NR 511 CEA Exam | Questions and Answers (Complete Solutions)

NR 511 CEA Exam | Questions and Answers (Complete Solutions) Your 22 year old male patient states during his review of systems that his scrotum is very enlarged and feels like it is full a powerlifter and works as a trash collector. You suspect the patient likely has which of the following diagnoses? A -Varicocele B -Meningocele C -Rectocele D -Hydrocele The point of maximum impulse (PMI) is MOST often palpable in healthy adults when positioned in the supine or left lateral decubitus position. Which one of the following locations is most commonly described as the PMI in a healthy adult? A -Left 2nd intercostal space, midaxillary line B -Left 5th intercostal space, midclavicular line C -Right 4th intercostal space, midaxillary line D -Right 2nd intercostal space, midclavicular line A40 year old, female, African American patient presents for history and physical. Upon your initial assessment, you notice she has severe exophthalmos as pictured below. Which one of the following diagnoses below would be the highest on your differential diagnose of this physical examination finding? A -Bilateral conjunctivitis B -Hyperthyroidism C -hypothyroidism D -Myexedma Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has underwent a pulmonary function test (PFT) with spirometry. As the patient's primary healthcare provider, you have been asked to explain the findings of the PFT to the patient in a follow-up visit at which time the patient asks what the study was evaluating. To describe the PFT to the patient in more useful terms, you state that the large inspiration of air to the furthest extent they could reasonably accomplish followed by a full exhalation is referred to as which of the following measurements during the PFT? A -Forced Expiratory Volume over 1 second (FEV1) B -Functional Reserve Capacity C -Inspiratory Reserve D -Forced Vital Capacity Your patient has a diagnosis of Addison's disease. Which of the following might you expect to find during examination? A -Abdominal striae B -Dowager hump C -Low body temperature D -Moon face The nurse practitioner's evaluation of a patient with Diabetes Mellitus type 2 should include which of the following while evaluating for end organ dysfunction of the disease? A -Renal function panel B -Urinalysis C -Non-dilated eye exam D -All of these are appropriate options During your visit with a 19 year old patient for a college health physical, your health history includes a diagnosis of angioedema. What of the following parts of the body are were likely involved? A -Isolated to the colon B -Anywhere in the enteral tract C -Chest D -Face and Lips Which of the following dermatologic lesions is precancerous and likely due to prolonged exposure to UV-B? A -Actinic Keratosis B -Basal cell carcinoma C -Verucca D -Seborrheic dermatitis Based on your evaluation of ABCDE for melanoma, which of the following represents a suspicious finding? A -Irregular borders B -Symmetrical nature C -Brown color D -Diameter of 0.4 cm Your patient is complaining of hypersomnia, lack of motivation, weight gain, and anhedonia. Suspecting a diagnosis of clinical depression, you anticipate the patient will benefit from treating their underlying deficit of which of the following neurotransmitters? A -GABA B -Serotonin C -Dobutamine D -Glutamate As a prudent nurse practitioner, the diabetic, hypertensive patient you are seeing should be evaluated for early evidence of renal damage from both diabetes and hypertension. Which of the following assessment tools should the nurse practitioner order first for the evaluation of early renal dysfunction secondary to diabetes or hypertension? A -BUN/creatinine ratio B -Urinalysis with micro/macro albumin C -Renal biopsy D -Urine sodium While evaluating a patient in your clinic for a routine health visit, you auscultate crackles in the poster left lower lobe, have the patient cough, with follow-up auscultation revealing clear breath sounds. Which one of the following would you suspect? A -Congestive heart failure B -Atelectasis C -Laryngospasm D -Bronchiactasis. Your 39 year old patient who has recently been hospitalized for an appendectomy and is being seen in your clinic for post-operative follow-up with primary care. On assessment, the patient complains of some incisional pain and otherwise examination is normal, with the exception of dull percussion sounds noted on the thorax over lung tissue. Which of the following diagnoses would be explained by this finding in post-operative patient? A -Left-sided heart failure B -Chronic bronchitis C -Atelectasis D -Healthy patient with no coexisting disease You are evaluating a 41 year old female patient in your clinic with symptoms of right upper quadrant pain which worsens with deep breathing. The patient exhibits a positive Murphy sign. These findings are most consistent which one of the following? A -Appendicitis B -Cholecystitis C -Crohn's flare D -Pancreatitis In educating your patient about the non-pharmacologic management of gastroesophageal reflux disease, you include teaching to the patient that their heartburn is aggravated by al of the following except which one? A -Activities including lifting or bending over B -Alcohol intake C -Foods, such as citrus, onions and coffee D -Gastric dumping, or increased emptying into the small intestines The patient is experiencing acute closed angle glaucoma. Which of the following examination findings by the nurse practitioner is most consistent with their diagnosis? A -Macular degeneration B -Increase in intraocular pressure C -AV nicking D -Loss of aqueous humor volume While managing the care of the patient with chronic alcoholism, the nurse practitioner would likely anticipate which findings on the CBC with differential? A -Low MCV and MCH B -Normal MCV and MCH C -Chronic alcoholism will not affect the differential D -Elevated MCV and MCH The nurse practitioner is caring for a patient with an elevated WBC, fever, chills, and malaise. When developing a differential diagnosis for this finding, which of the following is not a potential cause of the elevated WBC? A -Sepsis B -Diabetes Mellitus Type 2 C -Leukemia D -Recent oral corticosteroid therapy Your 21 year old sexually active female patient states during a routine health exam that they have some "weird bumps" on their vulva. She is concerned she has a sexually transmitted infection. You notify her that condyloma are caused by exposure to which of the following? A -Chlamydia B -Herpes zoster C -Human papilomavirus type 6 and 1 D -Parvovirus B19 Your patient who has underwent a recent major medical procedure is at a rehabilitation center and is having a hard time being motivated to do therapy. When you interview them as the nurse practitioner on staff for the subacute rehab center, they appear despondent, and are having a hard time being wakeful during therapy sessions. They have stable vital signs, temperature, urine output, and are not ill-appearing. As a prudent nurse practitioner, you understand this may represent which of the following? A -Cushing syndrome B -Situation depression C -Addison's disease D -Untreated anxiety The 18 year old female patient who inappropriately exhibits fear of abandonment, intense interpersonal relationships, affective instability, and recurrent self-harm describes which of the following diagnoses: A -Borderline personality disorder B -Seasonal affective disorder C -Reactive attachment disorder D -Bipolar disorder You are treating a patient who has stopped taking their diuretic regimen against medical advice while they are on vacation since it made them urinate too frequently for their plans. Now they are 21 pounds heavier than their baseline weight, have respiratory crackles in bilateral bases, and have severe generalized lower extremity and truncal edema extending to the sacrum and abdomen. On your documentation, this is referred to as which of the following conditions? A -Nephrotic syndrome B -Syndrome of inappropriate antidiuretic hormone (SAIDH) C -Ascites D -Anasarca The 84 year old lethargic patient who lives alone accidentally overdosed their amlodipine (Norvasc) was found by their daughter and taken to your clinic for evaluation. On exam, you found her blood pressure of 80/42 which the daughter says was "about what she found on her home cuff for the last 6 hours before bringing her in to be evaluated". The patient was then transferred to the hospital for evaluation. During her hospitalization she was also evaluated with CBC, BMP, and a UA. The results reflect normal labs except the UA showed trace WBCs in urine and no leukocyte esterases or nitrites and the BMP showed a creatinine of 1.9 with her normal baseline of1.2 (normal range 0.5-1.2mg/dL) and BUN of 34, with a baseline of 20 (normal range 10-20 mg/dL). What si likely to cause which of her renal issues? A -Pyelonephritis B -Chronic kidney disease C -Acute tubular necrosis D -Glomerulonephritis Your 52 year old male patient Gus has a diagnosis of heart failure with a low ejection fraction (HFrEF) (EF 30%) following a recent myocardial infarction and has been started on optimal medical therapy. Assuming he tolerates all the following medicines without side effects or contraindications, which one of the following agents should be avoided for optimal medical therapy specifically aimed at optimizing his HFrEF? A -Amlodipine (Norvasc) B -Entresto (Sacubitril/Valsartan) C -Furosemide (Lasix) D -Carvedilol (Coreg) Your 19 year old otherwise healthy male patient Vivek has been monitoring their peak flow at home after a recent visit at which time his symptoms suggest a new diagnosis of asthma. Which of the following is the most likely drug to be the first prescription? A -fluticasone/salmeterol (Advair diskus) 250/50 BID PRN for shortness of breath B -salmeterol (Serevent) 50mcg inhaled daily C -albuterol (Xopenex) MDI PRN for wheezing D -montelukast (Singulair) 10mg PO daily Margo, a 47 year old female patient recently underwent routine surveillance labs during her annual visit. From a routine screening lab of Hgb A1C of 7.2, you have diagnosed her with type 2 diabetes mellitus (T2DM) and anticipate discharging her with medication and referral to diabetic education. Your patient teaching should include notification of which common side effect of the most commonly prescribed first agent for T2DM? A -diarrhea B -delayed gastric emptying C -mycotic infections D -constipation Oliver, a 62 year old otherwise healthy male patient with an active lifestyle presents to your clinic today with a chief complaint of gnawing abdominal pain with a history of orthopedic overuse injuries. In developing a working differential diagnosis for this patient, which of the following questions is most useful in probing this further to rule out more serious conditions? A -What time of the day are you taking your acetaminophen (Tylenol)? B -Have you been taking any non-steroidal anti-inflammatory medications lately? C -When was the last time you took topical corticosteroids for pain? D -Have you noticed any particular food has made this worse? Zeke, a 2 year old male patient presented to your primary care clinic with unilateral leg swelling and tenderness after an "al nighter" playing video games. You suspect he has a provoked DVT from immobility and an ultrasound has been ordered. While awaiting this exam to be performed, you preemptively discuss anticoagulation with the patient assuming he will most likely be needing this therapy. Which of the following represents adequate understanding from the patient? A -The goal for my INR on rivaroxaban (Xarelto) should be somewhere over 20 B -Regardless of the venous doppler findings, I can start warfarin(Coumadin) alone an it will take around 4-5 days to get the drug to properly anticoagulate me C -If they find a blood clot, I will need to use enoxaparin (Lovenox) in addition to warfarin (Coumadin) until my INR is over 2.0 D -I will need to take enoxaparin (Lovenox) ifIma started on rivaroxaban Xarelto) Which of the following are common causes of a provoked deep vein thrombosis (DVT)? A -Cancer B -Factor V Leiden C -Protein C or S deficiency D -All of these are common causes of provoked DVT In discussing a new diagnosis of human immunodeficiency virus (HIV) for your patient, the patient demonstrates good understanding of the possible agents which may be used to include which of the following: A -All of these may be used to manage my disease B -Protease inhibitors C -Nucleoside reverse transcriptase inhibitors D -Non-nucleotide reverse transcriptase inhibitors Which class of medications are indicated as first line management of both post-traumatic stress disorder (PTSD) and major depressive disorder? A -Selective serotonin reuptake inhibitors B -Non-selective dopamine reuptake inhibitors C -Mood stabilizers D -Monoamine oxidase inhibitors. Dave, a 41 year old software engineer presents to your clinic with complaints of back spasms after being forced to return to their office instead of working from home. He believes the chair at his desk is the culprit and his causing him severe back spasms secondary to an aggravated old sports injury. In addition to non-pharmacologic solutions, which of the following represents an agent appropriate for the management of his spasms? A -Prednisone (Deltasone) B -Methy naltrexone (Relistor) C -Gabapentin (Neurontin) D -Cyclobenzaprine (amirx) Which of the following concepts refers to where small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life-threatening or result in persistent or significant disability or incapacity? A -Narrow therapeutic index B -Wide therapeutic index C -Post-antibiotic effect D -Zero order kinetics Which of the following agents will have the effect of dilating the efferent arteriole of the kidney and thereby reducing elimination of creatinine during administration? A -Valsartan (Diovan) B -Misoprostol (Cytotec) C -Furosemide (Lasix) D -Ibuprofen (advil) Patients with end-stage renal disease (ESRD) on dialysis experiencing anemia of chronic disease may benefit from the administration of erythropoeitin (Epocrit). Immediate evidence that this is working as desired would be evident by elevation in which level? A -Potassium B -Total iron binding capacity (TIBC) C -Lactate Dehydrogenase (LDH) D -Red cell distribution width (RDW) Karly, a 20 year old exchange student presents to your clinic with concerns of an unprotected sexual encounter and has concerns she has contracted a sexually transmitted infection. Her lab testing reveals a positive gonorrhea and chlamydia DNA probe. What medication should the prudent nurse practitioner include in the treatment plan? A -Ceftriaxone (Rocephin) IM plus Axithromycin (Zithromax) PO B -Amoxicillin (Amoxil) plus Metronidazole (Flagyl) C -Cephalexin (Keflex) only D -Doxycycline (Vibramycin) alone Jan, a 52 year old female patient is experiencing menopausal symptoms. Which non-prescription agent may be helpful during menopause to help with hot flashes? A -Echinacea B -Black cohosh C -Dandelion root D -St Johns Wart Your 38 year old male patient Mark is being seen in your clinic for routine health physical and complaints of heartburn. During your evaluation you identify darkened or velvety skin in the neck, groin, and/or axilla with associated achrocordons. This is most likely a diagnosis of which of the following? A -Seborrheic Kerstosis B -Actinic keratosis C -Keratoacanthoma D -Acanthuses nigricans The determination of topical corticosteroid potency is largely based on the unique drug as well as which of the following variables? A -Vehicle of delivery (cream, lotion, elixir, etc) B -None of these are correct C -Duration of use (once, continuous, etc) D -Site of use (back, face, arms, etc) The most commonly described non-life threatening side effect of HmgCo-A reductase inhibitor therapy is which of the following? A -Tachycardia B -Myalgia C -Rhabdomyolysis D -Airway swelling During a post-hospital discharge visit, you notice your 71 year old female patient has been diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4 heart sound? A -Diastole B -S3 in systole while S4 in diastole C -Systole D -S4 in diastole while S3 in systole The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would the S1 heart sounds correlate with the electrocardiographic waves? A -At the end of the T wave B -At the start of the T wave C -Peak of the R wave D -At the start of the P wave Michael, a 72 year old male patient who previously presented with stable cardiac-type chest pain has underwent a stress test. He presents today to review the stress test results, which show EKG findings of ST segment depression during the exam in leads V3 and V4 as well as some concurrent chest discomfort. Based on these findings, which of the following are NOT priority medical decisions? A -Prescribe metoprolol (Lopressor) 12.5mg PO BID B -Prescribe aspirin 81mg PO daily C -Refer to cardiology for angiography D -Check for thyroid dysfunction While examining a 53 year old female patient, you auscultate abnormal breath sounds over all fields, and now assess transmission of voice sounds by having the patient say "ee" while auscultating the chest with the diaphragm of your stethoscope. Normally, you should auscultate a muffled "e" sound, however, you hear a nasally "a" sound. Which one of the following will you document is present? A -Positive stereognosis B -Positive for egophony C -Negative for bronchophony D -Negative for egophony While assessing the 19 year old patient for a new onset cough, the nurse practitioner may inspect, auscultate, palpate, and/or percuss. How does performing percussion of the thorax assist the provider during the physical examination? A -To assist with the confirmation of cardiac origin of angina B -To assess for deep-seated lesion and tumors C -To assess for any pain or discomfort prior to palpitation of the chest wall D -To identify if underlying tissue are air-filled, fluid-filled or consolidated Your 42 year old male patient has been referred to your clinic for establishing care and on his intake survey, you note he has documented diagnosis of interstitial lung disease. You have decided to perform a diaphragmatic excursion test on the patient. Which one of the following results would you expect to see in this patient? A -Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration with a decreased overall inspiratory capacity B -Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration, though often much less on the right side due to the location of the heart and great vessels C -Much greater descent of the diaphragm on the right side due to the liver present (two-three times larger) D -Absent or no change in movement of the diaphragm noted between full inspiration and full expiration measurement Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years and is here for a history and physical examination. While examining the head and face, you see your patient has nonpitting periorbital edema, particularly underneath their eyes and very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin lateral eyebrows, Periobital edema). Which one of the following would you expect to cause this finding? A -Severe hypothyroidism B -Addison's disease C -Grave's disease D -Alzhemiers Your newly established patient states in the past year, they have progressively developed a noticeable bump on their neck and when asked about symptoms, they report feeling very anxious, have developed a tremor, and are commonly feeling palpitations in their chest. On examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following diagnoses, which is most likely for the patient to develop based on these findings above? A -Thyrotoxicosis B -lodine Excess C -Myxedema Coma D -Hashimotos Thyroiditis Your 32 year old female patient presented for a routine health exam states they have a diagnoses of hyperthyroidism by another provider a year ago. In addition to evaluation with TSH and T4 lab work, which of the following represent typical signs of hyperthyroidism expected on your exam of this patient? A -Hypersomnia B -Tachycardia C -Lethargy D -Recent unplanned weight gain Your patient with a diagnosis of autoimmune hepatitis is being seen in your clinic for routine liver serology and follow-up examination. Which of the following correctly identifies the normal liver span when percussing the liver of a HEALTHY adult? A -6-12 cm in the midsternal line B -4-8 in the left midclavicular line C -4-8 cm in the right midclavicular line D -6-12 cm in the right midclavicular line The 33 year old male patient presents with complaints of abdominal pain after a recent birthday party where other guests also suspected food borne illness and gastroenteritis. To elicit the most accurate evaluation of this patient, which is the order of assessment which should be done for the abdomen? A -Inspection, auscultation, palpation, percussion B -Inspection, auscultation, percussion, palpation C -Percussion, auscultation, palpation, inspection D -Auscultation, palpation, percussion, inspection The 19 year old male patient presents with acute symptoms of abdominal pain and a history of intermittent heartburn and spicy food intolerance, as well as anxiety due to his college athletic performance. You have a concern the patient may have a perforated gastric ulcer and is experiencing peritonitis. Which of the following exam findings is NOT supportive of this diagnosis? A -Guarding B -Rebound tenderness C -Absence of pain with withdrawal of palpation D -Rigidity Your 22 year old female patient is seeing you for complaints of sinus pressure and congestion. Which one of the following sinuses should be palpated during your examination? A -Mandibular B -Ethmoid C -Sphenoid D -Frontal Your 49 year old male patient presents with weight loss, night sweats, anhedonia, and a CXR showing profoundly enlarged hilar adenopathy. Based on these findings, a diagnosis of lymphoma would be in your working differential. Which one of the following assessment findings when palpating lymph nodes would be INCONSISTENT with this diagnosis? A -Hard nodes B -Fixed nodes C- Stationary or not moveable with palpation D -Non-tender, minimally palpable anterior cervical chain node palpation Your new patient intake history of an elderly man includes a history of Ehlers-Danlos with complications of retinal detachment treated with gas pneumopexy. In discussing this history, you recall the transparent mass of gelatinous material where the gas pneumopexy is performed can be found in which chamber(s) of the eye? A -None of the above; it's only seen as an abnormal finding with malignancy B -Anterior only