NURS 6560 WALDEN UNIVERSITY EXIT EXAM

NURS 6560 WALDEN UNIVERSITY EXIT EXAM 1. You see a 73-year-old woman with a 40 pack year smoking history, chronic obstruction pulmonary disease and peripheral artery disease who presents with an ulcer on the soul of her left foot. The also has an irregular edge and pale face and punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is: -arterial ulcer 2. Hey 75-year-old man presents with chief complaints of headache, Nausea, and muscle weakness. His creatinine level is 2.1 MG/DLNGFR is 30 ML/MIN/1.73 m2. He currently takes a thiazides diuretic for the management of hypertension. Which of the following statements is false regarding the use of diuretics in the elderly? -loop diuretics are contraindicated when GFR is 40 ml/min/1.73 m2 3. All of the following practices are recommended when prescribing medication with confusing or similar-sounding names except: - including either the generic or brand name on the prescription order, but not both 4. A 19-year-old is diagnosed with meningococcal meningitis. In order to prevent secondary infections among adults who had close contact with the patient, all of the following are recommended except: - Prophylaxis with acyclovir (Zovirax) 5. A 38-year-old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports early in the day she was feeling a migraine starting so she took a pill giving to her by her friend who also experience migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did see most likely take? -Almotriptan ( alert) 6. 826-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has not received any systematic anti microbials in the past year and it’s not taking any medications. She is currently not pregnant and is using etonogestrel/ estradiol vaginal ring for contraception. The local E. Coli resistance rate to TMP/SMX is about 12%. The preferred therapy for this patient is: - Trimethoprim-sulfamethoxazole 7. As part of the Deficit reduction act of 2005, Medicare will incorporate quality payment adjustments for certain hospitals-acquired conditions, including all of the following except: -Myocardial ischemic 8. Which of the following example describes a potential malpractice scenario? -A post-myocardial infraction patient is prescribed an inappropriate dose clopidogrel and experience a severe blessing episode. 9. A 57-year-old woman presents for a flu shot as she has heard reports that it will be “a bad flu season’. She has had no primary care for more than 10 years she like health insurance. She admits to a 30 pack here cigarette smoking history, currently smoking one pack for a day. Her history and examination are unremarkable. Which screening test would you recommend? - Mammography 10. A 28-year-old woman presents who complains of tugging chest pain unrelated to physical activity. She is generally in good health and non-smoker has a BMI of 23 KG/M2, and denies dyspnea of dizziness. Physical examination reveals a grade 2/6 late systolic murmur that follows a midsystoloc click at the 5th intercostal space, mid-clavicular line. An echocardiogram Fails to reveal mitral valve tissue redundancy. This can you go presentation is most consistent with: - Mitral Valve prolapse 11. A quality improvement plan characterized by Limiting variability and removing defects in a process best describes: - six sigma 12. Laboratory findings of a 28-year-old male suspected of a heart stroke can include all of the following except: - Hypermatremia 13. A 42-year-old male presents with a sudden onset of inability to tightly close the eye lid, frown, or smile on the right side. His examination is otherwise unremarkable and past medical history is unremarkable. This likely represent paralysis of cranial nerve: - VII 14. You see a 71-year-old man with atrial fibrillation and chronic obstructive pulmonary Disease who is diagnosed with community-acquired Pneumonia. His medical history does not show any drug allergies and he completed a course of respiratory fluoroquindore for the treatment of acute bacterial sinuses within the past month. Which of the following would you consider The most appropriate choice of anti-microbial? -High dose amoxicillin 15. According to the Consolidated Omnibus Reconciliation Act ( CORBA), The spouse of an eligible employee will be eligible for COBRA coverage in all of the following circumstances except when the eligible employee: - is terminated for misconduct 16. A 43-year-old woman presents in the emergency department with a chief complaint of swelling of the ankles, hands, and face. She also reports urine dad is darkly colored and foamy. Her blood pressure is 184/118 mm hg. All of the following urinalysis findings will support a diagnosis of glomerulonephritis except: - Elevated levels of ketones 17. A 78-year-old male is being treated for hypoglycemia episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable a A1C goal for this patient? - 8% 18. Tertiary Prevention activities for a 69-year-old woman with congestive heart failure and type 2 diabetes mellitus include: - Adjusting therapy to minimize dyspnea 19. A physicians employs an NP to provide service at a satellite acute care clinic. If the physician is never present at the clinic, which of the following statements is true? - The NP services should be billed under the NP’s provider number. 20. You see a 48-year-old man with a chief complaint of pain during urination. Imaging reveals the presence of a kidney stone in the ureter. Do you consider all of the following management option except: - Thiazides diuretic use 21. In managing a 58-year-old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medication due to risk of heparin induced thrombocytopenia? - Enoxaparin (lovenox) 22. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type two diabetes mellitus. An example of a secondary prevention strategy is: - Checking her blood pressure 23. All of the following persons are eligible for Medicare service except: - A 69-year-old undocumented resident in the US with atrial fibrillation 24. The NP is called to treat a 43-year-old woman for multiple contusions following a domestic violence attack. The NP realizes that one of the best predictors of a subsequent homicide of victims are domestic violence is: - History of perpetrator attempting to strangle the victim 25. When initiating therapy for a spironolactone for a patient who Is also and ace inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters? - Potassium 26. All of the following are examples of primary prevention strategies except: - performing a hemoglobin A1C for all patients admitted to the hospital 27. When considering HIPAA regulations, all the following are examples of” individual identifiable health information” except: - The number of prescriptions of oxycodone written each month by a provider 28. Which of the following statements is false regarding end-of-life decisions making for a patient that is hopelessly and terminally ill? - Advance directives are legally binding and recognized in all 50 states 29. While evaluating 833 or female with a two day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection caused by a gram-negative organism? - Nitrites 30. You are examining a 65-year-old woman with a history of rheumatic heart disease. In assessing the patient for mitral stenosis, you expect to find a heart heart murmur characterized as: -localized low-pitch late diastolic heard best at apex. 31. The privacy rule established by the US health department and human services in 1996 Implemented the requirements for: - Health insurance portability and accountability act (HIPPA) 32. When managing elderly patients with diminish cognitive function, which of the following statements is true regarding patient’s competence for making in form healthcare decisions? - only a court can appoint a guardian to make decisions for a patient declared incompetent 33. A 17-year-old male is admitted after experiencing sudden, severe pain in the scrotum during the night. Physical examination reveals swelling of the scrotum and the loss of cremasteric reflex. His heart rate is 110 bpm, Blood pressure 150/80 mm hg, and temperature 99.8 F. There’s most likely represents: - testicular torsion 34. In considering treatment for Jane in the previous question, which of the following would be most appropriate if she has a history of penicillin allergy? - amoxicillin 35. All of the following are required Medicare terms and conditions for paying NP service except: - separate charges are billed for NP services and facility charges 36. The NP is called to evaluate a 57-year-old man who reports episodes of acute angina with physical exertion. He is currently taking an ace inhibitor and low-dose aspirin. The NP considers which of the following approaches at the start of anginal symptoms? - A dose of nitroglycerin via sublingual spray 37. A 41-year-old woman is diagnosed with hypertension that requires medication. She is otherwise healthy but currently takes drospirenone/ethinyl estradiol for birth control. Which of the following antihypertensive medication would be least preferred for this patient? - Calcium channel blocker 38. The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse maculopapular rash that began on The trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalize lymphadenopathy And a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis? - Genital Herpes 39. Gary is a 63-year-old African-American male who has been treated for hypertension with ace inhibitors her monotherapy for the past six weeks. Despite carries insistence that he is taking his medication as directed, his blood pressure continues to elevated. Gary mentions that he prefers not having to take multiple medications is day due to the cost and convenience. Which of the following is the most appropriate course of action? - switch to a calcium channel blocker 40. A 15-year-old male is brought into the emergency department by his parents following a 12 hour history of nausea, family, and abdominal pain. Physical examination reveals obturator and psoas signs and a temperature of 102.6 F. Anticipated white blood cell with differential results are as follows: - Total WBC = 16,500/ mm3, Neutrophils=66%, Bands=8%, Lymphocytes=22% 41. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a bag of worms in his present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 KG/M2. He has been in a monogamous relationship for the past four months. The most likely diagnosis is: - Varicocele 42. In a patient diagnosed with infections mononucleosis, the use of amoxicillin should be avoided due to the risk: - Rash 43. Mrs. Gonzalez is a 53 old female who is being evaluated for routine follow-up care. Her medical history includes dyslipidemia; hypertension, and rheumatoid arthritis. Laboratory animal is reveals elevated serum alanine transaminase and aspartate transaminase. The long-term use of which of the following medications is the most likely cause of this finding? - Methotrexate 44. A 77 year old woman is accompanied by her husband for evaluation. She is currently being treated for metoprolol for hypertension and digoxin for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, fell into note in Porten family events such as birthdays sometime to come and confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is: - Dementia 45. A 22-year-old college student presents with a two day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and expects which are the following laboratory findings? - Lymphocytosis with atypical lymphocytes 46. Phyllis is a 34-year-old woman who presents with a chief complaint of a migraine resulting in nausea and vomiting. She reports that she experiences multiple migraines each month. She has given a prescription for sumatriptan 100-mg tablets orally to treat acute migraine pain. When counseling Phyllis about the medication, the nurse practitioner advises about all of the following adverse effects except: - Sedation 47. A 27-year-old woman is being evaluated for a seven day history of acute bacterial rhino-sinusitis. She is otherwise healthy and has not received any antimicrobial therapy in the past six months. She also has no history of drug allergy. In considering a first-line antimicrobial treatment, which of the following would be most appropriate? - Amoxicillin-clavulanate 48. A 21-year-old female student presents at the university clinic with a nose bleed. This is her third bleeding episode in the past week she is otherwise healthy with no history of bleeding disorders. The NP advises that the appropriate first line intervention of anterior epistaxis is: -Firm pressure to the area superior to the nasal alar cartilage 49. A 49-year-old woman presents with a three day history of Burning during urination, a thin and grayish white vaginal discharge in vagina itching. Laboratory examinations common you expect to find all-of the following except: - pseudohyphae 50. You see a 77-year-old male for treatment in lacerations on his forearm. Upon examination, you notice poor skin turgor what it says on the arms and back of the hands. This is likely a sign of: - normal age related change 51. A 26-year-old male presents with a chief complaint of bilateral, intermittent itchy eyes accompanied by a rope like discharge. This is most consistent with conjunctivitis caused by: - Allergen 52. A 32 -year-old woman in her second trimester pregnancy presents with fever, flank pain, and hematuria. The NP suspects pyelonephritis. Which of The following urinalysis results would be most indicative of pyelonephritis? -White blood cell(WBC) casts 53. A 21 year old camp counselor presents for evaluation with a chief complaint of generalized itchiness. He has just returned after a week of summer camp. Physical examination reveals excoriated papules along his axillary folds and at the belt line. The NP suspects scabies and prescribes permethrin lotion. In counseling the patient on the use of permethrin, the NP mention that: - itch often persists for a few weeks after successful treatment. 54. Bill is a 46-year-old man who rushed to the emergency department at the experiencing Senate onset of edema of the lips and face and a sensation of the tightness and difficulty breathing following a wasp sting. His blood pressure is 78/52 mm hg, heart rate 120 BPM, and respiratory rate is 32/min. The course of action in caring for Bill is to administer: - Epinephrine 55. A 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He Presents with the following Laboratory results: - Hepatitis A 56. A 57-year-old woman presents with a six month old numbness of the finger tips and oral irritation. Physical examination reveals pale conjunctiva and the heart murmur. She is otherwise healthy, exercise regularly, has a BMI of 22 kg/m2, and she states she is a vegan. Hemogram results are as follows: Hg= 8.2 g/dL (12-16 g/dL) Hct =23% (36% - 42%) MCV = 135 fl ( 80 - 96 fL) - Red Blood Cell distribution width =17%, These findings are most consistent with: - vitamin B12 deficiency 57. A 23-year-old man is admitted after experiencing seizures. A witness to the seizure described how the patient fell to the ground with rigid extension of the arms and legs which was followed by A period of jerking movement and loss of consciousness. This best describes which type seizures? - Tonic-clonic 58. A 23-year-old male patient is evaluated in the early morning hours for nausea with vomiting. He had eaten some food from the fridge from the night before that “was probably to old”. The NP expects acute gastroenteritis and would expect The course of the disease over the next 48 to 72 hours to involve: - Resolution of vomiting but onset of diarrhea 59. A 64-year-old woman with chronic kidney disease presents with a chief complaint lethargy. His hemogram is as follows: Hemoglobin (Hg)=9.9 g/dL, Hematocrit (Hct)=30% - Mean cell volume(MCV)=81 fL. These findings are most consistent with: -Anemia if chronic disease 60. There is no number 60 61. A 16-year-old male presents for evaluation after a syncopal Episode at school. He reports that he has recently been experiencing bouts of lightheadedness. His blood pressure is 126/76 episode at school. He reports that he has recently been experiencing bouts of lightheadedness. His blood pressure is 126/76 mm Hg and his BMI=33 kg/m2. You notice velvet-like plaques at the naps of the neck. Laboratory assessment should include which of the following tests? -Hemoglobin A1C 62. 846-year-old man is rushed to the emergency department while experiencing an acute adrenaline crisis that presents with abdominal pain, severe vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment for this patient is an injection of: - Hydrocortisone 63. A 17-year-old male with intermittent asthma presents for routine follow-up. He explains that he experienced asthma symptoms once or twice is weak, usually during physical activity. Symptoms are promptly will leave each time with albuterol per MDI with spacer. He does not report any nighttime awakenings due to his asthma. His act score is 24 and vital signs are all within normal limits. According to the NAEPP EPR-3, what is the next step in the management of his asthma? - Continued use of SABA on an as needed basis 64. Which of the following electrocardiogram changes do you expect to find in a person with myocardial ischemia? - T wave inversion in leads I, II, and aVF 65. Clinical features of Hashimoto’s thyroiditis typically include: -presence of anti-thyroid peroxidase antibody‘s. 66. Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 Diabetes mellitus, COPD and a beta lactam allergy? -Levaquin 67.The NP is called to evaluate a 56-year-old man complaining of severe pain in the upper right abdomen that radiates to the right shoulder, nausea and vomiting, which started soon after dinner. The NP suspects a cute cholecystitis. All of the following findings would be consistent with the diagnosis except: -microcytic anemia 68. The NP is called to evaluate a 34 year old non-pregnant woman who complains of a four week history of anxiety, palpitations, diarrhea, unexplained weight loss, and sensitivity to heat. Her medical history is unremarkable and she is not taking any medications. Physical examination reveals warm moist skin and exaggerated deep tendon reflexes. The NP suspects Graves’ disease. Which of the following laboratory results would best support this diagnosis? -thyroid stimulating hormone=0.05mU/L 69. A 27-year-old male is rushed to the emergency department after experiencing a series of seizures. He has no history of neurologic disorder. His girlfriend states that he was taking multiple medications for mood disorder but recently stopped taking one of them. The most likely medication the patient discontinue is a: -benzodiazepine 70. A 68-year-old woman who resides in a long-term care facility is being treated for a urinary tract infection. Her medical history includes hypertension, peripheral artery disease, and a 35 pack year smoking history. During the evaluation, she brings to your attention a painless, pearly nodule on the upper lip. This clinical presentation most likely represents: -basal cell carcinoma 71. A 24 year old with a history of major depressive disorder is rushed to the emergency department by his friends after taking an overdose of antidepressant medication. The ingestion of which of the following medications poses the greatest risk of death for this patient? -A two week supply of nortriptyline 72. You see a 24-year-old woman of Asian and Sestri who is being evaluated for a neurologic disorder. A thorough laboratory analysis is conducted in the hemogram results are as follows: hemoglobin 10.4, hematocrit 32%, Mean cell volume (MCV) 71, Red blood cell distribution with (RDW) 13%, Red blood cells 5.5, the most likely condition associated with these hemogram results are: -beta thalassemia minor 73. And 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long acting beta agonist, and a short acting beta agonist one and as needed basis. The most important component of the initial assessment includes an: -Peak expiratory flow reading 74. A 19 year old college freshman has been urged by her friends to be evaluated for lethargy, loss of appetite, and hypersomnia over the past two weeks. You administer the Beck Depression inventory assessment and she scores at 22. This would indicate: -moderate depression 75. 35-year-old woman presents with a chief complaint of being unable to close her right eyelid tightly, frown, or Smile on the right side. She is otherwise healthy with no significant prior medical history. Inappropriate diagnostic test for this patient would be: -lyme disease antibody titer 76. The NP is called to evaluate a 72 year old woman with community acquired pneumonia. Her vital signs include temperature 101.6°F, blood pressure 106/68 mmHg, and heart rate 78 BPM, physical examination reveals increased tactile fremitus and donis to percussion at the left lung base. These findings are consistent with: -consolidation 77. The nurse practitioner is evaluating a 19-year-old male suffering from a severe headache. He has a history of headaches that lead to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache? -oxygen therapy 78. When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection? -A 43-year-old man with type two diabetes mellitus and recurrent Pyelonephritis. 79. The NP is called to evaluate a 48-year-old man who was brought to the emergency department after experiencing severe low back pain following an attempt to lift heavy furniture. He also reports a coincident loss of bowel and bladder control. This most likely indicates: -Caude equina syndrome 80. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a funny smell prior to the symptoms starting. This description is most typical of: -migraine with aura 81. A 20-year-old college student living in a campus dormitory has been diagnosed with Meningococcal meningitis. The NP decides to speak with the University health officials and inform them that: -individuals with household type or more intimate contact or at risk for infection. 91. Mr. Waugh is a 62-year-old man who has been previously diagnosed with Dilated cardiomyopathy and is being evaluated for fatigue, Edina, and shortness of breath. On examination, you expect to find: - point of maximal impulse at 6th intercostal space 2cm left of midclavicular line. 92. A A 54-year-old man is being evaluated for pain related to acute bacterial prostatitis. In considering the diagnosis and management, the NP realizes that: - perineal pain with defecation is a common complaint 93. You see a 64-year-old man with an area erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis? -herpes zoster 94. While taking the history on a 60-year-old female patient the nurse practitioner learns that she has a 15-year-old history of poorly controlled hypertension. The patient admits that another provider had told her that the high blood pressure had affected her eyes. As a result, the nurse practitioner expects that funduscopic examination will likely reveal: - General vessel narrowing 95. A 71-year-old male presents to the emergency department. He is complaining of severe abdominal pain in the right lower quadrant. Diagnostic findings to support a ruptured appendix would include all of the following except: - leukopenia 96. You are evaluating a 43-year-old woman with community-acquired pneumonia. She has no comorbidities, no reported history of drug allergies, and has not received antimicrobial therapy in the past six months. Which of the following is the most appropriate treatment choice? - Azithromycin 97. You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n): - Angiotensin-concerting enzyme (ACE) inhibitor 98. Ms. Wang is a 57-year-old female who was seen 2 weeks ago for evaluation of ongoing abdominal discomfort and nausea. Laboratory assessment reveal H. pylori and she was treated for peptic ucler disease with an appropriate antibiotic/proton-pump inhibitor combination. She returns today and admits to no real change in her symptoms. This suggestion that: - the patient could have complicated peptic ulcer disease and should be referred for endoscopy. 99. You see a 26-year-old man with moderate persistent asthma who is experiencing a severe exacerbation. Which of the following would you most likely expect when evaluating this patient? - Expiratory Wheeze 100. A 70-year-old man who lives in a long-term care facility is being evaluated following a fall. He is fairly healthy with no mobility limitations or other obvious risk factors. He is taking simvastatin for dysilpidemia as well aspirin. A caregiver who witnessed the fall reports that the patient did not try to brace himself for the fall but just”fell flat on the ground.” This likely suggests: - A possible syncopal episode requiring cardiovascular and neurological evaluation 101. Which of the following is most consistent with the hepatic enzyme profile of a person with non-alcoholic fatty liver disease? - AST=98 U/L, ALT=149 U/L 102. A 40 sexual woman presents with a 12 hour history of fever, severe pain in the upper right abdomen, and positive Murphy’s sign. Her medical history is unremarkable and she is an otherwise good health. The most likely diagnosis is: - acute cholecystitis 103. You see a 54-year-old man living in subsidize housing with a history of hypertension. He states that he stopped taking his high blood pressure medication about four months ago because of calls. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of his patient, you would expect to detect an S4 sound heard during: - Late Diastole 104. A 47-year-old woman reports that her long-time boyfriend was recently diagnosed with liver cancer possibly caused by a chronic hepatitis B infection. Though she does not have symptoms, she wants to be checked for hepatitis B. She can’t recall if she has ever been vaccinated for hepatitis B. The laboratory results are as follows: Hepatitis B surface antigen positive, hepatitis B surface antibody negative, total hepatitis B core antibody positive, IgM antibody to hepatitis B core antigen negative. These findings are most consistent with: -Chronic hepatitis B