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NSG 6020 MIDTERM EXAM Help 2 – QUESTION AND ANSWERS (answered) Question 1 (2 points) The first step in the genomic assessment of a patient is obtaining information regarding: Question 1 options: a) ... Family history b) Environmental exposures c) Lifestyle and behaviors d) Current medications Save Question 2 (2 points) Rheumatic heart disease is a complication that can arise from which type of infection? Question 2 options: a) Epstein-Barr virus b) Diphtheria c) Group A beta hemolytic streptococcus d) Streptococcus pneumoniae Save Question 3 (2 points) A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Question 3 options: a) Bacterium b) Allergen c) Virus d) Fungi Save Question 4 (2 points) 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? Question 4 options: a) Musculoskeletal chest wall syndrome with radiation b) Esophageal motor disorder with radiation c) Acute cholecystitis with cholelithiasis d) Coronary artery disease with angina pectoris Save Question 5 (2 points) 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. Question 5 options: a) Acute pancreatitis b) Duodenal ulcer c) Biliary colic d) Cholecystitis Save Question 6 (2 points) 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? Question 6 options: 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. Save Question 7 (2 points) An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? Question 7 options: a) Atypical pneumonia b) Peptic ulcer disease c) Gastroesophageal reflux d) Mononucleosis (Epstein-Barr) Save Question 8 (2 points) 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: Question 8 options: a) Mitral Valve Prolapse b) Referred Pain from Cholecystitis c) Pericarditis d) Pulmonary Embolus Save Question 9 (2 points) The pathophysiological hallmark of ACD is: Question 9 options: a) Depleted iron stores b) Impaired ability to use iron stores c) Chronic uncorrectable bleeding d) Reduced intestinal absorption of iron Save Question 10 (2 points) A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Question 10 options: a) Women with ischemic heart disease many times do not present with chest pain b) Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction c) Elderly patients have the most severe symptoms d) A & B only Save Question 11 (2 points) The cytochrome p system involves enzymes that are generally: Question 11 options: a) Inhibited by drugs b) Induced by drugs c) Inhibited or induced by drugs d) Associated with decreased liver perfusion Save Question 12 (2 points) Which of the following details are NOT considered while staging asthma? Question 12 options: a) Nighttime awakenings b) Long-acting beta agonist usage c) Frequency of symptoms d) Spirometry findings Save Question 13 (2 points) 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: Question 13 options: a) Angina b) Pericarditis c) Mitral valve prolapse d) Congestive heart failure Save Question 14 (2 points) Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Question 14 options: a) Hemoglobin and Hematocrit b) Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) c) Serum ferritin and Serum iron d) Total iron binding capacity and transferrin saturation Save Question 15 (2 points) What is the most common valvular heart disease in the older adult? Question 15 options: a) Aortic regurgitation b) Aortic stenosis c) Mitral regurgitation d) Mitral stenosis Save Question 16 (2 points) Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Question 16 options: a) Malignant melanoma b) Squamous cell carcinoma c) Aphthous ulceration d) Behcet’s syndrome Save Question 17 (2 points) 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: Question 17 options: a) Peptic ulcer disease b) Barrett’s esophagus c) Esophageal varices d) Pancreatitis Save Question 18 (2 points) Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: Question 18 options: a) Anemia b) Anxiety c) Hyperthyroidism d) All of the above Save Question 19 (2 points) In AR disorders, carriers have: Question 19 options: a) Two mutated genes; one from each parent that cause disease b) A mutation on a sex chromosome that causes a disease c) A single gene mutation that causes the disease d) One copy of a gene mutation but not the disease Save Question 20 (2 points) Functional abilities are best assessed by: Question 20 options: a) Self-report of function b) Observed assessment of function c) A comprehensive head-to-toe examination d) Family report of function Save Question 21 (2 points) 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: Question 21 options: a) Pneumonia b) Pleuritis c) Pneumothorax d) A and B Save Question 22 (2 points) During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: Question 22 options: a) COPD b) Pneumothorax c) A normal finding d) Pleural effusion Save Question 23 (2 points) A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Question 23 options: a) Exercise-induced cough b) Bronchiectasis c) Alpha-1 deficiency d) Pericarditis Save Question 24 (2 points) 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: Question 24 options: a) Pulmonary embolism b) Pleural effusion c) Pneumothorax d) Fracture of ribs Save Question 25 (2 points) If it has been determined a patient has esophageal reflux, you should tell them: Question 25 options: a) They probably have a hiatal hernia causing reflux b) They probably need surgery c) They should avoid all fruit juices d) Smoking, alcohol, and caffeine can aggravate their problem Save Question 26 (2 points) The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Question 26 options: a) Age over 40 b) Fever greater than 101 c) Tachypnea greater than 30 breaths/minute d) Productive cough Save Question 27 (2 points) In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Question 27 options: a) Bacterial sinusitis b) Allergic rhinitis c) Drug abuse d) Skull fracture Save Question 28 (2 points) Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except: Question 28 options: a) Sore throat b) Fever c) Weight loss d) Headache Save Question 29 (2 points) Essential parts of a health history include all of the following except: Question 29 options: a) Chief complaint b) History of the present illness c) Current vital signs d) All of the above are essential history components Save Question 30 (2 points) 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: Question 30 options: a) No palpable vibration is felt b) Decreased fremitus is felt c) Increased fremitus is felt d) Vibration is referred to the non-obstructed lobe Save Question 31 (2 points) 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: Question 31 options: a) Appendicitis b) Cholecystitis c) Bowel Obstruction d) Diverticulitis Save Question 32 (2 points) Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? Question 32 options: a) History of bright flash of light followed by significantly blurred vision b) History of transient and painless monocular loss of vision c) History of monocular severe eye pain, blurred vision, and ciliary flush d) All of the above Save Question 33 (2 points) (*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? Question 33 options: a) Abdominal plain films b) Liver function tests c) Amylase/lipase d) Urinalysis Save Question 34 (2 points) Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Question 34 options: a) Fever of 102 b) Infiltrates on chest X-ray c) Pleural effusion on chest X-ray d) Elevated white blood cell count Save Question 35 (2 points) A specific exam used to evaluate the gall bladder is: Question 35 options: a) Psoas sign b) Obturator sign c) Cullens sign d) Murphy’s sign Save Question 36 (2 points) The best way to diagnose structural heart disease/dysfunction non-invasively is: Question 36 options: a) Chest X-ray b) EKG c) Echocardiogram d) Heart catheterization Save Question 37 (2 points) 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? Question 37 options: a) Identification of a fluid wave b) Positive Murphy’s sign c) Palpable spleen d) Midepigastric pain that is not reproducible with palpation Save Question 38 (2 points) A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: Question 38 options: a) Echocardiogram b) Exercise stress test c) Cardiac catheterization d) Myocardial perfusion imaging Save Question 39 (2 points) A common auscultatory finding in advanced CHF is: Question 39 options: a) Systolic ejection murmur b) S3 gallop rhythm c) Friction rub d) Bradycardia Save Question 40 (2 points) The most common cause of eye redness is: Question 40 options: a) Conjunctivitis b) Acute glaucoma c) Head trauma d) Corneal abrasion Save Question 41 (2 points) 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: Question 41 options: a) CBC with differential b) Stool culture and sensitivity c) Abdominal X-ray d) Colonoscopy Save Question 42 (2 points) A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, 1 dorsalis pedis pulse in the right foot, and 2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? Question 42 options: a) Arterial insufficiency b) Femoral vein thrombus c) Venous insufficiency d) Peripheral neuropathy Save Question 43 (2 points) According to the Genetic Information Nondiscrimination Act (GINA): Question 43 options: a) Nurse Practitioners (NPs) should keep all genetic information of patients confidential b) NPs must obtain informed consent prior to genetic testing of all patients c) Employers cannot inquire about an employee’s genetic information d) All of the above Save Question 44 (2 points) Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Question 44 options: a) Computed tomography (CT) scan b) Chest X-ray with PA, lateral, and lordotic views c) Ultrasound d) Positron emission tomography (PET) scan Save Question 45 (2 points) Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? Question 45 options: a) Viral gastroenteritis b) Staphylococcal food poisoning c) Acute hepatitis A d) E coli gastroenteritis Save Question 46 (2 points) 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: Question 46 options: a) Pneumothorax b) Pleural effusion c) Pneumonia d) Pulmonary embolism Save Question 47 (2 points) When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? Question 47 options: a) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. b) Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. c) Sit up for an hour after taking any medication and restrict fluid intake. d) Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal. Save Question 48 (2 points) Epistaxis can be a symptom of: Question 48 options: a) Over-anticoagulation b) Hematologic malignancy c) Cocaine abuse d) All of the above Save Question 49 (2 points) The first assessment to complete related to the eyes is: Question 49 options: a) Eye lids b) Visual acuity c) Extraocular movements d) Peripheral vision Save Question 50 (2 points) The major impact of the physiological changes that occur with aging is: Question 50 options: a) Reduced physiological reserve b) Reduced homeostatic mechanisms c) Impaired immunological response d) All of the above Save Question 51 (2 points) 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: Question 51 options: a) 50 x 2-pack years b) 100-pack years c) 50-year, 2-pack history d) 100-pack history Save Question 52 (2 points) What test is used to confirm the diagnosis of appendicitis? Question 52 options: a) CBC b) Flat plate of abdomen c) Rectal exam d) CT of abdomen with attention to appendix Save Question 53 (2 points) 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: Question 53 options: a) Legionnaires' disease b) Malaria c) Tuberculosis d) Pneumonia Save Question 54 (2 points) 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? Question 54 options: a) Pulmonary edema b) Heart failure c) Pulmonary embolism d) Pneumonia Save Question 55 (2 points) The main focus of treatment of patients with ACD is: Question 55 options: a) Replenishing iron stores b) Providing for adequate nutrition high in iron c) Management of the underlying disorder d) Administration of monthly vitamin B12 injections Save Question 56 (2 points) In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Question 56 options: a) Left upper quadrant b) Right upper quadrant c) Left lower quadrant d) Right lower quadrant Save Question 57 (2 points) 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: Question 57 options: a) Mallory-Weiss tear b) Esophageal varices c) Gastric ulcer d) Colon cancer Save Question 58 (2 points) 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? Question 58 options: a) Serum iron b) Total iron binding capacity c) Transferrin saturation d) Serum ferritin Save Question 59 (2 points) 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? Question 59 options: a) Ménière’s disease b) Benign paroxysmal positional vertigo c) Transient ischemic attack (TIA) d) Migraine Save Question 60 (2 points) When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Question 60 options: a) Hemoglobin b) Hemoglobin >12 g/dl, MCV increased, MCH increased c) Hemoglobin d) Hemoglobin >12 g/dl, MCV decreased, MCH increased Save Question 61 (2 points) A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? Question 61 options: C-reactive protein level of 3 mg White blood cell count of 11,000 Direct serum bilirubin level of 0.3 mg/dl Serum amylase level of 145 U/L Save Question 62 (2 points) A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: Question 62 options: a) Inflammatory bowel disease b) Irritable bowel syndrome c) Giardiasis d) Norovirus gastroenteritis Save Question 63 (2 points) 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? Question 63 options: Checking the macula Estimating cup-to-disk ratio Verifying a red reflex Extraocular movements Save Question 64 (2 points) Which of the following is not a contributing factor to the development of esophagitis in older adults? Question 64 options: a) Increased gastric emptying time b) Regular ingestion of NSAIDs c) Decreased salivation d) Fungal infections such as Candida Save Question 65 (2 points) Which symptom is more characteristic of Non-Cardiac chest pain? Question 65 options: a) Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm b) Pain tends to occur with movement, stretching or palpation c) Pain usually lasts less than 10 minutes and is relieved by nitroglycerine d) Pain is aggravated by exertion or stress Save Question 66 (2 points) In autosomal recessive (AR) disorders, individuals need: Question 66 options: a) Only one mutated gene on the sex chromosomes to acquire the disease b) Only one mutated gene to acquire the disease c) Two mutated genes to acquire the disease d) Two mutated genes to become carriers Save Question 67 (2 points) Which of the following is the most important question to ask during cardiovascular health history? Question 67 options: a) Number of offspring b) Last physical exam c) Sudden death of a family member d) Use of caffeine Save Question 68 (2 points) Which test is the clinical standard for the assessment of aortic stenosis? Question 68 options: a) Cardiac catheterization b) Stress test c) Chest X-ray d) Echocardiography Save Question 69 (2 points) 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? Question 69 options: a) Fictional keratosis b) Keratoacanthoma c) Lichen planus d) Leukoplakia Save Question 70 (2 points) Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Question 70 options: a) Femoral vein thrombosis b) Femoral artery thrombus c) Venous insufficiency d) Musculoskeletal injury Save Question 71 (2 points) Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: Question 71 options: a) Thrush b) Laryngeal cancer c) Carotidynia d) Thyroiditis Save Question 72 (2 points) 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? Question 72 options: a) Clinical practice guideline b) Clinical decision rule c) Clinical algorithm d) Clinical recommendation Save Question 73 (2 points) Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Question 73 options: a) Less obesity rates than women b) Prostate enlargement c) Prostate enlargement d) Less estrogen than women Save Question 74 (2 points) 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: Question 74 options: a) Can be treated as an outpatient b) Requires hospitalization for treatment c) Requires a high dose of parenteral antibiotic d) Can be treated with oral antibiotics Save Question 75 (2 points) A woman with an X-linked dominant disorder will: Question 75 options: a) Not be affected by the disorder herself b) Transmit the disorder to 50% of her offspring (male or female) c) Not transmit the disorder to her daughters d) Transmit the disorder to only her daughters Save Question 76 (2 points) 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? Question 76 options: a) Seasonal allergies b) Acute bronchitis c) Bronchial asthma d) Chronic bronchitis Save Question 77 (2 points) It is important to not dilate the eye if ____ is suspected Question 77 options: a) Cataract b) Macular degeneration c) Acute closed-angle glaucoma d) Chronic open-angle glaucoma Save Question 78 (2 points) A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Question 78 options: a) Bacterial conjunctivitis b) Allergic conjunctivitis c) Chemical conjunctivitis d) Viral conjunctivitis Save Question 79 (2 points) Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: Question 79 options: a) Variable expressivity related to inherited disease b) Dysmorphic features related to genetic disease c) De novo mutations of genetic disease d) Different penetrant signs of genetic disease Save Question 80 (2 points) (*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? Question 80 options: a) Trial of ursodiol b) ‘Watchful waiting’ c) Surgical consult d) HIDA scan Save Question 81 (2 points) Which of the following is the most common cause of heartburn-type epigastric pain? Question 81 options: a) Decreased lower esophageal sphincter tone b) Helicobacter pylori infection of stomach c) Esophageal spasm d) Peptic ulcer disease Save Question 82 (2 points) A cough is described as chronic if it has been present for: Question 82 options: a) 2 weeks or more b) 8 weeks or more c) 3 months or more d) 6 months or more Save Question 83 (2 points) The most common etiologic organism for community-acquired pneumonia is: Question 83 options: a) Streptococcus pneumoniae b) Beta hemolytic streptococcus c) Mycoplasma d) Methicillin resistant staphylococcus Save Question 84 (2 points) Which of the following symptoms is common with acute otitis media? Question 84 options: a) Bulging tympanic membrane b) Bright light reflex of tympanic membrane c) Increased tympanic membrane mobility d) All of the above Save Question 85 (2 points) (*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? Question 85 options: a) Abdominal upright and flat plate x-ray b) Abdominal MRI c) Abdominal CT scan with contrast d) Abdominal ultrasound Save Question 86 (2 points) 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: Question 86 options: a) Lung cancer b) Tuberculosis c) Pneumonia d) COPD Save Question 87 (2 points) Presbycusis is the hearing impairment that is associated with: Question 87 options: a) Physiologic aging b) Ménière’s disease c) Cerumen impaction d) Herpes zoster Save Question 88 (2 points) In order to provide a comprehensive genetic history of a patient, the NP should: Question 88 options: a) Ask patients to complete a family history worksheet b) Seek out pathology reports related to the patient’s disorder c) Interview family members regarding genetic disorders d) All of the above Save Question 89 (2 points) When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to: Question 89 options: a) Use all the medication b) Do not use for possible infectious diarrhea c) Use should exceed one week for effectiveness d) These drugs provide exactly the same pharmaceutical effects Save Question 90 (2 points) 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: Question 90 options: a) Digital rectal examination b) Endoscopy c) Pelvic examination d) Urinalysis Save Question 91 (2 points) Which of the following statements is true concerning anti-arrhythmic drugs? Question 91 options: a) Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. b) Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. c) Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. d) Anti-arrhythmic therapy should be initiated in the hospital for all patients. Save Question 92 (2 points) Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Question 92 options: a) Colon cancer in family member at age 70 b) Breast cancer in family member at age 75 c) Myocardial infarction in family member at age 35 d) All of the above Save Question 93 (2 points) Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Question 93 options: a) Sinus pain, increased vascular permeability, and bronchodilation b) Bronchospasm, vascular permeability, and vasodilatation c) Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction d) Vasodilatation, bronchodilation, and increased vascular permeability Save Question 94 (2 points) A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Question 94 options: a) Barrel-shaped chest b) Clubbing c) Pectus excavatum d) Prolonged capillary refill Save Question 95 (2 points) 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? Question 95 options: a) Mono spot b) Strep test c) Throat culture d) All of the above Save Question 96 (2 points) Which of the following medications are commonly associated with the side effect of cough? Question 96 options: a) Beta blocker b) Diuretic c) ACE inhibitor d) Calcium antagonist Save Question 97 (2 points) Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? Question 97 options: a) Cases of dyspepsia with constipation b) Symptoms persisting after six to eight weeks of therapy c) All clients with dyspepsia who smoke and drink alcohol d) When a therapeutic response to empiric treatment is obtained Save Question 98 (2 points) The aging process causes what normal physiological changes in the heart? Question 98 options: a) The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis b) Cardiology occurs along with prolapse of the mitral valve and regurgitation c) Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves d) Hypertrophy of the right ventricle Save Question 99 (2 points) Aortic regurgitation requires medical treatment for early signs of CHF with: Question 99 options: a) Beta blockers b) ACE inhibitors c) Surgery d) Hospitalization Save Question 100 (2 points) Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: Question 100 options: a) Diverticulitis b) Colon cancer c) Appendicitis d) Peptic ulcer disease Save ________________________________________ [Show More]

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