NURS6531 Midterm Exam Latest 2021

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Course  NURS-6531N-8,Adv.PracticeCareofAdults.2021SummerQtr 05/29-08/19-PT27

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Question1When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Ye s

No

Question2The most common cancer found on the auricle is:

Actinickeratosis

Basal cell carcinoma

Squamous cell carcinoma

Acral-lentiginous melanoma

Question3Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Xanthines

Antihistimine

s Steroids

Anticholinerg ics

Question4A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?

Instructthepatientonmeasurestopreventhemorrhoidssuchas bowel habits anddiet.

Order a topical hemorrhoid cream along with a stool softener.

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy.

Question5Which of the following patient characteristics are associated with chronic bronchitis?

Overweight, cyanosis, and normal or slightly increased respiratory rate

Underweight, pink skin, and increased respiratory rate

 

Overweight, pink skin, and normal or slightlyincreased respiratory rate

Normal weight, cyanosis, and greatlyincreased respiratory rate

•             Question6A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:

CBC/dif

Erythrocyte sedimentation rate

Abdominal ultrasound

CT scan

Question7A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

Purulent drainage

 Tearing Photophobia

A positive fluorescein stain

Question8A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:

Viralconjunctivitis Common pinkeye

Gonococcal conjunctivitis

Allergic conjunctivitis

Question9A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 diferent thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:

A common case of shingles and prescribe an analgesic and anantiviral agent

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

Herpes zoster and consider that this patient may be immunocompromised

A recurrence of chickenpox and treat the patient’s symptoms

Question10Which type of lung cancer has the poorest prognosis?

Adenocarcinoma

Epidermoid carcinoma

Small cell carcinoma

Large cell carcinoma

Question11An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3– 4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:

 

Acutediarrhea

Chronic diarrhea Irritablebowel

Functional bowel disease

Question12Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

An allergicreaction

Relapsing polychondritis

Lymphocytoma cutis

Systemiclupus

erythematosus

Question13Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

Chronicsinusitis

Acute bronchitis Bacterial pneumonia

Acute exacerbation of chronic bronchitis

Question14Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations afect her activities and they occur at least twice weekly and may last for days. She is afected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

Mild intermittent

Mild persistent

Moderate

persistent

Question15Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

Penicillin V 500 milligrams PO every 8 hours for 10 days

Ampicillin 250 milligrams PO twice a day for 10 days

Clarithromycin 500 milligrams po daily for 7 days

None of the above

Question16Acashiercomplainsofdullacheandpressuresensationinherlowerlegs.Itisrelievedby leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of theseproblems?

Congestiveheart failure

Varicose veins

Deep vein thrombosis

Arterial insufficiency

Question17Which statement below is correct about pertussis?

It is also called whooping cough

It begins with symptoms like strep throat It lasts about 3 weeks

It occurs most commonly in toddlers and young children

Question18Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?

Pneumo nia

Asthma

Sinusitis

Pertussis

Question19A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?

Diverticulo sis

Diverticula

Diverticulit is

Diverticulu m

Question20Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?

Varicella

Herpes zoster

Syphilis Rubella

Question21A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:

Alcohol

Gallstone s

Medicatio ns

Pregnanc y

Question22When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

Order abdominalx-rays

Order an abdominal ultrasound

Refer the patient to a surgeon for evaluation

Prescribe pain medication

Question23A false-positive result with the fecal occult blood test can result from:

ingestion of large amountsof vitaminC

a high dietary intake of rare cooked beef

a colonic neoplasm that is not bleeding

stool that has been stored before testing

Question24A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:

Colonoscopy

Small bowel follow- through

Barium enema

CT abdomen

Question25A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

Mitral regurgitation

Systolic heart failure

Cardiac myxoma

Diastolic heart failure

Question26Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?

Multilobar involvement on chest x-ray with the inability to take oral medications

Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home

Sputum and gram positive organisms

A complete blood count showing leukocytosis

Question27A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:

“It is the most common cause of death in patients withskin cancer.”

“It can be cured with surgical excision or radiation therapy.”

“It is a slow growing skin cancer that rarely undergoes malignant changes.”

“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”

Question28Expected spirometry readings when the patient has chronic emphysema include:

Decreased residual volume(RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

Increased total lung capacity (TLC)

Question29An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the diferential diagnosis for this patient’s dysphagia is:

 

Esophageal cancer

Chest pain GERD

A and C

All of the above

Question30A40yearoldfemalewithhistoryoffrequentsunexposurepresentswithamulticolored lesion on her back. It has irregular borders and is about 11mm in diameter. Whatshould the nurse practitionersuspect?

Squamous cell carcinoma

Malignant melanoma

A common nevus

Basal cell carcinoma

Question31Which of the following is not a goal of treatment for the patient with cystic fibrosis?

Preventintestinal obstruction

Provide adequate nutrition

Promote clearance of secretions

Replace water-soluble

vitamins

Question32Thenursepractitionerisperformingaphysicalexamonamiddle-agedAfrican-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinnedindividuals?

Scalp Nails

Feet

B and C

All of the above

Question33An adult presents with tinea corporis. Which item below is a risk factor for its development?

Topical steroid use

Topical antibiotic use

A recent laceration

Cold climates

Question34A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?

Prescribeloperamide(Immodium)oratropine-diphenoxylate(Lomotil) and a clear liquid diet for 24hours.

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

Ofer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction.

 

Order stool cultures.

Question35Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?

Aspirin NSAIDs

Opioids

Antihistami nes

Question36Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:

Peripheral edema

Weight gain

Shortness of breath

Nocturnal dyspnea

Question37A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?

Ibuprofen

Erythromyci n

Amoxicillin

Acetaminop hen

Question38A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to completehis 2 mile walk. What question asked during the history, if answered affirmatively,would suggest a diagnosis of arteriosclerosis obliterans?

“Are you wearing your usualshoes?”

“Do you also have chest pain when you have leg pain?”

“Is your leg pain relieved by rest?”

“Do you ever have the same pain in the other leg?”

Question39Which of the following statements about malignant melanomas is true?

They usually occur in older adultmales

The patient has no family history of melanoma They are common in blacks

The prognosis is directly related to the thickness of the lesion

Question40 Sheila,age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do yoususpect?

Asthma Nocturnal

allergies

Valvular disease

Heart failure

Question41Which antibiotic would be the most efective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

Erythromycin

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin

Question42Which of the following dermatologic vehicles are the most efective in absorbing moisture and decreasing friction?

Powde rs

Gels

Cream s

Lotion

Question43A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:

Squamous cell carcinoma

Basal cell carcinoma

Malignant melanoma

Acne vulgaris

Question44An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?

Assist the patient to a standing position and take her blood pressure.

Assess the patient’s cranial nerves.

 Compare the patient’s blood pressure lying first, then sitting, and then standing.

Compare the amplitude of the patient’s radial and pedal pulses.

Question45What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?

Ursodiol Ibuprofen

Prednisone

Surgery is the only answer

Question46A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

Staphylococcusaureus

Group A beta hemolytic streptococcus

Haemophilus influenza

Pseudomonas aeruginosa

Question47Which of the following is not a symptom of irritable bowel syndrome?

Painful diarrhea Painfulconstipation

Cramping and abdominal pain

Weight loss

Question48A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

Any recent trauma Difficulty swallowing

Stifness in the right shoulder

Change in sleeping habits

Question49Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?

ACEInhibitor

 Beta Blocker

Calcium channel blocker

Diuretic

Question50The diferential diagnosis for a patient complaining of a sore throat includes which of the following?

Gonococcal infection

Thrush Leukoplakia B only

A, B, and C

Question51A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Rhus dermatitis

Ophthalmic zoster

Chemosis

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