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NSG 6420 Final Exam
Week 10 – Question
and Answers
In AR disorders, carriers have:
- Two mutated genes; two from one parent that cause disease
- A mutation on a sex chromosome that causes a disease
- A single gene mutation that causes the disease - One copy of a gene mutation but not the disease
A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer Tuberculosis Pneumonia COPD
The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? It will be helpful to keep the head of your bed elevated on blocks
In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Leukoplakia
You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) MigraineDefinition
Age-related changes in the bladder, urethra, and ureters include all of the following in older women except:
An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to Acoustic neurom Cerumen impaction Otitis media Ménière’s disease
Which lesions are typically located along the distribution of dermatome? Herpes Zoster
n differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age
A pneumatic otoscopic examination is used to assess: A. Inner ear conditions B. Otitis externa C. Cerumen impaction D. Tympanic membrane mobility
In autosomal recessive (AR) disorders, individuals need:
- Only one mutated gene on the sex chromosomes to acquire the disease
- Only one mutated gene to acquire the disease
- Two mutated genes to acquire the disease
- Two mutated genes to become carriers
Which of the following disorders can cause urinary incontinence? Cystocele Overactive bladder Uterine prolapse All of the above
An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD?
A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation
Which of the following medications are commonly associated with the side effect of cough Beta blocker B. Diuretic C. ACE inhibitor D. Calcium antagonist
A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging
Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate
. Upper urinary tract infection B. Lower urinary tract infection C. Normal bacteriuria D. Urethritis
Epistaxis can be a symptom of:
A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition Inflammatory bowel disease Irritable bowel syndrome Giardiasis Lactose intolerance
When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease?
CORRECT Venous insufficiency Musculoskeletal injury
Which of the following details are NOT considered while staging asthma? A. Nighttime awakenings B. Long-acting beta agonist usage C. Frequency of symptoms D. Spirometry findings
Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms Acute MI GERD Pneumonia Angina
A 22-year-old female patient complains of excessive thirst, feeling “shaky when she misses meals” and increased frequency of urination. Family history is positive for cardiovascular disease, cerebrovascular disease, and diabetes. The patient denies use of tobacco, alcohol, or other drugs. She takes no medication. Daily diet is fast food, and the patient does not exercise regularly. On physical examination, there are no significant findings except obesity, demonstrated by a BMI of 35 and blood pressure of 145/ 90. The signs and symptoms are characteristic of: Type 2 diabetes mellitus B. Chronic fatigue syndrome C. Cushing’s disease D. Clinical depression
Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? A. Beta blocker B. ACE inhibitor C. Statin medication D. Metformin
. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test?
A. It is highly contagious and a mask should be worn at home. B. Treatment regimen is multiple lifetime medications. C. Treatment regimen is multiple medications taken daily for a few weeks. D. Treatment regimen is complicated and is not indicated unless the patient is symptomatic.
Which of the following is the most important question to ask during cardiovascular health history? Sudden death of a family member
Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris
The most common neurological cause of seizures in an older adult is Alzheimer’s disease Multiple sclerosis Stroke Peripheral neuropathy
A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C. Perform a biopsy or refer to a dermatologist. D. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away.
A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Peptic ulcer disease Barrett’s esophagus
Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? A. Hemoglobin and hematocrit B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) C. Serum ferritin and serum iron D. Total iron binding capacity and transferrin saturation
An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D. Colon cancer
A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: A. Osteoarthritis B. Rheumatoid arthritis C. Fibromyalgia D. Polymyalgia rheumatica
Which of the following dermatological conditions results from reactivation of the dormant varicella virus? . A. Tinea versicolor B.Seborrheic keratosis C.Verruca D.Herpes zoster
A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner’s appropriate intervention is:
A. Digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results
Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? Misoprostol (Cytotec) Cimetidine (Tagamet) Metronidazole (Flagyl) Bismuth subsalicylate (Pepto bismol)
A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a: A. Bacterial folliculitis B. Basal cell carcinoma C. Bullous impetigo D. Epidermoid cyst
The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in Pityriasis Rosea Shingles Psoriasis Lymes Disease
The most common complication of an untreated urinary obstruction due to a ureteral calculus is: Hydronephrosis B. Renal artery stenosis C. Ureteral rupture D. Kidney mass
Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy
In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of Bacterial sinusitis Allergic rhinitis Drug abuse Skull fracture
A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is: A. Lead intoxication B. Illegal whiskey C. Binge-eating D. Thiazide diuretics
A woman complains of malaise and arthralgias. You note a butterfly-shaped, macular, erythematous rash across her cheeks and nose. These conditions are common in:
. Psoriasis B. Lichen planus C. Systemic lupus erythematosus D. Erythema nodosum
Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following?
Alteration in micturition is the hallmark symptom for abdominal pain of genitourinary origin. Symptoms in alteration in micturition would include: Fever Dysuria Nausea/vomiting Right lower quadrant pain
Presbycusis is the hearing impairment that is associated with: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster
Ms. Smith, 37-year-old, comes to the clinic today complaining of dull, throbbing bilateral headaches almost every evening. You suspect she is experiencing: cluster headaches migraine headaches tension headaches benign intracranial hypertension
The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough
A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond? A. Discontinue the medication immediately B. Reassure the patient that this is an anticipated side effect C. Double the dosage of medication and have patient return in 1 week D. Order a chem. 7 to check for lactic acidosi
Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? A. Cellulitis is two times more common in women B. Facial cellulitis is more common in people > C. There is low incidence of cellulitis in patients with diabetes D. Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency
When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime.
Prokinetic agents H2 antagonists Proton pump inhibitors
Patients who have an underlying tinea infection to the cellulitis should also be treated with which one of the following? An anti-fungal medication Topical steroids Oral steroids Zinc oxide
Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? A. Fever of 102 B. Infiltrates on chest x-ray C. Pleural effusion on chest x-ray D. Elevated white blood cell count
Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: Recommending she increase her dietary intake of Calcium and Vitamin D Ordering once a year bisphosphonate and a proton pump inhibitor Participate in a fall prevention program Dual-energy X-ray (DEXA) scan and updating immunizations
The first assessment to complete related to the eyes is Eye lids Visual acuity Extraocular movements Peripheral vision
The major impact of the physiological changes that occur with aging is :
- Reduced physiological reserve
- Reduced homeostatic mechanisms
- Impaired immunological response
- All of the above
Which of the following describes the pathology of De Quervain’s tenosynovitis?
Irritation of a tendon located on the radial side of the wrist, near the thumb Impingement of the median nerve, causing pain in the palm and fingers Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist Ulnar nerve compression at the olecranon process
A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Mono spot Strep test Throat culture All of the above
On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should Defi Refer the patient for transrectal ultrasound guided prostate biopsy Obtain an abdominal X-ray of kidneys, ureter, and bladder Recognize this as a normal finding that requires periodic follow up Obtain urine culture and sensitivity for prostatitisnition
Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of Anemia Anxiety Hyperthyroidism CORRECT All of the above
The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days B. Doxycycline 100 mg BID for 5 days C. Prednisolone 35 mg QD for 5 days D. Ice therapy
Mr. Andrews experienced a brief onset of right-sided weakness, slurred speech, and confusion yesterday. The symptoms have resolved. What should the nurse practitioner do? Assure the patient that he will not experience the symptoms again Identify modifiable cardiovascular risk factors Do a thorough medication review and a CT scan Order a stat EEG and administer O2 by mask
A 62-year-old female complains of fatigue and lack of energy. Constipation has increased and the patient has gained ten pounds in the past 3 months. Depression is denied although the patient reports a lack of interest in usual hobbies. Vital signs are within normal limits and the patient’s skin is dry and cool. Which of the following must be included in the differential? A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Grave’s disease
A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? A. Joint infection B. Chondromalacia patella C. Prepatellar bursitis D. All of the above
Your 55-year-old male patient presents to your office with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately? Ultrasound of the abdomen B. Abdominal x-ray C. Digital rectal examination D. Spiral CT scan
A 62-year-old woman presents with a recurrent urinary tract infection. She now has a fever of 104°F and severe costovertebral tenderness with pyuria. What is the appropriate diagnosis and intervention for this patient? Septic arthritis and oral prednisolone is indicated Pyelonephritis and hospitalization is required Recurrent cystitis and 10 days of antibiotics are needed Pelvic inflammatory disease and 7 days of antibiotics are indicated
Which of the following is not a contributing factor to the development of esophagitis in older adults? Increased gastric emptying time Regular ingestion of NSAIDs Decreased salivation
Fungal infections such as Candida
An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that: A. All symptoms should disappear within three days B. Oral medications can dramatically reduce the duration and intensity of his symptoms C. He has chickenpox and can be contagious to his grandchildren D. He has a sexually transmitted disease
Which test is the clinical standard for the assessment of aortic stenosis? Cardiac catheterization Stress test Chest X-ray Echocardiography
