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NR511 Final exam questions with complete
solution
1. 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
2. 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
3. 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
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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
4. 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 ves-
ticular 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.
5. 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
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b. false: a. true
9. 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
10. Which causes the greatest percentage of mammalian bites?
a. dogs
b. cats
c. humans
d. rodents: a. dogs
11. 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
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c. this tissue supports healing of the esophagus
d. all of the above: d. all of the above
12. 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
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c. Emphysema
d. COPD: a. Asthma
17. Which of the following is an example of an articular structure
a. bone
b. synovium
c. tendons
d. fascia: b. synovium
18. 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
19. Which of the following statements is true concerning the management of the client
with a herniated disc?
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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 inter-vention
d. all of the above: c. intolerable pain for more than 3 months is an indication for surgical intervention
20. 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
21. 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
22. Cat bites are commonly associated with which of the following pathogens?
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b. Penicillin
c. Metronidazole
d. Bactrim: c. Metronidazole
26. 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)
27. 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
28. One of the initial steps in assessing patients with musculoskeletal com-plaints is to
determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular srtucture?
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A. Fascia
B. Bone
C. Synovium
D. Tendons: C. Synovium
29. 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
30. A 76 year old man is seen in the office for complaints of urinary inconti-nence. 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
31. 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
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a. last menstrual period
b. method of birth control
c. last unprotected sexual contact
d. all of the above: d. all of the above
35. 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
36. 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 cottee
37. Which of the following are predisposing factors for pyelonephritis?
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a. pregnancy
d. dehydration c. smoking d. alkaline urine: d. alkaline urine
38. 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 aminotrans-ferase (AST)
b. elevated alkaline phosphatase
c. elevated indirect biliruben
d. decreased white blood cell (WBC) count: b. elevated alkaline phosphatase
39. 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
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b. frequent constipation
c. flatulence
d. colicky abdominal pain: a. her age
43. 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
44. 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
45. 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
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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 ettective in managing your pain because long term use of NSAIDS can result in gastrointestinal (GI) disorders such as ulcers and hemmorhage
46. 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
47. SNAPPS pneumonic used to describe a technique in orally presenting a patient.
A. true b. false: A. true
48. 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
19 / 35 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
52. 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
53. 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
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b. her affected shoulder is also her dominant hand
c. her history of diabetes: c. her history of diabetes
54. 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
55. Joyce is seen in the clinic complaining of vague symptoms of feeling ner-vous 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 differ-ential diagnosis could be which of the following?
- Myxedema
- Cushing's Syndrome
- Pan-hypopituitism
- Thyrotoxicosis: • Thyrotoxicosis
56. As diabetic retinopathy progresses, the presence of "cotton wool" spots can be detected.
Cotton wool spots refer to:
a) Venous beading.
