Final exam nov 15, 2021 NRNP 6531

Final exam nov 15, 2021 NRNP 6531 An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area with her hand. Which of the following conditions is most likely? - ANS Abdominal aortic aneurysm Which of the following laboratory test is sensitive for evaluating the renal function - ANS Estimated glomerular filtration rate (eGFR) Which of the following groups has been recommended to be screened for thyroid disease? - ANS Women aged 50 years or older All of the following patients should be screened for diabetes mellitus except: - ANS A 30-year-old White man with hypertension A 40-year-old White woman with a body mass index (BMI) of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During the physical exam, the nurse practitioner presses deeply on the left lower quadrant of the abdomen and the patient complains of pain on the right side of the lower abdomen. What is the name of this finding? - ANS Rovsing's sign Which of the following symptoms characterize this disorder? - ANS 1.Ritualistic behaviors that the patient feels compelled to repeat. 2. increased axiety when attempting to ignore or suppress the repetitive behaviors. ent intrusive and repetive thoughts and impluses All the above Which of the following medications is indicated for the treatment of obsessive-compulsive disorder? - ANS Paroxetine (paxil CR) Which of the following conditions is most likely? - ANS Injury to the meniscus of the right knee Which of the following actions is the best course for patient? - ANS Refer him to an orthopedic specialist The patient's symptoms are highly suggestive of what condition? - ANS A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. - ANS Angina pectoris A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. Which of the following would you recommend to this 55-year-old patient? - ANS Consult ith a cardiologist for further evaluation A faun tail nevus is a sign of which of the following? - ANS Spina bifida A new mother is planning to breastfeed her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) during the first few days of life? - ANS Vit D drops An asthmatic exacerbation is characterized by all of the following symptoms except: - ANS Chronic coughing A 76-year-old woman reports that for the previous 4 months, she has noticed severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having a difficult time getting out of bed because of the severe stiffness and pain. It is difficult for her to put on a jacket or blouse or to fasten her bra. Along with these symptoms, she also has a low-grade fever, fatigue, loss of appetite, and weight loss. Starting yesterday, the vision in her right eye has progressively worsened. She has annual eye exams and denies that she has glaucoma. Which of the following conditions is most likely? - ANS Polymyalogia rheumatic (PMR) A 28-year-old woman with a history of hypothyroidism presents to an urgent care clinic complaining of numbness and tingling in the fingertips of both her hands for several hours. On examination, both radial pulses are at +2 and equal bilaterally. The patient reports that over the past few months she has had identical episodes, each lasting several hours. During these episodes, the skin changes color from blue to white, and then to dark red. Eventually, it returns to normal and the tingling and numbness disappear. Which of the following conditions is best described? - ANS Raynaud's phenomenon A fracture on the navicular area of the wrist is usually caused by falling forward and landing on the hands. The affected wrist is hyperextended to break the fall. The nurse practitioner is aware that all of the following statements are true regarding a fracture of the scaphoid bone of the wrist except: - ANS These fractures always require surgical intervention to stabilize the joint Glucosamine sulfate is a natural supplement that is used for which of the following conditions? - ANS Osteoarthritis The best form of aerobic exercise for a patient with severe rheumatoid arthritis is: - ANS Swimming The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant? - ANS Rule out any physiological cause for the crying spells A 22-year-old sexually active woman is complaining of amenorrhea and new-onset bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner order initially? - ANS Urine pregnancy test A 44-year-old woman who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure (BP) is 160/80 mmHg, pulse is 110 beats/min, and she is afebrile. Her labs reveal mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? - ANS Inevitable abortion The Pap smear result for a 22-year-old sexually active college student whose partner uses condoms inconsistently reveals a large number of white blood cells and blood along with inflammatory changes. During the speculum exam, the cervix bled very easily (friable), and a small amount of purulent discharge was present on the cervical surface. No cervical motion tenderness was noted during the bimanual vaginal exam. What is the next step in the management of this patient? - ANS Advise the patient be tested for chlamydia and gonorrhea All of the following are infections that affect mostly the labia and vagina except: - ANS Chlamydia trachomatis Medicare Part B will pay for all of the following services except: - ANS Eyeglasses and routine dental care Which of the following individuals is more likely to be affected by alpha thalassemia anemia? - ANS 25-year-old Chinese patient A nurse practitioner's right to practice is regulated under: - ANS The board of nursing A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered: - ANS Presumptive signs of pregnancy A new patient who is a 40-year-old female postal worker is being evaluated for complaints of a new-onset erythematous rash on both cheeks and the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with Synthroid 1.25 mg daily. Which of the following conditions is most likely? - ANS Lupus erythematosus A woman at 32 weeks gestation has a positive throat culture for Streptococcus pyogenes (strep throat). She denies allergies but becomes very nauseated with erythromycin. Which of the following is the best choice for this pregnant patient? - ANS Penicillin (Pen VK) The treatment plan of patients with AIDS who have CD4 counts of less than 200 cells/mm3 should emphasize: - ANS Preventive therapy for PCP What type of testing is recommended before starting a patient on a prescription of hydroxychloroquine (Plaquenil)? - ANS Comprehensive eye exam Pulsus paradoxus is best described as: - ANS A decrease in systolic blood pressure on inspiration Patients with Down syndrome are at higher risk for all of the following except: - ANS Melanoma An 18-year-old college student, who is sexually active, wants to start taking birth control pills. The nurse practitioner at the college health clinic explains the risks and benefits of combined oral contraceptives to the patient. All of the following are appropriate laboratory tests for this patient except: - ANS Pap smear Which of the following is the best method to diagnose a vaginal trichomonas infection? - ANS Wet smear with microscopy You are reviewing the bilirubin level of a 3-day-old full-term neonate. You note that it is 10 mg/dL. The infant has a slight yellow color to his skin, mucous membranes, and sclera. The infant is feeding well, is not irritable, and has eight to 10 wet diapers per day. Which of the following is a true statement? - ANS Keep monitoring the infant's bilirubin level until it returns to normal in about 1 week All of the following clinical signs are seen in patients with Parkinson's disease except: - ANS Increased facial movements due to tics Your female patient of 10 years is concerned about her most recent diagnosis. She was told by her dermatologist that she has an advanced case of actinic keratosis. Which of the following is the best explanation for this patient? - ANS It is a precancerous lesion and needs to be followed up with her dermatologist A 13-year-old girl has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. Which of the following antibiotics is the best choice? - ANS Azithromycin (Zithromax) An asthmatic 20-year-old woman who was seen for a viral upper respiratory infection 2 weeks ago presents to the nurse practitioner's office complaining of a recent onset of shortness of breath, inspiratory and expiratory wheezing, and chest tightness. She has been using her albuterol inhaler four to six times a day with poor relief. She is unable to speak in full sentences. When the nurse practitioner quickly evaluates the patient, she notices that the patient is pale, diaphoretic, fatigued, and using her sternocleidomastoid accessory muscles for respiration. Her respiratory rate is 32 breaths/min and pulse is 130 beats/min. Which of the following interventions is not indicated? - ANS Initiate cardiopulmonary resuscitation (CPR) immediately A 67-year-old woman with a 30-pack-year history of smoking presents for a routine annual physical examination. She complains of being easily short of breath and is frequently fatigued. Physical examination reveals diminished breath sounds, hyperresonance, and hypertrophied respiratory accessory muscles. Her complete blood count (CBC) results reveal that her hematocrit level is elevated. Her pulmonary function test (PFT) results show increased total lung capacity. What is the most likely diagnosis for this patient? - ANS Chronic obstructive pulmonary disease (COPD) Signs and symptoms of depression include all of the following except: - ANS Apraxia All of the following are considered category X drugs except: - ANS Meperidine (Demerol) A patient who is complaining of a new onset of severe headache is being examined. The patient is instructed to lie down on the examining table while the nurse practitioner flexes his head and neck forward to his chest. The patient reacts by quickly flexing his hip and knee. What is the name of this positive finding? - ANS Brudzinski's sign Which of the following findings is associated with B12 deficiency anemia? - ANS Tingling and numbness of both feet A 70-year-old man with open-angle glaucoma is prescribed Betimol (timolol) ophthalmic drops. All of the following are contraindications to Betimol ophthalmic drops except: - ANS Migraine headaches Which of the following murmurs can radiate to the neck? - ANS Aortic stenosis