NURS 552-1 Primary Health Care Nursing
Adult Midterm Exam
(True or False) A SABA given via a nebulizer is more effective compared to an MDI. - ANS
-False
\(True or False) An LTM and an ICS are interchangeable clinically because both groups of
medications have equivalent anti-inflammatory effects. - ANS -False
\(True or False) Approximated 80% of the dose of an ICS is systematically absorbed. - ANS
-False
\(True or False) Due to safety concerns, mast cell stabilizers are no longer available. - ANS
-False
\(True or False) During a severe asthma flare, OCSs should be given once the patient is
transferred to an acute care facility. - ANS -False
\(True or False) LAMAs can be used to reduce the risk of asthma flares. - ANS -True
\(True or False) Most prescribers are well-versed in the relative potency of ICSs and prescribe
the appropriate dose for the patient's clinical presentation. - ANS -False
\(True or False) Oxygen therapy should be titrated to maintain oxygen saturation greater than
96% (in treating an asthma exacerbation for an adult in the primary care setting). - ANS -False
\A 29-year-old woman presents with a chief complaint of a red, irritated right eye for the past 48
hours with eyelids that were "stuck together" this morning when she awoke. Examination
reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the
Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU),
and purulent eye discharge on the right only. This presentation is most consistent with:
A. Suppurative or bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Mechanical injury - ANS -A. Suppurative or bacterial conjunctivitis
\A 36-year-old man with asthma also needs antihypertensive therapy. Which of the following
products should you avoid prescribing?
A. Hydrochlorothiazide
B. Propranolol
C. Amlodipine
D. Enalapril - ANS -B. Propranolol
\A 39-year-old man presents with a complaint of bilaterally itchy, red eyes with tearing that
occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge
and clear nasal discharge. This is most consistent with conjunctival inflammation caused by:
A. A bacterium
B. A virus
,C. An allergen
D. An injury - ANS -C. An allergen
\A 40 year-old African American patient has blood pressure readings of 175/100 and 170/102.
What is a reasonable plan of care for this patient?
Select one:
A. Start HCTZ at 25 mg daily.
B. Start the patient on an ACE inhibitor.
C. Initiate HCTZ and diltiazem.
D. Initiate amlodipine. - ANS -C. Initiate HCTZ and diltiazem
\A 43yo woman has a 12 hour history of sudden onset right upper quadrant pain with radiation
to the should, fever and chills. She has had similar milder episodes in the past. Examination
reveals marked tenderness to the RUQ. Her most likely diagnosis is:
Select one:
A. acute cholecystitis
B. hepatoma
C. acute hepatitis
D. cholelithiasis - ANS -A. acute cholecystitis
\A 44 year-old non-smoker is diagnosed with pneumonia. He is otherwise healthy and does not
need hospitalization at this time. Which antibiotic can be used for empirical treatment according
to the 2007 Infectious Disease Society of America/American Thoracic Society?
Select one:
A. Bactrim
B. Levofloxacin
C. Azithromycin
D. Keflex - ANS -C. Azithromycin
\A 44-year-old man has a long-standing history of moderate persistent asthma that is normally
well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff twice a
day, and the use of albuterol one to two times a week as needed for wheezing. Three days ago,
he developed a sore throat, clear nasal discharge, body aches, and a cough with a small
amount of white sputum production. In the past 24 hours, he has had intermittent wheezing that
necessitated the use of albuterol, two puffs, every 3 hours, which produced partial relief. Your
next most appropriate action is to obtain a:
A. Chest radiograph
B. Measurement of oxygen saturation (SaO2)
C. Spirometry measurement
D. Sputum smear for WBCs - ANS -C. Spirometry measurement
\A 50 year-old with a history of 3-4 alcoholic drinks daily and weekend binges has elevated liver
enzymes. Which set of enzymes is most representative of this patient?
Select one:
, A. AST=200, ALT=75
B. AST=100, ALT=90
C. AST=100, ALT=200
D. AST=30, ALT=300 - ANS -A. AST=200, ALT=75
\A 60 year old male comes in complaining of chest pain. He has a history of HTN. What other
factors might make you concerned for a cardiac cause of his pain?
Select one:
A. He also has diabetes.
B. He smoked for 30 years.
C. His dad had an MI at 56 years old.
D. All of the above. - ANS -D. All of the above
\A 65 year-old patient has the following lipid levels:total cholesterol 240LDL 140HDL
35triglycerides 129Which class of medication will normalize his lipid elevations and decrease his
risk of a cardiac event?
Select one:
A. Niacin
B. Fibric acids
C. Statins
D. Bile acid sequestrants - ANS -C. Statins
\A 67 yo patient with COPD presents an immunization record that reflects having received the
pneumococcal immunization when she was 60 years old. What statement reflects the current
standard of practice?
Select one:
A. She should be revaccinated today.
B. She should receive Pneumovax every 8 years.
C. She should get vaccinated with Prevnar 13 for additional protection
D. She does not need the vaccine. - ANS -C. She should get vaccinated with Prevnar 13 for
additional protection
\A major side effect of cimetidine that would be of special concern when prescribing for an
elderly patient is
Select one:
A. decreased digoxin levels
B. hypophosphatemia
C. confusion
D. osteopenia - ANS -C. confusion
H2 blockers can lead to confusion and sometimes delirium in elderly patients.
\A medication which may produce exercise intolerance in a patient with hypertension is:
Select one:
Adult Midterm Exam
(True or False) A SABA given via a nebulizer is more effective compared to an MDI. - ANS
-False
\(True or False) An LTM and an ICS are interchangeable clinically because both groups of
medications have equivalent anti-inflammatory effects. - ANS -False
\(True or False) Approximated 80% of the dose of an ICS is systematically absorbed. - ANS
-False
\(True or False) Due to safety concerns, mast cell stabilizers are no longer available. - ANS
-False
\(True or False) During a severe asthma flare, OCSs should be given once the patient is
transferred to an acute care facility. - ANS -False
\(True or False) LAMAs can be used to reduce the risk of asthma flares. - ANS -True
\(True or False) Most prescribers are well-versed in the relative potency of ICSs and prescribe
the appropriate dose for the patient's clinical presentation. - ANS -False
\(True or False) Oxygen therapy should be titrated to maintain oxygen saturation greater than
96% (in treating an asthma exacerbation for an adult in the primary care setting). - ANS -False
\A 29-year-old woman presents with a chief complaint of a red, irritated right eye for the past 48
hours with eyelids that were "stuck together" this morning when she awoke. Examination
reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the
Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU),
and purulent eye discharge on the right only. This presentation is most consistent with:
A. Suppurative or bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Mechanical injury - ANS -A. Suppurative or bacterial conjunctivitis
\A 36-year-old man with asthma also needs antihypertensive therapy. Which of the following
products should you avoid prescribing?
A. Hydrochlorothiazide
B. Propranolol
C. Amlodipine
D. Enalapril - ANS -B. Propranolol
\A 39-year-old man presents with a complaint of bilaterally itchy, red eyes with tearing that
occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge
and clear nasal discharge. This is most consistent with conjunctival inflammation caused by:
A. A bacterium
B. A virus
,C. An allergen
D. An injury - ANS -C. An allergen
\A 40 year-old African American patient has blood pressure readings of 175/100 and 170/102.
What is a reasonable plan of care for this patient?
Select one:
A. Start HCTZ at 25 mg daily.
B. Start the patient on an ACE inhibitor.
C. Initiate HCTZ and diltiazem.
D. Initiate amlodipine. - ANS -C. Initiate HCTZ and diltiazem
\A 43yo woman has a 12 hour history of sudden onset right upper quadrant pain with radiation
to the should, fever and chills. She has had similar milder episodes in the past. Examination
reveals marked tenderness to the RUQ. Her most likely diagnosis is:
Select one:
A. acute cholecystitis
B. hepatoma
C. acute hepatitis
D. cholelithiasis - ANS -A. acute cholecystitis
\A 44 year-old non-smoker is diagnosed with pneumonia. He is otherwise healthy and does not
need hospitalization at this time. Which antibiotic can be used for empirical treatment according
to the 2007 Infectious Disease Society of America/American Thoracic Society?
Select one:
A. Bactrim
B. Levofloxacin
C. Azithromycin
D. Keflex - ANS -C. Azithromycin
\A 44-year-old man has a long-standing history of moderate persistent asthma that is normally
well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff twice a
day, and the use of albuterol one to two times a week as needed for wheezing. Three days ago,
he developed a sore throat, clear nasal discharge, body aches, and a cough with a small
amount of white sputum production. In the past 24 hours, he has had intermittent wheezing that
necessitated the use of albuterol, two puffs, every 3 hours, which produced partial relief. Your
next most appropriate action is to obtain a:
A. Chest radiograph
B. Measurement of oxygen saturation (SaO2)
C. Spirometry measurement
D. Sputum smear for WBCs - ANS -C. Spirometry measurement
\A 50 year-old with a history of 3-4 alcoholic drinks daily and weekend binges has elevated liver
enzymes. Which set of enzymes is most representative of this patient?
Select one:
, A. AST=200, ALT=75
B. AST=100, ALT=90
C. AST=100, ALT=200
D. AST=30, ALT=300 - ANS -A. AST=200, ALT=75
\A 60 year old male comes in complaining of chest pain. He has a history of HTN. What other
factors might make you concerned for a cardiac cause of his pain?
Select one:
A. He also has diabetes.
B. He smoked for 30 years.
C. His dad had an MI at 56 years old.
D. All of the above. - ANS -D. All of the above
\A 65 year-old patient has the following lipid levels:total cholesterol 240LDL 140HDL
35triglycerides 129Which class of medication will normalize his lipid elevations and decrease his
risk of a cardiac event?
Select one:
A. Niacin
B. Fibric acids
C. Statins
D. Bile acid sequestrants - ANS -C. Statins
\A 67 yo patient with COPD presents an immunization record that reflects having received the
pneumococcal immunization when she was 60 years old. What statement reflects the current
standard of practice?
Select one:
A. She should be revaccinated today.
B. She should receive Pneumovax every 8 years.
C. She should get vaccinated with Prevnar 13 for additional protection
D. She does not need the vaccine. - ANS -C. She should get vaccinated with Prevnar 13 for
additional protection
\A major side effect of cimetidine that would be of special concern when prescribing for an
elderly patient is
Select one:
A. decreased digoxin levels
B. hypophosphatemia
C. confusion
D. osteopenia - ANS -C. confusion
H2 blockers can lead to confusion and sometimes delirium in elderly patients.
\A medication which may produce exercise intolerance in a patient with hypertension is:
Select one:
