Exam (elaborations) NURS 6531 Spring 2019 Midterms

Exam (elaborations) NURS 6531 Spring 2019 Midterms 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? **The main focus of treatment is to prevent dehydration by drinking plenty of fluids. In severe cases, hospitalization and intravenous fluids are necessary. Over-thecounter oral rehydration solutions (OHS), such as Pedialyte, can be helpful in mild cases Question 2 1 out of 1 points Which type of lung cancer has the poorest prognosis? Small cell carcinoma Question 3 1 out of 1 points Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Candidiasis Question 4 1 out of 1 points 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: GERD & Cancer Question 5 1 out of 1 points A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: apply a topical antibiotic and warm compresses. Question 6 NURS 6531 Spring 2019 Midterms 1 out of 1 points Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to: Do nothing other than provide reassurance Isoniazid ppd Question 7 1 out of 1 points Which of the following is not a goal of treatment for the patient with cystic fibrosis? Replace water-soluble vitamins Question 8 0 out of 1 points The most common cancer found on the auricle is: **basal cell carcinoma** Question 9 1 out of 1 points Which of the following color changes in a pigmented lesion suggests malignant transformation? **ALL COLORS Question 10 1 out of 1 points Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Acute bronchitis Question 11 1 out of 1 points The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following? A and B only Question 12 1 out of 1 points When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Seventy-five of sodium intake is derived from processed foods Question 13 1 out of 1 points Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued? Nifedipine (Procardia XL) for long-term management of his chronic stable angina. Question 14 1 out of 1 points Which of the following patient characteristics are associated with chronic bronchitis? overweight, cyanosis & normal or slighted increased resp. rate "blue bloaters" Question 15 1 out of 1 points Treatment of acute vertigo includes: -bedrest and an antihistamine Question 16 1 out of 1 points 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: herpes zoster and consider that this patient may be immunocompromised. Question 17 0 out of 1 points A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? **A bronchodilator PRN and an inhaled corticosteroid Question 18 0 out of 1 points Diagnosis of Crohn’s disease is made considering signs, symptoms and: **Intestinal obstruction demonstrated by plain x-ray of the abdomen Question 19 0 out of 1 points Which of the following is a predisposing condition for furunculosis? **Diabetes mellitus Question 20 1 out of 1 points Expected spirometry readings when the patient has chronic emphysema include: increased total lung capacity (TLC). Question 21 1 out of 1 points 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- my answer Question 22 0 out of 1 points Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: **weight gain. Question 23 1 out of 1 points 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 Question 24 1 out of 1 points 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: suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis Question 25 1 out of 1 points 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: Epiglottitis Question 26 0 out of 1 points 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: **epigastric hernia Question 27 0 out of 1 points The differential diagnosis for a patient complaining of a sore throat includes which of the following? Thrush Question 28 1 out of 1 points 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? heart failure Question 29 1 out of 1 points The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every: flexible sigmoidoscopy (FS) every 5 years, Question 30 1 out of 1 points Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to: Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate. Question 31 1 out of 1 points A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? -Retinoblastoma Question 32 1 out of 1 points 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: Systolic HF Question 33 1 out of 1 points John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? OFTEN Question 34 0 out of 1 points A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: **Basal cell carcinoma (BCC) is the most common type of skin cancer. It’s also the most commonly diagnosed cancer in the United States. Every year, millions of people learn that they have BCC. This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, or back of the hands. BCC is especially common on the face, often forming on the nose. While BCC often develops on skin that has had the most sun, BCC can appear on any part of the body, including the trunk, legs, and arms. People who use tanning beds also get BCC, and they also tend to get it earlier in life. This type of skin cancer grows slowly. It rarely spreads to other parts of the body. Treatment is important because BCC can grow wide and deep, destroying skin, tissue, and bone. Question 35 0 out of 1 points Your patient Jerry has gout. What do you suggest? **treating the acute attack of inflammation when one or more joints are very inflamed and painful ongoing treatment to reduce the level of urate in your blood and to get rid of urate crystals. The two most commonly used drug treatments for acute attacks of gout are nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine.Acute attacks of gout are often treated with oral non-steroidal anti-inflammatory drugs (NSAIDs), which can ease pain and possibly reduce some of the inflammation. Examples include ibuprofen, naproxen and etoricoxib. Question 36 1 out of 1 points 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: Trauma or inflammation Question 37 1 out of 1 points A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: Gallstones Question 38 0 out of 1 points 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: **Imaging tests used to diagnose small bowel cancer include: Computerized tomography (CT) scan. Magnetic resonance imaging (MRI) Positron emission tomography (PET) CBC, Blood chem, endoscopy, biopsy Question 39 1 out of 1 points 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? Retinal Detachment Question 40 0 out of 1 points Management of a patient with hypertension and an abdominal aortic aneurysm would include: **The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Antihypertensive agents are used to reduce tension on the vessel wall in patients with abdominal aortic aneurysms (AAAs) who have elevated blood pressure (BP). Esmolol (Brevibloc) View full drug information An ultrashort-acting beta1 blocker, esmolol is particularly useful in patients with elevated arterial pressure, especially if surgery is planned. It can be discontinued abruptly if necessary. This agent is normally used in conjunction with nitroprusside. It may be useful as a means of testing beta-blocker safety and tolerance in patients with a history of obstructive pulmonary disease who are at uncertain risk for bronchospasm from beta blockade. The elimination half-life of esmolol is 9 minutes. Labetalol (Trandate) View full drug information Labetalol blocks alpha1-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure. Propranolol (Inderal LA, InnoPran XL) View full drug information A class II antiarrhythmic nonselective beta-adrenergic receptor blocker, propranolol has membrane-stabilizing activity and decreases the automaticity of contractions. It is not suitable for emergency treatment of hypertension; it should not be administered IV in hypertensive emergencies. Metoprolol (Lopressor, Toprol-XL) View full drug information Metoprolol is a selective beta 1-adrenergic receptor blocker that decreases the automaticity of contractions. During IV administration, carefully monitor blood pressure, heart rate, and electrocardiograms. When considering conversion from IV to oral (PO) dosage forms, use the ratio of 2.5 mg PO to 1 mg IV. Nitroprusside (Nitropress) View full drug information Nitroprusside causes peripheral vasodilation by acting directly on venous and arteriolar smooth muscle, thus reducing peripheral resistance. This agent is commonly used IV because of its rapid onset and short duration of action. It is easily titrated to the desired effect. Because nitroprusside is light-sensitive, both bottle and tubing should be wrapped in aluminum foil. Before initiating nitroprusside therapy, administer a beta blocker to counteract the physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response will increase the shear forces against the aortic wall, thus increasing dP/dt. The objective is to keep the heart rate between 60 and 80 beats/min. Morphine sulfate (Astramorph, Infumorph, Duramorph) Fentanyl citrate Question 41 1 out of 1 points Which of the following is not a symptom of irritable bowel syndrome? Symptoms are: Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement Excess gas Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation Weight loss Diarrhea at night Rectal bleeding Iron deficiency anemia Unexplained vomiting Difficulty swallowing Persistent pain that isn't relieved by passing gas or a bowel movement Mucus in the stool Question 42 1 out of 1 points Impetigo and folliculitis are usually successfully treated with: Topical antibiotics Question 43 1 out of 1 points Which of the following is not a risk factor for coronary arterial insufficiency? Risks are: Older age: Over age 45 years in men and over age 55 years in women Family history of early heart disease Race: Among persons with CAD, the cardiovascular death rate for African Americans is reported to be particularly high; in Asians, low levels of high-density lipoprotein cholesterol (HDL-C), which are considered to be a risk factor for coronary heart disease, appear to be especially prevalent; South Asians appear to have a higher independent risk for cardiovascular disease as well. High blood cholesterol levels (specifically, low-density lipoprotein cholesterol [LDLC]) High blood pressure Cigarette smoking: Cessation of cigarette smoking constitutes the single most important preventive measure for CAD Diabetes mellitus [1] Obesity Lack of physical activity Metabolic syndrome Mental stress and depression Question 44 1 out of 1 points The most appropriate treatment for a child with mild croup is: a cool mist vaporizer. Question 45 1 out of 1 points 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? psoriasis. Question 46 1 out of 1 points Appropriate therapy for peptic ulcer disease (PUD) is: **In general, 6-8 weeks of therapy with a PPI is required for complete healing of a duodenal ulcer. Active ulcers associated with NSAID use are treated with an appropriate course of PPI therapy and the cessation of NSAIDs.Eradication of H. pylori is recommended in all patients with PUD Based on etiology Question 47 1 out of 1 points An AST that is more than twice the level of ALT is suggestive of: **alcoholic liver disease, Question 48 1 out of 1 points 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 tinea pedis. What is the best initial treatment option for this patient? Prescribe an anti-fungal powder for application between her toes and in her shoes and a topical prescription strength anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection. Question 49 0 out of 1 points 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 1 out of 1 points Sandra has celiac disease. You place her on which diet? Gluten-free Question 51 1 out of 1 points 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 Question 52 1 out of 1 points Group A -hemolytic streptococcal (GABHS) pharyngitis is most common in which β age group? 6-12 Question 53 0 out of 1 points A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include: ** Question 54 1 out of 1 points Which of the following is a secondary cause of hyperlipidemia? Diabetes mellitus **Diet: excessive intake of saturated fat and/or calories, alcohol consumption, anorexia Drugs: diuretics, beta-blockers, cyclosporine, estrogen, glucocorticoids, anabolic steroids, retinoids, protease inhibitors Disease: chronic liver disease, primary biliary cirrhosis, chronic renal failure, nephrotic syndrome, Cushing’s syndrome, systemic lupus erythematosus Dysmetabolism: hypothyroidism, diabetes, obesity, insulin resistance Question 55 0 out of 1 points 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? a vestibular neurectomy Question 56 1 out of 1 points 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? Staphylococcus aureus Question 57 0 out of 1 points The nurse practitioner is performing a physical exam on a middle-aged AfricanAmerican man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? The most common site of melanoma in African Americans is the feet, with 60% of patients having subungual or plantar lesions Question 58 0 out of 1 points 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? ***Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you'll probably have a follow-up endoscopy in one year and then every three years if no changes occur. Treatment for GERD. Medication and lifestyle changes can ease your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option. Treating GERD doesn't treat the underlying Barrett's esophagus and likely won't decrease the risk of esophageal cancer, but can help make it easier to detect dysplasia. Endoscopic resection, which uses an endoscope to remove damaged cells. Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection. Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells. Photodynamic therapy, which destroys abnormal cells by making them sensitive to light. Surgery in which the damaged part of your esophagus is removed, and the remaining portion is attached to your stomach Question 59 1 out of 1 points 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? An ACE inhibitor Question 60 1 out of 1 points 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. Question 61 0 out of 1 points A patient presents to the office with a blood pressure 142/80. This patient is classified as having: HB stage 1 High Blood Pressure (Hypertension) Stage 1 Systolic: From 140 to 159 Diastolic: From 90 to 99 High Blood Pressure (Hypertension) Stage 2 Systolic: 160 or higher Diastolic: 100 or higher Hypertensive Crisis (Emergency care needed) Systolic: Higher than 180 Diastolic: Higher than 110 Question 62 1 out of 1 points 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 Question 63 1 out of 1 points 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: A purulent discharge. Question 64 0 out of 1 points 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? ** This class is called the ACE inhibitors. Some examples of ACE inhibitors include lisinopril, captopril, and ramipril. The cough is generally a dry one but can be quite annoying. 99 erick ** enalapril? Question 65 0 out of 1 points Which choice below is least effective for alleviating symptoms of the common cold? antibiotics liberal intake of fluids adequate rest Aspirin warm clothing Question 66 0 out of 1 points 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 0 out of 1 points 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? About 10% of affected persons become carriers and are at increased risk for hepatocellular carcinoma. Question 68 1 out of 1 points The most common correlate(s) with chronic bronchitis and emphysema is(are): Smoking Question 69 1 out of 1 points If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Iritis Question 70 1 out of 1 points Treatment of H.pylori includes which of the following? Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate A and B A, B, and C my answer Question 71 1 out of 1 points Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? pneumonia Question 72 1 out of 1 points What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Certain chemicals, such as ursodiol or chenodiol, Question 73 1 out of 1 points Which of the following best describes hypertrophic cardiomyopathy? of heart disease that affects the heart muscle. It causes thickening of the heart muscle (especially the ventricles, or lower heart chambers), left ventricular stiffness, mitral valve changes and cellular changes. Question 74 1 out of 1 points Amaurosis fugax is described as a: is a painless temporary loss of vision in one or both eyes. Transient and periodic Question 75 1 out of 1 points 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: **? A common cause of conductive hearing loss in adults ages 20 - 40 is otosclerosis, a gradual hardening of the tympanic membrane that causes the footplate of the stapes to become fixed in the oval window. Presbycusis, a progressive, bilaterally symmetrical perceptive hearing loss arising from structural changes in the hearing organs, usually occurs after age 50. Trauma may result in a conductive hearing loss, but this is certainly not common. Question 76 0 out of 1 points Which of the following heart murmurs warrants the greatest concern? ** Murmurs that occur during diastole are NEVER INNOCENT and should always raise concern and indicate further investigation Question 77 0 out of 1 points 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: Rhabdomyolysis- Drug interaction Question 78 0 out of 1 points Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? (HTN stage 2) ***First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs. • Second- and third-line alternatives included higher doses or combinations of ACE inhibitors, ARBs, thiazide-type diuretics, and CCBs. Several medications are now designated as later-line alternatives, including the following: beta-blockers, alphablockers, alpha1/beta-blockers (eg, carvedilo), vasodilating beta-blockers (eg, nebivolol), central alpha2/-adrenergic agonists (eg, clonidine), direct vasodilators (eg, hydralazine), loop diruretics (eg, furosemide), aldosterone antagoinsts (eg, spironolactone), and peripherally acting adrenergic antagonists (eg, reserpine). ACE inhibitors and ARBs should not be used in the same patient simultaneously. • CCBs and thiazide-type diuretics should be used instead of ACE inhibitors and ARBs in patients over the age of 75 years with impaired kidney function due to the risk of hyperkalemia, increased creatinine, and further renal impairment. Question 79 0 out of 1 points Of the following, the patient who should be referred for periodic colonoscopy is the patient with: Question 80 0 out of 1 points Dana has ischemic arterial ulcers. What is your first priority when counseling her? Tell her to reduce risk factors to improve tissue perfusion Question 81 1 out of 1 points 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? A low fat, tyramine-free, caffeine-free, high fiber diet, along with a daily diary, and attention to psychosocial factors. Question 82 1 out of 1 points 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?