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NSG 6340 Final Exam – Question and Answers

1. A 37-year-old female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today she complains of poor concentration and fatigue. Initially, the NP should:
2. Which of the following is an example of secondary prevention?
3. A 35-year old female with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the 2007 American ___Association’s guideline for endocarditis prophylaxis, what would you advise this patient?
4. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT:
5. A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should
6. A positive drawer sign support a diagnosis of
7. A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities.
8. A 16-year-old athlete complains of pain underneath his heel every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic interventions should the nurse practitioner prescribe for this patient?
9. A __-year-old with Type I diabetes has had itching and burning lesions between her toes for 6 months. Scrapings of the lesion confirm the diagnosis of tinea pedis. What is the best treatment option for this patient?
10. What is an appropriate drug for prophylactic treatment of migraine headaches in a 21-year-old female?
11. Which of the following are the classic features of ulcerative colitis?
12. Which drugs below would be expected to produce the least amount of hypokalemia?
13. What information should patients with diabetes and their families receive about hypoglycemia?
14. A 60-year-old male patient with a past history of glaucoma and frequent sinusitis presents today with hypertension. On his last 2 visits to the clinic his blood pressures were 150-160/90-98. The nurse practitioner decides to treat the hypertension with long-acting propranolol (Inderal). Before prescribing it, the nurse practitioner should ask:
15. Which of the following is NOT associated with Type 2 diabetes mellitus?
16. A 35-year-old male presents with a severe unilateral headache over his left eye. He says it started about one hour ago and has rapidly gotten worse. He gives a history of similar headaches over the past 2 years. Physical examination is negative except for left eye lacrimation. What is the most likely diagnosis?
17. A 16-year-old sexually active female present to the clinic. She has never had vaccination for hepatitis A or B, she has had one MMR immunization, and her last tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without further testing?
18. A 15-year-old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant. He complains of nausea, vomiting, anorexia, and low-grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis?
19. A 25-year-old hypertensive patient has a BMI of 16. His blood pressure is 165/100. There is an audible bruit in his left upper abdominal quadrant. He probably has:
20. Which of the following is the most common presenting sign of substance abuse in adolescents?
21. Therapeutic international normalized ratio (INR) for a patient takein warfarin (Coumadin) for chronic atrial fibrillation is expected to be
22. A 199-year-old female reports that she is having “panic attacks.” The NP knows that panic attacks are characterized by nsg 6340 final exam
23. A 25-year-old complains of fever and throat pain. The tonsils have exudate bilaterally. The patient describes having an anaphylactic reaction to penicillin in the past. What antibiotic should the NP prescribe if she believes the causative agent is bacterial?
24. A diagnostic finding of Hodgkin’s lymphoma is the presence of
25. With a history of ankle sprain, the nurse practitioner would most likely elicit a history of
26. Certification for nurse practitioners is offered through:
27. Simple cases of impetigo and folliculitis are usually successfully treated with:
28. A 43-year-old has chronic gout. He comes to the clinic for the 3rd time in as many months for treatment of an exacerbation. Dietary counseling should include avoidance of all of the following EXCEPT:
29. A 57-year-old patient presents for an annual physical exam. He reports having 3 attacks of acute gout during the past year. He does not take any medication except NSAIDs during the attacks which help “a little bit.” The NP would appropriately recommend
30. A 43-year-old male presents with a large and painful furuncle, the 3rd one in the past 6 months. The NP should _?_ all of the following EXCEPT:
31. A 64-year-old female has sudden onset of right eye pain, blurred vision, and dilated pupil. The most likely diagnosis is acute:
32. A 25-year-old patient presents with complaints of pain and burning in the vulvar area. Upon examination, the NP notices vesicles with an erythematous base arranged ina group on the patient’s labia major. The most likely diagnosis is:
33. An 85 – year-old is diagnosed with shingles. The patient states that she became “miserable” yesterday when the symptoms started. What pharmacologic interventions should the nurse practitioner offer this patient?
34. A 16-year-old presents to the clinic for a scheduled immunization. The patient is unaccompanied by an adult. The NPs action is based on the knowledge that: nsg 6340 final exam
35. The mechanism by which nurses are held accountable for practice, based on the quality of nursing car ein a given situation inaccordance with established standards of practice, is:
36. A 52- year-old female has a firm, non-tneder, one centimeter mass in the RLQ of her breast. There are no palpable axillary lymph nodes. A mammogram the month before her examination was netative. The most appropriate nurse practitioner action today is to:
37. Which of the following is NOT a characteristic of the S3 heart sound?
38. A characteristic of elders which affects the pharmacotherapeutics of drug therapy in that population is an increase in:
39. The AUDIT questionnaire is useful to assess:
40. A 32- year-old mother and her 10-year-old child each have a 10 cm round, reddened patch on the trunk. There is central clearing in the lesion. Different lesions run parallel to each other in a Christmas tree pattern. The mother has been treating the “ringworm” with an anti-fungal cream for 7 days without success. The NP best response is:
41. For the general adult population, total dietary fat intake should be no more than what percent of total calories?
42. A 23-year-old female college student is being evaluated by the nurse practitioner for immunization status. She has documentation of completion of IPV, DTaP, and MMR series. She states “I got a shot when I was 12 years old, but none since.” Which vaccine(s) should she receive today?
43. Which of the following patients is most likely to have a diagnosis of Type 2 diabetes mellitus?
44. Which of the following findings is consistent with otitis externa?
45. The most effective primary prevention of skin cancer is to educate the public about:
46. Which of the following is NOT a symptom of irritable bowel syndrome?
47. An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy:
48. A 50-year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis?
49. Which agent is most effective for the treatment of nodulocystic acne?
50. Which of the following signs and symptoms is typical of hyperthyroidism?
51. An 83-year-old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with? nsg 6340 final exam
52.  A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area.
53. The NP identifies popular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The NP would appropriately order:
54. Expected spirometry redings when the patient has chronic emphysema include:
55. Right-sided heart failure is characterized by all of the following clinical findings EXCEPT:
56. Moderate weight loss, particularly of visceral adipose tissue, in patients with Type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT:
57. Nurse practitioner services are filed with Medicare for reimbursement
58. Which of the following drugs has a beneficial effect on benign prostatic hyperplasia?
59. A 46-year-old female has hypertension and is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug?
60. The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is:
61. A 20-year-old male complains of a “skin rash” on his knees and elbows. The lesions have silvery scales and are pruritic. A positive Auspitz sign is present. What is the most likely diagnosis?
62. The daughter of a 75-year-old patient reports that her mother roams the house at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insomnia?
63. A 65-year-old African American patient was screened at his local church for “high cholesterol.” His total cholesterol (no-fasting) was 215 mg/dL (5.6 mmol/L). What action below is most appropriate for the NP?
64. Swan neck and boutonniere deformities are typical clinical findings in the later presentation of:
65. A 13- year-old patient complains the he fell while running during football practice. Now his knee hurts and sometimes “locks.” The NP conducts McMurray’s test. Which of the following is TRUE about this test?
66. A hemoglobin AIC level is 7.2 in a patient with Type 2 diabetes mellitus. The patient is currently taking a sulfonylurea medication. Which of the following drug should be added next to the medication regime?
67. A patient with a diagnosis of giardiasis is being treated with metronidazole (Flagyl). What information would be important to obtain before prescribing this medication? nsg 6340 final exam
68. The nurse practitioner is performing a routine assessment of a 47-year-old female who wants to lose weight She has truncal obesity with relatively slender forearm and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the nurse practitioner diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT:
69. A 59-year-old postmenopausal woman has atrophic vaginitis. She has a history of breast cancer at age 40 years. What is the appropriate initial treatment for this patient?
70. The process by which a profession association cofers recognition that a licensed profession has demonstrated mastery of a specialist body of knowledge and skills is termed:
71. A nurse practitioner has just diagnosed a patient as having acute hepatitis B. The principle which prohibits the nurse practitioner from notifying the patient’s spouse without permission is:
72. A 43-year-old female patient complains of dull ache around both ankles after a day’s work as a cashier. Her symptoms are relieved by sitting and elevating her legs. She reports ankle edema at the end of the day. What is the most likely cause of these problems?
73. Which of the following are characteristic of patients with Type 2 diabetes mellitus? 1. Beta cell destruction 2. High body mass 3. Central obesity 4. Unexplained weight loss
74. The sexual partner of a symptomatic male patient with gonorrhea should be empirically treated:
75. A patient on oral contraceptives complains of breast fullness, tenderness, and some nausea. The patient is concerned. How should the NP manage this?
76. 1. A 62-year-old with Type 2 diabetes mellitus complains of increased nocturia, fatigue, and weakness. His fasting blood glucose is 110 mg/dL (6.2 mmol/L), he is slightly anemic and his serum creatinine level is slightly elevated. All other laboratory tests and physical examination are within normal limits. What is the most likely diagnosis?
77. A 23-year-old female presents with scaly hypo-pigmented macular lesions on her trunk, shoulders, and upper arms. The lesions fluoresce under Wood’s lamp. Appropriate treatment for this condition is:
78. The goals of treatment for patients with alcohol abuse disorder are:
79. Which of the following drug classes may potentiate hyperkalemia in a patient taking a potassium-sparing supplement?
80. A patient has laboratory studies performed which demonstrate increased TSH, decreased free T4, and T3. Which symptoms might she complain of?
81. The anatomical site currently believed to be the best location for subcutaneous insulin administration is the
82. Following the finding of prostate gland abnormalities on DRE, the nurse practitioner orders appropriate labs. When preparing to review lab reports with the patient, the NP know all of the following are true EXCEPT: nsg 6340 final exam
83. An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include:
84. Which statement is true regarding dental health?
85. A 51-year-old post-menopausal female, requests guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT:
86. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?
87. Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP)
88. The first step when taking a patient history is the
89. Characteristics of prescription and OTC drug use in the elder population include all of the following EXCEPT:
90. The nurse practitioner wants to assess intactness of a patient’s cerebellar function. Which of the following clinical tests will provide information relative to cerebellar function?
91. A 57-year-old patient with known diverticulosis presents with fever, leukocytosis, and bright red rectal bleeding. The nurse practitioner’s least appropriate action at this time is:
92. A 41-year-old woman presents with multiple painful vesicular lesions in the vulvar area She has been with the sexual partner for 21 years. Which of the following is the MOST likely diagnosis?
93. The differential diagnoses for transient episodes of dizziness would appropriately include all of the following EXCEPT:
94. Which of the following is NOT a common early sign of benign prostatic hyperplasia (BPH)?
95. The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The LEAST likely diagnosis is:
96. A 16-year-old presents for a sports physical for football. The nurse practitioner auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP?
97. What is the most common causative pathogen found in cystitis, pyelonephritis, and prostatitis?
98. The most common symptoms of a transient ischemic attack (TIA) include:
99. A characteristic of delirium that is typically absent in dementia is:
100. A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time.
101. Which of the following would NOT be included in the differential diagnosis?
102. The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals
103. A 16-year-old sexually active student presents with complaints of a greenish-gray frothy vaginal discharge and vaginal itching. The nurse practitioner should suspect:
104. A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy? nsg 6340 final exam
105. A 60-year-old male diabetic presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous.
106. He reports history of a toothache in the past week which has resolved. His temperature is 102 degrees F and pulse is 100 bpm. The nurse practitioner’s most appropriate initial action is to:
107. A 44-year-old male Caucasian patient’s blood pressures are consistently 170 mm Hg systolic and 100-119 mm Hg diastolic. He has no significant medical history and is of normal weight. His lab tests and EKG are normal. What is the most appropriate action at this time?
108. A 65-year old diabetic patient has periorbital cellulitis secondary to a sinus infections, What course of action should the nurse practitioner take?
109. A 15- year-old swim team member presents with mild “swimmer’s ear.” Vital signs are normal. What is the most appropriate therapy for this patient?
110. Which of the following is true concerning sensitivity and specificity?
111. A nurse practitioner has recently been hire to work in a fast track facility. The NP’s employer asks if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is:
112. According to the American Diabetes Association, what is the lowest fasting plasma glucose level which warrants a diagnosis of diabetes mellitus if confirmed on a subsequent day?
113. A 23-year-old female patient of Italian descent has been diagnose with anemia secondary to glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. It is important to teach this patient to avoid:
114. A 14- year-old develops otitis externa with swelling erythema, and pain,. To facilitate antibiotic deliver to the canal, the NP should:
115. A patient taking levothyroxine is being over-replace. What condition is he at risk for?
116. A nurse practitioner plan to open a private clinic. Each patient will be expect pay $45 immediately following the visit. This is a example of:
117. Along with helping to prevent osteoporosis, hormone replacement therapy (HRT) in the post-menopausal woman has been shown to:
118. An elderly patient presents with a gray-white ring around the periphery of the iris. This is probably nsg 6340 final exam
119.  A patient complains of “stomach pains” on and off for the past month. In distinguishing between a gastric and duodenal ulcer, what question is least important to ask?
120. Which of the following is a microcytic hypochromic anemia?
121. What information should a 42- year old patient with newly diagnosed diabetes receive about exercise?
122.  A 14-year-old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. She also complains of a “sore lump on my knee.
123. ” The nurse practitioner notes swelling and point tenderness at the tibial tuberositiy X-ray is negative. What is the most likely diagnosis?
124. The obesity associated with Type 2 diabetes mellitus is:
125. Which of the following patients would appropriately be diagnosed with isolated systolic hypertension (ISH)?
126. An adolescent goes to Colorado for a ski trip. He is unaccustomed to the high altitude and very dry air. He develops nose bleeds and visits the nurse practitioner. What intervention is LEAST effective?
127. The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is
128. A person with 20/80 vision:
129. Which of the following is consider a non-inflammatory disease process?
130. A 49 – year-old Hispanic female has a blood pressure of 145/95. mmHg during a routine annual evaluation. She no history of hypertension. She takes a statin for dyslipidemia. How should the NP proceed with this patient?
131. With a diagnosis of syphilis, which of the following tests remains positive for the patient’s lifetime?
132. Stress urinary incontinence is:
133. Which of the following accurately describes the appropriate use of influenza vaccine?
134. Ideal weight for 5’7” female is 135
135. A 65-year-old diabetic patient has newly diagnosed peripheral artery disease in her lower extremities. She is exhibiting symptoms of this disease. In assessing this patient, the NP would expect to find:
136. A 75-year-old female complains that she awakens 3 to 4 times each night sensing bladder fullness, but is unable to “hold it” until she can get seated on the bathroom toilet. This type of urinary incontinence is termed:
137. The nurse practitioner strongly suspects hyperthyroidism in a 62-year-old patient. Which of the following would NOT be an appropriate initial intervention?
138. The Patient Self-Determination Act of 1991 requires all health care agencies receiving Medicare or Medicaid funds to give patients written information about their rights to make decisions regarding their medical care.
139. A document which declare in advance what type of medical care a person wants to be provide or withheld should he or she be unable to express his or her wishes is ….
140. A 2-year-old male complains of severe headaches localized to the left frontal and parietal area with blur vision. nsg 6340 final exam
141. The nurse practitioner identifies vesicular lesions on his forehead. The most appropriate intervention is to start:
142. A patient has experience nausea and vomiting, headache, malaise, low-grade fever, abdominal cramps, and diarrhea for 32 hours.
143. The white count is slightly ….with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?
144. The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of hospitalization for hepatitis-B infection 2 years ago. Her laboratory tests demonstrate positive HBsAg. The nurse practitioner would most likely diagnose:
145. What medication would be best to relieve symptomatic wheezing in a patient who has asthma? nsg 6340 final exam
146. Tricyclic antidepressants should be avoid in elderly patients because they have potentially disabling side effects. Which of the following is least likely to be a side effect of TCAs?
147. Of the following, the patient who should be referred for periodic colonoscopy is the patient with:
148. What is the most frequent cause of death in patients with anorexia nervosa?
149. All patients with renal calculi should be taught that the best prevention is:
150. In order to decrease deaths from lung cancer: