Nurs 6531 Midterm Exam (100% Correct answers) | Guaranteed Pass

Nursing 6531 Midterm Exam Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Acute Bronchitis Your patie nt Jerry has gout. What do you suggest? No purine foods Which of the following heart murmurs warrants the greatest concern? Diastolic murmur Which of the following color changes in a pigmented lesion suggests malignant transformation? All color changes An adult presents with tinea corporis. Which item below is a risk factor for its development? Steriod use 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? Hepatitis Panel 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? Antihistamines 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: No purulent drainage Which of the following can result from chronic inflammation of a meibomian gland? Chalazion 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? Blepharitis Risk factors for acute arterial insufficiency include which of the following? All the above Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? Not a rescue drug The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every: Every five years over age 50 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? Beta Blockers 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? Trauma 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? Not sure but I think its Hepatitis antibodies with negative core antibodies 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? Nails and Feet Which of the following is a predisposing condition for furunculosis? Diabetes 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? Low salt and rest 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? Nasal decongestant 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: Gonoccological conjunctivitis Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? Macrolid Clarithromycin Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction? Powder 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 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 500mg Which of the following are classic features of ulcerative colitis? Relapse remittent bloody diarrhea, abdominal cramping, etc. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? CT scan or ultrasound Which intervention listed below is safe for long term use by an adult with constipation? Bulk forming agents (fiber) What prophylactic medication is commonly recommended for the patient under 35 years of age with a positive PPD? Isoniazid (INH) 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? Herpes Zoster Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? BPH Which type of lung cancer has the poorest prognosis? Small cell carcinoma The most common correlate(s) with chronic bronchitis and emphysema is(are): Smoking The most common cancer found on the auricle is: Basal cell carcinoma What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Urosolis Impetigo and folliculitis are usually successfully treated with: Topical antibiotics 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 A 58 year old complains of tightness in his chest while cutting firewood. It disappears quickly if he stops chopping. He denies shortness of breath, his total cholesterol level is less than 200 mg/dL, and he is a non-smoker. What is the most appropriate action for the nurse practitioner to take with this patient? Cardiac in nature 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? Powder and topical antifungal, watch for secondary infection Of the following choices, the least likely cause of cough is: Pharyngitis Which of the following best describes hypertrophic cardiomyopathy? Decreased Ventricular filling and weak muscle Which of the following patient characteristics are associated with chronic bronchitis? Overweight, cyanotic, normal or slight increase in RR 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? Take BP lying, sitting, and standing The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following? Fever, Cervical lymphadenopathy, red sore throat with or without exudate, NO COUGH Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to: Not sure 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? Moderate persistent Of the following, the patient who should be referred for periodic colonoscopy is the patient with: Ulcerative colitis long duration 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: Cant remember but it was small something 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 with immunocompromised Which of the following is not a goal of treatment for the patient with cystic fibrosis? Water soluble vitamins Which of the following is not a risk factor for coronary arterial insufficiency? Alcohol Treatment of acute vertigo includes: Not sure Acute rheumatic fever is an inflammatory disease which can follow infection with: Strep A 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? Acute appendicitis 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 A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Topical antibiotics and warm compress An AST that is more than twice the level of ALT is suggestive of: Alcoholic liver An 18 year old patient is afebrile and complains of severe left ear pain. On examination, the TM is gray and intact and there is a green discharge in the external canal. What action by the nurse practitioner is most appropriate? Otic antibiotic/corticosteriod 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: Get EGD, manometry, etc. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: Acute cholecystitis 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? Bacterial pharyngitis 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? Give antibiotic What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? Dr. must be present during visit and active in care 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 and GERD 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: STOP smoking What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years? Chronic Bronchitis If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Iritis Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? Multilobar infection Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Weight gain 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: Less than 100 Appropriate therapy for peptic ulcer disease (PUD) is: Depends on eitology Which of the following is not a symptom of irritable bowel syndrome? Weight loss Risk factors for acute otitis media (AOM) include all of the following except: African American 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? Bill services so you can avoid missed billable service that leads to missed revenue. 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? Renal workup John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? Every 5 years 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 Martha had a less than 7% value on her Schilling test. What medication do you anticipate she might need? Vitamin B12 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? Lupus 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 infarct Which of the following statements about malignant melanomas is true? Staged based on depth of lesion An 18 year old 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? Tonsillar abscess 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? Get a barium enema and sigmoid test 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: CT scan Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued? Nifedipine (Calcium channel blocker) A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: Can be cured with removal and chemo Sandra has celiac disease. You place her on which diet? No gluten The differential diagnosis for a patient complaining of a sore throat includes which of the following? I think all of the above: candidiasis, gonorrhea, leukoplakia Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Candidiasis 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? Add thiazide diuretic Which of the following is a secondary cause of hyperlipidemia? Diabetes 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: Chronic diarrhea When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? 75% of salt comes from processed foods 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? Ace inhibitor 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: Ophthalmic shingles (herpes) What is the Gold standard for the diagnosis of asthma? Spirometry In the initial evaluation of a patient with new onset hypertension, the nurse practitioner should: Evaluate modifiable risk factors In order to decrease deaths from lung cancer: Stop smoking Treatment of H.pylori includes which of the following? Antibiotics, PPI, Bismuth subsalicylates 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? Malignant Melonoma Show Less