NURS6531 MIDTERM EXAM
A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72
... [Show More] hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?
**The main focus of treatment is to prevent dehydration by drinking plenty of fluids. In severe cases, hospitalization and intravenous fluids are necessary. Over-the-counter oral rehydration solutions (OHS), such as Pedialyte, can be helpful in mild cases
Question 2
Which type of lung cancer has the poorest prognosis?
Small cell carcinoma
Question 3
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
Candidiasis
Question 4
An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:
GERD & Cancer
Question 5
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
Apply a topical antibiotic and warm compresses.
Question 6
Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to:
Do nothing other than provide reassurance
Question 7
Which of the following is not a goal of treatment for the patient with cystic fibrosis?
Replace water-soluble vitamins
Question 9
Which of the following color changes in a pigmented lesion suggests malignant transformation?
ALL COLORS
Question 10
Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?
Acute bronchitis
Question 11
The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?
A and B only
Question 12
When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?
Seventy-five of sodium intake is derived from processed foods
Question 13
Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?
Nifedipine (Procardia XL) for long-term management of his chronic stable angina.
Question 14
Which of the following patient characteristics are associated with chronic bronchitis?
Overweight, cyanosis & normal or slighted increased resp. rate "blue bloaters"
Question 15
Treatment of acute vertigo includes:
-bedrest and an antihistamine
Question 16
A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:
Herpes zoster and consider that this patient may be immunocompromised.
Question 20
Expected spirometry readings when the patient has chronic emphysema include:
increased total lung capacity (TLC).
Question 21
A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?
Peritonsillar abscess
Question 23
Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
-It is not effective during an acute asthma attack
Question 24
An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to:
Suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis
Question 25
A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests:
Epiglottitis
Question 28
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?
Heart failure
Question 29
The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every:
flexible sigmoidoscopy (FS) every 5 years,
Question 65
Which choice below is least effective for alleviating symptoms of the common cold?
Antibiotics
Liberal intake of fluids
Adequate rest
Aspirin
Warm clothing
Question 67
A patient reports to the nurse practitioner that he was diagnosed with hepatitis B a year ago and has not seen a health care provider since then. What information should this patient be given?
About 10% of affected persons become carriers and are at increased risk for hepatocellular carcinoma.
Question 68
The most common correlate(s) with chronic bronchitis and emphysema is(are):
Smoking
Question 69
If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:
Iritis
Question 70
Treatment of H.pylori includes which of the following?
Proton pump inhibitor
Antibiotic therapy
Bismuth subsalicylate
A and B
Question 71
Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?
Pneumonia
Question 72
What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?
Certain chemicals, such as ursodiol or chenodiol,
Question 73
Which of the following best describes hypertrophic cardiomyopathy?
A heart disease that affects the heart muscle. It causes thickening of the heart muscle (especially the ventricles, or lower heart chambers), left ventricular stiffness, mitral valve changes and cellular changes.
Question 74
Amaurosis fugax is described as a:
A painless temporary loss of vision in one or both eyes. Transient and periodic
Question 30
Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:
Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate.
Question 31
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?
Retinoblastoma
Question 32
A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:
Systolic HF
Question 33
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?
OFTEN
Question 36
Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:
Trauma or inflammation
Question 37
A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:
Gallstones
Question 39
Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?
Retinal Detachment
Question 40
Management of a patient with hypertension and an abdominal aortic aneurysm would include:
**The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Antihypertensive agents are used to reduce tension on the vessel wall in patients with abdominal aortic aneurysms (AAAs) who have elevated blood pressure (BP).
Esmolol (Brevibloc)
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An ultrashort-acting beta1 blocker, esmolol is particularly useful in patients with elevated arterial pressure, especially if surgery is planned. It can be discontinued abruptly if necessary. This agent is normally used in conjunction with nitroprusside. It may be useful as a means of testing beta-blocker safety and tolerance in patients with a history of obstructive pulmonary disease who are at uncertain risk for bronchospasm from beta blockade. The elimination half-life of esmolol is 9 minutes.
Labetalol (Trandate)
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Labetalol blocks alpha1-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure.
Propranolol (Inderal LA, InnoPran XL)
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A class II antiarrhythmic nonselective beta-adrenergic receptor blocker, propranolol has membrane-stabilizing activity and decreases the automaticity of contractions. It is not suitable for emergency treatment of hypertension; it should not be administered IV in hypertensive emergencies.
Metoprolol (Lopressor, Toprol-XL)
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Metoprolol is a selective beta 1-adrenergic receptor blocker that decreases the automaticity of contractions. During IV administration, carefully monitor blood pressure, heart rate, and electrocardiograms. When considering conversion from IV to oral (PO) dosage forms, use the ratio of 2.5 mg PO to 1 mg IV.
Nitroprusside (Nitropress)
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Nitroprusside causes peripheral vasodilation by acting directly on venous and arteriolar smooth muscle, thus reducing peripheral resistance. This agent is commonly used IV because of its rapid onset and short duration of action. It is easily titrated to the desired effect.
Because nitroprusside is light-sensitive, both bottle and tubing should be wrapped in aluminum foil. Before initiating nitroprusside therapy, administer a beta blocker to counteract the physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response will increase the shear forces against the aortic wall, thus increasing dP/dt. The objective is to keep the heart rate between 60 and 80 beats/min.
Morphine sulfate (Astramorph, Infumorph, Duramorph)
Fentanyl citrate
Question 41
Which of the following is not a symptom of irritable bowel syndrome?
Symptoms are:
Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement
Excess gas
Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation
Weight loss
Diarrhea at night
Rectal bleeding
Iron deficiency anemia
Unexplained vomiting
Difficulty swallowing
Persistent pain that isn't relieved by passing gas or a bowel movement
Mucus in the stool
Question 42
Impetigo and folliculitis are usually successfully treated with:
Topical antibiotics
Question 43
Which of the following is not a risk factor for coronary arterial insufficiency?
Risks are:
Older age: Over age 45 years in men and over age 55 years in women
Family history of early heart disease
Race: Among persons with CAD, the cardiovascular death rate for African Americans is reported to be particularly high; in Asians, low levels of high-density lipoprotein cholesterol (HDL-C), which are considered to be a risk factor for coronary heart disease, appear to be especially prevalent; South Asians appear to have a higher independent risk for cardiovascular disease as well.
High blood cholesterol levels (specifically, low-density lipoprotein cholesterol [LDL-C])
High blood pressure
Cigarette smoking: Cessation of cigarette smoking constitutes the single most important preventive measure for CAD
Diabetes mellitus [1]
Obesity
Lack of physical activity
Metabolic syndrome
Mental stress and depression
Question 44
The most appropriate treatment for a child with mild croup is:
a cool mist vaporizer.
Question 45
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?
psoriasis.
Question 46
Appropriate therapy for peptic ulcer disease (PUD) is:
**In general, 6-8 weeks of therapy with a PPI is required for complete healing of a duodenal ulcer. Active ulcers associated with NSAID use are treated with an appropriate course of PPI therapy and the cessation of NSAIDs.Eradication of H. pylori is recommended in all patients with PUD
Based on etiology
Question 47
An AST that is more than twice the level of ALT is suggestive of:
**alcoholic liver disease,
Question 48
A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial treatment option for this patient?
Prescribe an anti-fungal powder for application between her toes and in her shoes and a topical prescription strength anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection.
Question 50
Sandra has celiac disease. You place her on which diet?
Gluten-free
Question 51
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:
Quit smoking
Question 52
Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?
6-12
Question 54
Which of the following is a secondary cause of hyperlipidemia?
Diabetes mellitus
**Diet: excessive intake of saturated fat and/or calories, alcohol consumption, anorexia
Drugs: diuretics, beta-blockers, cyclosporine, estrogen, glucocorticoids, anabolic steroids, retinoids, protease inhibitors
Disease: chronic liver disease, primary biliary cirrhosis, chronic renal failure, nephrotic syndrome, Cushing’s syndrome, systemic lupus erythematosus
Dysmetabolism: hypothyroidism, diabetes, obesity, insulin resistance
Question 56
An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent?
Staphylococcus aureus
Question 58
A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?
***Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you'll probably have a follow-up endoscopy in one year and then every three years if no changes occur.
Treatment for GERD. Medication and lifestyle changes can ease your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option. Treating GERD doesn't treat the underlying Barrett's esophagus and likely won't decrease the risk of esophageal cancer, but can help make it easier to detect dysplasia.
Endoscopic resection, which uses an endoscope to remove damaged cells.
Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.
Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells.
Photodynamic therapy, which destroys abnormal cells by making them sensitive to light.
Surgery in which the damaged part of your esophagus is removed, and the remaining portion is attached to your stomach
Question 59
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?
An ACE inhibitor
Question 60
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:
Squamous cell carcinoma.
Question 61
A patient presents to the office with a blood pressure 142/80. This patient is classified as having:
HB stage 1
High Blood Pressure
(Hypertension) Stage 1
Systolic: From 140 to 159
Diastolic: From 90 to 99
High Blood Pressure
(Hypertension) Stage 2
Systolic: 160 or higher
Diastolic: 100 or higher
Hypertensive Crisis
(Emergency care needed)
Systolic: Higher than 180
Diastolic: Higher than 110
Question 62
Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?
Penicillin
Question 63
A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:
A purulent discharge.
Question 75
The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:
A common cause of conductive hearing loss in adults ages 20 - 40 is otosclerosis, a gradual hardening of the tympanic membrane that causes the footplate of the stapes to become fixed in the oval window.
Presbycusis, a progressive, bilaterally symmetrical perceptive hearing loss arising from structural changes in the hearing organs, usually occurs after
age 50. Trauma may result in a conductive hearing loss, but this is certainly not common.
Question 78
Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? (HTN stage 2)
***First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs.
Second- and third-line alternatives included higher doses or combinations of ACE inhibitors, ARBs, thiazide-type diuretics, and CCBs. Several medications are now designated as later-line alternatives, including the following: beta-blockers, alphablockers, alpha1/beta-blockers (eg, carvedilo), vasodilating beta-blockers (eg, nebivolol), central alpha2/-adrenergic agonists (eg, clonidine), direct vasodilators (eg, hydralazine), loop diruretics (eg, furosemide), aldosterone antagoinsts (eg, spironolactone), and peripherally acting adrenergic antagonists (eg, reserpine).
ACE inhibitors and ARBs should not be used in the same patient simultaneously.
CCBs and thiazide-type diuretics should be used instead of ACE inhibitors and ARBs in patients over the age of 75 years with impaired kidney function due to the risk of hyperkalemia, increased creatinine, and further renal impairment.
Question 81
After thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently considered most effective?
A low fat, tyramine-free, caffeine-free, high fiber diet, along with a daily diary, and attention to psychosocial factors.
Question 82
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?
SLE
Question 83
What is the Gold standard for the diagnosis of asthma?
Spirometry
Question 84
An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis?
Croup
Question 85
The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:
Goal of less than 100 mg/dL with statin treatments in managed care patients at high risk for coronary heart disease
Question 87
The nurse practitioner is reviewing a patient’s lab report who completed the hepatitis B series 3 months ago. Which of the following lab results would you expect to see in this patient?
Positive hepatitis B surface antibody and negative core antibody- my answer
Question 96
A false-positive result with the fecal occult blood test can result from:
A high dietary intake of rare cooked beef
Question 99
A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:
OPthalmic zoster
Question 100
Which of the following are classic features of ulcerative colitis?
Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus). Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon.
Question 2
The most common cancer found on the auricle is:
Answer:
Basal cell carcinoma
Question 3
Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?
Answers:
Antihistimines
Question 4
A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?
Answers:
Refer the patient for a barium enema and sigmoidoscopy.
Question 5
Which of the following patient characteristics are associated with chronic bronchitis?
Answer:
Overweight, cyanosis, and normal or slightly increased respiratory rate
Question 6
A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:
Answer:
CT scan
Question 7
A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:
Answer:
Purulent drainage
Question 8
A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:
Answer:
Gonococcal conjunctivitis
Question 9
A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:
Answers:
Herpes zoster and consider that this patient may be immunocompromised
Question 10
Which type of lung cancer has the poorest prognosis?
Answer:
Small cell carcinoma
Question 11
An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:
Answer:
Chronic diarrhea
Question 12
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?
Answer:
Systemic lupus erythematosus
Question 13
Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?
Answer:
Acute bronchitis
Question 14
Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?
Answer:
Moderate persistent
Question 15
Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?
Answer:
Penicillin V 500 milligrams PO every 8 hours for 10 days
Question 16
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?
Answer:
Varicose veins
Question 17
Which statement below is correct about pertussis?
Answer:
It is also called whooping cough [Show Less]