GCU NUR
634
MID-TERM EXAM
CONTAINS:
✓ NUR 634 Advanced Health Assessment exam preparation material
✓ Exam-style multiple-choice questions
✓ Correct answers included
✓ Detailed explanations and rationales
✓ Graduate-level nursing assessment content
✓ Comprehensive head-to-toe physical assessment review
✓ Cardiovascular assessment (heart sounds, murmurs)
✓ Respiratory assessment (normal and abnormal breath sounds)
✓ Neurological assessment (cranial nerves, mental status)
✓ Abdominal assessment techniques
✓ Musculoskeletal assessment
✓ HEENT assessment
✓ Skin assessment findings||AMONG OTHERS!!
,A 68-year-old male patient with a history of hypertension, type 2 diabetes mellitus, and chronic
kidney disease (CKD) stage 3 presents for a follow-up. His current blood pressure is 152/92 mm Hg. He
is currently taking Lisinopril 20 mg daily. The physician is considering adding an additional
antihypertensive agent to manage his blood pressure more aggressively and provide renal protection.
Which of the following medications is the most appropriate choice to add to his regimen?
A) Hydrochlorothiazide 25 mg daily
B) Amlodipine 5 mg daily
C) Spironolactone 25 mg daily
D) Atenolol 50 mg daily
Correct Answer: B) Amlodipine 5 mg daily
Explanation / Rationale:
Amlodipine is a calcium channel blocker (CCB) that is safe and effective in patients with chronic kidney
disease and does not require dosage adjustment based on renal function. The combination of an ACE
inhibitor (Lisinopril) and a CCB is often recommended as a first-line combination therapy for patients
with hypertension and comorbidities like diabetes due to their synergistic effects in reducing
cardiovascular events. While Hydrochlorothiazide (A) is a diuretic often used in combination, thiazides
can be less effective as GFR declines (<30 mL/min), and in stage 3 CKD, loop diuretics or CCBs are often
preferred. Spironolactone (C) is a potassium-sparing diuretic; adding this to an ACE inhibitor
significantly increases the risk of hyperkalemia, which is already a concern in patients with CKD and
diabetes. Atenolol (D) is a beta-blocker, which is generally not a first-line agent for uncomplicated
hypertension unless the patient has specific compelling indications like heart failure or post-
myocardial infarction. It may also mask hypoglycemic symptoms in diabetic patients.
A 55-year-old female presents with complaints of "hot flashes" and mood swings consistent with
menopause. She has a history of breast cancer (ER-positive) treated 5 years ago with mastectomy and
chemotherapy. She is currently in remission. Which of the following is the most appropriate
pharmacologic intervention for managing her severe vasomotor symptoms?
A) Conjugated equine estrogens (Premarin)
B) Medroxyprogesterone acetate (Provera)
C) Paroxetine 7.5 mg (Brisdelle)
D) Black cohosh supplement
,Correct Answer: C) Paroxetine 7.5 mg (Brisdelle)
Explanation / Rationale:
The patient has a contraindication to estrogen therapy due to her history of ER-positive breast cancer.
Systemic hormone replacement therapy (Options A and B) is generally contraindicated in survivors of
hormone-sensitive breast cancer because it may stimulate the recurrence of cancer. Paroxetine is a
selective serotonin reuptake inhibitor (SSRI) that is FDA-approved specifically for the treatment of
moderate to severe vasomotor symptoms associated with menopause. It works by modulating the
neurotransmitter balance in the thermoregulatory center of the hypothalamus. While Black cohosh
(D) is a popular herbal remedy, its efficacy is inconsistent, it is not regulated by the FDA for purity or
potency, and some studies suggest it may have estrogenic properties, making it less safe than the non-
hormonal prescription option in this specific patient population.
A 24-year-old male is diagnosed with uncomplicated gonococcal urethritis. He has no known drug
allergies. According to current CDC guidelines, which of the following is the most appropriate
treatment regimen?
A) Oral Azithromycin 1 g single dose
B) Oral Cefixime 400 mg single dose
C) Intramuscular Ceftriaxone 500 mg single dose plus Oral Azithromycin 1 g single dose
D) Intramuscular Ceftriaxone 500 mg single dose
Correct Answer: D) Intramuscular Ceftriaxone 500 mg single dose
Explanation / Rationale:
Current CDC guidelines recommend a single 500 mg dose of intramuscular Ceftriaxone for the
treatment of uncomplicated gonorrhea. Previously, dual therapy with Ceftriaxone and Azithromycin
was recommended to prevent resistance and treat potential co-infection with chlamydia. However,
due to rising resistance of Neisseria gonorrhoeae to azithromycin, guidelines have shifted.
Azithromycin is no longer routinely recommended for gonorrhea treatment unless chlamydial infection
has not been excluded. If chlamydia status is unknown or positive, Doxycycline 100 mg twice daily for
7 days is the preferred agent for co-treatment (replacing Azithromycin). Oral Cefixime (B) is an
alternative only if Ceftriaxone is unavailable, but it is less effective. Oral Azithromycin alone (A) is not
recommended due to high resistance rates.
, A pediatric patient weighing 15 kg is prescribed Amoxicillin for acute otitis media. The standard
dosage is 80 to 90 mg/kg/day divided into two doses. What is the maximum single dose this patient
should receive per administration?
A) 250 mg
B) 375 mg
C) 500 mg
D) 750 mg
Correct Answer: C) 500 mg
Explanation / Rationale:
To calculate the daily dose: 15 kg × 85 mg/kg (midpoint of range) = 1275 mg/day.
Divided into two doses: 1275 mg / 2 = 637.5 mg per dose.
However, standard formulations of Amoxicillin suspension and capsules often cap specific strengths,
but clinically, 500 mg is the standard maximum single dose often utilized for high-dose therapy in
children to avoid excessive volume of suspension or GI toxicity, though strict calculation might suggest
a higher amount. However, looking at standard dosing tables for this weight range, 500 mg twice
daily is the appropriate therapeutic dose for high-dose amoxicillin (90mg/kg/day). Option B (375 mg)
would be 50 mg/kg/day, which is too low for resistant organisms. Option D (750 mg) exceeds the
typical single-dose limit for this weight.
A 70-year-old female with osteoporosis is prescribed Alendronate (Fosamax). The nurse practitioner
provides education regarding administration. Which of the following statements by the patient
indicates a need for further teaching?
A) "I will take this medication with a full glass of water first thing in the morning."
B) "I must remain upright for at least 30 minutes after taking the pill."
C) "I should wait at least 60 minutes before eating breakfast."
D) "I can crush the pill and mix it with applesauce if I have trouble swallowing."
Correct Answer: D) "I can crush the pill and mix it with applesauce if I have trouble swallowing."
634
MID-TERM EXAM
CONTAINS:
✓ NUR 634 Advanced Health Assessment exam preparation material
✓ Exam-style multiple-choice questions
✓ Correct answers included
✓ Detailed explanations and rationales
✓ Graduate-level nursing assessment content
✓ Comprehensive head-to-toe physical assessment review
✓ Cardiovascular assessment (heart sounds, murmurs)
✓ Respiratory assessment (normal and abnormal breath sounds)
✓ Neurological assessment (cranial nerves, mental status)
✓ Abdominal assessment techniques
✓ Musculoskeletal assessment
✓ HEENT assessment
✓ Skin assessment findings||AMONG OTHERS!!
,A 68-year-old male patient with a history of hypertension, type 2 diabetes mellitus, and chronic
kidney disease (CKD) stage 3 presents for a follow-up. His current blood pressure is 152/92 mm Hg. He
is currently taking Lisinopril 20 mg daily. The physician is considering adding an additional
antihypertensive agent to manage his blood pressure more aggressively and provide renal protection.
Which of the following medications is the most appropriate choice to add to his regimen?
A) Hydrochlorothiazide 25 mg daily
B) Amlodipine 5 mg daily
C) Spironolactone 25 mg daily
D) Atenolol 50 mg daily
Correct Answer: B) Amlodipine 5 mg daily
Explanation / Rationale:
Amlodipine is a calcium channel blocker (CCB) that is safe and effective in patients with chronic kidney
disease and does not require dosage adjustment based on renal function. The combination of an ACE
inhibitor (Lisinopril) and a CCB is often recommended as a first-line combination therapy for patients
with hypertension and comorbidities like diabetes due to their synergistic effects in reducing
cardiovascular events. While Hydrochlorothiazide (A) is a diuretic often used in combination, thiazides
can be less effective as GFR declines (<30 mL/min), and in stage 3 CKD, loop diuretics or CCBs are often
preferred. Spironolactone (C) is a potassium-sparing diuretic; adding this to an ACE inhibitor
significantly increases the risk of hyperkalemia, which is already a concern in patients with CKD and
diabetes. Atenolol (D) is a beta-blocker, which is generally not a first-line agent for uncomplicated
hypertension unless the patient has specific compelling indications like heart failure or post-
myocardial infarction. It may also mask hypoglycemic symptoms in diabetic patients.
A 55-year-old female presents with complaints of "hot flashes" and mood swings consistent with
menopause. She has a history of breast cancer (ER-positive) treated 5 years ago with mastectomy and
chemotherapy. She is currently in remission. Which of the following is the most appropriate
pharmacologic intervention for managing her severe vasomotor symptoms?
A) Conjugated equine estrogens (Premarin)
B) Medroxyprogesterone acetate (Provera)
C) Paroxetine 7.5 mg (Brisdelle)
D) Black cohosh supplement
,Correct Answer: C) Paroxetine 7.5 mg (Brisdelle)
Explanation / Rationale:
The patient has a contraindication to estrogen therapy due to her history of ER-positive breast cancer.
Systemic hormone replacement therapy (Options A and B) is generally contraindicated in survivors of
hormone-sensitive breast cancer because it may stimulate the recurrence of cancer. Paroxetine is a
selective serotonin reuptake inhibitor (SSRI) that is FDA-approved specifically for the treatment of
moderate to severe vasomotor symptoms associated with menopause. It works by modulating the
neurotransmitter balance in the thermoregulatory center of the hypothalamus. While Black cohosh
(D) is a popular herbal remedy, its efficacy is inconsistent, it is not regulated by the FDA for purity or
potency, and some studies suggest it may have estrogenic properties, making it less safe than the non-
hormonal prescription option in this specific patient population.
A 24-year-old male is diagnosed with uncomplicated gonococcal urethritis. He has no known drug
allergies. According to current CDC guidelines, which of the following is the most appropriate
treatment regimen?
A) Oral Azithromycin 1 g single dose
B) Oral Cefixime 400 mg single dose
C) Intramuscular Ceftriaxone 500 mg single dose plus Oral Azithromycin 1 g single dose
D) Intramuscular Ceftriaxone 500 mg single dose
Correct Answer: D) Intramuscular Ceftriaxone 500 mg single dose
Explanation / Rationale:
Current CDC guidelines recommend a single 500 mg dose of intramuscular Ceftriaxone for the
treatment of uncomplicated gonorrhea. Previously, dual therapy with Ceftriaxone and Azithromycin
was recommended to prevent resistance and treat potential co-infection with chlamydia. However,
due to rising resistance of Neisseria gonorrhoeae to azithromycin, guidelines have shifted.
Azithromycin is no longer routinely recommended for gonorrhea treatment unless chlamydial infection
has not been excluded. If chlamydia status is unknown or positive, Doxycycline 100 mg twice daily for
7 days is the preferred agent for co-treatment (replacing Azithromycin). Oral Cefixime (B) is an
alternative only if Ceftriaxone is unavailable, but it is less effective. Oral Azithromycin alone (A) is not
recommended due to high resistance rates.
, A pediatric patient weighing 15 kg is prescribed Amoxicillin for acute otitis media. The standard
dosage is 80 to 90 mg/kg/day divided into two doses. What is the maximum single dose this patient
should receive per administration?
A) 250 mg
B) 375 mg
C) 500 mg
D) 750 mg
Correct Answer: C) 500 mg
Explanation / Rationale:
To calculate the daily dose: 15 kg × 85 mg/kg (midpoint of range) = 1275 mg/day.
Divided into two doses: 1275 mg / 2 = 637.5 mg per dose.
However, standard formulations of Amoxicillin suspension and capsules often cap specific strengths,
but clinically, 500 mg is the standard maximum single dose often utilized for high-dose therapy in
children to avoid excessive volume of suspension or GI toxicity, though strict calculation might suggest
a higher amount. However, looking at standard dosing tables for this weight range, 500 mg twice
daily is the appropriate therapeutic dose for high-dose amoxicillin (90mg/kg/day). Option B (375 mg)
would be 50 mg/kg/day, which is too low for resistant organisms. Option D (750 mg) exceeds the
typical single-dose limit for this weight.
A 70-year-old female with osteoporosis is prescribed Alendronate (Fosamax). The nurse practitioner
provides education regarding administration. Which of the following statements by the patient
indicates a need for further teaching?
A) "I will take this medication with a full glass of water first thing in the morning."
B) "I must remain upright for at least 30 minutes after taking the pill."
C) "I should wait at least 60 minutes before eating breakfast."
D) "I can crush the pill and mix it with applesauce if I have trouble swallowing."
Correct Answer: D) "I can crush the pill and mix it with applesauce if I have trouble swallowing."
