NURS 5463 Exam 2 questions and answers.

NURS 5463 Exam 2 vv vv vv




1.A 65-year-old male with no prior medical history presents to the ED with
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a complaint of low back pain and fatigue x1 month. The pain is constant, a
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dull ache, does not radiate and has progressively gotten worse. Lab results:
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WBC 5,000, Hgb 7.0 g/dL, HCT 30%, MCV 80%, platelets 500,000, creatinine
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1.0 mg/dL, BUN 15 mg/dL, Na 135 mEq/L, potassium 3.5 mEq/L, calcium is
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10.5 mg/dL, Alkaline Phosphatase is 300 units/L. A lumbar x-ray shows lytic
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lesions. It is most important for the AGACNP to perform an exam on which
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body part/system?
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a.) Pulmonary Exam vv




b.) Cardiovascular exam vv




c.) Rectal Exam vv




d.) Abdominal Exam: c.) Rectal Exam vv vv vv vv




Rationale:
The patient has many manifestations which are concerning for a
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malignant process. A normocytic anemia in a male is never normal and
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should concern the AGACNP for a possible malignancy. Hypercalcemia
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with an elevated alkaline phosphatase is concerning for bone issues and
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coupled with lytic lesions on the lumbar vertebrae is very concerning for
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a malignancy. The most likely malignancy in this patient is prostate
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cancer, therefore the AGACNP should perform a rectal examination to
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assess the prostate. Prostate cancer most commonly metastasizes to the
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vertebrae.
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2.A female patient presents to your office for follow up after having a CT of
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the abdomen and pelvis completed to evaluate a complaint of abdominal pain.
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The CT scan showed liver lesions consistent with metastatic cancer with an
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unknown primary site. Her mother died from colon cancer. Which intervention
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should the AGACNP complete next?
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a.) Order an echocardiogram vv vv




b.) Complete a referral to hospice vv vv vv vv




c.) Refer for a preoperative cardiac evaluation vv vv vv vv vv




d.) Refer to GI for a colonoscopy: d.) Refer to GI for a colonoscopy
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Rationale:
The next stage in this patient's evaluation is to search for the primary
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cancer site, obtain a tissue biopsy and assess for any other sites of
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metastasis. The most likely location of the primary cancer is the colon.
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Colon cancer commonly metastasizes to the liver and she needs a
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colonoscopy.
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, NURS 5463 Exam 2
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3.A 20-year-old male expresses concern about testicular cancer and wants
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to know if he should perform testicular self-examinations. Which response
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from the AGACNP best demonstrates their knowledge of current recommen-
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, NURS 5463 Exam 2 vv vv vv




dations?
a.) Testicular self-examinations are no longer recommended. vv vv vv vv vv




b.) Testicular self-examinations should be done monthly, after a hot shower. vv vv vv vv vv vv vv vv vv




c.) Testicular self-examinations are ineffective, and your PCP should draw an vv vv vv vv vv vv vv vv vv




AFP level.
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d.) Testicular examinations should only be done by your primary care vv vv vv vv vv vv vv vv vv




provider.: a.) Testicular self-examinations are no longer
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recommended.
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Rationale:
Currently the USPSTF, the American Academy of Physicians and the
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American Academy of Pediatrics do not recommend testicular self-
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examinations because there is no data to support their effectiveness. vv vv vv vv vv vv vv vv vv




4.A 68-year-old female presents to the ED for a complaint of intermittent
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vaginal bleeding for the last two months. She is post-menopausal and has no
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other complaints. Vitals and exam are normal. Which diagnostic test should
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the AGACNP order next?
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a.) CT of the abdomen and Pelvis vv vv vv vv vv




b.) Gonorrhea and chlamydia screening vv vv vv




c.) Transvaginal Ultrasound vv




d.) Chest X-ray: c.) Transvaginal Ultrasound vv vv vv vv




Rationale:
This patient's symptoms are concerning for endometrial cancer. She
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requires a transvaginal US to assess the uterine endometrium.
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5.A patient with colon cancer is 5 days status post her cycle of chemotherapy.
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She presents to the ED with a fever of 101. Her ANC is 400. Which level of care
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does this patient require?
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a.) Intensive care vv




b.) Medical Floor vv




c.) Step down unit vv vv




d.) Discharge home: b.) Medical Floor vv vv vv vv




Rationale:
Any patient with a fever and neutropenia should be admitted. There are
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no clinical indicators in the question to suggest she needs a step-down
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unit or ICU, therefore admission to the medical floor is most
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appropriate.
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6.You are asked to admit a 45-year-old female with a brain tumor to your
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