NRNP 6531 Week 6 Midterm Exam) NRNP 6531 Week 6 Midterm Exam Graded A+, Exams of Nursing

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B. No

a. It^ assesses^ numeracy^ skills.

It enhances patient–provider

b. communication.

*c It evaluates medical word recognition.

.

d.

It measures technology knowledge.

*a Bonuses^ based^ on^ achievement^ of

.

benchmarks

b.

Care coordination for chronic diseases

c. Standards^ for^ minimum^ cash^ reserves

Strict requirements for financial

d. reporting

Angie is a new NP who just finished her FNP program. She is having a difficult time finding an FNP position in the rural area where she lives. So, since she was an ER nurse prior to her graduate program she decides to go back to the ER as an APRN. Does she meet the competency requirements for such a position?

*A Ye

.

s

What is the main reason for using the REALM-SF instrument to evaluate health literacy?

A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation?

Question 4

The Consensus Model identifies 3 core courses that all ANPs must take. All the following are Advanced core courses except:

*A Public Health

.

B. Physiology

C. Pharmacology

Physical

D. Assessment

The care provided by APRNs is not limited by setting but by patient care needs.

*True

Epidemiological

a. studies

b. Experimental design

*c Qualitative studies

.

Randomized clinical

d. trials

Associations with area

a. hospitals

b. Costs of ambulatory care

*c Ease of access to care

.

The ratio of providers to

d. patients

Mandates for communication among primary caregivers and

a. hospitalists

Penalties for failure to perform medication reconciliations at time

b. of discharge

*c Reduction^ of^ payments^ for^ patients^ readmitted^ within^30 days

.

after discharge

Requirements for written discharge instructions for patients and

d. caregivers

False

Which is the most appropriate research design for a Level III research study?

What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients?

To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy?

The Consensus Model for APRN regulation consists of which of the following roles?

A. CNM

B. CRNA

C.

APN

D. CNS

*True

False

*True

False

When assisting with a skin biopsy of a patient suspected of having bullous pemphigoid (BP) lesions, what will the practitioner do?

b. Punch^ biopsy

c. Shave^ biopsy

d.

Wide excision

biopsy

.

*a Excisional

Rules proposed by the various State Boards of Nursing must be approved by the state Legislatures.

In reviewing the Total Percentage of Body surface area for adult burn patients each, leg, arm and head are noted evaluated at 9%.

What is the initial approach when obtaining a biopsy of a potential malignant melanoma lesion?

a.

Avoid contact with the infected lesions. Elicit a positive Nikolsky sign to confirm the

b.

diagnosis.

*c Perform direct immunofluorescence

.

microscopy.

Prevent spread of the lesions to other areas of

d. the skin.

When recommending an over-the-counter topical medication to treat a dermatologic condition, which instruction to the patient is important to enhance absorption of the drug?

*E All the

.

Above

A, B & C

F. only

Apply a thick layer of medication over the affected

a. area.

A solution spray preparation will be more effective on

b. hairy areas.

*True

False

*True

False

*True

False

a. Clean^ and^ dress^ the^ burn^ wounds.

*b Order a CBC, glucose, and electrolytes.

.

c. Perform^ a^ chest^ radiograph.

Refer the patient to the emergency

d. department^ (ED).

A progesterone-only contraceptive is most beneficial for treating

a. acne.

Combined oral contraceptives are effective for non-inflammatory

b. acne^ only.

Oral contraceptives are effective because of their androgen

c. enhancing^ effects.

*d Yaz,^ Ortho^ Tri-Cyclen,^ and^ Estrostep,^ are^ approved^ for^ acne

.

treatment.

Carbuncles are typically treated with systemic antibiotics.

Mild acne is treated only with topicals.

Steroids should be avoided in cases of suspected fungal etiology.

A patient comes to the clinic after being splashed with boiling water while cooking. The patient has partial thickness burns on both forearms, the neck, and the chin. What will the provider do?

A provider is considering an oral contraceptive medication to treat acne in an adolescent female. Which is an important consideration when prescribing this drug?

*c Put^ cool^ compresses^ over^ the^ affected^ area^ after

.

application.

Use a lotion or cream instead of an ointment

d. preparation.

Ashley a 24 y/o female comes to the clinic with the following chief complaint: “I have these reddish/purple raised patches all over my skin. On physical exam the NP notes that the lesions are erythematous with discrete borders that are irregular, oval or round. The most likely diagnosis based on the physical exam is:

A. Seborrheic

*A First^ degree

.

burn

Second degree

B. burn

Third degree

C. burn

Fourth degree

D. burn

A. Nevi

Acanthosis

B. Nigricans

* Acrochordon

C.

D.

Cherry Angioma

The most common type of melanoma in African Americans and Asians is:

A. Basal Cell carcinoma

B.

Actinic Keratosis

* Acral Lentiginous

C.

Melanoma Toxic Epidermal

D.

Necrolysis

Olga was making French fries for her kids and gets splashed with hot oil. At the clinic the NP notes that she has red colored skin with superficial blisters and pain where the oil splashed. The most likely diagnosis is:

Patty comes to the clinic with these soft fatty cystic lesions on her neck, trunk and arms. The most likely diagnosis is:

keratoses

*B Urticaria

.

C.

Xanthelasma

D. Melasma

During a total body skin examination for skin cancer, the provider notes a raised, shiny, slightly pigmented lesion on the patient’s nose. What will the provider do?

During an eye examination, the provider notes a red-light reflex in one eye but not the other. What is the significance of this finding?

Azithromyci

D. n

Penicillin

C.

A. Amoxicillin

B.

Doxycycline Oral

*

Mikey is a 19 y/o male who is brought to the clinic because he has a fever, sore throat, pain on swallowing and mildly enlarged submandibular nodes First line pharmacological treatment for Mikey would include:

a. Normal physiologic variant

*b Ocular disease requiring

.

referral

Potential infection in the

c. “red” eye

Potential vision loss in one

d. eye

A patient diagnosed with allergic conjunctivitis and prescribed a topical antihistamine - vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms?

Consult with a dermatologist about possible

a. melanoma.

b. Reassure the patient that this is a benign lesion.

*c Refer^ the^ patient^ for^ possible^ electrodessication^ and

.

curettage.

Tell the patient this is likely a squamous cell

d. carcinoma.

Consider prescribing a topical mast cell

a. stabilizer.

*b Determine^ the^ duration^ of treatment^ with^ this

.

medication.

c.

Prescribe a non-sedating oral antihistamine.

d. Refer the patient to an ophthalmologist for

a. Antibiotic^ eye^ drops

Nasolacrimal duct

b. probing

c.

Systemic antibiotics

*d Warm compresses

.

*a Examination^ of^ scalp^ scrapings^ with^ potassium

.

hydroxide (KOH)

b.

Grasping and pulling on a few dozen hairs

c. Serum^ iron^ studies^ and^ a^ complete^ blood^ count

d. Venereal^ Disease^ Research^ Laboratory^ (VDRL)^ test

a. Anthralin

Cyclospori

b.

ne

c. Finasteride

*d Minoxidil

.

An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend?

A patient diagnosed with alopecia is noted to have scaling on the affected areas of the scalp. Which confirmatory test(s) will the provider order?

A female patient is diagnosed with androgenetic alopecia. Which medication will the primary health care provider prescribe?

Mikey is a 19 y/o male who is brought to the clinic because he has a fever, sore throat, pain on swallowing and mildly enlarged submandibular nodes The most likely organism causing Mikey’s infection is:

further care.

*A Streptococcus

. pyogenes

B.

Streptococcus pneumonia

C.

Streptococcus mutans

D. Streptomyces

A.

Lateralization to the good ear

*B Lateralization to the bad ear

.

Lateralization would be equal to

C. either^ ear.

*a Aqueous

.

deficiency

b.

Corneal abrasion

Evaporative

c. disorder

Poor eyelid

d. closure

Bacteremic spread from remote

a. infections

Inoculation from local trauma or

b. bug^ bites

*c Local^ spread^ from^ the^ ethmoid

.

sinus

d. Paranasal^ sinus^ inoculation

Audrey is a 16 y/o female who comes to the clinic because her teacher says that she is having a hard time hearing in class. The NP examines her ears and notes that she has otitis media. If the NP performed a Weber test on Audrey she would discover that there would be:

A patient experiencing chronically dry eyes reports having a foreign body sensation, burning, and itching. A Schirmer test is abnormal. What is the suspected cause of this patient’s symptoms based on this test finding?

Which is the most common cause of orbital cellulitis in all age groups?

A patient reports bilateral burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient’s eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely?

*a Allergic

.

Bacteri

b. al

Chemic

c. al

*True

False

Artificial tear drops are

a. contraindicated.

b. Spontaneous bleeding is likely.

*c UVB^ eye^ protection^ is^ especially

.

important.

Visine may be used for symptomatic

d. relief.

*a Asymmetric^ red

.

reflex

Corneal

b. opacification

c.

Excessive tearing

Injection of

d. conjunctiva

d. Viral

A retinal detachment would be identified by a shower of floaters with the addition of sudden flashes of light.

A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o’clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What information will the provider provide the patient about this lesion?

A primary care provider may suspect cataract formation in a patient with which finding?

Aaron an 18 y/o male comes to the clinic with the following symptoms: nasal stuffiness, sneezing, scratchy irritated throat and hoarseness. He also complains of a low-grade fever and a cough that he has had for the past 4 days. Prevention of Aaron’s condition would include which of the following:

Good hand

A. washing

B. Adequate rest

C. Zinc Lozenges

*D All the above

.

E. A & B only

*A Acute^ otitis

.

media

Bullous

B. Myringitis

C. Otitis externa

D. Swimmer’s ear

True

* False

A. Flu

B.

Peritonsillar abscess Streptococcal

*

C.

Pharyngitis

Administration of antibiotic eye

a. drops

*b Application^ of^ topical^ fluorescein

.

dye

Instillation of cycloplegic eye

c. drops

Irrigation of the eye with normal

d. saline

Bryce is a 17 y/o male who comes to the clinic with chief complaint of ear sudden onset of pain, popping noises, and muffled hearing. During the ear exam the NP notices that the TM has ruptured. The most likely diagnosis is:

Koplik spots on the buccal mucosa are pathognomonic for mumps.

Mikey is a 19 y/o male who is brought to the clinic because he has a fever, sore throat, pain on swallowing and mildly enlarged submandibular nodes. The most likely diagnosis for Mikey is:

A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step?

A patient is seen in the clinic for patches of hair loss. The provider notes several well- demarcated patches on the scalp and eyebrows without areas of inflammation and several hairs within the patch with thinner shafts near the scalp. Based on these findings, which type of alopecia is most likely?

*a Alopecia^ areata

Add a beta blocker to the patient’s

A. regimen.

*B Admit^ to^ the^ hospital^ for^ evaluation^ and

.

treatment.

Increase the dose of the thiazide

C. medication.

D.

Prescribe a calcium channel blocker.

*< 140 / 9

0

< 130 / 8

0

< 150 / 9

0

< 150 / 8

0

An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient?

A young adult patient is diagnosed with a mitral valve prolapse. During a routine 3-year health maintenance exam, the provider notes an apical systolic murmur and a mid-systolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What action will the provider take?

According to the JNC 8 guidelines the hypertension treatment goal for patients 60 years and younger should be:

.

Anagen

b. effluvium

Cicatricial

c. alopecia

Telogen

d. effluvium

Admit the patient to the hospital for evaluation and

a. treatment.

*b Consult with the cardiologist to determine appropriate

.

diagnostic tests.

c. Continue to monitor the patient every 3 years.

Autoimmune

a. disorder

b. Bacterial infection

c. Protozoal infection

*d Viral infection

.

a.

Daily aspirin therapy to prevent clotting

b.

Statin therapy with clopidogrel Walking slowly for 15 to 20 minutes

c.

twice daily

*d Walking to the point of pain each day

.

*True

False

*True

False

True

* False

A previously healthy patient presents with sudden onset of dyspnea, fatigue, and orthopnea. A family history is negative. The provider suspects myocarditis. What is the most likely etiology for this patient?

A patient is diagnosed with peripheral arterial disease (PAD) and elects not to have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help manage this patient’s symptoms?

A split S2 is best heard at the upper left sternum.

In coarctation of the aorta the BP of the arms is higher than the BP of the legs.

Pulsus paradoxus is a phenomenon in which the radial pulse can be palpated even though the apical pulse can’t be heard.

Juan is a known patient to the NP. He comes in for his quarterly check on his blood pressure.

d. Reassure the patient that these findings are expected.

A.

Normal

*B Prehypertensi

.

on

His blood pressure is 125/85. According to JNC 8 his BP falls into the category of:

a.

Digital subtraction angiography

*b Doppler ankle, arm index

.

c. Magnetic^ resonance^ angiography

Segmental limb pressure

d. measurement

A. Ventricular^ Tachycardia

B.

Pulsus paradoxus

*

C.

Atrial Fibrillation\ Atrial

Flutter

D. None^ of^ the^ above

*A Mitral

.

B.

Regurgitation

Aortic Stenosis

C. Mitral^ Stenosis

Aortic

D.

Regurgitation

An elderly adult patient without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms?

Ashley is a 47 y/o female who comes to the clinic with a chief complaint of sudden onset of palpitations and a feeling of weakness and dizziness. Additionally she notes that she has dyspnea on exertion. On the physical exam the NP notes that he HR is 120 bpm and her BP drops to 98/60. The NP after running an EKG and noting no discrete p waves and irregularly irregular rhythm diagnoses her as having:

I n performing a follow-up exam on a patient the NP discovers that the patient has a new murmur. The

murmur is best heard at the apex of the heart, radiates to the axilla, and is a loud blowing and high- pitched murmur. This type of murmur is associated with which of the following conditions:

C. Stage^ I

D. Stage^ II