South University NRSG6420 mid term 2017

Question 1.

1. Your patient has been using chewing tobacco for 10 years.
On physical eamination, you observe a white ulceration surrounded by

erythematous base on
the side of his tongue. The clinician should recognize that very often this is:
(Points : 2)

Malignant
melanoma

Squamous cell carcinoma

Aphthous
ulceration

Behcet’s
syndrome

Question 2.

2. Which of the following would be considered a “red flag”
that requires more investigation in a patient assessment? (Points : 2)

Colon cancer in
family member at age 70

Breast cancer
in family member at age 75

Myocardial infarction in family member at age
35

All of the
above

Question 3.

3. The pathophysiological hallmark of ACD is: (Points : 2)

Depleted iron
stores

Impaired ability to use iron stores

Chronic
uncorrectable bleeding

Reduced
intestinal absorption of iron

Question 4.

4. It is important to not dilate the eye if ____ is
suspected. (Points : 2)

Cataract

Macular degeneration

Acute closed-angle glaucoma

Chronic
open-angle glaucoma

Question 5.

5. A 66-year-old patient presents to the clinic complaining
of dyspnea and wheezing. The patient reports a smoking history of 2 packs of

cigarettes per day
since age 16. This would be recorded in the chart as: (Points : 2)

50 2-pack years

100-pack years

50-year, 2-pack
history

100-pack
history

Question 6.

6. When teaching a group of older adults regarding
prevention of gastroesophageal reflu disease symptoms, the nurse practitioner
will include

which of the
following instructions? (Points : 2)

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.

Sit up for an
hour after taking any medication and restrict fluid intake.

Avoid food intolerances, raise head of bed
on blocks, and take a proton pump inhibitor before a meal.

Question 7.

7. A 56-year-old male complains of anoreia, changes in bowel
habits, etreme fatigue, and unintentional weight loss. At times he is
constipated

and other times he has episodes of diarrhea. His physical eamination
is unremarkable. It is important for the clinician to recognize the

importance of:
(Points : 2)

CBC with
differential

Stool culture
and sensitivity

Abdominal -ray

Colonoscopy

Question 8.

8. 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 eercise, 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? (Points : 2)

Musculoskeletal
chest wall syndrome with radiation

Esophageal
motor disorder with radiation

Acute
cholecystitis with cholelithiasis

Coronary artery disease with angina pectoris

Question 9.

9. A common auscultatory finding in advanced CHF is: (Points
: 2)

Systolic
ejection murmur

S3 gallop rhythm

Friction rub

Bradycardia

Question 10.

10. Which of the following symptoms is common with acute
otitis media? (Points : 2)

Bulging tympanic membrane

Bright light
refle of tympanic membrane

Increased
tympanic membrane mobility

All of the
above

Question 11.

11. Rheumatic heart disease is a complication that can arise
from which type of infection? (Points : 2)

Epstein-Barr
virus

Diphtheria

Group
A beta hemolytic streptococcus

Streptococcus
pneumoniae

Question 12.

12. In eamining 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? (Points : 2)

Fictional
keratosis

Keratoacanthoma

Lichen planus

Leukoplakia

Question 13.

13. Jenny is a 24 year old graduate student that presents to
the clinic today with complaints of fever, midsternal chest pain and
generalized

fatigue for the past two days. She denies any cough or
sputum production. She states that when she takes Ibuprofen and rest that the
chest

pain does seem to
ease off. Upon eamination the patient presents looking very ill. She is leaning
forward and states that this is the most

comfortable position for her. Temp is 102. BP= 100/70. Heart
rate is 120/min and regular. Upon auscultation a friction rub is audible. Her
lung

sounds are clear. With these presenting symptoms your
initial diagnosis would be: (Points : 2)

Mitral Valve
Prolapse

Referred Pain
from Cholecystitis

Pericarditis

Pulmonary
Embolus

Question 14.

14. Which of the following findings should trigger an urgent
referral to a cardiologist or neurologist? (Points : 2)

History of
bright flash of light followed by significantly blurred vision

History of transient and painless monocular
loss of vision

History of monocular
severe eye pain, blurred vision, and ciliary flush

All of the
above

Question 15.

15. 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? (Points : 2)

It is highly
contagious and a mask should be worn at home.

Treatment
regimen is multiple lifetime medications.

Treatment regimen is multiple medications
taken daily for a few weeks.

Treatment
regimen is complicated and is not indicated unless the patient is symptomatic.

Question 16.

16. The best evidence rating drugs to consider in a post
myocardial infarction patient include: (Points : 2)

ASA, ACE/ARB, beta-blocker, aldosterone
blockade

ACE, ARB,
Calcium channel blocker, ASA

Long-acting
nitrates, warfarin, ACE, and ARB

ASA,
clopidogrel, nitrates

Question 17.

17. The most common cause of eye redness is: (Points : 2)

Conjunctivitis

Acute glaucoma

Head trauma

Corneal
abrasion

Question 18.

18. A specific eam used to evaluate the gall bladder is:
(Points : 2)

Psoas sign

Obturator sign

Cullens sign

Murphy’s sign

Question 19.

19. 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 eamination, she has
orthostatic hypotension and pallor. Fecal occult blood test is positive. A
likely etiology

of the patient’s
problem is: (Points : 2)

Mallory-Weiss
tear

Esophageal varices

Gastric ulcer

Colon cancer

Question 20.

20. Which of the following is not a contributing factor to
the development of esophagitis in older adults? (Points : 2)

Increased gastric emptying time

Regular
ingestion of NSAIDs

Decreased
salivation

Fungal
infections such as Candida

Question 21.

21. Susan P., a 60-year-old woman with a 30 pack year
history, presents to your primary care practice for evaluation of a persistent,

daily cough with
increased sputum production, worse in the morning, occurring over the past
three months. She tells you, “I have the

same thing, year after year.” Which of the following choices
would you consider strongly in your critical thinking process? (Points : 2)

Seasonal allergies

Acute
bronchitis

Bronchial
asthma

Chronic bronchitis

Question 22.

22. A 59-year-old patient with history of alcohol abuse
comes to your office because of ‘throwing up blood”. On physical eamination,
you note

ascites and caput
medusa. A likely cause for the hematemesis is: (Points : 2)

Peptic ulcer
disease

Barrett’s
esophagus

Esophageal varices

Pancreatitis

Question 23.

23. Which disease process typically causes episodic right
upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or
less,

often radiates to the back (classically under the right
shoulder blade) and is often accompanied by nausea or vomiting and often
follows a

heavy, fatty meal.
(Points : 2)

Acute pancreatitis

Duodenal ulcer

Biliary colic

Cholecystitis

Question 24.

24. 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? (Points : 2)

Acute MI

GERD

Pneumonia

Angina

Question 25.

25. In addition to the complete blood count (CBC) with
differential, which of the following laboratory tests is considered to be most
useful in

diagnosing ACD and
IDA? (Points : 2)

Serum iron

Total iron
binding capacity

Transferrin
saturation

Serum ferritin

Question 26.

26. If it has been determined a patient has esophageal reflu,
you should tell them: (Points : 2)

They probably
have a hiatal hernia causing reflu

They probably
need surgery

They should
avoid all fruit juices

Smoking, alcohol, and caffeine can aggravate
their problem

Question 27.

27. Which of the following imaging studies should be
considered if a pulmonary malignancy is suspected? (Points : 2)

Computed tomography (CT) scan

Chest -ray with
PA, lateral, and lordotic views

Ultrasound

Positron
emission tomography (PET) scan

Question 28.

28. 2. (*There are multiple questions on this eam related to
the following scenario. Be sure to read the whole way through to the question.)

Mr. Keenan is a 42-year-old man with a mild history of GERD
and a remote history of an appendectomy, presenting with an acute onset of

significant right upper-quadrant abdominal pain and
vomiting. His pain began after a large meal, was unrelieved by a proton-pump
inhibitor,

was unlike his previous episodes of heartburn, but upon
questioning, reports milder, prodromal episodes of similar post-prandial pain.
His

pain seems to radiate to his back. Despite a family history
of cardiac disease, he reports no classic anginal signs or chest pain. He
furthermore

denies respiratory or
pleuritic signs and denies fever, night sweats, and unintended weight loss.
Finally, there are no dermatologic signs, nor

genitourinary
symptoms.

When all lab work is returned within normal limits, what is
the most practical imaging study to order, considering cost, availability, and
sensitivity?

(Points : 2)

Abdominal
upright and flat plate -ray

Abdominal MRI

Abdominal CT
scan with contrast

Abdominal ultrasound

Question 29.

29. Emphysematous changes in the lungs produce the following
characteristic in COPD patients? (Points : 2)

Asymmetric
chest epansion

Increased
lateral diameter

Increased anterior-posterior diameter

Pectus ecavatum

Question 30.

30. (*There are multiple questions on this eam related to
the following scenario. Be sure to read the whole way through to the question.)

Mr. Keenan is a
42-year-old man with a mild history of GERD and a remote history of an
appendectomy, presenting with an acute onset

of significant right upper-quadrant abdominal pain and
vomiting. His pain began after a large meal, was unrelieved by a proton-pump
inhibitor,

was unlike his previous episodes of heartburn, but upon
questioning, reports milder, prodromal episodes of similar post-prandial pain.
His pain

seems to radiate to his back. Despite a family history of
cardiac disease, he reports no classic anginal signs or chest pain. He
furthermore

denies respiratory or
pleuritic signs and denies fever, night sweats, and unintended weight loss.
Finally, there are no dermatologic signs, nor

genitourinary symptoms.

The chosen imaging study reveals: “GB normal in size without
wall-thickening, but with 5-6 stones with shadowing. Common bile duct not

dilated. Liver is homogenous and normal in size. Pancreas
and kidneys are normal.” What is the most effective therapeutic/management

option at this point?
(Points : 2)

Trial of
ursodiol

‘Watchful
waiting’

Surgical
consult

HIDA scan

Question 31.

31. A 26-year-old, non-smoker, male presented to your clinic
with SOB with eertion. This could be due to: (Points : 2)

Eercise-induced
cough

Bronchiectasis

Alpha-1 deficiency

Pericarditis

Question 32.

32. (*There are multiple questions on this eam related to
this scenario. Be sure to read the whole way through to the question.)

Mr. Keenan is a
42-year-old man with a mild history of GERD and a remote history of an
appendectomy, presenting with an acute onset

of significant right upper-quadrant abdominal pain and
vomiting. His pain began after a large meal, was unrelieved by a proton-pump
inhibitor,

was unlike his previous episodes of heartburn, but upon
questioning, reports milder, prodromal episodes of similar post-prandial pain.
His

pain seems to radiate to his back. Despite a family history
of cardiac disease, he reports no classic anginal signs or chest pain. He
furthermore

denies respiratory or
pleuritic signs and denies fever, night sweats, and unintended weight loss.
Finally, there are no dermatologic signs, nor

genitourinary symptoms.

Of the following lab studies, which would provide little
help in determining your differential diagnosis? (Points : 2)

Abdominal plain
films

Liver function
tests

Amylase/lipase

Urinalysis

Question 33.

33. A 22-year-old female comes to your office with
complaints of right lower quadrant abdominal pain, which has been worsening
over the

last 24 hours. On eamination of the abdomen, there is a
palpable mass and rebound tenderness over the right lower quadrant. The
clinician

should recognize the importance of: (Points : 2)

Digital rectal
eamination

Endoscopy

Pelvic eamination

Urinalysis

Question 34.

34. A nurse practitioner reports that your patient’s
abdominal -ray demonstrates multiple air-fluid levels in the bowel. This is a
diagnostic

finding found in:
(Points : 2)

Appendicitis

Cholecystitis

Bowel Obstruction

Diverticulitis

Question 35.

35. Your patient is a 78-year-old female with a smoking
history of 120-pack years. She complains of hoarseness that has developed over

the last few months.
It is important to eclude the possibility of: (Points : 2)

Thrush

Laryngeal cancer

Carotidynia

Thyroiditis

Question 36.

36. Functional abilities are best assessed by: (Points : 2)

Self-report of
function

Observed assessment of function

A comprehensive
head-to-toe eamination

Family report
of function

Question 37.

37. Essential parts of a health history include all of the
following ecept: (Points : 2)

Chief complaint

History of the
present illness

Current vital signs

All of the
above are essential history components

Question 38.

38. 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: (Points : 2)

Acoustic
neuroma

Cerumen impaction

Otitis media

Ménière’s
disease

Question 39.

39. Upon assessment of respiratory ecursion, the clinician
notes asymmetric epansion of the chest. One side epands greater than the other.

This could be due to:
(Points : 2)

Pneumothora

Pleural
effusion

Pneumonia

Pulmonary
embolism

Question 40.

40. When interpreting laboratory data, you would epect to
see the following in a patient with Anemia of Chronic Disease (ACD): (Points :
2)

Hemoglobin <12 g/dl, MCV decreased, MCH
decreased

Hemoglobin
>12 g/dl, MCV increased, MCH increased

Hemoglobin
<12 g/dl, MCV normal, MCH normal

Hemoglobin
>12 g/dl, MCV decreased, MCH increased

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