NR511 / NR 511 FINAL EXAM DIFFERENTIAL DIAGNOSIS & PRIMARY CARE PRACTICUM WITH QUESTIONS & CORRECT ANSWERS.

NR511 / NR 511 FINAL EXAM DIFFERENTIAL DIAGNOSIS & PRIMARY CARE PRACTICUM WITH QUESTIONS & CORRECT ANSWERS. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD). - -3. Gastroesophageal reflux disease (GERD). Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1.A labyrinthectomy. 2.Pharmacological therapy. 3.A vestibular neurectomy. 4.Wearing an earplug in the ear that has the most hearing loss. - -3. A vestibular neurectomy. Which is the most common presenting symptom of gastric cancer? 1.Weight loss. 2.Dysphagia. 3.Hematemesis. 4.Gastrointestinal bleeding. - -1. Weight loss Treatment for achalasia may include: 1. Balloon dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy. - -1. Balloon dilation of the LES Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? 1.Ursodiol (Actigall). 2.Ibuprofen (Advil). 3.Prednisone (Deltasone). 4.Surgery is the only answer. - -1. Ursodiol (Actigall) All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1.Anticholinergics, such as scopolamine (Donnatal). 2.Antidopaminergic agents, such as prochlorperazine (Compazine). 3.Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4.Tetrahydrocannabinols, such as dronabinol (Marinol). - -3.Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1.Peritonitis. 2.A liver or spleen abscess. 3.A liver or spleen metastatic tumor. 4.Irritable bowel syndrome. - -4. IBS The metabolism of which drug is not affected in Marsha, age 74? 1.Alcohol. 2.Anticonvulsants. 3.Psychotropics. 4.Oral anticoagulants. - -1. Alcohol Nausea is difficult to discern in a young child. What question might you ask to determine if a child has nausea? 1."Are you sick to your tummy?" 2."Are you hungry?" 3."Are you eating the way you normally eat?" 4."Are you nauseous?" - -2. "Are you hungry?" Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1.Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2.Drink at least 2000 mL of fluids per day. 3.Decrease her dietary fiber for 1 month. 4.Take stool softeners as prescribed. - -3.Decrease her dietary fiber for 1 month.