NSG 6420 Week 2023 10 Final Exam (Adult Gero)

NSG 6420 Week 10 2023 Final Exam (Adult Gero) 1. In AR disorders, carriers have: • Two mutated genes; two from one parent that cause disease • A mutation on a sex chromosome that causes a disease • A single gene mutation that causes the disease • One copy of a gene mutation but not the disease 2. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer Tuberculosis Pneumonia COPD 3. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? It will be helpful to keep the head of your bed elevated on blocks 4. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Leukoplakia 5. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) MigraineDefinition 6. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: A. Increased estrogen production’s influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle 7. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Definition 8. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD) Hemoglobin 12 g/dl, MCV decreased, MCH decreased Hemoglobin 12 g/dl, MCV increased, MCH increased Hemoglobin 12 g/dl, MCV normal, MCH normal Hemoglobin 12 g/dl, MCV decreased, MCH increased 9. What test is used to confirm the diagnosis of appendicitis? CBC Flat plate of abdomen Rectal exam CT of abdomen with attention to appendix 10. Functional abilities are best assessed by: Observed assessment of function 11. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of: Carpal tunnel syndrome Osteoarthritis of the wrist Epicondylitis Cervical osteoarthritis 12. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to Acoustic neurom Cerumen impaction Otitis media Ménière’s disease 13. Which lesions are typically located along the distribution of dermatome? Herpes Zoster 14. when differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age 15. A pneumatic otoscopic examination is used to assess: A. Inner ear conditions B. Otitis externa C. Cerumen impaction D. Tympanic membrane mobility 16. In autosomal recessive (AR) disorders, individuals need: • Only one mutated gene on the sex chromosomes to acquire the disease • Only one mutated gene to acquire the disease • Two mutated genes to acquire the disease • Two mutated genes to become carriers 17. Which of the following disorders can cause urinary incontinence? Cystocele Overactive bladder Uterine prolapse All of the above 18. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation 19. Which of the following medications are commonly associated with the side effect of cough A. Beta blocker B. Diuretic C. ACE inhibitor D. Calcium antagonist 20. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include A. Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging 21. Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate A. Upper urinary tract infection B. Lower urinary tract infection C. Normal bacteriuria D. Urethritis 22. Epistaxis can be a symptom of: 23. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition Inflammatory bowel disease Irritable bowel syndrome Giardiasis Lactose intolerance 24. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? Any presence of tremor Symptoms of slowed movement, unstable angina, and tremor Resting tremor, slow unsteady gait, and cogwheel resistance Cogwheel rigidity, bradykinesia, and amnesia 25. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight bearing and/or use of the joint D. Begins in the morning but decreases with activity 26. During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: A. COPD B. Pneumothorax C. A normal finding D. Pleural effusion 27. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS midclavicular area. The ANP knows that this is a hallmark sign of: Angina Pericarditis Mitral valve prolapse Congestive heart failure 28. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Pneumonia Pleuritis Pneumothorax CORRECT A and B 29. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Femoral vein thrombosis Femoral artery thrombus CORRECT Venous insufficiency Musculoskeletal injury 30. Which of the following details are NOT considered while staging asthma? A. Nighttime awakenings B. Long-acting beta agonist usage C. Frequency of symptoms D. Spirometry findings 31. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms Acute MI GERD Pneumonia Angina 32. A 22-year-old female patient complains of excessive thirst, feeling “shaky when she misses meals” and increased frequency of urination. Family history is positive for cardiovascular disease, cerebrovascular disease, and diabetes. The patient denies use of tobacco, alcohol, or other drugs. She takes no medication. Daily diet is fast food, and the patient does not exercise regularly. On physical examination, there are no significant findings except obesity, demonstrated by a BMI of 35 and blood pressure of 145/ 90. The signs and symptoms are characteristic of: Type 2 diabetes mellitus B. Chronic fatigue syndrome C. Cushing’s disease D. Clinical depression 33. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? A. Beta blocker B. ACE inhibitor C. Statin medication D. Metformin 34. . Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? A. It is highly contagious and a mask should be worn at home. B. Treatment regimen is multiple lifetime medications. C. Treatment regimen is multiple medications taken daily for a few weeks. D. Treatment regimen is complicated and is not indicated unless the patient is symptomatic. 35. Which of the following is the most important question to ask during cardiovascular health history? Sudden death of a family member 36. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris 37. The most common neurological cause of seizures in an older adult is Alzheimer’s disease Multiple sclerosis Stroke Peripheral neuropathy 38. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C. Perform a biopsy or refer to a dermatologist. D. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away. 39. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Peptic ulcer disease Barrett’s esophagus Esophageal varices Pancreatitis 40. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: A. 50 x 2-pack years B. 100-pack years C. 50-year, 2-pack history D. 100 pack history 41. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea A. Viral gastroenteritis B. Staphylococcal food poisoning C. Acute hepatitis A D. E.coli gastroenteritis 42. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosion 43. Rheumatic heart disease is a complication that can arise from which type of infection? Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae 44. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which ofthe following: Barrel-shaped chest Clubbing Pectus excavatum Prolonged capillary refill 45. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? A. Hemoglobin and hematocrit B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) C. Serum ferritin and serum iron D. Total iron binding capacity and transferrin saturation 46. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self- medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D. Colon cancer 47. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: A. Osteoarthritis B. Rheumatoid arthritis C. Fibromyalgia D. Polymyalgia rheumatica 48. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? A. Tinea versicolor B. Seborrheic keratosis C. Verruca D. Herpes zoster 49. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner’s appropriate intervention is: A. Digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results 50. Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? Misoprostol (Cytotec) Cimetidine (Tagamet) Metronidazole (Flagyl) Bismuth subsalicylate (Pepto bismol) 51. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a: A. Bacterial folliculitis B. Basal cell carcinoma C. Bullous impetigo D. Epidermoid cyst 52. The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in Pityriasis Rosea Shingles Psoriasis Lymes Disease 53. The most common complication of an untreated urinary obstruction due to a ureteral calculus is: Hydronephrosis B. Renal artery stenosis C. Ureteral rupture D. Kidney mass