NR 511 final exam Questions and Answers with complete

NR 511 final exam Patient presents with mid epigastric pain, LUQ radiating to back, mild to very severe pain. Also has associated nausea and vomiting diaphoresis, pain is worse with lying supine. Physical assessment shows diminished bowel sounds and abdominal arteriogram. - Answer-mesenteric infarction Patient presents with a colicky flank pain progressing to constant and severe radiating to the groin in both lower quadrant, patient has associated nausea vomiting fever chills and abdominal distention. Costovertebral angle tenderness hematuria; do urinalysis IVP and US - Answer-Urinary stones/kidney stones Patient presents with severe, parietal, diffuse pain; has associated guarding, rebound tenderness, pain is relieved while lying still. Physical exam shows decreased bowel sounds, guarding, rebound tenderness; get abdominal x-ray - Answer-intestinal perforation Patient presents with colicky right lower quadrant and left lower quadrant pain; has associated nausea vomiting, Anorexia, obstipation; physical exam shows hyperactive high-pitched bowel sounds are hypo active bowel sounds, get an abdominal x-ray - Answer-intestinal obstruction Patient presents with severe, visceral, diffuse pain. Has associated hypotension tachycardia; pain is relieved by leaning forward. Physical exam shows abdominal distention, diminished bowel sounds, diffuse rebound tenderness; will have elevated amylase levels - Answer-Pancreatitis Patient will present with persistent right lower quadrant pain or left lower quadrant pain. May have vaginal bleeding. Physical exam will show tender adnexal mass and will have a positive hCG test. - Answer-ectopic pregnancy Patient will present with ripping, tearing, intense pain in chest, abdomen, lower back. Will have associated hypotension, feelings of doom, shock. Physical exam will show shock, diminished femoral pulses; get x-ray and CT scan - Answer-Dissection or Rupture of Aortic Aneurysm Patient presents with annoying pain in epigastric region radiating to the back, right shoulder, or side. Associated nausea, hunger; worse with empty stomach, alcohol, NSAIDs, ASA; relieved with food and antacids. Will have epigastric tenderness to palpation. Studies done is endoscopy and barium swallow - Answer-Peptic Ulcer Disease (PUD)Patient will present with epigastric, retrosternal pain. This pain will be intermittent. Patient may have sour taste, low-grade bleeding, hoarseness, pharyngitis; worse with bending at the waist, NSAIDs, ASA, alcohol, caffeine, recumbency; relieved with antacids. Test are barium swallow, upper G.I., esophageal endoscopy with biopsy - Answer-gastroesophageal reflux disease (GERD) Patient will present with epigastric pain that is constant. May have associated nausea, vomiting, diarrhea, fever, hemorrhage; worse with alcohol, NSAIDs, aspirin; is rarely worse with food - Answergastritis Patient will present with right lower quadrant and or left lower quadrant pain. Pain will be worse around menstruation and when ascending stairs. There will be cervical motion and adnexal tenderness - Answer-salpingitis Patient will present with left lower quadrant pain right lower quadrant pain the pain will be intermittent and recurrent. Will have associated diarrhea, mucus in store; worse with stress and eating; often relieved by defecation. There will be: tender to palpation; small bowel follow through to rule out other causes - Answer-irritable bowel syndrome (IBS) Patient will present with pain in the right lower quadrant and left lower quadrant; may have diarrhea, weight loss, rectal bleeding, tenesmus, fever; worse with stress. Physical exam will show tenderness in the right lower quadrant left lower quadrant; order CBC with differential small bowel follow through (crohns) and a colonoscopy (UC) - Answer-Inflammatory bowel disease (Crohn's disease, ulcerative colitis) This pain will be diffuse. May have associated nausea, vomiting, diarrhea, fever, chills; worse with food; relieved with vomiting or defecation. Physical exam will show hyperactive bowel sounds; stool ova and parasites, stool culture - Answer-gastroenteritis Patient will present with left lower quadrant intermittent pain. May have associated constipation, diarrhea, fever. Physical assessment Michelle left lower quadrant mass, mild tenderness in the left iliac fossa; laparoscopy will diagnose; other labs are normal - Answer-Diverticulitis Patient will present with right upper quadrant pain radiating to the infrascapular region, also mid at the gastric pain; starts as visceral progressing to parietal. May have associated nausea, vomiting, jaundice, dark urine, light colored stools, fever, chills; worse with high fat foods, estrogen containing medication, cholestyramine. Order ultrasound, CBC with differential, liver function test, amylase - Answer-Cholecystitis/CholelithiasisPatient will present with epigastrium or Peri umbilical pain later may turn into right lower quadrant pain. Pain starts as a cute visceral progressing to parietal. May present with vomiting, fever, constipation; pain is worse with movement and coughing, relieved by lying still. Physical exam will show right lower quadrant guarding and rebound tenderness; order CBC with differential, ultrasound, CT - Answer-Appendicitis Generally results from a diet that is low in fiber, sedentary lifestyle, holding stool - Answer-Functional constipation Most often seen an older adults and is caused by slowed transit time - Answer-disordered motility constipation Often is a result of medication such as opioids, anal Jesus, calcium channel blockers, antidepressants, anti-Parkinson drugs, cough medicine, aluminum antacids - Answer-Secondary constipation Patient should be instructed to slowly increase the amount of dietary fiber to 25 to 35 g per day at least 12 to 15 g at breakfast. Mild exercise in the morning is often helpful. Uninterrupted toilet time in the morning is also helpful. Patient needs to be instructed about adequate hydration and should be encouraged to drink at least 64 ounces of fluid daily - Answer-What is the management of simple constipation Increase fluid intake with electrolytes, if afebrile then use loperamide or Imodium or Pepto-Bismol empirical treatment with antibiotics is not recommended - Answer-management of diarrhea occasionally described as extreme pain, and this makes it difficult to distinguish heartburn pain from angina pectoris or myocardial infarction. patients sometimes describe heartburn as a pain that radiates to the back, arms, or jaw. - Answer-Heartburn Symptoms of this include epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, nausea, heartburn, vomiting, bloating, dysphasia, and abdominal burning - Answerdyspepsia (indigestion) Penicillin - Answer-The main principle of management for prostatitis is to treat the patient on an outpatient basis if he is afebrile. All of the following antibiotics are recommended in the pharmacologic treatment in men with bacterial prostatitis exceptUrethral stricture - Answer-A 72-year-old and married sexually active white man presents to your clinic with complaints of hesitancy, urgency and occasional uncontrolled dribbling. Although the nurse practitioner suspects BPH, what else should be the differential diagnosis Symptomatic sexually transmitted disease - Answer-A bladder tumor antigen test may be positive with Reduce action of androgens in the prostate - Answer-The action of a five alpha reductase inhibitor in the treatment of BPH is to balanoposthitis - Answer-What is the medical terminologies for inflammation of the glands and prepuce Alprostadil (Caverjet) - Answer-A patient is being treated for erectile dysfunction. The patient is morbidly obese and has been treated for cardiovascular disease and coagulopathy. Which of the following medication's would be contraindicated Orchitis - Answer-A patient's chief complaint is heaviness in the scrotum the nurse practitioner assesses the swelling of the testes, along with warm scrotal skin. What differential diagnosis is most probable Peyronie's disease - Answer-Harris age 68 is complaining of crooked painful directions. He has palpable, nontender, hard Plex just beneath the skin of his penis. Based on the chief complaint in assessment what is the most likely differential diagnosis A nocturnal penile tumescence and rigidity test - Answer-Morris, age 52, is in a new relationship and is not sure whether his erectile dysfunction is caused bus stress about his performance or is organic. What simple test could you suggest To determine if he has the ability to have an erection Human chorionic Gonadotropin(HCG), alpha-fetoprotein(AFP), lactate dehydrogenase(LDH) - AnswerWhat bio chemical markers would be ordered and analyzed for disease progression or remission after treatment of testicular cancer Bladder infection - Answer-What is the most common cause of gross hematuria in the male populationChronic bacterial prostatitis - Answer-72-year-old male presents to the clinic with complaints of a weak urine stream, hesitancy, painful ejaculation. On digital rectal exam you know that the prostate is boggy. The most common cause of his symptoms is Indirect inguinal hernia - Answer-What is the most common type of hernia in the male population C-reactive protein (CRP) - Answer-Which blood test is nonspecific method and most helpful for evaluating the severity and course of an inflammatory process Pain at the elbow with restricted movement at the wrist and forearm - Answer-Miss Thomas was seen in the office complaining of pain point tenderness in the area of her elbow. The pain has increased following a day gardening one week ago. I physical finding that differentiates a diagnosis and is most consistent with lateral epicondylitis or tennis elbow is The uninvolved side should be examined initially and then compared to the involved side - AnswerWhich of the following statements concerning the musculoskeletal examination is true Calcium TSH - Answer-A 25-year-old patient possessed to the clinic with fatigue, cold intolerance, weight gain, and constipation for the fat past three months. I'm physical examination the clinician nose is Santa spray to Cardia, muscle stiffness, course dry hair and a delay in relaxation of deep tendon reflexes. Which of the following test should be order next Glucotrol - Answer-Which of the following medication's for type two diabetes mellitus should not be prescribed during pregnancy An enlarged rubbery gland - Answer-During a digital rectal exam on a 75-year-old man, the clinician suspects the patient has prostate cancer. Which finding should make the clinician suspicious Immobilize the insect with 2% lidocaine - Answer-Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress what should be your first step Benign prosthetic hyperplasia, Parkinson's disease and prostate cancer - Answer-An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnosis? Joint swelling and immobility on rising - Answer-Early rheumatoid disease is characterized by:a. Pain and swelling in both small and large peripheral joints b. Rigid joints with diminished range of motion c. Joint swelling and immobility on rising d. A cardiac rub or pulmonary friction rub You should first obtain a wrist x-ray and place her wrist in a splint or prescribe a splint - Answer-A 70- year-old female has fallen two weeks ago and developed immediate pain in her left wrist. She thought she just bruised it and is worried because it has not improved. She has tried Tylenol and ice at home, and that has helped slightly. You examine her and find that she has a moderate swelling and Ekhymosis but is not overtly obvious deformity her range of motion is uncomfortable and severely diminished due to the pain. No crepitus is heartfelt. Her fingers are warm; her pulse is strong; and capillary refill is less than two seconds what should you do The scrotum will appear light pink or yellow - Answer-A 60-year-old man presents with an in large scrotum the clinician used as a pen light to transilluminate the scrotum. In a patient with a hydrocele what should the connection expect to find articular - Answer-You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: A. Articular B. Inflammatory C. Nonarticular D. A and B 1,500 mg/day - Answer-What is the recommended daily calcium intake for adults over the age of 50 with low bone mass Analysis of partner sperm - Answer-When assessing a woman for infertility, which of the following test should be done first? three - Answer-As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin Unilateral ridicular pain symptoms that extend below the knee and are equal to or greater than the back pain - Answer-Sam is a 25-year-old who has been diagnosed with low back strain based on hishistory of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? a. Morning stiffness and limited mobility of the lumbar spine b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain c. Fever, chills, and elevated erythrocyte sedimentation rate d. Pathologic fractures, severe night pain, weight loss, and fatigue Testosterone level - Answer-A 30-year-old man is saying with a chief complaint of loss of libido which of the following laboratory test would help establish a diagnosis I'll take my pill at least 30 minutes before breakfast - Answer-The clinician prescribes glipizide for a diabetic patient. Which statement made by the patient with indicate that you're teaching has been a Erythematous SLE - Answer-What is the second most common connective tissue disease and most destructive to the joints Refer to urologist immediately - Answer-A 14-year-old male a scene with complaints of severe testicular pain. The clinician suspects testicular torsion which of the following is an appropriate action Prednisone - Answer-Which of the following medication can cause hyperglycemia Fluoxetine - Answer-Which of the following is the Only drug for bulimia approved by the US food and drug administration McMurray circumduction test - Answer-John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? Pain - Answer-What is the Cardinals subjective symptoms of sickle cell crisisEndometriosis - Answer-A 25-year-old woman is seen in the clinic complaining of painful menstruation period which of the following pelvic pathologies is most common cause of dysmenorrhea Brown recluse spider - Answer-Which Arthropod bite can Contain cytotoxic and hemolytic toxins that may destroy Tissue Paresthesia of the perineum and buttocks - Answer-Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? Pregnancy test - Answer-A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following test as essential before prescribing oral contraceptives syngeneic - Answer-Which type of bone marrow transplant is obtained from an identical twin Carbon monoxide - Answer-Pink, cherry red tissues and skin my result from which type of poisoning Testicular cancer, inguinal hernia, varicocele - Answer-A 22-year-old male is seen in the clinic because he found a hard bump in his testicle when performing self testicular exam which of the following should be included in the list of differential diagnosis Radical orchiectomy - Answer-Which of the following treatment of choice for a patient diagnosis with testicular cancer Fluconazole - Answer-A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On the wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate A strain - Answer-A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? A. A sprain B. A strainC. A partial fracture D. A fracture Synovium - Answer-One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular srtucture? A. Fascia B. Bone C. Synovium D. Tendons Diabetes mellitus, Atherosclerosis, Hypertension - Answer-Which of the following should be considered in a patient presenting with erectile dysfunction Ceftriaxone - Answer-A 20-year-old woman Is seen in the clinic because her boyfriend was found to have gonorrhea which of the following as a treatment choice for gonorrhea Elevated uric acid level - Answer-Patient presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout which of the following should the clinician expect to have in the test for this patient absent cremasteric reflex - Answer-Which of the following data is indicative of testicular Torsion Fibromyalgia syndrome - Answer-What is the most common cause of generalize musculoskeletal pain and women ages 20 to 55 Withhold one or more days of the anticoagulant therapy - Answer-Is the international normalized ratio or INR result is above the therapeutic range on a patient with a fib on warfarin what might the clinician do acute myelogenous leukemia - Answer-Sandra is 42 years old and has been diagnosed with leukemia. She is complaining of bone and join pain. What type of leukemia is the likely culprit?• Chronic myelogenous leukemia • Acute lymphocytic leukemia • Acute myelogenous leukemia • Chronic lymphocytic leukemia SLE - Answer-Triggering factors for acute exacerbations of which of the following conditions include exposure to UVB and UVA lights