NR 511 Final Exam 2021
A factory line worker has Osteoarthritis (OA) of the right hand. According to the American
College of Rheumatology (ACR), the guidelines for pharmacologic treatment include:
Topical capsaicin, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral
NSAIDs.
For an adult patient with a knee injury, the nurse practitioner orders for a nonsteroidal anti-
inflammatory drug (NSAID) to be taken on a routine basis for the next two weeks. Patient
teaching should include which of the following?
If you have additional pain, an occasional acetaminophen (Tylenol) is permitted in
between the usual doses of NSAID.
A 13 year old obese (body mass index BMI above the 95th percentile) boy reports low-grade left
knee pain for the past two months. He denies antecedent trauma but admits to frequent
‘horseplay’ with his friends. The pain has progressively worsened, and he is now unable to bear
weight on his left leg. His current complaints include left groin, thigh and medial knee pain and
tenderness. His examination demonstrates negative drawer, Lachman and McMurray tests, left
hip with decreased internal rotation and abduction, and external hip rotation with knee flexion.
Based on the above scenario, the nurse practitioner should suspect:
A slipped capital femoral epiphysis (SCFE)
During assessment of a client’s foot, the nurse practitioner notes that the foot is in alignment with
the long axis of the lower leg and that weight bearing falls on the middle of the foot from the heel,
along the midfoot, to between the second and the third toes. These findings best describe:
A normal foot
Sam, age 50, presents with Paget disease that has been stable for several years. Recently, his serum
alkaline phosphatase level has been steadily rising. The nurse practitioner determines that it is
,time to start him on pharmacologic management. Which of the following should she initially
prescribe?
Biphosphonates
You are caring for a patient who has a history of psoriasis and is now showing signs of joint
involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PSA). The initial
treatment choice of management of the patient is:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
A 55 year old patient presents with complaints of paresthesias in the lower lateral arm, thumb and
middle finger. The nerve roots most commonly related to these symptoms are C6 and C7. The
most likely diagnosis would be:
Cervical radiculopathy
Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome.
The nurse practitioner’s next step is:
Try neutral position wrist splinting and order an oral nonsteroidal anti-inflammatory drug
(NSAID).
Janine, age 69, has class III rheumatoid arthritis. According to the American Rheumatism
Association, which of the following describes her ability to function?
Adequate to perform only for a few or none of the duties of usual occupation or self-care.
James, age 17, has been complaining of a painful knob below his right knee that has prevented
him from actively participating in sports. He has recently been given a diagnosis of Osgood-
Schlitter disease and asks you about his treatment options. The nurse practitioner should tell him
that the initial treatment is:
, Relative rest; he could benefit from hamstring, heel cord and quadriceps stretching
exercises
Daniel, age 45, is of Northern European ancestry and has a dysfunctional and disfiguring
condition affecting the palmar tissue under the skin of the distal palm and fourth and fifth fingers.
What do you suspect?
Dupuytren contracture
A patient, aged 49, comes in with low back pain. An x-ray of the lumbosacral spine is within
normal limits. Which of the following diagnoses do you explore further?
Herniated nucleus pulposus
Jill, age 49, has recently began a rigorous weightlifting regimen. She presents to the primary care
office with a shoulder dislocation. Which of the following clinical manifestations leads the nurse
practitioner to suspect an anterior shoulder dislocation over a posterior dislocation?
Inability to shrug the shoulder
In assessing a patient, you place the tip of your first 2 fingers in front of each ear and ask the
patient to open and close his mouth. Then you drop your fingers into the depressed area over the
joint and assess for smooth motion of the mandible. With this action you are checking for?
Temporomandibular joint syndrome
Karen, who is post-menopausal, is taking 1200mg of calcium daily, but does not understand why
she also needs to take vitamin D. you tell her that:
Vitamin D increases intestinal absorption of dietary calcium and mobilizes calcium from
the bones.
, Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence and
progressive loss of strength in the legs. You suspect cauda equine syndrome. What is your next
action?
Referring to neurosurgeon
Lois, age 52, who has just been given a diagnosis of sarcoidosis, has joint symptoms, including
arthralgia and arthritis. Your next plan of action would be to:
Begin a course of glucocorticoids
A 55 year old patient is able to complete range of motion (ROM) against gravity with some
resistance. The nurse practitioner would assign which of the following numerical grades to this
manual muscle testing description?
4
Marsha, age 24, is preparing for radioactive iodine therapy for her Grave’s disease. Which test
must she undergo first?
Beta-human chorionic gonadotropin
Eunice, age 32, has Type 2 diabetes. She said she heard she should take an aspirin a day after she
reaches menopause for its cardio-protective action. She does not have coronary artery disease, but
her father does. How do you respond?
The American Diabetes Association recommends that you start on low-dose aspirin
therapy now
Mr. Reynold is on the anti-thyroid drug (ATD) methimazole (Tapazole), so you make it a point to
check his:
Complete blood count (CBC) and liver transaminases
A factory line worker has Osteoarthritis (OA) of the right hand. According to the American
College of Rheumatology (ACR), the guidelines for pharmacologic treatment include:
Topical capsaicin, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral
NSAIDs.
For an adult patient with a knee injury, the nurse practitioner orders for a nonsteroidal anti-
inflammatory drug (NSAID) to be taken on a routine basis for the next two weeks. Patient
teaching should include which of the following?
If you have additional pain, an occasional acetaminophen (Tylenol) is permitted in
between the usual doses of NSAID.
A 13 year old obese (body mass index BMI above the 95th percentile) boy reports low-grade left
knee pain for the past two months. He denies antecedent trauma but admits to frequent
‘horseplay’ with his friends. The pain has progressively worsened, and he is now unable to bear
weight on his left leg. His current complaints include left groin, thigh and medial knee pain and
tenderness. His examination demonstrates negative drawer, Lachman and McMurray tests, left
hip with decreased internal rotation and abduction, and external hip rotation with knee flexion.
Based on the above scenario, the nurse practitioner should suspect:
A slipped capital femoral epiphysis (SCFE)
During assessment of a client’s foot, the nurse practitioner notes that the foot is in alignment with
the long axis of the lower leg and that weight bearing falls on the middle of the foot from the heel,
along the midfoot, to between the second and the third toes. These findings best describe:
A normal foot
Sam, age 50, presents with Paget disease that has been stable for several years. Recently, his serum
alkaline phosphatase level has been steadily rising. The nurse practitioner determines that it is
,time to start him on pharmacologic management. Which of the following should she initially
prescribe?
Biphosphonates
You are caring for a patient who has a history of psoriasis and is now showing signs of joint
involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PSA). The initial
treatment choice of management of the patient is:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
A 55 year old patient presents with complaints of paresthesias in the lower lateral arm, thumb and
middle finger. The nerve roots most commonly related to these symptoms are C6 and C7. The
most likely diagnosis would be:
Cervical radiculopathy
Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome.
The nurse practitioner’s next step is:
Try neutral position wrist splinting and order an oral nonsteroidal anti-inflammatory drug
(NSAID).
Janine, age 69, has class III rheumatoid arthritis. According to the American Rheumatism
Association, which of the following describes her ability to function?
Adequate to perform only for a few or none of the duties of usual occupation or self-care.
James, age 17, has been complaining of a painful knob below his right knee that has prevented
him from actively participating in sports. He has recently been given a diagnosis of Osgood-
Schlitter disease and asks you about his treatment options. The nurse practitioner should tell him
that the initial treatment is:
, Relative rest; he could benefit from hamstring, heel cord and quadriceps stretching
exercises
Daniel, age 45, is of Northern European ancestry and has a dysfunctional and disfiguring
condition affecting the palmar tissue under the skin of the distal palm and fourth and fifth fingers.
What do you suspect?
Dupuytren contracture
A patient, aged 49, comes in with low back pain. An x-ray of the lumbosacral spine is within
normal limits. Which of the following diagnoses do you explore further?
Herniated nucleus pulposus
Jill, age 49, has recently began a rigorous weightlifting regimen. She presents to the primary care
office with a shoulder dislocation. Which of the following clinical manifestations leads the nurse
practitioner to suspect an anterior shoulder dislocation over a posterior dislocation?
Inability to shrug the shoulder
In assessing a patient, you place the tip of your first 2 fingers in front of each ear and ask the
patient to open and close his mouth. Then you drop your fingers into the depressed area over the
joint and assess for smooth motion of the mandible. With this action you are checking for?
Temporomandibular joint syndrome
Karen, who is post-menopausal, is taking 1200mg of calcium daily, but does not understand why
she also needs to take vitamin D. you tell her that:
Vitamin D increases intestinal absorption of dietary calcium and mobilizes calcium from
the bones.
, Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence and
progressive loss of strength in the legs. You suspect cauda equine syndrome. What is your next
action?
Referring to neurosurgeon
Lois, age 52, who has just been given a diagnosis of sarcoidosis, has joint symptoms, including
arthralgia and arthritis. Your next plan of action would be to:
Begin a course of glucocorticoids
A 55 year old patient is able to complete range of motion (ROM) against gravity with some
resistance. The nurse practitioner would assign which of the following numerical grades to this
manual muscle testing description?
4
Marsha, age 24, is preparing for radioactive iodine therapy for her Grave’s disease. Which test
must she undergo first?
Beta-human chorionic gonadotropin
Eunice, age 32, has Type 2 diabetes. She said she heard she should take an aspirin a day after she
reaches menopause for its cardio-protective action. She does not have coronary artery disease, but
her father does. How do you respond?
The American Diabetes Association recommends that you start on low-dose aspirin
therapy now
Mr. Reynold is on the anti-thyroid drug (ATD) methimazole (Tapazole), so you make it a point to
check his:
Complete blood count (CBC) and liver transaminases
