NR 601 Final Exam Review Questions, Exams of Medicine

Download NR 601 Final Exam Review Questions and more Exams Medicine in PDF only on Docsity! NR 601 Final exam NR 601 Final Exam Review Questions (103 Terms) with Complete Solutions Updated 2024. Mr. A, experienced a brief onset of right sided weakness, slurred speech and confusion yesterday. The symptoms have resolved and the CT is normal. What is the next step of the plan for Mr. A? a. assure the patient that he will not experience the symptoms again b. identify modifiable cardiovascular risk factors c. order ASA 81mg stat d. order a stat EEG and administer O2 by mask - Answer: b. identify modifiable cardiovascular risk factors A 56-year old male patient screened for diabetes has a fasting plasma glucose level of 96mg/dl. The nurse practitioner management plan includes: NR 601 Final exam a. repeat fasting plasma glucose in three years b. prescribe Metformin 500mg po BID c. repeat fasting plasma glucose in one year d. refer to ophthalmology for eye exam - Answer: a. repeat fasting plasma glucose in three years RW, a 57 year old native American female, presents to the office. RW states she feels irritable and has difficulty concentrating as well as fallingn asleep and staying aleep. She states she is worried about her finances, her husband has just lost his job. The NP diagnoses anxiety. The NP prescribes a first line treatment which is a. Diazepam b. Clonazepam c. Ariprprazole d. Paroxetine - Answer: d. Paroxetine The most common sustained rhythmic disorder, which consists of fibrillatory p waves is: a. AV block b. atrial tachycardia c. atrial fibrillation d. atrial flutter - Answer: c. atrial fibrillation NR 601 Final exam b. gait instability requiring the use of a cane c. intentional tremors d. symptoms interfering with functional ability - Answer: d. symptoms interfering with functional ability Which of the following is a role of the advanced practice nurse in palliative cancer care? a. detecting cancer in asymptomatic paitents or those with specific symptoms b. arranging for follow up including patiennts c. identifying and managing complications of care d. all of the above - Answer: d. all of the above A 58 year old Caucasian mane with type 2 diabetes mellitus presents to the clinic as a new patient. He takes metformin 500mg twice a day. His last Hgb A1c was 7%. He is up to date on eye and foot examinations. His BP is 142/96. According to ACC 2017 guidelines for high blood pressure in adults, what is the most appropriate first line medication? a. lisinopril b. furosemide c. amlodipine d. clonidine - Answer: a. lisinopril NR 601 Final exam An older male patient is experiencing acute onset of right sided weakness, slurred speech and confusion. What should the nurse practitioner do promptly? a. order an EKG and administer O2 by cannula immediately b. Do a through medication review and stat blood sugar c. evaluate for a stroke and arrange transport to the hospital right away d. administer an aspirin by mouth - Answer: c. evaluate for a stroke and arrange transport to the hospital right away The NP knows that medications can trigger or worsen heart failure. With this knowledge in mind, the NP will avoiding prescribing the following classes of medications a. benzodiazepines b. macrolides c. muscle relaxants d. NSAIDS - Answer: d. NSAIDS MG, a 60 year old female presents with complaints of her "heart flipping in her chest" The NP wants to evaluate for arrhythmia. The nP knows that the cornerstone for arrhythmia evaluation includes: a. electrocardiogram b. physical examination c. all options are appropriate NR 601 Final exam d. history - Answer: c. all options are appropriate The elderly are at high risk for delerium because of: a. multiple medical problems b. multisensory deficits c. polypharmacy d. all of the above - Answer: d. all of the above A 68 year old woman presents with a complaint of urine leakage whenever she sneezes, laughs or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipstick is negative for RBC's leukocyte esterase, nitrates, ketones and urobilinogen. What is the diagnosis? a. stress incontinence b. urinary incontinence c. urge incontinence d. overflow incontninence - Answer: a. stress incontinence Which of the following signs or symptoms are not characteristics of delirium a. patient is coherent b. short duration c. sudden onset d. symptoms are worse in the evenings - Answer: a. patient is coherent NR 601 Final exam All of the following are true statements regarding elder abuse except: a. a new STI in an elderly patient can be a sign of abuse b. persons over 80 years of age are at highest risk for abuse c. missing scheduled appointments and delays in medical care are common d. common signs of abuse include decreased anxiety and depression - Answer: d. common signs of abuse include decreased anxiety and depression Hospice care differs from palliative care in that: a. it cannot be provided in the nursing home b. the majority of those admitted to hospice die within 7 days c. it is not covered by insurance d. it is designed for the last six months of life - Answer: d. it is designed for the last six months of life When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinsons disease? a. congwheel rigidity, bradykinesia, and macrorgraphia b. any presence of fever c. symptoms of slowed movement, unstable angina and tremor d. resting tremor, slow unsteady gait and cogwheel rigidity - Answer: d. resting tremor, slow unsteady gait and cogwheel rigidity NR 601 Final exam How dies womans anatomy make them more susceptible to UTI's a. the female urethra is shorter b. aymptomatic UTI's do not resolve themselves without treatment c. women tend to get UTI's when they are pregnant d. there is a longer distance between the urethra and anus - Answer: a. the female urethra is shorter Mrs. Smith, a 64 year old woman presents to the clinic for the first time and complains of uruinary incontinece and dyspareunia. She went through menipause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 87 years of age. The patiennt's most recent mammogram was 7 years ago and no known family history of breast cancer. She is not taking any medications. Her physical exam is unremarkable except for findings consistant with atrophic vaginitis. You prescribed topical hormone replacement therapy today. Which of the following evaluations should also be ordered today a. bone mineral density measurement b. mammogram - Answer: b. mammogram All of the following patients should be screened for diabetes except: a. a 44 year old caucasian male with hypertension NR 601 Final exam b. a 42 year old femal on disability from back injury from back injury who is unable to exercise c. an overweight middle aged african american woman with a family history of type 2 diabetes mellitus d. an obese hispanic man - Answer: a. a 44 year old caucasian male with hypertension A 60 year old obese male client has type 2 diabetes mellitus and a lipid panel of TC=250 HDL=32 LDL=165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: a. diabetes, obesity and hyperlipidemia b. advancing age, diabetes, hyperlipidemia, and male gender c. hyperlipidemia, smoking and family history of heart disease d. male with age >45, diabetes mellitys and hyperlipidemia - Answer: a. diabetes, obesity and hyperlipidemia When treating inflammatory pain, the NP knows treatmemnt is focused on managing the inflammation. Appropriate medications for inflammatory pain include all of the following except: a. NSAIDS b. Opioids c. Corticosteroids - Answer: b. Opioids NR 601 Final exam A 56 year old man presents to the office with concerns about low energy, lack of joy in his life and decreased appetite for 2 weeks. The nurse practitioner assesses him using SIG-E CAPS, the NP knows that the E stands for a. energy (decreased) b. emotional instability c. ego dystonia d. enthusiasm (decreased) - Answer: a. energy (decreased) Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrhythmia d. chronic prostatitis and atrial fibrillationn - Answer: a. benign prostatic hypertrophy and hypertension A 65 year old Hispanic woman who presents to the office for routine follow up of her type 2 diabetes mellitus. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients: a. result is normal, no further testing is necessary b. urine for culture and sensitivity c. recommend a screening intravenous pyelogram (IVP) NR 601 Final exam d. micoralbumin - Answer: d. micoralbumin A 87 year old man tells the nurse practitioner that his grandson locks him in his bedroom when he gets out. The grandson withholds food if the patient does not give him money every week. The patient appears frail, ungroomed, and his clothes are visibly dirty and smell of urine. Which of the following is the best action for the nurse practitioner. a. advise the patient to call his son and report the grandson's behavior as soon as possible b. call the grandson from the waiting room and educate him about proper care for his grandfather c. report the grandson to your states protective services d. advise the grandson if the patient reports the concerns at the end of the next visit, the NP is obligated to report to protective services - Answer: c. report the grandson to your states protective services A male patient with a BMI of 33 presents to the office with complaints of fatigue, excessive hunger and excessive thirst. You ordered a CMP and a Hgb A1C. The results are a fasting glucose 99, Hbg AIC 5.7. The nurse practitioner diagnosis is: a. type 2 diagnosis mellitus b. prediabetes c. euglycemia d. type 1 diabetes mellitus - Answer: b. prediabetes NR 601 Final exam All of the following patients have a risk of adverse reactions from Metformin except: a. patients with renal disease b. patients with BMI >30 c. patients with alcoholic disorder d. patients with hypoxia - Answer: b. patients with BMI >30 According to the ADA guidelines, which of the following arer screening tests for type 2 diabetes mellitus? a. all options are appropriate b. fasting plasma glucose c. two-hour OGTT d. Hemaglobin A1C - Answer: a. all options are appropriate The first step in treating delriuim is to: a. use side rails and/or wrist restraints to keep the patients safe b. give low dose haldol if the patient has psychosis c. identify the cause d. provide reality orientation - Answer: c. identify the cause NR 601 Final exam Acanthosis nigricans is associated with all of the following conditions except: a. tinea versicolor b. diabetes c. obesity d. colon cancer - Answer: a. tinea versicolor Which of the following medications can blunt the signs of hypoglycemia in diabetics? a. beta blockers b. calcium channel blockers c. angiotensin receptor blockers (ARB's) d diruetics - Answer: a. beta blockers The cornerstone of pharmacotherapy in treating Alzheimer's disease is: a. NMDA receptor antagonist b. Psychotropic medications c. Cholinesterase inhibitors d. Anxiolytics - Answer: c. Cholinesterase inhibitors NR 601 Final exam A 75 year old man is being treated as an outpatient for metastatic prostate cancer. Which of the following statements is true regarding the management of pain with opioids in the elderly? a. none of the options are appropriate management b. opioids with a long half life, such as methadone, are a good choice, because they stay inn the system longer and patients do not have to remember to take multiple pills - Answer: a. none of the options are appropriate management 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? a. a score of 0-2 is a positive screen for cognitive impairment b. the patient is asked to recall five images from picture cards following the drawing of the clock hands c. the patient will be asked to repeat five eworkds immediately following the directions by the practitioner d. the patient is asked to draw the hour and minute hands on a picture of an analog clock - Answer: a. a score of 0-2 is a positive screen for cognitive impairment 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 tremors? NR 601 Final exam a. the tremor occurs with purposeful movement b. the handwriting is not affected by the tremor - Answer: a. the tremor occurs with purposeful movement A 56 year old man is diagnosed with acute prostatitis, he is afebrile without severe pain and will be managed outpatient. He should initially be treated with antibiotics for how long? a. 6-12 weeks b. 14-21 days c. 3-6 weeks d. 10-14 days - Answer: d. 10-14 days An 80 year old female widow asks her nurse practitioner about her end of life options. Her diagnosis include congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and chrch. She does not use oxygen. She is able to maintain her home but requires more frequent rests after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today? a. start her on a medication for depression b provide her with information for senior day care services NR 601 Final exam a. diabetes mellitus b. artherosclerosis c. depression d. all options are appropriate - Answer: d. all options are appropriate urinary incontinence is defined as: a. unintentional voiding, loss or leakage of urine b. urination occurs more frequently during the day c. continous loss of urine or leakage of urine d. sudden, compelling desire to pass urine that is difficult to prevent - Answer: a. unintentional voiding, loss or leakage of urine A patient has been prescribed metformin (Glucophage). One week later he returns with complaints of some loose stools during the week. How should the nurse practitioner respond? a. double the dosage of medication and have patient return in one week b. order a chem. 7 to check for lactic acidosis c. discontinue the medication immediately d. reassure the patient that this is an anticipated side effect - Answer: d. reassure the patient that this is an anticipated side effect NR 601 Final exam An 82 year old mamn 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 differential diagnosis. a. parkinson's disease b. prostate cancer c. all options are appropriate d. benign prostatic hyperplasia (BPH) - Answer: c. all options are appropriate A 67 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. benign prostatic hypertrophy c. drug induced impotence d. irritative posterior urethral lesion - Answer: b. benign prostatic hypertrophy Which of the following maneuvers is contraindicated in acute prostatitis a. palpation of the epididymis b. massaging the infected prostate c. serial urine samples d. rectal exams - Answer: b. massaging the infected prostate NR 601 Final exam You are working up a 52 year old patient for microscopic hematuria. Your differential diagnosis list includes all of the following except a. nephrocalcinosis b. acute pyelonephritis c. renal stenosis d. bladder cancer - Answer: c. renal stenosis A 48 year old male patient screened for diabetes has a fasting plasma glucose level of 120mg/dl (6.7mmol/L). The nurse practitioner plan includes: a. prescribe metformin 500mg po BID b. educate the patient on lifestyle changes to lower blood glucose c. initiate self monitoring of blood glucose d. review the effects of oral hypoglycemic medications - Answer: b. educate the patient on lifestyle changes to lower blood glucose Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrythmia d. chronic prostatitis and atrial fibrillation - Answer: a. benign prostatic hypertrophy and hypertension NR 601 Final exam b. becomes worse toward the evening c. improves as the day goes on d. fluctuates during the course of the day - Answer: b. becomes worse toward the evening The proposed mechanism by which diphenhydramine caused delerium is: a. anticholinergic effects b. dopaminergic effects c. gabanergic effectis d. serotinergic effects - Answer: a. anticholinergic effects According to the Palliative Care Presentation, palliative care may be provided to a. only cancer patients b. anyone regardless of their life expectancy or disease progression c. those with a life expectancy > 6 months d. those with a life expectancy< 6 months - Answer: b. anyone regardless of their life expectancy or disease progression The highest level of evidence with the use of adjuvant analgesics is with a. therapeutic trials before discontinuing drugs b. patients with fibromyalgia are candidates for adjuvant analgesics c. tricyclic antidepressants avoided due to high adverse affects NR 601 Final exam d. neuropathic pain patients are candidates for adjuvant analgesia - Answer: d. neuropathic pain patients are candidates for adjuvant analgesia According o the Sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient a. older people dont talk about sex b. most elderly patients are not interested in sex c. ageist attitudes d. female post menopausal changes - Answer: c. ageist attitudes The patient with BPH is seen for follow-up.. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? a. headache b. urinary incontinence c. hypotensionn d. impotence - Answer: d. impotence Which of the following statements is true regarding pain? a. all of the above b. if a patient complains of pain but has no physical signs, he or she is most likely exhibiting drug-seeking behavior NR 601 Final exam c. pain is a subjective experience related to actual or potential tissue damage d. acute pain is more intense and severe than chronic pain - Answer: c. pain is a subjective experience related to actual or potential tissue damage The highest level of evidence to support interventions at the end of life is with a. hycosamine for respiratory secretions b. stimulant laxatives for treating constipation c. opioids for pain control d. opioids for dyspnea - Answer: d. opioids for dyspnea The comorbid psychiatric problem with the highest frequency in dementia is: a. depression b,, agitation and aggression c. psychosis d. anxiety - Answer: a. depression According to the World Health Orginazition's analgesic ladder, which drug would be most appropriate in opiate-niave patient who presents with moderate pain a. naproxen/morphine b. asprin/fentanyl c. acetaminophen/hydrocodone d. ibuprofen/impraminen - Answer: c. acetaminophen/hydrocodone NR 601 Final exam c. Emphysema d. COPD - Answer: a. Asthma The 2017 HTN guidelines recommend the following treatment for a healthy 54 year old African American woman with a BMI of 23 and consistant BP readings of 116-120/76-78 a. none, this is a normal BP b. hypertension, stage 1 requiring tretment with an ACE inhibitor c. elevated BP requiring treatment with a thiazide. d. hypertensionn stage 1 requiring treatment with a calcium channel blocker - Answer: a. none, this is a normal BP According to GOLD criteria, obstruction is defined as a reduction in the FEV1/FVC ration. A normal ratio is: a. >70% b. <70% c. 80-100% d. 50-79% - Answer: a. >70% Insomnia can be caused by medications. Acording to Gorroll, the following medications and substances are associated with insomnia except: a. guaifenesin NR 601 Final exam b. antihypertensive c. stimulants such as caffeine and nicotine d. corticosteroids - Answer: a. guaifenesin MK a 54 year old woman has returned to the office today for evaluation of your management plan for her complaints of insomnia. You saw her two weeks ago, diagnosed primary insomnia and educated MK on sleep hygeine practices. MK reports she is avoiding caffeine and alcohol as recommended. She does not look at her phone or computer prior to bed. She is falling asleep a little easier but she is not staying asleep. She wakes up after about 4 hours and cannot return to sleep. The next step in treatement of insomnia is: a. zolpidem 5mg by mouth at hs #30 with 3 refills b. eszopiclone 1mg by mouth at hs #30 with 5 refills c. ramelteon 8mg by mouth at hs # 21 with no refills d. zolpidem 5 mg by mouth at hs #7 with no refills - Answer: d. zolpidem 5 mg by mouth at hs #7 with no refills A 65 year old caucasian presented to your clinic with the following history and symptoms: reports good general health, asymptomatic mitral valve stenosis, current beta blocker use and physical exam findings unremarkable. The NP knows this patient's stage of heart failure is: a. Stage D b. Stage B - Answer: b. Stage B NR 601 Final exam Patient education for the COPD patient is essential. The nurse practitioner knows that COPD education includes all of the following except a. healthy diet b. increased risk for diabetes c. smoking cessation d. daily exercise - Answer: b. increased risk for diabetes According to the 2017 Guideline for High Blood pressure in adults, patients with stage 1 or 2 CKD with albuminuria should be started on the following medication to slow progression of kidney disease a. ACE inhibitors b. CCP c. ARNI d. thiazide diruetic - Answer: a. ACE inhibitors Pain which results from pathology or damage to the nervous system is classified as a. chronic b. neuropathic c. acute d. nociceptive - Answer: b. neuropathic