nsg 6420 midterm quiz 3&5 latest questions and answers

nsg 6420 midterm quiz 3&5 NSG6420 QUIZ 3 1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis 2. A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be? Observation and reassurance Treatment with an antibiotic such as amoxicillin Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler. 3. Emphysematous changes in the lungs produce the following characteristic in COPD patients? Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum 4. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: No palpable vibration is felt Decreased fremitus is felt Increased fremitus is felt Vibration is referred to the non-obstructed lobe 5. Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma? Clear, watery nasal drainage with nasal turbinate swelling Pharyngeal exudate and lymphadenopathy Clubbing, cyanosis and edema. Diminished lung sounds with rales in both bases 6. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Computed tomography (CT) scan Chest X-ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan 7. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Exercise-induced cough Bronchiectasis Alpha-1 deficiency Pericarditis 8. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: Pneumothorax Pleural effusion Pneumonia Pulmonary embolism 9. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? Pulmonary edema Heart failure Pulmonary embolism Pneumonia 10. A cough is described as chronic if it has been present for: 2 weeks or more 8 weeks or more 3 months or more 6 months or more 11. Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze? Chest X-ray Methacholine challenge test Spirometry, both with and without bronchodilation Ventilation/perfusion scan 12. In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include: Symptoms daily with nighttime awakening more than 1 time a week. FEV1 >60%, but predicted <80%. FEV1/FVC reduced 5% Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 >80% predicted. FEV1/FVC normal Symptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 >80% predicted. FEV1/FVC normal Symptoms throughout the day with nighttime awakenings every night. FEV1< 60% predicted. FEV1/FVC reduced >5% 13. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough 14. Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistent asthma, the preferred option for maintenance medication is: High-dose inhaled corticosteroid and leukotriene receptor antagonist Oral corticosteroid—high and low dose as appropriate Short acting beta2 agonist inhaler and theophylline Low dose inhaled corticosteroid and long acting beta2 agonist inhaler 15. A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Can be treated as an outpatient Requires hospitalization for treatment Requires a high dose of parenteral antibiotic Can be treated with oral antibiotics 16. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X-ray Elevated white blood cell count 17. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Barrel-shaped chest Clubbing Pectus excavatum Prolonged capillary refill 18. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: Legionnaires' disease Malaria Tuberculosis Pneumonia 19. 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 20. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Pulmonary embolism Pleural effusion Pneumothorax Fracture Ribs 1. Pelvic inflammatory disease, ectopic pregnancy and gastroenteritis are differentials for what diagnosis - I picked diverticulitis 2. Tx for infectious diarrhea - Flagyl 3. You would perform rhinomanometry for what reason - To identify an obstruction in nasal passage 4. PT has itchy watery eyes eczema and nasal drainage, what result would support allergic rhinitis - IGE >100 in child PMH - Nasal mechanical obstruction - Neutrophil >100 5. What lab values would support diagnosis of copd - Hgb & hct elevated 6. Nasal polyp looks suspicious what is the next step in diagnosis - Biopsy - Nasal smear for eosinophil 7. What medication causes GI BLEEDING potentially - Acyclytic acid (however you spell that lol asa) 8. TX for acute bronchitis - Antibiotics - Fluids and rest 9. Cough lasting 6 week is classified as - Acute - Subacute - Intermittent - Chronic 10. Curb score of 1 would indicate the need to treat the patient - Outpatient 11. NHLBI tx most effective to reduce ascvd score - STATINS 12. What food is high in folate - I picked spinach but had chicken breast and some other ones 13. What s/s is atypical for GERD - Insomnia - Fever - Loss of tooth enamel - JAW PAIN 14. Which would indicate a complication of GERD - Dysphagia 15. Who managed anemia once the diagnosis is made and treatment started in the patient long term - General practitioner - Hematologist 16. Allergy to eggs which vaccine do you pick - Recombinant - Quadrivalent 17. Which ones of these does not have otitis in the primary diagnosis - Mumps - Chronic otitis externa - Dental abscess 18. Patient is c/o supra pubic pain, what organ would you think is the cause - I picked bladder 19. Centor criteria - Person has a sore throat and you are determining whether they should be swabbed 20. COPD with FEV1 OF 40% WHAT STAGE IS THIS - Stage 3 21. Anemia will have what lab values - Low hct/hgb 22. What would warrant a colonoscopy in a 38 year old with asymptomatic anemia - GI malignancy - B12 deficiency - Folate deficiency 23. Person is pale, cool extremities and numbness what is the likely diagnosis - I picked anemia 24. CAGE criteria is for - Alcohol abuse 25. Which of these would warrant an urgent referral to ER - Corneal ptygerium - Blepharitis - Episcleritis - Gonorrhea 26. Complicated diverticulitis should be treated how - I picked ER with gi consult - The other answers didn’t make sense bc they were about lifestyle changes 27. BP 138/86 in woman age 60. What is your plan of care - I picked DASH diet - Hctx 12.5mg 28. Patient given hctz exercise and diet instruction, when should f/u be - 3 weeks - 6 weeks - 12 weeks 29. Difference between acute and chronic bronchitis - I picked the one about sputum productive and cough lasting 3 months multiple times a year Meds for certain conditions Herpes simplex tx Halpike test what is it for Metabolic syndrome risk factors Prostatis staging and treatment Athma tx for st 1 persistent asthma Pt is at risk for vit def when on this medication -anticonvulsants Testicular torsion tx non traumatic (surgery??) Test for dm- cmp (has glucose level) Shillings test for vit b def Thalasemmeia risk factor -genetic Pernicious anemia dx and treatment X Acute closed-angle glaucoma Chronic open-angle glaucoma Question 5. 5. 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: (Points : 2) 50 x 2-pack years X 100-pack years 50-year, 2-pack history 100-pack history Question 6. 6. When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? (Points : 2) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. Sit up for an hour after taking any medication and restrict fluid intake. X Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal. Question 7. 7. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: (Points : 2) CBC with differential Stool culture and sensitivity Abdominal X-ray X Colonoscopy Question 8. 8. 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? (Points : 2) Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis X Coronary artery disease with angina pectoris Question 9. 9. A common auscultatory finding in advanced CHF is: (Points : 2) Systolic ejection murmur X S3 gallop rhythm Friction rub Bradycardia Question 10. 10. Which of the following symptoms is common with acute otitis media? (Points : 2) X Bulging tympanic membrane Bright light reflex of tympanic membrane Increased tympanic membrane mobility All of the above Question 11. 11. Rheumatic heart disease is a complication that can arise from which type of infection? (Points : 2) Epstein-Barr virus Diphtheria X Group A beta hemolytic streptococcus Streptococcus pneumoniae Question 12. 12. 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? (Points : 2) Fictional keratosis Keratoacanthoma Lichen planus X Leukoplakia Question 13. 13. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: (Points : 2) Mitral Valve Prolapse Referred Pain from Cholecystitis X Pericarditis Pulmonary Embolus Question 14. 14. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? (Points : 2) History of bright flash of light followed by significantly blurred vision X History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above Question 15. 15. 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? (Points : 2) It is highly contagious and a mask should be worn at home. Treatment regimen is multiple lifetime medications. X Treatment regimen is multiple medications taken daily for a few weeks. Treatment regimen is complicated and is not indicated unless the patient is symptomatic. Question 16. 16. The best evidence rating drugs to consider in a post myocardial infarction patient include: (Points : 2) X ASA, ACE/ARB, beta-blocker, aldosterone blockade ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates Question 17. 17. The most common cause of eye redness is: (Points : 2) X Conjunctivitis Acute glaucoma Head trauma Corneal abrasion Question 18. 18. A specific exam used to evaluate the gall bladder is: (Points : 2) Psoas sign Obturator sign Cullens sign X Murphy’s sign Question 19. 19. 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: (Points : 2) Mallory-Weiss tear Esophageal varices X Gastric ulcer Colon cancer Question 20. 20. Which of the following is not a contributing factor to the development of esophagitis in older adults? (Points : 2) X Increased gastric emptying time Regular ingestion of NSAIDs Decreased salivation Fungal infections such as Candida Question 21. 21. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? (Points : 2) Seasonal allergies Acute bronchitis Bronchial asthma X Chronic bronchitis Question 22. 22. 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: (Points : 2) Peptic ulcer disease Barrett’s esophagus X Esophageal varices Pancreatitis Question 23. 23. Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. (Points : 2) Acute pancreatitis Duodenal ulcer Biliary colic X Cholecystitis Question 24. 24. 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? (Points : 2) Acute MI GERD Pneumonia X Angina Question 25. 25. In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? (Points : 2) Serum iron Total iron binding capacity Transferrin saturation X Serum ferritin Question 26. 26. If it has been determined a patient has esophageal reflux, you should tell them: (Points : 2) They probably have a hiatal hernia causing reflux They probably need surgery They should avoid all fruit juices X Smoking, alcohol, and caffeine can aggravate their problem Question 27. 27. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? (Points : 2) X Computed tomography (CT) scan Chest X-ray with PA, lateral, and lordotic views Ultrasound Positron emission tomography (PET) scan Question 28. 28. 2. (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? (Points : 2) Abdominal upright and flat plate x-ray Abdominal MRI Abdominal CT scan with contrast X Abdominal ultrasound Question 29. 29. Emphysematous changes in the lungs produce the following characteristic in COPD patients? (Points : 2) Asymmetric chest expansion Increased lateral diameter X Increased anterior-posterior diameter Pectus excavatum Question 30. 30. (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? (Points : 2) Trial of ursodiol ‘Watchful waiting’ Surgical consult X HIDA scan Question 31. 31. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: (Points : 2) Exercise-induced cough Bronchiectasis X Alpha-1 deficiency Pericarditis Question 32. 32. (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? (Points : 2) Abdominal plain films Liver function tests Amylase/lipase X Urinalysis Question 33. 33. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: (Points : 2) Digital rectal examination Endoscopy X Pelvic examination Urinalysis Question 34. 34. A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: (Points : 2) Appendicitis Question 40. 40. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): (Points : 2) X 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 Week 5 Mid-term Return to deck 1. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of Digital rectal examination Endoscopy Pelvic examination UrinalysisDefinition 2. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Clinical practice guideline Clinical decision rule Clinical algorithm Clinical recommendation 3. A common auscultatory finding in advanced CHF is S3 gallop rhythm 4. Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? chole 5. A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Mono spot Strep test Throat culture All of the above 6. Which of the following is not a contributing factor to the development of esophagitis in older adults? 7. Essential parts of a health history include all of the following except: 8. What test is used to confirm the diagnosis of appendicitis? 9. The first assessment to complete related to the eyes is Eye lids Visual acuity Extraocular movements Peripheral vision 10. The best way to diagnose structural heart disease/dysfunction non-invasively is Chest X-ray EKG CORRECT Echocardiogram Heart catheterization 11. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X-ray Elevated white blood cell count 12. In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Left upper quadrant Right upper quadrant Left lower quadrant Right lower quadrant 13. 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 14. 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 15. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? chronic bronichitis 16. The best evidence rating drugs to consider in a post myocardial infarction patient include: ASA, ACE/ARB, beta-blocker, aldosterone blockade ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates 17. 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 18. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to Pneumothorax Pleural effusion Pneumonia Pulmonary embolism 19. A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Bacterial conjunctivitis B. Allergic conjunctivitis C. Chemical conjunctivitis D. Viral conjunctivitis 20. Emphysematous changes in the lungs produce the following characteristic in COPD patients? Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum 21. 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 22. 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 23. The cytochrome p system involves enzymes that are generally Inhibited by drugs : • Inhibited by drugs • Induced by drugs • Inhibited or induced by drugs • Associated with decreased liver perfusion 24. Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? Abdominal plain films Liver function tests Amylase/lipase Urinalysis 25. 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 mid-clavicular area. The ANP knows that this is a hallmark sign of: Angina Pericarditis Mitral valve prolapse Congestive heart failur 26. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: • Less obesity rates than women • Prostate enlargement • Testosterone • Less estrogen than women 27. 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: Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D. Colon cancer 28. 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 29. . Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Checking the macula Estimating cup-to-disk ratio Verifying a red reflex Extraocular movements 30. If it has been determined a patient has esophageal reflux, you should tell them: They probably have a hiatal hernia causing reflux They probably need surgery They should avoid all fruit juices Smoking, alcohol, and caffeine can aggravate their problem 31. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough 32. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be Mitral Valve Prolapse Referred Pain from Cholecystitis Pericarditis Pulmonary Embolus 33. 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 34. Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of Anemia Anxiety Hyperthyroidism CORRECT All of the above 35. Presbycusis is the hearing impairment that is associated with: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster 36. Functional abilities are best assessed by : 37. • Self-report of function • Observed assessment of function • A comprehensive head-to-toe examination • Family report of function 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? Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia 38. The aging process causes what normal physiological changes in the heart? The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis Cardiology occurs along with prolapse of the mitral valve and regurgitation Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves Hypertrophy of the right ventricle 39. In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? History of prior red-eye episodes Grossly visible corneal defect Exophthalmos Photophobia 40. 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. NSG6420- 35 questions (88%) 1.A score of 1 on CURB65- treat as outpatient. 2.COPD labs TSH (/) hemoglobin of 12 3.LAD blockage – CABG 4. Ayptical GERD- dental 5. More complicated GERD symptom – dysphagia (difficulting swallowing- coughing or choking on food) other options were regurgitation, heartburn, insomnia 6. What labs for allergic rhinitis- Serum IgE will be elevated 7. Abnormal polyp on nasal inspection during allergic rhinitis what to do? I choose treat with intranasal steroids to reduce inflammation and swelling. The word abnormal threw me off bc biopsy is an option 8. rhinomanometry- I selected to evaluate obstruction… polyp is an answer, but obstruction is more broad. I would go with that. 9. 38 yo atypical anemia symptoms- refer for colonoscopy to rule out gastric malignancy. 10. folate deficiency, which food?- recommend spinach 11. flu vaccine with egg allergy- recombinant. 12. multiple stomach dx, which additional differential diagnosis- diverticulitis 13. acute diverticulitis/distress treatment-admit to hospital (this requires IV abx) 14. which rx for infection diarrhea- flagyl 15. which to refer/ consider emergent- increase redness with N. gonorrhea (the other options are not emergent) 16. which is not likely to be associated with otitis- blepharitis. 17. acute rhinitis for 6 weeks… I chose subacute 18. acute bronchitis tx- I select Augmentin (amox/cluv) 19. chronic bronch. 3mths symptoms for two consecutive years 20. CAGE- to assess alcohol use 21. FEV1 ratio .7 and FEV1 40- stage 3 severe 22. 45 yr with a BP of 162/101 placed on thiazide, increased activity, and diet, which should they follow up- I choose 3 weeks, the other options were 1 week, 3 mths, or 6mths 23. non pharmacological recommendations for hypertension – the option with DASH diet 24.Centor criteria -sore throat for bacteria likelihood 25. gastroenterology treating chronic hepatic issues, patient has developed anemia… who treats the anemia. I choose the gastro dr. but primary, hematologist were also options 26. which organ is involved if suprapubic pain? I choose bladder…other options were stomach, esophagus, ? maybe pancreas 27. DVT-d dimer 28. pallor and fatigue- I chose anemia 29. BMI of 31 scenario with GERD ??? all were GERD symptoms I think I would with regurgitation.- I honestly cant remember with one well. 30. NGLBI suggest- HMGCoA (statin) 31.GI bleeding- ASA 32.I may have referred another one for a colonoscopy, not sure, cant remember 33.a person with ??? when to admit- fever of 103 34. 35.