NUR 6531 FINAL EXAM Adult Primary Care

NUR 6531 FINAL EXAM Adult Primary Care Central obesity, “moon” face, and dorsocervical fat pad are associated with: An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is: The most effective treatment of non-infectious bursitis includes: Conservative treatment • Question 5 1 out of 1 points • Question 6 1 out of 1 points • Question 7 1 out of 1 points • Question 8 1 out of 1 points drugs (NSAIDs), bursal aspiration, and intrabursal steroid injections What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? Selected Answer: The physician must be on-site and engaged in patient care Answers: You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus? The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension. Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)? A. Nocturia B. Urgency incontinence C. Strong urinary stream flow D. Straining to void Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to includes rest, cold and heat treatments, elevation, administration of nonsteroidal anti-inflammatory • Question 9 1 out of 1 points • Question 10 1 out of 1 points • Question 11 1 out of 1 points • Question 12 1 out of 1 points reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid? Food that is very hot or very cold Fatty or fried foods Peppermint or spearmint, including flavoring Coffee, tea, and soft drinks that contain caffeine Spicy, highly seasoned foods Fried food DT caffeine, chocolate and anticholinergics Which drug category contains the drugs that are the first line Gold standard therapy for COPD? Beta antagonist The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is: Nsaid Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis? Erythromycin A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take? .A Obtain a thorough history and physical, and check serum cortisol and ACTH levels. B. Perform a diet history and check CBC and FBS. • Question 16 1 out of 1 points • Question 17 1 out of 1 points • Question 19 1 out of 1 points • Question 21 1 out of 1 points C. Provide nutritional guidance and have the patient return in one month. D. Consult home health for intravenous administration You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: he A. lateral meniscus B. cruciate ligament C. medial meniscus D. collateral ligament. A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is: Include 500 mg of oral ciprofloxacin (Cipro) twice per day for seven days; 1,000 mg of extended-release ciprofloxacin once per day for seven days; or 750 mg of levofloxacin (Levaquin) once per day for five days. A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is: epicondylitis • Question 22 1 out of 1 points • Question 23 1 out of 1 points • Question 24 1 out of 1 points • Question 25 1 out of 1 points • Question 28 1 out of 1 points • Question 29 The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy s to measure albumin in a spot urine sample, collected either as the first urine in the morning or at random, for example, at the medical visit. This method is accurate,:Early morning What is the first symptom seen in the majority of patients with Parkinson’s disease? Tremor at rest The most commonly recommended method for prostate cancer screening in a 55 year old male is: digital rectal exams, Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect? Otitis externa/ swimmer’s ear Which of the following symptoms suggests a more serious cause of back pain? Pain associated with lying down at night A patient taking levothyroxine is being over-replaced. What condition is he at risk for? osteoporosis A Lumbar disc disease . B Spinal stenosis . C Traumatic fracture . D Osteoporosis . • Question 30 1 out of 1 points • Question 31 1 out of 1 points A Arthritis . B Ulnar neuritis . C Septic arthritis . D Olecranon bursitis . Which of the following is the most common cause of low back pain? Which is the most common cause of end-stage renal disease in the United States? Diabetes A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: 1 out of 1 points • Question 33 1 out of 1 points • Question 35 1 out of 1 points • Question 37 1 out of 1 points • Question 38 A 60 year old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis? A. fibromyligia or neuro something Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further? Arthritis, C • Question 34 • D 1 out of 1 points A patient exhibits extrapyramidal side effects of antipsychotic medications. Which of the following symptoms would lead you to look for another diagnosis? high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure, profuse perspiration, and excessive sweating. called Malignant Hyperthermia” OR Neuroleptic malignant syndrome hallucinations. Phalen’s test, 90°wrist flexion for 60 seconds, reproduces symptoms of: carpal tunnel syndrome The most common cause of elevated liver function tests is: alcohol • Question 32 1 out of 1 points • Question 39 1 out of 1 points • Question 41 1 out of 1 points Primary hyperparathyroidism is treated with Vitamin D restriction Primary hyperparathyroidism is treated with parathyroidectomy Primary hyperparathyroidism is treated with daily magnesium Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH) • Question 43 1 out of 1 points Reed-Sternberg B lymphocytes are associated with which of the following disorders: A Aplastic anemia . B Hodgkin’s lymphoma . C Non Hodgkin’s . lymphoma D Myelodysplastic . syndromes Which of the following is a potential acquired cause of thrombophilia? A Homocysteinuria . B Protein C deficiency . C Factor V Leiden . D Antiphospholipid . antibodies A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains: A 25 year old overweight patient presents with a complaint of dull achiness in his groin 1 out of 1 points • Question 44 1 out of 1 points • Question 46 1 out of 1 points • Question 47 1 out of 1 points and history of a palpable lump in his scrotum that “comes and goes”. On physical examination, the nurse practitioner does not detect a scrotal mass. There is no tenderness, edema, or erythema of the scrotum, the scrotum does not transilluminate. What is the most likely diagnosis? A. Testicular torsion B. Epididymitis C. Inguinal hernia D. Varicocele Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? A. Prescribe nasal steroids and oral decongestants B. Prescribe antibiotic eardrops C. Prescribe systemic eardrops D. Refer David to an ear, nose, and throat specialist A. Prescribe The physiological explanation of syncope is: Syncope is a transient loss of consciousness (TLOC) due to global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery. • Question 48 1 out of 1 points • Question 49 1 out of 1 points • Question 51 1 out of 1 points A Weight gain . B Fracture risk . C Hypoglycem . ia D Weight loss . A 20 year old male patient complains of “scrotal swelling.” He states his scrotum feels heavy, but denies pain. On examination, the nurse practitioner notes transillumination of the scrotum. What is the most likely diagnosis? hydrocele A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be: nclude nitrofurantoin monohydrate/macrocrystals, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. trimethoprim and sulfamethoxazole Diagnostic radiological studies are indicated for low back pain: Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects? • Question 54 1 out of 1 points • Question 55 1 out of 1 points • Question 56 1 out of 1 points is an asymptomatic thyroid mass or a nodule that can be felt in the neck. • Question 57 1 out of 1 points The diagnosis of human papilloma virus (HPV) infection in males is usually made by: The diagnosis of HPV in men is made when external genital warts are seen. The diagnosis of genital warts is made by examination of the lesions Which history is commonly found in a patient with glomerulonephritis? upper respiratory tract infection or a skin infection that was caused by those bacteria A patient complains of generalized joint pain and stiffness associated with activity and relieved with rest. This patient history is consistent with which of the following disorders? Osteoarthritis The most common presentation of thyroid cancer is: The obligatory criteria for diagnosis of muscular dystrophy (MD) are: Genetic testing to evaluate missing or repeated mutations in the dystrophin gene. A lack of the dystrophin gene can lead to a diagnosis of Duchenne or Becker MD. The test is important not only to confirm the MD diagnosis in males but also to determine whether The case for genetic diagnosis. Accurate diagnosis of the muscular dystrophies is important for patients, their families, and efficient and cost-effective use of medical resources. • Question 53 1 out of 1 points women with a family history of Duchenne or Becker MD may be carriers.4 • Question 58 1 out of 1 points • Question 59 1 out of 1 points • Question 60 1 out of 1 points • Question 61 1 out of 1 points • Question 62 1 out of 1 points (EEG.) The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is: viral meningitis A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem? Hypertensive medication such as hydrochlorothiazides, and other DM2 medications A 72 year old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior? A. Dementia B. Delirium C. Parkinson's disease D. Depression Which of the following set of symptoms should raise suspicion of a brain tumor? Holocranial headaches present in the morning and accompanied by projectile vomiting without nausea • Question 63 1 out of 1 points • Question 64 1 out of 1 points • Question 65 1 out of 1 points • Question 66 1 out of 1 points The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is: relative rest-that being the cessation of the offending activity for a period of time until the irritation is eliminated, pain is gone and the bone is given a chance to heal. Rest the affected part of the body - Once pain free, the person can gradually begin the sporting activity again - Air splinting can reduce pain and decrease the time until return to full participation or intensity of exercise. - NSAIDs to reduce pain and inflammation Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to: a. refer her to a hand surgeon b. take a more complete hx c. try neutral position wrist splinting and order an oral NSAID d. order a nerve conduction study such as an electromyography (EMG) Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia? A. Musculosckeletal pain B. Difficulty sleeping C. Depression D. Fatigue The cardinal sign of infectious arthritis is: Affected joint is painful at rest, with movement and weight bearing • Question 70 1 out of 1 points • Question 71 1 out of 1 points • Question 73 1 out of 1 points • Question 75 1 out of 1 points Diagnostic evaluation for urinary calculi includes: Diagnosis is based on urinalysis and radiologic imaging, usually noncontrast helical CT. A 15 year-old female patient is 5 feet tall and weighs 85 pounds. You suspect anorexia and know that the best initial approach is to: Having the client in view of staff for 90 minutes after each meal Provide the client with a feeling of responsibility and control over her behavior A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time? A. Prescribe an alpha adrenergic blocker. B. Recommend saw palmetto. C. Prescribe an antibiotic D. Refer the client to urology. A positive drawer sign supports a diagnosis of: Posterior cruciate ligament injury A 14 year old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. The nurse practitioner notes swelling and point tenderness at the tibial tuberosity. X-ray is negative. What is the most likely diagnosis? • Question 77 1 out of 1 points • Question 79 1 out of 1 points • Question 80 1 out of 1 points • Question 81 1 out of 1 points • Question 82 1 out of 1 points prepatellar bursitis? Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be? Answer: stage 2 hypertension (lifestyle change, and medication Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: diabetes mellitus Successful management of a patient with attention deficit hyperactivity disorder (ADHD) may be achieved with: Ritalin and diet What diabetic complications result from hyperglycemia? Retinopathy Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis In which of the following presentations is further diagnostic testing not warranted? 1. 2. • Question 85 1 out of 1 points • Question 86 1 out of 1 points A Chlamydia . trachomatis B Ureaplasma . urealyticum C Mycoplasma . hominis D Trichonomas . vaginalis • Question 88 1 out of 1 points The most common symptoms of transient ischemic attack (TIA) include: Common symptoms are sudden and transient, and include unilateral paresis, speech disturbance, and monocular blindness. clinical symptoms typically lasting less than one hour, and without evidence of infarction on Establishment of a definitive diagnosis of osteomyelitis requires: Bone biopsy leads to a definitive diagnosis . Which of the following is the most common causative organism of nongonococcal urethritis? A 30 year old female patient presents to the clinic with heat intolerance, tremors, nervousness, and weight loss inconsistent with increased appetite. Which test would be imaging • Question 83 1 out of 1 points • Question 90 1 out of 1 points • Question 92 1 out of 1 points • Question 93 1 out of 1 points A Klebsiella . B Neiserria . gonorrhoaes C Chlamydia . trachomatis D Escherichia coli . • Question 94 1 out of 1 points most likely to confirm the suspected diagnosis? TSH. We also assess free thyroid hormone (FT4) and at times T3 Potential causes of hypocalcemia include which of the following? Hypoalbuminemia is the most common cause of hypocalcemia. Causes include cirrhosis, nephrosis . hypoparathyroidism, vitamin D deficiency, and renal disease. Which of the following is a contraindication for metformin therapy? hypersensitity metabolic acidiosis, dehydration, sepsis, hypoxemia, hepatic impairment, renal dysfunction The organism most often associated with prostatitis is: The most effective intervention(s) to prevent stroke is (are): • Question 95 1 out of 1 points • Question 98 1 out of 1 points • Question 101 1 out of 1 points Aspirin is one of the most common, most effective/or life style changes What is the most commonly abused substance? alcohol is the #1 abused substance in America. An estimated 135.5 million people drink alcohol, but of those people, 86 million are considered to be abusers, An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus, has fasting glucose values 180 to 250 mg/Dl. What is the most appropriate initial treatment to consider? A. A low-calorie diet and exercise B. Sliding-scale NPH insulin every 12 hours C. A sulfonylurea and/or metformin (Glucophage® -XR) D. Sliding-scale regular insulin every 6 hours • Question 100 Prolonged PT suggests: A Platelet abnormality . B Abnormality in intrinsic coagulation . pathway C Abnormality in extrinsic coagulation . pathway D None of the above . Deficiency of FII, FV, FX, or fibrinogen abnormalities