertensive medication
Referring to an ophthalmologist
Limiting protein intake - Correct Answer-Consulting with a nephrologist
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory
values reveal elevated TSH and decreased T3 and T4 levels. What will the provider
tell this patient?
She will need lifelong medication.
A thyroidectomy will be necessary.
This condition may be transient.
She should be referred to an endocrinologist. - Correct Answer-This condition may
be transient.
Which findings are symptoms of hyperparathyroidism? (Select all that apply.)
Cognitive impairment
Left ventricular hypertrophy
Renal calculi
Perioral paresthesias
Chvostek's sign - Correct Answer-Cognitive impairment
Left ventricular hypertrophy
Renal calculi
Which medication given for patients with metabolic syndrome helps to lower PAI-1
levels?
Aspirin
Niacin
Atorvastatin
Metformin - Correct Answer-Metformin
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up
evaluation. The provider notes that the patient appears confused and irritable and is
sweating and shaking. What intervention will the provider expect to perform once the
point of care blood glucose level is known?
Giving a rapid-acting carbohydrate
Performing a hemoglobin A1C
Dipstick urinalysis for ketones
Injection of rapid-acting insulin - Correct Answer-Giving a rapid-acting carbohydrate
A patient with type 2 diabetes mellitus becomes insulin dependent after a year of
therapy with oral diabetes medications. When explaining this change in therapy, the
provider will tell the patient:
that strict diet and exercise measures may be relaxed with insulin therapy.
it is necessary because the patient cannot comply with the previous regimen.
this is because of the natural progression of the disease.
the use of insulin therapy may be temporary. - Correct Answer-this is because of the
natural progression of the disease.
A patient develops a dry, non-productive cough and is diagnosed with bronchitis.
Several days later, the cough becomes productive with mucoid sputum. What may
be prescribed to help with symptoms?
Bronchodilator treatment
Mucokinetic agents
Antitussive medication
Antibiotic therapy - Correct Answer-Antitussive medication
A young adult patient without a previous history of lung disease has an increased
respiratory rate and reports a feeling of "not getting enough air." The provider
auscultates clear breath sounds and notes no signs of increased respiratory effort.
Which diagnostic test will the provider perform initially?
Chest radiograph
Complete blood count
Computerized tomography
Spirometry - Correct Answer-Complete blood count
A patient who has asthma calls the provider to report having a peak flow measure of
75%, shortness of breath, wheezing, and cough, and tells the provider that the
symptoms have not improved significantly after a dose of albuterol. The patient uses
an inhaled corticosteroid medication twice daily. What will the provider recommend?
Administering two more doses of albuterol
Taking an oral corticosteroid
Coming to the clinic for evaluation
Going to the emergency department - Correct Answer-Administering two more doses
of albuterol
The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the
provider if the infant may have an influenza vaccine. What will the provider tell this
patient?
The infant should have an influenza vaccine now with a booster in 1 month
The infant should be given prophylactic antiviral medications
The rest of the family and all close contacts should have the influenza vaccine
The infant should have the live attenuated influenza vaccine (LAIV) - Correct
Answer-The rest of the family and all close contacts should have the influenza
vaccine
A patient reports coughing up a small amount of blood after a week of cough and
fever. The patient has been previously healthy and does not smoke or work around
pollutants or irritants. What will the provider suspect as the most likely cause of this
patient's symptoms?
Thromboembolism
Infection
Malignancy
Lung abscess - Correct Answer-Infection
An older patient with COPD is experiencing dyspnea and has an oxygen saturation
of 89% on room air. The patient has no history of pulmonary hypertension or
congestive heart failure. What will the provider order to help manage this patient's
dyspnea?
Opioid medications
Anxiolytic drugs
Supplemental oxygen
Breathing exercises - Correct Answer-Breathing exercises
A patient reports shortness of breath with activity and exhibits increased work of
breathing with prolonged expirations. Which diagnostic test will the provider order to
confirm a diagnosis in this patient?
Arterial blood gases
ventilation/perfusion scan
Spirometry
Blood cultures - Correct Answer-Spirometry
A patient with hemoptysis and no other symptoms has a normal chest radiograph,
CT, and fiberoptic bronch studies. What is the next action in managing this patient?
Observation
Refer to specialist
Surgical intervention
Prophylactic ABX - Correct Answer-Observation
Which clinical sign is especially worrisome in a patient with a pulmonary embolism?
TachycardiaAsw
Dyspnea
Hypotension
Abnormal lung sounds - Correct Answer-Hypotension
A patient has chronic chest pain that occurs after meals and the provider suspects
gastroesophageal reflux disease (GERD). The provider prescribes a proton pump
inhibitor and after 2 months the patient reports improvement in symptoms. What is
the next action in treating this patient?
Schedule an upper endoscopy
Continue the proton pump inhibitor
Refer the patient to a gastroenterologist
Order esophageal pH monitoring - Correct Answer-PPI
A patient comes to an emergency department with chest pain. The patient describes
the pain is sharp and stabbing and reports that it has been present for several
weeks. Upon questioning, the examiner determines that the pain is worse after
eating. The patient reports getting relief after taking a friend's nitroglycerin during one
episode. What is the most likely cause of this chest pain?
Pleural pain
Cardiac pain
Aortic dissection pain
Esophageal pain - Correct Answer-Esophageal pain
A patient who has a central line develops respiratory compromise. What is the initial
intervention for this patient?
Obtaining cultures and starting antibiotics
Lung ultrasonography to determine the cause
Prompt removal of the central line
Rapid assessment and resuscitation - Correct Answer-Rapid assessment and
resuscitation
A patient has a cough and fever and the provider auscultates rales in both lungs that
do not clear with cough. The patient reports having a headache and sore throat prior
to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous
infiltrates. Based on these findings, which organism is the most likely cause of this
patient's pneumonia?
S. pneumonia
A virus
Mycoplasma
Tuberculosis - Correct Answer-Mycoplasma
A high school athlete reports recent onset of chest pain that is aggravated by deep
breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The
examiner notes localized pain near the sternum that increases with pressure. What
will the provider do next?
Recommend an NSAID
Prescribe an antibiotic
Refer to a cardiologist
Order a chest radiograph - Correct Answer-Recommend an NSAID
A patient who was initially treated as an outpatient for pneumonia and then
hospitalized for two weeks after no improvement continues to show no improvement
after several antibiotic regimens have been attempted. What is the next step in
managing this patient?
Increasing the dose of the antibiotics
Open lung biopsy
Performing diagnostic bronchoscopy
Administration of the pneumonia vaccine - Correct Answer-Performing a diagnostic
broncho
A young adult, previously healthy clinic patient has symptoms of pneumonia
including high fever and cough. Auscultation reveals rales in the left lower lobe. A
chest radiograph is normal. The patient is unable to expectorate sputum. Which
treatment is recommended for this patient?
A respiratory fluoroquinolone antibiotic
Empiric treatment with a macrolide antibiotic
Hospitalization for intravenous antibiotics
A B-lactam antibiotic plus a fluoroquinolone - Correct Answer-Empiric treatment with
a macrolide antibiotic
Which are causes of pleural effusions? (Select all that apply.)
Bronchiectasis
Breast Cancer
Dehydration
Congestive Heart failure
Allergies - Correct Answer-Bronchiectasis
Breast Cancer
Congestive Heart failure
An adult patient who had pertussis immunizations as a child is exposed to pertussis
and develops a runny nose, low-grade fever, and upper respiratory illness symptoms
without a paroxysmal cough. What is recommended for this patient?... [Show Less]