FAMILY NUR NSG 6420 3Ps copy Exam University of Miami

You are auscultating Jon's chest. When he sits up and leans forward, you can hear a high pitched, blowing murmur at S2. What does this type of murmur most likely indicate? a. Mitral stenosis b. Aortic Stenosis c. Mitral regurgitation d. Aortic regurgitation - d. Aortic regurgitation Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the 3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole, radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur heard at apex and is pansystolic. Which of the following is the most common clinical manifestation of osteoporosis? a. Bone deformity b. Bone pain c. Pathologic fracture d. Fat embolism - a. Bone deformity most common metabolic bone disease, is chronic, progressive, & systemic; Low bone mass and deterioration of bone tissue, = leads to increased skeletal fragility & deformity. Osteoporosis usually not apparent until AFTER a fracture; 2/3 of vertebral fractures are painless. Fat embolism from fat obstruction d/t injury or trauma & not common in osteoporosis. A male patient requests a phosphodiesterase inhibitor to treat erectile dysfunction. Which of the following is appropriate? a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hours before sexual activity FAMILY NUR NSG 6420 3Ps copy Exam University of Miami c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as the patient has a resting blood pressure below 170/110 mm Hg d. Avanafil (Stendra) is recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity. - a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. Which of the following is NOT part of Virchow's Triad? a. Hypercoagulability b. Damage to endothelial cells c. Sympathetic tone d. Turbulent blood flow - c. Sympathetic tone Virchow's triad is a method of describing the three main factors that lead to a thrombosis -- sympathetic tone is not one of those and doesn't affect blood clotting. Hypercoagulability does lead to clotting, including malignancy, trauma, sepsis, and thrombophilia. Endothelial cell damage is part of Virchow's triad bc it causes blood to clot by promoting platelet adherence to the wall of the vessels; vascular wall injury is the second aspect of Virchow's triad. Lastly, turbulent blood flow is a constituent of circulatory stasis the third component of the triad, which can be caused by atrial fibrillation, venous obstruction, and ventricular dysfunction A patient with kidney stones also presents with hypercalcemia and mental confusion. The practitioner should evaluate the patient for which of the following? a. Cushing Syndrome b. Conn's Syndrome c. Hyperparathyroidism d. Addison's disease - c. Hyperparathyroidism Which of the following statements is true regarding contraceptives? a. Because oral contraceptives may cause harm to the fetus, they are pregnancy category X drugs in pregnancy. b. Oral contraceptives are linked to the promotion of ovarian, endometrial, and breast cancer. c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood pressure. d. Oral contraceptives may reduce the effects of theophylline, benzodiazepines, and tricyclic antidepressants - c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood pressure. estrogen promotes aldosterone production= sodium retention & HTN. Also believed stimulates hepatic production of angiotensinogen, affecting renal system via elevated angiotensin & BP. OCP are category X, but because serve no use, decrease incidence of ovarian and endometrial ca and don't increase risk of breast ca. OCP containing progestin may enhance effects of theophylline, benzos, and tricyclic antidepressants by decreasing clearance. Upon percussion of the chest, you notice hyperresonance. Of the following choices which would most likely be the cause? a. Atelectasis b. Normal Lung c. Pneumothorax d. Pulmonary embolism - c. Pneumothorax What is the proper order of steps to accurately perform the Ortolani maneuver? a. Extend the legs, adduct the legs, and abduct the knees b. Flex the knees, abduct the knees, and adduct the legs c. Flex the knees, adduct the legs, and abduct the legs d. Extend the knees, abduct the legs, and adduct the knees - b. Flex the knees, abduct the knees, and adduct the legs done on supine infant, flex knees while holding thighs. Adduct legs until thumbs touch, follow with abduct knees until lateral part of knee touch table. You have four patients who all have a family history of developing coronary heart disease at an early age. According to their blood test results, which patient would most likely develop coronary heart disease first? a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45 b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30 c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20 d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 - d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 3 of the 4 measurements are above what should be; HDL <40 in men & 50 in women increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart disease. This low-molecular-weight heparin is indicated for use with warfarin for the treatment of acute symptomatic deep vein thrombosis, either with or without pulmonary embolism: a. Nadroparin b. Dalteparin c. Tinzaparin d. Fondaparinux - c. Tinzaparin- can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood. Nadroparin & Dalteparin don't use w/ warfarin, use independently. Fondaparinux is a Xa inhibitor NOT LMWH. he main reason for discontinuance of implanted etonogestrel (Nexplanon) is: a. Weight gain b. Pregnancy c. Breast tenderness d. Irregular bleeding - d. Irregular bleeding For the treatment of relapsing-remitting multiple sclerosis, the nurse practitioner knows that: a. First-line therapy typically involves an immunomodulator b. Natalizumab is one of the safest drugs to use as initial therapy c. A patient using interferon-beta products would have to have renal function monitored. d. Fingolimod is given intravenously for patients with resistant remitting-relapsing multiple sclerosis. - a. First-line therapy typically involves an immune modulator therapy begins with interferon-beta products (fingolimod, glatiramer, natalizumab) which are immune modulator. Natalizumab limited (assoc w/ infections in brain) are used if others don't work. Meds are hepatotoxic and need liver function monitoring. Fingolimod is 1st ORAL disease modifying med approved for MS. Which of these are unique features of aripiprazole (Abilify)? a. It causes hyperprolactinemia and gynecomastia as side effects. b. It is a dopamine system stabilizer with affects against schizophrenia, mania, and agitation. c. It causes agranulocytosis, which may be fatal; patient monitoring is necessary d. It induces diabetes and myocarditis in certain patients - b. It is a dopamine system stabilizer with affects against schizophrenia, mania, and agitation. All of the following facial movements are still possible after a cerebrovascular accident except: a. Raising the eyebrows b. Wrinkling the forehead c. Raising both sides of the mouth d. Closing both eyes - c. Raising both sides of the mouth Which of the following is a characteristic of Somogyi effect? a. It is characterized by an early morning rise in blood glucose, with no hypoglycemia during the night. b. It is more common in type 2 diabetics c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia. d. It is more common in elderly patients with poorly controlled blood sugars. - c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia - Nocturnal hypoglycemia stimulates hyperglycemia counter-regulation in am. No hypoglycemia in night is Dawn phenomenon, more common in T1DM, esp children w/ T1DM Which of the following is a characteristic of B cell deficiency? a. Inability to fight off cancer cells. b. Inability to make antibodies c. Increased incidence of granulomas d. Increased incidence of anemia - b. Inability to make antibodies When counseling a pregnant patient on drug use during pregnancy, it is important that the nurse practitioner advises her: a. "The placenta provides a good protective barrier for your baby against almost all drugs you might ingest." b. "The placenta will screen out most harmful drugs, so they will never reach significant levels in your baby." c. "The placenta will protect your baby against narcotic exposure, but all other drugs will permeate within 15 minutes to an hour." d. "The placenta is a barrier as far as time is concerned only- ultimately, your baby will be exposed to any drug that you take." - d. "The placenta is a barrier as far as time is concerned only- ultimately, your baby will be exposed to any drug that you take." Assuming these do not present with symptoms other than those stated, antibiotic use is most likely to be appropriate for which of the following patients? a. The 2-year-old with onset of mucopurulent rhinitis two days ago b. The 10-year-old with dry cough lasting 7 days c. The 60-year-old with clear rhinorrhea for 3 weeks. d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks - d. The 5- year-old with cough and mucopurulent rhinitis for 3 weeks In a patient diagnosed with syndrome of inappropriate antidiuretic hormone, the nurse practitioner would expect to find which of the following? a. Solute retention and water retention b. Solute retention and water loss c. Solute dilution and water retention d. Solute dilution and water loss - c. Solute dilution and water retention SIADH (syndrome of inappropriate antidiuretic hormone) defined as hyponatremia despite NL or increased plasma volume= impaired water excretion. Result of excess H2O vs deficiency of sodium. Sandra comes into the clinic complaining of the inability to discern touch as well as she used to. During the physical examination, you tell Sandra to close her eyes and trace the outline of a number into the palm of her hand. Which of the following tests have you performed? a. Graphesthesia b. Position c. Stereognosis d. Vibration - a. Graphesthesia A 68-year-old male patient desires testosterone replacement to enhance his libido. His testosterone level is found to be 250 ng/dL. The nurse practitioner knows that a. AndroGel once daily would restore sex drive and fertility in this client b. Testosterone replacement is associated with cardiovascular risks, including myocardial infarction, and is not indicated for this patient. c. Testosterone cypionate injections would be a good treatment option for this patient. d. Testosterone replacement is known to suppress the development of prostate cancer, which would be a benefit. - b. Testosterone replacement is associated with cardiovascular risks, including myocardial infarction, and is not indicated for this patient. Regarding the split S2 heart sound, which of these is false? a. It is a normal phenomenon b. The aortic valve closes significantly earlier than the pulmonic valve c. It is noted only in the aortic auscultatory area d. It occurs on end inspiration. - c. It is noted only in the aortic auscultatory area - normal & can be heard throughout precordium, not just aortic area. In split S2, more blood present on left side= decrease LV stroke volume & shortens LV systole, allows aortic valve to close earlier than NL. Split S2 ONLY happens during end of inspiration. Azole antifungals are most likely to cause torsades de pointes in which patient population? a. Patients taking isoproterenol b. African- Americans c. Females d. Adults over the age of 65 - c. Females- Azole can cause in Men and women, but 2-3x more common in Women. Prolonged QT interval is 10 microseconds longer in women= more recorded dysrhythmias. Isoproterenol is beta agonist used in tx of torsades & no significant interaction w/ azoles. African Americans less susceptible to torsades than Caucasians, & most common ages 35-50. Which of the following is the most effective agent to help a patient with insomnia that involves both difficulty falling asleep and maintaining sleep? a. Triazolam (Halcion) b. Zolpidem (Ambien CR) c. Zaleplon (Sonata) d. Ramelteon (Rozerem) - b. Zolpidem (Ambien CR) Which of the following is not a step in the Hirschberg test? a. Shine a light towards patient's eyes to assess parallel alignment b. Assess reflection of light on the corneas c. Hold the light about 12 inches from the patient d. Ask the patient to stare straight ahead at your nose - d. Ask the patient to stare straight ahead at your nose Asking patient to stare at the nose is one of the steps of the COVER test, which assesses muscle weakness in the eye. The Hirschberg test is designed to assess symmetry of the light reflex within the corneas. It is performed by shining a light towards the patient's eyes and directing them to stare ahead as the nurse holds the light 12 inches away. Symmetrical light reflection in the eye indicates that they eye muscles are properly aligned. Which of he following statements is true regarding atopic dermatitis? a. The diagnosis of atopic dermatitis is typically based on clinical history and presentation of symptoms. b. Immunoglobulin M levels are usually elevated in the patient c. Histamine is a major pruritogen in atopic dermatitis d. It has no influence on the development of the other allergic diseases. - a. The diagnosis of atopic dermatitis is typically based on clinical history and presentation of symptoms. The practitioner enrolls a patient for a Phase 3 drug trial. Which of the following is an appropriate statement to tell this patient? a. "I realize you do not have the disease this drug treats, but your participation will give us valuable information." b. "You have a better chance of getting a placebo agent than a real drug to treat this disease." c. "Make sure you tell me about any side effects you feel while in this study." d. "Birth defects and cancers have been reported in patients in this trial." - c. "Make sure you tell me about any side effects you feel while in this study." Select the true statement below: a. Chronic lymphomas do not respond well to chemotherapy due to slow progression b. Stage III lymphomas are far more treatable than stage I c. Lymphomas are more common in children than adults. d. Acute leukemias occur primarily in childhood and are rarely seen in older adults - a. Chronic lymphomas do not respond well to chemotherapy due to slow progression- don't respond well to chemo and may have unpredictable blast phase, culminating in death. Stage I are more differentiated and easier to treat, Lymphomas are more common in adults, acute leukemias increase in incidence dramatically after age 60. A child presents with a community acquired viral pneumonia. Presenting signs and symptoms will include: a. Mild to high fever, cough, rhinorrhea, crackles, rhonchi, and wheezes b. High fever, productive cough, and pleuritic chest pain c. Decreased breath sounds in areas of consolidation and dyspnea d. Increased respiratory rate and respiratory alkalosis - a. Mild to high fever, cough, rhinorrhea, crackles, rhonchi, and wheezes- wheezing esp more common in children w/ viral CAP. Productive cough may be present, by pleuritic chest pain more w/ bacterial CAP, decreased breath sounds, dyspnea also more with bacterial CAP. Inc resp rathe and resp alkalosis not usually hallmark sx of CAP. Jenny, age 32, comes into the clinic complaining of severe acid reflux. When taking her health history, you try to identify aggravating factors and things that make the pain a little more manageable. Jenny tells you that when she remains active and doesn't lie down, the pain almost completely disappears. Which part of the PQRSTU method is designed to acquire information about what makes the symptoms worse? a. T b. S c. Q d. P - d. P- P is for provocative or palliative so what have tried to make better, or has made worse. T= timing of sx, S= scale of pain, Q= quantity and quality of pain. U= understanding of problem. The nurse practitioner is examining a patient with a presumed diagnosis of Osgood-Schlatter disease. Which of the following is true regarding this condition and/or patient? a. This patient is a postmenopausal female who should have calcium and vitamin d supplementation as part of her treatment plan b. This patient is an adult athlete with a repetitive use injury of the anterior tibial tubercle c. This patient has bursitis of the subscapular bursa in the glenohumeral joint. d. This patient is an adolescent without a history of knee injury or sport participation. - b. This patient is an adult athlete with a repetitive use injury of the anterior tibial tubercle. Result of repetitive quadriceps contraction through patellar tendon. Repeated traction on anterior portion developing ossification center= multiple subacute fx or tendinous inflammation. Pain, swelling, tender. Seen in Adolescents, combo w/ growth spurt and sports. Any active adult or athlete at risk. Ca = Vit D= tx for osteoporosis. Postmenopausal female not traditionally at risk. Bursitis= inflammation of Bursa= soft, fluid filled sac cushions mvmt btw bones, shares similarities w/ Osgood but is different condition. . A patient with sepsis is at risk of developing shock via which mechanism? a. Loss of systemic vascular resistance b. Slowly evolving pump failure of the heart c. Loss of blood volume d. Loss of centrally-mediated neurogenic tone - a. Loss of systemic vascular resistance The advances practice nurse is considering an anticonvulsant regimen in a patient who suffers from partial seizures and who takes several other medications for comorbid conditions. Which of the following antiepileptic drugs would cause the lowest drug interactions? a. Carbamazepine (Tegretol) b. Phenytoin (Dilantin) c. Levetiracetam (Keppra) d. Valproic Acid (Depakene) - c. Levetiracetam (Keppra) Beta blockers are not used for which of the following conditions? a. Performance anxiety b. Migraine prophylaxis c. Reduction of perioperative mortality d. Insulin induced hypoglycemia - d. Insulin induced hypoglycemia.- will not aid, more likely to retard recovery. Low dose can be used for performance enhancement, treat migraines, and decrease perioperative mortality of cardiac Pts. A patient presents with pustular lesions on her perineum and groin. She has some oral mucous membranes lesions, a warty rash on her hands and feet, lymphadenopathy, and pruritis. A presumptive diagnosis would be: a. Herpes simplex b. Syphilis c. Chlamydia d. Trichomonas - b. Syphilis A patient who has suffered a cerebrovascular accident has speech dysphasia involving word finding and difficulty writing. Which area of the brain has most likely been affected? a. Parietal lobe b. Left frontal lobe c. Temporal lobe d. Limbic system. - b. Left frontal lobe- Broca's area is in left frontal lobe is one of language centers= non fluency w/ sparse output, agrammatism, impaired repetition, affects writing r/t to speech. Parietal lobe= agnosia, Temporal lobe = word deafness, limbic = emotional instability Sally, age 46, comes to your practice concerned about a lump in her breast that appeared within the past few days. She is very worried that is may be cancerous and says that the lump is tender and moves around when she touches it. Based on Sally's description of the lump, what is most likely true? a. Masses that are tender and movable are typically benign b. It is most likely fibroadenoma c. Masses that are tender and moveable are typically malignant d. The lump can likely be diagnosed with a routine physical exam. - a. Masses that are tender and movable are typically benign In which part of the lung fields should vesicular breath sounds be noted? a. Anterior chest b. Peripheral lung fields c. Anterior bifurcation of the mainstream bronchi d. Posterior chest. - b. Peripheral lung fields - hear vesicular here, low, soft like, sound of wind in trees. Anterior- bronchial breath sounds= high & loud (harsh, hollow, tubular), anterior bifurcation = bronchovesicular sounds which also hear in posterior chest & are soft/ tubular . For managing breakthrough pain in the opioid tolerant cancer patient already receiving around the clock opioids: a. Transmucosal fentanyl (Actiq) or immediate release oral morphine would be considered first choice medications. b. Based on the equianalgesic table, the dosage of opioid to manage this pain should be half the total daily opioid dose c. Dosing of the breakthrough pain medication should be repeated every 6 hours on a fixed schedule. d. Breakthrough pain should be managed with nonpharmacologic means or acetaminophen. - a. Transmucosal fentanyl (Actiq) or immediate release oral morphine would be considered first choice medications. 61. Which of the following is most likely to be effective in the treatment of acute cluster headaches? a. 6 mg subcutaneous injection of sumatriptan b. 300 mg acetaminophen c. 40 mg riboflavin d. 240 mg verapamil. - a. 6 mg subcutaneous injection of sumatriptan- correct drug and dose for cluster HA; verapamil & APAP not indicated for cluster, but verapamil can be used as prophylaxis for migraines. Riboflavin is for migraines, but dose is 400 not 40. 60. Which of the following is of true intention tremors? a. Resembles a snake-like movement b. Becomes worse with voluntary movement c. Disappears with sleep d. Disappears with voluntary movement - b. Becomes worse with voluntary movement 59. Kussmaul respirations are best defined by which of the following? a. It is typically seen in patients with anxiety, a cause of respiratory acidosis b. It is a compensatory mechanism to help rid the body of excessive carbon dioxide c. It indicates that the acidosis is causing damage to the respiratory compensatory muscles. d. It indicates that more oxygen is necessary because the patient is going into respiratory distress. - b. It is a compensatory mechanism to help rid the body of excessive carbon dioxide- compensates for acidosis. Is an ABNL breathing pattern of series of long deep breaths in Pts w/ metabolic acidosis, diabetic ketoacidosis, NOT respiratory acidosis which = hyperventilation. Early detection of acute leukemia would include which of the following symptoms? a. Dizziness, dehydration, palpitations, hypotension b. Dyspnea, paresthesia, malaise c. Bradycardia, abdominal pain, fever d. Bruising, fatigue, bone pain, anorexia. - d. Bruising, fatigue, bone pain, anorexia. Which of the following is not an accurate statement regarding Babinski's reflex in infants? a. The nurse must stroke the finger up the lateral edge and ball of the infant's foot. b. A positive Babinski's reflex results in the fanning of toes c. The reflex typically disappears after 6 months of age. d. A positive Babinski's reflex may indicate pyramidal tract disease - a. The nurse must stroke the finger up the lateral edge and ball of the infant's foot.- stroke edge of foot. May resolve by 12 months, completely gone by 24 months. The stroke should fan toes. If still present at 2-2.5 years, could indicated pyramidal tract disease. A patient is started on levodopa for the treatment of Parkinson's disease. The practitioner will advise the patient with which of the following? a. "If you experience symptoms of psychosis while on this drug, then we will add haloperidol to your regimen." b. "If you eat protein in your diet, space it out evenly throughout the day." c. "This drug may turn your sweat, tears, and urine orange-red. This is a normal side effect." d. "Your blood pressure will likely increase while on this medication. We will have to monitor it." - b. "If you eat protein in your diet, space it out evenly throughout the day." You are examining the neurologic system of Ethel, age 72. Which of the following questions would be most effective in identifying Ethel's memory and ability to learn new information? a. "Can you repeat cup, book, highlighter, pencil?" b. "What year were you born?" c. "What did you do yesterday?" d. "Can you repeat choose, lose, crews, snooze?" - a. "Can you repeat cup, book, highlighter, pencil?" Which of the following is a correctly written prescription for meloxicam? a. With milk or food, take meloxicam 7.5 mg orally, once daily, for 10 days b. Meloxicam 7.5 mg for 10 days, one capsule orally, once a day with 8 ox of liquid, c. Take Meloxicam 7.5 mg orally with milk or food, once daily, for 10 days. d. Meloxicam 7.5 mg, one capsule orally per day, for 10 days. Take with milk or food. - d. Meloxicam 7.5 mg, one capsule orally per day, for 10 days. Take with milk or food. With respect to multiple sclerosis, which of the following is true? a. This condition has its onset commonly between the ages of 60-80 ears old b. The most common form of multiple sclerosis is relapsing-remitting c. The first step in the disease is the breakdown of the axons of neurons. d. Patients with the spinal type of multiple sclerosis rarely have bowel or bladder symptoms. - b. The most common form of multiple sclerosis is relapsing-remitting