NUR634 Final Exam Test Prep

NUR-634 Final Exam Test Prep  (Limited Questions With Full Answers)

•                             You are examining an elderly man and notice the following: Decreased vibration sense in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and diminished abdominal reflexes. Which of these is abnormal?

•             Decreased vibration sense

•             Diminished gag reflex

•             Diminished right patellar reflex compared to the left

•             Diminished abdominal reflexes

•A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

•             Actinic keratosis

•             Seborrheic keratosis

•             Basal cell carcinoma

•             Squamous cell carcinoma

•             A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise his examination is normal. He is agreeable to taking a drug test.

What is the most likely cause of his gynecomastia?

•             Breast cancer

•             Imbalance of hormones of puberty

•             Drug use

 •            Alcohol use

•             A 17-year-old female presents to your office, complaining of a clear discharge

from her right breast for 2 months. She states that she noticed it when she and her boyfriend were “messing around” and he squeezed her nipple. She continues to have this discharge anytime she squeezes that nipple. She denies any trauma to her breasts. Her past medical history is unremarkable. She denies any pregnancies. Both of her parents are healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week. On examination, her breasts are symmetric with no skin changes. You are able to express clear discharge from her right nipple. You feel no discrete masses and her axillae are normal. The remainder of her heart, lung, abdominal, and pelvic examinations are unremarkable. A urine pregnancy test is negative.

What cause of nipple discharge is the most likely in her circumstance?

•             Benign breast abnormality

•             Breast cancer

•             Nonpuerperal galactorrhea

•             Pagets disease

•             A 26-year-old flight attendant presents in for a third trimester prenatal visit. She has had prenatal care since her sixth week of pregnancy. She has no complaints today and her prenatal course has been unremarkable. Today her blood pressure and weight gain are appropriate, and her urine is unremarkable. You have a first-year medical student shadowing you, so you ask the student to get Doptones and measure the patient’s uterus in centimeters. The nurse practitioner student promptly reports fetal heart tones of 140, but he is having difficulty obtaining the correct measurement. He knows one end of the tape goes over the uterine fundus.

From what inferior anatomic position should the tape be placed?

•             Vagina

•             Clitoris

•             Pubic symphysis

•             Umbilicus

•             A 58-year-old gardener presents to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wart like texture on palpation. Based on this description, what is your most likely diagnosis?

•             Actinic keratosis

•             Seborrheic keratosis

•             Basal cell carcinoma

•             Squamous cell carcinoma

•             Which of the following represents age-related changes in the lungs?

•             Decrease in chest wall compliance

•             Speed of expiration increases

•             Increase in respiratory muscle strength

•             Increased elastic recoil of lung tissue

•             A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and

fussiness. The ear examination is as follows: external ear, normal appearance and no tenderness with manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is the most likely condition here?

•             Otitis externa

•             Cholesteatoma

•             Ruptured tympanic membrane

•             Otitis media

•             A 28-year-old musician presents to your clinic, complaining of a “spot” on his penis. He states his partner noticed it 2 days ago and it hasn’t gone away. He says it doesn’t hurt. He has had no burning with urination and no pain during intercourse. He has had several partners in the last year and uses condoms occasionally. His past medical history consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana and occasionally crack. He has injected IV drugs before but not in the last few years. He is single and currently unemployed. His mother has rheumatoid arthritis, and he doesn’t know anything about his father. On examination, you see a young man appearing deconditioned but pleasant. His vital signs are unremarkable. On visualization of his penis, there is a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce because of neonatal circumcision. On palpation, the ulcer is nontender. In the inguinal region, there is nontender lymphadenopathy.

What disorder of the penis is most likely the diagnosis?

•             Condylomata acuminata

•             Genital herpes

•             Syphilitic chancre

•             Penile carcinoma

•             A 22-year-old law student presents to your office complaining of severe abdominal pain radiating to his back. He states it began last night after hours of heavy drinking. He has had abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep any food or water down, and these symptoms have been going on for almost 12 hours. He has had no recent illnesses or injuries. His past medical history is unremarkable. He denies smoking or using illegal drugs but admits to drinking 6 to 10 beers per weekend night. He admits that last night he drank something like 14 drinks. On examination you find a young male appearing his stated age in some distress. He is leaning over on the examination table and holding his abdomen with his arms. His blood pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination reveals normal bowel sounds, but he is very tender in the left upper quadrant and epigastric area. He has no Murphy’s sign or tenderness in the right lower quadrant. The remainder of his abdominal examination is normal. His rectal, prostate, penile, and testicular examinations are normal. He has no inguinal hernias or tenderness with that examination. Blood work is pending.

What etiology of abdominal pain is most likely causing his symptoms?

•             Peptic ulcer disease

•             Biliary colic

•             Acute cholecystitis

•             Acute pancreatitis

 •            A 56-year-old female presents to your clinic complaining that her left breast looks unusual. She says that for 2 months the angle of the nipple has changed direction. She does not do self-examinations, so she doesn’t know if she has a lump. She has no history of weight loss, weight gain, fever, or night sweats. Her past medical history is significant for high blood pressure. She smokes two packs of cigarettes a day and has three to four drinks per weekend night. Her paternal aunt died of breast cancer in her forties. Her mother is healthy, but her father died of prostate cancer. On examination, you find a middle-aged woman appearing older than her stated age. Inspection of her left breast reveals a flattened nipple deviating toward the lateral side. On palpation, the nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm mass. The axilla contains several fixed nodes. The right breast and axilla examinations are unremarkable.

What visible skin change of the breast does she have?

•             Nipple retraction

•             Paget’s disease

•             Peau d’orange sign

•             Mastitis

•             A 32-year-old white female presents to your clinic complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work, but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination, you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable.

What type of mood disorder do you think is most likely?

•             Dysthymic disorder

•             Manic (bipolar) disorder

•             Major depressive episode

•             Anxiety disorder

 •            A young Hispanic mother brings in her 2-month-old son. She is upset because her neighbors have threatened to call the Child Protective Agency because they think his birthmark is a bruise. Her son was the product of an uneventful pregnancy and spontaneous vaginal delivery. On examination, you see a large, smooth-bordered bluish mark on his buttock and lower back. Otherwise his examination is unremarkable.

What form of birthmark is this likely to be?

•             Café-au-lait spot

•             Salmon patch

•             Mongolian spot

•             Cherry hemangioma

•             A 15-year-old high school sophomore presents to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough.

Which is the most likely pathologic process?

•             Infection

•             Inflammation

•             Allergic

•             Vascular

•             A 22-year-old clerk, primigravida, presents to your office for a prenatal visit. She is in her second trimester and has had prenatal care since she was 8 weeks pregnant. Her only complaint is that she has a new brownish line straight down her abdomen. On examination her vital signs are unremarkable. Her urine has no protein, glucose, or leukocytes. With a doppler the fetal heart rate is 140, and her uterus is palpated to the umbilicus. Today you are sending her for congenital abnormality screening and setting up an ultrasound.

What physical finding is responsible for her new “brown line”?

•             Corpus luteum

•             Linea nigra

 •            Linea alba

•             Diastasis recti

•             Mr. Q. is a 45-year-old salesman who presents to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem?

•             You are an alcoholic, aren’t you?

•             When was your last drink?

•             Do you drink 2 to 3 beers every weekend?

•             Do you drink alcohol when you are supposed to be working?

•             A 35-year-old bus driver presents to your office for a prenatal visit. She is approximately 28 weeks pregnant and has had no complications. She is complaining only of heartburn and has had no fatigue, headaches, leg swelling, contractions, leakage of fluid, or bleeding. On examination, her blood pressure is 142/92 and her urine shows no glucose, protein, or leukocytes. Her weight gain is appropriate, with no large recent increases. Fetal tones are 140 and her uterus measures 32 cm from the pubic bone. Looking back through her chart, you see her prenatal blood pressure was 120/70 and her blood pressures during the first 20 weeks were usually 120 to 130/70 to 80.

What type of blood pressure is this?

•             Normotensive for pregnancy

•             Chronic hypertension

•             Gestational hypertension

•             Preeclampsia

•             A sudden, painless unilateral vision loss may be caused by which of the following?

•             Retinal detachment

 •            Corneal ulcer

•             Acute glaucoma

•             Uveitis

•             A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise, she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable.

Which risk factor of her personal and family history most puts her in danger of getting breast cancer?

•             First-degree relative with premenopausal breast cancer

•             Age at menarche of less than 12

•             First live birth between the ages of 25 and 29

•             First-degree relative with postmenopausal breast cancer

•             When should a woman conduct breast self-examination with respect to her menses?

•             Five to seven days following her menses

•             Midcycle

•             Immediately prior to menses

•             During her menses

•             Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass.

What is most likely?

•             An enlarged lymph node

•             A sebaceous cyst

•             An actinic keratosis

•             A malignant lesion

•             You have been unable to hear normal S2 splitting in children up to this point. What technique will maximize your chances of hearing this phenomenon?

•             Listen with the diaphragm over the left lower sternal border.

•             Listen with the bell over the 2nd left intercostal space.

•             Listen with the bell over the apex.

•             Listen with the diaphragm in the axilla.

•             A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last week when he took off his shirt that his breastbone seemed collapsed. He seems embarrassed and tells you that it has been that way for quite some time. He states he has no symptoms from it, and he just tries not to take off his shirt in front of anyone. He denies any shortness of breath, chest pain, or lightheadedness on exertion. His past medical history is unremarkable. He is in sixth grade and just moved in with his grandmother after his father was deployed to the Middle East. His mother died several years ago in a car accident. He states that he does not smoke and has never touched alcohol. On examination, you see a teenage boy appearing his stated age. On visual examination, of his chest you see that the lower portion of the sternum is depressed. Auscultation of the lungs and heart are unremarkable.

What disorder of the thorax best describes your findings?

•             Barrel chest

•             Funnel chest (pectus excavatum)

•             Pigeon chest (pectus carinatum)

•             Thoracic kyphoscoliosis

 •            Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move the shoulder passively, he has full range of motion without pain and there is no gross swelling or tenderness. What type of joint disease does this most likely represent?

•             Articular

•             Extra-articular

•             Neither

•             Both

.               Blood pressure abnormalities found more commonly in Western elderly include which of the following?

•             Isolated elevation of the diastolic BP

•             Narrow pulse pressure

•             Elevation of the systolic BP

•             Elevation of the BP with standing

 

•                             A 22-year-old architecture major presents to your office complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination, you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum, there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative.

Which disorder of the vulva is most likely in this case?

•             Genital herpes

 •            Condylomata acuminata

•             Syphilitic chancre

•             Epidermoid cyst

•             A 36-year-old married bank teller presents to your office, complaining of pain with defecation and occasional blood on the toilet paper. She states that last week she had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but no black or bloody stools. Ever since her illness, she has continued to have severe pain with bowel movements. She now tries to put off defecation as long as possible. Although she is having constipation she denies any further diarrhea or leakage of stool. She has a past medical history of hypothyroidism and two spontaneous vaginal deliveries. She has had no other chronic illnesses or surgeries. She does not smoke and rarely drinks. She has two children. There is no family history of breast or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On examination she is afebrile, with a blood pressure of 115/70 and a pulse of 80. On abdominal examination, she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?

•             Anorectal fistula

•             External hemorrhoids

•             Anal fissure

•             Anorectal cancer

•             Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it “would be better if I was not here.” What would you do next?

•             Tell him that he has a very promising career in anything he chooses and soon he will

feel better.

•             Tell him that he needs an antidepressant and it will take about 4 weeks to work.

•             Speak with his mother about getting him together more with his friends.

•             Assess his suicide risk.

 •            Which of the following is a “red flag” regarding patients presenting with headache?

•             Unilateral headache

•             Pain over the sinuses

•             New onset over age 40

•             Aggravated or relieved by change in position

•             A 73-year-old nurse presents to your office for evaluation of new onset of pill rolling tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient’s symptoms?

•             Cushing’s syndrome

•             Nephrotic syndrome

•             Myxedema

•             Parkinson’s disease

•             Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have?

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