NR511 FINAL EXAM STUDY GUIDE (NR511)

Exam (elaborations) NR511 FINAL EXAM STUDY GUIDE (NR511) 1. Signs and symptoms and management of musculoskeletal sprains/strains/dislocations 16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. is an injury th 16-98 Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use continuous heat for the fi rst 12 hours and then use heat or cold to your own preference.” B. “Use continuous cold for the fi rst 12 hours and then use heat or cold to your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45 minutes; repeat this for the fi rst 24 to 48 hours while awake.” D. “Alternate between cold and heat for 20 minutes each for the fi rst 24 to 48 hours.” 16-69 Ankylosis is defi ned as A. muscle shortening. B. joint stiffness. C. malposition of a joint. D. dislocation of a joint. 16-108 Jill, age 49, has recently begun a rigorous weight- lifting regimen. She presents to the primary care offi ce with a shoulder dislocation. Which of the following clinical manifestations lead the nurse practitioner to suspect an anterior shoulder dislocation over a posterior dislocation? A. Inability to shrug the shoulder B. Absence of pain C. Inability to rotate the shoulder externally D. Shortening of the arm 16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the practitioner places the infant supine, fl exes the knees by holding the thumbs on the inner mid- thighs, with fi ngers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver. 16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her many sports activities. The nurse practitioner thinks that the patient was probably never taught about health promotion and maintenance regarding physical activity. What information should be included in patient teaching? A. “After an activity, if any part hurts, apply ice for 20 minutes.” B. “You must fi rst get in shape with a rigorous schedule of weight training, and then you can participate in any activity once you are physically fi t.” C. “After any strenuous activity, you must completely rest your muscles before beginning your next activity.” D. “Stretching and warm- up exercises are an important part of any exercise routine.” 16-27 Upon assessment, the nurse practitioner notes unilateral back pain that had an acute onset and increases when standing and bending. A straight- leg test is negative. The most likely differential diagnosis is A. herniated nucleus pulposus. B. muscle strain. C. osteoarthritis. D. spondylolisthesis. 16-67 June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back and muscles without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. NR511 FINAL EXAM STUDY GUIDE NR511 Final Exam Study Guide What is the most likely differential diagnosis? A. Ankylosing spondylitis B. Musculoskeletal strain C. Spondylolisthesis D. Herniated disk 2. Signs and symptoms and management of spinal disorders (spondylosis, stenosis, etc.) 6-79 Sam, age 73, has lumbar spinal stenosis and asks which exercises he should do to help his condition. You advise him to A. do any exercise that results in hyperextension of the lumbar spine. B. do exercises that encourage lumbar fl exion and fl attening of the lumbar lordotic curve. C. refrain from exercising. D. see a surgeon because surgery is the best treatment option. 7-57 Clients with spinal cord injuries often have bowel incontinence and need to have a bowel program instituted. What is the most effective way to stimulate the rectum to evacuate in the quadriplegic client? A. Administer stool softeners every night. B. Insert a rectal suppository and then eventually perform digital stimulation. C. Administer laxatives every other night. D. Administer enemas on a regular basis. 13-12 Decreased bladder capacity; bladder irritation from a urinary tract infection, tumor, stones, or irritants such as caffeine and alcohol; and central nervous system disorders or spinal cord lesions are all contributing factors to A. stress urinary incontinence. B. urge urinary incontinence. C. overfl ow urinary incontinence. D. refl ex urinary incontinence. 16-50 Beth, age 49, comes in with low back pain. An x- ray of the lumbar/sacral spine is within normal limits. Which of the following diagnoses do you explore further? A. Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus 16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? A. Cancer B. Cauda equina syndrome D spinal fracture 16-14 Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which agerelated change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis 16-90 What disorder affects older individuals, particularly women, and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, weight loss, sweats, and low- grade fever? A. Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica D. Reiter’s syndrome 3. Recognition and immediate management of cauda equina syndrome 16-11 The most common cause of cauda equina syndrome is A. fracture. B. hematoma. C. lumbar intervertebral disk herniation. D. space- occupying lesion. 16-60 Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? A. Order physical therapy B. Order a lumbar/sacral x- ray C. Order extensive lab work D. Refer to a neurosurgeon 16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological compromise D. Spinal fracture NR511 Final Exam Study Guide 4. Maneuvers and expected findings with joint pain (knee, shoulder, wrist, etc.) Chap 16 16-24 To aid in the diagnosis of meniscus damage, which test should a nurse practitioner perform? A. The bulge test B. The Lachman test C. The drawer test D. Apley’s compression test 16-35 You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the A. lateral meniscus. B. cruciate ligament. C. medial meniscus. D. collateral ligament. 16-29 The straight leg–raising maneuver can be used to diagnose A. nerve root compression. B. a fractured hip. C. an anterior cruciate ligament tear. D. tendinitis. 16-96 What is the name of the test used to assess for nerve- root compression? A. The Apley scratch test B. The drop arm test C. Finkelstein’s test D. Spurling’s maneuver 16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the practitioner places the infant supine, fl exes the knees by holding the thumbs on the inner mid- thighs, with fi ngers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver. 5. Initial assessment of FOOSH injury in correlation to anatomical location of radial head bone 16-39 Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You knows this probably indicates a(n) A. ulnar styloid fracture. B. scaphoid fracture. C. hamate fracture. D. radial head fracture. 16-71 Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest with her elbow fl exed. Based on the specifi c location of her pain, you suspect a radial head fracture. The best initial strategy to assess for radial head fracture would be A. to palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle. B. to palpate for tenderness, swelling, and crepitus along the radial wrist. C. to palpate for tenderness in the “anatomical snuffbox.” D. to order an x- ray of the wrist. 6. Assessment and management of Myofascial pain 16-90 What disorder affects older individuals, particularly women, and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, weight loss, sweats, and low- grade fever? A. Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica D. Reiter’s syndrome Myofascial somatic dysfunction is described as impairments of the body framework. The impairments can affect joints, skeletal, and myofascial structures along with their related vascular, lymphatic, and neural function. 7. Health promotion activities to prevent sport related musculoskeletal injuries NR511 Final Exam Study Guide 16-16 Which of the following is NOT a management principal for an acute musculoskeletal injury that does not require emergent treatment? A. RICE B. NSAIDs or acetaminophen C. Imaging studies D. Skeletal muscle relaxants. 16-86 James, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given a diagnosis of Osgood-Schlatter disease and asks you about his treatment options. The nurse practitioner should tell him that the initial treatment is A. relative rest; he could benefi t from hamstring, heel cord, and quadricep stretching exercises. B. immobilization; a long- leg knee immobilizer is recommended. C. surgical intervention; removal of the bony fragments is necessary. D. bedrest for 1 week.. 16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her many sports activities. The nurse practitioner thinks that the patient was probably never taught about health promotion and maintenance regarding physical activity. What information should be included in patient teaching? A. “After an activity, if any part hurts, apply ice for 20 minutes.” B. “You must fi rst get in shape with a rigorous schedule of weight training, and then you can participate in any activity once you are physically fi t.” C. “After any strenuous activity, you must completely rest your muscles before beginning your next activity.” D. “Stretching and warm- up exercises are an important part of any exercise routine.”. 16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. is an injury that does not result in joint instability.. 16-98 Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use continuous heat for the fi rst 12 hours and then use heat or cold to your own preference.” B. “Use continuous cold for the fi rst 12 hours and then use heat or cold to your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45 minutes; repeat this for the fi rst 24 to 48 hours while awake.” D. “Alternate between cold and heat for 20 minutes each for the fi rst 24 to 48 hours.” 8. Osteopenia 6-87 Shelley, 65 years old, sees you for the fi rst time. She has demonstrated osteopenia on a bone density test, and you have prescribed the appropriate medication for her. What additional lifestyle changes should you counsel for this client? A. She should begin a rigorous swimming program to actively build bone. B. She should cut down on coffee, but tea is okay. C. She needs to take a multivitamin every day. D. She should begin weight training.. 12-51 Marisa, age 42, has celiac disease. She is prone to osteopenic bone disease as a result of impaired calcium absorption because of A. increased calcium absorption by the small intestine. B. increased absorption of the fat-soluble vitamin D. C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. D. decreased magnesium absorption.. NR511 Final Exam Study Guide 15-90 Mrs. Thomas, age 69, comes to your offi ce for the results of her DEXA scan. She reports that her mother had osteopenia before she died. The DEXA scan result shows a T score of −2.7 in the hip and −2.8 in the spine. You explain to her that her results show A. normal bone density. B. osteopenia. C. osteoporosis. 16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological compromise D. Spinal fracture. . 16-18 Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis A. develops when loss of bone occurs more rapidly than new bone growth. B. is a degenerative joint disease characterized by loss of cartilage in certain joints.. 16-40 Black men have a relatively low incidence of osteoporosis because they have A. increased bone resorption. B. a higher bone mass. C. wide and thick long bones. D. decreased bone deposition.. 16-45 Joan, age 76, has been given a diagnosis of osteoporosis confi rmed with a dualenergy x- ray absorptiometry (DEXA) scan. The nurse practitioner has educated her about the importance of increasing calcium and vitamin D in her diet and starting a lowimpact, weight- bearing exercise program. The nurse practitioner is also going to start the patient on medial management. Joan asks about a drug called a “SERM” that she has heard has been shown in studies to prevent vertebral fractures. Which of the following pharmacological therapies for osteoporosis is classifi ed as a selective estrogen receptor modulator (SERM)? A. Alendronate (Fosamax) B. Risedronate (Actonel) C. Salmon calcitonin D. Raloxifene (Evista) 16-32 Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? A. “Caffeine has no effect on osteoporosis.” B. “A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly. 16-89 Which of the following is a modifi able risk factor for osteoporosis? A. Low alcohol intake B. Low caffeine intake C. Smoking D. Excessive exercise 16-121 Bone mineral density (BMD) testing is recommended by the National Osteoporosis Foundation for which of the following client populations to assess whether they are at high risk for osteoporosis? A. All women age 65 and older regardless of risk factors B. All men age 65 and older regardless of risk factors C. All women in their 30s for a baseline D. All women of menopausal age. 72 Jill is perimenopausal and asks you about the relationship between exercise and preventing osteoporosis. You tell her that A. exercise has no effect; she should take calcium supplements. B. weight-bearing exercise prevents bone mass loss. C. all types of exercise assist in preventing osteoporosis. D. since she was very athletic during her formative years, her bones will maintain their bone mass. 9. Assessment and management of gout. 8-40 Eric, age 52, has gout. What do you suggest? A. Using salicylates for an acute attack B. Limiting consumption of purine-rich foods C. Testing his uric acid level every 6 months D. Decreasing fl uid intake NR511 Final Exam Study Guide 8-92 Gouty pain in the great toe is A. toe gout. B. hyperuricemia of the toe. Podagra 16-82 The nurse practitioner is considering a diagnosis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout in a 72- year- old man who presents with complaints of pain and stiffness in his wrists and knees. The most useful diagnostic test to assist in confi rming this diagnosis would be CPPD disease (pseudo gout) may appear clinically similar to gouty arthritis; 16-118 Gout is caused by urate crystals being deposited in certain joints leading to acute pain, erythema and edema. Gout typically occurs most often in the joint of the A. foot. B. wrist. C. elbow. D. fi nger. 17-24 Which of the following medications can increase uric acid and lead to an acute gouty attack? A. HCTZ B. Beta blockers C. Calcium channel blocker D. ACE inhibitors Medication management for acute vs. chronic gout A uricosuric such as Probenecid, with the addition of the antiinfl ammatory colchicine, is indicated for chronic gouty arthritis. 17-4 What is the medication of choice for an initial acute attack of gout? A. An NSAID 16-2 Colchicine may be used to terminate an acute attack of gouty arthritis as well as to prevent recurrent episodes. The mechanism of action is to A. interrupt the cycle of urate crystal deposition and infl ammatory response. B. increase serum uric acid levels. C. potentiate the excretion of uric acid. D. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid. 16-7 Bursitis is an infl ammatory process that may be caused by infection, trauma, repetitive movement disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is from which of the following? Staph aureus 10. Dietary restrictions for gout 6-96 You are teaching a client about his gout. Which of the following should you include in your teaching? A. Once gout is treated, there is no danger of permanent damage. B. Diet and alcohol consumption may remain the same. C. Drink at least 1 quart of fl uid per day. D. Kidney stones and kidney damage may result if gout is not adequately managed. 17-85 Joy has gout. In teaching her about her disease, which food do you tell her is allowed on the diet? A. Asparagus B. Beans C. Broccoli D. Mushrooms 11. Signs and symptoms and management of thyroid disorders 5-80 You are seeing Minnie, a 15-year-old girl. You suspect that Minnie is suffering from bulimia, based on your physical exam. When assessing Minnie you observe the following. A. An absence of bowel sounds, epigastric rumbling, and halitosis B. Hyperactive bowel sounds, an enlarged thyroid, and tachycardia C. Erosion on the inside of the teeth, enlarged parotid glands, and a scar on the dorsal surface of a fi nger D. Clear evidence of dehydration, sore gums, and subjective complaints of stomach pain 12. Thyroid screening tests, confirmatory tests and monitoring 17-11 An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? A. Adrenergic fi ndings such as tachycardia B. Weight gain, depression, and heat intolerance C. Atrial fi brillation, depression, and weight loss D. Heat intolerance, hyperrefl exia, and anorexia NR511 Final Exam Study Guide 17-13 Hyperthyroidism is seen in which of the following lab results ? A. Increased TSH and decreased free T4 B. Decreased TSH and decreased free T4 C. Decreased TSH and increased free T4 D. Increased TSH and increased free T4 17-27 Mr. Reynolds is on the antithyroid drug methimazole (Tapazole), so you make it a point to check his A. HbA1c. B. CBC and liver transaminases. C. uric acid level. D. total T4. 17-44 After establishing clinical and biochemical euthyroidism after a thyroidectomy, you should perform a measurement of the serum thyroidstimulating hormone (TSH) level every A. 3 months. B. 6 months. C. 1 year. D. 2 years. 17-46 The major risk factor for development of thyroid cancer is A. inadequate iodine intake. B. presence of a goiter. C. exposure to radiation. D. smoking. 17-69 The thyroid-stimulating hormone (TSH) test measures the A. total serum level of thyroxine. B. serum level of T 3 and T 4 . C. pituitary’s response to peripheral levels of thyroid hormone. D. combined serum levels of T 3 and T 4 . 17-76 Four clients present with an undetectable TSH level and a normal free T4 indicating subclinical hyperthyroidism. Which client should be treated? A. The client over the age of 50 B. The client with bradycardia C. The client with cardiovascular disease D. The client with a thyroid bruit 17-80 You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has A. elevated serum phosphate levels. B. elevated serum calcium levels. C. decreased neuromuscular irritability. D. increased bone resorption, as implied by her bone density test. 17-89 Why is parathyroid hormone secretion increased during pregnancy? A. To meet the increased stress demands on the mother B. To meet the increased requirements for calcium and vitamin D for fetal skeletal growth C. To help prevent neural tube defects in the fetus D. To help promote neurological g 7-92 Which of the following medications should not be used by a client who has a history of medullary thyroid cancer? A. Sitagliptin (Januvia) B. Metformin (Glucophage) C. Liraglutide (Victoza) D. Canaglifl ozin (Invokana) 17-115 Which is the only treatment option that is curative for primary hyperparathyroidism (PHPT)? A. Type II calcimimetic cinacalcet B. Hormone therapy C. Parathyroidectomy D. Bisphosphonates 13. Risk factors for Hashimoto's & Grave’s disease 9-58 Which of the following signs of thyroid dysfunction in a 49-year-old patient is a sign of hyperthyroidism? A. Slow pulse B. Decreased systolic BP C. Exophthalmos D. Dry, coarse, cool skin 17-5 Marsha, age 24, is preparing for radioactive iodine therapy for her Graves’ disease. Which test must she undergo fi rst? A. Beta human chorionic gonadotropin B. Basal metabolism rate C. Lithium level D. Serum calcium 17-17 Which of the following can increase the ocular manifestations of Graves’ disease? A. Pregnancy B. Hypertension C. Smoking D. Hyperlipidemia 17-36 Which of the following statements is true regarding the epidemiology of Graves’ disease? A. It is more common in males. B. The diagnosis is most commonly made during the early teenage years. C. It is the most common autoimmune disease in the United States. D. It is more common in African Americans. NR511 Final Exam Study Guide 17-42 A client presents with clinical manifestations of hyperthyroidism. The differential diagnoses include Graves’ disease and subacute thyroiditis. Which of the following fi ndings is consistent with subacute thyroiditis? A. A 24-hour radioactive iodine uptake (RAIU) demonstrating increased uptake B. A 24-hour radioactive iodine uptake demonstrating decreased uptake C. A 24 hour RAIU demonstrating a “cold” nodule D. A fi ne-needle aspiration is required for diagnosis. 17-73 Which of the following statements is true about the ophthalmopathy in Graves’ disease? A. Propranolol (Inderal) initially helps to control symptoms related to ophthalmopathy. B. Treatment often includes prednisone. C. Radiation or surgical decompression should never be done until the eyes are no longer bulging. D. Radioactive iodine may be effective. 17-102 Sadie, age 40, has just been given a diagnosis of Graves’ disease. She has recently lost 25 lb, has palpitations, is very irritable, feels very warm, and has a noticeable bulge on her neck. The most likely cause of her increased thyroid function is A. hyperplasia of the thyroid. B. an anterior pituitary tumor. C. a thyroid carcinoma. D. an autoimmune response. 17-104 To lower the serum concentration of thyroid hormones and reestablish a euthyroid state in the client with Graves’ disease, which of the following therapies may be used? A. Radiation B. Antithyroid drugs C. Beta adrenergic antagonists D. Parathyroid surgery 17-110 Which blood test should be obtained before initiating antithyroid drugs for Graves’ disease? A. Serum electrolytes B. Lipid profi le C. White blood cell count D. HbA1c 17-107 The most common worldwide cause of hypothyroidism is A. an autoimmune process. B. Hashimoto’s thyroiditis. C. iodine defi ciency. D. iatrogenic hypothyroidism. 14. Risk factors for secondary obesity 17-114 Sandra, age 28, has secondary obesity. Which of the following may have caused this? A. An intake of more calories than are expended B. Polycystic ovary disease C. Her antihypertensive medications D. Her sedentary lifestyle 15. Macrocytic vs microcytic vs normocytic anemia (causes, symptoms, testing) 18-8 Sherri’s blood work returns with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? A. Order a serum iron and total iron binding capacity (TIBC) B. Order a serum ferritin C. Order a serum folate level D. Order a serum iron, TIBC, and serum ferritin level 18-33 Macrocytic normochromic anemias are caused by A. acute blood loss. B. an infection or tumor. C. a nutritional defi ciency of iron. D. a defi ciency of folic acid. 18-40 Mrs. Bartley, age 58, presents with complaints of unsteady gait and numbness and tingling in her fi ngers. Her laboratory values show increased MCV, normal MCHC, and normal hemoglobin. Which of the following laboratory test results would you also expect? A. Decreased B 12 , normal folate, and increased reticulocyte count B. Normal B