Nursing

NURS 6531 FINAL EXAM (2 VERSIONS) & NURS 6531 MIDTERM EXAM (2 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 400 Q & A)

NURS 6531 Final Exam / NURS6531 Final Exam (Latest): Walden University

Walden NURS 6531 Final Exam / Walden NURS6531 Final Exam (Latest)

· Question 1

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

· Question 2

Central obesity, “moon” face, and dorsocervical fat pad are associated with:

A.

Metabolic syndrome

B.

Unilateral pheochromocytoma

C.

Cushing’s syndrome

D.

None of the above

· Question 3

An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is:

A.

Trauma

B.

Tight shoes

C.

Arthritis flare

D.

Hydrochlorothiazide

· Question 4

The most effective treatment of non-infectious bursitis includes:

· Question 5

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

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 6

Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?

· Question 7

Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)?

A. Nocturia
B. Urgency incontinence
C. Strong urinary stream flow
D. Straining to void

· Question 8

Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?

§ Food that is very hot or very cold

§ Fatty or fried foods

§ Peppermint or spearmint, including flavoring

§ Coffee, tea, and soft drinks that contain caffeine

§ Spicy, highly seasoned foods

§ Fried foodDT caffeine, chocolate and anticholinergics

· Question 9

Which drug category contains the drugs that are the first line Gold standard therapy for COPD?

· Question 10

The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:

· Question 11

Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?

· Question 12

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?

.A Obtain a thorough history and physical, and check serum cortisol and ACTH levels.

B. Perform a diet history and check CBC and FBS.

C. Provide nutritional guidance and have the patient return in one month.

D. Consult home health for intravenous administration

· Question 13

The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:

· Question 14

How do you respond when Jessica, age 42, asks you what constitutes a good minimum cardiovascular workout?

· Question 15

The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:

· Question 16

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: he
A. lateral meniscus
B. cruciate ligament
C. medial meniscus
D. collateral ligament.

· Question 17

A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is:

· Question 18

A 21-year-old female presents to the office complaining of urinary frequency and urinary burning. The nurse practitioner suspects a urinary tract infection when the urinalysis reveals

· Question 19

A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is:

· Question 20

The initial clinical sign of Dupuytren’s contracture is:

·

· Question 21

The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy

· Question 22

What is the first symptom seen in the majority of patients with Parkinson’s disease?

· Question 23

The most commonly recommended method for prostate cancer screening in a 55 year old male is:

· Question 24

Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect?

· Question 25

Which of the following symptoms suggests a more serious cause of back pain?

· Question 26

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?

· Question 27

A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?

· Question 28

A patient taking levothyroxine is being over-replaced. What condition is he at risk for?

· Question 29

Which of the following is the most common cause of low back pain?

A.

Lumbar disc disease

B.

Spinal stenosis

C.

Traumatic fracture

D.

Osteoporosis

· Question 30

Which is the most common cause of end-stage renal disease in the United States?

· Question 31

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:

A.

Arthritis

B.

Ulnar neuritis

C.

Septic arthritis

D.

Olecranon bursitis

· Question 32

A 60 year old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis?

· Question 33

Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further?

· Question 34

A patient exhibits extrapyramidal side effects of antipsychotic medications. Which of the following symptoms would lead you to look for another diagnosis?

· Question 35

Phalen’s test, 90°wrist flexion for 60 seconds, reproduces symptoms of:

· Question 36

Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?

· Question 37

The most common cause of elevated liver function tests is:

· Question 38

Reed-Sternberg B lymphocytes are associated with which of the following disorders:

A.

Aplastic anemia

B.

Hodgkin’s lymphoma

C.

Non Hodgkin’s lymphoma

D.

Myelodysplastic syndromes

· Question 39

Which of the following is a potential acquired cause of thrombophilia?

A.

Homocysteinuria

B.

Protein C deficiency

C.

Factor V Leiden

D.

Antiphospholipid antibodies

· Question 41

A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:

Primary hyperparathyroidism is treated with Vitamin D restriction

Primary hyperparathyroidism is treated with parathyroidectomy

Primary hyperparathyroidism is treated with daily magnesium

Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

· Question 42

Diagnostic confirmation of acute leukemia is based on:

·

· Question 43

A 25 year old overweight patient presents with a complaint of dull achiness in his groin and history of a palpable lump in his scrotum that “comes and goes”. On physical examination, the nurse practitioner does not detect a scrotal mass. There is no tenderness, edema, or erythema of the scrotum, the scrotum does not transilluminate. What is the most likely diagnosis?

A. Testicular torsion

B. Epididymitis

C. Inguinal hernia

D. Varicocele

· Question 44

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?

A. Prescribe nasal steroids and oral decongestants
B. Prescribe antibiotic eardrops
C. Prescribe systemic eardrops
D. Refer David to an ear, nose, and throat specialist

· Question 45

Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester?

· Question 46

The physiological explanation of syncope is:

· Question 47

A 20 year old male patient complains of “scrotal swelling.” He states his scrotum feels heavy, but denies pain. On examination, the nurse practitioner notes transillumination of the scrotum. What is the most likely diagnosis?

· Question 48

A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be: nclude nitrofurantoin monohydrate/macrocrystals, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin.

· Question 49

Diagnostic radiological studies are indicated for low back pain:

· Question 50

Who is at a higher risk for developing nephrolithiasis?

·

· Question 51

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?

A.

Weight gain

B.

Fracture risk

C.

Hypoglycemia

D.

Weight loss

· Question 52

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:

· Question 53

The diagnosis of human papilloma virus (HPV) infection in males is usually made by:

· Question 54

Which history is commonly found in a patient with glomerulonephritis?

· Question 55

A patient complains of generalized joint pain and stiffness associated with activity and relieved with rest. This patient history is consistent with which of the following disorders?

· Question 56

The most common presentation of thyroid cancer is:

· Question 57

The obligatory criteria for diagnosis of muscular dystrophy (MD) are:

· Question 58

The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is:

· Question 59

A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?

· Question 60

A 72 year old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior?

A. Dementia

C. Parkinson’s disease

D. Depression

· Question 61

Which of the following set of symptoms should raise suspicion of a brain tumor?

· Question 62

The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is:

· Question 63

Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to:

· Question 64

Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia?

A. Musculosckeletal pain
B. Difficulty sleeping
C. Depression
D. Fatigue

· Question 65

The cardinal sign of infectious arthritis is:

· Question 66

Diagnostic evaluation for urinary calculi includes:

· Question 67

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?

See a podiatrist yearly; wash your feet daily with
warm, soapy water and towel dry between the
toes; inspect your feet daily for any lesions; and
apply lotion to any dry areas.

· Question 68

Potential causes of septic arthritis include which of the following?

· Question 69

Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse?

· Question 70

A 15 year-old female patient is 5 feet tall and weighs 85 pounds. You suspect anorexia and know that the best initial approach is to:

Having the client in view of staff for 90 minutes after each meal

· Question 71

A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?

A. Prescribe an alpha adrenergic blocker.
B. Recommend saw palmetto.
C. Prescribe an antibiotic
D. Refer the client to urology.

· Question 72

A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?

· Question 73

A positive drawer sign supports a diagnosis of:

· Question 74

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?

·

· Question 75

A 14 year old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. The nurse practitioner notes swelling and point tenderness at the tibial tuberosity. X-ray is negative. What is the most likely diagnosis?

· Question 76

A 35 year old male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced force of stream. The nurse practitioner suspects acute bacterial prostatitis. Which of the following specimens would be least helpful for diagnosis?

· Question 77

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?

· Question 78

A patient has just been diagnosed with Bell’s palsy. He is understandably upset and has questions about the prognosis. You response should be:

·

· Question 79

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:

· Question 80

Successful management of a patient with attention deficit hyperactivity disorder (ADHD) may be achieved with:

· Question 81

What diabetic complications result from hyperglycemia?

1.

1.

1. Retinopathy

2. Hypertension resistant to treatment

3. Peripheral neuropathy

4. Accelerated atherogenesis

· Question 82

· Question 83

The most common symptoms of transient ischemic attack (TIA) include:

· Question 84

What is the first step in the treatment of uric acid kidney stones?

· Question 85

Establishment of a definitive diagnosis of osteomyelitis requires:

· Question 86

Which of the following is the most common causative organism of nongonococcal urethritis?

A.

Chlamydia trachomatis

B.

Ureaplasma urealyticum

C.

Mycoplasma hominis

D.

Trichonomas vaginalis

· Question 87

Urine cultures should be obtained for which of the following patients?

·

· Question 88

A 30 year old female patient presents to the clinic with heat intolerance, tremors, nervousness, and weight loss inconsistent with increased appetite. Which test would be most likely to confirm the suspected diagnosis?

· Question 89

A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient’s TSH?

· Question 90

Potential causes of hypocalcemia include which of the following?

· Question 91

Which of the following patients most warrants screening for hypothyroidism?

· Question 92

Which of the following is a contraindication for metformin therapy?

· Question 93

The organism most often associated with prostatitis is:

A.

Klebsiella

B.

Neiserria gonorrhoaes

C.

Chlamydia trachomatis

D.

Escherichia coli

· Question 94

The most effective intervention(s) to prevent stroke is (are):

· Question 95

What is the most commonly abused substance?

· Question 96

The hallmark of neurofibromatosis (von Recklinghausen’s disease) present in almost 100% of patients is:

· Question 97

Diagnostic evaluation of hypothyroidism reveals:

· Question 98

An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus, has fasting glucose values 180 to 250 mg/Dl. What is the most appropriate initial treatment to consider?

A. A low-calorie diet and exercise
B. Sliding-scale NPH insulin every 12 hours
C. A sulfonylurea and/or metformin (Glucophage® -XR)
D. Sliding-scale regular insulin every 6 hours

· Question 99

The correct treatment for ankle sprain during the first 48 hours after injury includes:

· Question 100

Prolonged PT suggests:

A.

Platelet abnormality

B.

Abnormality in intrinsic coagulation pathway

C.

Abnormality in extrinsic coagulation pathway

D.

None of the above

Question 101

·

A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:

· Question 102

The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are):

· Question 103

Risk factors for Addison’s disease include which of the following?

· Question 104

Major depression occurs most often in which of the following conditions?

· Question 105

Which of the following medications increase the risk for metabolic syndrome?

· Question 106

A 27 year old female patient with epilepsy is well controlled with phenytoin (Dilantin). She requests information about contraception. The nurse practitioner should instruct her that while taking phenytoin:

· Question 107

Risk factors for prostate cancer include all of the following except:

· Question 108

Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?Post-traumatic stress disorder

NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University

Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest)

· Question 1

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

No

· Question 2

The most common cancer found on the auricle is:

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?

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?

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?

Overweight, cyanosis, and normal or slightly increased respiratory rate

Underweight, pink skin, and increased respiratory rate

Overweight, pink skin, and normal or slightly increased respiratory rate

Normal weight, cyanosis, and greatly increased respiratory rate

· Question 6

A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:

CBCdiff

Erythrocyte sedimentation rate

Abdominal ultrasound

CT scan

· Question 7

A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

Purulent drainage

Tearing

Photophobia

A positive fluorescein stain

· Question 8

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:

Viral conjunctivitis

Common pink eye

Gonococcal conjunctivitis

Allergic conjunctivitis

· Question 9

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:

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?

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, chills, pain, recent antibiotic use. The history suggests that the patient has:

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?

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?

Chronic sinusitis

Acute bronchitis

Bacterial pneumonia

Acute exacerbation of chronic 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?

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?

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?

Congestive heart failure

Varicose veins

Deep vein thrombosis

Arterial insufficiency

· Question 17

Which statement below is correct about pertussis?

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

Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?

Pneumonia

Asthma

Sinusitis

Pertussis

· Question 19

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?

Diverticulosis

Diverticula

Diverticulitis

Diverticulum

· Question 20

Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?

Varicella

Herpes zoster

Syphilis

Rubella

· Question 21

A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:

Alcohol

Gallstones

Medications

Pregnancy

· Question 22

When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

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:

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 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:

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:

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?

Multilobar involvement on chest x-ray with the inability to take oral medications

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:

“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

Expected spirometry readings when the patient has chronic emphysema include:

Decreased residual volume (RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

Increased total lung capacity (TLC)

· Question 29

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:

Esophageal cancer

Chest pain

GERD

A and C

All of the above

· Question 30

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?

Squamous cell carcinoma

Malignant melanoma

A common nevus

Basal cell carcinoma

· Question 31

Which of the following is not a goal of treatment for the patient with cystic fibrosis?

Prevent intestinal obstruction

Provide adequate nutrition

Promote clearance of secretions

Replace water-soluble vitamins

· Question 32

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?

Scalp

Nails

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?

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?

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?

Aspirin

NSAIDs

Opioids

Antihistamines

· Question 36

Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:

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?

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?

“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?

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

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?

Asthma

Nocturnal allergies

Valvular disease

Heart failure

· Question 41

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

Erythromycin

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin

· Question 42

Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?

Powders

Gels

Creams

Lotion

· Question 43

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:

Squamous cell carcinoma

Basal cell carcinoma

Malignant melanoma

Acne vulgaris

· Question 44

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?

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 cholethiasis in a patient who is a poor candidate for surgery?

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:

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?

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?

Any recent trauma

Difficulty swallowing

Stiffness in the right shoulder

Change in sleeping habits

· Question 49

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?

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?

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:

Rhus dermatitis

Ophthalmic zoster

Chemosis

Optic neuritis

· Question 52

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?

Serologic markers for hepatitis

Serum bilirubin

Serum cholesterol with HDL and LDL

A liver biopsy

· Question 53

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:

A drug interaction

Hepatic dysfunction

Hypersensitivity to lovastatin

Rhabdomyolysis

· Question 54

Treatment of acute vertigo includes:

Bedrest and an antihistamine

Fluids and a decongestant

A sedative and decongestant

Rest and a low sodium diet

· Question 55

Treatment of H.pylori includes which of the following?

Proton pump inhibitor

Antibiotic therapy

Bismuth subsalicylate

A and B

A, B, and C

· Question 56

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?

Cataracts

Glaucoma

Retinal detachment

Iritis

· Question 57

In order to decrease deaths from lung cancer:

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 mgdL. How often should he be screened for hypercholesterolemia?

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?

Mort is black

Mort also has congestive heart failure

Mort has benign prostatic hyperplasia

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?

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 17089. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?

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

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:

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:

Primarily by eradication of infection

Based on etiology

Aimed at diminishing prostaglandin synthesis

Dependent on cessation of NSAID use

· Question 64

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?

A calcium channel blocker

A beta blocker

An ACE Inhibitor

No hypertension medication

· Question 65

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?

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

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?

Viral conjunctivitis

Glaucoma

Corneal abrasion

Retinoblastoma

· Question 67

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

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?

Hyperhomocysteinemia

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?

Allergic conjunctivitis

Bacterial conjunctivitis

Gonococcal conjunctivitis

Viral conjunctivitis

· Question 70

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?

A long-acting bronchodilator

An inhaled corticosteroid and cromolyn

Theophylline and a short acting bronchodilator

A bronchodilator PRN and an inhaled corticosteroid

· Question 71

Acute rheumatic fever is an inflammatory disease which can follow infection with:

Group A Streptococcus

Staphlococcus areus

Β-hemolytic Streptococcus

Streptococcus pyogenes

· 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:

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:

Iritis

Allergic conjunctivitis

Viral conjunctivitis

Bacterial conjunctivitis

· Question 74

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:

160 mgdL

130 mgdL

100 mgdL

70 mgdL

· Question 75

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:

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

Investigation with endoscopy, manometry, andor pH testing

· Question 76

Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?

Under 3 years of age

Preschool children

6 to 12 years of age

Adolescents

· Question 77

The most appropriate treatment for a child with mild croup is:

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?

Peritonsillar abscess

Thyroiditis

Mononucleosis

Epiglottitis

· Question 79

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?

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.

· Question 80

Which intervention listed below is safe for long term use by an adult with constipation?

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:

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?

An antihistamine intranasal spray

A decongestant nasal spray

Ipratropium

Omalizumab

· Question 83

What is the Gold standard for the diagnosis of asthma?

Patient’s perception of clogged airways

Validated quality-of-life questionnaires

Bronchoscopy

Spirometry

· Question 84

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?

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:

Herpes simplex

Aphthous ulcers

Candidiasis

Oral cancer

· Question 86

Risk factors for acute otitis media (AOM) include all of the following except:

Household cigarette smoke

Group daycare attendance

Sibling history of acute otitis media

African-American ethnicity

· Question 87

Which of the following can result from chronic inflammation of a meibomian gland?

A chalazion

Uveitis

Keratitis

A pterygium

· Question 88

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 89

Of the following choices, the least likely cause of cough is:

Asthma

Gastroesophageal reflux

Acute pharyngitis

Allergic rhinitis

· Question 90

The most common correlate(s) with chronic bronchitis and emphysema is(are):

Familial and genetic factors

Cigarette smoking

Air pollution

Occupational environment

· Question 91

Which choice below is least effective for alleviating symptoms of the common cold?

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?

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 following heart murmurs warrants the greatest concern?

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?

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

· 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?

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:

Acute otitis media (AOM)

Otitis media with effusion

Mucoid otitis media

Serous otitis media

· Question 97

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:

inguinal hernia

epigastric hernia

umbilical hernia

incisional hernia

· Question 98

A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?

Omeprazole

Ranitidine

An antacid

None of the above

· Question 99

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

Quit smoking

Maintain aggressive hypertension therapy

Stick to a low-fat, low-sodium diet

Continue with his exercise program

· Question 100

Risk factors for acute arterial insufficiency include which of the following?

Recent myocardial infarction

Atrial fibrillation

Atherosclerosis

All of the above

· Question 101

Impetigo and folliculitis are usually successfully treated with:

Systemic antibiotics

Topical antibiotics

Topical steroid creams

Cleansing and debridement

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