NURS-656 Exam Questions With
Verified Answers
A female patient, currently at 26 weeks gestation, has experienced a slow rise of her blood
pressure over the past 2 weeks. Her urine specimen is negative for protein. She has reduced her
sodium intake and has begun a walking program. The patient's blood pressure today is 155/102,
which is consistent with her readings at home. Associated symptoms include a dull headache.
The nurse practitioner's best response is:
a. "Try yoga and meditation to decrease your blood pressure."
b. Start the patient on methyldopa 250 mg po twice daily.
c. "Monitor your blood pressure at home and call the office if you have swelling or a pounding
headache."
d. Start the patient on metoprolol 100mg po twice daily. - answer✔✔*b. Start the patient on
methyldopa 250 mg po twice daily.
Rationale: Methyldopa has the longest record of safety at a starting dosage of 250 mg po bid or
tid. Therapy with beta blockers or calcium channel blockers is also acceptable. (Papadakis&
McPhee, 2015. P. 801.) Metoprolol is a Category C medication and 100 mg po bid is not the
lowest possible starting dose. The initiation of anti-hypertensive therapy in pregnant women is
indicated if the sustained blood pressure is > 150/100 or if there is evidence of end-organ damage
(Papadakis &McPhee, 2015, p. 801)
Resistant hypertension may be caused by which of the following?
a. NSAIDs
b. Oral Contraceptives
c. Obesity
d. All of the above - answer✔✔*d. All of the above
EXAM STUDY MATERIALS July 23, 2024 4:26 PM
,Rationale: JNC 7 defines resistant hypertension as the inability to control blood pressure in those
patients who are compliant with the appropriate three-drug regimen, including a diuretic. Causes
of resistant hypertension listed in table 11-11 include nonadherence, NSAIDs, oral
contraceptives, adrenal steroids, licorice, obesity, and excessive alcohol intake (Sutters, 2015,
p.458-459).
Cholesterol medication that works by obstructing the absorption of cholesterol by blocking the
passage of cholesterol across the intestinal wall through the inhibition of a cholesterol transporter
is ?
a. Statins
b. Fibric Acid
c. Ezetimibe
d. Bile Acid - answer✔✔*c. Ezetimibe (Zetia) [Cholesterol absorption inhibitor]
Rationale: "Ezetimibe is the lipid lower drug that works by inhibiting the intestinal absorption of
biliary and dietary cholesterol by blocking passage across the intestinal wall by inhibiting a
cholesterol transporter. Statins block the rate-limiting enzyme in the formation of cholesterol.
Fibrates are peroxisome proliferative-activated receptor-alpha agonists that results in potent
reductions of plasms triglycerides and increases in HDL. Bile acids work by binding bile acid in
the intestine" (Baron, 2015).
A 2 year girl arrives to your clinic with a history of a fever for 7 days, cervical
lymphadenopathy, edema and desquamation of extremities, bilateral, non-exudative
conjunctivitis, and polymorphous exanthema. You correctly diagnose the girl with :
a. Rheumatic fever
b. Kawasaki disease
c. Lyme disease
d. Infective endocarditis - answer✔✔*b. Kawasaki disease
EXAM STUDY MATERIALS July 23, 2024 4:26 PM
,Rationale: The diagnostic criteria for Kawasaki disease are fever that lasts for greater than 5 days
and at least 4 of the following other manifestations: (1) cervical lymphadenopathy, usually
unilateral and great than or equal to 1.5 cm in diameter, (2) extremity changes (redness and
swelling of the hands and feet with subsequent desquamation), (3) polymorphous exanthema, (4)
oral cavity or lip changes, (such as strawberry tongues, fissuring and cracking, and inflammation
of the oral mucosa), and (5) painless, bilateral, non-exudative conjunctivitis. Rheumatic fever
consists of 2 major criteria such as carditis, erythema marginatum, Sydenham chorea, or
polyarthritis, or 1 major criteria and 1 minor criteria, such as polyarthalgia, fever, and previous
rheumatic heart disease or fever, plus evidence to support streptococcal infection. Infective
endocarditis often presents with weight loss, malaise, and fever. (Darst, Collins, & Miyamoto,
2014, p. 628). Lyme disease may develop after a tick bite, and is characterized by erythema
chronicum migrans (Ogle & Anderson, 2014, p. 1350).
The Moro Reflex:
a. Disappears by age 3 months.
b. Disappears by age 4 months.
c. Disappears by age 8 months.
d. Disappears by age 12 months - answer✔✔*a. Disappears by age 3 months.
Rationale: (pg 15) The Moro (startle) reflex - hold the infant supine while supporting the head.
Allow head to drop 1-2 cm suddenly. Arms will abduct at shoulder and extend at elbow with
spreading of fingers. Adduction with flexion will follow. Develops by 28 weeks' gestation
(incomplete) and disappears by age 3 months. The palmar grasp disappears by age 4 months. The
tonic neck reflex disappears by age 8 months.
Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin, R. R.
Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 15). San Francisco, CA:
McGraw Hill Education.
*P. 568 Seidel-infant supported in semisitting position, allow head and trunk to dropback*
Signs of hypoglycemia in the newborn infant include all of the following *except:*
a. Lethargy
b. Apnea
c. Poor feeding
d. Kernicterus - answer✔✔*d. Kernicterus
Rationale: (pg 27) Signs of hypoglycemia in newborn infant may be non-specific and subtle:
lethargy, poor feeding, irritability, tremors, jitteriness, apnea, seizures.
EXAM STUDY MATERIALS July 23, 2024 4:26 PM
, Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin, R. R.
Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 27). San Francisco, CA:
McGraw Hill Education.
*Kernicterus is Chronic Bilirubin Encephalopathy-irreversible brain injury char. by cerebral
palsy and hearing impairment*
A 7 month old male child is in your office for his checkup. The nurse practitioner expects the
child to be able to do which of the following:
a. Stands alone.
b. Roll from back to stomach.
c. Uses thumb and index finger to pick up cheerio.
d. Points to named object. - answer✔✔*b. Roll from back to stomach.
Rationale: (pg 85) A & C - Standing alone 9-11 months. D - 24 mos.
Goldson, E., & Reynolds, A. (2014). Child development & behavior. In W. W. Hay Jr, M. J.
Levin, R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 85).
San Francisco, CA: McGraw Hill Education.
Mom brings her 6-year-old son in for episodic visit stating he has started having bowel
movements at least two times a week in his underwear at school for about 9 weeks. She states he
says it hurts when he has a bowel movement at home. You suspect which of the following:
a. Enuresis
b. Encopresis
c. Colic
d. Viral gastroenteritis - answer✔✔*b. Encopresis
Rationale: (p. 95) Encopresis - repeated passage of stool into inappropriate places by child who
is chronologically or developmentally older than 4 years. 90% of cases result from constipation
Goldson, E., & Reynolds, A. (2014). Child development & behavior. In W. W. Hay Jr, M. J.
Levin, R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 85).
EXAM STUDY MATERIALS July 23, 2024 4:26 PM
