NR 511 Final Exam Questions and Answers, Exams of Nursing

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NR 511 / NR511 FINAL EXAM 2

Janet is a 30 year old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspician of cauda equna compression. Which of the following is a sign or symptom of cauda equina compression?

a. gastrocnemius weakness b. reduced or absent ankle refles c. numbness of the lateral foot d. paresthesia of the perineum and buttocks

d. paresthesia of the perineum and buttocks

The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson's Criteria. In order to plan care, the clinician understands that this criteria score has which of the following meanings?

a. a high mortality rate b. an increased chance of recurrence c. 7% chance of the disease becoming chronic d. all of the above a. a high mortality rate

Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load What does this indicate

a. a favorable diagnostic trend

b. disease progression c. the need to be more aggressive with Reuben's medications d. the eradication of the HIV a. a favorable diagnostic trend

Which is the differentiating symptom mbetween labyrinthitis and vestibular neuritis?

a. symptoms with vestibular neuritis are usually acute in onset, whereas with labyrinthitis the onet is more gradual

b. hearing loss may be associated with vestibular neuritis, but not with labyrinthitis c. symptoms with labyrinthitis are usually acute in onset, ,whereas with vesticular neuritis the onset is more gradual d. hearing loss may be associated with labyrinthitis ,but not with vestibular neuritis.

d. hearing loss may be associated with labyrinthitis ,but not with vestibular neuritis.

A 27 year old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection. what are some additional symptoms consistant with a diagnosis of lower UTI?

a. back and abdominal pain b. fever, chills, costovertebral angle (CVA) tenderness c. blood in urine and frequency d. foul-smelling discharge, perineal itch

c. blood in urine and frequency

The differential diagnosis for vertigo can be classified into which of the following categories:

a. peripheral vestibular disease b. CNS disorders c. Systemic disorders d. all of the above

d. all of the above

Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

a. morning stiffness and limited mobility of the lumbar spine b. unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain c. Fever, chills, and elevated erythrocyte sedimentation rate d. pathologic fractures, severe night pain, weight loss and fatigue b. unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain

Preceptors must always see the patients that the students see in the clinical setting

a. true b. false a. true

An 82 year old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differentials?

a. BPH b. Prostate cancer c. UTI d. all of the above

d. all of the above

Which causes the greatest percentage of mammalian bites?

a. dogs b. cats c. humans d. rodents a. dogs

Endoscopic report reveals the presents of Barrett's epithelium. Which of the following information should the clinician include in the explaination of the pathology report?

a. this is a premalignant tissue b. this tissue is resistant to gastric acid c. this tissue supports healing of the esophagus d. all of the above

d. all of the above

Which of the following data are indicative of testicular torsion?

a. absent cremasteric reflux b. pain relived on testicular elevation c. testicle very low in the scrotum d. swollen scrotum with a red dot sign a. absent cremasteric reflux

Most nosocomial pneumonias are caused by:

a. Fungi. b. Viruses c. Gram-negative bacteria. d. Pneumococcal pneumonia. c. Gram-negative bacteria.

A family practice office for all 5 of your clinical rotations will guarantee that you will gain the required pediatric exposure

a. true b. false

b. false

The most common precancerous skin lesion found in Caucasians is

a. skin tags b. actinic keratosis c. melanoma d. basal skin lesion

b. actinic keratosis

Which obstructive lung disease is classified as reversible?

a. Asthma b. Chronic bronchitis c. Emphysema d. COPD a. Asthma

Which of the following is an example of an articular structure

a. bone b. synovium c. tendons d. fascia b. synovium

Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. posterior dislocations are more common than anterior dislocations b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses

b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses

Which of the following statements is true concerning the management of the client with a herniated disc?

a. muscle relaxants and narcotics can be used to control moderate pain but should be

discontinued after 3 weeks of use

b. an epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. c. intolerable pain for more than 3 months is an indication for surgical intervention d. all of the above

c. intolerable pain for more than 3 months is an indication for surgical intervention

After 6 months of synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?

a. elevated TSH b. normal TSH c. low TSH d. undetectable TSH

b. normal TSH

The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?

a. thryoid stimulating hormone (TSH) and free T b. TSH and thyrotoxin antibodies

•High sensitivity thyroid stimulating hormone TSH and free T

• Free T4 and serum calcium a. thryoid stimulating hormone (TSH) and free T

Cat bites are commonly associated with which of the following pathogens?

a. pasteurella multocida b. vibri vulnificus c. group B streptococcus d. Group A beta hemolytic streptococcus a. pasteurella multocida

The 56 year old man with chronic prostatitis should be treated with trimethoprim 80mg- sulfamethoxazole 400 (TMP-SMX, Bactrim) for how long?

a. 3-7 days b. 14-21 days

c. 3-6 weeks d 6-12 weeks

d 6-12 weeks

The A in SNAPPS stands for Assessment

a. true b. false

b. false

A patient is diagnosed with Giardia after backpacking trip in the mountains. Which of the following would be the appropriate treatement?

a. Vancomycin b. Penicillin c. Metronidazole d. Bactrim

c. Metronidazole

The most cost effective screening test to determine HIV status is which of the following?

a. western blot b. enzyme-linked immunosorbent assay (ELISA) c. venereal disease research laboratory test (VDRL) d. Viral load

b. enzyme-linked immunosorbent assay (ELISA)

The clinician sees a patient who is 5 feet tall and weighs 150 pounds (:BMI 29.3). How would the clinician classify this patient?

a. overweight b. Mild Obesity c. Moderate Obesity d. morbid obesity

b. Mild Obesity

One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular srtucture?

A. Fascia

B. Bone

C. Synovium

D. Tendons

C. Synovium

Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her

fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. posterior dislocations are more common than anterior dislocations b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses

b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses

Which of the following types of cellulitis is a streptococcal infection of the superficial layers of the skin which does not involve the subcutaneous layers?

a. necrotizing fascitis b. periorbital cellulitis c. erysipelas d. flesh eating bacteria

c. erysipelas

A 76 year old man is seen in the office for complaints of urinary incontinence. The clinican should suspect which of these causes of incontinence in men?

a. urethral polyps

b,. urinary tract infection (UTI)

c. anticholinergic medications

d. all of the above

d. all of the above

Sally, aged 25, presents with impetigo that has been diagnosed as infected with staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. She has not been adequately treated recently. Which type of impetigo is this?

a. Bullous impetigo b. Staphylococcal scalded skin syndrome (SSSS) c. Nonbullous impetigo d. Ecthyma

d. Ecthyma

A 42 year old woman is seen in the clinic with fever, chills, vomiting and severe dysuria. She is diagnosed with acute pyelonepritis. How should this patient be managed?

a. 3 day course of oral antibiotics b. hospitalization

b. hospitalization

Which of the following are risk factors associated with obesity?

a. diabetes b. skin infections c. arthritis d. all of the above

d. all of the above

Which of the following information is essential before prescribing Bactrim DS to a 24 year old woman witht urinary tract infection?

a. last menstrual period b. method of birth control c. last unprotected sexual contact d. all of the above

d. all of the above

A 22 year old male is seen in the clinic because he found a hard lump in his testicle during a testicular self exam (TSE). which of the following shoud be included in the differential diagnosis.

a. testicular cancer b.. inguinal hernia c. varicocele d. all of the above

d. all of the above

Which of the following dietary information should be given to a patient with gastroesophageal reflux disease (GERD)?

a. eliminate coffee b. drink peppermint ice to relieve stomach distress c. recline and rest after meal d. limit the amount of antacids a. eliminate coffee

Which of the following are predisposing factors for pyelonephritis?

a. pregnancy

d. dehydration

c. smoking

d. alkaline urine

d. alkaline urine

A patient is seen in the clinic with right upper quadrant pain (RUQ) that is radiating to the middle of the back. The clinical suspects acute cholelithasis. The clinician should expect with of the following laboratory findings?

a. Decreased alanine anminotransferase (ALT) and aspartate aminotransferase (AST) b. elevated alkaline phosphatase c. elevated indirect biliruben d. decreased white blood cell (WBC) count b. elevated alkaline phosphatase

A 25 year old patient presents to the clinic with fatigue, cold intolerance, weght gain and constipation for the past 3 months. On physical exam, the clinican notices a sinus bradycardia, muscular stiffness, coarse dry hair and a delay in relaxation in deep tendon reflexes (DTR's). Which of the following tests should be ordered next?

a. Serum Calcium b. Thyroid Stimulating Hormone (TSH) c. electrolytes d. urine specific gravity

b. Thyroid Stimulating Hormone (TSH)

You are preforming muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete range of motion with gravity eliminated. Which numeric grade of muscle strength would you give this patient?

a. 1

b. 2

c. 3

d. 4

b. 2

The patient is diagnosed with overactive bladder (OAB). Which of the following instructions should be given to this woman?

a. Limit the amount of water that you drink b. eliminate caffeine from your diet c. wear panty liners d. all of the above

b. eliminate caffeine from your diet

A 28 year old patient is seen in the office with colicky abdominal pain, particularly with meals. She has frequent constipation, flatulence and abdominal distention. Which of the data makes a diagnosis of diverticulitis unlikely?

a. her age b. frequent constipation c. flatulence d. colicky abdominal pain a. her age

Treatment for epididymitis includes which of the following?

a. warm sitz baths b. scrotal elevation c. masturbation d. all of the above b. scrotal elevation

Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?

a. there are round hypopigmented macules on his back b. there are red papules on his face c. there are crusted placques in Josh's groin area d. there are white streaks on his neck a. there are round hypopigmented macules on his back

The clinican has instructed Sam, a 25 year old patient with low back strain, to use NSAID's to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate withn teaching sam about the use of NSAID' to manage his pain

a. you should start with the lowest dose that is effective in managing your pain because long term use of NSAIDS can result in gastrointestinal (GI) disorders such as ulcers and hemmorhage b. you should start with the lowest dose that is effective in managing your pain in order to avoid developing tolerance to the medication c. you should take the maximum recommended dose of NSAID's so that you will not need to take narcotics to control your pain a. you should start with the lowest dose that is effective in managing your pain because long term use of NSAIDS can result in gastrointestinal (GI) disorders such as ulcers and hemmorhage

Which of the following patients are at risk for developing urinary tract cancer?

a. the 45 year old woman who is 100 pounds overweight b. the 78 year old man who smokes three packs of cigarettes a day c. the 84 year old man who worked in the asbestos mines d. all of the above

d. all of the above

SNAPPS pneumonic used to describe a technique in orally presenting a patient.

A. true

b. false

A. true

The clinician is caring for Diane, a 22 year old woman who presents with an injured ankle. Diane asks if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiography is dependent on the exam and Diane's description of the injury. Which of the following clues in Diane exam or history would alert the clinician to the need for obtaining radiographs

a. if she was not able to bear weight immediately after the injury b. if the ankle developed marked swelling and discoloration after the injury c. if crepitation occurs with palpation or movement of the ankle d. all of the above

d. all of the above

A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting and diaphoresis. In addition to nephrolithasis, which of the following should be added to the list of differential diagnosis

a. Pancreatitis' b. peptic ulcer disease c. diverticulitis

d all of the above

d all of the above

Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure

a. 0 to 7 mmHg

b 8 to 21 mmHg

c. 22 to 40 mmHg

d. 40-80mmHg

b 8 to 21 mmHg

A 28 year old patient is seen with complaints of diarrhea. Which of the following questions would help the clinician establish the diagnosis of irratible bowel syndrome?

a. Feels relief after a bowel movement b. sometimes is constipated c. does not defecate in the middle of the night d. all of the above

d. all of the above

The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection?

a. HSV Type 2

b HIV

c Pneumonia

d. Syphilis

b HIV

Mrs. Gary is a 55 year old woman who presents with tightness, pain and limited movement in her right shoulder. She denies any history of trauma. Her exam reveals a 75% reduction in both active and passive range of motion of the right shoulder. Mrs. Gray is also experiencing tenderness with motion and pain at the deltoid insertion. HEr medical history is significant for type 1 DMm and HTN. HEr social history reveals that she is a secretary ant that she is right handed. Based on her exam and medical history, you suspect adhesive capulitis or "frozen shoulder" Which clue in Mrs. Grays history supports the diagnosis?

a. history of hypertension b. her affected shoulder is also her dominant hand c. her history of diabetes

c. her history of diabetes

A 63 year old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis?

a. Psychogenic nocturia b. Urethral polyp c. Irritative posterior urethral lesion

d. Benign prostatic hypertrophy

d. Benign prostatic hypertrophy

Joyce is seen in the clinic complaining of vague symptoms of feeling nervous and irritable, and that her hair will not hold a curl anymore. On physical exam, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis could be which of the following?

• Myxedema
• Cushing's Syndrome
• Pan-hypopituitism
• Thyrotoxicosis
• Thyrotoxicosis

As diabetic retinopathy progresses, the presence of "cotton wool" spots can be detected. Cotton wool spots refer to:

a) Venous beading. b) Retinal hemorrhage. c) Nerve fiber layer infarctions. d) Blood vessel proliferation

c) Nerve fiber layer infarctions.

Which of the following instructions should be given to a patient with nephrolithasis?

a. take ibuprofen 600mg every 8 hours b. take tums for upset stomach c. drink more black tea d. increase intake of vegetables like spinach a. take ibuprofen 600mg every 8 hours

Joyce is taking a long-acting beta agonist for her moderate persistent asthma. What additional medication should she be taking?

a. Inhaled corticosteroid (Flovent) b. Leukotriene receptor antagonist c. Systemic corticosteroid (Prednisone) d. Methyl xanthenes (Theophylline a. Inhaled corticosteroid (Flovent)

You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:

A. Articular

B. Inflammatory

C. Nonarticular

D. A and B

A. Articular