NR511 Final Exam Latest 2022

Final Exam

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Question :           The most cost-effective screening test for determining HIV status is which of the following?

                Western blot

Enzyme-linked immunosorbent assay Venereal Disease Research Laboratory test Viral load

Question 2          Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?

                Erythrocyte sedimentation rate

White blood cell count Polymorphonuclear cells

C-reactive protein (CRP)

 Question 3         Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?

                GABA Acetylcholine Dopamine Serotonin

Question 4          Mrs. Thomas was seen in the o?ce complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:

                                Ecchymosis, edema, and erythema over the lateral epicondyle

   Pain at the elbow with resisted movements at the wrist

and forearm

Inability to supinate and pronate the arm

Inability to flex or extend the elbow against resistance

Question 5          Which of the following statements concerning the musculoskeletal examination is true?

                                  The uninvolved side should be examined initially and then compared to the involved side.

   The part of the body that is causing the patient pain should be examined first.

When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain.

Radiographs should always be obtained prior to

examination so as not to cause further injury to the patient.

Question 6          Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

                Decreased C-reactive protein

Hyperalbuminemia Morning stiffness Weight gain

               

Question 7          Which causes the greatest percentage of mammalian bites?

  Dogs 

Cats

   Humans 

Rodents

Question 8          A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?

                Transvaginal ultrasound

Endometrial biopsy MRI

Abdominal computed tomography scan               

Question 9          A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?

                “Control of glucose will help postpone or delay

complications.”

“Regularly checking blood sugar will help establish a routine.”

“Monitoring glucose will promote a sense of control.”

All of the above                 

Question 10        A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?

                Serum calcium TSH

Electrolytes

Urine specific gravity       

Question 11        Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?

                Insulin Metformin Glucotrol Precose

               

Question 12        During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

                An enlarged rubbery gland

A hard irregular gland A tender gland

A boggy gland     

Question 13        Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step?

                Remove the insect with tweezers.

Immobilize the insect with 2% lidocaine. Sedate Eddie with diazepam.

Shine a light in the ear for the insect to “find its way out.”            

Question 14        What is the most common cause of microcytic anemia?

                Anemia of chronic disease

Sideroblastic anemia Iron-deficiency anemia Thalassemia

Question 15        An 82-year-old man is seen in the primary care o?ce with complaints of dribbling urine and di?culty starting his stream. Which of the following should be included in the list of differential diagnoses?

                Benign prostatic hyperplasia (BPH)

Parkinson’s disease Prostate cancer

All of the above                 

Question 16        Early rheumatoid disease is characterized by:

                                Pain and swelling in both small and large peripheral joints

Rigid joints with diminished range of motion

Joint swelling and immobility on rising A cardiac rub or pulmonary friction rub

Question 17        A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?

                                  Make an immediate referral for an orthopedic evaluation without further assessment.

   Tell her that it takes time for these bruises to improve, so she should be patient.

Obtain a wrist x-ray and place her wrist in a splint or

 prescribe a splint.

   Send her to the emergency room for reduction of this obvious wrist fracture.

                Question 18        The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:

                1 month 3 months

6 months

12 months   

Question 19     A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

                The scrotum will be dark.

The scrotum will appear light pink or yellow. The scrotum will appear milky white.

The internal structures will be clearly visible.

                Question 20        According to Kübler-Ross, the stages of grief occur in which order?

                Anger, denial, depression, bargaining, acceptance

Anger, denial, bargaining, acceptance, depression Denial, anger, depression, bargaining, acceptance Denial, anger, bargaining, depression, acceptance

Question 21        Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?

                  A favorable prognostic trend

Disease progression

The need to be more aggressive with Reuben’s medications

   The eradication of the HIV

Question 22        The exanthem of Lyme disease is:                           Erythema infectiosum

Laterothoracic exanthem Erythema migrans Morbilli exanthem

Question 23        You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:

                Articular Inflammatory Nonarticular A and B

Question 24        What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?

                1,200 mg/day 1,000 mg/day

1,300 mg/day

1,500 mg/day      

Question 25        When assessing a woman for infertility, which of the following tests should be done first?

                Analysis of partner’s sperm

Magnetic resonance imaging (MRI) Hysterosalpingogram

    Estrogen level              

Question 26        Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

                  Superficial burns

   Superficial partial-thickness burns   Deep partial-thickness burns

   Full-thickness burns      

Question 27        A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?

                Human papillomavirus (HPV)

Endometrial hyperplasia Vagismus

Polycystic ovarian syndrome      

Question 28        As a rule of thumb, the estimated level of hematocrit is how any times the value of the hemoglobin?

                Two Three Four Five

Question 29        Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

                Morning stiffness and limited mobility of the lumbar spine

Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain

   Fever, chills, and elevated erythrocyte sedimentation rate

   Pathologic fractures, severe night pain, weight loss, and fatigue

Question 30        A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?

                Testosterone level Prostate-specific antigen

Nocturnal penile tumescence and rigidity Prolactin level

Question 31        The clinician prescribes glipizide (Glucotrol) for a diabeticpatient. Which statement made by the patient would indicate that your teaching has been effective?

                “I’ll take my pill at least 30 minutes before breakfast.”

“I’ll take my Glucotrol before bedtime.”

“It is important to take my medication right after I eat.” “Since I only like to eat two meals a day, I can take the pill

between my meals.”     

Question 32        In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

                Osteoarthritis

Systemic lupus erythematosus (SLE) Rheumatoid arthritis

Sjögren’s syndrome         

 Question 33       The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?

                  Acetylcholine

   Gamma-aminobutyric acid (GABA)   Dopamine

   Serotonin          

Question 34     A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?

          Refer to a urologist immediately.

   Obtain a computed tomography (CT) scan.   Instruct the patient to elevate the scrotum.   Prescribe ibuprofen.

Question 35        Which of the following medications can cause hyperglycemia?

                Prednisone Metformin Synthroid Cephalexin

Question 36        During treatment for anaphylaxis, what site is used for the initial injection of epinephrine?

                IV

Abdomen

Upper lateral thigh Deltoid

Question 37    It is important to educate patients with depression and their

family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?

                Before the initiation of treatment

1 to 2 weeks after the initiation of treatment When switching to a different medication

1 to 2 weeks after tapering off medications

Question 38        What is the most common cause of secondary amenorrhea?

                Pregnancy

Pituitary dysfunction Inadequate estrogen levels Genetic disorders

Question 39        Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration?

                                  Sertraline  Fluoxetine  Citoprolam  Imipramine

Question 40        The goals of the 15-minute hour approach include:                          Enhance self-esteem, expand behavioral repertoire,

prevent dire consequences, and reestablish premorbid levels of functioning

   Emerge with a higher level of functioning and commitment to long-term psychotherapy

   Accept need for antidepressant therapy and psychiatric referral; share concerns with primary care clinician

Improve family functioning and sexual performance as well as accept need for antidepressant medication

Question 41        John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

                Valgus stress test

McMurray circumduction test Lachman test

Varus stress test               

Question 42        The cardinal subjective symptom of sickle cell crisis is which of the following?

                Pain Nausea

Light-headedness Palpitations

Question 43        A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?

                Pelvic inflammatory disease

Endometriosis

Sexually transmitted infections Ovarian cyst

Question 44        Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?

                Tick

Brown recluse spider Wasp

Stinging caterpillar            

Question 45        Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

                  Gastrocnemius weakness

   A reduced or absent ankle reflex   Numbness in the lateral foot

   Paresthesia of the perineum and buttocks       

Question 46        A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?

                  Pregnancy test

   Complete blood cell count   Thyroid-stimulating hormone   Urine dip for protein

Question 47        A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?

                Ketoacidosis Cirrhosis

Hypoglycemic episodes All of the above

Question 48        The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?

                SSRIs are more effective than TCAs.

SSRIs take less time to work than TCAs.

SSRIs have a more favorable side-effect profile than TCAs.

SSRIs are not lethal in overdose.

 Question 49       Which type of bone marrow transplant is obtained from an identical twin?

                Autogenic Autologous Allogeneic Syngeneic

Question 50        Pink, cherry red tissues and skin may result from which type of poisoning?

                Arsenic Lead

Carbon monoxide Strychnine

Question 51        Basic human needs are identified as:                     

Autonomy and feeling valued by others

Exhilaration and productivity Spirituality

Career success and material rewards     

Question 52        The clinician sees a patient who is 5 feet tall and weighs 150

pounds. How would the clinician classify this patient?

                Overweight Mild obesity

Moderate obesity Morbid obesity

Question 53        A 22-year-old male is seen in the clinic because he found a

hard lump in his testicle when performing testicular self-

 examination (TSE). Which of the following should be included in the list of differential diagnoses?

                Testicular cancer Inguinal hernia Varicocele

All of the above                 

Question 54        What is the treatment of choice for a patient diagnosed with testicular cancer?

                Radical orchidectomy

Lumpectomy Radiation implants All of the above

Question 55        Which method is used to remove heavy metals, such as lead, that are ingested as poisons?

                Chelation Dialysis Gastric lavage

Bowel irrigation                 

Question 56        A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

                “It is probably just a cyst because that is the most

common breast mass.”

“We will order a mammogram and ultrasound to help establish a diagnosis.”

“We will go ahead and schedule you for a biopsy because

that is the only way to know for sure.”

   “Because your lump is painful, it is most likely not cancer.”

               

Question 57        A 36-year-old woman is seen with complaints of vaginal

itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?

                  Fluconazole

   Estrogen vaginal cream   Metronidazole

   Doxycycline      

Question 58        The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?

                                “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.”

   “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.”

“You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.”

“It is important to take NSAIDs on an empty stomach in

order to increase absorption.”  

Question 59        A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury?

                                  A sprain   A strain

   A partial fracture   A fracture

Question 60        Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status

 

changes, absent sweat, and tachypnea?

                                  Heat cramps   Heat syncope

   Heat exhaustion   Heat stroke

Question 61        Which of the following may be used to evaluate a person’s suicide risk?

                CAGE SANE

SAD PERSONAS DIGFAST

Question 62        One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?

                  Bone

   Synovium  Tendons  Fascia

Question 63        After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering?

                A viral syndrome Lyme disease

Rocky Mountain spotted fever Relapsing fever

Question 64        A patient is diagnosed with hypothyroidism. Which of the  following electrocardiogram changes should the clinician expect as a manifestation of the disease?

                Sinus bradycardia Atrial fibrillation

Supraventricular tachycardia U waves

Question 65        Which of the following tests is essential for a 46-year-old

woman who the clinician suspects is perimenopausal?

                Pregnancy Estrogen level Progesterone level LH level

Question 66        After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?

                Elevated TSH Normal TSH Low TSH

Undetectable TSH            

Question 67        A patient is 66 inches in height, weighing 200 pounds, and

newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?

                No treatment at this time

Diet and exercise f

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