SOUTH UNIVERSITY NRSG 6420 MIDTERM EXAM/ 100% CORRECT.

Question 1. 1. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recogniz ...

Question 1. 1. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: (Points : 2) Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Question 2. 2. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? (Points : 2) Colon cancer in family member at age 70 Breast cancer in family member at age 75 Myocardial infarction in family member at age 35 All of the above Question 3. 3. The pathophysiological hallmark of ACD is: (Points : 2) Depleted iron stores Impaired ability to use iron stores Chronic uncorrectable bleeding Reduced intestinal absorption of iron Question 4. 4. It is important to not dilate the eye if ____ is suspected. (Points : 2) Cataract Macular degeneration Acute closed-angle glaucoma Chronic open-angle glaucoma Question 5. 5. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: (Points : 2) 50 x 2-pack years 100-pack years 50-year, 2-pack history 100-pack history Question 6. 6. When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? (Points : 2) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. Sit up for an hour after taking any medication and restrict fluid intake. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal. Question 7. 7. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: (Points : 2) CBC with differential Stool culture and sensitivity Abdominal X-ray Colonoscopy Question 8. 8. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? (Points : 2) Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris Question 9. 9. A common auscultatory finding in advanced CHF is: (Points : 2) Systolic ejection murmur S3 gallop rhythm Friction rub Bradycardia Question 10. 10. Which of the following symptoms is common with acute otitis media? (Points : 2) Bulging tympanic membrane Bright light reflex of tympanic membrane Increased tympanic membrane mobility All of the above Question 11. 11. Rheumatic heart disease is a complication that can arise from which type of infection? (Points : 2) Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae Question 12. 12. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? (Points : 2) Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia Question 13. 13. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: (Points : 2) Mitral Valve Prolapse Referred Pain from Cholecystitis Pericarditis Pulmonary Embolus Question 14. 14. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? (Points : 2) History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above Question 15. 15. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2) It is highly contagious and a mask should be worn at home. Treatment regimen is multiple lifetime medications. Treatment regimen is multiple medications taken daily for a few weeks. Treatment regimen is complicated and is not indicated unless the patient is symptomatic. Question 16. 16. The best evidence rating drugs to consider in a post myocardial infarction patient include: (Points : 2) ASA, ACE/ARB, beta-blocker, aldosterone blockade ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates Question 17. 17. The most common cause of eye redness is: (Points : 2) Conjunctivitis Acute glaucoma Head trauma Corneal abrasion Question 18. 18. A specific exam used to evaluate the gall bladder is: (Points : 2) Psoas sign Obturator sign Cullens sign Murphy’s sign Question 19. 19. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: (Points : 2) Mallory-Weiss tear Esophageal varices Gastric ulcer Colon cancer Question 20. 20. Which of the following is not a contributing factor to the development of esophagitis in older adults? (Points : 2) Increased gastric emptying time Regular ingestion of NSAIDs Decreased salivation Fungal infections such as Candida Question 21. 21. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? (Points : 2) Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis Question 22. 22. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: (Points : 2) Peptic ulcer disease Barrett’s esophagus Esophageal varices Pancreatitis Question 23. 23. Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. (Points : 2) Acute pancreatitis Duodenal ulcer Biliary colic Cholecystitis Question 24. 24. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? (Points : 2) Acute MI GERD Pneumonia Angina Question 25. 25. In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? (Points : 2) Serum iron Total iron binding capacity Transferrin saturation Serum ferritin Question 26. 26. If it has been determined a patient has esophageal reflux, you should tell them: (Points : 2) They probably have a hiatal hernia causing reflux They probably need surgery They should avoid all fruit juices Smoking, alcohol, and caffeine can aggravate their problem Question 27. 27. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? (Points : 2) Computed tomography (CT) scan Chest X-ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan Question 28. 28. 2. (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? (Points : 2) Abdominal upright and flat plate x-ray Abdominal MRI Abdominal CT scan with contrast Abdominal ultrasound Question 29. 29. Emphysematous changes in the lungs produce the following characteristic in COPD patients? (Points : 2) Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum Question 30. 30. (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? (Points : 2) Trial of ursodiol ‘Watchful waiting’ Surgical consult HIDA scan Question 31. 31. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: (Points : 2) Exercise-induced cough Bronchiectasis Alpha-1 deficiency Pericarditis Question 32. 32. (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? (Points : 2) Abdominal plain films Liver function tests Amylase/lipase Urinalysis Question 33. 33. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: (Points : 2) Digital rectal examination Endoscopy Pelvic examination Urinalysis Question 34. 34. A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: (Points : 2) Appendicitis Cholecystitis Bowel Obstruction Diverticulitis Question 35. 35. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: (Points : 2) Thrush Laryngeal cancer Carotidynia Thyroiditis Question 36. 36. Functional abilities are best assessed by: (Points : 2) Self-report of function Observed assessment of function A comprehensive head-to-toe examination Family report of function Question 37. 37. Essential parts of a health history include all of the following except: (Points : 2) Chief complaint History of the present illness Current vital signs All of the above are essential history components Question 38. 38. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: (Points : 2) Acoustic neuroma Cerumen impaction Otitis media Ménière’s disease Question 39. 39. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: (Points : 2) Pneumothorax Pleural effusion Pneumonia Pulmonary embolism Question 40. 40. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): (Points : 2) Hemoglobin <12 g/dl, MCV decreased, MCH decreased Hemoglobin >12 g/dl, MCV increased, MCH increased Hemoglobin <12 g/dl, MCV normal, MCH normal Hemoglobin >12 g/dl, MCV decreased, MCH increased