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SOUTH UNIV NSG6340 FINAL EXAM (GRADED A)

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SOUTH UNIV NSG6340 FINAL EXAM (GRADED A) 1. A 37-year-old female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today ... she complains of poor concentration and fatigue. Initially, the NP should: 3. Which of the following is an example of secondary prevention? 7. A 35-year old female with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the 2007 American ___Association’s guideline for endocarditis prophylaxis, what would you advise this patient? a. 8. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: 9. A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should 10. A positive drawer sign support a diagnosis of 11. A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities. 12. A 16-year-old athlete complains of pain underneath his heel every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic interventions should the nurse practitioner prescribe for this patient? 13. A __-year-old with Type I diabetes has had itching and burning lesions between her toes for 6 months. Scrapings of the lesion confirm the diagnosis of tinea pedis. What is the best treatment option for this patient? c. Prescribe an oral anti-fungal for 4 to 12 weeks. Monitor liver enzymes, BUN and creatinine at one week, 2 weeks, and every month thereafter. d. Prescribe a prescription strength antifungal/steroid combination cream. Monitor for a secondary bacterial infection. 14. What is an appropriate drug for prophylactic treatment of migraine headaches in a 21-year-old female? a. Sumatriptan (Imitrex) b. propranolol (Inderal) c. ibuprofen (Motrin) d. dihydroergotamine (DHE) 15. Which of the following are the classic features of ulcerative colitis? a. RLQ pain, frequently accompanied by a palpable mass, fever, and leukopenia b. Massive painful hematemesis, occasionally accompanied by melena c. Rapidly progressive dysphagia to solid foods, anoriexia, and weight loss out of proportion to the dysphagia d. Remission and exacerbations of bloody diarrhea, tenesmus, fecal incontinence, abdominal pain, and ___. 16. Which drugs below would be expected to produce the least amount of hypokalemia? a. Furosemide (Lasix) b. hydrochlorothiazide (HCTZ) and spironolactone (Aldactone) c. Spironolactone (Aldactone) d. hydrochlorothiazide (HCTZ) 17. What information should patients with diabetes and their families receive about hypoglycemia? a. Hypoglycemia is very rare b. Hypoglycemia requires professional medical treatment c. Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly d. Hypoglycemia occurs only as a result of overdose of insulin 18. A 60-year-old male patient with a past history of glaucoma and frequent sinusitis presents today with hypertension. On his last 2 visits to the clinic his blood pressures were 150-160/90-98. The nurse practitioner decides to treat the hypertension with long-acting propranolol (Inderal). Before prescribing it, the nurse practitioner should ask: a. whether he smokes or consumes alcohol on a daily basis b. what other medications have been prescribed for him c. if he takes a daily antihistamine d. if other family members are hypertensive 19. Which of the following is NOT associated with Type 2 diabetes mellitus? a. Gestational diabetes, birth of a macrosomic infant b. Hispanic, African-American, or Native American descent c. Alcohol or other drug abuse d. Obesity, hypertension, hypertriglyceridemia 20. A 35-year-old male presents with a severe unilateral headache over his left eye. He says it started about one hour ago and has rapidly gotten worse. He gives a history of similar headaches over the past 2 years. Physical examination is negative except for left eye lacrimation. What is the most likely diagnosis? c. Cluster headache d. Classic migraine headache 21. A 16-year-old sexually active female present to the clinic. She has never had vaccination for hepatitis A or B, she has had one MMR immunization, and her last tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without further testing? 22. A 15-year-old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant. He complains of nausea, vomiting, anorexia, and low-grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis? 23. A 25-year-old hypertensive patient has a BMI of 16. His blood pressure is 165/100. There is an audible bruit in his left upper abdominal quadrant. He probably has: a. Essential hypertension b. Secondary hypertension 24. Which of the following is the most common presenting sign of substance abuse in adolescents? 25. Therapeutic international normalized ratio (INR) for a patient takein warfarin (Coumadin) for chronic atrial fibrillation is expected to be 26. A 199-year-old female reports that she is having “panic attacks.” The NP knows that panic attacks are characterized by 27. A 25-year-old complains of fever and throat pain. The tonsils have exudate bilaterally. The patient describes having an anaphylactic reaction to penicillin in the past. What antibiotic should the NP prescribe if she believes the causative agent is bacterial? a. amoxicillin (Amoxil) b. erythromycin 28. A diagnostic finding of Hodgkin’s lymphoma is the presence of 29. With a history of ankle sprain, the nurse practitioner would most likely elicit a history of 30. Certification for nurse practitioners is offered through: 31. Simple cases of impetigo and folliculitis are usually successfully treated with: a. systemic antibiotics b. topical antibiotics 32. A 43-year-old has chronic gout. He comes to the clinic for the 3rd time in as many months for treatment of an exacerbation. Dietary counseling should include avoidance of all of the following EXCEPT: 33. A 57-year-old patient presents for an annual physical exam. He reports having 3 attacks of acute gout during the past year. He does not take any medication except NSAIDs during the attacks which help “a little bit.” The NP would appropriately recommend 34. A 43-year-old male presents with a large and painful furuncle, the 3rd one in the past 6 months. The NP should _?_ all of the following EXCEPT: 37. A 64-year-old female has sudden onset of right eye pain, blurred vision, and dilated pupil. The most likely diagnosis is acute: 38. A 25-year-old patient presents with complaints of pain and burning in the vulvar area. Upon examination, the NP notices vesicles with an erythematous base arranged ina group on the patient’s labia major. The most likely diagnosis is: 39. An 85 – year-old is diagnosed with shingles. The patient states that she became “miserable” yesterday when the symptoms started. What pharmacologic interventions should the nurse practitioner offer this patient? 40. A 16-year-old presents to the clinic for a scheduled immunization. The patient is unaccompanied by an adult. The NPs action is based on the knowledge that: 41. The mechanism by which nurses are held accountable for practice, based on the quality of nursing car ein a given situation inaccordance with established standards of practice, is: 42. A 52- year-old female has a firm, non-tneder, one centimeter mass in the RLQ of her breast. There are no palpable axillary lymph nodes. A mammogram the month before her examination was netative. The most appropriate nurse practitioner action today is to: 43. Which of the following is NOT a characteristic of the S3 heart sound? 44. A characteristic of elders which affects the pharmacotherapeutics of drug therapy in that population is an increase in: 45. The AUDIT questionnaire is useful to assess: 46. A 32- year-old mother and her 10-year-old child each have a 10 cm round, reddened patch on the trunk. There is central clearing in the lesion. Different lesions run parallel to each other in a Christmas tree pattern. The mother has been treating the “ringworm” with an anti-fungal cream for 7 days without success. The NP best response is: . 47. For the general adult population, total dietary fat intake should be no more than what percent of total calories? 48. A 23-year-old female college student is being evaluated by the nurse practitioner for immunization status. She has documentation of completion of IPV, DTaP, and MMR series. She states “I got a shot when I was 12 years old, but none since.” Which vaccine(s) should she receive today? 49.Which of the following patients is most likely to have a diagnosis of Type 2 diabetes mellitus? 50. Which of the following findings is consistent with otitis externa? 51. The most effective primary prevention of skin cancer is to educate the public about: 52. Which of the following is NOT a symptom of irritable bowel syndrome? 53. An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy: 54. A 50-year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis? a. uterine fibroids b. normal peri-menopause c. endometrial cancer d. cervical cancer 55. Which agent is most effective for the treatment of nodulocystic acne? 56. Which of the following signs and symptoms is typical of hyperthyroidism? 57. An 83-year-old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with? a. Multiple sclerosis (MS) b. Parkinson’s disease c. diabetic neuropathy 58. A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area. The NP identifies popular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The NP would appropriately order: d. a topical steroid cream 59. Expected spirometry redings when the patient has chronic emphysema include: 60. Right-sided heart failure is characterized by all of the following clinical findings EXCEPT: 61. Moderate weight loss, particularly of visceral adipose tissue, in patients with Type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: d 62. Nurse practitioner services are filed with Medicare for reimbursement 63. Which of the following drugs has a beneficial effect on benign prostatic hyperplasia? 64. A 46-year-old female has hypertension and is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug? 65. The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is: a. enlarged, symmetrical, semi-firm, and non-tender b. enlarged, symmetrical, boggy, and exquisitely tender 66. A 20-year-old male complains of a “skin rash” on his knees and elbows. The lesions have silvery scales and are pruritic. A positive Auspitz sign is present. What is the most likely diagnosis? 67. The daughter of a 75-year-old patient reports that her mother roams the house at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insomnia? 68. A 65-year-old African American patient was screened at his local church for “high cholesterol.” His total cholesterol (no-fasting) was 215 mg/dL (5.6 mmol/L). What action below is most appropriate for the NP? 69. Swan neck and boutonniere deformities are typical clinical findings in the later presentation of: a. gouty arthritis b. rheumatoid arthritis 70. A 13- year-old patient complains the he fell while running during football practice. Now his knee hurts and sometimes “locks.” The NP conducts McMurray’s test. Which of the following is TRUE about this test? 71. A hemoglobin AIC level is 7.2 in a patient with Type 2 diabetes mellitus. The patient is currently taking a sulfonylurea medication. Which of the following drug should be added next to the medication regime? 72. A patient with a diagnosis of giardiasis is being treated with metronidazole (Flagyl). What information would be important to obtain before prescribing this medication? 73. The nurse practitioner is performing a routine assessment of a 47-year-old female who wants to lose weight She has truncal obesity with relatively slender forearm and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the nurse practitioner diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT: 74. A 59-year-old postmenopausal woman has atrophic vaginitis. She has a history of breast cancer at age 40 years. What is the appropriate initial treatment for this patient? 75. The process by which a profession association cofers recognition that a licensed profession has demonstrated mastery of a specialist body of knowledge and skills is termed: 76. A nurse practitioner has just diagnosed a patient as having acute hepatitis B. The principle which prohibits the nurse practitioner from notifying the patient’s spouse without permission is: 77. A 43-year-old female patient complains of dull ache around both ankles after a day’s work as a cashier. Her symptoms are relieved by sitting and elevating her legs. She reports ankle edema at the end of the day. What is the most likely cause of these problems? 78. Which of the following are characteristic of patients with Type 2 diabetes mellitus? 1. Beta cell destruction 2. High body mass 3. Central obesity 4. Unexplained weight loss a. 1,2,3 b. 2,3 c. 1,4 79. The sexual partner of a symptomatic male patient with gonorrhea should be empirically treated: 80. A patient on oral contraceptives complains of breast fullness, tenderness, and some nausea. The patient is concerned. How should the NP manage this? 81. A 62-year-old with Type 2 diabetes mellitus complains of increased nocturia, fatigue, and weakness. His fasting blood glucose is 110 mg/dL (6.2 mmol/L), he is slightly anemic and his serum creatinine level is slightly elevated. All other laboratory tests and physical examination are within normal limits. What is the most likely diagnosis? 82. A 23-year-old female presents with scaly hypo-pigmented macular lesions on her trunk, shoulders, and upper arms. The lesions fluoresce under Wood’s lamp. Appropriate treatment for this condition is: 83. The goals of treatment for patients with alcohol abuse disorder are: c. abstinence or reduction in sue, relapse prevention and rehabilitation d. marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment 84. Which of the following drug classes may potentiate hyperkalemia in a patient taking a potassium-sparing supplement? a. thiazide diuretic b. angiotensin-converting enzyme inhibitor 85. A patient has laboratory studies performed which demonstrate increased TSH, decreased free T4, and T3. Which symptoms might she complain of? 86. The anatomical site currently believed to be the best location for subcutaneous insulin administration is the 87. Following the finding of prostate gland abnormalities on DRE, the nurse practitioner orders appropriate labs. When preparing to review lab reports with the patient, the NP know all of the following are true EXCEPT: 88. An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include: 89. Which statement is true regarding dental health? a. a diet high in sugar has no effect on dental caries b. individuals with dentures should visit the dentist every 2 years 90. A 51-year-old post-menopausal female, requests guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT: 91. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? a. order abdominal x-rays b. order abdominal ultrasound 92. Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP) 93. The first step when taking a patient history is the 94. Characteristics of prescription and OTC drug use in the elder population include all of the following EXCEPT: a. high incidence of drug reactions b. multiple prescribers and polypharmacy 95. The nurse practitioner wants to assess intactness of a patient’s cerebellar function. Which of the following clinical tests will provide information relative to cerebellar function? a. kinesthesia b. stereognosis c. Romberg 96. A 57-year-old patient with known diverticulosis presents with fever, leukocytosis, and bright red rectal bleeding. The nurse practitioner’s least appropriate action at this time is: 97. A 41-year-old woman presents with multiple painful vesicular lesions in the vulvar area She has been with the sexual partner for 21 years. Which of the following is the MOST likely diagnosis? c. herpes simplex d. chlamydia 98. The differential diagnoses for transient episodes of dizziness would appropriately include all of the following EXCEPT: 99. Which of the following is NOT a common early sign of benign prostatic hyperplasia (BPH)? 100. The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The LEAST likely diagnosis is: 101. A 16-year-old presents for a sports physical for football. The nurse practitioner auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP? 102. What is the most common causative pathogen found in cystitis, pyelonephritis, and prostatitis? 103. The most common symptoms of a transient ischemic attack (TIA) include: a. nausea, vomiting, syncope, incontinence, dizziness, and seizure b. weakness in an extremity, abruptly slurred speech or partial loss of vision, and sudden gait changes 104. A characteristic of delirium that is typically absent in dementia is: a. acute onset of confusion in a previously alert and oriented patient b. gradual loss of short-term memory c. loss of language skills d. long-term memory gaps filled in with confabulation 105. A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time. Which of the following would NOT be included in the differential diagnosis? d. Parkinson’s disease 106. The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals a. an increased reticulocyte count b. a mean corpuscular volume (MCV >100) c. hemoglobin (Hgb) 14.0 d. an increase total iron binding capacity (TIBC) 107. A 16-year-old sexually active student presents with complaints of a greenish-gray frothy vaginal discharge and vaginal itching. The nurse practitioner should suspect: a. bacterial vaginosis (BV) b. trichomoniasis c. syphilis d. gonorrhea 108. A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy? 109. A 60-year-old male diabetic presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which has resolved. His temperature is 102 degrees F and pulse is 100 bpm. The nurse practitioner’s most appropriate initial action is to: a. start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days b. order mandibular x-rays and question the patient about physical abuse c. start an oral antibiotic, mouth swishes with an oral anti-infectives, and an analgesic d. initiate an IM/IV antibiotic and consider hospital admission 110. A 44-year-old male Caucasian patient’s blood pressures are consistently 170 mm Hg systolic and 100-119 mm Hg diastolic. He has no significant medical history and is of normal weight. His lab tests and EKG are normal. What is the most appropriate action at this time? d. Prescribe and ACE inhibitor and a low dose thiazide diuretic 111. A 65-year old diabetic patient has periorbital cellulitis secondary to a sinus infections, What course of action should the nurse practitioner take? d. Consider collaboration with a physician regarding antibiotic treatment, culture and subsequent action 112. A 15- year-old swim team member presents with mild “swimmer’s ear.” Vital signs are normal. What is the most appropriate therapy for this patient? a. Oral amoxicillin-clavulanate (Augmentin) b. Oral cefaclor (Ceclor) c. Keep the ear canals dry at all times until the condition resolves on its own d. hydrocortisone-bacitracin-polymyxin B (Corisporin) otic suspension 113. Which of the following is true concerning sensitivity and specificity? a. Assessment techniques must be highly sensitive and highly specific to be useful b. Sensitivity relates to the reliability of a technique to give a positive result when the finding is present. Specificity relates to the reliability of a technique to successfully rule out a finding. 114. A nurse practitioner has recently been hired to work in a fast track facility. The NP’s employer asks if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is: a. grounds for dismissal b. an ethical dilemma for the NP c. illegal according to the standards of nursing d. patient abandonment 115. According to the American Diabetes Association, what is the lowest fasting plasma glucose level which warrants a diagnosis of diabetes mellitus if confirmed on a subsequent day? a. 121 mg/dL b. 126 mg/dL c. 130 mg/dL d. 140 mg/dL 116. A 23-year-old female patient of Italian descent has been diagnosed with anemia secondary to glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. It is important to teach this patient to avoid: a. beef or pork liver b. fava beans c. phenylalanine d. milk and mild products 117. A 14- year-old develops otitis externa with swelling erythema, and pain,. To facilitate antibiotic deliver to the canal, the NP should: a. use a cotton tipped swab to apply medication b. insert a wick by gently twisting it into the canal c. prescribe an oral antibiotic prescribe an oil-based otic antibiotic to seep into the canal 118. A patient taking levothyroxine is being over-replaced. What condition is he at risk for? a. Osteoporosis b. diarrhea c. bipolar disorder d. periorbital puffiness 119. A nurse practitioner plan to open a private clinic. Each patient will be expected pay $45 immediately following the visit. This is a example of: a. utilitarianism b. fee-for-service c. case management d. preferred providership 120. Along with helping to prevent osteoporosis, hormone replacement therapy (HRT) in the post-menopausal woman has been shown to: a. raise high density lipoprotein (HDL) b. raise low density lipoprotein (LDL) c. lower triglyceride d. prevent coronary heart disease (CAD) 121. An elderly patient presents with a gray-white ring around the periphery of the iris. This is probably a. indicative of underlying atherosclerotic disease b. a normal variant associated with the aging process 122. A patient complains of “stomach pains” on and off for the past month. In distinguishing between a gastric and duodenal ulcer, what question is least important to ask? a. Have you been out of the country in the past several months? b. Have you had dark, tarry or bloody stools? 123. Which of the following is a microcytic hypochromic anemia? a. Folic acid deficiency anemia b. Iron deficiency anemia 124. What information should a 42- year old patient with newly diagnosed diabetes receive about exercise? 125. A 14-year-old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. She also complains of a “sore lump on my knee.” The nurse practitioner notes swelling and point tenderness at the tibial tuberositiy X-ray is negative. What is the most likely diagnosis? 126. The obesity associated with Type 2 diabetes mellitus is: 127. Which of the following patients would appropriately be diagnosed with isolated systolic hypertension (ISH)? 128. An adolescent goes to Colorado for a ski trip. He is unaccustomed to the high altitude and very dry air. He develops nose bleeds and visits the nurse practitioner. What intervention is LEAST effective? 129. The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is a. psychotherapy b. electroconvulsive therapy (ECT) 131. A person with 20/80 vision: 132. Which of the following is considered a non-inflammatory disease process? 133. A 49 – year-old Hispanic female has a blood pressure of 145/95. mmHg during a routine annual evaluation. She no history of hypertension. She takes a statin for dyslipidemia. How should the NP proceed with this patient? 134. With a diagnosis of syphilis, which of the following tests remains positive for the patient’s lifetime? b. RPR c. FTA-Abs or MHA-TP 135. Stress urinary incontinence is: a. associated with the normal aging process b. may be caused by anticholinergic or antidepressant medication c. due to detrusor muscle instability d. may be aggravated by caffeine or alcohol 136. Which of the following accurately describes the appropriate use of influenza vaccine? a. Influenza vaccine is recommended on a one-time only basis for all 65 yrs. or older and to persons 6 months or older who are in chronic care facilities or who suffer cardiopulmonary disorders, metabolic diseases, hemoglobinopathies, or immunosuppression. a. Influenza vaccine should be given annually to all persons 65 yrs. or older and to persons 6 months or older who are in chronic care facilities or who suffer cardiopulmonary disorders, metabolic diseases, hemoglobinopathies, or immunosuppression. a. Influenza vaccine should be administered to all persons born after 1956 who lack evidence of immunity to influenza. a. Influenza vaccine should be administered to all young adults not previously immunized and also to susceptible adults in high risk groups including homosexual men, injecting drug users, and persons in health-related job with frequent exposure to influenza 137. Ideal weight for 5’7” female is 138. A 65-year-old diabetic patient has newly diagnosed peripheral artery disease in her lower extremities. She is exhibiting symptoms of this disease. In assessing this patient, the NP would expect to find: a. decreased pulses proximal to the blockage b. pain in affected leg at rest c. diminished pedal pulses d. dependent rubor 139. A 75-year-old female complains that she awakens 3 to 4 times each night sensing bladder fullness, but is unable to “hold it” until she can get seated on the bathroom toilet. This type of urinary incontinence is termed: a. overflow incontinence b. stress incontinence c. functional incontinence d. urge incontinence 140. The nurse practitioner strongly suspects hyperthyroidism in a 62-year-old patient. Which of the following would NOT be an appropriate initial intervention? 141. The Patient Self-Determination Act of 1991 requires all health care agencies receiving Medicare or Medicaid funds to give patients written information about their rights to make decisions regarding their medical care. A document which declare in advance what type of medical care a person wants to be provided or withheld should he or she be unable to express his or her wishes is called: 142. A 2-year-old male complains of severe headaches localized to the left frontal and parietal area with blurred vision. The nurse practitioner identifies vesicular lesions on his forehead. The most appropriate intervention is to start: 143. A patient has experienced nausea and vomiting, headache, malaise, low-grade fever, abdominal cramps, and diarrhea for 32 hours. The white count is slightly elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? 144. The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of hospitalization for hepatitis-B infection 2 years ago. Her laboratory tests demonstrate positive HBsAg. The nurse practitioner would most likely diagnose: 145. What medication would be best to relieve symptomatic wheezing in a patient who has asthma? 146. Tricyclic antidepressants should be avoided in elderly patients because they have potentially disabling side effects. Which of the following is least likely to be a side effect of TCAs? 147. Of the following, the patient who should be referred for periodic colonoscopy is the patient with: a. diverticulitis resistant to traditional medical management b. extensive ulcerative colitis of long duration c. irritable bowel syndrome (IBS) complicated by psychiatric illness d. lactose intolerance 148. What is the most frequent cause of death in patients with anorexia nervosa? 149. All patients with renal calculi should be taught that the best prevention is: 150. In order to decrease deaths from lung cancer: OTHER PRE-TEST QUESTIONS 2. Which of the following physical findings is consistent with a diagnosis of beta-thalassemia major? 4. Weber test with lateralization to right ear 5. Yesterday, a patient got sand in his eye during a volleyball game at the beach. Today, he presents with an exquisitely painful left eye, photophobia, and constant tearing. The nurse practitioner removes a tiny spec of sand from under the lid and notes vertical corneal abrasion. The treatment of choice is: a. patching the injured eye only; no medication is needed b. an ophthalmic steroid to reduce swelling, inflammation, and pain c. an ophthalmic antibiotic ointment, eye patch, and ibuprofen d. normal saline drops only, eye-patching is not necessary 6. A critically ill patient states “my family is well provided for. The nurse practitioner must interpret this as meaning the patient a. is suicidal b. wishes to discuss the topic of death 7. The patient who has iron deficiency anemia should be advised that food high in iron content include: a. bananas, apples, and oranges b. yellow vegetables c. organ meats, and dark, leafy vegetables 8. Microalbuminuria is a measure of: 9. Appropriate therapy for peptic ulcer disease (PUD) is: a. primarily by eradication of infection b. based on etiology 10. All of the following are medical emergencies which may be attributed to acute cocaine intoxication EXCEPT: 11. The treatment of choice for chronic bacterial prostatitis (CBP) is: 12. Before initiating a HMG-CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What lavoratory test(s) should be ordered? 13. Subsequent to successful completion of the nurse practitioner certification exam, the candidate is considered to be: 14. Which of the following patient characteristics are associated with chronic bronchitis? 15. The nurse practitioner would be correct to include all of the following points in the education of patients with folic acid deficiency anemia EXCEPT: 17. On examination, a 67-year-old patient is noted to have high-tone hearing loss. This finding is consistent with what diagnosis. 18. Which of the following is appropriate to teach a patient who is using a daily nitrate agent for treatment of chronic angina? a. continuous 24-hour coverage is necessary for maximum protection b. A daily 12-hour nitrate free period is important to prevent tolerance 19. An 83-year-old has heart failure (HF). He takes Prinivil (Lisinopril), metoprolol (Lopressor), ASA, and low dose furosemide every morning. After assessing the patient today, the NP determines that he is having a mild exacerbation of HF. The LEAST likely cause of this is: 22. Upon ophthalmic examination of a 78-year-old patient, the nurse practitioner observes dark spots against a red retina. What diagnosis is this finding most consistent with? 24. Which immunization(s) is (are) contraindicated in an immunodeficient individual? 1. Varicella 2. IPV 3. MMR 4. HBV 25. Which of the following may predispose the patient to hyperglycemia? 26. An 18-year-old college student lives in the dormitory. He has been treated for scabies infestation with permethrin (Nix). He was asymptomatic for two weeks, but now complain again of itching and skin bumps. How should the nurse practitioner proceed? 27. Pre-diabetes is: 29. The nurse practitioner suspects a TMJ disorder. As the patient slowly opens and closes the lower jaw, the nurse practitioner palpates the temporomandibular joint (TMJ) bilaterally: a. anterior to the mastoid process b. anterior to the tragus 30. A patient newly diagnosed with Type 2 diabetes referred to a diabetes nurse educator and complete the initial educational program. The need for further education is indicated when the patient says which of the following? 31. A 44-year-old patient complains of stiffness and soreness in his hands, hips, and knees. There is noticeable PIP and DIP joint enlargement in his hands. The nurse practitioner suspects arthritis. All of the following questions are helpful in differentiation between rheumatoid arthritis (RA) and osteoarthritis(OA) EXCEPT: 32. Changes in pulmonary air flow associated with asthma exacerbations and remissions is best assessed by monitoring: 33. The most effective intervention to prevent stroke is (are): 35. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: 36. What is the most common chronic condition in the elder population in the United States? 38. It is imperative that the nurse practitioner teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following, would be of LEAST concern to the nurse practitioner? 41. A patient reports to the nurse practitioner that he was diagnosed with hepatitis B one year ago and has not seen a health care provider since then. What information should this patient be given? 42. An active 82-year-old male in good health complains “I don’t see as well as I used to and my eyes are very sensitive to glare.” His near-distant visual acuity is diminished, and he has a bilateral white pupillary reflex. The most likely diagnosis is: 43. A female patient asks “How do I calculate my ideal body weight?” The nurse practitioner appropriately answers: 44. What assessment findings are NOT typical of the patient with psoriasis? 45. A patient presents to the nurse practitioner with complaints of diarrhea and malaise which started at 2:00 am the morning of the visit. After history and examination, the nurse practitioner advises the patient that the problem should be self-limiting. If the diarrhea does not resolve, when should the nurse practitioner advise the patient to return? 46. The nurse practitioner diagnoses epididymitis in a 24-year-old sexually active male patient. The drug of choice for treatment of this patient is: 47. A 75-year-old patient is well controlled on timolol maleate (Timoptic) for chronic open-angle glaucoma. Prescribing propranolol (Inderal) for this patient may precipitate: 48. What intervention does the American College of Rheumatology recommend as first-line therapy for osteoarthritis? 50. Electrocardiogram markers of hypokalemia include all of the following EXCEPT: 52. Which of the following drugs classes would be most effective in decreasing elevated triglyceride levels (650 md/dL)? 53. The most effective treatment for anemia of chronic disease is: 54. A 17-year-old presents with a wound receive while building a fence. He has completed a primary vaccination series and he had a Td booster 3 years ago. Does he need a Td booster today? 56. Phalen’s test, 90 degress wrist flexion for 60 seconds, reproduces symptoms of: 58. Health People 2020 published by the U.S. Department of Health and Human Service: 61. A 16-year-old received stitches in his arm after an accident. He tells the nurse practitioner that his last tetanus shot was “on time.” Should he receive another one? 63. Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis? 65. A 72-year-old patient reports a 6-month history of progressively more swollen and painful distal interphalangeal (DIP) joints of one hand. There are no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? 66. Persons with thalassemia should avoid: 67. Of the following characteristics, which are most closely associated with risk for becoming an abusive parent? 68. The nurse practitioner must increase a patient’s dosage of theophylline to achieve a therapeutic level. After the dosage has been increased, a serum theophylline level should be checked: 70. Education of women with fibrocystic breast disease should include which of the following statements? 71. An adult patient has an S4 heart sound and the PMI is located at the 5th left ICS, left of the MCL. What are these findings associated with? 72. Which of the following is an appropriate drug for initial treatment of gastroesophageal reflux disease (GERD) in adults? 73. The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is: 75. What diabetic complications result from hyperglycemia? 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis 76. A 66-year-old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior? 77. The preferred therapeutic regimen for an 18-year-old pregnant patient diagnosed with Chlamydia trachomatis infection is: 78. An 80-year-old Caucasian female has heart failure (HF). Which symptom below is an early indication of failure? 79. What is the most common cause of Cushing’s syndrome? 81. A 45-year-old male is diagnosed with hypertension. The blood pressures have been gradually increasing over time, with a reading today of 152/98. Diagnostic studies are normal. The most likely diagnosis for this patient is: 82. A patient with hepatic cirrhosis presents with pedal edema. He reports that his iwfe prepares the same lunch for him every day: a ham and cheese sandwich on white bread with mustard, a bowl of fresh vegetable soup, a fresh orange, banana or grapes, and sweetened iced tea. He denies adding salt to his food. The food that is most likely causing his edema is the: 83. A depressed patient has been treated and has had relief of symptoms while on medication for depression. Which patient statements is a correct understanding of depression? 84. 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 the LEAST appropriate to prescribe? 85. An 87-year-old patient was placed on low dose amlodipine (Norvasc) for treatment of hypertensionadn angina. She takes no other medications. What side effects might be expected from amlodipine? 86. Patients diagnosed with polycystic ovarian disease are at increased risk of developing: 87. A patient present 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? 88. What disease process are Bouchard’s nodes most commonly associated with? 89. An adult female presents with a hordeolum. A topical antibiotic is prescribed. Which of the following instructions is NOT appropriate advice for the nurse practitioner to give the patient? a. Apply warm, moist compresses several times per day b. Do not use soap near the affected eyelid c. Do not wear eye makeup and discard all use eye makeup d. Do not rub your eyes 90. A 43-year-old patient complains of dull ache around both ankles after a day’s work as a cashier. Her symptoms are relieved by sitting and elevating her legs. She reports ankle edema at the end of the day. What is the most likely cause of these problems? 91. A patient reports, “something flew in my eye” about an hour ago while he was splitting logs. If there was a foreign body in his eye, the nurse practitioner would expect to find all EXCEPT: 92. Which of the following is NOT a symptom of irritable bowel syndrome? 93. A 76-year-old female patient with chronic atrial fibrillation is taking warfarin (Coumadin) and being managed on an outpatient basis. What is the preferred laboratory test to evaluate this patient’s coagulation status? 95. Which drug(s) below would be expected to produce the least amount of hypokalemia? 97. Which choice below is NOT a symptom of COPD? 98. A 21-year-old patient presents with abdominal guarding, rigid abdominal musculature, rebound tenderness at McBurney’s point, and leukocytosis. What is the most likely diagnosis? 99. What is the marker for asthma in the WBC differential? 100. The most appropriate first-line drug treatment for African American patients diagnosed with hypertension is: 102. A 25-year-old female complains that she never had a bladder infection before she became sexually active, but now she has had 3 in the past year. What intervention is especially important for the nurse practitioner to teach this patient to help prevent recurrence of bladder infections? 103. An obese patient presents with intertrigo under her breasts. The nurse practitioner prescribes an anti-fungal cream and encourages her to: 104. The long-term prognosis for a patient with a diagnosis of dementia is: 106. A mother has been breastfeeding her infant since giving birth 6 weeks ago. Her right breast is engorged, erythematous, hot to touch, and very painful. She says the problem began 48 hours earlier. She has been feeding exclusively with the left breast. The nurse practitioner diagnosis acute mastitis and recommends all of the following EXCEPT: 107. Which murmur is associated with radiation to the neck? 108. A 50-year-old nonsmoker with no comorbidities presents to the clinic and is diagnosed with community-acquired pneumonia. His vitals are normal except for temperature 101.6 F. A sputum specimen is collected and sent for culture and sensitivity. What action does the nurse practitioner take today? 111. correct answer is fenofibrate 112. A 24-year-old female insists on having a screening mammogram. Upon further questioning, the nurse practitioner discovers the patient is concerned about breast cancer because her mother has fibrocystic breast disease. The nurse practitioner would be accurate if she tells patient that a major risk factor for development of breast cancer in women is: 113. A 44-year-old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dL (6.5 mmol/L), LDL=190 mg/dL (4.94 mmol/L), HDL = 25 mg/dL (6.5 mmol/L), and triglycerides = 344 mg/dL (8.94 mmol/L). What agent would have the greatest effect on improving her lipid profile and reducing morbidity and mortality associated with dyslipidemia? 114. In which of the following presentation is further diagnostic testing NOT warranted? 115. A 65-year-old presents with a past medical history of coronary artery disease, temperature 101 degrees F, tachypnea 24 breaths per minute, and consolidation in the left lower lobe. A chest x-ray confirms left lower lobe pneumonia. What antimicrobial agent(s) should the nurse practitioner prescribe? 117. A 17-year-old female is diagnosed with secondary amenorrhea. Findings in her history which may account for the cessation of menses include all of the following EXCEPT she: 119. Atenolol (Tenormin) should be avoided in: 120. The correct treatment for ankle sprain during the first 48 hours after injury include: 122. Medical interventions that have proven most successful in the initial treatment of bulimia nervosa are: 123. Prescriptive authority for APRNs is: a. legislated and regulated at the state level b. uniform for all states c. governed by the state medical board d. regulated by federal and state laws 124. What diagnosis is associated with an elevated serum amylase? 126. A very active 35-year-old male has painful hemorrhoids, but he does not want hemorrhoid surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select foods that are: 127. An 18-year-old patient is diagnosed with classic migraine headache. Her headaches are frequent and debilitating. She is offered an abortive therapy, but say she would rather take a medication for prophylaxis. The nurse practitioner would recommend: 128. Which of the following set of symptoms should raise suspicion of a brain tumor? 129. A patient with a history of alcohol abuse presents with acute nausea vomiting, and severe retrosternal pain which radiates to the ____. Based on the most probable diagnosis, the nurse practitioner would appropriately order a CBC, chemistry profle, and: 130. A 65-year-old male patient presents with a history of alcoholism, hemoglobin of 10 g/dL, and mean corpuscular volume (MCV) 110. These laboratory values are most consistent with which of the following: 131. During a routine pre-employment screen, a patient is noted to have a positive hepatitis B surface antigen. This finding indicates he: 133. The nurse practitioner correctly teaches the patient with diabetes mellitus that if blood glucose is less than 100 mg/dL and she want to exercise, the patient should first consume 15 grams of carbohydrates, such as: 135. A 35-year old high school student presents with a mild sore throat, and low-grade fever that has persisted for about 1 week. She has general malaise, fatigue and loss of appetite. The nurse practitioner suspects mononucleosis. Which of the following is the LEAST appropriate intervention? 139. Which class of drugs increases a patient’s risk for developing rhabdomyolysis? 142. The nurse practitioner assess an asymptomatic 43-year-old male and determines that he is at minimal risk for a myocardial infarction (MI). The patient asks whether he would benefit from taking aspirin 325 mg every day to prevent an MI. What should the nurse practitioner recommend? 143. Which oral hypoglycemic agent would be safest for an elderly patient if hypoglycemia is a major concern? 144. A 42-year-old male executive has been diagnosed with depression. He is otherwise healthy. An appropriate initial treatment choice is a: 145. A patient requests information about foods to include in his diet while vacationing in Mexico to avoid “Montezuma’s revenge.” The nurse practitioner should advise him to ingest only: 146. A 36-year-old penicillin allergic patient has folliculitis on a bearded part of his face. The nurse practitioner prescribes erythromycin and tells the patient: 149. A PPD is considered positive at 5 millimeters for which population? 150. According to Erikson, the developmental task of the elderly adult is: [Show More]

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