NURS-6531 Midterm Exam – Primary Care of Adults Across The Lifespan

NURS-6531 Midterm Exam – Primary Care of Adults Across The Lifespan

Nurs 6531 Midterm

• Question 1

1 out of 1 points

Antibiotic administration has been demonstrated to be of little benefit to the treatment of

which of the following disease processes? Acute Bronchitis

• Question 2

1 out of 1 points

Your patient Jerry has gout. What do you suggest? No purine foods

• Question 3

1 out of 1 points

Which of the following heart murmurs warrants the greatest concern? Diastolic murmur

• Question 4

1 out of 1 points

Which of the following color changes in a pigmented lesion suggests malignant transformation?

All color changes

• Question 5

1 out of 1 points

An adult presents with tinea corporis. Which item below is a risk factor for its development?

Steriod use

• Question 6

1 out of 1 points

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?

Hepatitis Panel

• Question 7

1 out of 1 points

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Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Antihistamines

• Question 8

1 out of 1 points

A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

No purulent drainage

• Question 9

1 out of 1 points

Which of the following can result from chronic inflammation of a meibomian gland? Chalazion

• Question 10

1 out of 1 points

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there

is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?

Blepharitis

• Question 11

1 out of 1 points

Risk factors for acute arterial insufficiency include which of the following? All the above

• Question 12

1 out of 1 points

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important

• Question 18

1 out of 1 points

Which of the following is a predisposing condition for furunculosis? Diabetes

• Question 19

1 out of 1 points

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

Low salt and rest

• Question 20

1 out of 1 points

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?

Nasal decongestant

• Question 21

1 out of 1 points

A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:

Gonoccological conjunctivitis

• Question 22

1 out of 1 points

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

Macrolid Clarithromycin

• Question 23

1 out of 1 points

Which of the following dermatologic vehicles are the most effective in absorbing moisture

and decreasing friction? Powder

• Question 24

1 out of 1 points

Carl, age 78, is brought to the office by his son, who states that his father has been

unable to see clearly since last night. Carl reports that his vision is “like looking through a

veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?

Retinal detachment

• Question 25

1 out of 1 points

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

Penicillin V 500mg

• Question 26

1 out of 1 points

Which of the following are classic features of ulcerative colitis? Relapse remittent bloody diarrhea, abdominal cramping, etc.

• Question 27

1 out of 1 points

When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

CT scan or ultrasound

• Question 28

1 out of 1 points

Which intervention listed below is safe for long term use by an adult with constipation? Bulk forming agents (fiber)

• Question 29

1 out of 1 points

What prophylactic medication is commonly recommended for the patient under 35 years

of age with a positive PPD? Isoniazid (INH)

Impetigo and folliculitis are usually successfully treated with:

Topical antibiotics

• Question 37

1 out of 1 points

Your well-nourished 75-year-old patient has come into the office for a physical exam and

states that she recently had two nosebleeds. She does not take any anticoagulants, and

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you have ruled out any coagulopathies. The most likely cause of these nosebleeds is: Trauma

• Question 38

1 out of 1 points

A 58 year old complains of tightness in his chest while cutting firewood. It disappears quickly if he stops chopping. He denies shortness of breath, his total cholesterol level is

less than 200 mg/dL, and he is a non-smoker. What is the most appropriate action for the

nurse practitioner to take with this patient? Cardiac in nature

• Question 39

1 out of 1 points

A 45 year old with diabetes has had itching and burning lesions between her toes for 2

months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial

treatment option for this patient?

Powder and topical antifungal, watch for secondary infection

• Question 40

1 out of 1 points

Of the following choices, the least likely cause of cough is:

Pharyngitis

• Question 41

0 out of 1 points

Which of the following best describes hypertrophic cardiomyopathy? Decreased Ventricular filling and weak muscle

• Question 42

1 out of 1 points

Which of the following patient characteristics are associated with chronic bronchitis? Overweight, cyanotic, normal or slight increase in RR

• Question 43

1 out of 1 points

An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?

Take BP lying, sitting, and standing

• Question 44

1 out of 1 points

The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?

Fever, Cervical lymphadenopathy, red sore throat with or without exudate, NO COUGH

• Question 45

0 out of 1 points

Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:

Not sure

• Question 46

1 out of 1 points

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-

agonist daily. Her exacerbations affect her activities and they occur at least twice weekly

and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

Moderate persistent

• Question 47

1 out of 1 points

Of the following, the patient who should be referred for periodic colonoscopy is the patient with:

Ulcerative colitis long duration

• Question 54

1 out of 1 points

A 15 year old male presents with abdominal pain that began in the peri-umbilical area

then localized to the right lower quadrant (RLQ). He complains of anorexia, and low grade

fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis?

Acute appendicitis

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• Question 55

1 out of 1 points

An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?

Allergic conjunctivitis

• Question 56

1 out of 1 points

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to: Topical antibiotics and warm compress

• Question 57

1 out of 1 points

An AST that is more than twice the level of ALT is suggestive of: Alcoholic liver

• Question 58

1 out of 1 points

An 18 year old patient is afebrile and complains of severe left ear pain. On examination, the TM is gray and intact and there is a green discharge in the external canal. What action by the nurse practitioner is most appropriate?

Otic antibiotic/corticosteriod

• Question 59

1 out of 1 points

A patient presents with classic symptoms of gastroesophageal reflux disease (GERD).

He

is instructed on life style modifications and drug therapy for 8 weeks. Three months later

he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:

Get EGD, manometry, etc.

• Question 60

1 out of 1 points

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: Acute cholecystitis

• Question 61

1 out of 1 points

A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?

Bacterial pharyngitis

• Question 62

1 out of 1 points

A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?

Give antibiotic

• Question 63

1 out of 1 points

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

Dr. must be present during visit and active in care

• Question 64

1 out of 1 points

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is: Esophageal cancer and GERD

• Question 71

1 out of 1 points

Appropriate therapy for peptic ulcer disease (PUD) is: Depends on eitology

• Question 72

1 out of 1 points

Which of the following is not a symptom of irritable bowel syndrome?

Weight loss

• Question 73

1 out of 1 points

Risk factors for acute otitis media (AOM) include all of the following except: African American

• Question 74

1 out of 1 points

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?

Bill services so you can avoid missed billable service that leads to missed revenue.

• Question 75

1 out of 1 points

A 55 year old patient has a work-up for hypertension and is noted to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect?

Renal workup

• Question 76

1 out of 1 points

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened

for hypercholesterolemia? Every 5 years

• Question 77

1 out of 1 points

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?

Heart Failure

• Question 78

1 out of 1 points

NURS-6531 Midterm Exam – Primary Care of Adults Across The Lifespan

Martha had a less than 7% value on her Schilling test. What medication do you anticipate

she might need? Vitamin B

• Question 79

1 out of 1 points

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a

butterfly distribution on her face. The rash has red papules and plaques with a fine scale.

What do you suspect? Lupus

• Question 80

1 out of 1 points

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

Inferior wall infarct

• Question 81

1 out of 1 points

Which of the following statements about malignant melanomas is true? Staged based on depth of lesion

• Question 82

1 out of 1 points No gluten

• Question 88

1 out of 1 points

The differential diagnosis for a patient complaining of a sore throat includes which of the

following?

I think all of the above: candidiasis, gonorrhea, leukoplakia

• Question 89

1 out of 1 points

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth.

They are probably caused by:

Candidiasis

• Question 90

1 out of 1 points

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?

Add thiazide diuretic

• Question 91

1 out of 1 points

Which of the following is a secondary cause of hyperlipidemia? Diabetes

• Question 92

1 out of 1 points

An 83-year-old female presents to the office complaining of diarrhea for several days.

She explains she has even had fecal incontinence one time. She describes loose stools 3–

4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:

Chronic diarrhea

• Question 93

1 out of 1 points

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?

75% of salt comes from processed foods

• Question 94

1 out of 1 points

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than

her diabetes medications, what would you prescribe today during her routine office visit?

Ace inhibitor

• Question 95

1 out of 1 points

A patient presents to the primary care provider complaining of a rash on his right

forehead that started yesterday and is burning and painful. The physical exam reveals an

erythematous, maculopapular rash that extends over the patient’s right eye to his upper

right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Ophthalmic shingles (herpes)

• Question 96

1 out of 1 points

What is the Gold standard for the diagnosis of asthma? Spirometry

• Question 97

1 out of 1 points

In the initial evaluation of a patient with new onset hypertension, the nurse practitioner should:

Evaluate modifiable risk factors

• Question 98

1 out of 1 points

In order to decrease deaths from lung cancer: Stop smoking

• Question 99