Chamberlain Prediagnostic NR607
Advanced Physical Assessment NR 607
Midterm and Finals Examplify Online
Proctored Exam Questions and Answers |
100% Pass Guaranteed | Graded A+
1. A 52-year-old obese man with type 2 diabetes reports dozing off while
driving, watching TV, or reading, with increased apathy and fatigue. The PMHNP
ordered a sleep study, which revealed 10 episodes of apnea lasting 15 to 20
seconds each per hour of sleep. Based on these findings, what should the
PMHNP prescribe for his condition?
• A) Referral to otolaryngology for rhinoplasty
• B) Antidepressant medications
• C) Referral to otolaryngology for uvuloplasty
• D) Continuous positive airway pressure
Answer: D) Continuous positive airway pressure
Rationale: The patient has obstructive sleep apnea (OSA) with an apnea-hypopnea
index (AHI) of 10 (moderate OSA). CPAP is the gold standard treatment for
moderate to severe OSA and works by providing positive airway pressure to keep
the airway patent during sleep. CPAP reduces daytime sleepiness, improves
cognitive function, and decreases cardiovascular risk. Rhinoplasty addresses nasal
structural issues but does not treat sleep apnea. Uvuloplasty may be considered
for mild OSA or snoring but is not first-line for moderate OSA. Antidepressants
would not address the underlying sleep-disordered breathing. CPAP therapy
requires patient education and adherence support, as compliance is essential for
,effectiveness. The PMHNP should also discuss weight management and positional
therapy as adjunctive treatments .
2. Which of the following is an indication for monitoring of serum drug levels?
• A) Smoking cessation
• B) New diagnosis of hyperlipidemia
• C) Resolution of symptoms
• D) New diagnosis of diabetes
Answer: A) Smoking cessation
Rationale: Smoking cessation is an indication for monitoring serum drug levels
because smoking induces CYP1A2 enzymes, which metabolize many psychotropic
medications including clozapine, olanzapine, and some antidepressants. When a
patient stops smoking, drug metabolism slows, potentially leading to increased
serum drug levels and toxicity. Dose adjustment may be needed during and after
smoking cessation. Therapeutic drug monitoring (TDM) is also indicated when:
starting or adjusting medications with narrow therapeutic indices, when a patient is
non-adherent or has unexpected responses, when there are drug-drug interactions,
or when there are changes in organ function (hepatic/renal). Monitoring serum drug
levels helps optimize efficacy and minimize toxicity. New diagnosis of
hyperlipidemia does not directly indicate TDM. Resolution of symptoms may
support continuing the current dose but does not by itself indicate the need for
TDM. New diagnosis of diabetes may affect medication selection but does not by
itself indicate TDM for psychotropics .
,3. Your client Jamie asks you about a mole of her forearm. You refer her to
dermatology. As an APRN, you recognize that cancerous moles can be
detected on exam. Which of the following would NOT be of concern?
• A) A mole that is not elevated
• B) All of the above
• C) A dark mole
• D) A mole that is 5 mm in size
Answer: B) All of the above
Rationale: This question asks which finding would NOT be concerning, and the
correct answer is all of the above because the stated features are not necessarily
concerning for melanoma. The ABCDE mnemonic is used to identify concerning
moles: Asymmetric shape, Border irregularity, Color variation (multiple
colors), Diameter >6mm (pencil eraser size), and Evolving (changing over time). A
mole that is not elevated (flat) is normal and not concerning—melanomas can be
flat or elevated. A dark mole can be benign (normal melanocytic nevi can be dark).
A mole that is 5 mm in size is smaller than the 6 mm threshold for concern.
Concerning moles are asymmetric, have irregular borders, have color variation,
diameter >6mm, and are elevated. The PMHNP should use the ABCDE criteria for
skin cancer screening and refer concerning lesions to dermatology .
4. A 42-year-old female recalls a brief episode of chest tightness with no
radiation or chest wall injury during her new taekwondo martial arts class. This
pain subsided during "the cool down period" of her class. Which of the
following is most likely given her presentation?
• A) Pericarditis
• B) Acute myocardial infarction
, • C) Hiatal hernia
• D) Angina pectoris
Answer: D) Angina pectoris
Rationale: Chest pain with activity and relieved at rest in a middle-aged adult
should prompt concern for myocardial ischemia (angina pectoris). This
presentation is classic for stable angina: chest tightness or pressure that occurs
with exertion (increased oxygen demand) and subsides with rest or during cool-
down when myocardial oxygen demand decreases. Angina may be substernal and
can radiate to the left arm, jaw, or back, though this patient had no radiation.
Pericarditis pain is typically pleuritic, worsened by lying flat, and improved by
leaning forward—different from this presentation. Acute myocardial infarction
would present with more severe, prolonged chest pain that does not subside with
rest and is associated with diaphoresis, nausea, and shortness of breath. Hiatal
hernia may cause chest discomfort but is not typically exertion-related and relieved
by rest. This patient's presentation requires further cardiac evaluation, including
stress testing and risk factor assessment .
5. Gloria is a 68-year-old female with a chronic history of severe anxiety
disorder presents with mild shortness of breath, fine crackles in the right lower
lobe with auscultation and a nonproductive cough. She recently "ran out of
pills." Which medication omission most likely led to her current presenting
symptoms?
• A) Metoprolol
• B) Lorazepam
• C) Furosemide
• D) Metformin
Advanced Physical Assessment NR 607
Midterm and Finals Examplify Online
Proctored Exam Questions and Answers |
100% Pass Guaranteed | Graded A+
1. A 52-year-old obese man with type 2 diabetes reports dozing off while
driving, watching TV, or reading, with increased apathy and fatigue. The PMHNP
ordered a sleep study, which revealed 10 episodes of apnea lasting 15 to 20
seconds each per hour of sleep. Based on these findings, what should the
PMHNP prescribe for his condition?
• A) Referral to otolaryngology for rhinoplasty
• B) Antidepressant medications
• C) Referral to otolaryngology for uvuloplasty
• D) Continuous positive airway pressure
Answer: D) Continuous positive airway pressure
Rationale: The patient has obstructive sleep apnea (OSA) with an apnea-hypopnea
index (AHI) of 10 (moderate OSA). CPAP is the gold standard treatment for
moderate to severe OSA and works by providing positive airway pressure to keep
the airway patent during sleep. CPAP reduces daytime sleepiness, improves
cognitive function, and decreases cardiovascular risk. Rhinoplasty addresses nasal
structural issues but does not treat sleep apnea. Uvuloplasty may be considered
for mild OSA or snoring but is not first-line for moderate OSA. Antidepressants
would not address the underlying sleep-disordered breathing. CPAP therapy
requires patient education and adherence support, as compliance is essential for
,effectiveness. The PMHNP should also discuss weight management and positional
therapy as adjunctive treatments .
2. Which of the following is an indication for monitoring of serum drug levels?
• A) Smoking cessation
• B) New diagnosis of hyperlipidemia
• C) Resolution of symptoms
• D) New diagnosis of diabetes
Answer: A) Smoking cessation
Rationale: Smoking cessation is an indication for monitoring serum drug levels
because smoking induces CYP1A2 enzymes, which metabolize many psychotropic
medications including clozapine, olanzapine, and some antidepressants. When a
patient stops smoking, drug metabolism slows, potentially leading to increased
serum drug levels and toxicity. Dose adjustment may be needed during and after
smoking cessation. Therapeutic drug monitoring (TDM) is also indicated when:
starting or adjusting medications with narrow therapeutic indices, when a patient is
non-adherent or has unexpected responses, when there are drug-drug interactions,
or when there are changes in organ function (hepatic/renal). Monitoring serum drug
levels helps optimize efficacy and minimize toxicity. New diagnosis of
hyperlipidemia does not directly indicate TDM. Resolution of symptoms may
support continuing the current dose but does not by itself indicate the need for
TDM. New diagnosis of diabetes may affect medication selection but does not by
itself indicate TDM for psychotropics .
,3. Your client Jamie asks you about a mole of her forearm. You refer her to
dermatology. As an APRN, you recognize that cancerous moles can be
detected on exam. Which of the following would NOT be of concern?
• A) A mole that is not elevated
• B) All of the above
• C) A dark mole
• D) A mole that is 5 mm in size
Answer: B) All of the above
Rationale: This question asks which finding would NOT be concerning, and the
correct answer is all of the above because the stated features are not necessarily
concerning for melanoma. The ABCDE mnemonic is used to identify concerning
moles: Asymmetric shape, Border irregularity, Color variation (multiple
colors), Diameter >6mm (pencil eraser size), and Evolving (changing over time). A
mole that is not elevated (flat) is normal and not concerning—melanomas can be
flat or elevated. A dark mole can be benign (normal melanocytic nevi can be dark).
A mole that is 5 mm in size is smaller than the 6 mm threshold for concern.
Concerning moles are asymmetric, have irregular borders, have color variation,
diameter >6mm, and are elevated. The PMHNP should use the ABCDE criteria for
skin cancer screening and refer concerning lesions to dermatology .
4. A 42-year-old female recalls a brief episode of chest tightness with no
radiation or chest wall injury during her new taekwondo martial arts class. This
pain subsided during "the cool down period" of her class. Which of the
following is most likely given her presentation?
• A) Pericarditis
• B) Acute myocardial infarction
, • C) Hiatal hernia
• D) Angina pectoris
Answer: D) Angina pectoris
Rationale: Chest pain with activity and relieved at rest in a middle-aged adult
should prompt concern for myocardial ischemia (angina pectoris). This
presentation is classic for stable angina: chest tightness or pressure that occurs
with exertion (increased oxygen demand) and subsides with rest or during cool-
down when myocardial oxygen demand decreases. Angina may be substernal and
can radiate to the left arm, jaw, or back, though this patient had no radiation.
Pericarditis pain is typically pleuritic, worsened by lying flat, and improved by
leaning forward—different from this presentation. Acute myocardial infarction
would present with more severe, prolonged chest pain that does not subside with
rest and is associated with diaphoresis, nausea, and shortness of breath. Hiatal
hernia may cause chest discomfort but is not typically exertion-related and relieved
by rest. This patient's presentation requires further cardiac evaluation, including
stress testing and risk factor assessment .
5. Gloria is a 68-year-old female with a chronic history of severe anxiety
disorder presents with mild shortness of breath, fine crackles in the right lower
lobe with auscultation and a nonproductive cough. She recently "ran out of
pills." Which medication omission most likely led to her current presenting
symptoms?
• A) Metoprolol
• B) Lorazepam
• C) Furosemide
• D) Metformin
