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NR 511 MIDTERM EXAM COMPREHENSIVE
STUDY GUIDE 2026
◉ You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have:
- Yogurt. 2.Foods containing whey. 3.Prehydrolyzed milk. 4.Oranges. Answer: Foods containing whey rationale: Advise clients who are lactose intolerant to avoid foods containing whey. Whey is a lactose-rich ingredient found in some foods, so clients who are lactose intolerant need to read labels on all foods. To control symptoms, dietary lactose should be reduced or restricted by using lactose-reduced and lactose-free dairy products or by eating lactose-rich foods in small amounts or in combination with low-lactose or lactose-free foods. ◉ Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1."You should have two to three stools per day." 2."You should defecate once a day." 3."You should have at least three stools per week."
4."There is no such thing as a 'normal' pattern of defecation." Answer: There is no such thing as a normal pattern of defecation rationale: There is no such thing as a "normal" pattern of defecation. Patterns of defecation vary widely and may in part be affected by dietary habits, fluid intake, bacteria in the stool, psychological stress, or voluntary postponement of defecation. Defecating every third day could be the routine pattern for Simon. He should be questioned if this is routine for him. ◉ Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1.Constipation. 2.Colorectal cancer. 3.Irritable bowel syndrome. 4.Acute appendicitis. Answer: Colorectal cancer rationale: A middle-aged or older client with an abrupt change in defecation pattern must be evaluated for colorectal cancer ◉ Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1.Cheese. 2.Leafy green vegetables.
1."She must be lactose intolerant from the formula, and this is altering the fluid balance." 2."Her body's telling you that it's time to introduce some solids into her system." 3."The virus is causing irritation of the gastrointestinal lining, which causes diarrhea." 4."The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients." Answer: "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients." rationale: In 80% of cases, gastroenteritis is viral in nature. This viral infection causes diarrhea by stimulating the secretion of electrolytes into the intestine. This is rapidly followed by water along the osmotic gradient, resulting in watery stools. ◉ Sandy, age 52, presents with jaundice, dark urine, and light- colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? 1.Incubation. 2.Prodromal. 3.Icteric. 4.Convalescent. Answer: Icteric
rationale: In the icteric stage of viral hepatitis, there is jaundice, dark urine, and light-colored stools. There are continued prodromal complaints, with gradual improvement. ◉ Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1.Antibiotics. 2.Nonsteroidal anti-inflammatory drugs (NSAIDs). 3.Oral contraceptives. 4.Antifungals. Answer: NSAIDS rationale: Clients with GERD should avoid taking NSAIDs because they tend to aggravate the already irritated gastric mucosa. ◉ Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1.A gastric ulcer. 2.Gastritis. 3.Pelvic inflammatory disease. 4.Pancreatitis. Answer: PID
4.A family history of peptic ulcers. Answer: Infection by H. Pylori rationale: About 90% of cases of peptic ulcers have been found to be caused by infection with the bacteria H pylori ◉ You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1.A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2.Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3.Amoxicillin (Amoxil) and omeprazole (Prilosec). 4.Clarithromycin (Biaxin) and metronidazole (Flagyl) Answer: Amoxicillin (Amoxil) and omeprazole (Prilosec) rationale: Both drugs listed are used in the eradication of H pylori, but do not complete the regimen. ◉ A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F,
pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1.Appendicitis. 2.Cholecystitis. 3.Constipation. 4.Gastroenteritis Answer: appendicitis rationale: This is the clinical scenario typical for appendicitis ◉ What is the recommended treatment to eradicate a Helicobacter pylori infection? 1.Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2.Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3.Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4.Bismuth, doxycycline, metronidazole, and ranitidine. Answer: Amoxicillin, clarithromycin, and omeprazole for 2 weeks rationale: This is the recommended treatment to eradicate H pylori. ◉ A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature
◉ The screening guidelines for colon cancer recommend which of the following for the general population? 1.Colonoscopy starting at age 50. 2.Colonoscopy starting at age 45. 3.Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4.Fecal occult blood test (FOBT) and rectal exam starting at age 45. Answer: Colonoscopy after age 50 rationale: This is the recommended age to start colonoscopic examination in someone with a low risk for colon cancer ◉ Which of the following is not a risk factor for cholecystitis? 1.Female gender. 2.Obesity. 3.Sickle cell anemia. 4.Younger age Answer: Younger age rationale: The risk of cholecystitis actually increases with age ◉ A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD?
1.Order an endoscopy. 2.Order a Helicobacter pylori blood test. 3.Try adding ranitidine to the patient's regimen. 4.Try adding bismuth to the patient's regimen. Answer: Order an endoscopy rationale: This is the next step in treatment in order to evaluate the etiology of the patient's GERD and consider biopsy if necessary ◉ A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? 1.Topical steroids and close follow-up with an ophthalmologist. 2.Sending the patient to the emergency department for immediate ophthalmology consult. 3.Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. 4.Cold compresses and frequent handwashing Answer: Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient's symptoms? 1.Order a computed tomography (CT) scan to rule out acoustic neuroma. 2.Start her on high-dose Augmentin. 3.Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4.Immediate referral to an ear, nose, and throat (ENT) specialist Answer: Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks rationale: This is the treatment for symptoms of Meniere disease. You would also want to consider an ear, nose, and throat consult to rule out other etiologies of the patient's symptoms. Meniere disease is diagnosed based on history and the exclusion of other conditions as well ◉ What is the most common bacterial pathogen associated with acute otitis media? 1.Streptococcus pneumoniae. 2.Haemophilus influenzae. 3.Streptococcus pyogenes. 4.Moraxella (Branhamella) catarrhalis. Answer: Streptococcus pneumoniae
rationale: This causes 40% to 50% of cases. ◉ A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1.Viral pharyngitis. 2.Mononucleosis. 3.Streptococcal pharyngitis. 4.Upper respiratory infection Answer: Mono rationale: This presentation could be a viral pharyngitis; however, with posterior cervical lymphadenitis, you would suspect mononucleosis. ◉ The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1.Amoxicillin (Amoxil). 2.Amoxicillin and potassium clavulanate (Augmentin). 3.Azithromycin (Zithromax).
◉ Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1."The eardrum, in most cases, heals within several weeks." 2."We need to schedule Aaron for a surgical repair." 3."He must absolutely stay out of the water for 3 to 6 months." 4."If the eardrum is not healed in several months, it can be surgically repaired." Answer: "The eardrum, in most cases, heals within several weeks. rationale: Most perforated tympanic membranes seen with acute otitis media heal within several weeks ◉ Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1.Acute otitis media. 2.Chronic otitis media. 3.External otitis. 4.Temporomandibular joint (TMJ) syndrome Answer: External otitis rationale: With external otitis, there is pain, an erythematous ear canal, and usually a history of recent swimming
◉ Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1.Prescribe nasal steroids and oral decongestants. 2.Prescribe antibiotic ear drops. 3.Prescribe systemic antibiotics. 4.Refer Max to an ear, nose, and throat specialist Answer: Prescribe nasal steroids and oral decongestants. rationale: Barotrauma of the auditory canal, causing a sensation of abnormal middle ear pressure, may be relieved by the use of nasal steroids and oral decongestants. ◉ A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1.Esophageal varices. 2.Esophageal cancer.
rationale: If a client is taking timolol maleate (Timoptic) drops for chronic open-angle glaucoma, you should be most concerned if the client is also taking atenolol (Tenormin), a beta blocker, for high blood pressure. Because timolol maleate drops are beta-adrenergic blockers, additional beta blockers can cause worsening of congestive heart failure or reactive airway disease, as well as acute delirium. ◉ Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1.A throat culture. 2.A Monospot test. 3.A rapid antigen test.
- Thayer-Martin plate test. Answer: A Monospot test rationale: If a client has a persistent sore throat, fever, and malaise not relieved by penicillin therapy, a Monospot test should be performed to rule out mononucleosis (Epstein-Barr virus) ◉ Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax
and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1.Classic migraine. 2.Tension headache. 3.Sinus headache. 4.Cluster headache Answer: Tension headache rationale: Tension headache is the most common type of headache. These headaches are usually bilateral and tend to wax and wane but have a characteristic pressure/tightening (viselike grip) in the forehead, temporal, or nuchal areas and can last from minutes to weeks. Tension headache may be associated with stress, depression, or anxiety disorders ◉ Regular ocular pressure testing is indicated for older adults taking: 1.High-dose inhaled glucocorticoids. 2.Nonsteroidal anti-inflammatory drugs (NSAIDs). 3.Angiotensin-converting enzyme (ACE) inhibitors. 4.Insulin Answer: High-dose inhaled glucocorticoids. rationale: Although regular ocular pressure testing is indicated on a routine basis for all older adults, it is especially important for clients taking an extended regimen of high-dose inhaled glucocorticoids
