Nursing

NUR6550 Final Exam

1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions?

2. Which of the following conditions may result in lower extremity edema?

Nephrotic syndrome

Decompensated congestive heart failure

Cirrhosis

Renal failure

Deep venous thrombosis

Late-stage pregnancy

All of the above

3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation.

Question: Which of the following physical findings would support this diagnostic hypothesis?

A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border

A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border

A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line

4. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI.

True

False

5. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values:

·          Na 126 mEq/L

·          K 4.0 mEq/L

·          Cl 93 mEq/L

·          CO2 28 mEq/L

·          BUN 40 mg/dL

·          Cr 1.3 mg/dL

Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse?

Hyponatremia

Hypokalemia

Metabolic acidosis

6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995?

Dilated cardiomyopathy

Symbol Hypertrophic cardiomyopathy (HCM)

Symbol Restrictive cardiomyopathy

Symbol Arrhythmogenic right ventricular dysplasia

Symbol Unclassified

All of the above

7. What is the most common cause of sudden cardiac death in young people?

What is the most common cause of sudden cardiac death in young people?

Myocardial infarction

Hypertrophic cardiomyopathy

Supraventricular tachycardia

Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC)

8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.)

ACE inhibitors

Induction if stable

Emergent cesarean section if unstable

Digoxin

Nitroglycerin

9. What are the 3 major clinical complications related to cardiomyopathies?

Arrhythmias; including ventricular tachycardia and ventricular fibrillation

Thromboembolic complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime.

True

False

11. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?

Acetaminophen and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan (Axert ® )

Butalbital, acetaminophen and caffeine (Fioricet ® )

12. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:

Drug-related reaction.

Consequence of occupational chemical exposure.

Early sign of dementia.

Normal age-related change in hearing

13. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein

Epithelial cells

pH>8

14. All of the following are examples of primary prevention strategies except:

Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.

Performing a hemoglobin A1C for all patients admitted to the hospital.

Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.

Immunizing all adults ?60 years with zoster vaccine.

15. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?

Usually obliterates S2.

Becomes softer when going from a supine to standing position.

Occurs late in systole.

Has localized area of auscultation

16. You see a 73-year-old woman with a 40 pack- year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:

Pressure ulcer

Pyoderma gangrenosum

Venous ulcer

Arterial ulcer

17. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:

Administering the seasonal influenza vaccine.

Screening for physical or financial abuse/Checking her blood glucose level.

Checking her blood pressure.

Adjusting her insulin dosing regimen.

18. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:

Migraine with aura.

Cluster headache.

Transient ischemic attack.

Tension-type headache.

19. You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:

Early systole.

Late systole.

Early diastole.

Late diastole.

20. 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:

Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel

Anti-HAV Negative HBsAg Negative Anti-HCV Positive

IgM Negative Anti-HBc Negative HCV RNA Negative

IgM NegativeAnti-HBs Positive

You recognize the patient is susceptible to:

Hepatitis A and B

Hepatitis B and C

Hepatitis B only

Hepatitis A only

21.  When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:

The likelihood of polypharmacy.

Decreased compensatory mechanisms in the elderly.

An increased physiologic response to illness in the elderly.

Presence of comorbid conditions.

22. When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.

A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.

A 23-year-old woman with mitral valve prolapse without tissue redundancy.

A 65-year-old man with nonobstructive cardiomyopathy.

A 75-year-old woman with a nonorganic prosthetic aortic valve.

23. The legal authority for NPs to perform healthcare services as defined by state law is called:

Duty of care.

Non-malfeasance.

Autonomy.

Scope of practice.

24. When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?

A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI).

A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months.

A 57-year-old man with acute bacterial prostatitis.

A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.

25. The NP is called to evaluate Jane, a 43-year- old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?

Primary syphilis.

Secondary syphilis.

Genital herpes.

Gonorrhea.

26. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:

Testicular torsion.

Syphilis.

Varicocele.

Testicular cancer.

27. An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long- acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):

Continuous pulse oximetry reading

Peak expiratory flow reading

Chest X-ray

Arterial Blood Gas

28. A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?

T wave inversion.

Pathologic Q wave.

ST segment elevation.

Tall R wave.

29. A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?

Sotalol (Betapace ® )

Digoxin (Lanoxin ® )

Dabigatran (Pradaxa ® )

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