NRNP 6531 MIDTERM EXAM Questions with
100% verified Answers Latest Version 2024
GRADE A+
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a
heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency
department. What initial intervention may be attempted in the clinic?
Administration of intravenous adenosine Using a vagal maneuver or carotid massage Providing a loading
dose of digoxin
Giving a beta blocker - Using a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that apply.) Using a ratio
of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a
minimum Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - Using a ratio of 2 rescue breaths to 30
compressions
A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without
breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The
provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - Give the patient a beta blocker medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly- controlled
hypertension, and decompensated heart failure. What is the recommendation for treatment for this
patient?
No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular
stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - Serial ultrasonographic surveillance of the
aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a
diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with
hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - Inappropriate secretion of PTH
along with hypercalcemia
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time.
What initial diagnostic test will the provider order in the clinic at this visit?
Hemoglobin A1C Random serum glucose C-peptide level
Thyroid studies - Hemoglobin A1C
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3- 4)
0.2 uIU/L
4.2 uIU/L
0.4 uIU/L
2.4 uIU/L - 0.2 uIU/L
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following
laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is
negative. What is the initial treatment for this patient?
,Radioiodine therapy
Surgical resection of the thyroid gland Beta blocker medications
Thionamide therapy - Beta blocker medications
A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above
normal without signs of nephrolithiasis. What is the recommended treatment for this patient?
Avoidance of weight bearing exercises
Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until
values normal
Parathyroidectomy - Annual monitoring of calcium, creatinine, and bone density
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for
potential malignancy, which test is performed?
Serum calcitonin Radionucleotide imaging Serum TSH level
Thyroid ultrasound - Thyroid ultrasound
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a
diagnosis of primary hyperparathyroidism?
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH
along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Appropriately increased PTH and low or normal serum calcium - Inappropriate secretion of PTH along with
hypercalcemia
What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause
increased insulin resistance.
They predispose patients to dyslipidemia. They lower the risk of hypertension.
They increase the risk of arterial thrombosis. - They increase the risk of arterial thrombosis.
A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by
the primary care provider is indicated for management of this patient?
Consulting with a nephrologist
Prescribing an antihypertensive medication Referring to an ophthalmologist
Limiting protein intake - Consulting with a nephrologist
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated
TSH and decreased T3 and T4 levels. What will the provider tell this patient?
She will need lifelong medication. A thyroidectomy will be necessary. This condition may be transient.
She should be referred to an endocrinologist. - This condition may be transient.
A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be
used to identify the need to initiate cardiopulmonary resuscitation (CPR)?
Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial
infarction Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - Assessment of gasping breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports
blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the
recommended action for this patient?
Increase the dose of the thiazide medication
Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - Admit to the hospital for evaluation and treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?
Atrial fibrillation Anemia Extrasystole
Paroxysmal attacks - Atrial fibrillation
,A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border.
The provider determines that the murmur decreases in intensity when the patient changes from standing
to squatting and increases in intensity with the Valsalva maneuver.
Which cause will the provider suspect for this murmur? Aortic stenosis
Tricuspid regurgitation Hypertrophic cardiomyopathy
Mitral valve prolapse - Hypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away.
What is the initial treatment for this patient?
Give the patient an oral beta blocker Transfer to the PCI-capable institution Administer heparin
Initiate fibrinolytic treatment - Initiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are
those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - previous myocardial infarction. a low-density
lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for
30 minutes or more. What the does provider suspect as the cause for these symptoms?
Buerger's disease Cauda equina syndrome Diabetic neuropathy
Peripheral arterial disease - Cauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.) Oral contraceptives
Isometic excercises NSAIDS
Sleep apnea
Increased salt intake - Oral contraceptives NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the
provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest
pain, syncope, or palpitations. What will the provider do?
Reassure the patient that these findings are expected Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - Consult with cardiology to determine
appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes
a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - US of the mass to determine size
A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away.
What is the initial treatment for this patient?
Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin
Transfer to the PCI-capable institution - Initiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches,
palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the
provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - Order urinalysis, CBC, BUN and creatinine
, A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial
obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in
this patient?
Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent
clotting
Walking slowly for 15 to 20 minutes twice daily - Walking to the point of pain each day
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart
rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital
signs
Reassure the patient that the symptoms are non-cardiac in origin - Evaluate the patient's orthostatic vital
signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital
setting because most victims have which arrhythmia?
Atrial flutter Ventricular fibrillation Atrial fibrillation
Ventricular tachycardia - Ventricular fibrillation
Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment
Left ventricular hypertrophy Renal calculi
Perioral paresthesias
Chvostek's sign - Cognitive impairment Left ventricular hypertrophy
Renal calculi
Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Aspirin
Niacin Atorvastatin
Metformin - Metformin
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The
provider notes that the patient appears confused and irritable and is sweating and shaking. What
intervention will the provider expect to perform once the point of care blood glucose level is known?
Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones
Injection of rapid-acting insulin - Giving a rapid-acting carbohydrate
A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral
diabetes medications. When explaining this change in therapy, the provider will tell the patient:
that strict diet and exercise measures may be relaxed with insulin therapy.
it is necessary because the patient cannot comply with the previous regimen. this is because of the natural
progression of the disease.
the use of insulin therapy may be temporary. - this is because of the natural progression of the disease.
A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
Bronchodilator treatment Mucokinetic agents Antitussive medication
Antibiotic therapy - Antitussive medication
A young adult patient without a previous history of lung disease has an increased respiratory rate and
reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no
signs of increased respiratory effort. Which diagnostic test will the provider perform initially?
Chest radiograph Complete blood count Computerized tomography
Spirometry - Complete blood count
A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of
breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly
after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the
provider recommend?
Administering two more doses of albuterol Taking an oral corticosteroid
Coming to the clinic for evaluation
Going to the emergency department - Administering two more doses of albuterol
100% verified Answers Latest Version 2024
GRADE A+
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a
heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency
department. What initial intervention may be attempted in the clinic?
Administration of intravenous adenosine Using a vagal maneuver or carotid massage Providing a loading
dose of digoxin
Giving a beta blocker - Using a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that apply.) Using a ratio
of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a
minimum Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - Using a ratio of 2 rescue breaths to 30
compressions
A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without
breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The
provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - Give the patient a beta blocker medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly- controlled
hypertension, and decompensated heart failure. What is the recommendation for treatment for this
patient?
No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular
stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - Serial ultrasonographic surveillance of the
aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a
diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with
hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - Inappropriate secretion of PTH
along with hypercalcemia
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time.
What initial diagnostic test will the provider order in the clinic at this visit?
Hemoglobin A1C Random serum glucose C-peptide level
Thyroid studies - Hemoglobin A1C
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3- 4)
0.2 uIU/L
4.2 uIU/L
0.4 uIU/L
2.4 uIU/L - 0.2 uIU/L
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following
laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is
negative. What is the initial treatment for this patient?
,Radioiodine therapy
Surgical resection of the thyroid gland Beta blocker medications
Thionamide therapy - Beta blocker medications
A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above
normal without signs of nephrolithiasis. What is the recommended treatment for this patient?
Avoidance of weight bearing exercises
Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until
values normal
Parathyroidectomy - Annual monitoring of calcium, creatinine, and bone density
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for
potential malignancy, which test is performed?
Serum calcitonin Radionucleotide imaging Serum TSH level
Thyroid ultrasound - Thyroid ultrasound
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a
diagnosis of primary hyperparathyroidism?
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH
along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Appropriately increased PTH and low or normal serum calcium - Inappropriate secretion of PTH along with
hypercalcemia
What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause
increased insulin resistance.
They predispose patients to dyslipidemia. They lower the risk of hypertension.
They increase the risk of arterial thrombosis. - They increase the risk of arterial thrombosis.
A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by
the primary care provider is indicated for management of this patient?
Consulting with a nephrologist
Prescribing an antihypertensive medication Referring to an ophthalmologist
Limiting protein intake - Consulting with a nephrologist
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated
TSH and decreased T3 and T4 levels. What will the provider tell this patient?
She will need lifelong medication. A thyroidectomy will be necessary. This condition may be transient.
She should be referred to an endocrinologist. - This condition may be transient.
A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be
used to identify the need to initiate cardiopulmonary resuscitation (CPR)?
Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial
infarction Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - Assessment of gasping breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports
blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the
recommended action for this patient?
Increase the dose of the thiazide medication
Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - Admit to the hospital for evaluation and treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?
Atrial fibrillation Anemia Extrasystole
Paroxysmal attacks - Atrial fibrillation
,A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border.
The provider determines that the murmur decreases in intensity when the patient changes from standing
to squatting and increases in intensity with the Valsalva maneuver.
Which cause will the provider suspect for this murmur? Aortic stenosis
Tricuspid regurgitation Hypertrophic cardiomyopathy
Mitral valve prolapse - Hypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away.
What is the initial treatment for this patient?
Give the patient an oral beta blocker Transfer to the PCI-capable institution Administer heparin
Initiate fibrinolytic treatment - Initiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are
those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - previous myocardial infarction. a low-density
lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for
30 minutes or more. What the does provider suspect as the cause for these symptoms?
Buerger's disease Cauda equina syndrome Diabetic neuropathy
Peripheral arterial disease - Cauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.) Oral contraceptives
Isometic excercises NSAIDS
Sleep apnea
Increased salt intake - Oral contraceptives NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the
provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest
pain, syncope, or palpitations. What will the provider do?
Reassure the patient that these findings are expected Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - Consult with cardiology to determine
appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes
a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - US of the mass to determine size
A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI
(STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away.
What is the initial treatment for this patient?
Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin
Transfer to the PCI-capable institution - Initiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches,
palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the
provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - Order urinalysis, CBC, BUN and creatinine
, A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial
obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in
this patient?
Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent
clotting
Walking slowly for 15 to 20 minutes twice daily - Walking to the point of pain each day
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart
rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital
signs
Reassure the patient that the symptoms are non-cardiac in origin - Evaluate the patient's orthostatic vital
signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital
setting because most victims have which arrhythmia?
Atrial flutter Ventricular fibrillation Atrial fibrillation
Ventricular tachycardia - Ventricular fibrillation
Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment
Left ventricular hypertrophy Renal calculi
Perioral paresthesias
Chvostek's sign - Cognitive impairment Left ventricular hypertrophy
Renal calculi
Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Aspirin
Niacin Atorvastatin
Metformin - Metformin
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The
provider notes that the patient appears confused and irritable and is sweating and shaking. What
intervention will the provider expect to perform once the point of care blood glucose level is known?
Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones
Injection of rapid-acting insulin - Giving a rapid-acting carbohydrate
A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral
diabetes medications. When explaining this change in therapy, the provider will tell the patient:
that strict diet and exercise measures may be relaxed with insulin therapy.
it is necessary because the patient cannot comply with the previous regimen. this is because of the natural
progression of the disease.
the use of insulin therapy may be temporary. - this is because of the natural progression of the disease.
A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
Bronchodilator treatment Mucokinetic agents Antitussive medication
Antibiotic therapy - Antitussive medication
A young adult patient without a previous history of lung disease has an increased respiratory rate and
reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no
signs of increased respiratory effort. Which diagnostic test will the provider perform initially?
Chest radiograph Complete blood count Computerized tomography
Spirometry - Complete blood count
A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of
breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly
after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the
provider recommend?
Administering two more doses of albuterol Taking an oral corticosteroid
Coming to the clinic for evaluation
Going to the emergency department - Administering two more doses of albuterol
