NSG 6340 Final Exam 1: Practice Questions and Answers, Exams of Nursing

Download NSG 6340 Final Exam 1: Practice Questions and Answers and more Exams Nursing in PDF only on Docsity! NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS A 37-year-old female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today she complains of poor concentration and fatigue. Initially, the NP should: a. Question her further 3. Which of the following is an example of secondary prevention? a. Annual influenza vaccination 7. A 35-year old female with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the 2007 American Association’s guideline for endocarditis prophylaxis, what would you advise this patient? a. She does not need prophylaxis for any dental procedure b. 8. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: a. b. milk and milk products 9. A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should a. start aggressive antibiotic therapy 10. A positive drawer sign support a diagnosis of b. cruciate ligament injury 11. A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities. b. peripheral artery insufficiency 12. A 16-year-old athlete complains of pain underneath his heel every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic interventions should the nurse practitioner prescribe for this patient? a. salicylic acid plasters 13. A -year-old with Type I diabetes has had itching and burning lesions between her toes for 6 months. Scrapings of the lesion confirm the diagnosis of tinea pedis. What is the best treatment option for this NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS patient? a. prescribe an anti-fungal powder for application between her toes and in her shoes and a topical prescription strength anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection. c. Prescribe an oral anti-fungal for 4 to 12 weeks. Monitor liver enzymes, BUN and creatinine at one week, 2 weeks, and every month thereafter. NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. ankle inversion NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 30. Certification for nurse practitioners is offered through: c. national certifying organizations 31. Simple cases of impetigo and folliculitis are usually successfully treated with: a. systemic antibiotics b. topical antibiotics 32. A 43-year-old has chronic gout. He comes to the clinic for the 3rd time in as many months for treatment of an exacerbation. Dietary counseling should include avoidance of all of the following EXCEPT: c. green, leafy vegetables 33. A 57-year-old patient presents for an annual physical exam. He reports having 3 attacks of acute gout during the past year. He does not take any medication except NSAIDs during the attacks which help “a little bit.” The NP would appropriately recommend c. avoidance of dietary purine sources 34. A 43-year-old male presents with a large and painful furuncle, the 3rd one in the past 6 months. The NP should _?_ all of the following EXCEPT: b. prescription of a prophylactic antibiotic 37. A 64-year-old female has sudden onset of right eye pain, blurred vision, and dilated pupil. The most likely diagnosis is acute: b. angle-closure glaucoma 38. A 25-year-old patient presents with complaints of pain and burning in the vulvar area. Upon examination, the NP notices vesicles with an erythematous base arranged ina group on the patient’s labia major. The most likely diagnosis is: d. herpes simplex II 39. An 85 – year-old is diagnosed with shingles. The patient states that she became “miserable” yesterday when the symptoms started. What pharmacologic interventions should the nurse practitioner offer this patient? c. Oral acyclovir (Zovirax) for 7-10 days, NSAIDs, and topical capsaicin cream after resolution of the lesions 40. A 16-year-old presents to the clinic for a scheduled immunization. The patient is unaccompanied by an adult. The NPs action is based on the knowledge that: a. a minor must have the informed consent of a parent or guardian to receive an immunization 41. The mechanism by which nurses are held accountable for practice, based on the quality of nursing car NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS ein a given situation inaccordance with established standards of practice, is: c. peer review NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 54. A 50-year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis? a. uterine fibroids b. normal peri-menopause c. endometrial cancer d. cervical cancer 55. Which agent is most effective for the treatment of nodulocystic acne? d. isotretinoin (Accutane) 56. Which of the following signs and symptoms is typical of hyperthyroidism? a. heat intolerance 57. An 83-year-old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with? a. Multiple sclerosis (MS) b. Parkinson’s disease c. diabetic neuropathy 58. A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area. The NP identifies popular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The NP would appropriately order: c. an oral antiviral d. a topical steroid cream 59. Expected spirometry redings when the patient has chronic emphysema include: d. increased total lung capacity (TLC) 60. Right-sided heart failure is characterized by all of the following clinical findings EXCEPT: Answer: a 4th heart sound 61. Moderate weight loss, particularly of visceral adipose tissue, in patients with Type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: c. increased lean muscle mass d 62. Nurse practitioner services are filed with Medicare for reimbursement a. and paid by Medicare Part B 63. Which of the following drugs has a beneficial effect on benign prostatic hyperplasia? a. doxazosin (Cardura) 64. A 46-year-old female has hypertension and is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug? d. migraine prophylaxis 65. The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is: NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS a. enlarged, symmetrical, semi-firm, and non-tender b. enlarged, symmetrical, boggy, and exquisitely tender NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 66. A 20-year-old male complains of a “skin rash” on his knees and elbows. The lesions have silvery scales and are pruritic. A positive Auspitz sign is present. What is the most likely diagnosis? d. psoriasis 67. The daughter of a 75-year-old patient reports that her mother roams the house at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insomnia? a. doxepin (Sinequan) 68. A 65-year-old African American patient was screened at his local church for “high cholesterol.” His total cholesterol (no-fasting) was 215 mg/dL (5.6 mmol/L). What action below is most appropriate for the NP? a. Recommend a fasting lipid profile 69. Swan neck and boutonniere deformities are typical clinical findings in the later presentation of: a. gouty arthritis b. rheumatoid arthritis 70. A 13- year-old patient complains the he fell while running during football practice. Now his knee hurts and sometimes “locks.” The NP conducts McMurray’s test. Which of the following is TRUE about this test? a. an audible or palpable click is positive for a torn meniscus 71. A hemoglobin AIC level is 7.2 in a patient with Type 2 diabetes mellitus. The patient is currently taking a sulfonylurea medication. Which of the following drug should be added next to the medication regime? d. Metformin (Glucophage) 72. A patient with a diagnosis of giardiasis is being treated with metronidazole (Flagyl). What information would be important to obtain before prescribing this medication? c. if the patient drinks alcohol 73. The nurse practitioner is performing a routine assessment of a 47-year-old female who wants to lose weight She has truncal obesity with relatively slender forearm and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the nurse practitioner diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT: d. cardiac arrhythmias 74. A 59-year-old postmenopausal woman has atrophic vaginitis. She has a history of breast cancer at age 40 years. What is the appropriate initial treatment for this patient? d. Topical conjugate estrogen cream 75. The process by which a profession association cofers recognition that a licensed profession has demonstrated mastery of a specialist body of knowledge and skills is termed: c. certification NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 87. Following the finding of prostate gland abnormalities on DRE, the nurse practitioner orders appropriate labs. When preparing to review lab reports with the patient, the NP know all of the following are true EXCEPT: a. normal PSA is 10 mg/ml or less 88. An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include: a. recommended screening for diabetes mellitus and HIV infection 89. Which statement is true regarding dental health? a. a diet high in sugar has no effect on dental caries b. individuals with dentures should visit the dentist every 2 years 90. A 51-year-old post-menopausal female, requests guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT: d. weight loss 91. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? a. order abdominal x-rays b. order abdominal ultrasound 92. Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP) d. nitrofurantoin (Macrobid) 93. The first step when taking a patient history is the c. introductory information 94. Characteristics of prescription and OTC drug use in the elder population include all of the following EXCEPT: a. high incidence of drug reactions b. multiple prescribers and polypharmacy 95. The nurse practitioner wants to assess intactness of a patient’s cerebellar function. Which of the following clinical tests will provide information relative to cerebellar function? a. kinesthesia b. stereognosis c. Romberg 96. A 57-year-old patient with known diverticulosis presents with fever, leukocytosis, and bright red rectal bleeding. The nurse practitioner’s least appropriate action at this time is: d. education regarding low fiber diet NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 97. A 41-year-old woman presents with multiple painful vesicular lesions in the vulvar area She has been with the sexual partner for 21 years. Which of the following is the MOST likely diagnosis? NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. herpes simplex d. chlamydia 98. The differential diagnoses for transient episodes of dizziness would appropriately include all of the following EXCEPT: c. allergic rhinitis 99. Which of the following is NOT a common early sign of benign prostatic hyperplasia (BPH)? d. increased force of urine flow 100. The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The LEAST likely diagnosis is: a. acute otitis media (AOM) 101. A 16-year-old presents for a sports physical for football. The nurse practitioner auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP? a. refer this patient to a cardiologist 102. What is the most common causative pathogen found in cystitis, pyelonephritis, and prostatitis? a. Escherichia coli 103. The most common symptoms of a transient ischemic attack (TIA) include: a. nausea, vomiting, syncope, incontinence, dizziness, and seizure b. weakness in an extremity, abruptly slurred speech or partial loss of vision, and sudden gait changes 104. A characteristic of delirium that is typically absent in dementia is: a. acute onset of confusion in a previously alert and oriented patient b. gradual loss of short-term memory c. loss of language skills d. long-term memory gaps filled in with confabulation 105. A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time. Which of the following would NOT be included in the differential diagnosis? d. Parkinson’s disease 106. The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals a. an increased reticulocyte count b. a mean corpuscular volume (MCV >100) c. hemoglobin (Hgb) 14.0 NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 114. A nurse practitioner has recently been hired to work in a fast track facility. The NP’s employer asks if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is: a. grounds for dismissal b. an ethical dilemma for the NP c. illegal according to the standards of nursing d. patient abandonment 115. According to the American Diabetes Association, what is the lowest fasting plasma glucose level which warrants a diagnosis of diabetes mellitus if confirmed on a subsequent day? a. 121 mg/dL b. 126 mg/dL c. 130 mg/dL d. 140 mg/dL 116. A 23-year-old female patient of Italian descent has been diagnosed with anemia secondary to glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. It is important to teach this patient to avoid: a. beef or pork liver b. fava beans c. phenylalanine d. milk and mild products 117. A 14- year-old develops otitis externa with swelling erythema, and pain,. To facilitate antibiotic deliver to the canal, the NP should: a. use a cotton tipped swab to apply medication b. insert a wick by gently twisting it into the canal c. prescribe an oral antibiotic prescribe an oil-based otic antibiotic to seep into the canal 118. A patient taking levothyroxine is being over-replaced. What condition is he at risk for? a. Osteoporosis b. diarrhea c. bipolar disorder d. periorbital puffiness 119. A nurse practitioner plan to open a private clinic. Each patient will be expected pay $45 immediately following the visit. This is a example of: a. utilitarianism b. fee-for-service c. case management d. preferred providership 120. Along with helping to prevent osteoporosis, hormone replacement therapy (HRT) in the post- menopausal woman has been shown to: NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS a. raise high density lipoprotein (HDL) b. raise low density lipoprotein (LDL) NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. lower triglyceride d. prevent coronary heart disease (CAD) 121. An elderly patient presents with a gray-white ring around the periphery of the iris. This is probably a. indicative of underlying atherosclerotic disease b. a normal variant associated with the aging process 122. A patient complains of “stomach pains” on and off for the past month. In distinguishing between a gastric and duodenal ulcer, what question is least important to ask? a. Have you been out of the country in the past several months? b. Have you had dark, tarry or bloody stools? 123. Which of the following is a microcytic hypochromic anemia? a. Folic acid deficiency anemia b. Iron deficiency anemia 124. What information should a 42- year old patient with newly diagnosed diabetes receive about exercise? c. Snack before exercise 125. A 14-year-old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. She also complains of a “sore lump on my knee.” The nurse practitioner notes swelling and point tenderness at the tibial tuberositiy X-ray is negative. What is the most likely diagnosis? c. Osgood-Schlatter disease 126. The obesity associated with Type 2 diabetes mellitus is: d. a truncal (android distribution) 127. Which of the following patients would appropriately be diagnosed with isolated systolic hypertension (ISH)? a. a 69-year old male with BP 156/86 128. An adolescent goes to Colorado for a ski trip. He is unaccustomed to the high altitude and very dry air. He develops nose bleeds and visits the nurse practitioner. What intervention is LEAST effective? d. Drink adequate water to promote hydration of the nares 129. The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is a. psychotherapy b. electroconvulsive therapy (ECT) 131. A person with 20/80 vision: d. has poorer vision than someone with 20/40 vision NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. urge incontinence NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 140. The nurse practitioner strongly suspects hyperthyroidism in a 62-year-old patient. Which of the following would NOT be an appropriate initial intervention? d. Start levothyroxine (Synthroid) 0.025 mg (25 mcg) daily and re-assess in 2 weeks 141. The Patient Self-Determination Act of 1991 requires all health care agencies receiving Medicare or Medicaid funds to give patients written information about their rights to make decisions regarding their medical care. A document which declare in advance what type of medical care a person wants to be provided or withheld should he or she be unable to express his or her wishes is called: a. an advanced directive 142. A 2-year-old male complains of severe headaches localized to the left frontal and parietal area with blurred vision. The nurse practitioner identifies vesicular lesions on his forehead. The most appropriate intervention is to start: a. acyclovir, and referral to an ophthalmologist 143. A patient has experienced nausea and vomiting, headache, malaise, low-grade fever, abdominal cramps, and diarrhea for 32 hours. The white count is slightly elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? c. Offer an anti-emetic medication such as prochlorperazine (Compazine) and provide oral fluid and electrolyte replacement instruction 144. The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of hospitalization for hepatitis-B infection 2 years ago. Her laboratory tests demonstrate positive HBsAg. The nurse practitioner would most likely diagnose: a. chronic hepatitis B infection 145. What medication would be best to relieve symptomatic wheezing in a patient who has asthma? a. Short-acting bronchodilator 146. Tricyclic antidepressants should be avoided in elderly patients because they have potentially disabling side effects. Which of the following is least likely to be a side effect of TCAs? d. potentiation of seizures 147. Of the following, the patient who should be referred for periodic colonoscopy is the patient with: a. diverticulitis resistant to traditional medical management b. extensive ulcerative colitis of long duration c. irritable bowel syndrome (IBS) complicated by psychiatric illness d. lactose intolerance 148. What is the most frequent cause of death in patients with anorexia nervosa? d. cardiac arrest 149. All patients with renal calculi should be taught that the best prevention is: a. increased fluid intake NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 150. In order to decrease deaths from lung cancer: NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Retreat him with permethrin and have him launder all of his bedding and clothing. NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 27. Pre-diabetes is: a. the result of insulin resistance and hyperinsulinemia 29. The nurse practitioner suspects a TMJ disorder. As the patient slowly opens and closes the lower jaw, the nurse practitioner palpates the temporomandibular joint (TMJ) bilaterally: a. anterior to the mastoid process b. anterior to the tragus 30. A patient newly diagnosed with Type 2 diabetes referred to a diabetes nurse educator and complete the initial educational program. The need for further education is indicated when the patient says which of the following? b. “I may notice some weight loss as my diabetes gets under better control” 31. A 44-year-old patient complains of stiffness and soreness in his hands, hips, and knees. There is noticeable PIP and DIP joint enlargement in his hands. The nurse practitioner suspects arthritis. All of the following questions are helpful in differentiation between rheumatoid arthritis (RA) and osteoarthritis(OA) EXCEPT: d. Have you notice decreased joint movement or flexibility? 32. Changes in pulmonary air flow associated with asthma exacerbations and remissions is best assessed by monitoring: c. peak expiratory flow rate (PEFR) as measured by a peak flowmeter 33. The most effective intervention to prevent stroke is (are): d. smoking cessation and treatment of hypertension 35. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: b. milk and milk products 36. What is the most common chronic condition in the elder population in the United States? b. arthritis 38. It is imperative that the nurse practitioner teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following, would be of LEAST concern to the nurse practitioner? d. weight gain 41. A patient reports to the nurse practitioner that he was diagnosed with hepatitis B one year ago and has not seen a health care provider since then. What information should this patient be given? b. About 10% of affected persons become carriers, and are at increased risk for hepatocellular carcinoma 42. An active 82-year-old male in good health complains “I don’t see as well as I used to and my eyes are very sensitive to glare.” His near-distant visual acuity is diminished, and he has a bilateral white pupillary NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS reflex. The most likely diagnosis is: c. cataracts NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 61. A 16-year-old received stitches in his arm after an accident. He tells the nurse practitioner that his last tetanus shot was “on time.” Should he receive another one? b. Yes, because there is no documentation of the previous immunization 63. Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? a. pneumonia 65. A 72-year-old patient reports a 6-month history of progressively more swollen and painful distal interphalangeal (DIP) joints of one hand. There are no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? b. osteoarthritis 66. Persons with thalassemia should avoid: d. iron replacement therapy 67. Of the following characteristics, which are most closely associated with risk for becoming an abusive parent? b. Young, isolated, with unreasonable expectations of the child 68. The nurse practitioner must increase a patient’s dosage of theophylline to achieve a therapeutic level. After the dosage has been increased, a serum theophylline level should be checked: c. just prior to the fifth dose 70. Education of women with fibrocystic breast disease should include which of the following statements? c. Caffeine may trigger breast pain 71. An adult patient has an S4 heart sound and the PMI is located at the 5th left ICS, left of the MCL. What are these findings associated with? c. hypertension 72. Which of the following is an appropriate drug for initial treatment of gastroesophageal reflux disease (GERD) in adults? a. famotidine (Pepcid) 73. The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is: a. absolute rest from activities which may further stress the bone 75. What diabetic complications result from hyperglycemia? 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis c. 1,3,4 76. A 66-year-old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS likely cause of this behavior? b. delirium NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 77. The preferred therapeutic regimen for an 18-year-old pregnant patient diagnosed with Chlamydia trachomatis infection is: d. a single dose of azithromycin (Zithromax) one gram orally 78. An 80-year-old Caucasian female has heart failure (HF). Which symptom below is an early indication of failure? a. Weight gain 79. What is the most common cause of Cushing’s syndrome? b. Administration of a glucocorticoid or ACTH 81. A 45-year-old male is diagnosed with hypertension. The blood pressures have been gradually increasing over time, with a reading today of 152/98. Diagnostic studies are normal. The most likely diagnosis for this patient is: b. essential hypertension 82. A patient with hepatic cirrhosis presents with pedal edema. He reports that his iwfe prepares the same lunch for him every day: a ham and cheese sandwich on white bread with mustard, a bowl of fresh vegetable soup, a fresh orange, banana or grapes, and sweetened iced tea. He denies adding salt to his food. The food that is most likely causing his edema is the: b. ham and cheese 83. A depressed patient has been treated and has had relief of symptoms while on medication for depression. Which patient statements is a correct understanding of depression? b. I must remain on medication for about 6 months since this is my first episode of depression 84. A 16-year-old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be the LEAST appropriate to prescribe? d. doxycycline 85. An 87-year-old patient was placed on low dose amlodipine (Norvasc) for treatment of hypertensionadn angina. She takes no other medications. What side effects might be expected from amlodipine? b. orthostatic hypotension 86. Patients diagnosed with polycystic ovarian disease are at increased risk of developing: a. diabetes mellitus 87. A patient present with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated? c. Blepharitis, treat with warm compresses and gentle debridement with a cotton swab 88. What disease process are Bouchard’s nodes most commonly associated with? c. osteoarthritis (OA) 89. An adult female presents with a hordeolum. A topical antibiotic is prescribed. Which of the following instructions is NOT appropriate advice for the nurse practitioner to give the patient? a. Apply warm, moist compresses several times per day b. Do not use soap near the affected eyelid NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS emotional stability is progressive NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 106. A mother has been breastfeeding her infant since giving birth 6 weeks ago. Her right breast is engorged, erythematous, hot to touch, and very painful. She says the problem began 48 hours earlier. She has been feeding exclusively with the left breast. The nurse practitioner diagnosis acute mastitis and recommends all of the following EXCEPT: d. discontinue breastfeeding from the affected breast and wearing a bra until the pain and engorgement have resolved. 107. Which murmur is associated with radiation to the neck? b. aortic stenosis 108. A 50-year-old nonsmoker with no comorbidities presents to the clinic and is diagnosed with community-acquired pneumonia. His vitals are normal except for temperature 101.6 F. A sputum specimen is collected and sent for culture and sensitivity. What action does the nurse practitioner take today? a. b. Start clarithromycin (Biaxin) 500 mg BID for 5 days 111. correct answer is fenofibrate 112. A 24-year-old female insists on having a screening mammogram. Upon further questioning, the nurse practitioner discovers the patient is concerned about breast cancer because her mother has fibrocystic breast disease. The nurse practitioner would be accurate if she tells patient that a major risk factor for development of breast cancer in women is: c. first full term pregnancy after 30 years of age 113. A 44-year-old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dL (6.5 mmol/L), LDL=190 mg/dL (4.94 mmol/L), HDL = 25 mg/dL (6.5 mmol/L), and triglycerides = 344 mg/dL (8.94 mmol/L). What agent would have the greatest effect on improving her lipid profile and reducing morbidity and mortality associated with dyslipidemia? b. Atorvastatin 114. In which of the following presentation is further diagnostic testing NOT warranted? b. Bilateral gynecomastia in a 13-year-old male wit normal testicular size and volume 115. A 65-year-old presents with a past medical history of coronary artery disease, temperature 101 degrees F, tachypnea 24 breaths per minute, and consolidation in the left lower lobe. A chest x-ray confirms left lower lobe pneumonia. What antimicrobial agent(s) should the nurse practitioner prescribe? b. levofloxacin (Levaquin) 117. A 17-year-old female is diagnosed with secondary amenorrhea. Findings in her history which may account for the cessation of menses include all of the following EXCEPT she: c. frequently uses the designer drug ecstasy or smoke marijuana on the weekends with friends 119. Atenolol (Tenormin) should be avoided in: a. a 643-year old female with asthma 120. The correct treatment for ankle sprain during the first 48 hours after injury include: c. rest, elevation, compression, ice, and pain relief 122. Medical interventions that have proven most successful in the initial treatment of bulimia nervosa NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS are: c. antidepressant medication and cognitive therapy that focuses on behavior NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. the “statins” 142. The nurse practitioner assess an asymptomatic 43-year-old male and determines that he is at minimal risk for a myocardial infarction (MI). The patient asks whether he would benefit from taking aspirin 325 mg every day to prevent an MI. What should the nurse practitioner recommend? c. Do not take a daily aspirin as there is insufficient evidence at this time for primary prevention of heart attack in people without heart symptoms 143. Which oral hypoglycemic agent would be safest for an elderly patient if hypoglycemia is a major concern? c. metformin (Glucophage XR) 144. A 42-year-old male executive has been diagnosed with depression. He is otherwise healthy. An appropriate initial treatment choice is a: b. selective serotonin uptake inhibitor (SSRI) 145. A patient requests information about foods to include in his diet while vacationing in Mexico to avoid “Montezuma’s revenge.” The nurse practitioner should advise him to ingest only: d. cooked vegetables in soup, bottled water and wine 146. A 36-year-old penicillin allergic patient has folliculitis on a bearded part of his face. The nurse practitioner prescribes erythromycin and tells the patient: a. erythromycin may upset his stomach, so it should be taken with food 149. A PPD is considered positive at 5 millimeters for which population? d. confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with chest x-ray suggestive of TB 150. According to Erikson, the developmental task of the elderly adult is: a. b. ego integrity vs despair c. NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Typed Pre-Predictor 1) A 15 years old high school student with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention? a. Palpate the lymph nodes and spleen b. Examine the posterior oropharynx for petechiae c. Obtain a CBC, throat culture, and heterophil antibody test. d. Obtain an urinalyses and serum for LFTs and amylase Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Common signs and symptoms following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC. 2) A 32 years old male patient complaint of urinary frequency and burning on urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be: a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day b. ciprofloxacin (Cipro) for 3-5 days c. Trimethoprim-Sulfamethoxazole for 3 days d. 750 mg ciprofloxacin as a one-time dose Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication to treat urinary tract infections in most patients. In the case of community resistance to TMPS >20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days. Women may be treated for 3 days for uncomplicated UTI 3) Which agent is most effective for the treatment of nodulocystic acne? a. Benzoyl peroxide (Benzac) b. Retinoic acid (Retin A) NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. Topical tetracycline NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS recommend statin therapy because they primarily lower LDL-C levels, but they also have the secondary effects of lowering triglyceride and increasing HDL-C levels. 6) A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. The NP fails to refer the patient to a surgeon. The appendix ruptures and the woman die. This is an example of a. Failure of diligence b. Professional liability c. Negligence d. Malpractice Explanation: malpractice, a negligence tort, occurs when a health care professional’s actions fall bellow the appropriate standard of care and hurts the patient. In this case the patient came with sings and symptoms indicating appendicitis and the NP failed to refer the patient.. 7) A NP has recently been hired to work in a fast track facility. The NP employer asked if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is: a. Grounds for dismissal b. An ethical dilemma for the NP c. Illegal according to the standards of nursing d. Patient abandonment. Explanation: in this instance, the NP has a difference of opinion with her employer based on her religious or moral belief about providing emergency contraception. This situation is an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on the NP’s beliefs is neither against the law nor a violation of the standards of practice 8) A patient presents with pruritic lesions on both knees. There are visible silver scales. How Should this condition be managed? a. Topical antifungal cream or ointment b. Oral antibiotics c. Topical corticosteroids cream d. Topical anti-fungal/ steroid cream NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be ordered. 9) Antidepressant discontinuation syndrome is less likely if the patient a. Is male b. Is less than 35 y/o c. Has taken an SSRI with a short half life d. Gradually tapers SSRI use Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation, because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a “withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts. 10) Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of the following drug classes? a. Alpha adrenergic antagonist b. Anti-androgen agents c. Tricyclic antidepressant (TCA) d. Sulfonamides Explanation: tricyclic antidepressant should not be used by men with benign prostatic hyperplasia because of the increased risk of urinary retention secondary to the anticholigergic effects of TCAs. 11) Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse? a. What was if you did to make him angry? b. You must seek refuge immediately c. I am concerned about your safety d. I am going to call a shelter for you Explanation: The first step is to establish trust in the therapeutic relationship. without trust future collaboration, intervention and client outcome cannot be accomplished to facilitate appropriate and safe NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS behavior. The experience of abuse is a traumatic psychological crisis that must be addressed as such. The healthcare providers must emphasize the fact that the victim has not done anything wrong and they must NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Tonsillitis Explanation: Herpangina is a viral infection common in toddlers and young children caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be very painful but usually resolve in 7 to 10 days. Treatment is symptomatic. 15) A patient has Kawasaki syndrome. Which characteristics would be UNUSUAL? a. Age > 15 years b. Fever > 101 F (38.3 C) c. Exudative pharyngitis d. Painful rash explanation: Kawasaki disease is an acute febrile vasculitis syndrome that evolves inflammation of the blood vessels. This condition often causes cardiac complication in children by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. 16) According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when blood pressure exceeds a. 140/90 b. 130/90 c. 125/85 d. 150/100 Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic BP greater than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken from 2 or more readings on 2 different occasions after an initial screening. 17) A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. Osteoarthritis (OA) d. Osteoporosis NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Explanation: Rheumatoid arthritis is characterized by several joint deformities, usually bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not. RA and OA are chronic conditions. Gout is characterized by acute exacerbations related to a defect in purine metabolism, increased uric acid production, or decreased uric acid excretion. 18) A 7-year old female patient presents with severe injuries that are inconsistent with the explanation given for them. The nurse practitioner questions the mother about abuse. She admits that her husband, the child’s father, beat the child. How should the nurse practitioner proceed? a. Inform the mother that the abuse must be reported to child protection authorities. b. Counsel the mother that if it happens again it will be reported to child protection service. c. Ask the child what she did to cause the punishment d. Refer the family to the National Domestic Violence hotline. Explanation: An awareness of all the unique presentations of child abuse, subjective or objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as broken bones, burns, and bruises, may be as a result of an intentional injury from physical abuse or from an unintentional injury as a result of neglect. Both must be considered. Repeated visits to the emergency department, frequent or suspicious injuries, or bilateral or multiple healing fractures are often indicators of physical abuse. Once the diagnosis of child abuse has been made, the primary role of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing abuse, it’s critical to report it—and to continue reporting each separate incidence if it continues to recur. 19) A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the legs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? a. Intussusception b. Volvulus c. Crohn’s disease d. Foreign body in the GI tract explanation: Intussusception is one of the most common causes of abdominal obstruction in children prior 2 years of age; is best described as a portion of the intestine which telescopes into a more distal intestinal segment. The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient may pull up his knees with crying. The patient may develop vomiting with bilious emesis. Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. Rubella vaccine today NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Vitamin E 400 IU daily Explanation: Supplementation with folic acid decreases the development of neural tube defects, such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure. Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks’ gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent tube defects. 23) A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? a. Refer to a cardiologist as soon as possible b. Prescribe long-acting nitroglycerin c. Order treadmill stress test d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours Explanation: The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery). 24) A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: a. Infection proximal to the nodes b. A possible cancer diagnosis c. Shorty nodes, a common normal variant in children d. An infectious process distal to the nodes explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be asses carefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection. 25) The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the NP do next? a. Send the infant for x-ray of the hips b. Send the infant for ultrasound of the hips c. Perform Ortolani and Barlow test NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Examine the infant for unequal arm length NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia Explanation: Hydrocele is common in newborns and usually disappears without treatment within the first year. Older men can develop hydroceles, sometimes due to inflammation or injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound may be needed to diagnose the condition. 30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this information, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. 31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to. a) Refer for surgical interventions such as partial or complete fundoplication. b) Refer for endoscopy, namometry, and/or PH testing c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications. d) Review proper proton pump inhibitor dosing time and adherence with the patient. Explanation: poor adherence is an importance cause of inadequate acid suppression and refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and superficially timing in relation to meals, should be sought first alarm features such as iron deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need for further diagnostic testing. Diagnostic testing procedures should proceed any surgical intervention like fundoplication. 32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk. The NP NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS would be correct to recommend all of the following EXCEPT NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS a. Moderate weight bearing exercise 3 times per week b. 1200 – 1500 mg calcium daily c. Avoidance of alcoholic beverages d. Weight loss Explanation: the recommended calcium intake is 1,200 mg – 1500 mg a day. Regular weight-bearing and muscle-strengthening exercise reduce the risk of falls and fractures. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. However, alcohol intake of more than two drinks per day for women or three drinks a day for men may be detrimental to bone health, increases the risk of falling and requires further evaluation for possible alcoholism. In addition, Risk factors for osteoporosis include age greater than 65, white or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen deficiency including premature menopause. 33) According to Erickson, the developmental task of the elderly adult is: a. Intimacy VS isolation b. Ego integrity VS despair c. Industry VS self-doubt d. Trust Vs mistrust explanation: NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS explanation: Most bouts of oral thrush occur for no apparent reason. However, regularly sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent some bouts. 37) A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed recommendations of her nurse midwife. She is in the office to discuss results of her maternal serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy? a. Elevated MSAFPO is an indicator of Down Syndrome b. Low MSAFP is expected at 18 weeks’ gestation c. Neural tube defects are highly probable d. Elevated MSAFP is an expected finding Explanation: elevated maternal serum alfa Protein is expected when a woman is pregnant with twins. An elevation can also be an indication of a miscalculated due date. Low levels can indicate Down Syndrome 38) The hallmark of neurofibromatosis (von Recklinghousen disease) present in almost 100% of patients is: a. Acoustic neuroma b. Astrocytoma of the retina c. Distinctive osseous lesion d. Café au lait spots Explanation: Von Recklinghausen disease is also known as neurofibromatosis. It is characterized by multiple neurofibromas, or tumors, forming that vary in shape, size, and location. Neurofibromatosis type 1 and neurofibromatosis are differentiated by clinical features. They both include benign tumors of the nerve tissue (neurofibromas). Only neurofibromatosis type 1 (90%) has prominent clinical features, such as cafe-au-lait pigmentation. Neurofibromatosis type 2 consists of neurofibromas only without clinical features. 39) The NP correctly teaches an elderly patient with pernicious anemia that food sources of B12 include a. Red meat, poultry, fish, eggs, dairy products b. Canned and frozen fruit NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. Whole grain breads, cereals and pastas NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Fresh vegetables explanation: Pernicious anemia is a type of vitamin B12 anemia. VB12 can be found in foods such as meat, poultry, shellfish, eggs, and dairy products. A special protein, called intrinsic factor (IF), helps the intestines absorb vitamin B12. This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12. 40) An 18-year-old female applying for college admission present to the health clinic because evidence of rubella vaccination is required for admission. She says, “don’t remember ever getting that shot” She has negative serologic evidence of rubella antibody. The NP should: a. Tell her that her serologic evidence demonstrates that she is immune to the rubella and that she probably has the disease as a child b. Administer the vaccination after a negative pregnancy test and advise the patient that she must not get pregnant for 28 days c. Tell her that she needs the immunization and can get today if her pregnancy test is negative d. Administer the rubella vaccination after a negative pregnancy test and advise her not to get pregnant for at least 6 months. Explanation: Due to this very small chance of illness, the Centers for Disease Control and Prevention (CDC) recommend waiting 28 days after getting the MMR vaccine before trying to get pregnant. 41) A 45 y/o obese pre-menopausal female complains of indigestion, flatulence, RUQ pain and epigastric “crampy pain”. Symptoms are exacerbated by high-fat meal. What is the most likely diagnosis? a. Hepatitis b. Chronic cholecystitis c. Acute pancreatitis d. Myocarditis Explanation: The “typical” patient with chronic cholecystitis is “female, fat, fertile, and (over) 40” years of age. Myocarditis produces retrosternal pain that is not related to diet. The pain of pancreatitis radiates to the back. The pain of hepatitis is non-specific upper quadrant pain. 42) A 16 y/o male presents w/ mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechia. With for this patient, what drug would be the LEAST appropriate to prescribe? a. Ibuprofen b. Erythromycin c. Ampicillin d. Doxycycline NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS motor, intellectual, emotional, and language to determine whether a child is within normal range for various behaviors or is developmentally delayed NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS b. Applicable to children from birth to 5 years; evaluates four major categories of development: motor, vision, hearing and psychosocial to determine whether a child is normal or developmentally compromised c. Applicable to children from age 6 months to 6 years; evaluates 4 major categories of development: intellectual, verbal, social and memory to determine IQ and aptitude d. Applicable to children from birth to 6 years; evaluates four major categories of development: gross motor, fine motor-adaptive, language, and personal social to determine whether a child is within normal range for behaviors or is developmentally delayed. Explanation: The Denver Developmental Screening Test (DDST) is a screening test for cognitive and behavioral problems in children from birth until the age of 6 The purposes of the DDST and Denver II are to screen children or possible developmental problems and to verify suspected problems with an objective measure. The Denver II screens general development in four areas: Social – Personal: Aspects of socialization inside and outside the home – eg, smiling. Fine motor function – Adaptive: Eye/hand co-ordination, problem solving and manipulation of small objects – eg, grasping and drawing. Language: Production of sounds, and ability to recognize, understand and use language – eg, ability to combine words Gross motor functions: Motor control, sitting, walking, jumping, and overall large muscle movements. 47) A 12-month-old has conjunctivitis in his right eye with a mucopurulent discharge. The mother asks if the child can forego for antibiotic eye drops because he does not’s like drops in his eyes. The NP replies that: a. If untreated, conjunctivitis may permanently damage the cornea b. Conjunctivitis is usually caused by a virus. Let’s wait a few days c. If no one else at the daycare has it, we can wait a few days. d. An oral antihistamine may be prescribed instead of eye drops. Explanation: Pink eye does not normally cause loss of vision, especially when treatment is administered in a timely manner. However, if bacterial conjunctivitis is serious and left untreated, it may damage the eye permanently, leading to loss of vision. 48) which oral hypoglycemic agent would be safest for an elderly patient if hypoglycemia is a major concern? a. Tolbutamide (orinase) b. Glipizide (Glucotrol) c. Metformin (Glucophage) d. Chlorpropamide (diabinese) Explanation: When used alone, metformin typically does not cause hypoglycemia and is usually weight NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS neutral or causes modest weight loss. Given the low risk of hypoglycemia, metformin has NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d)40% Explanation: Clinical trials suggest that heart disease mortality rates un the US could be lowered by 5 to 20% if all Americans restricted their fat intake to less than 30% of total daily calories, 7% from saturated fat. 52) A 30 y/o female patient is being seen by the NP for the first time. She is seeking advice from the NP about becoming pregnant. She is currently taking an oral contraceptive. She gives a hx of having hydatidiform molar pregnancy 2 years ago. An appropriate plan of care for this a. patient should include b. Delaying pregnancy for 1 more year c. Measuring serum chorionic gonadotropin level d. Discontinuing oral contraceptive e. Recommending permanent sterilization Explanation: A Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. Pregnancy raises hCG levels which increases the risk for choriocarcinoma. 53) which of the following is NOT a goal for treatment for the patient with cystic fibrosis? a. Prevent intestinal obstruction b. Provide adequate nutrition c. Promote clearance of secretions d. Replace water soluble vitamins Explanation: most patients with cystic fibrosis have insufficient release of pancreatic enzymes. This results in malabsorption of the fat-soluble vitamins….meconium ileus , resembles appendicitis in these patients 54) A 24 y/o female taking oral contraceptive has missed her last 2 pills. What should the NP advise her to do to minimize her risk of pregnancy? a. Take today’s dose and do not miss any more during this month b. Double today’s dose and use a barrier method for the rest of this month c. Double today’s dose and tomorrow’s dose and use a barrier method for the rest of this month d. Stop the pills and restart a new pill pack in one week. Explanation: If 2 pills are missed on consecutive days, the next 2 days’ dosage should be double, and a barrier method recommended for the remainder of the cycle 55) Which red blood cell (RBC) index is most useful for differentiating types of anemias? a. Mean corpuscular volume (MCV) b. Mean corpuscular hemoglobin concentration (MCHC) NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS c. Hematocrit (HCT d. Platelet count NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Explanation: The MCV is the most useful value in the RBC indices to help determine the type of anemia you may have. Your doctor will see if your MCV is low, normal, or high to help determine what is causing your anemia. 56) what is a Tzanck test used to diagnosed? a. Mastoiditis b. Trichomoniasis c. Hyphema d. Herpes virus Explanation: Tzanck prep is the only test in this list which is diagnostic for herpes simplex. KOH prep is used to diagnose candidal and bacterial vaginosis. Gram stain is used to help distinguish Gram positive and Gram negative organisms. The Papanicolaou (Pap) smear is used to screen for cervical dysplasia and cancer. 57) a 40 y/o female with hx. Of frequent sun exposure present with multicolored lesion on her back it has irregular borders and is about 11 mm in diameter. What should the NP suspect? a. Squamous cell carcinoma b. Malignant melanoma c. Common Nevis d. Basal cell carcinoma Explanation: ABCDE RULE Another commonly used tool for early detection of melanoma is the ABCDE acronym (Asymmetry, Border irregularity, Color variation, Diameter >6mm and Evolution or history of change) introduced to alert patients and health professionals to the diagnosis of melanoma. 58) a 16 y/o sexually active female presents to the clinic. She has never had vaccinations for hepatitis A or B. She has had one MMR immunization, and her last tetanus vaccination was 4 years ago. which vaccination would be contraindicated without further testing? a. Hepatitis B b. Hepatitis A c. MMR d. Tetanus Explanation: Patient should have a pregnancy test before MMR vaccine. The MMR vaccine is contraindicated during pregnancy because it contains live, attenuated viruses that pose a theoretical risk to the fetus 59) following the finding of prostate gland abnormalities on DRE, The NP orders appropriate labs. When preparing to review with the patient, the NP knows all of the following are true EXCEPT NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Exercise NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Explanation: exercise is most consistently effective in reducing the pain associated with rheumatoid arthritis. Exercise improve blood flow, cartilage health, range of motion. Exercise can also improve self- efficacy. Patients with RA should be cautioned to limit joint range of motion, and/or splint affected joints during acute…..Heat, cold, and TENS application can also have a role in pain relief. 64) The NP is counseling a 25 y/o sexually active male patient about condom use, which of the following statement is INCORRECT a. Adequate lubrication is needed to prevent damage to the condom b. Roll the condom over an erect penis before any sexual contact c. Make sure the condom is tight against the head of the penis d. Withdraw while the penis is erect, so that the condom stays in place Explanation: Condoms come in all different types and sizes. Condoms that are too tight can choke off blood supply, which contributes to erectile dysfunction. And if you choose a condom that’s too big, it can slip off during intercourse, which not only defeats the purpose of wearing the condom but can also undo an erection. 65) a patient with moderate persistent asthma will probably be most effectively managed with daily a. Oral leukotriene blockers b. Short and long acting bronchodilators c. Inhaled steroids and long acting bronchodilators d. Oral steroids and short acting bronchodilators Explanation: People with moderate persistent asthma are not well controlled on low doses of inhaled corticosteroids. A combination of this drug and long-acting inhaled beta2 agonists provides improved control compared with doubling of the maintenance dose of inhaled corticosteroids. https://www.ncbi.nlm.nih.gov/pubmed/16935690 66) diagnosis of systemic lupus erythematosus (SLE) is made a. On the basis of demonstrable anti-nuclear antibodies (ANA) b. Considering symptom complex with confirmation by laboratory test c. Using renal function studies and rheumatoid factor for confirmation d. On the basis of renal or cutaneous biopsy Explanation: The American College of Rheumatology has proposed the revised criteria for diagnosis of systemic lupus erythematosus (SLE) abnormalities associated with disease. At least four of these criteria are required to make the diagnosis. Laboratory test…. 67) which of the following would not be considered a developmental red flag to a NP assessing a 4 y/o? a. Persistent fear of going to sleep NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS b. Missing speech sounds c. Fire-setting NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS d. Fitness bar Explanation: A ringworm infection can be spread in many direct and indirect ways, including: Person to person, Pet/animal to person, Inanimate item to person: It’s possible to get ringworm through indirect contact with objects, including hair of an infected person, bedding, clothing, shower stalls, and floors, Soil to person, having a weak immune system. 70) Acute rheumatic fever is diagnosed using the modified Jones criteria. Which is NOT a major criterion in the Jones System? e. Jaundice f. Carditis g. Polyarthritis h. Subcutaneous nodules Explanation: One of the major criteria for diagnosis of acute rheumatic fever using the Jones System is polyarthritis, the most common finding. This usually responds to aspirin therapy within 48 hours. Another common finding is carditis. Other major criteria which are far less common include erythema marginatum and subcutaneous nodules. 71) A pt is taking an ACE inhibitor for the blood pressure control. The NP decides to add a diuretic which of the following is the best choice? e. a thiazide diuretic f. a loop diuretic g. a potassium-sparing diuretic h. Fitness bar Explanation: First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs. 72) which of the following drugs classes would be most effective in decreasing elevated triglycerides levels (650 mg/dL)? a. bile acid sequestrants b. nicotinic acid c. fibrates d. statins Explanation: Classes of medications that are appropriate for the management of major triglyceride elevations include fibric acid derivatives, niacin, and omega-3 fatty acids. 73) the mother of a 16 y/o high school student athlete is concerned that her daughter has not had a menstrual period yet. on physical examination, the NP finds normal growth and development including appropriate secondary sexual characteristics what is the most appropriate NP action? a. refer to a endocrinolist b. order a pelvic ultrasound c. attempt progesterone challenge d. prescribe oral contraceptive Explanation: Normal age for menarche is between nine and 17. Since this patient has secondary sexual characteristics and normal anatomy, she should be offered reassurance that she is normal and her menses will probably start soon. NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS 74) factors known to be associated with early sexual activity include. a. early development of secondary sex characteristics, living in an urban area, and easy access to contraceptives b. legalized abortion, frequent viewing of adult television and movies, and lack of church affiliation c. lower socioeconomic status, use of tobacco, alcohol or other drugs, and single parent household d. exposure to sex education information at school Explanation: Factors found to be associated with early sexual activity are lower socioeconomic status, use of tobacco, alcohol, or other drugs, and belonging to a single parent household. 75) the finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of prostatic gland that is a. enlarged, symmetrical, semi firm and non-tender b. enlarged, symmetrical, boggy and exquisitely tender c. asymmetrical and nodular d. exquisitely tender with absence of median sulcus Explanation: During the digital rectal exam, the practitioner palpates the prostate, noting its size, shape, and consistency and any nodules or tenderness. The normal prostate is rubbery and nontender. With BPH, the prostate feels symmetrically enlarged, firm, slightly elastic, and smooth. A distinct, hard nodule may signal a malignancy. 76) The NP correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals a. an increase reticulocyte count b. a mean corpuscular volume (MCV) > 100 c. hemoglobin (hgb) 140 mg/dL (140 g/L) d. an increased total iron binding capacity (TIBC) Explanation: A total iron binding capacity value above 450 mcg/dL usually means that there's a low level of iron in your blood. This may be caused by a lack of iron in the diet, increased blood loss during menstruation, pregnancy, or a chronic infection. 77) Strabismus is observed in a 13-month-old child. The most appropriate action for the NP to take a. refer the patient to an ophthalmologist b. patch the child affected eye c. follow the child closely for 2 more month d. teach the patient and parent, eye muscle exercises Explanation: Strabismus can also be an indicator of severe eye and health problems. As it can indicate poor vision, it may in rare cases be the first sign of childhood cataract, glaucoma, or tumors of the eye, optic nerve, orbit or brain, such as retinoblastoma, glioma, or rhabdomyosarcoma. 78) giving appropriate patient education by the primary care provider, poor compliance with medical recommendations is most often due to: a. willful disobedience b. vision and/or hearing deficits c. anxiety d. limited cognitive ability NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS Explanation: In the National adult Literacy Survey, 75% of Americans with chronic or mental health problems scored in the lowest 2 out of 5 …. Literacy. Among the elderly, minorities, and lo income groups, 2/5 cannot read the simple brochure. Most patients are not likely to volume….. 79) the physical exam findings in an infant are most effected by which item listed below? a. what was the Apgar score at one minute? b. is the child breast of bottle fed? c. are the immunizations current? d. what was the gestational age at birth? Explanation: Gestational age is the most important predictor of growth impairment, followed by birth weight and length standard deviation scores. https://www.sciencedirect.com/topics/nursing-and-health- professions/gestational-age 80) Babies should begin oral iron supplementation: a. when they are able to eat iron enriched cereal b. 2 months of age c. 4-6 months d. any time after their teeth have erupted Explanation: Recommends giving breastfed infants 1 mg/kg/day of a liquid iron supplement until iron- containing solid foods are introduced at about 6 months of age. 81) the most common cause of cerebral palsy is a. unknown b. intra-partial hypoxia c. in utero infection d. intraventricular hemorrhage Explanation: in approx. 70% of cases, neither cause (s) nor risk factors can be identified as correlates to cerebral palsy 82) A patient with diabetes bring his glucose dairy from the past 7 days for the NP to review and evaluate what changes should be made? DAY 1234567 AM 67, 52, 61, 48, 39, 68, 70 PM138, 161, 148, 168, 171, 142, 176 a. increase the PM dose of NPH insulin b. increase the PM dose of regular insulin c. decrease the PM dose of NPH insulin d. decrease the PM dose of regular insulin Explanation: NPH Human Insulin which has an onset of insulin effect of 1 to 2 hours, a peak effect of 4 to 6 hours, and duration of action of more than 12 hours. 83) which of the following patient is at highest risk of suicide? a. 65 y/o female b. 70 y/o male c. 35 y/o white divorce male d. 42 y/o single mother Explanation: There is a common perception that suicide rates are highest among the young. However, it NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. 88) palpable thyroid nodule is benign. How does it feel on palpation? a. smooth b. hard c. non-tender d. fixed Explanation: Clinically, thyroid enlargement may be smooth and diffuse or nodular with the nodules being either single or multinodular. A smooth, diffuse enlargement is indicative of benign thyroid disease, although rarely anaplastic carcinoma or lymphoma may present this way. 89) A 53 y/o postmenopausal female with a 38 BMI and gastric esophageal reflux disease, takes a daily calcium supplement for protection against osteoporosis. All of the following are appropriate teaching points for this patient, except a. take the calcium supplement with milk to facilitate absorption b. the addition of HRT may further decrease osteoporosis risk c. take an OTC calcium containing antacid to increase calcium intake d. avoid caffeine containing beverages. Explanation: Taking calcium paired with vitamin D seems to be more beneficial for bone health than taking calcium alone. Antacids contain calcium, but do not contain vitamin D. So if you choose antacids as a calcium source, you may want to consider taking a separate vitamin D supplement. Discuss your options with a health care provider. 90) A 65 y/o immunocompetent man with no underlying medical condition presents in mid-October and request the "flu and pneumonia shots" Records show he received the influenza and PCV13 ten month ago. The NP recommends that he a. receive the PCV13 and influenza vaccine today, and return in January for the PPS23 b. should return in January to receive both the influenza and PPSV23 c. receive the influenza vaccine at this time and return in January for the PPSV23 d. receive the PPSV23 and the influenza vaccine today and again in January Explanation: For adults who have not received any pneumococcal vaccine previously, PCV13 should be given before PPSV23. If the primary indication for vaccination is age ≥65 years, PPSV23 should be given ≥1 year after PCV13. For adults between ages 19 and 64 years who require both vaccines, PPSV23 can be given ≥8 weeks after PCV13. 91) when discussing treatment option with a patient. The NP would be correct to say that surgery can be curative for: a. ulcerative colitis b. irritable bowel syndrome c. crohn's disease d. inflammatory bowel disease Explanation: Ulcerative colitis (UC) is an inflammatory bowel disease that mainly affects the lining of NSG 6340 FINAL EXAM 1 LATEST UPDATED GUIDE 2024/2025 CORRECTLY 100% VERIFIED QUESTIONS AND ANSWERS the large intestine (colon). This autoimmune disease has a relapsing-remitting course, which means that