Description

NURS 6531 Midterm Exam

1. Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?
2. Your patient Jerry has gout. What do you suggest?
3. Which of the following heart murmurs warrants the greatest concern?
4. Which of the following color changes in a pigmented lesion suggests malignant transformation?
5. An adult presents with tinea corporis. Which item below is a risk factor for its development?
6. 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?
7. 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?
8. 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:
9. Which of the following can result from chronic inflammation of a meibomian gland?
10. 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?
11. Risk factors for acute arterial insufficiency include which of the following?
12. Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
13. The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every:
14. 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?
15. 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?
16. 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?    
17. 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?
18. Which of the following is a predisposing condition for furunculosis?
19. 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?
20. 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?
21. 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:
22. Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?
23. Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?
24. 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?
25. 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?
26. Which of the following are classic features of ulcerative colitis?
27. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?
28. Which intervention listed below is safe for long term use by an adult with constipation?
29. What prophylactic medication is commonly recommended for the patient under 35 years of age with a positive PPD?
30. 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?
31. Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?
32. Which type of lung cancer has the poorest prognosis?
33. The most common correlate(s) with chronic bronchitis and emphysema is(are):
34. The most common cancer found on the auricle is:
35. What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?
36. Impetigo and folliculitis are usually successfully treated with:
37. 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:
38. A 58 year old complains of tightness in his chest while cutting firewood. It disappears quickly if he stops chopping. He denies shortness of breath, his total cholesterol level is less than 200 mg/dL, and he is a non-smoker. What is the most appropriate action for the nurse practitioner to take with this patient?
39. 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 tinea pedis. What is the best initial treatment option for this patient?
40. Of the following choices, the least likely cause of cough is:
41. Which of the following best describes hypertrophic cardiomyopathy?
42. Which of the following patient characteristics are associated with chronic bronchitis?
43. 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?
44. The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?
45. Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:
46. 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?
47. Of the following, the patient who should be referred for periodic colonoscopy is the patient with:
48. 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:
49. 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:
50. Which of the following is not a goal of treatment for the patient with cystic fibrosis?
51. Which of the following is not a risk factor for coronary arterial insufficiency?
52. Treatment of acute vertigo includes:
53. Acute rheumatic fever is an inflammatory disease which can follow infection with:
54. 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?
55. 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?
56. A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
57. An AST that is more than twice the level of ALT is suggestive of:
58. An 18 year old patient is afebrile and complains of severe left ear pain. On examination, the TM is gray and intact and there is a green discharge in the external canal. What action by the nurse practitioner is most appropriate?
59. 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:
60. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be:
61. 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?
62. 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?
63. What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
64. 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:
65. 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:
66. What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?
67. If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:
68. Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?
69. Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:
70. 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:
71. Appropriate therapy for peptic ulcer disease (PUD) is:
72. Which of the following is not a symptom of irritable bowel syndrome?
73. Risk factors for acute otitis media (AOM) include all of the following except:
74. 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?
75. 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?
76. John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?
77. 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?
78. Martha had a less than 7% value on her Schilling test. What medication do you anticipate she might need?
79. 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?
80. 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?
81. Which of the following statements about malignant melanomas is true?
82. An 18 year old 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?
83. 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?
84. 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:
85. Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?
86. A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:
87. Sandra has celiac disease. You place her on which diet?
88. The differential diagnosis for a patient complaining of a sore throat includes which of the following?
89. Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
90. 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 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?
91. Which of the following is a secondary cause of hyperlipidemia?
92. 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:
93. When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?
94. 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?
95. 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:
96. What is the Gold standard for the diagnosis of asthma?
97. In the initial evaluation of a patient with new onset hypertension, the nurse practitioner should:
98. In order to decrease deaths from lung cancer:
99. Treatment of H.pylori includes which of the following?
100. 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?