NURS 6531 Midterm Exam 1 2019/2020 – Question and Answers

NURS 6531 Midterm Exam 1 2019/2020 – Question and Answers 1. A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elev ...

NURS 6531 Midterm Exam 1 2019/2020 – Question and Answers 1. 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? 2. Which type of lung cancer has the poorest prognosis? 3. Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: 4. 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: 5. A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: 6. Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to: 7. Which of the following is not a goal of treatment for the patient with cystic fibrosis? 8. The most common cancer found on the auricle is: 9. Which of the following color changes in a pigmented lesion suggests malignant transformation? 10. Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? 11. The Centorcriteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following? 12. When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? 13. Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued? 14. Which of the following patient characteristics are associated with chronic bronchitis? 15. Treatment of acute vertigo includes: 16. 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: 17. A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? 18. Diagnosis of Crohn’s disease is made considering signs, symptoms and: 19. Which of the following is a predisposing condition for furunculosis? 20. Expected spirometry readings when the patient has chronic emphysema include: 21. 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? 22. Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: 23. Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? 24. 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: 25. A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests: 26. 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: 27. The differential diagnosis for a patient complaining of a sore throat includes which of the following? 28. 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? 29. The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every: 30. Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to: 31. A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? 32. 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: 33. John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? 34. A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: 35. Your patient Jerry has gout. What do you suggest? 36. Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is: 37. A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: 38. 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: 39. 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? 40. Management of a patient with hypertension and an abdominal aortic aneurysm would include: 41. Which of the following is not a symptom of irritable bowel syndrome? 42. Impetigo and folliculitis are usually successfully treated with: 43. Which of the following is not a risk factor for coronary arterial insufficiency? 44. The most appropriate treatment for a child with mild croup is: 45. 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? 46. Appropriate therapy for peptic ulcer disease (PUD) is: 47. An AST that is more than twice the level of ALT is suggestive of: 48. A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tineapedis. What is the best initial treatment option for this patient? 49. 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? 50. Sandra has celiac disease. You place her on which diet?. 51. 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: 52. Group A ?-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? 53. A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include: 54. Which of the following is a secondary cause of hyperlipidemia? 55. 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? nurs 6531 midterm exam 56. An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent? 57. 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? 58. 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? 59. 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? 60. 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: 61. A patient presents to the office with a blood pressure 142/80. This patient is classified as having: 62. 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? nurs 6531 midterm exam 63. 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: 64. 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? 65. Which choice below is least effective for alleviating symptoms of the common cold? 66. 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: 67. A patient reports to the nurse practitioner that he was diagnose with hepatitis B a year ago and has not …a health care provider since then. What information should this patient be ….? 68. The most common correlate(s) with chronic bronchitis and emphysema is(are): 69. If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: 70. Treatment of H.pylori includes which of the following? 71. Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? 72. What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? 73. Which of the following best describes hypertrophic cardiomyopathy? 74. Amaurosisfugax is described as a: 75. 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: 76. Which of the following heart murmurs warrants the greatest concern? 77. 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: nurs 6531 midterm exam 78. 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, Lisinopril5mg 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? (HTN stage 2) 79. Of the following, the patient who should be referred for periodic colonoscopy is the patient with: 80. Dana has ischemic arterial ulcers. What is your first priority when counseling her? 81. After thorough history, physical examination, and laboratory tests, a patient is diagnose with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently consider most effective? 82. 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? 83. What is the Gold standard for the diagnosis of asthma? 84. An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis? croup 85. 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:goal of less than 100 mg/dL with statin treatments in managed care patients at high risk for coronary heart disease 86. Which intervention listed below is safe for long term use by an adult with constipation? 87. The nurse practitioner is reviewing a patient’s lab report who completed the hepatitis B series 3 months ago. Which of the following lab results would you expect to see in this patient? 88. Sarah has allergic rhinitis and is currently being bothere by nasal congestion. Which of the following meds order for allergic rhinitis would be most appropriate? nurs 6531 midterm exam 89. A cashier complains of dull ache and pressure sensation in her lower legs. It is relieve 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? 90. A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnose with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is: 91. 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: 92. 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? 93. Which of the following can result from chronic inflammation of a meibomian gland? nurs 6531 midterm exam 94. A 15 year old male presents with abdominal pain that began in the peri-umbilical area then localize to the right lower quadrant (RLQ). He complains of anorexia, and low grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis? 95. Which of the following medication classes should be avoide in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient? 96. A false-positive result with the fecal occult blood test can result from: 97. A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instruct 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: 98. Risk factors for acute arterial insufficiency include which of the following? 99. .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: 100. Which of the following are classic features of ulcerative colitis? 101. A 55 year old patient has a work-up for hypertension and is note to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect? 102. 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? 103. A 58 year old complains of tightness in his chest while cutting firewood. It disappears quickly if he stops chopping. He denies shortness of breath, his total cholesterol level is less than 200 mg/dL, and he is a non-smoker. What is the most appropriate action for the nurse practitioner to take with this patient? 104. Lisa, age 49, has daily symptoms of asthma. She uses her inhale 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 affect more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in? 105. Risk factors for acute otitis media (AOM) include all of the following except: nurs 6531 midterm exam 106. Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?