SOUTH UNIVERSITY NSG6420 WEEK 10 FINAL EXAM (2 VERSIONS) / NSG 6420 FINAL EXAM (LATEST, 2021): (100 CORRECT Q & A IN EACH VERSION) |100% CORRECT ANSWERS, DOWNLOAD TO SCORE “A”|

SOUTH UNIVERSITY NSG6420 WEEK 10 FINAL EXAM (2 VERSIONS) / NSG 6420 FINAL EXAM (LATEST, 2021): (100 CORRECT Q & A IN EACH VERSION) |100% CORRECT ANSWERS, DOWNLOAD TO SCORE “A”| NSG 6420 FINAL EXAM Which of the following is the most common cause of heartburn-type epigastric pain? Question 1 options: a) Decreased lower esophageal sphincter tone b) Helicobacter pylori infection of stomach c) Esophageal spasm d) Peptic ulcer disease Save Question 2 (1 point) An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? Question 2 options: a) Identification of a fluid wave b) Positive Murphy’s sign c) Palpable spleen d) Midepigastric pain that is not reproducible with palpation Save Question 3 (1 point) Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: Question 3 options: a) Diverticulitis b) Colon cancer c) Appendicitis d) Peptic ulcer disease Save Question 4 (1 point) A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: Question 4 options: a) Digital rectal examination b) Endoscopy c) Pelvic examination d) Urinalysis Save Question 5 (1 point) A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: Question 5 options: a) Appendicitis b) Cholecystitis c) Bowel Obstruction d) Diverticulitis Save Question 6 (1 point) Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? Question 6 options: a) Viral gastroenteritis b) Staphylococcal food poisoning c) Acute hepatitis A d) E coli gastroenteritis Save Question 7 (1 point) A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: Question 7 options: a) CBC with differential b) Stool culture and sensitivity c) Abdominal X-ray d) Colonoscopy Save Question 8 (1 point) A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Question 8 options: a) Peptic ulcer disease b) Barrett’s esophagus c) Esophageal varices d) Pancreatitis Save Question 9 (1 point) An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: Question 9 options: a) Mallory-Weiss tear b) Esophageal varices c) Gastric ulcer d) Colon cancer Save Question 10 (1 point) When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to: Question 10 options: a) Use all the medication b) Do not use for possible infectious diarrhea c) Use should exceed one week for effectiveness d) These drugs provide exactly the same pharmaceutical effects Save Question 11 (1 point) When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? Question 11 options: a) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. b) Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. c) Sit up for an hour after taking any medication and restrict fluid intake. d) Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal. Save Question 12 (1 point) In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Question 12 options: a) Left upper quadrant b) Right upper quadrant c) Left lower quadrant d) Right lower quadrant Save Question 13 (1 point) Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? Question 13 options: a) It is highly contagious and a mask should be worn at home. b) Treatment regimen is multiple lifetime medications. c) Treatment regimen is multiple medications taken daily for a few weeks. d) Treatment regimen is complicated and is not indicated unless the patient is symptomatic. Save Question 14 (1 point) An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? Question 14 options: a) Atypical pneumonia b) Peptic ulcer disease c) Gastroesophageal reflux d) Mononucleosis (Epstein-Barr) Save Question 15 (1 point) Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? Question 15 options: a) Cases of dyspepsia with constipation b) Symptoms persisting after six to eight weeks of therapy c) All clients with dyspepsia who smoke and drink alcohol d) When a therapeutic response to empiric treatment is obtained Save Question 16 (1 point) A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: Question 16 options: a) Inflammatory bowel disease b) Irritable bowel syndrome c) Giardiasis d) Norovirus gastroenteritis Save Question 17 (1 point) What test is used to confirm the diagnosis of appendicitis? Question 17 options: a) CBC b) Flat plate of abdomen c) Rectal exam d) CT of abdomen with attention to appendix Save Question 18 (1 point) If it has been determined a patient has esophageal reflux, you should tell them: Question 18 options: a) They probably have a hiatal hernia causing reflux b) They probably need surgery c) They should avoid all fruit juices d) Smoking, alcohol, and caffeine can aggravate their problem Save Question 19 (1 point) A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? Question 19 options: C-reactive protein level of 3 mg White blood cell count of 11,000 Direct serum bilirubin level of 0.3 mg/dl Serum amylase level of 145 U/L Save Question 20 (1 point) Which of the following is not a contributing factor to the development of esophagitis in older adults? Question 20 options: a) Increased gastric emptying time b) Regular ingestion of NSAIDs c) Decreased salivation d) Fungal infections such as Candida Save Question 21 (1 point) The major impact of the physiological changes that occur with aging is: Question 21 options: a) Reduced physiological reserve b) Reduced homeostatic mechanisms c) Impaired immunological response d) All of the above Save Question 22 (1 point) Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Question 22 options: a) Less obesity rates than women b) Prostate enlargement c) More testosterone than women d) Less estrogen than women Save Question 23 (1 point) The cytochrome p system involves enzymes that are generally: Question 23 options: a) Inhibited by drugs b) Induced by drugs c) Inhibited or induced by drugs d) Associated with decreased liver perfusion Save Question 24 (1 point) Functional abilities are best assessed by: Question 24 options: a) Self-report of function b) Observed assessment of function c) A comprehensive head-to-toe examination d) Family report of function Save Question 25 (1 point) When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Question 25 options: a) Hemoglobin >8 g/dl, MCV increased, MCH increased b) Hemoglobin >12 g/dl, MCV increased, MCH increased c) Hemoglobin >8 g/dl, MCV decreased, MCH decreased d) Hemoglobin >12 g/dl, MCV decreased, MCH increased Save Question 26 (1 point) Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Question 26 options: a) Hemoglobin and Hematocrit b) Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) c) Serum ferritin and Serum iron d) Total iron binding capacity and transferrin saturation Save Question 27 (1 point) The pathophysiological hallmark of ACD is: Question 27 options: a) Depleted iron stores b) Impaired ability to use iron stores c) Chronic uncorrectable bleeding d) Reduced intestinal absorption of iron Save Question 28 (1 point) The main focus of treatment of patients with ACD is: Question 28 options: a) Replenishing iron stores b) Providing for adequate nutrition high in iron c) Management of the underlying disorder d) Administration of monthly vitamin B12 injections Save Question 29 (1 point) In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? Question 29 options: a) Serum iron b) Total iron binding capacity c) Transferrin saturation d) Serum ferritin Save Question 30 (1 point) Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except: Question 30 options: a) Sore throat b) Fever c) Weight loss d) Headache Save Question 31 (1 point) Essential parts of a health history include all of the following except: Question 31 options: a) Chief complaint b) History of the present illness c) Current vital signs d) All of the above are essential history components Save Question 32 (1 point) Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Question 32 options: a) Clinical practice guideline b) Clinical decision rule c) Clinical algorithm d) Clinical recommendation Save Question 33 (1 point) The first step in the genomic assessment of a patient is obtaining information regarding: Question 33 options: a) Family history b) Environmental exposures c) Lifestyle and behaviors d) Current medications Save Question 34 (1 point) In autosomal recessive (AR) disorders, individuals need: Question 34 options: a) Only one mutated gene on the sex chromosomes to acquire the disease b) Only one mutated gene to acquire the disease c) Two mutated genes to acquire the disease d) Two mutated genes to become carriers Save Question 35 (1 point) In AR disorders, carriers have: Question 35 options: a) Two mutated genes; one from each parent that cause disease b) A mutation on a sex chromosome that causes a disease c) A single gene mutation that causes the disease d) One copy of a gene mutation but not the disease Save Question 36 (1 point) A woman with an X-linked dominant disorder will: Question 36 options: a) Not be affected by the disorder herself b) Transmit the disorder to 50% of her offspring (male or female) c) Not transmit the disorder to her daughters d) Transmit the disorder to only her daughters Save Question 37 (1 point) According to the Genetic Information Nondiscrimination Act (GINA): Question 37 options: a) Nurse Practitioners (NPs) should keep all genetic information of patients confidential b) NPs must obtain informed consent prior to genetic testing of all patients c) Employers cannot inquire about an employee’s genetic information d) All of the above Save Question 38 (1 point) Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Question 38 options: a) Colon cancer in family member at age 70 b) Breast cancer in family member at age 75 c) Myocardial infarction in family member at age 35 d) All of the above Save Question 39 (1 point) Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: Question 39 options: a) Variable expressivity related to inherited disease b) Dysmorphic features related to genetic disease c) De novo mutations of genetic disease d) Different penetrant signs of genetic disease Save Question 40 (1 point) In order to provide a comprehensive genetic history of a patient, the NP should: Question 40 options: a) Ask patients to complete a family history worksheet b) Seek out pathology reports related to the patient’s disorder c) Interview family members regarding genetic disorders d) All of the above Save Question 41 (1 point) An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: Question 41 options: a) Acoustic neuroma b) Cerumen impaction c) Otitis media d) Ménière’s disease Save Question 42 (1 point) In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Question 42 options: a) Bacterial sinusitis b) Allergic rhinitis c) Drug abuse d) Skull fracture Save Question 43 (1 point) Which of the following symptoms is common with acute otitis media? Question 43 options: a) Bulging tympanic membrane b) Bright light reflex of tympanic membrane c) Increased tympanic membrane mobility d) All of the above Save Question 44 (1 point) Presbycusis is the hearing impairment that is associated with: Question 44 options: a) Physiologic aging b) Ménière’s disease c) Cerumen impaction d) Herpes zoster Save Question 45 (1 point) Epistaxis can be a symptom of: Question 45 options: a) Over-anticoagulation b) Hematologic malignancy c) Cocaine abuse d) All of the above Save Question 46 (1 point) Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Question 46 options: a) Malignant melanoma b) Squamous cell carcinoma c) Aphthous ulceration d) Behcet’s syndrome Save Question 47 (1 point) Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: Question 47 options: a) Thrush b) Laryngeal cancer c) Carotidynia d) Thyroiditis Save Question 48 (1 point) Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? Question 48 options: a) History of bright flash of light followed by significantly blurred vision b) History of transient and painless monocular loss of vision c) History of monocular severe eye pain, blurred vision, and ciliary flush d) All of the above Save Question 49 (1 point) The first assessment to complete related to the eyes is: Question 49 options: a) Eye lids b) Visual acuity c) Extraocular movements d) Peripheral vision It is important to not dilate the eye if ____ is suspected. Question 50 options: a) Cataract b) Macular degeneration c) Acute closed-angle glaucoma d) Chronic open-angle glaucoma Save Question 51 (1 point) Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Question 51 options: Checking the macula Estimating cup-to-disk ratio Verifying a red reflex Extraocular movements Save Question 52 (1 point) The most common cause of eye redness is: Question 52 options: a) Conjunctivitis b) Acute glaucoma c) Head trauma d) Corneal abrasion Save Question 53 (1 point) A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Question 53 options: a) Bacterial conjunctivitis b) Allergic conjunctivitis c) Chemical conjunctivitis d) Viral conjunctivitis Save Question 54 (1 point) In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? Question 54 options: a) History of prior red-eye episodes b) Grossly visible corneal defect c) Exophthalmos d) Photophobia Save Question 55 (1 point) A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Question 55 options: a) Bacterium b) Allergen c) Virus d) Fungi Save Question 56 (1 point) Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Question 56 options: a) Sinus pain, increased vascular permeability, and bronchodilation b) Bronchospasm, vascular permeability, and vasodilatation c) Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction d) Vasodilatation, bronchodilation, and increased vascular permeability Save Question 57 (1 point) You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Question 57 options: a) Ménière’s disease b) Benign paroxysmal positional vertigo c) Transient ischemic attack (TIA) d) Migraine Save Question 58 (1 point) In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Question 58 options: a) Fictional keratosis b) Keratoacanthoma c) Lichen planus d) Leukoplakia Save Question 59 (1 point) Rheumatic heart disease is a complication that can arise from which type of infection? Question 59 options: a) Epstein-Barr virus b) Diphtheria c) Group A beta hemolytic streptococcus d) Streptococcus pneumoniae Save Question 60 (1 point) A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Question 60 options: a) Mono spot b) Strep test c) Throat culture d) All of the above Save Question 61 (1 point) Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Question 61 options: a) Seasonal allergies b) Acute bronchitis c) Bronchial asthma d) Chronic bronchitis Save Question 62 (1 point) A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: Question 62 options: a) 50 x 2-pack years b) 100-pack years c) 50-year, 2-pack history d) 100-pack history Save Question 63 (1 point) Emphysematous changes in the lungs produce the following characteristic in COPD patients? Question 63 options: a) Asymmetric chest expansion b) Increased lateral diameter c) Increased anterior-posterior diameter d) Pectus excavatum Save Question 64 (1 point) When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: Question 64 options: a) No palpable vibration is felt b) Decreased fremitus is felt c) Increased fremitus is felt d) Vibration is referred to the non-obstructed lobe Save Question 65 (1 point) During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: Question 65 options: a) COPD b) Pneumothorax c) A normal finding d) Pleural effusion Save Question 66 (1 point) Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Question 66 options: a) Computed tomography (CT) scan b) Chest X-ray with PA, lateral, and lordotic views c) Ultrasound d) Positron emission tomography (PET) scan Save Question 67 (1 point) Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: Question 67 options: a) Pneumothorax b) Pleural effusion c) Pneumonia d) Pulmonary embolism Save Question 68 (1 point) A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? Question 68 options: a) Pulmonary edema b) Heart failure c) Pulmonary embolism d) Pneumonia Save Question 69 (1 point) A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Question 69 options: a) Exercise-induced cough b) Bronchiectasis c) Alpha-1 deficiency d) Pericarditis Save Question 70 (1 point) A cough is described as chronic if it has been present for: Question 70 options: a) 2 weeks or more b) 8 weeks or more c) 3 months or more d) 6 months or more Save Question 71 (1 point) Which of the following medications are commonly associated with the side effect of cough? Question 71 options: a) Beta blocker b) Diuretic c) ACE inhibitor d) Calcium antagonist Save Question 72 (1 point) Which of the following details are NOT considered while staging asthma? Question 72 options: a) Nighttime awakenings b) Long-acting beta agonist usage c) Frequency of symptoms d) Spirometry findings Save Question 73 (1 point) The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Question 73 options: a) Age over 40 b) Fever greater than 101 c) Tachypnea greater than 30 breaths/minute d) Productive cough Save Question 74 (1 point) The most common etiologic organism for community-acquired pneumonia is: Question 74 options: a) Streptococcus pneumoniae b) Beta hemolytic streptococcus c) Mycoplasma d) Methicillin resistant staphylococcus Save Question 75 (1 point) A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Question 75 options: a) Can be treated as an outpatient b) Requires hospitalization for treatment c) Requires a high dose of parenteral antibiotic d) Can be treated with oral antibiotics Save Question 76 (1 point) Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Question 76 options: a) Fever of 102 b) Infiltrates on chest X-ray c) Pleural effusion on chest X-ray d) Elevated white blood cell count Save Question 77 (1 point) A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Question 77 options: a) Barrel-shaped chest b) Clubbing c) Pectus excavatum d) Prolonged capillary refill Save Question 78 (1 point) Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: Question 78 options: a) Legionnaires' disease b) Malaria c) Tuberculosis d) Pneumonia Save Question 79 (1 point) A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Question 79 options: a) Lung cancer b) Tuberculosis c) Pneumonia d) COPD Save Question 80 (1 point) A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Question 80 options: a) Pulmonary embolism b) Pleural effusion c) Pneumothorax d) Fracture of ribs Save Question 81 (1 point) Which of the following is the most important question to ask during cardiovascular health history? Question 81 options: a) Number of offspring b) Last physical exam c) Sudden death of a family member d) Use of caffeine Save Question 82 (1 point) Aortic regurgitation requires medical treatment for early signs of CHF with: Question 82 options: a) Beta blockers b) ACE inhibitors c) Surgery d) Hospitalization Save Question 83 (1 point) A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Question 83 options: a) Women with ischemic heart disease many times do not present with chest pain b) Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction c) Elderly patients have the most severe symptoms d) A & B only Save Question 84 (1 point) The best evidence rating drugs to consider in a post myocardial infarction patient include: Question 84 options: ASA, ACE/ARB, beta-blocker, aldosterone blockade ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates Save Question 85 (1 point) A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: Question 85 options: a) Echocardiogram b) Exercise stress test c) Cardiac catheterization d) Myocardial perfusion imaging Save Question 86 (1 point) Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: Question 86 options: a) Mitral Valve Prolapse b) Referred Pain from Cholecystitis c) Pericarditis d) Pulmonary Embolus Save Question 87 (1 point) Which symptom is more characteristic of Non-Cardiac chest pain? Question 87 options: a) Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm b) Pain tends to occur with movement, stretching or palpation c) Pain usually lasts less than 10 minutes and is relieved by nitroglycerine d) Pain is aggravated by exertion or stress Save Question 88 (1 point) What is the most common valvular heart disease in the older adult? Question 88 options: a) Aortic regurgitation b) Aortic stenosis c) Mitral regurgitation d) Mitral stenosis Save Question 89 (1 point) Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? Question 89 options: a) Acute MI b) GERD c) Pneumonia d) Angina Save Question 90 (1 point) Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Question 90 options: a) Angina b) Pericarditis c) Mitral valve prolapse d) Congestive heart failure Save Question 91 (1 point) Which test is the clinical standard for the assessment of aortic stenosis? Question 91 options: a) Cardiac catheterization b) Stress test c) Chest X-ray d) Echocardiography Save Question 92 (1 point) The aging process causes what normal physiological changes in the heart? Question 92 options: a) The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis b) Cardiology occurs along with prolapse of the mitral valve and regurgitation c) Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves d) Hypertrophy of the right ventricle Save Question 93 (1 point) Which of the following statements is true concerning anti-arrhythmic drugs? Question 93 options: a) Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. b) Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. c) Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. d) Anti-arrhythmic therapy should be initiated in the hospital for all patients. Save Question 94 (1 point) Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? Question 94 options: a) Musculoskeletal chest wall syndrome with radiation b) Esophageal motor disorder with radiation c) Acute cholecystitis with cholelithiasis d) Coronary artery disease with angina pectoris Save Question 95 (1 point) A common auscultatory finding in advanced CHF is: Question 95 options: a) Systolic ejection murmur b) S3 gallop rhythm c) Friction rub d) Bradycardia Save Question 96 (1 point) Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: Question 96 options: a) Anemia b) Anxiety c) Hyperthyroidism d) All of the above Save Question 97 (1 point) The best way to diagnose structural heart disease/dysfunction non-invasively is: Question 97 options: a) Chest X-ray b) EKG c) Echocardiogram d) Heart catheterization Save Question 98 (1 point) During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Question 98 options: a) Pneumonia b) Pleuritis c) Pneumothorax d) A and B Save Question 99 (1 point) A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? Question 99 options: a) Arterial insufficiency b) Femoral vein thrombus c) Venous insufficiency d) Peripheral neuropathy Save Question 100 (1 point) Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Question 100 options: a) Femoral vein thrombosis b) Femoral artery thrombus c) Venous insufficiency d) Musculoskeletal injury Save Question 101 (1 point) (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? Question 101 options: a) Abdominal plain films b) Liver function tests c) Amylase/lipase d) Urinalysis Save Question 102 (1 point) (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? Question 102 options: a) Abdominal upright and flat plate x-ray b) Abdominal MRI c) Abdominal CT scan with contrast d) Abdominal ultrasound Save Question 103 (1 point) (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? Question 103 options: a) Trial of ursodiol b) ‘Watchful waiting’ c) Surgical consult d) HIDA scan Save Question 104 (1 point) A specific exam used to evaluate the gall bladder is: Question 104 options: a) Psoas sign b) Obturator sign c) Cullens sign d) Murphy’s sign Save Question 105 (1 point) Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. Question 105 options: a) Acute pancreatitis b) Duodenal ulcer c) Biliary colic d) Cholecystitis NSG 6420 Final Exam 1. In AR disorders, carriers have: Two mutated genes; two from one parent that cause disease A mutation on a sex chromosome that causes a disease A single gene mutation that causes the disease One copy of a gene mutation but not the disease 2. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer Tuberculosis Pneumonia COPD 3. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? It will be helpful to keep the head of your bed elevated on blocks 4. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? leukoplakia 5. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) MigraineDefinition 6. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: A. Increased estrogen production’s influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle 7. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndromeDefinition 8. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD) Hemoglobin <12 g/dl, MCV decreased, MCH decreased Hemoglobin >12 g/dl, MCV increased, MCH increased Hemoglobin <12 g/dl, MCV normal, MCH normal Hemoglobin >12 g/dl, MCV decreased, MCH increased 9. What test is used to confirm the diagnosis of appendicitis? CBC Flat plate of abdomen Rectal exam CT of abdomen with attention to appendix 10. Functional abilities are best assessed by: observed assessment of function 11. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of: Carpal tunnel syndrome Osteoarthritis of the wrist Epicondylitis Cervical osteoarthritis 12. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to Acoustic neurom Cerumen impaction Otitis media Ménière’s disease 13. Which lesions are typically located along the distribution of dermatome? Herpes Zoster 14. n differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age 15. A pneumatic otoscopic examination is used to assess: A. Inner ear conditions B. Otitis externa C. Cerumen impaction D. Tympanic membrane mobility 16. In autosomal recessive (AR) disorders, individuals need: Only one mutated gene on the sex chromosomes to acquire the disease Only one mutated gene to acquire the disease Two mutated genes to acquire the disease Two mutated genes to become carriers 17. Which of the following disorders can cause urinary incontinence? Cystocele Overactive bladder Uterine prolapse All of the above 18. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation 19. Which of the following medications are commonly associated with the side effect of cough Beta blocker B. Diuretic C. ACE inhibitor D. Calcium antagonist 20. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging 21. Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate A. Upper urinary tract infection B. Lower urinary tract infection C. Normal bacteriuria D. Urethritis 22. Epistaxis can be a symptom of: Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above 23. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition Inflammatory bowel disease Irritable bowel syndrome Giardiasis Lactose intolerance 24. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? Any presence of tremor Symptoms of slowed movement, unstable angina, and tremor Resting tremor, slow unsteady gait, and cogwheel resistance Cogwheel rigidity, bradykinesia, and amnesia 25. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight bearing and/or use of the joint D. Begins in the morning but decreases with activity 26. During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: A. COPD B. Pneumothorax C. A normal finding D. Pleural effusion 27. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Angina Pericarditis Mitral valve prolapse Congestive heart failur 28. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Pneumonia Pleuritis Pneumothorax CORRECT A and B 29. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Femoral vein thrombosis Femoral artery thrombus Venous insufficiency Musculoskeletal injury 30. Which of the following details are NOT considered while staging asthma? A. Nighttime awakenings B. Long-acting beta agonist usage C. Frequency of symptoms D. Spirometry findings 31. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms Acute MI GERD Pneumonia Angina 32. A 22-year-old female patient complains of excessive thirst, feeling “shaky when she misses meals” and increased frequency of urination. Family history is positive for cardiovascular disease, cerebrovascular disease, and diabetes. The patient denies use of tobacco, alcohol, or other drugs. She takes no medication. Daily diet is fast food, and the patient does not exercise regularly. On physical examination, there are no significant findings except obesity, demonstrated by a BMI of 35 and blood pressure of 145/ 90. The signs and symptoms are characteristic of: Type 2 diabetes mellitus B. Chronic fatigue syndrome C. Cushing’s disease D. Clinical depression 33. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? A. Beta blocker B. ACE inhibitor C. Statin medication D. Metformin 34. . Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? A. It is highly contagious and a mask should be worn at home. B. Treatment regimen is multiple lifetime medications. C. Treatment regimen is multiple medications taken daily for a few weeks. D. Treatment regimen is complicated and is not indicated unless the patient is symptomatic. 35. Which of the following is the most important question to ask during cardiovascular health history? Sudden death of a family member 36. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely Musculoskeletal chest wall syndrome with radiation Esophageal motor disorder with radiation Acute cholecystitis with cholelithiasis Coronary artery disease with angina pectoris 37. The most common neurological cause of seizures in an older adult is Alzheimer’s disease Multiple sclerosis Stroke Peripheral neuropathy 38. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B.Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C.Perform a biopsy or refer to a dermatologist. D.Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away. 39. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Peptic ulcer disease Barrett’s esophagus Esophageal varices Pancreatitis 40. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: A. 50 x 2-pack years B. 100-pack years C. 50-year, 2-pack history D. 100 pack history 41. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea A. Viral gastroenteritis B. Staphylococcal food poisoning C. Acute hepatitis A D. E.coli gastroenteritis 42. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosion 43. Rheumatic heart disease is a complication that can arise from which type of infection? Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae 44. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which ofthe following: Barrel-shaped chest Clubbing Pectus excavatum Prolonged capillary refill 45. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? A. Hemoglobin and hematocrit B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) C. Serum ferritin and serum iron D. Total iron binding capacity and transferrin saturation 46. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D. Colon cancer 47. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: A. Osteoarthritis B. Rheumatoid arthritis C. Fibromyalgia D. Polymyalgia rheumatica 48. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? . A. Tinea versicolor B.Seborrheic keratosis C.Verruca D.Herpes zoster 49. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner’s appropriate intervention is: A. Digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results 50. Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? Misoprostol (Cytotec) Cimetidine (Tagamet) Metronidazole (Flagyl) Bismuth subsalicylate (Pepto bismol) 51. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a: A. Bacterial folliculitis B. Basal cell carcinoma C. Bullous impetigo D. Epidermoid cyst 52. The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in Pityriasis Rosea Shingles Psoriasis Lymes Disease 53. The most common complication of an untreated urinary obstruction due to a ureteral calculus is: Hydronephrosis B. Renal artery stenosis C. Ureteral rupture D. Kidney mass 54. Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy C. All clients with dyspepsia who smoke and drink alcohol D. When a therapeutic response to empiric treatment is obtained 55. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider A. Diverticulitis B. Appendicitis C. Colon cancer D. Peptic ulcer diseaseDefinition 56. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is: Lower urinary tract infection Pyelonephritis Nephrolithiasis Hydonephrosis 57. Which of the following males would be at greatest risk for testicular cancer? John, a 52-year-old, married African American Attorney who lives in Detroit, MI Jacob, a 22-year-old, homosexual male, who works as an accountant, resides in Cumming GA, and has a history of cryptorchidism Andy, a 27-year-old, Caucasian, single male who resides in Waukesha, WI and works as a maintenance mechanic Ryan, a 34-year-old healthy, married man from Sweden, who works as a Registered Nurse in Boston, MA 58. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: A. Fibromyalgia B. Sarcoidosis C. Systemic lupus erythematosus D. Rheumatoid arthritis 59. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of Bacterial sinusitis Allergic rhinitis Drug abuse Skull fracture 60. A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is: A. Lead intoxication B. Illegal whiskey C. Binge-eating D. Thiazide diuretics 61. A woman complains of malaise and arthralgias. You note a butterfly-shaped, macular, erythematous rash across her cheeks and nose. These conditions are common in: A. Psoriasis B. Lichen planus C. Systemic lupus erythematosus D. Erythema nodosum 62. Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? a) Sinus pain, increased vascular permeability, and bronchodilation b) Bronchospasm, vascular permeability, and vasodilatation c) Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction d) Vasodilatation, bronchodilation, and increased vascular permeability 63. Alteration in micturition is the hallmark symptom for abdominal pain of genitourinary origin. Symptoms in alteration in micturition would include: Fever Dysuria Nausea/vomiting Right lower quadrant pain 64. Presbycusis is the hearing impairment that is associated with: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster 65. Ms. Smith, 37-year-old, comes to the clinic today complaining of dull, throbbing bilateral headaches almost every evening. You suspect she is experiencing: cluster headaches migraine headaches tension headaches benign intracranial hypertension 66. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minute Productive cough 67. A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond? . Discontinue the medication immediately B. Reassure the patient that this is an anticipated side effect C. Double the dosage of medication and have patient return in 1 week D. Order a chem. 7 to check for lactic acidosi 68. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? A. Cellulitis is two times more common in women B. Facial cellulitis is more common in people >55 C. There is low incidence of cellulitis in patients with diabetes D. Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency 69. When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. Raise the head of the bed on blocks and take the proton pump inh