150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray
on PA view shows a left lower chest area of consolidation adjacent to the left
border of the heart approximately 2 rib spaces above the costophrenic angle. The
lateral x-ray view shows this lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe Answer - Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the
cardiac margin/silhouette is obliterated by the mass, the lesion is either
right middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses? Answer - Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of
diastolic dysfunction and is common in patients with thickened hypertrophic
myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood
pressure is still elevated. Which is the BEST medication to prescribe him? Answer -
Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be
managed with a dihydropyridine calcium channel blocker such as amlodipine
(Norvasc) as first line management therapy for hypertension not at goal with
DASH and lifestyle modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance? Answer -
CT angiography of the chest
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
,150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: CT angiography is considered the standard of care for measuring
vascular luminal dimensions with contrast. CT PE protocol is not timed properly
for the aorta (it's timed for the pulmonary artery). Although a plain film is able to
catch large aneurysms at times, they are not able to provide multi-axis
reconstruction needed to accurately measure the size. Transesophageal echo is
not needed to accurately measure the aorta and requires the patient to undergo
sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation? Answer -
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three
all have beta receptor activity.
A 50-year-old woman with a history of hypertension presents with dyspnea on
exertion and orthopnea. On examination, she has jugular venous distention and
bilateral crackles on lung auscultation. What is the most likely diagnosis? Answer -
Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive
heart failure as it is signifying both a right ventricular back up with jugular venous
extension and crackles on lung assault, which are suggestive of left ventricular
back up. it is possible the patient may have an acute myocardial infarction that
precipitated this, however, a patient has not described that, rather is only
describing dyspnea on exertion and orthopnea, which both speak to a state of
fluid overload. The only appropriate response of these available is congestive
heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction)
with an ejection fraction of 40% who is also not on optimal medical therapy has
been diagnosed with a myocardial infarction this admission and received
emergent placement of a drug-eluting stent to the left anterior descending artery.
As the medical home who will manage this patient after discharge, which
medication strategy would you expect to be a priority in the patient's care?
Answer - Ordering a transthoracic echocardiogram and order a Lifevest if EF is less
than 35%
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
,150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: The patient should have a protective mechanism such as an
implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is
less than 35% due to the increased risk of sudden cardiac death with low EF
states. Since most patients are not eligible for 90 days for an AICD in this state,
optimizing their medication regimen and repeating an echo in 2-3 months to re-
evaluate for improvement in their EF is required by most insurance companies. A
baseline echo is needed at discharge to provide a baseline for improvement vs
their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as
presented.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and
her hypertension is now adequately controlled with medication. Her mother died
at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240
mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle
changes, the nurse practitioner should start the patient on: Answer - a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be
useful in reducing ASVD risk, but for a patient who is an active smoker with
premature coronary disease history (less than age 65 for women), has
hypertension and is far from an LDL goal, this patient is most certainly a candidate
for statin therapy, which represents the most aggressive therapy option of these
four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? Answer - Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral
neuropathy, it is only directly attributed to patients who are also diabetic and is
commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking,
and hemorrhagic stroke are all caused by uncontrolled hypertension.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1.
What is the most appropriate initial treatment? Answer - Oral contraceptives
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
, 150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: These are classic symptoms of polycystic ovarian syndrome and the
patient should be treated with oral contraceptives to help stabilize their estrogen
and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase
the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help
reduce symptoms like acne, hirsutism (unwanted body and facial hair), and
androgenic alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring
regular ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for
early signs of diabetic nephropathy? Answer - Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the
evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
other options might describe macro-organ function (such as BUN/Creat from a
BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings),
but at the functional level of the nephron, namely the glomerulus, evidence of
glucose-related damage is easily identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing
levothryoxine Answer - 25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism
in the elderly is to "go slow and start low". 25 mcg is the most appropriate low
dose
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray
on PA view shows a left lower chest area of consolidation adjacent to the left
border of the heart approximately 2 rib spaces above the costophrenic angle. The
lateral x-ray view shows this lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe Answer - Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the
cardiac margin/silhouette is obliterated by the mass, the lesion is either
right middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses? Answer - Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of
diastolic dysfunction and is common in patients with thickened hypertrophic
myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood
pressure is still elevated. Which is the BEST medication to prescribe him? Answer -
Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be
managed with a dihydropyridine calcium channel blocker such as amlodipine
(Norvasc) as first line management therapy for hypertension not at goal with
DASH and lifestyle modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance? Answer -
CT angiography of the chest
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
,150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: CT angiography is considered the standard of care for measuring
vascular luminal dimensions with contrast. CT PE protocol is not timed properly
for the aorta (it's timed for the pulmonary artery). Although a plain film is able to
catch large aneurysms at times, they are not able to provide multi-axis
reconstruction needed to accurately measure the size. Transesophageal echo is
not needed to accurately measure the aorta and requires the patient to undergo
sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation? Answer -
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three
all have beta receptor activity.
A 50-year-old woman with a history of hypertension presents with dyspnea on
exertion and orthopnea. On examination, she has jugular venous distention and
bilateral crackles on lung auscultation. What is the most likely diagnosis? Answer -
Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive
heart failure as it is signifying both a right ventricular back up with jugular venous
extension and crackles on lung assault, which are suggestive of left ventricular
back up. it is possible the patient may have an acute myocardial infarction that
precipitated this, however, a patient has not described that, rather is only
describing dyspnea on exertion and orthopnea, which both speak to a state of
fluid overload. The only appropriate response of these available is congestive
heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction)
with an ejection fraction of 40% who is also not on optimal medical therapy has
been diagnosed with a myocardial infarction this admission and received
emergent placement of a drug-eluting stent to the left anterior descending artery.
As the medical home who will manage this patient after discharge, which
medication strategy would you expect to be a priority in the patient's care?
Answer - Ordering a transthoracic echocardiogram and order a Lifevest if EF is less
than 35%
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
,150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: The patient should have a protective mechanism such as an
implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is
less than 35% due to the increased risk of sudden cardiac death with low EF
states. Since most patients are not eligible for 90 days for an AICD in this state,
optimizing their medication regimen and repeating an echo in 2-3 months to re-
evaluate for improvement in their EF is required by most insurance companies. A
baseline echo is needed at discharge to provide a baseline for improvement vs
their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as
presented.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and
her hypertension is now adequately controlled with medication. Her mother died
at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240
mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle
changes, the nurse practitioner should start the patient on: Answer - a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be
useful in reducing ASVD risk, but for a patient who is an active smoker with
premature coronary disease history (less than age 65 for women), has
hypertension and is far from an LDL goal, this patient is most certainly a candidate
for statin therapy, which represents the most aggressive therapy option of these
four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? Answer - Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral
neuropathy, it is only directly attributed to patients who are also diabetic and is
commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking,
and hemorrhagic stroke are all caused by uncontrolled hypertension.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1.
What is the most appropriate initial treatment? Answer - Oral contraceptives
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
, 150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
Rationale: These are classic symptoms of polycystic ovarian syndrome and the
patient should be treated with oral contraceptives to help stabilize their estrogen
and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase
the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help
reduce symptoms like acne, hirsutism (unwanted body and facial hair), and
androgenic alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring
regular ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for
early signs of diabetic nephropathy? Answer - Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the
evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
other options might describe macro-organ function (such as BUN/Creat from a
BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings),
but at the functional level of the nephron, namely the glomerulus, evidence of
glucose-related damage is easily identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing
levothryoxine Answer - 25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism
in the elderly is to "go slow and start low". 25 mcg is the most appropriate low
dose
150 Question Bank for NR667: Clinical Assessment and Diagnosis With 100% Complete Solutions
