NURS 6531 Midterm Exam Graded Solutions

NURS 6531 Midterm Exam Graded Solutions

NURS 6531 Midterm Exam Graded Solutions

Question 1 When completing this quiz, did you comply with University’s Code of Conduct including the expectations for academic integrity?

Answers:

Yes

No

• Question 2 The most common cancer found on the auricle is:

Answers: Actinic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Acral-lentiginous melanoma

• Question 3 Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Answers: Xanthines

Antihistimines

Steroids

Anticholinergics

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• 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?

Answers: Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet.

Order a topical hemorrhoid cream along with a stool softener.

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy.

• Question 5 Which of the following patient characteristics are associated with chronic bronchitis?

Answers:

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

NURS 6531 Midterm Exam Graded Solutions 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:

Answers: CBC/diff

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:

Answers:

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:

Answers: 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:

Answers: A common case of shingles and prescribe an analgesic and an antiviral agent

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

Herpes zoster and consider that this patient may be immunocompromised

A recurrence of chickenpox and treat the patient’s symptoms

• Question 10 Which type of lung cancer has the poorest prognosis?

Answers: Adenocarcinoma

Epidermoid carcinoma

Small cell carcinoma

Large cell carcinoma

NURS 6531 Midterm Exam Graded Solutions 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:

Answers: Acute diarrhea

Chronic diarrhea

Irritable bowel

Functional bowel disease

• Question 12 Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

Answers: An allergic reaction

Relapsing polychondritis

Lymphocytoma cutis

Systemic lupus erythematosus

• Question 13 Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

Answers: 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?

Answers: Mild intermittent

Mild persistent

Moderate persistent

NURS 6531 Midterm Exam Graded Solutions 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?

Answers:

Penicillin V 500 milligrams PO every 8 hours for 10 days

Ampicillin 250 milligrams PO twice a day for 10 days

Clarithromycin 500 milligrams po daily for 7 days

None of the above

• Question 16 A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?

Answers: Congestive heart failure

Varicose veins

Deep vein thrombosis

Arterial insufficiency

• Question 17 Which statement below is correct about pertussis?

Answers:

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?

Answers:

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?

Answers: 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?

Answers: 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:

Answers: Alcohol

Gallstones

Medications

Pregnancy

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NURS 6531 Midterm Exam Graded Solutions Question 22 When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

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:

Answers: ingestion of large amounts of vitamin C

a high dietary intake of rare cooked beef

a colonic neoplasm that is not bleeding

stool that has been stored before testing

• Question 24 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal 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:

Answers: Colonoscopy

Small bowel follow-through

Barium enema

CT abdomen

• Question 25 A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

Answers: Mitral regurgitation

Systolic heart failure

Cardiac myxoma

Diastolic heart failure

• Question 26 Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?

Answers:

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:

Answers: “It is the most common cause of death in patients with skin cancer.”

“It can be cured with surgical excision or radiation therapy.”

“It is a slow growing skin cancer that rarely undergoes malignant changes.”

“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”

• Question 28 Expected spirometry readings when the patient has chronic emphysema include:

Answers: Decreased residual volume (RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

Increased total lung capacity (TLC)

NURS 6531 Midterm Exam Graded Solutions 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:

Answers: 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?

Answers: 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?

Answers: 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?

Answers: 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?

Answers:

Topical steroid use

Topical antibiotic use

A recent laceration

Cold climates

• Question 34 A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?

Answers: Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours.

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction.

Order stool cultures.

• Question 35 Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?

Answers: Aspirin

NSAIDs

Opioids

Antihistamines

• Question 36 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:

Answers: Peripheral edema

Weight gain

Shortness of breath

Nocturnal dyspnea

• Question 37 A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?

Answers: Ibuprofen

Erythromycin

Amoxicillin

Acetaminophen

• Question 38 A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?

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?

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 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?

Answers: Asthma

Nocturnal allergies

Valvular disease

Heart failure

NURS 6531 Midterm Exam Graded Solutions Question 41 Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

Answers: Erythromycin

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin

• Question 42 Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?

Answers:

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:

Answers:

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?

Answers: Assist the patient to a standing position and take her blood pressure.

Assess the patient’s cranial nerves.

Compare the patient’s blood pressure lying first, then sitting, and then standing.

Compare the amplitude of the patient’s radial and pedal pulses.

• Question 45 What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?

Answers:

Ursodiol

Ibuprofen

Prednisone

Surgery is the only answer

• Question 46 A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

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?

Answers: Painful diarrhea

Painful constipation

Cramping and abdominal pain

Weight loss

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NURS 6531 Midterm Exam Graded Solutions 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?

Answers:

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?

Answers: ACE Inhibitor

Beta Blocker

Calcium channel blocker

Diuretic

• Question 50 The differential diagnosis for a patient complaining of a sore throat includes which of the following?

Answers: Gonococcal infection

Thrush

Leukoplakia

B only

A, B, and C

• Question 51 A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Answers: 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?

Answers:

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:

Answers: A drug interaction

Hepatic dysfunction

Hypersensitivity to lovastatin

Rhabdomyolysis

• Question 54 Treatment of acute vertigo includes:

Answers:

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?

Answers: 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?

Answers: Cataracts

Glaucoma

Retinal detachment

Iritis

• Question 57In order to decrease deaths from lung cancer:

Answers: All smokers should be screened annually

All patients should be screened annually

Only high risk patients should be screened routinely

Patients should be counseled to quit smoking

NURS 6531 Midterm Exam Graded Solutions Question 58 John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?

Answers:

Every 5 years

Every 2 years

Every year

Whenever blood work is done

• Question 59 Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?

Answers: 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?

Answers: Actinic keratosis

Eczema

Psoriasis

Seborrheic dermatitis

• Question 61 Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?

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 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:

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.

NURS 6531 Midterm Exam Graded Solutions Question 63 Appropriate therapy for peptic ulcer disease (PUD) is:

Answers: 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?

Answers: 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?

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

Answers: 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?

Answers: Pharmacological therapy

A labyrinthectomy

A vestibular neurectomy

Wearing an earplug in the ear with the most hearing loss

• Question 68 Which of the following is not a risk factor for coronary arterial insufficiency?

Answers: 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?

Answers:

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?

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

Answers:

Group A Streptococcus

Staphlococcus areus

?-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:

Answers: Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days

Order mandibular x-rays and question the patient about physical abuse

Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic

Initiate a parenteral antibiotic and consider hospital admission

• Question 73 If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:

Answers:

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:

Answers: 160 mg/dL

130 mg/dL

100 mg/dL

70 mg/dL

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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:

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

Investigation with endoscopy, manometry, and/or pH testing

• Question 76

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

Answers: 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:

Answers: A bronchodilator

An antibiotic

A decongestant

A cool mist vaporizer

• Question 78 A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?

Answers:

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?

Answers:

It is not effective during an acute asthma attack.

It may take 2 to 3 days to begin working.

This drug works within 10 minutes.

This drug may be used by patients 6 years and older.

• Question 80 Which intervention listed below is safe for long term use by an adult with constipation?

Answers:

Bulk-forming agents

Stool softeners

Laxatives

Osmotic agents

• Question 81 A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:

Answers:

Apply a topical antibiotic and warm compresses.

Apply cool compresses and avoid touching the hordeolum.

Use an oral antibiotic and eye flushes.

Apply light palpation to facilitate drainage.

• Question 82 Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?

Answers: An antihistamine intranasal spray

A decongestant nasal spray

Ipratropium

Omalizumab

Question 83 What is the Gold standard for the diagnosis of asthma?

Answers: 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?

Answers: Methyldopa

Enalapril

Amlodipine

Hydrochlorothiazide

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