NURS-656-Student Questions
65. A mother presents to the clinic with her 10 year old daughter to the clinic for a well-child check. She asks about the signs of
puberty. Which is the initial sign of puberty?
a) Pubarche
b) Adenarche
c) Thelarche
d) Menarche: *c) Thelarche
Rational: The correct answer is thelarche, breast development, is the initiation of puberty. Pubarche comes after thelarche which i
development of axillary and pubic hair. Menarche is the final stage which is the first menstrual period. Adenarche is the increased
secretion of adrenal androgens (Alford & Nurudeen, 2015).
Alford, C., & Nurudeen, S. (2015). Obstetrics & Obstetric Disorders. In Papadakis, M.A.
& McPhee S.J. (Eds.), Current Medical Diagnosis & Treatment (pp 97).
New York: McGraw-Hill Education.
66. The most common bacterial cause of community-acquired pneumonia is which of the following?
a. M. pneumonia.
b. S. aureus.
c. S. pneumonia.
d. H. influenza.: *c. S. pneumonia.
Rationale: A, B, & D. can all be causes of CAP, but C (S. pneumonia) is the most common pathogen identified by many studies relat
to CAP (McPhee, pg. 267).
67. A 55 year-old patient presents to the clinic complaining of severe shortness of breath, occasional cough with scant sputum. H
appears thin and there is obvious use of accessory muscles with respiration. The NP knows that the most likely diagnosis based
these signs and symptoms is: a. Emphysema.
b. Bronchiolitis.
c. Cystic Fibrosis.
d. Community Acquired Pneumonia.: *a. Emphysema.
Rationale:
A. Emphysema usually presents at age 50 or older, is often characterized by severe shortness of breath, occasional cough producti
of scant amount of sputum, use of accessory muscles with respiration. Patients are usually thin with no peripheral edema (McPhee
pg.257). B. Bronchiolitis is characterized by shortness of breath and insidious onset of cough, and irreversible airflow obstruction o
PFTs. Risk factors include exposure to toxic fumes, connective tissue disease, organ transplant, and viral infections (McPhee, pg. 26
C. Cystic Fibrosis is characterized by cough, sputum production, exercise intolerance, hemoptysis, chronic rhinosinusitis, steatorrhe
, NURS-656-Student Questions
diarrhea, and abdominal pain. Individuals with CF are often malnourished, have digital clubbing, and anteroposterior chest diamet
is increased (McPhee, pg. 264). D. Characteristics of CAP include fever, tachypnea, productive or non-productive cough. Auscultati
of inspiratory crackles or bronchial breath sounds. It occurs outside of the hospital or within 48 hours of hospital admission in
patients not living in a long-term care facility (McPhee, pg. 266).
68. A 40 year old female comes to see you in clinic to establish care. She has not seen a PCP in over 5 years and has no complain
at today's visit. After getting a thorough history, you perform a full head-to-toe physical exam. Upon auscultation of the heart,
you hear recurrent mid-systolic clicks. As a FNP, what do you suspect this murmur is?
a. Mitral stenosis
b. Mitral valve prolapse
c. Patent ductus arteriosus
d. Mitral regurgitation: *b. Mitral valve prolapse
Rationale: Mitral valve prolapse (MVP) is usually asymptomatic. Upon auscultation, there are characteristic mid-systolic clicks that
may be single or multiple in nature. It is often heard late in systole. Mitral stenosis is a diastolic murmur that often has a low pitch
and whose duration increases in severity of the stenosis. Patent ductus arteriosus is accentuated in late systole and is a continuous
rough "machinery" murmur. Mitral regurgitation is a pan-systolic murmur maximized at the apex and radiating to the axilla.
Reference:
Bashore, T., Granger, C., Jackson, K., & Patel, M. (2015). Heart disease. In M. A.
Papadakis &
S.J. McPhee (Eds.), Current medical diagnosis & treatment: 2015 (54th ed., pp.
327-337). New
York, NY: McGraw-Hill.
69. Which of the following is *true* regarding ACE inhibitors?
a. They are not the agents of choice for patients with kidney dysfunction
b. They are more effective in African Americans with HTN than Caucasians
c. Hypokalemia is a side effect that needs to be monitored
d. A chronic dry cough is a reason some patients may not adhere to taking this medication: *d. A chronic dry cough is a
reason some patients may not adhere to taking this medication
Rationale: A chronic dry cough is common and is seen in 10% of patients, which may require stopping the drug. ACE inhibitors are
less effective in African Americans in treating HTN. Hyperkalemia is a side effect that should be monitored especially in patients wi
kidney disease. ACE inhibitors are the agents of choice for patients with kidney dysfunction because they delay the progression of
end stage kidney disease.
Reference:
, NURS-656-Student Questions
Sutters, M. (2015). Systemic hypertension. In M. A. Papadakis & S.J. McPhee (Eds.), Current medical diagnosis & treatment: 2015
(54th ed., pp. 446-450). New York, NY: McGraw-Hill.
70. Pulmonary function testing is performed on a six year old child with asthma. All of the following measurements except ____
will definitely be decreased?
a. FVC
b. FEV1
c. FEV1:FVC ratio
d. FEF25-75: *a. FVC Definitions:
FVC-Forced Vital Capacity
FEV1-Forced Expiratory Volume in the first second of exhalation
FEV1:FEVC ratio- the ratio
FEF25-75-Forced expiratory flow at the middle of the vital capacity.
Rationale: Asthma is classified as an obstructive lung disease. With obstructive lung diseases, such as asthma, bronchopulmonary
dysplasia (BPD), and cystic fibrosis (CF), the FEV1, FEV1:FVC ratio, and FEF25-75 will all be decreased on pulmonary function tests.
The FVC will either be normal or decreased. With restrictive lung disease processes, such as chest wall deformities that limits lung
expansion, muscle weakness, and interstitial lung diseases, the FVC and FEV1 will be decreased, the FEV1:FVC ratio will be normal
increased, and the FEF25-75 will be normal, increased, or decreased. [2] p. 536
71. A 22 year old female presents to your clinic for her routine well woman exam. She denies ever having an abnormal pap sme
previously, but is unsure of the exact timing of her last pap smear, "sometime in college." You perform a pap smear at this visit
and inform her that, according to new official guidelines, if her sample from today comes back normal as well, she will be due fo
her next pap smear in ____ years. a. 1
b. 2
c. 3
d. 5: *c. 3
Rationale: Official recommendations for cervical cancer screening changed in 2012, and the U.S. Preventative Services Task Force
(USPSTF) in agreement with the American Cancer Society, now recommends screening women age 21 to 65 years using cytology
(Papanicolau smear) every 3 years. Women age 30 to 65 may be screened using either cytology alone every 3 years OR a
combination of cytology and HPV testing every 5 years, though the combination co-test is the preferred approach. [2] p. 752
72. The optimal timing for Tdap immunization during pregnancy is between ____ and ____ weeks of gestation. a. 8-16
b. 20-23
c. 24-32
d. 27-36: *d. 27-36
65. A mother presents to the clinic with her 10 year old daughter to the clinic for a well-child check. She asks about the signs of
puberty. Which is the initial sign of puberty?
a) Pubarche
b) Adenarche
c) Thelarche
d) Menarche: *c) Thelarche
Rational: The correct answer is thelarche, breast development, is the initiation of puberty. Pubarche comes after thelarche which i
development of axillary and pubic hair. Menarche is the final stage which is the first menstrual period. Adenarche is the increased
secretion of adrenal androgens (Alford & Nurudeen, 2015).
Alford, C., & Nurudeen, S. (2015). Obstetrics & Obstetric Disorders. In Papadakis, M.A.
& McPhee S.J. (Eds.), Current Medical Diagnosis & Treatment (pp 97).
New York: McGraw-Hill Education.
66. The most common bacterial cause of community-acquired pneumonia is which of the following?
a. M. pneumonia.
b. S. aureus.
c. S. pneumonia.
d. H. influenza.: *c. S. pneumonia.
Rationale: A, B, & D. can all be causes of CAP, but C (S. pneumonia) is the most common pathogen identified by many studies relat
to CAP (McPhee, pg. 267).
67. A 55 year-old patient presents to the clinic complaining of severe shortness of breath, occasional cough with scant sputum. H
appears thin and there is obvious use of accessory muscles with respiration. The NP knows that the most likely diagnosis based
these signs and symptoms is: a. Emphysema.
b. Bronchiolitis.
c. Cystic Fibrosis.
d. Community Acquired Pneumonia.: *a. Emphysema.
Rationale:
A. Emphysema usually presents at age 50 or older, is often characterized by severe shortness of breath, occasional cough producti
of scant amount of sputum, use of accessory muscles with respiration. Patients are usually thin with no peripheral edema (McPhee
pg.257). B. Bronchiolitis is characterized by shortness of breath and insidious onset of cough, and irreversible airflow obstruction o
PFTs. Risk factors include exposure to toxic fumes, connective tissue disease, organ transplant, and viral infections (McPhee, pg. 26
C. Cystic Fibrosis is characterized by cough, sputum production, exercise intolerance, hemoptysis, chronic rhinosinusitis, steatorrhe
, NURS-656-Student Questions
diarrhea, and abdominal pain. Individuals with CF are often malnourished, have digital clubbing, and anteroposterior chest diamet
is increased (McPhee, pg. 264). D. Characteristics of CAP include fever, tachypnea, productive or non-productive cough. Auscultati
of inspiratory crackles or bronchial breath sounds. It occurs outside of the hospital or within 48 hours of hospital admission in
patients not living in a long-term care facility (McPhee, pg. 266).
68. A 40 year old female comes to see you in clinic to establish care. She has not seen a PCP in over 5 years and has no complain
at today's visit. After getting a thorough history, you perform a full head-to-toe physical exam. Upon auscultation of the heart,
you hear recurrent mid-systolic clicks. As a FNP, what do you suspect this murmur is?
a. Mitral stenosis
b. Mitral valve prolapse
c. Patent ductus arteriosus
d. Mitral regurgitation: *b. Mitral valve prolapse
Rationale: Mitral valve prolapse (MVP) is usually asymptomatic. Upon auscultation, there are characteristic mid-systolic clicks that
may be single or multiple in nature. It is often heard late in systole. Mitral stenosis is a diastolic murmur that often has a low pitch
and whose duration increases in severity of the stenosis. Patent ductus arteriosus is accentuated in late systole and is a continuous
rough "machinery" murmur. Mitral regurgitation is a pan-systolic murmur maximized at the apex and radiating to the axilla.
Reference:
Bashore, T., Granger, C., Jackson, K., & Patel, M. (2015). Heart disease. In M. A.
Papadakis &
S.J. McPhee (Eds.), Current medical diagnosis & treatment: 2015 (54th ed., pp.
327-337). New
York, NY: McGraw-Hill.
69. Which of the following is *true* regarding ACE inhibitors?
a. They are not the agents of choice for patients with kidney dysfunction
b. They are more effective in African Americans with HTN than Caucasians
c. Hypokalemia is a side effect that needs to be monitored
d. A chronic dry cough is a reason some patients may not adhere to taking this medication: *d. A chronic dry cough is a
reason some patients may not adhere to taking this medication
Rationale: A chronic dry cough is common and is seen in 10% of patients, which may require stopping the drug. ACE inhibitors are
less effective in African Americans in treating HTN. Hyperkalemia is a side effect that should be monitored especially in patients wi
kidney disease. ACE inhibitors are the agents of choice for patients with kidney dysfunction because they delay the progression of
end stage kidney disease.
Reference:
, NURS-656-Student Questions
Sutters, M. (2015). Systemic hypertension. In M. A. Papadakis & S.J. McPhee (Eds.), Current medical diagnosis & treatment: 2015
(54th ed., pp. 446-450). New York, NY: McGraw-Hill.
70. Pulmonary function testing is performed on a six year old child with asthma. All of the following measurements except ____
will definitely be decreased?
a. FVC
b. FEV1
c. FEV1:FVC ratio
d. FEF25-75: *a. FVC Definitions:
FVC-Forced Vital Capacity
FEV1-Forced Expiratory Volume in the first second of exhalation
FEV1:FEVC ratio- the ratio
FEF25-75-Forced expiratory flow at the middle of the vital capacity.
Rationale: Asthma is classified as an obstructive lung disease. With obstructive lung diseases, such as asthma, bronchopulmonary
dysplasia (BPD), and cystic fibrosis (CF), the FEV1, FEV1:FVC ratio, and FEF25-75 will all be decreased on pulmonary function tests.
The FVC will either be normal or decreased. With restrictive lung disease processes, such as chest wall deformities that limits lung
expansion, muscle weakness, and interstitial lung diseases, the FVC and FEV1 will be decreased, the FEV1:FVC ratio will be normal
increased, and the FEF25-75 will be normal, increased, or decreased. [2] p. 536
71. A 22 year old female presents to your clinic for her routine well woman exam. She denies ever having an abnormal pap sme
previously, but is unsure of the exact timing of her last pap smear, "sometime in college." You perform a pap smear at this visit
and inform her that, according to new official guidelines, if her sample from today comes back normal as well, she will be due fo
her next pap smear in ____ years. a. 1
b. 2
c. 3
d. 5: *c. 3
Rationale: Official recommendations for cervical cancer screening changed in 2012, and the U.S. Preventative Services Task Force
(USPSTF) in agreement with the American Cancer Society, now recommends screening women age 21 to 65 years using cytology
(Papanicolau smear) every 3 years. Women age 30 to 65 may be screened using either cytology alone every 3 years OR a
combination of cytology and HPV testing every 5 years, though the combination co-test is the preferred approach. [2] p. 752
72. The optimal timing for Tdap immunization during pregnancy is between ____ and ____ weeks of gestation. a. 8-16
b. 20-23
c. 24-32
d. 27-36: *d. 27-36
