Download Dunphy Primary Care Midterm Review 2024: Questions and Answers and more Exams Nursing in PDF only on Docsity!
DUNPHY PRIMARY CARE MIDTERM REVIEW 2024
QUESTIONS AND ANSWERS 100% PASS
"Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect:
Appendicitis.
Gastroenteritis.
Acute pancreatitis.
Rocky Mountain spotted fever. - CORRECT ANSWER Appendicitis."
"Which of the following is not a modifiable risk factor?
Weight.
Stress level.
Race.
Physical activity level. - CORRECT ANSWER Race."
"Which of the following doesn't fall under the umbrella of health promotion as a nurse practitioner?
Information about online dating.
Exercise programs.
Immunizations.
Nutrition support. - CORRECT ANSWER Information about online dating."
"Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily?
Drink all the soda you like—it has no effect on your bone density.
It has not been proved that smoking affects bone loss.
Replace estrogen when you reach menopause.
Perform aerobic exercise at least 3 times a week. - CORRECT ANSWER Perform aerobic exercise at
least 3 times a week." “Nausea is difficult to discern in a young child. What question might you ask to determine if a child has nausea?
- "Are you sick to your tummy?"
- "Are you hungry?"
- "Are you eating the way you normally eat?"
4. "Are you nauseous?" - CORRECT ANSWER "Are you hungry?""
"Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond:
- "You should have two to three stools per day."
- "You should defecate once a day."
- "You should have at least three stools per week."
4. "There is no such thing as a 'normal' pattern of defecation." - CORRECT ANSWER "There is no such
thing as a 'normal' pattern of defecation."" "Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect?
Campylobacter jejuni.
Clostridium botulinum.
Clostridium perfringens.
Staphylococcus. - CORRECT ANSWER Clostridium botulinum."
"Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for:
Constipation.
Colorectal cancer.
Irritable bowel syndrome.
Acute appendicitis. - CORRECT ANSWER Colorectal cancer."
Gastric lavage. - CORRECT ANSWER Supportive care."
"Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using?
Antibiotics.
Nonsteroidal anti-inflammatory drugs (NSAIDs).
Oral contraceptives.
Antifungals. - CORRECT ANSWER Nonsteroidal anti-inflammatory drugs (NSAIDs)."
"Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect?
A gastric ulcer.
Gastritis.
Pelvic inflammatory disease.
Pancreatitis. - CORRECT ANSWER Pelvic inflammatory disease."
"Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will:
Avoid coffee, alcohol, chocolate, peppermint, and spicy foods.
Eat smaller meals.
Have a snack before retiring so that the esophagus and stomach are not empty at bedtime.
Stop smoking. - CORRECT ANSWER Have a snack before retiring so that the esophagus and stomach
are not empty at bedtime." "Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an:
Inguinal hernia.
Epigastric hernia.
Umbilical hernia.
Incisional hernia. - CORRECT ANSWER Epigastric hernia."
"You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect?
Cirrhosis.
Inflammation of the kidney.
Inflammation of the spleen.
Peritonitis. - CORRECT ANSWER Inflammation of the kidney."
"Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond?
"Occasionally he accumulates blood in the gut."
"There is an interruption of the normal clotting mechanism."
"Long-term alcohol abuse has made his vessels very friable."
"His bone marrow has been affected." - CORRECT ANSWER "There is an interruption of the normal
clotting mechanism."" "Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign?
Left-sided pleural effusion.
Bluish discoloration over the flanks.
Bluish discoloration around the umbilicus.
Jaundice. - CORRECT ANSWER Bluish discoloration over the flanks."
"Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her?
Age.
Infection.
Pain.
Salmonella.
Shigella. - CORRECT ANSWER Escherichia coli."
"A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis?
Appendicitis.
Cholecystitis.
Constipation.
Gastroenteritis. - CORRECT ANSWER Appendicitis."
"A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis?
Internal hemorrhoid.
External hemorrhoid.
Bleeding peptic ulcer.
Rectal fissure. - CORRECT ANSWER Internal hemorrhoid."
"The screening guidelines for colon cancer recommend which of the following for the general population?
Colonoscopy starting at age 50.
Colonoscopy starting at age 45.
Fecal occult blood test (FOBT) and rectal exam starting at age 50.
Fecal occult blood test (FOBT) and rectal exam starting at age 45. - CORRECT ANSWER Colonoscopy
starting at age 50." "Which of the following is not a risk factor for cholecystitis?
Female gender.
Obesity.
Sickle cell anemia.
Younger age. - CORRECT ANSWER Younger age."
"Which of the following is the most common cause of acute pancreatitis?
Gallstone obstruction of the pancreatic duct.
Alcoholism.
Hypertriglyceridemia.
Gallstone obstruction of the pancreatic duct and alcoholism. - CORRECT ANSWER Gallstone
obstruction of the pancreatic duct and alcoholism." "In relation to writing a patient encounter note, the acronym SOAP stands for which of the following words?
Subjective, objective, assessment, plan.
Symptoms, objective, assessment, pills.
Subjective, outward findings, assessment, plan.
Symptoms, objective, assessment, plan. - CORRECT ANSWER Subjective, objective, assessment, plan."
"Which of the following demonstrates a subjective finding?
Pain level.
Pulse rate.
Eye color.
Family relationships. - CORRECT ANSWER Focusing on increasing lifespan."
"As a nurse practitioner, which of the following would not be an example of primary health promotion?
Posting health articles on your social media account.
Speaking to patients at each visit about strategies for maintaining/attaining a healthy life.
Lecturing at local community centers about diabetes.
Organizing a 5K running event for the patients in your practice. - CORRECT ANSWER Posting health
articles on your social media account." "Which of the following patients is health literate?
A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive.
A 70-year-old patient with dementia.
A 22-year-old migrant worker who only speaks Spanish.
A 45-year-old college graduate with no health insurance. - CORRECT ANSWER A 62-year-old female
who speaks the language of her provider, has Medicare for insurance, and can drive." "Which of the following initiatives does not fall under the National Prevention Strategy?
Diabetes management.
Tobacco-free living.
Healthy eating.
Mental and emotional well-being. - CORRECT ANSWER Diabetes management."
"Which of the following statements does not belong in the past medical history portion of your chart note?
Your patient had lab work at their last appointment that was negative.
Your patient had a cholecystectomy 3 years prior.
Your patient's father passed away from lung cancer.
Your patient has an allergy to penicillin. - CORRECT ANSWER Your patient had lab work at their last
appointment that was negative." "You have a patient who presents with ankle pain. Which of the following facts or observations does not belong in the physical exam portion of your note?
The patient's pain started after a fall off his skateboard.
The patient has a normal pulse and normal sensation of the foot.
The patient has edema in his ankle.
The patient has limited motion of his ankle. - CORRECT ANSWER The patient's pain started after a fall
off his skateboard." "Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will:
- Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery.
- Drink at least 2000 mL of fluids per day.
- Decrease her dietary fiber for 1 month.
4. Take stool softeners as prescribed. - CORRECT ANSWER Decrease her dietary fiber for 1 month."
"Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her?
- As a healthy adult with several problems.
- As having a glycemic event.
- As having metabolic syndrome.
4. As having multiple organ dysfunction. - CORRECT ANSWER As having metabolic syndrome."
"Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Joseph receive today regarding the care of his feet?
"Wash your feet with cold water only."
"See a podiatrist every two years, inspect your own feet monthly, and apply lotion to your feet daily."
"Go to a spa and have a pedicure monthly."
"See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes;
inspect your feet daily for any lesions; and apply lotion to any dry areas." - CORRECT ANSWER "See a
27 cal.
30 cal. - CORRECT ANSWER 27 cal."
"What is the most common bacterial pathogen associated with acute otitis media?
Streptococcus pneumoniae.
Haemophilus influenzae.
Streptococcus pyogenes.
Moraxella (Branhamella) catarrhalis. - CORRECT ANSWER Streptococcus pneumoniae."
"You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication?
Achilles tendon rupture.
Peripheral neuropathy.
Nephrotoxicity.
Stevens-Johnson syndrome. - CORRECT ANSWER Stevens-Johnson syndrome."
"Which of the following is not a complication of untreated group A streptococcal pharyngitis?
Glomerulonephritis.
Rheumatic heart disease.
Scarlet fever.
Hemolytic anemia. - CORRECT ANSWER Hemolytic anemia."
"What is the most common cause of epistaxis?
Digital trauma.
Warfarin.
Vitamin C deficiency.
Hemophilia A. - CORRECT ANSWER Digital trauma."
"Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect:
Bell palsy.
A lesion affecting the trigeminal nerve.
A stroke—brain attack, cerebrovascular accident (CVA).
Shingles. - CORRECT ANSWER A lesion affecting the trigeminal nerve."
"Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is:
Eye discomfort.
Slow progression.
A ciliary flush.
No change in or slightly blurred vision. - CORRECT ANSWER A ciliary flush."
"Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis?
Acute otitis media.
Chronic otitis media.
External otitis.
Temporomandibular joint (TMJ) syndrome. - CORRECT ANSWER External otitis."
"Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis?
Allergic rhinitis.
Viral rhinitis.
"Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect:
Dental abscess.
Acute rhinosinusitis.
Chronic rhinosinusitis.
Nasal tumor. - CORRECT ANSWER Acute rhinosinusitis."
"Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected?
Maxillary sinus.
Ethmoid sinus.
Sphenoid sinus.
Frontal sinus. - CORRECT ANSWER Maxillary sinus."
"You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include:
Gentamicin ophthalmic ointment.
Ciprofloxacin ophthalmic drops.
Supportive measures and lubricating drops (artificial tears).
Oral erythromycin for 14 days. - CORRECT ANSWER Supportive measures and lubricating drops
(artificial tears)." "Your client George, age 60, presents with pruritus and complains of lymphadenopathy in his neck. He also complains of night sweats and has noticed a low-grade fever. He has not lost any weight and otherwise feels well. He is widowed and has been dating a new woman recently. On physical exam, you find enlarged supraclavicular nodes. You suspect:
Lung cancer.
Hodgkin lymphoma.
A lingering viral infection from a bout of flu he had 6 weeks ago.
Non-Hodgkin lymphoma. - CORRECT ANSWER Hodgkin lymphoma."
"Ms. Jones, your client, has an elevated platelet count. You suspect:
Systemic lupus erythematosus (SLE).
Infectious mononucleosis.
Disseminated intravascular coagulation (DIC).
Splenectomy. - CORRECT ANSWER Splenectomy."
"You have a new client, Robert, age 67, who presents with generalized lymphadenopathy. You know that this is indicative of:
Disseminated malignancy, particularly of the hematologic system.
Cancer of the liver.
Sjögren syndrome.
Pancreatic cancer. - CORRECT ANSWER Disseminated malignancy, particularly of the hematologic
system." "Caroline, 65, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has a stomach ulcer. Which of the following is not one of her risk factors for iron deficiency anemia?
Smoking.
Poverty.
Ulcer.
Age greater than 60. - CORRECT ANSWER Smoking."
"The gold standard for definitive diagnosis of sickle cell anemia is:
A reticulocyte count.
The sickle cell test.
Chronic fatigue syndrome. - CORRECT ANSWER Iron deficiency anemia."
"Your client Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in terms of diagnosis?
Iron deficiency anemias.
Hemolytic anemias.
Lead poisoning.
Liver disease. - CORRECT ANSWER Liver disease."
"Which is the best serum test for spotting an iron deficiency early, before it progresses to full-blown anemia?
Hemoglobin.
Hematocrit.
Ferritin.
Reticulocytes. - CORRECT ANSWER Ferritin."
"Which of the following indicate that Jim, a 32-year-old client with AIDS, has oropharyngeal candidiasis?
Small vesicles.
White, fissured, thickened patches.
Removable white plaques.
Flat-topped papules with thin, bluish-white spiderweb lines. - CORRECT ANSWER Removable white
plaques." "Which of the following is the most common cause of megaloblastic anemia?
Vitamin B12 deficiency.
Pernicious anemia.
Iatrogenesis.
Folate deficiency. - CORRECT ANSWER Pernicious anemia."
"Doug, age 6, appears with abdominal distention and pain, an abdominal mass on the right side, fever, and slight hematuria. There is no precipitating event. What do you suspect?
A urinary tract infection (UTI).
Appendicitis.
Wilms tumor.
An intestinal obstruction. - CORRECT ANSWER Wilms tumor."
"You explain to Yolanda that pelvic floor (Kegel) exercises help to restore and maintain continence by improving pelvic muscle strength, increasing urethral pressure, and decreasing abnormal detrusor muscle contractions. These exercises are used for her diagnosis of:
Stool incontinence.
Full-bladder incontinence.
Cystitis-related incontinence.
Stress incontinence. - CORRECT ANSWER Stress incontinence."
"Leslie, age 13, says that her mother has polycystic kidney disease and asks about her chances of developing it. How do you respond?
"It is hereditary, but if you develop it, a cure is possible."
"It is hereditary and unfortunately incurable, but there are some measures we can use in dealing with it."
"It is not hereditary, but you may develop it anyway."
"It is hereditary, but it skips generations." - CORRECT ANSWER "It is hereditary and unfortunately
incurable, but there are some measures we can use in dealing with it."" "The kidneys excrete increased amounts of Hco3 to lower the pH as a mode of compensation for which acid-base disturbance?
Respiratory acidosis.
Respiratory alkalosis.
