NURS 6531 Midterms Questions and Answers Available

NURS 6531 Midterms Questions and Answers Available Question 1 0out of 1points Apatient hasexperienced nausea and vomiting, headache, malaise, lowgrade fever, abdominal cramps, andwaterydiarrhea for 72 hours. Hiswhitecount iselevated witha shiftto the left. Heisrequesting medication fordiarrhea. What is the most appropriate response? **The main focus oftreatment istopreventdehydration bydrinkingplenty offluids. In severecases, hospitalization andintravenous fluids are necessary. Over-the-counter oral rehydration solutions (OHS), suchas Pedialyte, canbehelpfulin mildcases Question 2 1out of 1points Which type oflungcancer has the poorestprognosis? Smallcellcarcinoma Question 3 1out of 1points Stacy, age 27, states thatshe haspainless, white, slightlyraised patches inhermouth. Theyare probablycaused by: Candidiasis Question 4 1out of 1points An 80-year-old male admits todifficultyswallowingduringthe reviewofsystems. The nurse practitioner recognizes the differentialdiagnosis forthis patient’s dysphagiais: GERD& Cancer Question 5 1out of 1points A40 yearold presents withahordeolum. The nurse practitioner teaches thepatient to: applya topical antibioticand warmcompresses. Question 6 1out of 1points Marvin hassuddeneyeredness that occurred after astrenuouscoughingepisode. You diagnoseasubconjunctival hemorrhage. Yournext stepis to: Do nothing otherthan providereassurance Isoniazidppd Question 7 1out of 1points Which ofthe following is not agoaloftreatment for the patient withcysticfibrosis? Replace water-soluble vitamins Question 8 0out of 1points The most common cancerfound on the auricle is: **basal cellcarcinoma** Question 9 1out of 1points Which ofthe following colorchanges inapigmented lesion suggests malignant transformation? **ALL COLORS Question 10 1out of 1points Antibiotic administration hasbeendemonstratedtobe oflittle benefittothe treatment ofwhichofthe following diseaseprocesses? Acute bronchitis Question 11 1out of 1points The Centorcriteria fordiagnosis of Group AB-hemolytic streptococcus includeswhich ofthe following? Aand Bonly Question 12 1out of 1points When teaching apatient withhypertension about restrictingsodium, youwould includewhichofthe following instructions? Seventy-five ofsodium intake isderivedfromprocessedfoods Question 13 1out of 1points Markhas just beengivenadiagnosis ofcongestive heartfailure. Which of his medications should bediscontinued? Nifedipine (Procardia XL) forlong-term management ofhis chronicstable angina. Question 14 1out of 1points Which ofthe following patient characteristics are associated withchronicbronchitis? overweight, cyanosis & normal orslighted increasedresp. rate "blue bloaters" Question 15 1out of 1points Treatment ofacute vertigoincludes: -bedrest and an antihistamine Question 16 1out of 1points A35 yearold man presents withradicularpain followed bythe appearance ofgrouped vesiclesconsistingof about 15 lesions across 3different thoracic dermatomes. He complains ofpain, burning, anditching. The nurse practitioner should suspect: herpeszosterandconsider that this patient maybe immunocompromised. Question 17 0out of 1points A20 yearold isdiagnosed withmild persistent asthma. What drugcombination would be most effectiveinkeepinghimsymptom-free? **Abronchodilator PRNandaninhaledcorticosteroid Question 18 0out of 1points Diagnosisof Crohn’s diseaseis made consideringsigns, symptoms and: **Intestinal obstructiondemonstrated byplain x-rayof the abdomen Question 19 0out of 1points Which ofthe following isapredisposingconditionforfurunculosis? **Diabetes mellitus Question 20 1out of 1points Expectedspirometryreadings when the patient haschronicemphysemainclude: increased total lungcapacity (TLC). Question 21 1out of 1points Achildcomplains that his“throat hurts” withswallowing. Hisvoiceisvery“throaty” and he ishyperextending his neckto talk. Examination reveals asymmetrical swellingofhis tonsils. His uvulais deviated to the left. What is themost likelydiagnosis? Peritonsillarabscess- myanswer Question 22 0out of 1points Of the followingsigns andsymptoms ofcongestive heartfailure(CHF), the earliest clinical manifestation is: **weight gain. Question 23 1out of 1points Salmeterol (Servent) isprescribedforapatient with asthma. What is the most important teaching point about this medication? -It is not effectiveduring anacute asthma attack Question 24 1out of 1points An active 65-year-old man under yourcarehasknown acquired valvular aortic stenosis and mitralregurgitation. He also hasahistoryofinfectious endocarditis. Hehasrecently been told he needs electivereplacement ofhis aortic valve. When he comesintothe officeyoudiscover that hehas 10remaining teethinpoorrepair. Yourrecommendation would be to: suggest that he consultwithhisoral surgeon about removingall the teethatonceand receivingappropriate antibiotic prophylaxis Question 25 1out of 1points Amiddle-aged male presents to urgent carecomplaining offever, dysphagia, and shortness ofbreath. The nurse practitioner notesthe patient leaning forward ina tripod position and drooling. The clinicalpresentationofthis patient suggests: Epiglottitis Question 26 0out of 1points Alan, age 54, notices abulge inhis midline everytime he risesfrombedin the morning. Youtell himitisaventral hernia, also known as: **epigastrichernia Question 27 0out of 1points Thedifferentialdiagnosis forapatient complaining ofa sore throat includeswhichof the following? Thrush Question 28 1out of 1points Sheila, age 78, presentswitha chiefcomplaint of wakingup duringthe night coughing. Youexamine herandfindan S3heartsound, pulmonary crackles that do not clearwith coughing, andperipheraledema. What doyoususpect? heartfailure Question 29 1out of 1points The American Cancer Societyrecommendsaflexible sigmoidoscopyforcolorectal cancerscreening inpersons at average riskevery: flexible sigmoidoscopy(FS) every5years, Question 30 1out of 1points Jennifer, age 49, whohasahistoryof hyperlipidemia, hassymptoms that lead youto suspect unstable angina. Yournext action would be to: Hospitalize the client in a monitored setting withpharmacological control ofischemia, arrhythmias, and thrombosis as appropriate. Question 31 1out of 1points A2year old presents withawhitepupillary reflex. What is the most likelycause ofthis finding? -Retinoblastoma Question 32 1out of 1points Apatient presents to urgent carecomplaining ofdyspnea, fatigue, and lower extremity edema. Theechocardiogram revealsandejectionfraction of38%. The nurse practitioner knows that these findings are consistent with: Systolic HF Question 33 1out of 1points John, age 33, hasa total cholesterollevel of 188mg/dL. Howoften should he bescreened forhypercholesterolemia? OFTEN Question 34 0out of 1points A55 yearold man isdiagnosed withbasal cellcarcinoma. The nurse practitioner correctlytells him: **Basal cellcarcinoma(BCC) is the most common type ofskin cancer. It’s also the most commonlydiagnosed cancerin the United States. Everyyear, millions ofpeople learn that they have BCC. Thisskincancerusually develops on skin that getssunexposure, suchason the head, neck, orbackofthe hands. BCCis especiallycommon on the face, often forming on the nose. While BCCoften develops on skin that hashad the most sun, BCCcan appear on any part ofthe body, includingthe trunk, legs, and arms. Peoplewhouse tanningbeds also get BCC, and they also tendtogetitearlier in life. This type ofskin cancergrowsslowly. It rarelyspreads toother parts ofthe body. Treatment isimportantbecause BCCcan growwide and deep, destroyingskin, tissue, andbone. Question 35 0out of 1points Yourpatient Jerryhasgout. What doyousuggest? **treating the acute attackofinflammation whenone ormore joints are veryinflamed andpainful ongoingtreatment toreduce the level ofurate inyourblood andtogetrid of urate crystals. The twomost commonly used drugtreatments foracute attacks ofgout are non- steroidal anti-inflammatory drugs (NSAIDs) andcolchicine.Acute attacks of gout are often treated withoral non-steroidal anti-inflammatorydrugs (NSAIDs), whichcan easepain and possibly reduce some ofthe inflammation. Examples include ibuprofen, naproxen andetoricoxib. Question 36 1out of 1points Yourwell-nourished 75-year-old patient hascomeintothe officeforaphysicalexam andstates that sherecently had twonosebleeds. Shedoes not take anyanticoagulants, andyouhaveruled outany coagulopathies. The most likelycause ofthese nosebleedsis: Trauma or inflammation Question 37 1out of 1points A33-year-old female isadmitted withacute pancreatitis. The nurse practitioner knows that the most common cause ofpancreatitis is: Gallstones Question 38 0out of 1points A76-year-old male complains ofweight loss, nausea, vomiting, abdominal cramping andpain. Physicalfindingsincludean abdominalmass andstoolpositiveforoccult blood. The nurse practitioner pain suspectsa tumorin the smallintestine. Thebest diagnostic testforthis patient is: **Imagingtests used todiagnose smallbowelcancerinclude: Computerized tomography(CT) scan. Magnetic resonance imaging(MRI) Positronemission tomography(PET) CBC, Blood chem, endoscopy, biopsy Question 39 1out of 1points Carl, age 78, isbroughtto the officebyhisson, whostates that hisfatherhasbeen unable toseeclearlysince last night. Carlreports that hisvisionis“like lookingthrough aveil.” He also seesfloatersandflashinglights but is not havinganypain. What do yoususpect? Retinal Detachment Question 40 0out of 1points Management ofa patientwithhypertension and an abdominal aortic aneurysm would include: **The goals ofpharmacotherapy are toreduce morbidityandtopreventcomplications. Antihypertensive agents are used toreduce tension on the vesselwall inpatients with abdominal aortic aneurysms (AAAs) whohaveelevatedblood pressure(BP). Esmolol(Brevibloc) Viewfull druginformation An ultrashort-actingbeta1 blocker, esmololisparticularly usefulin patients with elevated arterial pressure, especiallyifsurgery isplanned. It canbediscontinued abruptlyifnecessary. This agent is normallyused inconjunction withnitroprusside. It maybe usefulas a means oftesting beta-blocker safety and tolerance inpatients witha historyofobstructive pulmonarydisease whoare at uncertain riskforbronchospasm frombetablockade. Theelimination half-life ofesmolol is9 minutes. Labetalol (Trandate) Viewfull druginformation Labetalol blocks alpha1-, beta1-, and beta2-adrenergic receptorsites, decreasingblood pressure. Propranolol (Inderal LA, InnoPran XL) Viewfull druginformation Aclass IIantiarrhythmic nonselective beta-adrenergicreceptorblocker, propranolol has membrane-stabilizing activityand decreases the automaticityofcontractions. It is not suitable foremergencytreatment ofhypertension; itshould not be administered IV inhypertensiveemergencies. Metoprolol(Lopressor, Toprol-XL) Viewfull druginformation Metoprololisaselectivebeta 1-adrenergic receptor blocker that decreases the automaticityofcontractions. During IV administration, carefullymonitor blood pressure, heartrate, andelectrocardiograms. When consideringconversionfrom IVto oral (PO) dosageforms, use the ratio of2.5mg POto1mg IV. Nitroprusside(Nitropress) Viewfull druginformation Nitroprussidecausesperipheral vasodilation byactingdirectlyon venousand arteriolarsmoothmuscle, thus reducingperipheral resistance. This agent iscommonly used IVbecause ofits rapid onset and shortduration ofaction. It iseasilytitrated to the desiredeffect. Because nitroprusside islight-sensitive, bothbottle and tubingshould bewrapped in aluminumfoil. Before initiating nitroprusside therapy, administer abetablocker to counteract the physiologicresponse ofreflextachycardia that occurs when nitroprusside is used alone. Thisphysiologicresponsewillincrease the shearforces against the aortic wall, thus increasingdP/dt. The objectiveistokeep the heartrate between 60and 80beats/min. Morphinesulfate(Astramorph, Infumorph, Duramorph) Fentanyl citrate Question 41 1out of 1points Which ofthe following is not asymptomofirritable bowelsyndrome? Symptoms are: Abdominal pain, cramping orbloating that is typicallyrelieved orpartially relievedby passing abowel movement Excessgas Diarrhea orconstipation — sometimes alternating bouts ofdiarrhea andconstipation Weight loss Diarrheaat night Rectal bleeding Irondeficiency anemia Unexplained vomiting Difficultyswallowing Persistentpain that isn'trelievedbypassing gas ora bowel movement Mucus in the stool Question 42 1out of 1points Impetigo andfolliculitis are usuallysuccessfully treated with: Topical antibiotics Question 43 1out of 1points Which ofthe following is not ariskfactorforcoronary arterial insufficiency? Risks are: Olderage: Over age 45years in men andoverage 55yearsinwomen Familyhistoryof earlyheart disease Race: Amongpersons with CAD, the cardiovascular death rate for African Americans is reported tobeparticularly high; in Asians, lowlevels ofhigh-densitylipoprotein cholesterol(HDL-C), which are consideredtobeariskfactorforcoronaryheartdisease, appearto beespeciallyprevalent;South Asians appear tohaveahigherindependent riskforcardiovascular disease aswell. Highblood cholesterollevels(specifically, low-density lipoprotein cholesterol [LDL- C]) Highblood pressure Cigarette smoking: Cessation ofcigarette smokingconstitutes the single most important preventive measure for CAD Diabetes mellitus [1] Obesity Lackofphysical activity Metabolic syndrome Mental stress and depression Question 44 1out of 1points The most appropriate treatment forachildwith mild croupis: a cool mist vaporizer. Question 45 1out of 1points John, age 59, presents withrecurrent, sharplycircumscribed redpapulesand plaques withapowderywhitescale on the extensoraspect ofhis elbowsandknees. What doyou suspect? psoriasis. Question 46 1out of 1points Appropriate therapy forpeptic ulcerdisease (PUD) is: **In general, 6-8weeksoftherapy witha PPIisrequired forcomplete healingofa duodenal ulcer. Active ulcersassociated with NSAID use are treated withan appropriate course of PPItherapy and the cessation of NSAIDs.Eradication of H. pylori is recommendedin all patients with PUD Based on etiology Question 47 1out of 1points An ASTthat is more than twice the level of ALTissuggestiveof: **alcoholic liver disease, Question 48 1out of 1points A45 yearold withdiabeteshashaditchingandburning lesions betweenhertoes for2 months. Scrapings of the lesions confirmthe diagnosis tineapedis. What is the best initialtreatment optionforthis patient? Prescribeananti-fungal powderforapplication betweenhertoes andinhershoesanda topical prescription strength anti-fungalcream forotheraffected areas. Monitorfora secondarybacterial infection. Question 49 0out of 1points An elderlypatient isbeingseenin the clinicforcomplaint of“weakspells” relievedby sitting orlyingdown. Howshould the nurse practitioner proceedwiththephysical examination? Question 50 1out of 1points Sandra hasceliacdisease. Youplace heron whichdiet? Gluten-free Question 51 1out of 1points Larry, age 66, isasmokerwithhyperlipidemia and hypertension. Heis6months post- MI. To preventreinfarction, the most important behaviorchange that he can make is to: Quit smoking Question 52 1out of 1points Group Aβ-hemolytic streptococcal (GABHS) pharyngitis is most common inwhichage group? 6-12 Question 53 0out of 1points Avery active elderlypatient hasadocumenteddiagnosis ofarteriosclerosis obliterans. Common expected lower extremityphysicalexamfindingsinclude: ** Question 54 1out of 1points Which ofthe following isasecondarycause ofhyperlipidemia? Diabetes mellitus **Diet: excessiveintakeofsaturated fat and/orcalories, alcoholconsumption, anorexia Drugs: diuretics, beta-blockers, cyclosporine, estrogen, glucocorticoids, anabolic steroids, retinoids, proteaseinhibitors Disease: chronic liver disease, primarybiliarycirrhosis, chronicrenal failure, nephrotic syndrome, Cushing’s syndrome, systemic lupus erythematosus Dysmetabolism:hypothyroidism, diabetes, obesity, insulinresistance Question 55 0out of 1points Harvey hashad Meniere’sdisease forseveral years. Hehassomehearingloss but now haspersistentvertigo. What treatment might beinstituted torelieve the vertigo? avestibularneurectomy Question 56 1out of 1points An employee picnic menu includesgrilledhamburgers, potato salad, and homemadeice creamsundaes. Within an hourafterthe meal, severalchildrenandparents beginto have nausea, vomitingandstomachcramps. None ofthose affected havefever. What is the most likelyetiologic agent? Staphylococcus aureus Question 57 0out of 1points The nurse practitioner isperforming aphysicalexam on a middle-aged African- American man. Which of the followingareas isacommon siteformelanomas in African- Americans andotherdark-skinned individuals? The most common site of melanoma in African Americans is the feet, with60% of patients havingsubungual orplantar lesions Question 58 0out of 1points A58-year-old man isdiagnosed with Barrett’s esophagus afteran endoscopy. Hehasno known allergies. Which ofthe followingmedications is MOST appropriateto treat this patient’sdisorder? ***Periodic endoscopyto monitor the cellsinyouresophagus. If yourbiopsiesshowno dysplasia, you'llprobablyhaveafollow-up endoscopyinoneyearand then everythree yearsifnochanges occur. Treatment for GERD. Medication and lifestyle changes can easeyoursignsand symptoms. Surgeryto tighten the sphincterthat controls the flowofstomach acid may beanoption. Treating GERDdoesn't treat the underlying Barrett's esophagus and likely won'tdecrease the risk ofesophagealcancer, but canhelpmake iteasiertodetect dysplasia. Endoscopic resection, whichuses anendoscope to removedamaged cells. Radiofrequency ablation, whichuses heattoremove abnormal esophagus tissue. Radiofrequency ablation maybe recommended afterendoscopic resection. Cryotherapy, which uses anendoscopetoapplya cold liquid orgas to abnormal cellsin the esophagus. Thecells are allowed towarm up and then are frozen again. Thecycle of freezingand thawing damages the abnormal cells. Photodynamic therapy, whichdestroys abnormal cellsbymakingthemsensitive to light. Surgeryin whichthe damaged part ofyouresophagus isremoved, and the remaining portion is attached toyourstomach Question 59 1out of 1points Shirley, age 58, hasbeenadiabetic for7years. Herblood pressureis normal. Otherthan herdiabetes medications, whatwould youprescribe today duringherroutine office visit? An ACE inhibitor Question 60 1out of 1points A70 yearold patient presents withaslightlyraised, scaly, erythematous patchon her forehead. She admits tohavingbeena“sunworshiper.” The nurse practitioner suspects actinic keratosis. This lesion isaprecursorto: squamous cellcarcinoma. Question 61 0out of 1points Apatient presents to theoffice withablood pressure 142/80. Thispatientis classified ashaving: HBstage 1 High Blood Pressure (Hypertension) Stage 1 Systolic: From140to 159 Diastolic:From90 to99 High Blood Pressure (Hypertension) Stage 2 Systolic: 160or higher Diastolic:100 orhigher Hypertensive Crisis (Emergencycare needed) Systolic: Higher than 180 Diastolic:Higher than 110 Question 62 1out of 1points Which ofthe following is the most appropriate therapeutic regimenforan adult patient withnoknown allergies diagnosed withgroup AB-hemolytic strep? Penicillin Question 63 1out of 1points Apatient reports “somethingflewinmyeye” about anhourago while he was splitting logs. If there wereaforeignbodyinhiseye, the nurse practitioner would expecttofind allexcept: Apurulent discharge. Question 64 0out of 1points Apatient complains of “an aggravating cough forthepast 6weeks.” Thereisno physiologicalcauseforthecough. Which medication is most likelycausingthe cough? ** Thisclassiscalled the ACE inhibitors. Someexamples of ACE inhibitorsinclude lisinopril, captopril, and ramipril. Thecoughisgenerally adryonebut canbequite annoying. 99erick ** enalapril? Question 65 0out of 1points Which choicebelowis least effectiveforalleviating symptoms ofthe common cold? antibiotics liberal intake offluids adequate rest Aspirin warmclothing Question 66 0out of 1points An 83-year-old female presents to the officecomplaining ofdiarrhea forseveral days. Sheexplains shehaseven hadfecalincontinence one time. Shedescribesloosestools3– 4times aday forseveral weeksanddeniesfever,chills, pain, recent antibiotic use. The historysuggests that the patient has: ** Question 67 0out of 1points Apatient reports to the nurse practitioner that he was diagnosed withhepatitis Bayear agoand has not seenahealthcare providersince then. What information should this patientbe given? About 10% ofaffected persons becomecarriersand are atincreasedriskfor hepatocellularcarcinoma. Question 68 1out of 1points The most common correlate(s) withchronicbronchitis andemphysemais(are): Smoking Question 69 1out of 1points Ifa patient presents withadeep aching, redeye and there isnodischarge, youshould suspect: Iritis Question 70 1out of 1points Treatment of H.pylori includeswhichofthe following? Proton pump inhibitor Antibiotic therapy Bismuth subsalicylate Aand B A, B, and Cmyanswer Question 71 1out of 1points Which ofthe following is the most important diagnosis toruleout in the adult patient withacute bronchitis? pneumonia Question 72 1out of 1points What oral medication might be used to treat chronic cholethiasisinapatient whoisa poorcandidate forsurgery? Certain chemicals, suchas ursodiol orchenodiol, Question 73 1out of 1points Which ofthe following bestdescribeshypertrophiccardiomyopathy? ofheart disease that affects the heart muscle. It causes thickeningofthe heart muscle (especiallythe ventricles, orlower heartchambers), left ventricular stiffness, mitral valve changes andcellular changes. Question 74 1out of 1points Amaurosis fugax isdescribedasa: isapainless temporary loss ofvision inone orboth eyes. Transient andperiodic Question 75 1out of 1points The nurse practitioner observesa tympanic membrane that isopaque, hasdecreased mobility, andiswithoutbulgingorinflammation. The least likelydiagnosis forthis patientis: **? Acommon causeofconductive hearingloss in adults ages 20 - 40isotosclerosis, a gradual hardeningof the tympanic membrane that causes the footplate ofthe stapesto becomefixedin the oval window. Presbycusis, aprogressive, bilaterallysymmetrical perceptive hearingloss arising fromstructural changes in the hearingorgans, usuallyoccurs after age 50. Trauma may result inaconductive hearingloss, but this iscertainly not common. Question 76 0out of 1points Which ofthe following heart murmurs warrants the greatest concern? ** Murmurs that occurduring diastole are NEVERINNOCENTandshould always raise concernandindicatefurther investigation Question 77 0out of 1points Apatient withelevated lipids hasbeenstarted onlovastatin. After3weeks oftherapy, he callstoreportgeneralized muscleaches. The nurse practitioner should suspect: Rhabdomyolysis- Druginteraction Question 78 0out of 1points Harriet, a 79-year-old woman, comestoyourofficeevery3 months forfollowup on her hypertension. Her medications include one baby aspirin daily, Lisinopril5mgdaily, and Calcium1500 mgdaily. At today’s visit. Herblood pressureis170/89. Accordingto JNC VIIIguidelines, whatshould youdo next tocontrol Harriet’s blood pressure?(HTNstage 2) ***First-line and later-line treatments should nowbe limited to4classes of medications: thiazide-type diuretics, calciumchannel blockers (CCBs), ACEinhibitors, and ARBs. • Second- and third-line alternatives includedhigherdoses orcombinations of ACE inhibitors, ARBs, thiazide-type diuretics, and CCBs. Several medicationsare now designated as later-line alternatives, includingthe following: beta-blockers, alphablockers, alpha1/beta-blockers (eg, carvedilo), vasodilating beta-blockers (eg, nebivolol), central alpha2/-adrenergic agonists (eg, clonidine), directvasodilators (eg, hydralazine), loop diruretics(eg, furosemide), aldosterone antagoinsts (eg, spironolactone), and peripherallyactingadrenergic antagonists (eg, reserpine). ACE inhibitorsand ARBs should not be used in thesame patient simultaneously. • CCBsand thiazide-type diureticsshould be usedinstead of ACE inhibitors and ARBsin patients overthe age of 75yearswithimpaired kidney function due to therisk of hyperkalemia, increasedcreatinine, and further renalimpairment. Question 79 0out of 1points Of the following, the patient whoshould bereferredforperiodiccolonoscopyis the patient with: Question 80 0out of 1points Danahasischemic arterial ulcers. What isyourfirstprioritywhencounseling her? Tellhertoreduce riskfactors toimprove tissue perfusion Question 81 1out of 1points Afterthorough history, physicalexamination, and laboratorytests, apatient is diagnosed withirritablebowel syndrome (IBS). Which ofthe followinginitial treatment plans iscurrentlyconsidered most effective? Alow fat, tyramine-free, caffeine-free, highfiberdiet, alongwitha dailydiary, and attentiontopsychosocialfactors. Question 82 1out of 1points Margaret, age 32, comesintothe office withpainful jointsandadistinctiverash ina butterflydistribution on herface. Therash hasredpapules and plaques withafinescale. What doyoususpect? SLE Question 83 1out of 1points What is the Gold standard forthe diagnosis ofasthma? Spirometry Question 84 0out of 1points An 8yearold presents to the healthclinicwithhistoryofacute onsetseveresore throat andrespiratorydistresswithstridorin the last 2 hours. Thechild’s historyispositivefor feverandpharyngitis for 2days. What is the most likelydiagnosis? croup Question 85 0out of 1points The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goalfor lowdensity lipoproteins inhighriskpatients be less than: goalofless than 100 mg/dL withstatin treatments in managed carepatients athighrisk forcoronaryheartdisease Question 86 0out of 1points Which intervention listed belowissafeforlong term use byan adult withconstipation? **bulk-forminglaxatives, also referredtoasfibersupplements, are the gentlest on your bodyandsafestto use longterm. Metamucil and Citrucel fallintothis category Question 87 1out of 1points The nurse practitioner isreviewingapatient’s lab reportwhocompleted the hepatitis B series 3months ago. Which ofthe followinglab resultswould youexpecttoseein this patient? Positivehepatitis Bsurface antibody and negative core antibody- myanswer Question 88 0out of 1points Sarah has allergic rhinitis andiscurrentlybeing botheredbynasal congestion. Which of the following meds orderedforallergic rhinitis would be most appropriate? OTCoral antihistaminessuchas loratadine, cetirizine, fexofenadine, desloratadine, levocetirizine, anddiphenhydramine. These medications are most effectiveat decreasingrhinorrhea, nasal itching, andsneezing. Question 89 0out of 1points Acashiercomplains of dullache andpressuresensationinherlower legs. It isrelieved bylegelevation. Sheoccasionally hasedemainherlower legs at the end ofthe day. What is the most likelycause ofthese problems? superficialvenousinsufficiency(SVI) ordeep venousinsufficiency(DVI), andtoa lesser extentperipheral arterydisease (PAD). Question 90 0out of 1points A46-year-old female withapast medical historyofdiabetes presents withaswollen, erythematous rightauricle andisdiagnosed withmalignant otitisexterna. The nurse practitioner knows that the most likelycausative organism for this patient’s problemis: Pseudomonas aeruginosa, Question 91 0out of 1points A60 yearold male diabeticpatientpresents withredness, tenderness, and edema ofthe left lateral aspect ofhis face. His left eyelidisgrosslyedematous. Hereports historyofa toothache in the past weekwhich“isbetter.” Histemperatureis100°Fandpulse is 102 bpm. The most appropriate initial action is to: ** Question 92 0out of 1points A57-year-old male presents to urgent carecomplaining ofsubsternalchest discomfort forthe past hour. The EKGreveals STelevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistentwithwhichmyocardial infarction territory? acute inferiormyocardial infarction-occurs wheninferiormyocardial tissue supplied bythe rightcoronaryartery, or RCA, isinjured dueto thrombosis ofthat vessel. Question 93 0out of 1points Which ofthe following can resultfromchronicinflammation ofa meibomian gland? Blepharitis Dryeyesyndrom Stasis, loss offunction ofglands Question 94 0out of 1points A15 yearold male presents withabdominal pain that beganin the peri-umbilical area then localized to the right lower quadrant (RLQ). Hecomplains ofanorexia, and low grade fever. Acomplete blood count (CBC) reveals moderate leukocytosis. What is the most likelydiagnosis? Acute appendicitis Question 95 0out of 1points Which ofthe following medicationclassesshould be avoided inpatients with acute or chronicbronchitisbecauseitwillcontribute toventilation-perfusion mismatch in the patient? Question 96 0out of 1points Afalse-positiveresultwith the fecaloccultblood testcanresultfrom: ahighdietary intake of rare cookedbeef -my answer Question 97 0out of 1points Apatient presents withclassic symptoms ofgastroesophageal refluxdisease (GERD). Heisinstructed on life style modifications anddrugtherapy for8 weeks. Three months later he returns, reporting that he was “fine” as longas he tookthe medication. The most appropriate next stepis: ** Question 98 0out of 1points Riskfactors foracute arterial insufficiencyincludewhichofthe following? Question 99 0out of 1points Apatient presents to the primarycareprovidercomplaining ofa rash on hisright forehead that started yesterday andisburning and painful. Thephysicalexamreveals anerythematous, maculopapular rash that extendsoverthe patient’s righteyetohis upper rightforehead. Based on the historyandexamination, the most likely cause ofthis patient’s symptoms is: OPthalmic zoster Question 100 0out of 1points Which ofthe following areclassicfeatures ofulcerative colitis? Signsandsymptoms include bloody diarrhea, abdominal cramps andpain, and an inability to move the bowelsinspite ofthe urge todoso(tenesmus). Left-sidedcolitis. Inflammation extendsfromthe rectumup through the sigmoidanddescending colon. A40 yearold female withhistoryoffrequent sunexposurepresents witha multi- colored lesion on herback. It hasirregularborders andis about 11 mmin diameter. What should the nurse practitioner suspect? A. Squamous cellcarcinoma B. Malignant melanoma C. Common nevus D. Basal cellcarcinoma B Aclientcomesincomplaining of1week ofpain in the posteriorneckwithdifficulty turning the headto the right. What additional historyis needed? A. Recent trauma B. Difficultyswallowing C. Stiffness in the rightshoulder D. Changeinsleepinghabits Recent Trauma What prophylactic medication iscommonlyrecommended forthe patient under 35 years ofage withapositive PPD? Ethambutol Streptomycin Pyrazinamide Isoniazid(INH) An adult presents with tinea corporis. Which itembelowisariskfactorforits development? Topicalsteroid use* Topicalantibiotic use Arecent laceration Coldclimates 67. A55yearold patient hasawork-up forhypertensionand is noted tohaveelevated BUN andcreatinine. Which ofthe followingshould the nurse practitionersuspect? Pheochromocytoma Renal disease Diabetes* Dehydration 68A 16 yearold male presents withmild sore throat, fever, fatigue, posteriorcervical adenopathy, andpalatine petechiae. Without adefinitive diagnosis forthis patient, whatdrug would be least appropriate toprescribe? Ibuprofen* Erythromycin Amoxicillin Acetaminophen 75erick management or hypertension Elizabeth, age 83, presents witha 3-day history of pain and burning in the left forehead. This morning she noticed arash witherythematous papules in that site. Yoususpect: avaricella. Bherpeszoster. C. syphilis. D. rubella. b 80jerry goutsalicylates 84Janine, age 29, has numerous transient lesions that comeandgo, andsheisdiagnosed withurticaria. What doyouorder? Aspirin NSAIDs Opioids Antihistamines 86 Which ofthe following canresultfromchronicinflammation ofa meibomian gland? Achalazion Uveitis Keratitis Apterygium 87A 58 yearold complains oftightness inhischestwhilecuttingfirewood. It disappears quicklyifhe stopschopping. Hedenies shortnessofbreath, his total cholesterol level is less than 200mg/dL, and he isa non-smoker. What is the most appropriate action forthe nurse practitioner to take withthis patient? Treat the complaints as“cardiac” inorigin until provenotherwise.** Consideragastrointestinal workup toruleout GERD. Considerarthritis andorderchestandspinal xrays. Encourage the patient tochopfewerpieces ofwood ata time. Lisa, age 49, hasdaily symptoms ofasthma. She uses herinhaledshort-acting beta-2 agonist daily. Herexacerbations affect heractivities and they occurat least twice weekly and maylast fordays. Sheis affected more than onceweeklyduringthe night withan exacerbation. Which categoryofasthma severityis Lisain? Mildintermittent Mildpersistent Moderatepersistent ** 92 Risk factorsforacute otitis media (AOM) include all ofthe following except: Householdcigarette smok Groupdaycare attendance Sibling historyofacute otitis media African-American ethnicity** 94 Which antibiotic would be the most effectivein treating community acquired pneumonia (CAP) inayoungadult without anycomorbid conditions? Erythromycin Clarithromycin (Biaxin) Doxycycline(Vibramycin) Penicillin**