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2024 NR577 FINAL EXAM WITH CORRECT ANSWERS
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2024 NR577 FINAL EXAM WITH CORRECT ANSWERS
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2024 NR577 FINAL EXAM WITHCORRECT ANSWERS
A 56-year-old patient comes in for a routine well visit. He has a history of a
previous stroke and Type 2 Diabetes. Which of the following orders would be
appropriate for a patient with a previous stroke?
A. Initiate statin therapy
B. EEG
C. Warfarin therapy with an INR goal of 2-3
D. MRI - CORRECT-ANSWERSA.
Patients with a history of an ASCVD should be started on statin therapy
regardless of current LDL. The question did not mention any other symptoms
that would warrant additional diagnostics. Warfarin therapy is only indicated
if AFIB would be the primary indication for anticoagulation after a stroke.
285. A 16-year-old patient presents to the ED. He is hyperactive and
vomiting. What additional clinical feature may be present in a patient
experiencing cocaine overdose?
a. Pupil dilation
b. Pupil constriction
c. hypothermia
d. decreased heart rate - CORRECT-ANSWERSA.
. A 77-year-old female patient presents to your clinic with complaint of
severe back pain following a fall 3 days ago. After further prompting she also
reports that she has experienced episodes of bowel incontinence and urinary
urgency over the past 3 days. She denies head trauma from the fall or
headaches. She is alert and oriented x 4. What is the most appropriate next
step in your treatment plan?
A. Encourage patient to rest, ice, and use NSAID's for pain.
B. Emergent referral to ED for CT scan.
C. Referral for physical therapy for mobility.
D. Spinal X-ray to assess for fractures. - CORRECT-ANSWERSB.
An 8-year-old male patient presents to your office due to parental concern
after he fell and hit his head falling off of a swing set yesterday, he did not
lose consciousness. Patient reports with headache, sensitivity to light and
feeling dizzy. His mini neuro exam is within normal limits. You diagnose him
with post concussive syndrome. His mother asks if he can play in his little
league baseball game tonight. Which answer is most appropriate?
,A. He can play in his game as long as he is feeling better by tonight.
B. He should refrain from all physical activity for the next 2 weeks.
C. He cannot play in tonight's game; he should have a head CT completed
before he can participate in sports.
D. He should not play in tonight's game, let me walk you through a
graduated "return-to-play" protocol. - CORRECT-ANSWERSD.
An elderly woman presents to your clinic with complaint of new onset urinary
incontinence "a few weeks ago". She is alert and oriented, states that she
lives alone, she uses a walker for mobility, and she is unable to recall the
names of her "many" medications. You recall the numerous transient causes
of urinary incontinence. Which of the following is NOT a transient cause of
urinary incontinence?
A. Detrusor overactivity.
B. Restricted mobility.
C. Fecal impaction.
D. Anticholinergic medications. - CORRECT-ANSWERSA.
An 87-year-old male presents to your clinic accompanied by his son, who he
lives with. His son expresses concern that his dad has been more forgetful
and confused the past few months. The patient reports that he has forgotten
to turn off the oven and has difficulty remembering where he has placed
things around the house. You perform a mini-cog exam and the patient fails
this test. Your next best step is to:
A. Recommend that the son look into long-term placement options.
B. Prescribe donepezil 5 mg PO daily for mild Alzheimer's.
C. Perform a Montreal Cognitive Assessment.
D. Perform HIV, RPR, heavy metal, and liver enzyme tests. - CORRECT-
ANSWERSD.
. After a psychiatric evaluation, an 8-year-old male is diagnosed with
attention deficit hyperactivity disorder (ADHD). His mother brings him to the
clinic today and states she does not want the patient to start on a stimulant
medication for his ADHD and asks for other options to help control his
symptoms. Which medication would be best to place the patient on at this
time?
A. Methylphenidate (Concerta)
B. Atomoxetine (Strattera)
C. Dextroamphetamine (Dexedrine)
D. Dexmethylphenidate (Focalin) - CORRECT-ANSWERSB.
,. A 10-year-old female with a recent diagnosis of depression presents to the
clinic today with her mother. The patient has completed cognitive behavior
therapy (CBT), but her mother states she has seen minimal improvement
with her child's depression symptoms. At this age and with no previous
medicinal treatment, the preferred first line medication to prescribe at this
time would be:
A.Fluoxetine (Prozac)
B.Bupropion (Wellbutrin)
C.Venlafaxine (Effexor)
D.Clonidine (Catapres) - CORRECT-ANSWERSA.
A 9-year-old African American fostered child who is prepubertal, with history
of α-thalassemia minor comes to your clinic with c/o being tired and
appearing pale for 1 week. No other medical history or hospitalization is
known to foster parents. She is not ill appearing or weak and appears well
developed. You have also drawn CBC with hemoglobin electrophoresis during
current visit. At time of discharge you instruct the patient and foster parents
to, (choose the best answer):
a. Start on daily Iron supplements with ascorbic acid (vitamin C)
b. Start on daily supplements of Vitamin B 6
c. Start on daily supplements of Folic Acid
d. Go to ER for further workup with PRBC transfusion. - CORRECT-ANSWERSC.
A 32-year-old female returns to you with new complaints of mucocutaneous
bleeding while brushing teeth and unexplained bruising to thighs 1 week
after starting on Phenytoin (Dilantin) with a platelet count of 95,000/mcL
(normal range 150,000 - 450,000 mcL). Based on platelet reduction you
suspect drug induced thrombocytopenia. At time of discharge you ask
patient to stop taking phenytoin and tell her:
a. To go to the ER to be admitted with possibility of platelet transfusion
b. That her symptoms will improve within next 7-10 days
c. Start her on high dose prednisone daily
d. Start her on Vitamin K 10mg, PO, once daily for 7 days. - CORRECT-
ANSWERSB.
Your 45-year-old female patient comes in for a lab review after she initially
came in with complaints of increasing anxiety, unintentional weight loss,
weakness, heat intolerance and bulging eye. Her labs show a suppressed
TSH and elevated T4 levels. You diagnose your patient with hyperthyroidism.
All the following are used to treat this EXCEPT:
a) Methimazole
b) Propranolol
, c) Levothyroxine
d) Propylthiouracil - CORRECT-ANSWERSC.
Your 40-year-old female patient comes in with complaints of fatigue,
increased thirst, skin changes including purple striae, increasing abdominal
girth with decreased muscles in the upper and lower extremities. You do
your physical exam and notice the patient has a "moon face", "buffalo
hump", and varying bruises on her arms. Based on the patient's complaints
and your physical examination you expect the patient to be diagnosed with
which of the following?
a) Addison's disease
b) Cushing syndrome
c) Primary aldosteronism
d) Pheochromocytoma - CORRECT-ANSWERSB.
296. Your 45-year-old male patient is newly diagnosed with diabetes mellitus
type II and you plan on starting him on Metformin. You teach the patient
about some side effects that can occur with metformin use. All the following
are side effects of metformin EXCEPT:
a) Anorexia
b) Diarrhea
c) Vitamin B 12 deficiency
d) Hypoglycemia - CORRECT-ANSWERSD.
What complication of type 2 diabetes is three to five times more common
and is also the leading cause of death in patients with type 2 diabetes?
a) Stroke
b) Myocardial infarction
c) Cancer
d) Liver disease - CORRECT-ANSWERSB.
A nurse practitioner sees a 34-year-old white female with complaints of
apprehension, worry, irritability, difficulty concentrating, insomnia, and
generalized aches and pains of no specific origin for most days over the last
6 months. The nurse practitioner would like to start this patient on a low
dose SSRI/SNRI for suspected generalized anxiety disorder. Which of the
following has been approved by the FDA as first-line treatment for this
condition?
A. Venlafaxine and paroxetine
B. Venlafaxine and duloxetine
C. Propranolol and sertraline
D. Sertraline and gabapentin - CORRECT-ANSWERSA.
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