NURS-6531 Advanced Practice Care of Adults, Exams of Nursing

Download NURS-6531 Advanced Practice Care of Adults and more Exams Nursing in PDF only on Docsity! 1 NURS-6531Adv. Practice Care of Adults Correct Answers Marked in Red Question 1 When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes Answers: Yes No Question 2 The most common cancer found on the auricle is: Selected Answer: Basal cell carcinoma Answers: Actinic keratosis Basal cell carcinoma Squamous cell carcinoma Acral-lentiginous melanoma Question 3 Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient? 2 Selected Answer: Anticholinergics Answers: Xanthines Antihistimines Steroids Anticholinergics Question 4 A 47-year-old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed? Selected Answer: Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet. Answers: Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet. Order a topical hemorrhoid cream along with a stool softener. Refer the patient for a barium enema and sigmoidoscopy. Refer the patient for a surgical hemorrhoidectomy. Question 5 Which of the following patient characteristics are associated with chronic bronchitis? Selected Answer: Underweight, pink skin, and increased respiratory rate Answers: Overweight, cyanosis, and normal or slightly 5 Selected Answer: A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream Answers: A common case of shingles and prescribe an analgesic and an antiviral agent A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream Herpes zoster and consider that this patient may be immunocompromised A recurrence of chickenpox and treat the patient’s symptoms Question 10 Which type of lung cancer has the poorest prognosis? Selected Answer: Adenocarcinoma Answers: Adenocarcinoma Epidermoid carcinoma Small cell carcinoma Large cell carcinoma Question 11 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, 6 chills, pain, recent antibiotic use. The history suggests that the patient has: Selected Answer: Chronic diarrhea Answers: Acute diarrhea Chronic diarrhea Irritable bowel Functional bowel disease Question 12 Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? Selected Answer: Systemic lupus erythematosus Answers: An allergic reaction Relapsing polychondritis Lymphocytoma cutis Systemic lupus erythematosus Question 13 Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Selected Answer: Acute bronchitis Answers: Chronic sinusitis Acute bronchitis Bacterial pneumonia Acute exacerbation of chronic 7 bronchitis Question 14 Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short- acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in? Selected Answer: Mild persistent Answers: Mild intermittent Mild persistent Moderate persistent Question 15 Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep? Selected Answer: None of the above Answers: Penicillin V 500 milligrams PO every 8 hours for 10 days Ampicillin 250 milligrams PO twice a day for 10 days Clarithromycin 500 milligrams po daily for 7 days None of the above Question 16 A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems? 10 Gallstone s Medications Pregnancy Question 22 When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? Selected Answer: Order an abdominal ultrasound Answers: Order abdominal x-rays Order an abdominal ultrasound Refer the patient to a surgeon for evaluation Prescribe pain medication Question 23 A false-positive result with the fecal occult blood test can result from: Selected Answer: stool that has been stored before testing Answers: ingestion of large amounts of vitamin C a high dietary intake of rare cooked beef a colonic neoplasm that is not bleeding stool that has been stored before testing Question 24 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal 11 cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is: Selected Answer: Colonoscopy Answers: Colonoscopy Small bowel follow- through Barium enema CT abdomen Question 25 A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with: Selected Answer: Systolic heart failure Answers: Mitral regurgitation Systolic heart failure Cardiac myxoma Diastolic heart failure Question 26 Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? Selected Answer: Multilobar involvement on chest x-ray with the inability to take oral medications Answers: Multilobar involvement on chest x-ray with the inability to take oral medications 12 Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home Sputum and gram-positive organisms A complete blood count showing leukocytosis Question 27 A 55-year-old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: Selected Answer: “It is the most common cause of death in patients with skin cancer.” Answers: “It is the most common cause of death in patients with skin cancer.” “It can be cured with surgical excision or radiation therapy.” “It is a slow growing skin cancer that rarely undergoes malignant changes.” “It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.” Question 28 15 Feet B and C All of the above Question 33 An adult presents with tinea corporis. Which item below is a risk factor for its development? Selected Answer: Topical steroid use Answers: Topical steroid use Topical antibiotic use A recent laceration Cold climates Question 34 A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? 16 Selected Answer: Order stool cultures. Answers: Prescribe loperamide (Immodium) or atropine- diphenoxylate (Lomotil) and a clear liquid diet for 24 hours. Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management. Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction. Order stool cultures. Question 35 Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? Selected Answer: Antihistamines Answers: Aspirin NSAIDs Opioids Antihistamine s Question 36 Of the following signs and symptoms of congestive heart failure (CHF), the 17 earliest clinical manifestation is: Selected Answer: Peripheral edema Answers: Peripheral edema Weight gain Shortness of breath Nocturnal dyspnea Question 37 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 least appropriate to prescribe? Selected Answer: Amoxicillin Answers: Ibuprofen Erythromycin Amoxicillin Acetaminophen Question 38 A 70-year-old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans? Selected Answer: “Is your leg pain relieved by rest?” Answers: “Are you wearing your usual shoes?” “Do you also have chest pain when you have leg pain?” “Is your leg pain relieved by rest?” 20 An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? Selected Answer: Compare the patient’s blood pressure lying first, then sitting, and then standing. Answers: Assist the patient to a standing position and take her blood pressure. Assess the patient’s cranial nerves. Compare the patient’s blood pressure lying first, then sitting, and then standing. Compare the amplitude of the patient’s radial and pedal pulses. Question 45 What oral medication might be used to treat chronic cholestasis in a patient who is a poor candidate for surgery? Selected Answer: Ursodiol Answers: Ursodiol Ibuprofen Prednisone Surgery is the only answer Question 46 A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is: Selected Answer: Staphylococcus aureus Answers: Staphylococcus aureus 21 Group A beta hemolytic streptococcus Haemophilus influenza Pseudomonas aeruginosa Question 47 Which of the following is not a symptom of irritable bowel syndrome? Selected Answer: Painful diarrhea Answers: Painful diarrhea Painful constipation Cramping and abdominal pain Weight loss Question 48 A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed? Selected Answer: Any recent trauma Answers: Any recent trauma Difficulty swallowing Stiffness in the right shoulder Change in sleeping habits Question 49 22 Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? Selected Answer: ACE Inhibitor Answers: ACE Inhibitor Beta Blocker Calcium channel blocker Diuretic Question 50 The differential diagnosis for a patient complaining of a sore throat includes which of the following? Selected Answer: A, B, and C Answers: Gonococcal infection Thrush Leukoplakia B only A, B, and C Question 51 A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is: Selected Answer: Rhus dermatitis Answers: Rhus dermatitis Ophthalmic zoster 25 Question 57 In order to decrease deaths from lung cancer: Selected Answer: Patients should be counseled to quit smoking Answers: All smokers should be screened annually All patients should be screened annually Only high risk patients should be screened routinely Patients should be counseled to quit smoking Question 58 John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? Selected Answer: Every 5 years Answers: Every 5 years Every 2 years Every year Whenever blood work is done Question 59 Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? Selected Answer: Mort has benign prostatic hyperplasia Answers: Mort is black Mort also has congestive heart failure Mort has benign prostatic hyperplasia 26 Mort has frequent migraine headaches Question 60 John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Selected Answer: Psoriasis Answers: Actinic keratosis Eczema Psoriasis Seborrheic dermatitis Question 61 Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? Selected Answer: Add a thiazide diuretic to the Lisinopril 5mg daily Answers: Increase her Lisinopril to 20mg daily Add a thiazide diuretic to the Lisinopril 5mg daily Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker Discontinue the Lisinopril and start a diuretic 27 Question 62 An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: Selected Answer: coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications. Answers: defer any further dental work until his valve replacement is completed instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed. suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications. Question 63 Appropriate therapy for peptic ulcer disease (PUD) is: Selected Answer: Dependent on cessation of NSAID use 30 Answers: Pharmacological therapy A labyrinthectomy A vestibular neurectomy Wearing an earplug in the ear with the most hearing loss Question 68 Which of the following is not a risk factor for coronary arterial insufficiency? Selected Answer: Hyperhomocysteinemi a Answers: Hyperhomocysteinemi a Smoking Genetic factors Alcohol ingestion Question 69 An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms? Selected Answer: Allergic conjunctivitis Answers: Allergic conjunctivitis Bacterial conjunctivitis Gonococcal conjunctivitis Viral conjunctivitis 31 Question 70 A 20-year-old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? Selected Answer: A long-acting bronchodilator Answers: A long-acting bronchodilator An inhaled corticosteroid and cromolyn Theophylline and a short acting bronchodilation A bronchodilator PRN and an inhaled corticosteroid Question 71 Acute rheumatic fever is an inflammatory disease which can follow infection with: Selected Answer: Β-hemolytic Streptococcus Answers: Group A Streptococcus Staphlococcus areus Β-hemolytic Streptococcus Streptococcus pyogenes 32 Question 72 A 60-year-old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to: Selected Answer: Start an oral antibiotic, mouth swishes with an oral anti- infective, and an analgesic Answers: Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days Order mandibular x-rays and question the patient about physical abuse Start an oral antibiotic, mouth swishes with an oral anti- infective, and an analgesic Initiate a parenteral antibiotic and consider hospital admission Question 73 If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Selected Answer: Iritis Answers: Iritis Allergic conjunctivitis Viral conjunctivitis 35 Selected Answer: A decongestant Answers: A bronchodilator An antibiotic A decongestant A cool mist vaporizer Question 78 A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis? Selected Answer: Epiglottitis Answers: Peritonsillar abscess Thyroiditis Mononucleosis Epiglottitis Question 79 1 out of 1 points Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? Selected Answer: It is not effective during an acute asthma attack. Answers: It is not effective during an acute asthma attack. It may take 2 to 3 days to begin working. This drug works within 10 minutes. This drug may be used by patients 6 years and older. 36 Question 80 Which intervention listed below is safe for long term use by an adult with constipation? Selected Answer: Stool softeners Answers: Bulk-forming agents Stool softeners Laxatives Osmotic agents Question 81 A 40-year-old presents with a hordeolum. The nurse practitioner teaches the patient to: Selected Answer: Apply a topical antibiotic and warm compresses. Answers: Apply a topical antibiotic and warm compresses. Apply cool compresses and avoid touching the hordeolum. Use an oral antibiotic and eye flushes. Apply light palpation to facilitate drainage. Question 82 Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate? Selected Answer: A decongestant nasal spray Answers: An antihistamine intranasal spray 37 A decongestant nasal spray Ipratropium Omalizumab Question 83 What is the Gold standard for the diagnosis of asthma? Selected Answer: Spirometry Answers: Patient’s perception of clogged airways Validated quality-of-life questionnaires Bronchoscopy Spirometry Question 84 1 out of 1 points A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough? Selected Answer: Methyldopa Answers: Methyldopa Enalapril Amlodipine Hydrochlorothiazide Question 85 Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Selected Answer: Candidiasis 40 Question 91 Which choice below is least effective for alleviating symptoms of the common cold? Selected Answer: Topical decongestants Answers: Antihistamines Oral decongestants Topical decongestants Antipyretics Question 92 When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Selected Answer: Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control Answers: Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control Sodium restriction can cause serious adverse effects A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable Seventy-five of sodium intake is derived from processed foods Question 93 41 Which of the following heart murmurs warrants the greatest concern? Selected Answer: Diastolic murmur Answers: Systolic murmur Venous hum murmur Diastolic murmur Flow murmur Question 94 A patient presents 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? Selected Answer: Blepharitis; treat with warm compresses and gentle debridement with a cotton swab Answers: Hordeolum; treat with a topical antibiotic and warm compress Conjunctivitis; treat with topical antibiotic and warm compresses Blepharitis; treat with warm compresses and gentle debridement with a cotton swab Chalazion; refer to an ophthalmologist for incision and drainage 42 Question 95 A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? Selected Answer: Inferior wall Answers: Inferior wall Anterior wall Apical wall Lateral wall Question 96 The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: Selected Answer: Otitis media with effusion Answers: Acute otitis media (AOM) Otitis media with effusion Mucoid otitis media Serous otitis media