NR 601 FINAL EXAM 1- QUESTION AND ANSWERS LATEST VERSION

NR 601 FINAL EXAM 1- QUESTION AND ANSWERS   NR 601 FINAL EXAM 1- QUESTION AND ANSWERS 1. ‘Which of the following statements is NOT true about palliative care teams? • A: Provide weekly home visits 2. A 55-year-old women has type 2 DM she had three UTIs in the last 9 months and she is concerned about her kidneys. She has no report of dysuria, frequency or urgency at this time. Which of the following is the best action to follow? • A: Recheck UA dipstick today 3. According to the sexuality presentation, atrophic vaginitis (AV) • A: Is a contributing factor for frequent UTIs 4. Ms. L 55-year-old women with BMI of 28, has 20-yearhx of primary HTN and has been on hydrochlorothiazide 25 mg daily for years with excellent response. During follow up visit Mrs L reports that for the last 6 months she has felt thirsty all of the time even though she drinks at least 10 glasses of water a day. Upon chart review the N notes that the last two fasting blood glucose levels have been 136 mg/dl and 165 mg/dl. The NP checks a random blood glucose, which is 210 mg/dl. What is the next appropriate test? • A: Prescribe Metformin 500 mg PO BID 5. A patient has been prescribed Metformin (Glucophage). One week later he returns with lowered blood sugars but complaints of some loose stools during the week. How should the NP respond? • A: Reassure the patient that this is an anticipated side effect 6. A 60-year-old obese male client has type 2 DM and a lipid panel of TC= 250, HDL = 32, LDL= 165. The NP teaches the patient about his modifiable cardiac risk factors which include: • A: Diabetes, obesity, and hyperlipidemia 7. Lifestyle approaches to postmenopausal symptom management include • A: avoiding sugar, coffee, chocolate and alcohol 8. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed? • A: Amitriptyline 9. How does women’s anatomy make them more susceptible to UTIs? • A: the urethra is shorter 10. A 48-year-old male patient screened for diabetes has a fasting plasma glucose level of 120 mg/dl. The NP plan includes • A: Educate the patient of lifestyle changes to lower blood glucose 11. Which of the following assessments are commonly noted in a client with Parkinson’s disease? • A: Micrographia and bradykinesia 12. A 76-year-old man is seen in the office for c/o urinary incontinence. The clinician should explore which of these causes of incontinence in men? • A: Urinary Tract Infection (UTI) 13. Which of the following maneuvers is contraindicated in acute prostatis? • A: Massaging the infected prostate 14. Mrs. N a 65-year-old women with BMI of 29 on Medicare , has a 20-yearhx of primary HTN and has been on HCTZ 25 mg daily for years , reports that for the past 6 months she has felt thirsty all of the time even though she drinks at least 10 glasses of water a day. Upon charting NP notes that the last two fasting blood glucose levels have been 136 mg/dl and 165 mg/dl. What actions should the NP perform next? • A: order a fasting blood glucose??? PRESCRIBE METFORMIN XR 500MG PO 15. According to the WHO analgesic ladder, which drug combination would be most appropriate in an opiate-naïve patient who presents with moderate pain? • A: Indomethacin/ hydrocodone 16. The cornerstone of pharmacotherapy in treating Alzheimer’s disease is : • A: Cholinesterase inhibitors 17. The highest level of evidence to support interventions at the end of life is with: • A: opioids for dyspnea 18. The comorbid psychiatric problem with the highest frequency in dementia is: • A: Anxiety 19. All of the following are true statements regarding elder abuse EXCEPT: • A : common signs of abuse include decreased anxiety and depression 20. Which of the following is a role of the advanced nurse in ????? • A: All of the above 21. The proposed mechanism by which diphenhydramine causes delirium is: • A: Anticholinergic effect 22. A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea) is : • A : Morphine 23. According to the Palliative Care presentation, hospice care may be provided to: • A: those with a life expectancy 6 months 24. A 68-year-old women is being worked up for stress incontinence. UA reveals positive leukocyte esterase, positive nitrites, 15 WBCs, no RBS, no protein, no casts. She denies frequency, urgency, suprapubic pressure or urgency. What is the first treatment for her US results? • A: no treatment is necessary 25. The elderly are at higher risk for delirium because of: • A: All of the above 26. A 63-year-old man is seen in the clinic with a c/o nocturia. Which of the following should be included in the differential diagnosis? • A: Benign prostatic hypertrophy (BPH) 27. A 75-year-old man is being treated as an outpatient for metastatic prostate cancer. Which of the following statements is true regarding the management of pain with opioids in the elderly? • A: none of the above 28. The highest level of evidence with the use of adjuvant analgesics is with: • A: neuropathic pain patients are candidates for adjuvant analgesia 29. The 56-year-old man with chronic prostatis should initially be treated with antibiotics for how long? • A: 14 days 30. A 50-year-old female patient screened for diabetes has a fasting plasma glucose level of 124 mg/dl. The NP plan includes: • A: repeat fasting plasma glucose in one year 31. When assessing a patient who complains of a tremor, the NP must differentiate essential tremor from the tremor of Parkinson’s disease. Which of the following findings are consistent with essential tremor? • A: The tremor occurs with purposeful movement 32. Which characteristic of delirium helps to distinguish it from dementia? • A: abrupt or Acute onset 33. According to the sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient: • A: Ageist attitudes 34. Mrs. Smith a 65-year-old women presents to the clinic for the first time and c/o UI and dyspareunia, she went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for fibroid. Her mother had a hip fracture at 82, pt had mammogram 5 years ago and no known fam hx of breast cancer……you decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior initiating hormone replacement therapy? • A: Mammogram 35. Mr. A experienced a brief onset of right-sided weakness, slurred speech and confusion yesterday. The symptom has resolved. What should the NP do? • A: identify modifiable cardiovascular risk factors 36. Any women with a complicated cystitis or symptoms of upper tract disease needs a urine culture and • A: sensitivity test 37. All of the following patients have a risk of adverse reaction from Metformin except: • A: patients with BMI 30 38. A middle-aged patient has been diagnosed with Parkinson’s disease. What influences the NP’s decision to begin pharmacological treatment for this patient? • A: symptom interfering with functional ability 39. Which of the following medications can blunt the signs of hypoglycemia in diabetes? • A: beta blockers 40. The Mini-cog is a short screening tool used to assess cognition. Which of the following statements pertaining to the test is a true statement? • A: A score of 0-2 is a positive screen for dementia 41. What is a sign of insulin resistance that can present in African American patients? • A: Acanthosis Nigricans 42. Age related changes in bladder, urethra and ureters include all of the following in older womenexcept: • A: increased estrogen production’s influence on the bladder and ureter 43. The majority of patients enrolled in hospice care die: • A: at home 44. Diabetes is the leading cause of: • A: kidney failure 45. A male pt with a BMI of 30 presents to the office for an annual exam. You ordered a CMP as part of routine labs. The fasting glucose was 130. Your next action is: • A: repeat the fasting glucose 46. A pelvic mass in a postmenopausal woman: • A: highly suspicious of ovarian cancer 47. A 65-year-old Hispanic woman presents to the office for routine follow up for her DM2. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which test would you order next? • A: 24-hour urine for albumin 48. Hospice services and palliative services are underutilized due to: • A: All of the above (Services not well understood, confusion remains over when it is appropriate to consult palliative care, denial of impending death) 49. Which of the following would be an appropriate treatment for a patient with mild BPH? • A: reevaluate symptoms in 1-3 months 50. The most common neurological cause of seizures in an older adult is: • A: stroke 51. A 68-year-old women presents with a c/o urine leakage whenever she sneezes, laughs, or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipsticks is negative for RBCs, leukocytes esterase, nitrites, ketones and urobilinogen. What is the diagnosis? • A: stress incontinence 52. The tasks of grieving include all of the following EXCEPT: • A: begin to disengage 53. Acanthosis nigrans is associated with all of the following conditions except: • A: tinea versicolor 54. Which of the following statements is trueregarding pain? • A: pain is subjective experience related to actual or potential tissue damage 55. A 51-year-old male pt screened for diabetes has a fasting plasma glucose level of 98 mg/dl. The NP plan includes: • A: repeat fasting plasma glucose in 3 years 56. Increased risk factors for erectile dysfunction include all EXCEPT: • A: dominant personality 57. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? • A: Resting tremor, slow unsteady gait, and cogwheel resistance 58. Which of the following is the most appropriate screening tool for delirium? • A: Confusion Assessment Method 59. An 82-year-old man is seen in the primary care office with complaints of dribbling urine, difficulty starting his stream. Which of the following should be included in the list of differential diagnosis? • A: all of the above (BPH, Parkinson’s disease, prostate cancer) 60. The patient with BPH is seen for follow up. He has been taking finasteride(Proscar) for 6 months. The clinician should assess this patient for which of the side effects? • A: Erectile dysfunction 61. Hospice care differs from palliative care in that: • A: supports patients and families through both the dying and the bereavement process 62. According to the genitourinary presentation, the number 1 risk factor for urinary incontinence is: • A: AGING 63. The firs step in treating delirium is to: • A: identify the cause 64. Which of the listed conditions is most likely to cause delirium? • A: Acute infection 65. You are working up a 52-year-old patient for microscopic hematuria. Your differential diagnosis list includes all of the following EXCEPT: • A: renal stenosis 66. Don’t have 67. A 55-year-old Caucasian man with type 2 DM presents to the clinic a as new pt. he takes metformin 500 mg twice a day. His last Hgb A1C was 7%. He is up to date on eye and foot examinations. His BP is 142/96. According to JNC8, what is the most appropriate medication? • A: lisinopril 68. Delirium is typically characterized by all of the following except: • A: Hyperactive level of psychomotor activity 69. An 80-year-old female widow asks her NP about hospice enrolment. Her diagnosis includes congestive HF, HTN and DM2. She has noticed that in the last month she has lower extremity edema and she is finding it difficult to walk to the grocery store and church, she does not use oxygen. She is able to maintain her home but requires more frequent rest after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to remain full code status. Why is this patient NOT appropriate for hospice? • A: her prognosis is 6 months 70. Jean a 42-year-old, presents to the clinic with c/o dysuria, frequency and strong odor of her urine for 5 days. This is the second occurrence this year. What is the appropriate next step to this patient? • A: order UA and urine culture and sensitivity and treat the patient with antibiotics today 71. All of the following patients should be screened for diabetes EXCEPT: • A: 44-year-old Caucasian with HTN 72. A male patient with a BMI of 33 presents to the office with c/o fatique, excessive hunger and excessive thirst. You suspect type 2 DM . initial testing to confirm diagnosis can include: • A: all of the above 73. An 87-year-old tells the NP that his grandson locks him in his bedroom when he goes out. The grandson withholds food if the patient does not give him money every week. The patient appears frail, ungroomed, and his clothes are visibly dirty and smell of urine. Which of the following is the best action for NP? • A: report the grandson to your state’s protective services 74. The leading cause of death in elderly travelers worldwide is: • A: accidents 75. The majority of depressed older adults remain untreated because of : • A: All of the above (misdiagnosis, social stigma, environmental…) 76. When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as a: • A: scoliosis 77. Which of the following patients has the highest risk for the development of osteoporosis? • A: A 5’4” Asian female weighing 95 lbs 78. When assessing a patient’s mental health, the NP knows: • A: both A & B ( cognition affects mental status and affect reflects mood) 79. You are working with an older male adult with a long hx of alcohol abuse and a 30-yearhx of smoking. In recommending an intervention for this client, your responsibility is to: • A: Promote positive change in lifestyle choices 80. The pathophysiology of heart failure is due to: • A: inadequate cardiac output to meet the metabolic and oxygen demands of the body 81. The leading cause of disability worldwide is: • A: depression 82. Which of the following patients has the highest risk for the development of osteoporosis? • A: A 5’4” Asian female weighing 95 lbs 83. Mrs. G is a 65-year-old Caucasian female who presents for her yearly physical. A review of her chart reveals she smokes 1 pack of cigarettes a day, and drinks 2 beers every evening since she retired. She does not exercise, she likes to sit and knit. The NP know the NONMODIFIABLE risk factor for osteoporosis for Mrs. G is : • A: Age 84. The NP orders bilateral wrist X-rays on a 69-year-old gentleman c/o of pain in both wrists for the past 6 weeks not related to any known trauma. The NP suspects elderly onset RA. The initial radiographic finding in a patient with elderly onset RA would be: • A: soft tissue swelling 85. The NP is reviewing a patient chart prior to the start of the encounter. The NP notes that the patient is using topical CAPSAICIN. The NP knows that topical capsaicin id often used for treatment of: • A: Diabetic neuropathy 86. Which of the following statements about OA is true? • A: It affects primarily weight bearing joints 87. MJ presents to the clinic with the following hx and presentation: hx of structural damage with current s/s of HF. Treatment will be based on MJs stage of HF which is: • A: Stage C 88. Dietary supplements such as Omega 3 (fish oils) are often taken for cardioprotective benefit. The NP knows regarding Omega 3 consumption: • A: randomized control trials have found no reduction in morbidity or mortality 89. A 55-year-old Caucasian male pt follows up with you after referral to a cardiologist. The pt reports he thinks the medication is causing cough and sometimes he has difficulty breathing, which of the following medication was most likely prescribed? • A: Lisinopril 90. The prevalence of depression in nursing home residents is _____greater than adults living in the community: • A: 3-4 times 91. The NP orders bilateral wrist Xrays on a 69-year-old gentleman c/o of pain in both wrists for the past 6 weeks not related to any known trauma. The NP suspects elderly onset RA. The initial radiographic finding in a patient with elderly onset RA would be: • A: soft tissue swelling 92. The NP knows that the goal of treatment for anxiety should: • A: reduce symptoms and improve function 93. All of the following statements are true regarding anxiety EXCEPT: • A: is a normal part of aging 94. Which of the following best describes the pain associated with OA? • A: Begins upon arising and after prolonged weight bearing and/or use of the joint 95. Which organism that can be prevented by immunization is most often responsible for infectious outbreak in the nursing home setting? • A: Influenza A 96. JK 60 year old women comes to the office today for evaluation of mgmt. plan of her c/o insomnia…..she wakes up after about 4 hrs and cannot return to sleep. The next step in treatment of insomnia is: • A: Zolpidem 5 mg by mouth at hs#7 with no refills 97. You have ordered a CBC for your patient you suspect has PMR. Which two clinical findings are common in pt with PMR? • A: Normochromic, Normocytic anemia and thrombocytosis 98. PG is a 58-year-old Caucasian man with stable mental health diagnosis of schizophrenia who presents for a yearly physical. PG is prescribed aripiprazole for treatment of his schizophrenia. The NP knows the following labs should be ordered to assess for cardiometabolic changes related to his medication EXCEPT: • A: AST/ALT