NURS 6550 BOARD VITALS QUIZ WEEK 8 WITH ANSWERS1. A 35-year-old man is for a physical examination. Labs reveal an HIV test that is positive. He undergoes counseling regarding his diagnosis. His CD4 count is 125, and viral load is 36,000; he is Toxoplasma gondii IgG positive. His hepatitis panel sho...
nurs 6550 board vitals quiz week 8 with answers 1 a 35 year old man is for a physical examination labs reveal an hiv test that is positive he undergoes counseling regarding his diagnosis his cd4 c
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NURS 6550 BOARD VITALS QUIZ WEEK 8 WITH
ANSWERS
1. A 35-year-old man is for a physical examination. Labs reveal an HIV test that is
positive. He undergoes counseling regarding his diagnosis. His CD4 count is 125,
and viral load is 36,000; he is Toxoplasma gondii IgG positive. His hepatitis panel
shows hepatitis B surface antibody positive and hepatitis C antibody negative. He
had a tuberculin skin test (TST) reaction measuring 4 mm. Which of the following
prophylaxis treatments for opportunistic infections should you offer?
Correct answer: (A) TMP-SMX for Pneumocystis jiroveci prophylaxis.
2. Which of the following is a risk factor for urinary tract infection in sexually active
women?
Correct answer: (A) Recent spermicide use.
3. A 39-year-old female presents with anxiety and frequent “panic attacks.” She was
seen 2 weeks ago, and her examination was unremarkable. The patient is referred to
a therapist for a psychological evaluation. She returns today while experiencing a
panic attack. She is diaphoretic with a heart rate of 101, blood pressure of 150/90,
and papilledema. The patient denies chest pain or dyspnea. She states this is a
typical episode. Which of the following tests is the next best step in establishing a
diagnosis?
Correct answer: (B) 24-hour urinary fractionated metanephrines.
4. Which of the following is true of management goals in sepsis?
Correct answer: (D) Urine output of 0.5 mL/kg/hour or more should be targeted in fluid
resuscitation in early sepsis.
5. A patient presents with the lesion shown below. Which of the following drugs should
be given as post-exposure prophylaxis (PEP) for this disease?
Correct Answer: B. Doxycycline
6. A 45-year-old white woman with clinical findings suggestive of Cushing syndrome
has 2 elevated late night salivary cortisol levels and 2 elevated urinary free-cortisol
tests of 220 and 300 (normal 2-50mg/24 hour); her ACTH level is 55 (normal 5-
50pg/mL), and her pituitary MRI shows a 3mm adenoma. Which of the followings is
the best next course of action?
Correct answer: (D) High-dose dexamethasone suppression test (HDDST) and/or
corticotropin-releasing hormone (CRH) stimulation test.
7. A female patient with primary hypothyroidism has been stable (normal TSH) on
replacement LT4 (dose 1.6μg/kg of body weight) for several years. On annual follow-up,
the following laboratory tests are obtained: T4 = 14.1μg/dL (normal 5.0-10.5) and TSH =
23.4μU/mL (normal 0.4-5.5). Which is the most likely diagnosis?
,Correct answer: (D) Poor compliance this past year, with recent attempt to “catch up” with
excessive LT4 intake.
8. Which of the following is the organism most frequently implicated in toxic shock
syndrome in women who are using tampons?
Correct answer: (B) Staphylococcus aureus.
9. Rocky Mountain spotted fever is caused by which of the following?
Correct answer: (C) Tick bite.
10. A 36-year-old female presents to a primary healthcare provider with a history of irregular
menstrual cycles and secondary amenorrhea. She had no problem conceiving her first
child at age 24, but she has been trying unsuccessfully to become pregnant for the past 2
years. She also reports a weight gain of about 5kg, increasing fatigue, a puffy face, and
marked cold intolerance. CBC reveals an Hb of 11.1 and an MCV of 90. Physical exam
reveals a moderate-sized diffuse enlargement of the thyroid gland. Which of the
following thyroid profiles is most likely present in this woman?
Correct answer: (A) Low T3, low T4, high TSH.
11. A 40-year-old white woman with a history of severe asthma and Hashimoto thyroiditis
reports 2 months of fatigue, anorexia, nausea, weight loss, and myalgia. Examination is
remarkable only for a BP of 98/60 mmHg and a pulse of 98 beats/minute without
orthostasis. She shows no hyperpigmentation. Lab values are as follows: sodium 130
mEq/L, potassium 4.5 mEq/L, chloride 105 mEq/L, and bicarbonate 24 mEq/L. ACTH
stimulation testing shows an AM cortisol level of 5.8 μg/dL at T0 (normal is 10-20
μg/dL) and 13.2 μg/dL (normal >18 μg/dL) at T60 (60 minutes after administration of
ACTH). Which of the following is correct?
ANSWER: B. The most likely cause of her adrenal insufficiency is prior exogenous
corticosteroid use.
12. Which of the following is the first line treatment for gonorrheal infections?
Correct answer: (C) Azithromycin plus ceftriaxone.
13. A 59-year-old woman presents to the ED feeling generally unwell with 2 months of
worsening lethargy, nausea, generalized abdominal pain, and constipation. She is a heavy
smoker and has hypertension, high cholesterol, and chronic bronchitis. She takes
amlodipine 5mg daily and atorvastatin 40mg daily with no recent changes in doses or
frequency. The patient has lost 15lbs despite a normal appetite over this period. There has
been no recent exacerbation of her chronic cough. She had a few episodes of minimal
hemoptysis a few months ago but none since. Vital signs are within normal limits.
Auscultation of the lungs reveals mild decreased air entry throughout and no adventitious
sounds. Mild generalized abdominal tenderness to palpation is noted. Physical
examination is otherwise unremarkable. Laboratory investigations are notable for a Cr of
0.8 and Ca of 12.1. Albumin is 3.8. Chest radiograph shows a discrete mass in the right
hilum that is approximately 10mm in diameter; otherwise, lung fields are clear without
collapse or consolidation. What is the best initial management of this patient?
, Correct answer: (B) IV hydration with normal saline.
14. A 26-year-old man has had a painless penile lesion for several weeks and new swelling in
the groin. On examination, a single nontender penile ulcer and bilateral palpable
nontender inguinal lymph nodes are present. Rapid plasma reagin test results are
negative. What is the most likely diagnosis?
Correct answer: (C) Primary syphilis.
15. A 60-year-old male patient is evaluated in the emergency department for mental
status changes. He has a history of COPD and a 40 pack year history of tobacco
use. Laboratory results reveal:
Na: 123 mEq/L
K: 4.0/L
HCO3: 25 mEq/L
BUN: 20 mg/dL
Cr: 1.0 mg/dL
Glucose: 110 mg/dL
Urinalysis:
Osmolality 340 mOsm/kg (280-295)
Na 50 mEq/L
Which of the following is the likely etiology of the patient’s mental status changes?
Correct answer: (C) Syndrome of inappropriate antidiuretic hormone.
16. Which of the following is a characteristic of acromegaly
Correct answer: (D) Coarse facial features.
17. Which of the following oral antimicrobials should a nurse practitioner prescribe for
outpatient treatment of community acquired methicillin resistant Staphylococcus aureus
infection?
Correct answer: (C) Clindamycin.
18. An 85-year-old male nursing care resident with Alzheimer disease is brought to the
emergency department with diarrhea and vomiting for 3 days. His nurse-aid reports
that the patient has been unable to eat or drink for the past 24 hours and appears
more lethargic than usual. His vitals at the time of admission are temperature 37.0
degrees C (98.6 degrees F), blood pressure 90/60 mmHg, heart rate 138/min, and
respiratory rate 19/min. The patient's mucous membranes are dry.
Laboratory studies show the following:
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