Exam

NURS 6531 Midterm Exam (2 Versions, 200 Q & A ) / NURS6531N Midterm Exam (Year-2019/2020, 100 Q & A in Each Version, Verified and 100% Correct Answers)

NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest) Question 1 A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? Question 2 Which type of lung cancer has the poorest prognosis? Question 3 Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Question 4 An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is: Question 5 A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Question 6 Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to: Question 7 Which of the following is not a goal of treatment for the patient with cystic fibrosis? Question 8 The most common cancer found on the auricle is: Question 9 Which of the following color changes in a pigmented lesion suggests malignant transformation? Question 10 Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Question 11 The Centorcriteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following? Question 12 When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Question 13 Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued? Question 14 Which of the following patient characteristics are associated with chronic bronchitis? Question 15 Treatment of acute vertigo includes: Question 16 A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect: Question 17 A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? Question 18 Diagnosis of Crohn’s disease is made considering signs, symptoms and: Question 19 Which of the following is a predisposing condition for furunculosis? Question 20 Expected spirometry readings when the patient has chronic emphysema include: Question 21 A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis? Question 22 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Question 23 Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? Question 24 An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: Question 25 A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests: Question 26 Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as: Question 27 The differential diagnosis for a patient complaining of a sore throat includes which of the following? Question 28 Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect? Question 29 The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every: Question 30 Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to: Question 31 A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? Question 32 A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with: Question 33 John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia? Question 34 A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: Question 35 Your patient Jerry has gout. What do you suggest? Question 36 Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is: Question 37 A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: Question 38 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is: Question 39 Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect? Question 40 A 55 year old patient has a work-up for hypertension and is noted to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect? Question 41 Which of the following is not a symptom of irritable bowel syndrome? Question 42 Impetigo and folliculitis are usually successfully treated with: Question 43 Which of the following is not a risk factor for coronary arterial insufficiency? Question 44 The most appropriate treatment for a child with mild croup is: Question 45 John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Question 46 Appropriate therapy for peptic ulcer disease (PUD) is: Question 47 An AST that is more than twice the level of ALT is suggestive of: Question 48 A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tineapedis. What is the best initial treatment option for this patient? Question 49 An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? Question 50 Sandra has celiac disease. You place her on which diet? Question 51 Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to: Question 52 Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? Question 53 A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include: Question 54 Which of the following is a secondary cause of hyperlipidemia? Question 55 Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? Question 56 An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent? Question 57 The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? Question 58 A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder? Question 59 Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? Question 60 A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to: Question 61 A patient presents to the office with a blood pressure 142/80. This patient is classified as having: Question 62 Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep? Question 63 A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except: Question 64 A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough? Question 65 Which choice below is least effective for alleviating symptoms of the common cold? Question 66 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has: Question 67 A patient reports to the nurse practitioner that he was diagnosed with hepatitis B a year ago and has not seen a health care provider since then. What information should this patient be given? Question 68 The most common correlate(s) with chronic bronchitis and emphysema is(are): Question 69 If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Question 70 Treatment of H.pylori includes which of the following? Question 71 Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? Question 72 What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Question 73 Which of the following best describes hypertrophic cardiomyopathy? Question 74 Amaurosisfugax is described as a: Question 75 The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: Question 76 Which of the following heart murmurs warrants the greatest concern? Question 77 A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: Question 78 Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? Question 79 Of the following, the patient who should be referred for periodic colonoscopy is the patient with: Question 80 Dana has ischemic arterial ulcers. What is your first priority when counseling her? Question 81 After thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently considered most effective? Question 82 Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? Question 83 What is the Gold standard for the diagnosis of asthma? Question 84 An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis? Question 85 The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than: Question 86 Which intervention listed below is safe for long term use by an adult with constipation? Question 87 The nurse practitioner is reviewing a patient’s lab report who completed the hepatitis B series 3 months ago. Which of the following lab results would you expect to see in this patient? Question 88 Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate? Question 89 A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems? Question 90 A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is: Question 91 A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to: Question 92 A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? Question 93 Which of the following can result from chronic inflammation of a meibomian gland? Question 94 A 15 year old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant (RLQ). He complains of anorexia, and low grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis? Question 95 Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient? Question 96 A false-positive result with the fecal occult blood test can result from: Question 97 A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is: Question 98 Risk factors for acute arterial insufficiency include which of the following? Question 99 A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is: Question 100 Which of the following are classic features of ulcerative colitis? NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest) • Question 1 When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Yes No • Question 2 The most common cancer found on the auricle is: Actinic keratosis Basal cell carcinoma Squamous cell carcinoma Acral-lentiginous melanoma • Question 3 Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient? Xanthines Antihistimines Steroids Anticholinergics • Question 4 A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed? Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet. Order a topical hemorrhoid cream along with a stool softener. Refer the patient for a barium enema and sigmoidoscopy. Refer the patient for a surgical hemorrhoidectomy. • Question 5 Which of the following patient characteristics are associated with chronic bronchitis? Overweight, cyanosis, and normal or slightly increased respiratory rate Underweight, pink skin, and increased respiratory rate Overweight, pink skin, and normal or slightly increased respiratory rate Normal weight, cyanosis, and greatly increased respiratory rate • Question 6 A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is: CBCdiff Erythrocyte sedimentation rate Abdominal ultrasound CT scan • Question 7 A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except: Purulent drainage Tearing Photophobia A positive fluorescein stain • Question 8 A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect: Viral conjunctivitis Common pink eye Gonococcal conjunctivitis Allergic conjunctivitis • Question 9 A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect: A common case of shingles and prescribe an analgesic and an antiviral agent A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream Herpes zoster and consider that this patient may be immunocompromised A recurrence of chickenpox and treat the patient’s symptoms • Question 10 Which type of lung cancer has the poorest prognosis? Adenocarcinoma Epidermoid carcinoma Small cell carcinoma Large cell carcinoma • Question 11 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has: Acute diarrhea Chronic diarrhea Irritable bowel Functional bowel disease • Question 12 Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? An allergic reaction Relapsing polychondritis Lymphocytoma cutis Systemic lupus erythematosus • Question 13 Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes? Chronic sinusitis Acute bronchitis Bacterial pneumonia Acute exacerbation of chronic bronchitis • Question 14 Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in? Mild intermittent Mild persistent Moderate persistent • Question 15 Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep? Penicillin V 500 milligrams PO every 8 hours for 10 days Ampicillin 250 milligrams PO twice a day for 10 days Clarithromycin 500 milligrams po daily for 7 days None of the above • Question 16 A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems? Congestive heart failure Varicose veins Deep vein thrombosis Arterial insufficiency • Question 17 Which statement below is correct about pertussis? It is also called whooping cough It begins with symptoms like strep throat It lasts about 3 weeks It occurs most commonly in toddlers and young children • Question 18 Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? Pneumonia Asthma Sinusitis Pertussis • Question 19 A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition? Diverticulosis Diverticula Diverticulitis Diverticulum • Question 20 Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect? Varicella Herpes zoster Syphilis Rubella • Question 21 A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is: Alcohol Gallstones Medications Pregnancy • Question 22 When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? Order abdominal x-rays Order an abdominal ultrasound Refer the patient to a surgeon for evaluation Prescribe pain medication • Question 23 A false-positive result with the fecal occult blood test can result from: ingestion of large amounts of vitamin C a high dietary intake of rare cooked beef a colonic neoplasm that is not bleeding stool that has been stored before testing • Question 24 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is: Colonoscopy Small bowel follow-through Barium enema CT abdomen • Question 25 A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with: Mitral regurgitation Systolic heart failure Cardiac myxoma Diastolic heart failure • Question 26 Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized? Multilobar involvement on chest x-ray with the inability to take oral medications Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home Sputum and gram positive organisms A complete blood count showing leukocytosis • Question 27 A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him: “It is the most common cause of death in patients with skin cancer.” “It can be cured with surgical excision or radiation therapy.” “It is a slow growing skin cancer that rarely undergoes malignant changes.” “It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.” • Question 28 Expected spirometry readings when the patient has chronic emphysema include: Decreased residual volume (RV) Increased vital capacity (VC) Increased forced expiratory volume (FEV-1) Increased total lung capacity (TLC) • Question 29 An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is: Esophageal cancer Chest pain GERD A and C All of the above • Question 30 A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect? Squamous cell carcinoma Malignant melanoma A common nevus Basal cell carcinoma • Question 31 Which of the following is not a goal of treatment for the patient with cystic fibrosis? Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water-soluble vitamins • Question 32 The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals? Scalp Nails Feet B and C All of the above • Question 33 An adult presents with tinea corporis. Which item below is a risk factor for its development? Topical steroid use Topical antibiotic use A recent laceration Cold climates • Question 34 A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours. Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management. Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction. Order stool cultures. • Question 35 Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? Aspirin NSAIDs Opioids Antihistamines • Question 36 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is: Peripheral edema Weight gain Shortness of breath Nocturnal dyspnea • Question 37 A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe? Ibuprofen Erythromycin Amoxicillin Acetaminophen • Question 38 A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans? “Are you wearing your usual shoes?” “Do you also have chest pain when you have leg pain?” “Is your leg pain relieved by rest?” “Do you ever have the same pain in the other leg?” • Question 39 Which of the following statements about malignant melanomas is true? They usually occur in older adult males The patient has no family history of melanoma They are common in blacks The prognosis is directly related to the thickness of the lesion • Question 40 Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect? Asthma Nocturnal allergies Valvular disease Heart failure • Question 41 Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? Erythromycin Clarithromycin (Biaxin) Doxycycline (Vibramycin) Penicillin • Question 42 Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction? Powders Gels Creams Lotion • Question 43 A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to: Squamous cell carcinoma Basal cell carcinoma Malignant melanoma Acne vulgaris • Question 44 An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? Assist the patient to a standing position and take her blood pressure. Assess the patient’s cranial nerves. Compare the patient’s blood pressure lying first, then sitting, and then standing. Compare the amplitude of the patient’s radial and pedal pulses. • Question 45 What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery? Ursodiol Ibuprofen Prednisone Surgery is the only answer • Question 46 A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is: Staphylococcus aureus Group A beta hemolytic streptococcus Haemophilus influenza Pseudomonas aeruginosa • Question 47 Which of the following is not a symptom of irritable bowel syndrome? Painful diarrhea Painful constipation Cramping and abdominal pain Weight loss • Question 48 A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed? Any recent trauma Difficulty swallowing Stiffness in the right shoulder Change in sleeping habits • Question 49 Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? ACE Inhibitor Beta Blocker Calcium channel blocker Diuretic • Question 50 The differential diagnosis for a patient complaining of a sore throat includes which of the following? Gonococcal infection Thrush Leukoplakia B only A, B, and C • Question 51 A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is: Rhus dermatitis Ophthalmic zoster Chemosis Optic neuritis • Question 52 Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered? Serologic markers for hepatitis Serum bilirubin Serum cholesterol with HDL and LDL A liver biopsy • Question 53 A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: A drug interaction Hepatic dysfunction Hypersensitivity to lovastatin Rhabdomyolysis • Question 54 Treatment of acute vertigo includes: Bedrest and an antihistamine Fluids and a decongestant A sedative and decongestant Rest and a low sodium diet • Question 55 Treatment of H.pylori includes which of the following? Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate A and B A, B, and C • Question 56 Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect? Cataracts Glaucoma Retinal detachment Iritis • Question 57 In order to decrease deaths from lung cancer: All smokers should be screened annually All patients should be screened annually Only high risk patients should be screened routinely Patients should be counseled to quit smoking • Question 58 John, age 33, has a total cholesterol level of 188 mgdL. How often should he be screened for hypercholesterolemia? Every 5 years Every 2 years Every year Whenever blood work is done • Question 59 Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? Mort is black Mort also has congestive heart failure Mort has benign prostatic hyperplasia Mort has frequent migraine headaches • Question 60 John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Actinic keratosis Eczema Psoriasis Seborrheic dermatitis • Question 61 Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 17089. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? Increase her Lisinopril to 20mg daily Add a thiazide diuretic to the Lisinopril 5mg daily Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker Discontinue the Lisinopril and start a diuretic • Question 62 An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: defer any further dental work until his valve replacement is completed instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed. suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications. • Question 63 Appropriate therapy for peptic ulcer disease (PUD) is: Primarily by eradication of infection Based on etiology Aimed at diminishing prostaglandin synthesis Dependent on cessation of NSAID use • Question 64 Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? A calcium channel blocker A beta blocker An ACE Inhibitor No hypertension medication • Question 65 Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices? It is important to “undercode” so that one does not get charged with Medicare fraud The practice of “overcoding” is essential in this age of decreasing reimbursements Failing to bill for billable services will lead to unnecessarily low revenues Time spent with the patient is a very important determinant of billing • Question 66 A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding? Viral conjunctivitis Glaucoma Corneal abrasion Retinoblastoma • Question 67 Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? Pharmacological therapy A labyrinthectomy A vestibular neurectomy Wearing an earplug in the ear with the most hearing loss • Question 68 Which of the following is not a risk factor for coronary arterial insufficiency? Hyperhomocysteinemia Smoking Genetic factors Alcohol ingestion • Question 69 An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms? Allergic conjunctivitis Bacterial conjunctivitis Gonococcal conjunctivitis Viral conjunctivitis • Question 70 A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free? A long-acting bronchodilator An inhaled corticosteroid and cromolyn Theophylline and a short acting bronchodilator A bronchodilator PRN and an inhaled corticosteroid • Question 71 Acute rheumatic fever is an inflammatory disease which can follow infection with: Group A Streptococcus Staphlococcus areus Β-hemolytic Streptococcus Streptococcus pyogenes • Question 72 A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to: Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days Order mandibular x-rays and question the patient about physical abuse Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic Initiate a parenteral antibiotic and consider hospital admission • Question 73 If a patient presents with a deep aching, red eye and there is no discharge, you should suspect: Iritis Allergic conjunctivitis Viral conjunctivitis Bacterial conjunctivitis • Question 74 The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than: 160 mgdL 130 mgdL 100 mgdL 70 mgdL • Question 75 A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is: Referral for surgical intervention such as a partial or complete fundoplication Dependent upon how sever the practitioner believes the condition To repeat the 8 week course of drug therapy while continuing lifestyle modifications Investigation with endoscopy, manometry, andor pH testing • Question 76 Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? Under 3 years of age Preschool children 6 to 12 years of age Adolescents • Question 77 The most appropriate treatment for a child with mild croup is: A bronchodilator An antibiotic A decongestant A cool mist vaporizer • Question 78 A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis? Peritonsillar abscess Thyroiditis Mononucleosis Epiglottitis • Question 79 Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication? It is not effective during an acute asthma attack. It may take 2 to 3 days to begin working. This drug works within 10 minutes. This drug may be used by patients 6 years and older. • Question 80 Which intervention listed below is safe for long term use by an adult with constipation? Bulk-forming agents Stool softeners Laxatives Osmotic agents • Question 81 A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Apply a topical antibiotic and warm compresses. Apply cool compresses and avoid touching the hordeolum. Use an oral antibiotic and eye flushes. Apply light palpation to facilitate drainage. • Question 82 Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate? An antihistamine intranasal spray A decongestant nasal spray Ipratropium Omalizumab • Question 83 What is the Gold standard for the diagnosis of asthma? Patient’s perception of clogged airways Validated quality-of-life questionnaires Bronchoscopy Spirometry • Question 84 A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough? Methyldopa Enalapril Amlodipine Hydrochlorothiazide • Question 85 Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by: Herpes simplex Aphthous ulcers Candidiasis Oral cancer • Question 86 Risk factors for acute otitis media (AOM) include all of the following except: Household cigarette smoke Group daycare attendance Sibling history of acute otitis media African-American ethnicity • Question 87 Which of the following can result from chronic inflammation of a meibomian gland? A chalazion Uveitis Keratitis A pterygium • Question 88 What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient • Question 89 Of the following choices, the least likely cause of cough is: Asthma Gastroesophageal reflux Acute pharyngitis Allergic rhinitis • Question 90 The most common correlate(s) with chronic bronchitis and emphysema is(are): Familial and genetic factors Cigarette smoking Air pollution Occupational environment • Question 91 Which choice below is least effective for alleviating symptoms of the common cold? Antihistamines Oral decongestants Topical decongestants Antipyretics • Question 92 When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions? Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control Sodium restriction can cause serious adverse effects A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable Seventy-five of sodium intake is derived from processed foods • Question 93 Which of the following heart murmurs warrants the greatest concern? Systolic murmur Venous hum murmur Diastolic murmur Flow murmur • Question 94 A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated? Hordeolum; treat with a topical antibiotic and warm compress Conjunctivitis; treat with topical antibiotic and warm compresses Blepharitis; treat with warm compresses and gentle debridement with a cotton swab Chalazion; refer to an ophthalmologist for incision and drainage • Question 95 A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? Inferior wall Anterior wall Apical wall Lateral wall • Question 96 The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: Acute otitis media (AOM) Otitis media with effusion Mucoid otitis media Serous otitis media • Question 97 Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as: inguinal hernia epigastric hernia umbilical hernia incisional hernia • Question 98 A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder? Omeprazole Ranitidine An antacid None of the above • Question 99 Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to: Quit smoking Maintain aggressive hypertension therapy Stick to a low-fat, low-sodium diet Continue with his exercise program • Question 100 Risk factors for acute arterial insufficiency include which of the following? Recent myocardial infarction Atrial fibrillation Atherosclerosis All of the above • Question 101 Impetigo and folliculitis are usually successfully treated with: Systemic antibiotics Topical antibiotics Topical steroid creams Cleansing and debridement