NURS-6531N-8 Final Exam-Advanced Practice Care of Adults, Exams of Nursing

Download NURS-6531N-8 Final Exam-Advanced Practice Care of Adults and more Exams Nursing in PDF only on Docsity! 1 NURS-6531N-8 Final Exam-Advanced. Practice Care of Adults Best Rated User Course NURS-6531N-8 Final Exam,Advanced. Practice Care of Adults.2018 Summer Qtr 05/29-08/19-PT27 Test Midterm Exam Status Needs Grading Attemp t Score 0 out of 100 points Time Elapsed 1 hour, 53 minutes out of 1 hour and 50 minutes Results Displaye d All Answers, Submitted Answers, Correct Answers • Question 1 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Ye s Answers: Y e s No • Question 2 The most common cancer found on the auricle is: Selected Answer: Basal cell carcinoma Answers: Actinic keratosis B as al ce ll ca rci no m a S 1 quamous cell carcinoma Acral- lentiginous melanoma • Question 3 1 out of 1 points 0 out of 1 points 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? 1 • Question 8 1 out of 1 points A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect: Selected Answer: Gonococcal conjunctiviti s Answers: Viral conjunctivitis Common pink eye Gonococcal conjunctiviti s Allergic conjunctiviti s • Question 9 0 out of 1 points A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect: 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 1 • Question 10 0 out of 1 points 1 Which type of lung cancer has the poorest prognosis? Selected Answer: Adenocarcinoma Answers: Adenocarcinoma Epidermoid carcinoma Small cell carcinoma Large cell carcinoma • Question 11 1 out of 1 points 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, 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 1 out of 1 points 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 erythematos 1 1 Moderate persistent • Question 15 0 out of 1 points 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 0 out of 1 points 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? Selected Answer: Arterial insufficienc y Answers: Congestive heart failure Varicose veins Deep vein thrombos is Arterial insufficiency • Question 17 Which statement below is correct about pertussis? Selected 1 out of 1 points 1 Answer: It is also called whooping cough Answer s: It is also called whooping cough It begins with symptoms like strep throat It lasts about 3 weeks It occurs most commonly in toddlers and young children • Question 18 0 out of 1 points Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? Selected Answer: Asthma Answer s: Pneum o nia Asthm a Sinusiti s Pertussis • Question 19 1 out of 1 points A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition? Selected Answer: Diverticul it is 1 1 out of 1 points 1 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 0 out of 1 points 0 out of 1 points A 76-year-old male complains of weight loss, nausea, vomiting, abdominal 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 1 Answers: Colonoscopy Small bowel follow- through Barium enema CT abdomen • Question 25 1 out of 1 points 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 regurgitatio n Systolic heart failure Cardiac myxoma Diastolic heart failure • Question 26 1 out of 1 points 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 Answer s: Multilobar involvement on chest x-ray with the inability to take oral medications 1 • Question 31 1 out of 1 points Which of the following is not a goal of treatment for the patient with cystic fibrosis? 1 Selected Answer: Replace water- soluble vitamins Answers: Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water- soluble vitamins • Question 32 1 out of 1 points The nurse practitioner is performing a physical exam on a middle-aged African- American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? Selected Answer: B and C Answers: Scal p Nail s Feet B and C All of the above • Question 33 1 out of 1 points 1 An adult presents with tinea corporis. Which item below is a risk factor for its development? Selected Answer: Topical steroid use 1 Antihista mi nes • Question 36 0 out of 1 points Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Selected Answer: Peripher al edema Answers: Peripher al edema Weight gain Shortness of breath Nocturn al dyspnea • Question 37 1 out of 1 points 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 Erythromy ci n Amoxicillin Acetaminop hen • Question 38 1 out of 1 points A 70 year old man who walks 2 miles every day complains of pain in his left calf 1 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 1 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?” “Do you ever have the same pain in the other leg?” • Question 39 Which of the following statements about malignant melanomas is true? Selected Answer: They usually occur in older adult males Answers: They usually occur in older adult males The patient has no family history of melanoma They are common in blacks The prognosis is directly related to the thickness of the lesion • Question 40 0 out of 1 points 1 out of 1 points Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect? Selected Answer: Heart failure Answers: Asthma Nocturn al allergies Valvular 1 1 out of 1 points A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to: Selected Answer: Squamous cell carcinoma Answer s: Squamous cell carcinoma Basal cell carcinoma Malignant melanoma Acne vulgaris • Question 44 1 out of 1 points 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 1 out of 1 points What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? 1 Selected Answer: Ursodiol Answer s: Ursodiol Ibuprofe n Prednisone Surgery is the only answer • Question 46 0 out of 1 points 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 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 Cr a m pi n g a n d ab do mi na l pa in 1 0 out of 1 points 1 Serum bilirubin Serum cholesterol with HDL and LDL A liver biopsy • Question 53 1 out of 1 points A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: Selected Answer: Rhabdomyolysis Answers: A drug interaction Hepatic dysfunction Hypersensitivity to lovastatin Rhabdomyolysis • Question 54 Treatment of acute vertigo includes: Selected Answer: Bedrest and an antihistamin e 1 out of 1 points Answer s: Bedrest and an antihistamin e Fluids and a decongesta nt A sedative and decongestan t 1 R e s t a n d a l o w s o d i u m d i e t 1 • Question 55 Treatment of H.pylori includes which of the following? Selected Answer: A, B, and C Answers: Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate A and B A, B, and C • Question 56 1 out of 1 points 1 out of 1 points Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect? Selected Answer: Retinal detachme nt Answers: Cataract s Glaucom a Retinal detachmen t 1 Mort has benign prostatic hyperplasia Mort has frequent migraine headaches • Question 60 1 out of 1 points 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 1 out of 1 points 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 • Question 62 0 out of 1 points 1 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 Answers: Primarily by eradication of infection Based on etiology Aimed at diminishing prostaglandin synthesis Dependent on cessation of NSAID use • Question 64 0 out of 1 points 1 out of 1 points Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? Selected 1 Answer: An ACE Inhibitor Answers: A calcium channel blocker A beta blocker An ACE Inhibitor No hypertension medication • Question 65 1 out of 1 points Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices? Selected Answer: Failing to bill for billable services will lead to unnecessarily low revenues Answers: It is important to “undercode” so that one does not get charged with Medicare fraud The practice of “overcoding” is essential in this age of decreasing reimbursements Failing to bill for billable services will lead to unnecessarily low revenues Time spent with the patient is a very important determinant of billing • Question 66 1 out of 1 points A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? Selected Answer: Retinoblasto m a Answers: Viral conjunctiviti s Glaucoma 1 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 conjunctiviti s Answer s: Allergic conjunctivitis Bacterial conjunctivitis Gonococcal conjunctivitis Viral conjunctivitis • Question 70 0 out of 1 points 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 bronchodilator A bronchodilator PRN and an inhaled corticosteroid • Question 71 0 out of 1 points Acute rheumatic fever is an inflammatory disease which can follow infection with: Selected Answer: Β-hemolytic Streptococc us 1 Answer s: Group A Streptococcus Staphlococcus areus Β-hemolytic Streptococcus Streptococcu s pyogenes • Question 72 0 out of 1 points 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 1 out of 1 points If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Selected Answer: Iritis Answer s: Iritis 1 Allergic conjunctiviti s Viral conjunctivitis Bacterial conjunctiviti s • Question 74 1 out of 1 points The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than: Selected Answer: 100 mg/dL Answers: 160 mg/dL 130 mg/dL 100 mg/dL 70 mg/dL • Question 75 1 out of 1 points A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is: Selected Answer: Investigation with endoscopy, manometry, and/or pH testing Answers: Referral for surgical intervention such as a partial or complete fundoplication Dependent upon how sever the practitioner believes the condition To repeat the 8 week course of drug therapy while continuing lifestyle modifications 1 Stool softeners Laxatives Osmotic agents • Question 81 1 out of 1 points A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Selected Answer: Apply a topical antibiotic and warm compresses. Answer s: 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 1 out of 1 points 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 A decongestant nasal spray Ipratropium Omalizuma 1 b • Question 83 1 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 0 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 Amlodipin e Hydrochloroth ia zide • Question 85 1 out of 1 points Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Selected Answer: Candidiasis Answers: 1 A p t e r y g i u m 1 • Question 88 0 out of 1 points What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? Selected Answer: You must initiate the plan of care for the patient Answers: You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient • Question 89 Of the following choices, the least likely cause of cough is: Selected Answer: Acute pharyngitis Answers: Asthma Gastroesophageal reflux Acute pharyngitis Allergic rhinitis • Question 90 1 out of 1 points 1 out of 1 points The most common correlate(s) with chronic bronchitis and emphysema is(are): Selected Answer: Cigarette smoking Answers: Familial and genetic factors Cigarette smoking 1 Air pollution Occupation al environmen t • Question 91 0 out of 1 points Which choice below is least effective for alleviating symptoms of the common cold? Selected Answer: Topical decongestan ts Answer s: Antihistamines Oral decongestants Topical decongestants Antipyretics • Question 92 0 out of 1 points 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 Which of the 1 Selected Answer: Inferio r wall 1 Answer s: Inferior wall Anterior wall Apical wall Lateral wall • Question 96 0 out of 1 points 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 Answer s: Acute otitis media (AOM) Otitis media with effusion Mucoid otitis media Serous otitis media • Question 97 0 out of 1 points Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as: Selected Answer: incision al hernia Answers: inguin 1 al hernia 1 Continue with his exercise program • Question 100 Risk factors for acute arterial insufficiency include which of the following? Selected Answer: All of the above Answers: Recent myocardial infarction Atrial fibrillation Atherosclerosi s All of the above • Question 101 Impetigo and folliculitis are usually successfully treated with: Selected Answer: Topical antibiotics Answers: Systemic antibiotics Topical antibiotics Topical steroid creams 1 out of 1 points 1 out of 1 points Cleansing and debridemen t Quizlet finals What are signs & symptoms of SIADH (Syndrome of inappropriate antidiuretic hormone)? Increased production of ADH (antidiuretic hormone), hyponatremia, concentrated urine (from excess 1 water resorption), elevated urine osmolality, mental status changes from cerebral edema. Diabetes insipidus is associated with what sodium level? Hypernatremia 1 Psychogenic polydipsia results in urine that is: diluted with low osmolality and hyponatremia How would you determine the cause of a patient's AKI who presents with decreased urine output, history of neurogenic bladder, chronic foley, dark urine, and Cr increase from 1.3 to 2.1 over 3 months? Flush the foley catheter to see if urine comes out and assess the patency of the catheter. This action will unblock clogged sediment or biofilm from chronic bacteriuria. When a female patient presents to the ER after sexual assault, what medications should be offered prior to discharge? Ceftriaxone, azithromycin, Plan B, and Metronidazole. Manifestations of Conn syndrome (hyperaldosteronism)? hypernatremia, hypokalemia, and hypertension What causes Cushing syndrome? Increased levels of glucocorticoids, can be exogenous (from therapy) or endogenous (from adenoma or neoplasm). Manifestations of Cushing syndrome? hypertension, truncal obesity, osteoporosis, skin fragility, and hyperglycemia. What differentiates primary adrenocortical insufficiency from secondary adrenocortical insufficiency? Skin hyperpigmentation is present in primary adrenocortical insufficiency What is Trousseau's sign? A carpal spasm elicited by compression of the upper arm with a BP cuff that indicates hypocalcemia. What is Chovstek's sign? A hemifacial tic that is induced by tapping the facial nerve below the maxilla that indicates hypocalcemia. What is Babinski's sign? An upward response (extension) of the hallux when the sole of the foot is stimulated with a blunt instrument. Can identify spinal cord disease in adults. What is Romberg's sign? 1 Pituitary apoplexy dexamethasone 2mg IV q 6hr then surgery if mental status change present. What causes hypocalcemia in patients with end stage renal disease? Decreased conversion of Vitamin D. What condition is associated with recurrent nephrolithiasis? Primary hyperparathyroidism What stabilizes the cardiac membrane in treatment of hyperkalemia? Calcium gluconate What medication acts rapidly to antagonize the membrane effects of potassium in hyperkalemia? Calcium is cardioprotective What is the most common cause of euvolemic hyponatremia? SIADH (syndrome of inappropriate antidiuretic hormone secretion) What causes are associated with hypervolemic hyponatremia? Cirrhosis and CHF What is a long-term complication of radio-active iodine therapy? Hypothyroidism 80% of acute pyelonephritis cases in women are caused by what pathogen? E coli Most common cause of acute scrotal pain in adults? epididymitis What are predisposing factors for hypocalcemia? hypoparathyroidism, pancreatitis, vitamin D deficiency, chronic alcohol use disorder, and medications such as phenytoin, cisplatin, and estrogen. What are prerenal causes of AKI? decrease in extracellular fluid volume, decreased renal blood flow, or altered intrarenal hemodynamics. Post-renal causes of AKI 1 benign prostatic hyperplasia, bladder cancer, nephrolithiasis, neuromuscular disorders, prostate cancer, strictures, trauma What is are intrinsic causes of renal failure? Acute glomerulonephritis, ischemic injury, nephrotoxins, malignant hypertension What classification of drugs cause urinary retention? anticholinergics (ipratropium) Common secondary causes of nephrotic syndrome lupus and diabetes Presenting symptoms of nephrotic syndrome loss of appetite, fatigue, ascites, lower extremity edema, proteinuria, low blood albumin, and hyperlipidemia. What is the initial insulin loading dose for a patient in DKA? 0.1 to 0.15 units/kg/hr with hourly glucose monitoring What is Hashimoto's thyroiditis? autoimmune destruction of thyroid gland, Anti-thyroid stimulating hormone (TSH) receptor antibodies inhibit release of thyroid hormone. Upgrade to remove ads Only $2.99/month What would you do first for an incidental finding of an adrenal mass? Overnight dexamethasone suppression test. Clinical signs of PCOS oligomenorrhea, infertility, hirsutism, obesity, and 2/3 Rotterdam criteria: oligo-ovulation or anovulation clinic of biochemical signs of hyperandrogenism polycystic ovaries on US Treatment for simple cystitis 5 days of nitrofurantoin 1 Define the acronym MUDPILES Acronym for identifying a high anion gap metabolic acidosis: Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, isoniazid Lactate Ethanol, ethylene glycol Salicylates First-line evaluation of vulvovaginal candidiasis wet mount Prolonged nausea and vomiting can result in: Metabolic alkalosis loss of gastric acid Clinical signs/symptoms of uremic pericarditis worsening anemia, absence of diffuse ST-segment T-wave elevations, fever, pleuritic chest pain, pain that increases in recumbent position. Hemodialysis treatment should be heparin free. What is hepatorenal syndrome? chronic or acute renal disease with advanced hepatic failure and portal hypertension. What complaint is common with patients who have acute on chronic urinary retention? urinary incontinence Aside from potassium chloride as a supplement, what can be used to treat hypokalemia? Magnesium For a patient who is lethargic and hyperkalemic, what is the first line therapy? Calcium gluconate or calcium chloride Priapism is a known side effect of what medication? Trazodone What is the maximum compensation of PaCO2 in metabolic acidosis? 1 pain. When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection. As a part of a pre-employment physical when heavy lifting is included in the job description. Question 12 After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured? An enzyme-linked immunosorbent assay titer A urea breath test A rapid urease test A repeat endoscopy Question 13 Which appropriate test for the initial assessment of Alzheimer's disease provides the performance ratings on 10 complex, higher order activities? MMSE CAGE questionnaire FAQ - Functional Activities Questionnaire Holmes and Rahe social readjustment scale Question 14 Major depression occurs most often in which of the following conditions? A. Myocardial infarction Parkinson's disease Stroke Alzheimer's disease Question 15 Which of the following statements about multiple sclerosis (MS) is correct? MS is a chronic, untreatable illness that is almost always fatal. MS is a disease of steadily progressive and unrelenting neurologic deterioration. MS is a chronic, treatable illness with unknown cause and a variable course. Patients with MS who take active steps to improve their health have the best cure rate. Question 16 Diagnostic evaluation of hypothyroidism reveals: Elevated TSH and decreased T4 Decreased TSH and increased T4 Decreased TSH and decreased T3 Elevated TSH and increased T4 1 Question 17 Risk factors for prostate cancer include all of the following except: Family history Benign prostatic hypertrophy African American race Age Question 18 What information should patients with diabetes and their families receive about hypoglycemia? Hypoglycemia is a rare complication. Hypoglycemia requires professional medical treatment. Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly. Hypoglycemia occurs only as a result of insulin overdose. Question 19 Which history is commonly found in a patient with glomerulonephritis? Beta-hemolytic strep infection Frequent urinary tract infections Kidney stones Hypotension Question 20 Which of the following is characteristic of a manic episode? weight loss of gain insomnia or hypersomnia diminished ability to think or concentrate grandiose delusions Question 21 Central obesity, "moon" face, and dorsocervical fat pad are associated with: Metabolic syndrome Unilateral pheochromocytoma Cushing's syndrome None of the above Question 22 Which of the following is the most common cause of low back pain? Lumbar disc disease Spinal stenosis 1 Traumatic fracture Osteoporosis Question 23 A middle-aged female presents complaining of recent weight loss. The physical exam reveals an enlarged painless cervical lymph node. The differential diagnosis for this patient's problem includes: Infection Toxoplasmosis Mononucleosis All of the above None of the above Question 24 An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects? Weight gain Fracture risk Hypoglycemia Weight loss Question 25 A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is cryptococcosis toxoplasmosis cryptosporidiosis cytomegalovirus Question 26 Which of the following is the most common causative organism of nongonococcal urethritis? Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Trichonomas vaginalis Question 27 The most common symptoms of transient ischemic attack (TIA) include Nausea, vomiting, syncope, incontinence, dizziness, and seizure. Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes. Headache and visual symptoms such as bright spots or sparkles crossing the visual field. Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness 1 Question 38 Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? Prescribe systemic antibiotics Prescribe antibiotic ear drops Prescribe nasal steroids and oral decongestants Refer him to an ear, nose, and throat specialist Question 39 Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following? Maintain moderate bed rest for 3-4 days Call the office for narcotics if there is no relief with the NSAID in 24-48 hours Begin lower back strengthening exercises depending on pain tolerance Wear a Boston brace at night Question 40 Risk factors for Addison's disease include which of the following? Tuberculosis Autoimmune disease AIDS All of the above Question 41 Urine cultures should be obtained for which of the following patients? Suspected urinary tract infection in pregnancy Febrile patients Young men All of the above Question 42 Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? "Caffeine has not effect on osteoporosis." "A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly." "Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix." "Caffeine increase bone resorption." 1 Question 43 The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is: Migraine headache Subarachnoid hemorrhage Glaucoma Meningitis Question 44 What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient Question 45 The most commonly recommended method for prostate cancer screening in a 55 year old male is: Digital rectal examination (DRE) plus prostate specific antigen (PSA) Prostate specific antigen (PSA) alone Transrectal ultrasound (TRUS) alone Prostate specific antigen (PSA) and transrectal ultrasound (TRUS) Question 46 The primary goals of treatment for patients with alcohol abuse disorder are: Reduction in withdrawal symptoms and reduction in desire for alcohol Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol Abstinence or reduction in use, relapse prevention, and rehabilitation Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment Question 47 You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: Lateral meniscus Cruciate ligament Medical meniscus Collateral ligament 1 Question 48 Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia? Musculoskeletal pain Difficulty sleeping Depression Fatigue Question 49 Differential diagnosis of proteinuria includes which of the following? Orthostatic proteinuria Nephrotic syndrome Infection Trauma A and B Question 50 A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as: Underweight Normal weight Overweight Obese Question 51 Reed-Sternberg B lymphocytes are associated with which of the following disorders: Aplastic anemia Hodgkin's lymphoma Non Hodgkin's lymphoma Myelodysplastic syndromes Question 53 A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: Arthritis Ulnar neuritis Septic arthritis Olecranon bursitis 1 Advise the patient to stop the antidepressant medication Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication Recommend that the patient continue the antidepressant medication for at least 4 more months Discuss with the patient the need to take the antidepressant medication indefinitely Question 65 Your patient has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis? Iron-deficiency anemia Hemolytic anemia Lead poisoning Liver disease Question 66 Which of the following medications increase the risk for metabolic syndrome? Antihistamines Proton pump inhibitors Protease inhibitors A and C All of the above Question 67 The hallmark of neurofibromatosis (von Recklinghausen's disease) present in almost 100% of patients is Acoustic neuroma Astrocytoma of the retina Distinctive osseous lesions Café au lait spots Question 68 The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is: Acetaminophen or an NSAID A muscle relaxant as an adjunct to an NSAID An oral corticosteroid and diazepam (Valium) Colchicine and an opioid analgesic Question 69 Legal authority for advanced practice nursing rests with: The Health Care Financing Administration Federal statutes 1 State laws and regulations Certifying bodies Question 70 Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long term pain relief? Superficial and deep heat Application of cold Transcutaneous electrical nerve stimulation (TENS) Exercise Question 71 A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? Obtain a thorough history and physical, and check serum cortisol and ACTH levels. Obtain a diet history and check CBC and FBS. Provide nutritional guidance and have the patient return in 1 month. Consult home health for intravenous administration of fluids and electrolytes. Question 72 Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be? Start him on an ACE Inhibitor Start him on a diuretic Have him monitor his blood pressure at home Try nonpharmacological methods and have him monitor his blood pressure at home Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: Parkinson's disease Epilepsy Multiple sclerosis Diabetes mellitus Question 74 Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus? 1 Hypertriglyceridemia and low high-density lipoprotein (HDL) Gestational diabetes and polycystic ovarian syndrome Hispanic, African-American, Native-American, and Pacific Islander ethnicity Postprandial hypoglycemia Question 75 A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that: The patient should start anticoagulant therapy immediately. Hereditary thrombophilia does not always require anticoagulation therapy. Women of childbearing age cannot take anticoagulant therapy. Genetic and risk management counseling are recommended. B and D Question 76 The 4 classic features of Parkinson's disease are Mask-like facies, dysarthria, excessive salivation, and dementia. Tremor at rest, rigidity, bradykinesia, and postural disturbances. Depression, cognitive impairment, constipation and shuffling gait. Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy. Question 77 Which of the following set of symptoms should raise suspicion of a brain tumor? Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances. Vague, dull headaches that are accompanied by a reported sense of impending doom. Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia. Holocranial headaches present in the morning and accompanied by projective vomiting without nausea. Question 78 The most common cause of elevated liver function tests is: Hepatitis Biliary tract obstruction Chronic alcohol abuse A drug- induced injury 1 1, 3, 4 1, 2, 4 Question 89 Diagnostic confirmation of acute leukemia is based on: Bone marrow aspiration and biopsy Pancytopenia Hyperuricemia All of the above Question 90 The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy: A dipstick strip done during routine urinalysis in the office A 24-hour urine collection An early morning spot urine collection A serum albumin test Question 91 Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester? Trimethoprim-sulfamethoxazole Erythromycin Cefuroxime Levofloxacin Question 92 Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet? Wash your feet with cold water daily See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily Go to a spa and have a pedicure monthly See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes; inspect your feet daily for lesions; apply lotion to dry areas Question 93 The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is: Psychotherapy 1 Electroconvulsive therapy (ECT) A selective serotonin reuptake inhibitor (SSRI) A tricyclic antidepressant (TCA) Question 94 The initial clinical sign of Dupuytren's contracture is: Pain with ulnar deviation Painless nodule on palmer fascia Pain and numbness in the ring finger Inability to passively extend finger Question 95 Which of the following is the most common complication of the myelodysplastic syndromes Fatigue Cardiomyopathy Falls Bleeding Question 96 What information should a 42 year old patient with newly diagnosed diabetes receive about exercise? Buy good walking shoes with support and a flexible sole. Exercise at least 5 days per week. Snack before exercise. Do not exercise if your blood sugar is greater than 180 mg/dL Question 97 What is the most commonly abused substance? Heroin Cocaine Alcohol Marijuana Question 98 Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting "better." How do you respond? "You're right; it seems like your diabetes is improving." "Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it." 1 "You have watched your diet for all these years and as a result, your body is using less insulin." "I will have to change your oral hyperglycemic agents as it seems your body is making more insulin." Question 99 A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition? Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am. Instruct the child's parents on physical activities to help weight loss. Increase the evening insulin dose and check CBG at 2:00 am. Refer the child for instruction on a strict diabetic diet. Question 100 At what age is screening most likely to detect scoliosis? 4 to 6 years 8 to 10 years 12 to 14 years 18 to 20 years Question 101 The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are): Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs. History of significant trauma relative to the patient's age. Decreased reflexes, strength, and sensation in the lower extremities. Patient report of pain with the crossed straight leg raise. A patient who has had a swollen, nontender scrotum for one week is found to have a mass within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects: a.) a hydrocele. b.) a varicocele. c.) an indirect inguinal hernia. d.) carcinoma of the testis. a hydrocele. A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A) Prerenal inflammation B) Bladder outlet obstruction 1 A. 1 B. 6 C. 16 D. 24 6 To prevent a recurrence of testicular torsion, which of the following is recommended? A. use of a scrotal support B. avoidance of testicular trauma C. orchiopexy D. limiting the number of sexual partners orchiopexy Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. You are trying to differentiate between epididymitis and testicular torsion. Which test to determine whether swelling is in the testis or the epididymis should be your first choice? A. X-ray B. Ultrasound C. Technetium scan D. Physical examination Ultrasound The nurse practitioner recognizes that the most common cause of epididymitis in a young man is: A chlamydia B E. coli C mycoplasma D Proteus species Chlamydia Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema. Which of the following is likely the diagnosis? A acute bacteria prostatitis B acute pyelonephritis C epididymitis D urinary tract infection epididymitis The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to: reduce action of androgens in the prostate. 1 Milton, a 72 year old unmarried, sexually active white man presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect benign prostatic hypertrophy, what else should your differential diagnosis include? Urethral stricture (may develop as a result of sexually transmitted diseases and should be considered in a sexually active individual no matter what the age) Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow incontinence would be to order a: Post void residual urine measurement Lower urinary tract symptoms in males can present as a constellation of storage or voiding symptoms. Storage symptoms include: urgency and nocturia A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a moderately enlarged prostate that is smooth. The client's PSA is 1.2. What is the most appropriate management strategy for you to follow at this time? Prescribe an alpha adrenergic blocker, which will relax bladder and prostate smooth muscle to improve flow and relieve symptoms. According to the AUA guideline on the management of BPH, when is referral for invasive surgery automatically warranted? With the presence of refractory retention and bladder stones. What differentiates prostate cancer symptoms from BPH? Symptoms of prostate cancer in general tend to progress more rapidly than those of BPH. The most common gram-negative bacteria that causes both acute and chronic bacterial prostatitis is A. Staphylococcus aureus B. Klebsiella C. Escherichia coli D. Enterobacteriaceae Escherichia coli A history of urinary tract infections in males is often seen in men with chronic bacterial prostatitis. Other signs and symptoms of chronic bacterial prostatitis includes A. irritative voiding symptoms, low back pain, and perineal pain. B. nausea and vomiting, as well as fever. 1 C. loss of appetite and weight loss. D. irritative voiding symptoms, inability to ambulate, and fever. irritative voiding symptoms, low back pain, and perineal pain. When performing a prostate examination, you note a tender, warm prostate. What do you suspect? A. Benign prostatic hypertrophy B. Prostatic abscess C. Prostate cancer D. Bacterial prostatitis Bacterial prostatitis Gerard is complaining of a scrotal mass; however, the scrotum is so edematous that it is difficult to assess. How do you determine if it is a hernia or a hydrocele? Bowel sounds may be heard over a hernia. Mr. S comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain? Inguinal hernia and peritonitis A 17 year old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a "bag of worms" are noted underneath the scrotal skin. It is not swollen or reddened. The most likely diagnosis is A. Chronic orchitis B. Chronic epididymitis C. Testicular torsion D. Varicocele Varicocele What risk factors contribute to varicocele? A. Younger age B. Current cigarette smoker C. Multiple sex partners D. None of the above None of the above Treatment options for varicocele repair include all of the following except: A. Open surgery B. Laparoscopic surgery