NR 577 FINAL EXAM | QUESTIONS AND ANSWERS
WITH RATIONALE | WITH COMPLETE SOLUTIONS
1. A 56-year-old patient comes in for a routine well visit. He has
a history of a previous stroke and Type 2 Diabetes. Which of the
following orders would be appropriate for a patient with a
previous stroke?
A. Initiate statin therapy
B. EEG
C. Warfarin therapy with an INR goal of 2-3
D. MRI Correct Answers A.
Patients with a history of an ASCVD should be started on statin
therapy regardless of current LDL. The question did not mention
any other symptoms that would warrant additional diagnostics.
Warfarin therapy is only indicated if AFIB would be the primary
indication for anticoagulation after a stroke.
10. A 67-year-old female comes into your clinic stating that her
daughter just gave birth to her first grandchild and she if
planning to fly to visit them next month. She reports her
daughter told her to make sure her immunizations were up to
date as her grandchild was 2 months premature. She wants to
know what immunizations she needs as she has not had any
"since high school". You advise her to get which of the
following immunizations?
A. Influenza, MMR, PCV 13, Herpes Zoster, Tdap
B. Influenza, PCV13, Herpes Zoster
C. MMR, PCV13, Herpes Zoster
D. Influenza, Herpes Zoster Correct Answers A.
,The CDC and The Advisory Committee on Immunization
Practices (ACIP) recommend routine influenza vaccination for
all persons aged 6 months and older. The ACIP recommend one
dose of MMR for non-high-risk adults aged 18 years and older.
PCV 13 is recommended for those 65 and older. Increasing
reports of pertussis among US adolescents, adults, and their
infant contacts have stimulated vaccine development for older
age groups. The ACIP recommends Tdap for those age 65 years
and older who are around at-risk infants such as those with
prematurity. The ACIP also recommends Herpes Zoster
vaccination at age 50.
100. A 4-year-old presents to your clinic today in need of
vaccines before starting pre-school. She is currently up to date
on all of her other vaccines prior to this visit. What vaccines will
she receive today?
a) Hep A, Hib, IPV, DTaP
b) DTaP, IPV, MMR, VAR
c) Tdap, MMR, VAR, IPV
d) DTaP, MMR, VAR, Hib Correct Answers B.
101. In differentiating between acute epididymitis and testicular
torsion, which key finding on physical exam should you expect
to see with acute epididymitis versus testicular torsion?
A. Positive Prehn's sign
B. Swelling of the effected testicle
C. Irritative voiding symptoms
D. Unilateral groin pain Correct Answers A.
Elevating the scrotum in acute epididymitis alleviates pain,
whereas in testicular torsion there is no difference in pain
quality. Swelling and unilateral groin pain will be present in
,both conditions. Irritative voiding symptoms will occur with
acute epididymitis than testicular torsion
102. You are seeing a patient in the clinic who states he has tried
for over a year with his fiancé to conceive. His fiancé has a child
from a previous relationship. When reviewing medical history, a
history of _____ in adolescence would help to pinpoint a
possible cause of infertility?
A. Chickenpox
B. Wilson's disease
C. Mumps
D. Mononucleosis Correct Answers C.
In reviewing the history, an infection of mumps orchitis impairs
fertility in 13% of patients (Defendi, 2019). The other illnesses
do not impair fertility.
103. A 30-year old female is being seen in your office utilizing
sliding scale self-pay for monitoring of her INR on chronic
Coumadin therapy for an artificial valve. She states she had a
positive pregnancy test and her last menstrual period was 8
weeks prior. She denies cramping or bleeding. The next course
of action is to:
A. Discontinue Coumadin and begin on a DOAC
B. Refer the patient to cardiology for management
C. Obtain a PT/INR and ensure dosage of Coumadin is at or
below 5mg/daily
D. Discontinue Coumadin and avoid blood thinners during the
pregnancy Correct Answers C.
Coumadin in the first trimester is safe at dosages of 5mg/day or
less (McPhee & Papadakis, 2018). The risks of stopping
, Coumadin is greater for the mother than the developing fetus, so
discontinuing the medicine would not be appropriate. The
patient does not have insurance, so referring to cardiology would
be an expense the patient would not be able to afford. DOACs
are not recommended for mechanical valve replacements since
there is no data to support its use in pregnancy.
104 A 16-year-old female presents to the clinic stating she has
noticed a mass in her right breast. On examination, the mass is
2cm, mobile, rubbery, and nontender, located in the upper, outer
quadrant in the 10 o'clock position. Fibroadenoma is suspected.
What is the next step?
a. Observation
b. Surgical excision
c. Ultrasound
d. Biopsy Correct Answers A.
Fibroadenoma is common in adolescent girls. Diagnosed on
examination with findings of nontender, smooth, rubbery, well-
circumscribed, and mobile. Management is observation.
Fibroadenomas less than 5cm should be monitored over 3-4
months for growth or regression, then semiannually for a few
years, and then for regressing fibroadenomas yearly. Referral to
breast specialist should be made if larger than 5cm, enlarging,
skin changes in overlying skin, or previous malignancy.
105. A 15-year-old female is brought into the clinic by her
mother. The mother is concerned she has not started her period.
Secondary sex characteristics are present, but no history of
menses. Patient denies being sexually active. Patient has not had
any recent illness and has no PMH. All of the following
laboratory test would be warranted except?
WITH RATIONALE | WITH COMPLETE SOLUTIONS
1. A 56-year-old patient comes in for a routine well visit. He has
a history of a previous stroke and Type 2 Diabetes. Which of the
following orders would be appropriate for a patient with a
previous stroke?
A. Initiate statin therapy
B. EEG
C. Warfarin therapy with an INR goal of 2-3
D. MRI Correct Answers A.
Patients with a history of an ASCVD should be started on statin
therapy regardless of current LDL. The question did not mention
any other symptoms that would warrant additional diagnostics.
Warfarin therapy is only indicated if AFIB would be the primary
indication for anticoagulation after a stroke.
10. A 67-year-old female comes into your clinic stating that her
daughter just gave birth to her first grandchild and she if
planning to fly to visit them next month. She reports her
daughter told her to make sure her immunizations were up to
date as her grandchild was 2 months premature. She wants to
know what immunizations she needs as she has not had any
"since high school". You advise her to get which of the
following immunizations?
A. Influenza, MMR, PCV 13, Herpes Zoster, Tdap
B. Influenza, PCV13, Herpes Zoster
C. MMR, PCV13, Herpes Zoster
D. Influenza, Herpes Zoster Correct Answers A.
,The CDC and The Advisory Committee on Immunization
Practices (ACIP) recommend routine influenza vaccination for
all persons aged 6 months and older. The ACIP recommend one
dose of MMR for non-high-risk adults aged 18 years and older.
PCV 13 is recommended for those 65 and older. Increasing
reports of pertussis among US adolescents, adults, and their
infant contacts have stimulated vaccine development for older
age groups. The ACIP recommends Tdap for those age 65 years
and older who are around at-risk infants such as those with
prematurity. The ACIP also recommends Herpes Zoster
vaccination at age 50.
100. A 4-year-old presents to your clinic today in need of
vaccines before starting pre-school. She is currently up to date
on all of her other vaccines prior to this visit. What vaccines will
she receive today?
a) Hep A, Hib, IPV, DTaP
b) DTaP, IPV, MMR, VAR
c) Tdap, MMR, VAR, IPV
d) DTaP, MMR, VAR, Hib Correct Answers B.
101. In differentiating between acute epididymitis and testicular
torsion, which key finding on physical exam should you expect
to see with acute epididymitis versus testicular torsion?
A. Positive Prehn's sign
B. Swelling of the effected testicle
C. Irritative voiding symptoms
D. Unilateral groin pain Correct Answers A.
Elevating the scrotum in acute epididymitis alleviates pain,
whereas in testicular torsion there is no difference in pain
quality. Swelling and unilateral groin pain will be present in
,both conditions. Irritative voiding symptoms will occur with
acute epididymitis than testicular torsion
102. You are seeing a patient in the clinic who states he has tried
for over a year with his fiancé to conceive. His fiancé has a child
from a previous relationship. When reviewing medical history, a
history of _____ in adolescence would help to pinpoint a
possible cause of infertility?
A. Chickenpox
B. Wilson's disease
C. Mumps
D. Mononucleosis Correct Answers C.
In reviewing the history, an infection of mumps orchitis impairs
fertility in 13% of patients (Defendi, 2019). The other illnesses
do not impair fertility.
103. A 30-year old female is being seen in your office utilizing
sliding scale self-pay for monitoring of her INR on chronic
Coumadin therapy for an artificial valve. She states she had a
positive pregnancy test and her last menstrual period was 8
weeks prior. She denies cramping or bleeding. The next course
of action is to:
A. Discontinue Coumadin and begin on a DOAC
B. Refer the patient to cardiology for management
C. Obtain a PT/INR and ensure dosage of Coumadin is at or
below 5mg/daily
D. Discontinue Coumadin and avoid blood thinners during the
pregnancy Correct Answers C.
Coumadin in the first trimester is safe at dosages of 5mg/day or
less (McPhee & Papadakis, 2018). The risks of stopping
, Coumadin is greater for the mother than the developing fetus, so
discontinuing the medicine would not be appropriate. The
patient does not have insurance, so referring to cardiology would
be an expense the patient would not be able to afford. DOACs
are not recommended for mechanical valve replacements since
there is no data to support its use in pregnancy.
104 A 16-year-old female presents to the clinic stating she has
noticed a mass in her right breast. On examination, the mass is
2cm, mobile, rubbery, and nontender, located in the upper, outer
quadrant in the 10 o'clock position. Fibroadenoma is suspected.
What is the next step?
a. Observation
b. Surgical excision
c. Ultrasound
d. Biopsy Correct Answers A.
Fibroadenoma is common in adolescent girls. Diagnosed on
examination with findings of nontender, smooth, rubbery, well-
circumscribed, and mobile. Management is observation.
Fibroadenomas less than 5cm should be monitored over 3-4
months for growth or regression, then semiannually for a few
years, and then for regressing fibroadenomas yearly. Referral to
breast specialist should be made if larger than 5cm, enlarging,
skin changes in overlying skin, or previous malignancy.
105. A 15-year-old female is brought into the clinic by her
mother. The mother is concerned she has not started her period.
Secondary sex characteristics are present, but no history of
menses. Patient denies being sexually active. Patient has not had
any recent illness and has no PMH. All of the following
laboratory test would be warranted except?
