NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED, Exams of Nursing

Download NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED and more Exams Nursing in PDF only on Docsity! c) Acute closed-angle glaucoma 51 Estimating cup-to-disk ratio NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED It is important to not dilate the eye if is suspected. Question 50 options: a) Cataract b) Macular degeneration d) Chronic open-angle glaucoma Save Question 51 (1 point) Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Question 51 options: Checking the macula Verifying a red reflex Extraocular movements Save Question 52 (1 point) 52 a) Conjunctivitis 53 d) Viral conjunctivitis 54 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED The most common cause of eye redness is: Question 52 options: b) Acute glaucoma c) Head trauma d) Corneal abrasion Save Question 53 (1 point) A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Question 53 options: a) Bacterial conjunctivitis b) Allergic conjunctivitis c) Chemical conjunctivitis Save Question 54 (1 point) In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? d) Leukoplakia 59 c) Group A beta hemolytic streptococcus 60 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED a) Fictional keratosis b) Keratoacanthoma c) Lichen planus Save Question 59 (1 point) Rheumatic heart disease is a complication that can arise from which type of infection? Question 59 options: a) Epstein-Barr virus b) Diphtheria d) Streptococcus pneumoniae Save Question 60 (1 point) A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Question 60 options: a) Mono spot b) Strep test d) All of the above 61 d) Chronic bronchitis 62 b) 100-pack years NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED c) Throat culture Save Question 61 (1 point) Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Question 61 options: a) Seasonal allergies b) Acute bronchitis c) Bronchial asthma Save Question 62 (1 point) A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: Question 62 options: a) 50 x 2-pack years 63 c) Increased anterior-posterior diameter 64 a) No palpable vibration is felt NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED c) 50-year, 2-pack history d) 100-pack history Save Question 63 (1 point) Emphysematous changes in the lungs produce the following characteristic in COPD patients? Question 63 options: a) Asymmetric chest expansion b) Increased lateral diameter d) Pectus excavatum Save Question 64 (1 point) When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: Question 64 options: b) Decreased fremitus is felt c) Increased fremitus is felt 69 c) Alpha-1 deficiency 70 b) 8 weeks or more 71 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Question 69 options: a) Exercise-induced cough b) Bronchiectasis d) Pericarditis Save Question 70 (1 point) A cough is described as chronic if it has been present for: Question 70 options: a) 2 weeks or more c) 3 months or more d) 6 months or more Save Question 71 (1 point) c) ACE inhibitor 72 b) Long-acting beta agonist usage 73 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Which of the following medications are commonly associated with the side effect of cough? Question 71 options: a) Beta blocker b) Diuretic d) Calcium antagonist Save Question 72 (1 point) Which of the following details are NOT considered while staging asthma? Question 72 options: a) Nighttime awakenings c) Frequency of symptoms d) Spirometry findings Save Question 73 (1 point) The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Question 73 options: c) Tachypnea greater than 30 breaths/minute 74 a) Streptococcus pneumoniae 75 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED a) Age over 40 b) Fever greater than 101 d) Productive cough Save Question 74 (1 point) The most common etiologic organism for community-acquired pneumonia is: Question 74 options: b) Beta hemolytic streptococcus c) Mycoplasma d) Methicillin resistant staphylococcus Save Question 75 (1 point) A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Question 75 options: a) Can be treated as an outpatient 80 c) Pneumothorax 81 c) Sudden death of a family member NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED d) COPD Save Question 80 (1 point) A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Question 80 options: a) Pulmonary embolism b) Pleural effusion d) Fracture of ribs Save Question 81 (1 point) Which of the following is the most important question to ask during cardiovascular health history? Question 81 options: a) Number of offspring b) Last physical exam d) Use of caffeine 82 b) ACE inhibitors 83 d) A & B only NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Save Question 82 (1 point) Aortic regurgitation requires medical treatment for early signs of CHF with: Question 82 options: a) Beta blockers c) Surgery d) Hospitalization Save Question 83 (1 point) A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Question 83 options: a) Women with ischemic heart disease many times do not present with chest pain b) Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction c) Elderly patients have the most severe symptoms Save Question 84 (1 point) 84 ASA, ACE/ARB, beta-blocker, aldosterone blockade 85 b) Exercise stress test NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED The best evidence rating drugs to consider in a post myocardial infarction patient include: Question 84 options: ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates Save Question 85 (1 point) A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: Question 85 options: a) Echocardiogram c) Cardiac catheterization d) Myocardial perfusion imaging Save Question 86 (1 point) 90 c) Mitral valve prolapse 91 d) Echocardiography NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Question 90 options: a) Angina b) Pericarditis d) Congestive heart failure Save Question 91 (1 point) Which test is the clinical standard for the assessment of aortic stenosis? Question 91 options: a) Cardiac catheterization b) Stress test c) Chest X-ray Save Question 92 (1 point) 92 a) The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis 93 c) Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED The aging process causes what normal physiological changes in the heart? Question 92 options: b) Cardiology occurs along with prolapse of the mitral valve and regurgitation c) Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves d) Hypertrophy of the right ventricle Save Question 93 (1 point) Which of the following statements is true concerning anti-arrhythmic drugs? Question 93 options: a) Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. b) Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. d) Anti-arrhythmic therapy should be initiated in the hospital for all patients. Save Question 94 (1 point) Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left- sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by 94 d) Coronary artery disease with angina pectoris 95 b) S3 gallop rhythm 96 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? Question 94 options: a) Musculoskeletal chest wall syndrome with radiation b) Esophageal motor disorder with radiation c) Acute cholecystitis with cholelithiasis Save Question 95 (1 point) A common auscultatory finding in advanced CHF is: Question 95 options: a) Systolic ejection murmur c) Friction rub d) Bradycardia Save Question 96 (1 point) c) Venous insufficiency 101 d) Urinalysis NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED a) Femoral vein thrombosis b) Femoral artery thrombus d) Musculoskeletal injury Save Question 101 (1 point) (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? Question 101 options: a) Abdominal plain films b) Liver function tests c) Amylase/lipase Save Question 102 (1 point) 102 d) Abdominal ultrasound 103 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? Question 102 options: a) Abdominal upright and flat plate x-ray b) Abdominal MRI c) Abdominal CT scan with contrast Save Question 103 (1 point) (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with d) HIDA scan 104 d) Murphy’s sign 105 NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? Question 103 options: a) Trial of ursodiol b) ‘Watchful waiting’ c) Surgical consult Save Question 104 (1 point) A specific exam used to evaluate the gall bladder is: Question 104 options: a) Psoas sign b) Obturator sign c) Cullens sign Save Question 105 (1 point) Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 3. Question : A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with antibiotics to prevent complications and to shorten the course of disease. Which of the following antibiotics should be considered when a patient is allergic to Penicillin? Student Answer: Amoxicillin EES (erythromycin) Bicillin L-A Dicloxacillin Instructor Explanation: MedU Card #1 Points Received: (not graded) Comments: Question 4. Question : Presbycusis is the hearing impairment that is associated with: Student Answer: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Instructor Explanation: Presbycusis is an age-related cause of gradual sensorineural hearing loss and involves diminished hairy cell function within the cochlea as well as decreased elasticity of the TM. Although the changes associated with presbycusis often start in early adulthood, the decreased hearing acuity is usually not noticed until the individual is older than 65. (Goolsby 138) Because presbycusis is gradual and insidious, hearing loss may go unnoticed until it has progressed significantly. (Kennedy-Malone 170) Points Received: 2 of 2 Comments: Question 5. Question : Epistaxis can be a symptom of: Student Answer: Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above Instructor Explanation: Cocaine abuse, which is more common than might be expected, frequently causes epistaxis. Hematologic disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums. (Goolsby 142) Epistaxis results from a spontaneous rupture of a blood vessel in the nose, usually in the anterior septum in Kiesselbach's plexus (Nguyen, 2012). The bleeding may be secondary to local infections, systemic infections, drying of the nasal mucous membrane, trauma, arteriosclerosis, hypertension, or bleeding disorders. Trauma is usually the primary mechanism of disruption of the nasal mucosa. Posterior NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED epistaxis can result in nausea and respiratory compromise. In older adults, nasal and paranasal tumors may be involved (Mäkitie, 2010). (Kennedy-Malone 168-169) Points Received: 2 of 2 Comments: Question 6. Question : Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Student Answer: Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Instructor Explanation: Most oral malignancies are painless until quite advanced, so patients are often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions. Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco use or poor dentition, these are not risk factors for malignant melanoma. In Behcet’s syndrome, the patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than 1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by erythema. The majority of patients also develop lesions on the genitals and eyes. (Goolsby 153) NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Student Answer: Presyncope Disequilibrium Vertigo Syncope Instructor Explanation: MedU Card #5 Points Received: (not graded) Comments: Question 10. Question : It is important to not dilate the eye if is suspected. Student Answer: Cataract Macular degeneration Acute closed-angle glaucoma Chronic open-angle glaucoma Instructor Explanation: If the patient has experienced sudden onset of eye pain, it is important not to dilate the eyes before determining whether acute closed-angle glaucoma is present because dilating the eye may increase the intraocular pressure. (Goolsby 108) Acute glaucoma, also known as angle-closure or narrow-angle glaucoma, is an obstruction to the outflow of aqueous humor from the posterior to the anterior chamber through the trabecular meshwork, canal of Schlemm, and associated structures. It results in an elevation of intraocular pressure, damaging the optic nerve and causing loss of peripheral vision, eye pain, and redness. This type of glaucoma is NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED uncommon but may occur as a primary disease or secondary to other conditions and constitutes an ophthalmic emergency (Kennedy-Malone 161) Points Received: 2 of 2 Comments: Question 11. Question : Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any history of headaches or migraines. What would the most likely diagnosis be? Student Answer: Vestibular neruitis Benign paroxysmal positional vertigo Vestibular migraine Benign hypertensive central vertigo Instructor Explanation: MedU Card #9 Points Received: 0 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 12. Question : Which of the following patients with vertigo would require neurologic imaging? Student Answer: A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not disappear when she focuses. A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix- Hallpike maneuver. A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test is positive. A 28-year-old otherwise well woman with new onset constant vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze is fixed. Instructor Explanation: MedU Card #11. There are multiple reasons to be concerned about a central lesion and possible infarct in this patient. Her age puts her at risk as does her hypertension. Her physical exam shows nystagmus that changes direction and that does not inhibit with focus. Both of these findings are consistent with a central lesion. She needs an urgent MRI. Points Received: 0 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 16. Question : Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Student Answer: Sinus pain, increased vascular permeability, and bronchodilation Bronchospasm, vascular permeability, and vasodilatation Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction Vasodilatation, bronchodilation, and increased vascular permeability Instructor Explanation: Rhinitis may be either allergic or nonallergic. Allergic rhinitis results as a response of the nasal mucosa to airborne allergens in atopic genetically prone individuals. This response is mediated by the production of immunoglobulin E (IgE). IgE antibodies produced in response to the initial and subsequent exposure to allergens bind to the nasal mucosa. With repeated exposure, immediate type 1 hypersensitivity reactions may occur (Simoens & Laekeman, 2009). Antigen-specific T cells are activated through the lymphatic system in response to the antigen. The activated antigen- specific T cells activate B cells, and IgE is created in lymphoid tissue and at local tissue sites (Adelman, Casale, & Corren, 2002; Novak, 2009). The newly created antigen-specific IgE is released by plasma cells and binds to high-affinity IgE receptors located on the basophils and mast cells. This leads to the sensitization of the cells in the tissues of the nose, lung, or skin (Adelman et al., 2002; Cirillo, Pistorio, Tosca, & Ciprandi, 2009). IgE also binds with the antigen protein, beginning degranulation of the mast cells and basophils. These actions start the allergic cascade. Mediators are released as a result of the degranulation and include histamine, proteoglycans, enzymes, leukotrienes, cytokines, and many others. The chain in the release of mediators is responsible for the immediate and late phase responses of the cells. Histamine may be fully released within 30 minutes of degranulation, whereas cytokines may be released over many hours (Adelman et al., 2002; Derendorf & Meltzer, 2008). (Kennedy-Malone 181- 182) NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Points Received: 2 of 2 Comments: Question 17. Question : You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Student Answer: Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) Migraine Instructor Explanation: Ménière's disease commonly involves a triad of symptoms—severe vertigo, tinnitus, and hearing loss (Goolsby 140) Points Received: 2 of 2 Comments: Question 18. Question : In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? How an individual's primary genetic disease(s) may affect their overall health. What secondary disease(s) the individual may be likely to develop. The appearance in which common diseases may presenting individuals with genetic disorders. NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Student Answer: Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia Instructor Explanation: The cause of most episodes of leukoplakia is not determined. However, this condition, which results in the development of white patches on the oral mucosa, is associated with an increased risk of oral squamous cell cancer. Risk factors for the development of leukoplakia include chronic/recurrent trauma to the affected site and the use of smokeless and smoked tobacco and alcohol. (Goolsby 152) Points Received: 2 of 2 Comments: As a nurse practitioner it is important for you to know (select all that apply): Question 2 options: Lynch syndrome has no life time risk associated with colon cancer. NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Points Received: 2 of 2 Comments: Question 20. Question : A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Student Answer: Mono spot Strep test Throat culture All of the above Instructor Explanation: The physical examination for sore throat should include a comprehensive assessment of the upper and lower respiratory systems, including ears, nose, mouth, throat, and lungs. The neck assessment should include, at a minimum, assessment of the cervical lymph nodes. Strep screens, throat cultures, and mononucleosis screens are common diagnostic studies used to narrow the differential diagnosis of sore throat. A CBC with differential count is helpful in determining the cause of sore throat. (Goolsby 156) A 22-year-old woman presents with a "pimple" on her right eyelid. Examination reveals a 2-mm pustule on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion B. a hordeolum/ C. blepharitis D. cellulitis Vasoconstriction Decreased morbidity Increased mortality Decreased function Impaired quality of life What are the effects of sensory impairment (vision and hearing) in elderly adults? Select all that apply. Question 2 options: Inhibiting histamine receptor sites NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED A 22-year-old woman presents with a "bump" on her right eyelid. Examination reveals a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion/ B. a hordeolum C. blepharitis D. cellulitis Question 1 (1 point) The nurse practitioner educates the patient that antihistamines have what effect? Question 1 options: Vasodilatation Blocking leukotriene effects 4-5 days 1 to 2 days 2-4 hours Histamine blockade What is the anticipated onset of symptom relief with the use of nasal corticosteroid sprays? Question 4 options: 6-7 hours Leukotriene inhibition Blocking the effects of IgE Mast cell stabilization What is the mechanism of action of Cromolyn sodium? Question 3 options: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Points Received: (not graded) Which of the following conditions is the leading cause of blindness in the United States? Question 5 options: Macular degeneration Points Received: 2 of 2 Comments: Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 3 . Question : Emphysematous changes in the lungs produce the following characteristic in COPD patients? Student Answer: Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum Instructor Explanation: In COPD, patients commonly develop a barrel-shaped chest due to emphysematous changes in the lungs. A barrel shape is due to an increased anterior-posterior (AP) diameter. In emphysema, there is a 1:1 ratio of AP to lateral diameter; AP diameter equals the lateral diameter. Normally the AP diameter is twice the lateral diameter. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file( page 213-214) & Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 206) Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 4 . Question : When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: Student Answer: No palpable vibration is felt Decreased fremitus is felt Increased fremitus is felt Vibration is referred to the non-obstructed lobe Instructor Explanation: Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. Conversely, areas of decreased fremitus raise the suspicion of abnormal fluid- or air-filled spaces, such as occurs with pleural effusion, pneumothorax, or emphysema. In the instance of an extensive bronchial obstruction, no palpable vibration is felt in the related field. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 209) & Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 193) Question 5 . Question : Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma? Points Received: 0 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Student Answer: Clear, watery nasal drainage with nasal turbinate swelling Pharyngeal exudate and lymphadenopathy Clubbing, cyanosis and edema. Diminished lung sounds with rales in both bases Instructor Explanation: MedU Card #9 Question 6 . Question : Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Student Answer: Computed tomography (CT) scan Chest X-ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan Instructor Explanation: For pulmonary malignancy, chest films are often nondiagnostic, although they may reveal a nodule, mass, or other abnormality. A CT scan of the chest is typically diagnostic. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 217-218) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 251) Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Pulmonary embolism Pneumonia Instructor Explanation: The problem may occur when these symptoms are attributed to aging or existing comorbidities. Dyspnea (acute onset), anxiety or apprehension, pleuritic chest pain, cough, tachypnea, and accentuation of the pul-monic component of S2 are frequently present and may be accompanied by diaphoresis, syncope, tachycardia, S3 or S4 gallop, hypoxemia, or hemoptysis . Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 246) Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file (page 202) Question 10. Question : A cough is described as chronic if it has been present for: Student Answer: 2 weeks or more 8 weeks or more 3 months or more 6 months or more Instructor Explanation: Cough is classified as acute (less than 3 weeks in duration), subacute (lasting 3 to 8 weeks), and chronic (8 or more weeks in duration), and these distinctions help to narrow the potential differential diagnoses. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 211) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing Points Received: 2 of 2 Comments: Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. ((page 206) Question 11. Question : Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze? Student Answer: Chest X-ray Methacholine challenge test Spirometry, both with and without bronchodilation Ventilation/perfusion scan Instructor Explanation: MedU Card #10 Question 12. Question : In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include: Student Answer: Symptoms daily with nighttime awakening more than 1 time a week. Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED FEV1 >60%, but predicted <80%. FEV1/FVC reduced 5% Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 >80% predicted. FEV1/FVC normal Symptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 >80% predicted. FEV1/FVC normal Symptoms throughout the day with nighttime awakenings every night. FEV1< 60% predicted. FEV1/FVC reduced >5% Instructor Explanation: MedU Card #15 Question 13. Question : The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Student Answer: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough Instructor Explanation: Decision Rule: CURB-65 provides framework for determining whether the patient diagnosed with community-acquired pneumonia can be safely monitored and treated at home. One point is awarded for each of the following factors present: Confusion of new onset BUN greater than 20mg/dL Respiratory rate of ≥ 30 breaths/minute Blood pressure is less than 90 mmHg systolic or diastolic ≤ 60 mm Hg Age 65 or older Patients scoring 3 to 5 typically require hospitalization for observation and therapy. Scores of 0 to 1 indicate likelihood that outpatient management is appropriate. A score Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Student Answer: Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X- ray Elevated white blood cell count Instructor Explanation: With pneumonia, the chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients. The white blood cell count is often elevated. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 214) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 240) Question 17. Question : A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Student Answer: Barrel-shaped chest Clubbing Pectus excavatum Prolonged capillary refill Instructor Explanation: In bronchiectasis, there is usually a history of chronic, productive cough. Sputum is typically mucopurulent and produced in increased amounts. Other common findings include Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED shortness of breath, wheezing, fatigue, and possibly hemoptysis. Physical examination reveals rhonchi and/or wheezing. In advanced disease, clubbing and cyanosis may be present. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file (page 216) Question 18. Question : Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: Student Answer: Legionnaires' disease Malaria Tuberculosis Pneumonia Instructor Explanation: Many times, patients with active tuberculosis are essentially symptom free. Some complain of malaise and/or fevers but have no significantly disruptive complaints. When respiratory symptoms occur with tuberculosis, cough is common; the cough is nonproductive at first and is later associated with sputum production. Additionally, patients with tuberculosis may experience progressive dyspnea, night sweats, weight loss, and hemoptysis. It is important to suspect tuberculosis when the patient has travelled to a country where TB is endemic, such as Asia. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 217) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 249) Points Received: 2 of 2 Comments: Points Received: 2 of 2 Comments: NURS 6420 PERFECT EXAM QUESTIONS AND ANSWERS 2023A+SUCCESS ASSURED Question 19. Question : A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Student Answer: Lung cancer Tuberculosis Pneumonia COPD Instructor Explanation: Dyspnea is the most common symptom associated with pleural effusion, but effusion may be accompanied by cough, pain, and systemic symptoms, such as malaise and fever. Abnormal physical findings become evident as the effusion increases in volume. These include decreased lung sounds, dullness over the effusion, decreased fremitus, egophony, and whispered pectoriloquy. With extremely large effusions, the mediastinum and trachea may shift to the opposite side. The exception involves effusion related to malignancy, in which case the mediastinum and trachea may be pulled toward the malignancy. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file (page 217-218) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.(page 232)