6531 midterm review 2022 with complete solutions

The most common cancer found on the auricle is: - ANSWER Basal cell carcinoma Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to vent ...

The most common cancer found on the auricle is: - ANSWER Basal cell carcinoma 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? - ANSWER Antihistimines 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? - ANSWER Refer the patient for a barium enema and sigmoidoscopy. Which of the following patient characteristics are associated with chronic bronchitis? - ANSWER Overweight, cyanosis, and normal or slightly increased respiratory rate 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: - ANSWER CT scan 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: - ANSWER Purulent drainage 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: - ANSWER Gonococcal conjunctivitis 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: - ANSWER Herpes zoster and consider that this patient may be immunocompromised Which type of lung cancer has the poorest prognosis? - ANSWER Small cell carcinoma 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: - ANSWER Chronic diarrhea 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? - ANSWER Systemic lupus erythematosus Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? - ANSWER Acute bronchitis 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? - ANSWER Moderate persistent 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? - ANSWER Penicillin V 500 milligrams PO every 8 hours for 10 days 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? - ANSWER Varicose veins Which statement below is correct about pertussis? - ANSWER It is also called whooping cough Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? - ANSWER Pneumonia 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? - ANSWER Diverticulitis 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? - ANSWER Herpes zoster A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: - ANSWER Gallstones When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? - ANSWER Order an abdominal ultrasound A false-positive result with the fecal occult blood test can result from: - ANSWER a high dietary intake of rare cooked beef 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: - ANSWER Small bowel follow-through 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: - ANSWER Systolic heart failure Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? - ANSWER Multilobar involvement on chest x-ray with the inability to take oral medications A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: - ANSWER "It can be cured with surgical excision or radiation therapy." Expected spirometry readings when the patient has chronic emphysema include: - ANSWER Increased total lung capacity (TLC) 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: - ANSWER A and C (Esophageal cancer, GERD) 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? - ANSWER Malignant melanoma Which of the following is not a goal of treatment for the patient with cystic fibrosis? - ANSWER Replace water-soluble vitamins 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? - ANSWER B and C (Nails and feet) An adult presents with tinea corporis. Which item below is a risk factor for its development? - ANSWER Topical steroid use 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? - ANSWER Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management. Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? - ANSWER Antihistamines Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: - ANSWER Weight gain 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? - ANSWER Amoxicillin 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? - ANSWER "Is your leg pain relieved by rest?" Which of the following statements about malignant melanomas is true? - ANSWER The prognosis is directly related to the thickness of the lesion 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? - ANSWER Heart failure Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? - ANSWER Clarithromycin (Biaxin) Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction? - ANSWER Powders 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: - ANSWER Squamous cell carcinoma 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? - ANSWER Compare the patient's blood pressure lying first, then sitting, and then standing. What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? - ANSWER Ursodiol 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: - ANSWER Pseudomonas aeruginosa Which of the following is not a symptom of irritable bowel syndrome? - ANSWER Weight loss 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? - ANSWER Any recent trauma 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? - ANSWER Beta Blocker The differential diagnosis for a patient complaining of a sore throat includes which of the following? - ANSWER A, B, and C (Gonococcal infection, thrush, leukoplakia) 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: - ANSWER Ophthalmic zoster 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? - ANSWER Serologic markers for hepatitis 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: - ANSWER Rhabdomyolysis Treatment of acute vertigo includes: - ANSWER Bedrest and an antihistamine Treatment of H.pylori includes which of the following? - ANSWER A, B, and C (Proton pump inhibitor, antibiotic therapy, bismuth subsalicylate) 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? - ANSWER Retinal detachment In order to decrease deaths from lung cancer: - ANSWER Patients should be counseled to quit smoking John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? - ANSWER Every 5 years Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? - ANSWER Mort has benign prostatic hyperplasia 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? - ANSWER Psoriasis 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? - ANSWER Add a thiazide diuretic to the Lisinopril 5mg daily 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: - ANSWER suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis Appropriate therapy for peptic ulcer disease (PUD) is: - ANSWER Based on etiology 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? - ANSWER An ACE Inhibitor 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? - ANSWER Failing to bill for billable services will lead to unnecessarily low revenues A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? - ANSWER Retinoblastoma 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? - ANSWER A vestibular neurectomy Which of the following is not a risk factor for coronary arterial insufficiency? - ANSWER Alcohol ingestion 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? - ANSWER Allergic conjunctivitis A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? - ANSWER A bronchodilator PRN and an inhaled corticosteroid Acute rheumatic fever is an inflammatory disease which can follow infection with: - ANSWER Group A Streptococcus 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