Nurs 6531 midterm exam / nurs6531 midterm exam (2 versions) (100

  

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NURS 6531 MIDTERM EXAM / NURS6531 MIDTERM EXAM (2 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 200 Q & A)

  

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

  

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

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

Question 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?

Question 2

Which type of lung cancer has the poorest prognosis?

Question 3

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:

Question 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:

Question 5

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

Question 6

Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to:

Question 7

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

Question 8

The most common cancer found on the auricle is:

Question 9

Which of the following color changes in a pigmented lesion suggests malignant transformation?

Question 10

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

Question 11

The Centorcriteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?

Question 12

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?

Question 13

Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?

Question 14

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

Question 15

Treatment of acute vertigo includes:

Question 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:

Question 17

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

Question 18

Diagnosis of Crohn’s disease is made considering signs, symptoms and:

Question 19

Which of the following is a predisposing condition for furunculosis?

Question 20

Expected spirometry readings when the patient has chronic emphysema include:

Question 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?

Question 22

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

Question 23

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

Question 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:

Question 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:

Question 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:

Question 27

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

Question 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?

Question 29

The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every:

Question 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:

Question 31

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

Question 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:

Question 33

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?

Question 34

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:

Question 35

Your patient Jerry has gout. What do you suggest?

Question 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:

Question 37

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

Question 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:

Question 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?

Question 40

A 55 year old patient has a work-up for hypertension and is noted to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect? 

Question 41

Which of the following is not a symptom of irritable bowel syndrome?

Question 42

Impetigo and folliculitis are usually successfully treated with:

Question 43

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

Question 44

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

Question 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?

Question 46

Appropriate therapy for peptic ulcer disease (PUD) is:

Question 47

An AST that is more than twice the level of ALT is suggestive of:

Question 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? 

Question 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? 

Question 50

Sandra has celiac disease. You place her on which diet?

Question 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:

Question 52

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

Question 53

A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include:

Question 54

Which of the following is a secondary cause of hyperlipidemia?

Question 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?

Question 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?

Question 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?

Question 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?

Question 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?

Question 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:

Question 61

A patient presents to the office with a blood pressure 142/80. This patient is classified as having:

Question 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?

Question 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:

Question 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?

Question 65

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

Question 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:

Question 67

A patient reports to the nurse practitioner that he was diagnosed with hepatitis B a year ago and has not seen a health care provider since then. What information should this patient be given?

Question 68

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

Question 69

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

Question 70

Treatment of H.pylori includes which of the following?

Question 71

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

Question 72

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

Question 73

Which of the following best describes hypertrophic cardiomyopathy?

Question 74

Amaurosisfugax is described as a:

Question 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: 

Question 76

Which of the following heart murmurs warrants the greatest concern?

Question 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:

Question 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? 

Question 79

Of the following, the patient who should be referred for periodic colonoscopy is the patient with:

Question 80

Dana has ischemic arterial ulcers. What is your first priority when counseling her?

Question 81

After thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently considered most effective?

Question 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?

Question 83

What is the Gold standard for the diagnosis of asthma?

Question 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?

Question 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:

Question 86

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

Question 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? 

Question 88

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?

Question 89

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?

Question 90

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:

Question 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:

Question 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?

Question 93

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

Question 94

A 15 year old male presents with abdominal pain that began in the peri-umbilical area then localized 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?

Question 95

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?

Question 96

A false-positive result with the fecal occult blood test can result from:

Question 97

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:

Question 98

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

             

Question 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:

Question 100

Which of the following are classic features of ulcerative colitis?

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