NURS 6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS AND ANSWERS 2022

NURS 6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS AND ANSWERS 2022 A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)? Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial infarction Determination of pulselessness or bradycardia Assessment of gasping breaths or not breathing - Correct Answer-Assessment of gasping breaths or not breathing An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Increase the dose of the thiazide medication Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment Prescribe a calcium channel blocker - Correct Answer-Admit to the hospital for evaluation and treatment A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms? Atrial fibrillation Anemia Extrasystole Paroxysmal attacks - Correct Answer-Atrial fibrillation A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur? Aortic stenosis Tricuspid regurgitation Hypertrophic cardiomyopathy Mitral valve prolapse - Correct Answer-Hypertrophic cardiomyopathy A patient is brought to an emergency department with symptoms of acute STsegment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Transfer to the PCI-capable institution Administer heparin Initiate fibrinolytic treatment - Correct Answer-Initiate fibrinolytic treatment Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are those with a history of (Select all that apply.) previous myocardial infarction. a low-density lipoprotein (LDL) level 190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL. a 10 year risk score of 5% and an LDL of 165 mg/dL. - Correct Answer-previous myocardial infarction. a low-density lipoprotein (LDL) level 190 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL. A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What the does provider suspect as the cause for these symptoms? Buerger's disease Cauda equina syndrome Diabetic neuropathy Peripheral arterial disease - Correct Answer-Cauda equina syndrome Which are causes of secondary hypertension? (Select all that apply.) Oral contraceptives Isometic excercises NSAIDS Sleep apnea Increased salt intake - Correct Answer-Oral contraceptives NSAIDS Sleep apnea A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do? Reassure the patient that these findings are expected Continue to monitor the patient every 3 years Admit the patient to the hospital for evaluation and treatment Consult with cardiology to determine appropriate diagnostic tests - Correct AnswerConsult with cardiology to determine appropriate diagnostic tests A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon US of the mass to determine size Ordering CT angiography - Correct Answer-US of the mass to determine size A patient is brought to an emergency department with symptoms of acute STsegment elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin Transfer to the PCI-capable institution - Correct Answer-Initiate fibrinolytic treatment A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient? Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels Order urinalysis, CBC, BUN and creatinine Refer to specialist for sleep study - Correct Answer-Order urinalysis, CBC, BUN and creatinine A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient? Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent clotting Walking slowly for 15 to 20 minutes twice daily - Correct Answer-Walking to the point of pain each day An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minute. What will the provider do next? Order an electrocardiogram and exercise stress test Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital signs Reassure the patient that the symptoms are non-cardiac in origin - Correct AnswerEvaluate the patient's orthostatic vital signs The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia? Atrial flutter Ventricular fibrillation Atrial fibrillation Ventricular tachycardia - Correct Answer-Ventricular fibrillation A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency department. What initial intervention may be attempted in the clinic? Administration of intravenous adenosine Using a vagal maneuver or carotid massage Providing a loading dose of digoxin Giving a beta blocker - Correct Answer-Using a vagal maneuver or carotid massage Current American Heart Association (AHA) recommendations include: (Select all that apply.) Using a ratio of 2 rescue breaths to 30 compressions A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths Rescue breaths given during 2 seconds to allow full chest rise - Correct AnswerUsing a ratio of 2 rescue breaths to 30 compressions A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action? Prescribe a calcium channel blocker medication Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication Administer a second nitroglycerin tablet - Correct Answer-Give the patient a beta blocker medication A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient? No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular stent grafting of the aneurysm Serial ultrasonographic surveillance of the aneurysm - Correct Answer-Serial ultrasonographic surveillance of the aneurysm Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Appropriately increased PTH and low or normal serum calcium Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - Correct Answer-Inappropriate secretion of PTH along with hypercalcemia A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? Hemoglobin A1C Random serum glucose C-peptide level Thyroid studies - Correct Answer-Hemoglobin A1C Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3-4) 0.2 uIU/L 4.2 uIU/L 0.4 uIU/L 2.4 uIU/L - Correct Answer-0.2 uIU/L A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Radioiodine therapy Surgical resection of the thyroid gland Beta blocker medications Thionamide therapy - Correct Answer-Beta blocker medications A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? Avoidance of weight bearing exercises Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until values normal Parathyroidectomy - Correct Answer-Annual monitoring of calcium, creatinine, and bone density A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Serum calcitonin Radionucleotide imaging Serum TSH level Thyroid ultrasound - Correct Answer-Thyroid ultrasound Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Appropriately increased PTH and low or normal serum calcium - Correct AnswerInappropriate secretion of PTH along with hypercalcemia What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause increased insulin resistance. They predispose patients to dyslipidemia. They lower the risk of hypertension. They increase the risk of arterial thrombosis. - Correct Answer-They increase the risk of arterial thrombosis. A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by the primary care provider is indicated for management of this patient? Consulting with a nephrologist Prescribing an antihypertensive medication Referring to an ophthalmologist Limiting protein intake - Correct Answer-Consulting with a nephrologist A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She will need lifelong medication. A thyroidectomy will be necessary. This condition may be transient. She should be referred to an endocrinologist. - Correct Answer-This condition may be transient. Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment Left ventricular hypertrophy Renal calculi Perioral paresthesias Chvostek's sign - Correct Answer-Cognitive impairment Left ventricular hypertrophy Renal calculi Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Aspirin Niacin Atorvastatin Metformin - Correct Answer-Metformin A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones Injection of rapid-acting insulin - Correct Answer-Giving a rapid-acting carbohydrate A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient: that strict diet and exercise measures may be relaxed with insulin therapy. it is necessary because the patient cannot comply with the previous regimen. this is because of the natural progression of the disease. the use of insulin therapy may be temporary. - Correct Answer-this is because of the natural progression of the disease. A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms? Bronchodilator treatment Mucokinetic agents Antitussive medication Antibiotic therapy - Correct Answer-Antitussive medication A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Chest radiograph Complete blood count Computerized tomography Spirometry - Correct Answer-Complete blood count A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? Administering two more doses of albuterol Taking an oral corticosteroid Coming to the clinic for evaluation Going to the emergency department - Correct Answer-Administering two more doses of albuterol The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this patient? The infant should have an influenza vaccine now with a booster in 1 month The infant should be given prophylactic antiviral medications The rest of the family and all close contacts should have the influenza vaccine The infant should have the live attenuated influenza vaccine (LAIV) - Correct Answer-The rest of the family and all close contacts should have the influenza vaccine A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient's symptoms? Thromboembolism Infection Malignancy Lung abscess - Correct Answer-Infection An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient's dyspnea? Opioid medications Anxiolytic drugs Supplemental oxygen Breathing exercises - Correct Answer-Breathing exercises A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient? Arterial blood gases ventilation/perfusion scan Spirometry Blood cultures - Correct Answer-Spirometry A patient with hemoptysis and no other symptoms has a normal chest radiograph, CT, and fiberoptic bronch studies. What is the next action in managing this patient? Observation Refer to specialist Surgical intervention Prophylactic ABX - Correct Answer-Observation Which clinical sign is especially worrisome in a patient with a pulmonary embolism? TachycardiaAsw Dyspnea Hypotension Abnormal lung sounds - Correct Answer-Hypotension A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient reports improvement in symptoms. What is the next action in treating this patient? Schedule an upper endoscopy Continue the proton pump inhibitor Refer the patient to a gastroenterologist Order esophageal pH monitoring - Correct Answer-PPI A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain? Pleural pain Cardiac pain Aortic dissection pain Esophageal pain - Correct Answer-Esophageal pain A patient who has a central line develops respiratory compromise. What is the initial intervention for this patient? Obtaining cultures and starting antibiotics Lung ultrasonography to determine the cause Prompt removal of the central line Rapid assessment and resuscitation - Correct Answer-Rapid assessment and resuscitation A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient's pneumonia? S. pneumonia A virus Mycoplasma Tuberculosis - Correct Answer-Mycoplasma A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next? Recommend an NSAID Prescribe an antibiotic Refer to a cardiologist Order a chest radiograph - Correct Answer-Recommend an NSAID A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient? Increasing the dose of the antibiotics Open lung biopsy Performing diagnostic bronchoscopy Administration of the pneumonia vaccine - Correct Answer-Performing a diagnostic broncho A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? A respiratory fluoroquinolone antibiotic Empiric treatment with a macrolide antibiotic Hospitalization for intravenous antibiotics A B-lactam antibiotic plus a fluoroquinolone - Correct Answer-Empiric treatment with a macrolide antibiotic Which are causes of pleural effusions? (Select all that apply.) Bronchiectasis Breast Cancer Dehydration Congestive Heart failure Allergies - Correct Answer-Bronchiectasis Breast Cancer Congestive Heart failure An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient?...