NUr6550 final exam questions

1. The Valsalva maneuver and the squat-to-stand maneuver are
likely to increase the sound of a cardiac murmur associated with which of these
conditions?

2. Which of the following conditions may result in lower
extremity edema?

3. Art Bakke is a 46-year-old male who is being treated for
an acute myocardial infarction. He has now developed significant dyspnea at rest
and, per physical exam, has coarse rales involving the lower 2/3 of the lung
fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle
rupture and acute mitral-valve regurgitation.

Question: Which of the following physical findings would
support this diagnostic hypothesis?

4. The most common ECG finding in a patient with a
cardiomyopathy is an ST-elevation MI.

5. Nina Martinez is a 70-year-old female who experienced an
episode of acute pulmonary edema following an endovascular aneurysm repair. She
was discharged on furosemide 60 mg daily and instructed to follow up with
cardiology. She is now seen in the office at 2 weeks post discharge. Her
metabolic panel includes the following lab values:Question: This patient has which of the following
abnormalities as a likely consequence of diuretic overuse?

Hyponatremia

Hypokalemia

Metabolic acidosis

6. Which of the following are primary cardiomyopathy
categories, as described by the World Health Organization (WHO) in 1995?

7. What is the most common cause of sudden cardiac death in
young people?

What is the most common cause of sudden cardiac death in
young people?

8. Which of the following are treatment options for a
patient who presents with peripartum cardiomyopathy while still carrying the
fetus? (Select all that apply.)

9. What are the 3 major clinical complications related to
cardiomyopathies?

Arrhythmias;
including ventricular tachycardia and ventricular fibrillation

Thromboembolic
complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

10. Some patients with primary cardiomyopathies remain
asymptomatic throughout their lifetime.

A 38-year -old woman comes to the emergency
department complaining of a rapid heartbeat, tremors, and chest tightness. She
reports earlier in the day she was feeling a migraine starting so she took a
pill given to her by her friend who also experiences migraines. Her medical
history reveals that she is currently taking a monoamine oxidase inhibitor for
depression. Which migraine medication did she most likely take?

Acetaminophen
and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan
(Axert ® )

Butalbital,
acetaminophen and caffeine (Fioricet ® )

well-controlled hypertension, type 2 diabetes
mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor
(ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry
cleaning facility until approximately 8 years ago. During her evaluation, she
mentions that she sometimes has difficulty understanding conversation,
especially in noisy environments. This is likely a:

Drug-related
reaction.

Consequence
of occupational chemical exposure.

Early
sign of dementia.

Normal
age-related change in hearing

While
evaluating a 33-year-old female with a 2-day history of dysuria, which of the
following findings in urinalysis is most suggestive of urinary tract infection
(UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein Epithelial cells pH>8

All of the
following are examples of primary prevention strategies except:

Counseling
an elderly patient prior to discharge about fall risk at home and how to
prevent falls through adequate illumination.

Performing
a hemoglobin A1C for all patients admitted to the hospital.

Conducting
a study to identify the leading cause of mortality in teenagers and how to
reduce risk.

Immunizing
all adults ?60 years with zoster vaccine.

A 23-year-old woman is
being evaluated for an upper respiratory tract infection. As you prepare for
auscultation, the patient states “I have a benign murmur that has been with me
my whole life”. Anticipating a physiologic murmur, you would expect which of
the following characteristics?

Usually
obliterates S2.

Becomes
softer when going from a supine to standing position.

Occurs
late in systole.

Has
localized area of auscultation

You
see a 73-year-old woman with a 40 pack- year smoking history, chronic
obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who
presents with an ulcer on the sole of her left foot. The ulcer has an irregular
edge and pale base and a punched out appearance, with the surrounding skin
white and shiny. The patient states that the pain is worse at night in bed and
when the legs are elevated. The most likely diagnosis is:

Pressure
ulcer

Pyoderma
gangrenosum

Venous ulcer

Arterial
ulcer

You
see a 76-year-old woman living at home who is accompanied by her home care
provider. She has COPD and type 2 diabetes mellitus. An example of a secondary
prevention strategy is:

Administering
the seasonal influenza vaccine.

Screening
for physical or financial abuse/Checking her blood glucose level.

Checking
her blood pressure.

Adjusting
her insulin dosing regimen.

A 43-year-old woman is being evaluated in the
emergency department with a complaint of a severe headache. She describes a
unilateral, pulsing headache that was preceded by a gradual onset of
paresthesia affecting the ipsilateral face and arm. The patient stated she noticed
a “funny smell” prior to the symptoms starting. This description is most
typical of:

Migraine
with aura.

Cluster
headache.

Transient
ischemic attack.

Tension-type
headache.

You
see a 54-year-old man living in subsidized housing with a history of
hypertension. He states that he stopped taking his blood pressure medication
about 4 months ago because of costs. He is concerned because his blood pressure
is high whenever he checks it, though he does not report any symptoms. His BP
at this visit is 196/104 mm Hg. Upon examination of this patient, you would
expect to detect an S 4 sound heard during:

Early
systole.

Late
systole.

Early
diastole.

Late
diastole.

32-year-old man requires evaluation for hepatitis
infection prior to taking a job as a restaurant cook. He presents with the
following laboratory results:

When
evaluating illness symptoms in older patients, the disease will often present
differently from younger adults due to:

The
likelihood of polypharmacy.

Decreased
compensatory mechanisms in the elderly.

An
increased physiologic response to illness in the elderly.

Presence
of comorbid conditions.

When prioritizing risk factors for bacterial
endocarditis, the nurse practitioner knows who among the following patients has
the highest risk.

A
55-year-old man with 3-vessel coronary artery bypass grafts with stents.

A
23-year-old woman with mitral valve prolapse without tissue redundancy.

A
65-year-old man with nonobstructive cardiomyopathy.

A
75-year-old woman with a nonorganic prosthetic aortic valve.

The legal
authority for NPs to perform healthcare services as defined by state law is
called:

Duty of care.

Non-malfeasance.

Autonomy.

Scope
of practice.

When
developing a management plan for patients with genitourinary infections, which
of the following would you most likely recommend for follow-up imaging
following resolution of their infection?

A 27-year-old nonpregnant woman with
acute, uncomplicated urinary tract infection (UTI). A 38-year-old nonpregnant
woman with 2 acute, uncomplicated UTIs in the past 9 months. A 57-year-old man
with acute bacterial prostatitis.

A
43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.

The NP is called to evaluate Jane, a 43-year- old
woman, who presents with a diffuse maculopapular rash that began on the trunk
but now covers the entire body, including the palms and soles. The rash is not
itchy but wart-like sores are present in the mouth and genital area as well as
skin folds. Initial evaluation reveals generalized lymphadenopathy and a
low-grade fever, and she complains of lethargy and headache. The patient
reports that she had a painless genital ulcer that healed on its own about 3
weeks earlier. Which of the following is the most likely diagnosis?

Primary
syphilis.

Secondary
syphilis.

Genital
herpes.

Gonorrhea.

A
27-year-old man presents with a chief concern of an abnormal mass within his
left scrotum. He describes it as feeling like a “bag of worms” and is present
when he is standing but disappears when he lies down. His past medical history
is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous
relationship for the past 4months. The most likely diagnosis is:

Testicular
torsion.

Syphilis.

Varicocele.

Testicular
cancer.

An 18-year-old man is
being evaluated for a severe exacerbation of asthma. He is currently taking an
inhaled corticosteroid, a long- acting beta-agonist, and a short-acting
beta-agonist on an as needed basis. The most important component of the initial
assessment includes a(n):

Continuous
pulse oximetry reading

Peak expiratory flow reading

Chest
X-ray

Arterial
Blood Gas

A
67-year-old man is being evaluated for shortness of breath. His medical history
reveals that he experienced a myocardial infarction about 2 years ago and a
history of hypertension, which is well controlled by diet.. Otherwise, his
medical history is unremarkable. Which of the following would you expect to
find on electrocardiogram (ECG)?

T
wave inversion.

Pathologic
Q wave.

ST
segment elevation.

Tall
R wave.

A 74-year-old male with
asymptomatic atrial fibrillation underwent electrical cardioversion that
successfully restored the heart’s rhythm. Which of the following medications
can be considered for the purpose of maintaining the heart’s rhythm?

Sotalol
(Betapace ® )

Digoxin
(Lanoxin ® )

Dabigatran
(Pradaxa ® )

Enalapri

A 14-year-old male is
brought in for evaluation after he reportedly collapsed during a tennis match,
though he quickly regained consciousness. His medical history is otherwise
unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following
heart murmur characteristics would support the diagnosis?

Occurs
late in systole.

Widely split S?.

Becomes
louder when going from a supine to standing position.

Murmur
follows mid-systolic click.

You
see a 64-year-old man with an area of erythema concentrated on the left side of
his neck with clusters of vesicles forming a line. He reported pain in the area
a couple of days before the eruption of the lesions. He states that he recently
initiated biologic therapy for rheumatoid arthritis. Which of the following is
the most likely diagnosis?

Impetigo.

Herpes
zoster.

Drug-related
adverse reaction.

Viral
exanthem.

l
(Vasotec ® )

An NP’s duty of
care can be established:

Only
in the setting of a healthcare institution (e.g., hospital, clinic, etc.).

When
the NP gives professional advice or treatment in any setting.

Only
when a fee is charged, either to the patient or third-party payer, for
services.

Only
when both the NP and patient acknowledge a patient-provider relationship.

In
managing a 58-year- old woman who is admitted for deep vein thrombosis, caution
should be used with which of the following medications due to a risk of
drug-induced thrombocytopenia?

Warfarin
(Coumadin®)

Clopidogrel
(Plavix®)

Dabigatran
(Pradaxa®)

Unfractionated
heparin

An
84-year-old female patient is admitted from a local long-term care facility
(illnes). The patient is normally awake, alert, and oriented. She resides in
the LTCF because she has not fully recovered from a broken hip resulting from a
fall 4 months ago; otherwise she is in relatively good health. She can walk
short distances with a walker, though she primarily stays in a wheelchair.
Today, however, the nursing staff found her to be acutely confused and unable
to ambulate without falling. She was transferred to the emergency department
for evaluation. Initial laboratory testing must include:

2
sets of blood cultures.

Serum
thyroid stimulating hormone (TSH) level.

Urinalysis.

Lumbar
puncture.

A 23-year-old college student presents with a 2-day
history of severe sore throat and difficulty eating or drinking due to trouble
swallowing. A physical examination reveals exudative pharyngitis and minimally
tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious
mononucleosis and would expect which of the following laboratory findings?

Neutrophilia
with reactive forms.

Thrombocytosis.

Lymphocytosis
with atypical lymphocytes.

Diminished
ALT/AST levels.

“Incident-to”
services are defined as those which are “an integral, although incidental,
part of the physician’s personal professional services in the course of
diagnosis or treatment of an injury or illness”. As long as certain
criteria are met, “incident to” billing is an option in all of the following settings
except:

Office
visits.

Hospital.

Nursing
home.

Home
visits.

A 78-year- old male is
being treated for a hypoglycemic episode. He has a long history of type 2
diabetes mellitus as well as congestive heart failure and COPD. He is currently
taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for
this patient?

?6.5%

?7.0%

?8.0%

?9.0%

You see a 74- year-old male who is accompanied by
his granddaughter who lives with him. He has hypertension, a prior myocardial
infarction, long-standing type 2 diabetes, and recently underwent a lower limb
amputation secondary to diabetes. He is currently taking an ACE inhibitor,
statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports
that since the amputation, her grandfather sometimes becomes withdrawn,
irritable and moody for no apparent reason, does not want to participate in the
typical activities he enjoys, and often does not appear to eat much during the
day. She also states that he often complains of being tired but normally wakes
up in the early morning hours. The most appropriate action is to evaluate the
patient for:

Dementia.

Depression.

Delirium.

Drug
interaction.

You see a 58-year-old man who complains of a
persistent dry, hacking cough. He reports that he recently started taking a
medication to treat high blood pressure. He is most likely taking a(n):

Angiotensin-converting
enzyme (ACE) inhibitor

Alpha-adrenergic
antagonist

Angiotensin
receptor blocker

Beta-adrenergic antagonist

A
77-year-old woman is accompanied by her husband for evaluation. She is
currently being treated with metoprolol (Lopressor ® ) for hypertension and
digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is
becoming increasingly forgetful over the past year, failing to note important
family events such as birthdays, and sometimes becomes confused with driving
directions to familiar locations. She has no previous psychiatric history. The
most likely diagnosis is:

Parkinson’s
disease.

Delirium.

Dementia.

Early
stage of congestive heart failure.

Mrs. Conner is a 76- year-old woman living in a
long-term care facility and has been bedridden with a respiratory infection for
the past 4 days. She is brought in for evaluation and you note signs of
dehydration as well as a section of epidermal skin loss about 3 cm in diameter
on her right hip. The dermal layer appears intact. This would be considered a
pressure ulcer of Stage:

1

2

3

4

Which of the
following represents the highest level of scientific evidence when evaluating
clinical research?

A
randomized controlled trial.

Systematic
review/ Meta-analysis of randomized controlled troals.

Observational
study.

Cohort
study.

A 64-year- old woman with chronic kidney disease
presents with a chief complaint of lethargy. His hemogram is as follows:

-Hemoglobin
(Hg)=9.9 g/dL (12–14 g/dL -Hematocrit (Hct)=30% (36%–42%) -Mean cell volume
(MCV)=81 fL (80–96 fL -Reticulocytes=0.7% (1%–2%)

These findings
are most consistent with:

Iron
deficiency anemia.

Anemia
of chronic disease.

Folate
deficiency anemia.

Thalassemia
trait.

You
see a 68-year-old woman who is being treated for moderate depression. She
complains that her medication is causing symptoms of dry mouth and
constipation. She is most likely taking which of the following medications?

Venlafaxine
(Effexor ® )

Citalopram
(Celexa ® )

Fluoxetine
(Prozac ® )

Nortriptyline
(Pamelor ® )

All of the
following persons are eligible for Medicare services except:

A
74-year-old ex-smoker with COPD and high income from assets.

A 69-year-old
undocumented resident in the US with atrial fibrillation.

A 62-year-old with a

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