NR 601 Midterm questions with verified answers
A 54-year-old Hispanic woman has home BP of 155/95 mmHg, confirmed by
multiple similar readings and office BP of 154/94 mmHg. She exercises, follows a
low-salt diet, and rarely drinks alcohol. Which one of the following medications
would be most appropriate for this patient? Ans✓✓✓ Chlorthalidone
A 60-year-old woman presents with a chief complaint of
uncomfortable breathing on exertion. She has had a minimally
productive cough for several years that does not bother her. On
further questioning, she states that her breathing gets much
worse when she lies down. The most likely cause of her dyspnea
is Ans✓✓✓ Cardiac
A 65-year-old female is evaluated for dyspnea, chronic cough, and mucoid sputum
for the past 4 months. She has noticed that she has to walk slower than she used
to and has to stop to catch her breath after walking 5 to 6 city blocks. The patient
has a 40 pack-year history of cigarette smoking but quit smoking 1 year ago. She is
otherwise healthy. On physical examination, vital signs are normal. Breath sounds
are decreased, but there is no edema or jugular venous distention. What is the
next best test you would order to make a diagnosis? Ans✓✓✓ Obtain spirometry.
A 65-year-old male is evaluated in a follow-up examination for worsening dyspnea
and chronic cough productive of mucoid sputum for the past 6 months. Was
diagnosed with (COPD) 3 years ago, and uses inhaled albuterol as needed. The
patient has a 40 pack-year history of cigarette smoking but quit smoking 8 months
ago. On physical examination, vital signs are normal and the patient is not in any
respiratory distress. Breath sounds are decreased, but there is no edema or
jugular venous distention. Spirometry shows a forced expiratory volume in the
first second (FEV1) of 58% of predicted with no reversibility and an FEV1/forced
,vital capacity (FVC) ratio of 65%. His COPD symptoms seem poorly controlled and
he has had one exacerbation in the past year. A chest radiograph is obtained and
shows mild hyperinflation. Which of the following is the most appropriate therapy
for this patient? Ans✓✓✓ Add a long-acting inhaled bronchodilator.
A 65-year-old male with Parkinson disease comes to your clinic after a 6-week
hospitalization for aspiration pneumonia. He has had worsening mobility in the
past year and uses a wheelchair. He developed a stage 3 heel pressure injury.
Vascular was consulted and determined that he had adequate arterial flow for
wound healing. They recommended wet to dry dressings TID. The wife has been
providing his rehabilitative care at home. She notes that the wet to dry dressings
are painful to the patient. She gives him oxycodone before dressing changes. The
wound has moderate foul-smelling drainage, wet necrotic slough that does not
obscure the wound base, and mild erythema. The wife notes that her husband
has increasing pain over the past few days and bleeds easily with dressing
changes. He has had no fever, chills, or other systemic symptoms. Which of the
following signs or symptoms would suggest that a wound is infected? Ans✓✓✓ a.
Increasing pain
b. Foul-smelling drainage
c. Necrotic tissue
d. Erythema
e. All of the above
A 65-year-old man is hospitalized with sudden onset chest pain but has a negative
cardiac workup. You notice pink eroded papules along the left sternum and left
flank that abruptly stop at the midline, where he thinks electrical leads were
placed. He thinks these painful and somewhat itchy bumps are increasing in
number. He is afebrile, otherwise stable, and has no other complaints. Which of
the following is the most appropriate next step? Ans✓✓✓ Empiric valacyclovir.
, A 65-year-old otherwise healthy woman presents to the office with dysphagia
that has been ongoing for nearly a year. She states that sticky foods, such as rice
and tougher foods, such as beef or chicken, can transiently get stuck in her
esophagus. She has had to vomit food out because it would not pass with time or
by drinking water. She has had no weight loss and her symptoms have not been
particularly progressive in nature. She has never had an endoscopy, but is up-to-
date with her health care maintenance, including colon cancer screening. no
significant family history of gastrointestinal (GI) diseases or malignancies.
Her examination is notable only for conjunctival pallor. Laboratories are
significant for a microcytic anemia. A barium esophagram is performed, which
reveals a thin, smooth, transverse filling defect in the midesophagus.
Which of the following complications is this patient most at risk for? Ans✓✓✓
Achalasia
A 70-year-old man undergoes an upper endoscopy for the evaluation of
dyspepsia. He has a large nonbleeding ulcer and biopsies reveal the present of
Helicobacter pylori infection. He is given a 10-day course of clarithromycin,
tetracycline, and omeprazole twice daily. His symptoms resolve. A urea breath
test performed 2 weeks later is positive for H. pylori.
Which of the following is the best next step in management of this patient?
Ans✓✓✓ Treatment with bismuth, metronidazole, tetracycline, and omeprazole
for 14 days
A 70-year-old patient has scattered nummular plaques with thick scale on his
shins that are extremely pruritic. He also has very dry skin. Skin scraping is
negative for dermatophyte. He had already completed a course of oral antifungal
medication prescribed to him by an urgent care physician. Assuming this is
nummular eczema, which of the following topical medication and vehicle is the
best choice? Ans✓✓✓ Triamcinolone 0.1% ointment
A 54-year-old Hispanic woman has home BP of 155/95 mmHg, confirmed by
multiple similar readings and office BP of 154/94 mmHg. She exercises, follows a
low-salt diet, and rarely drinks alcohol. Which one of the following medications
would be most appropriate for this patient? Ans✓✓✓ Chlorthalidone
A 60-year-old woman presents with a chief complaint of
uncomfortable breathing on exertion. She has had a minimally
productive cough for several years that does not bother her. On
further questioning, she states that her breathing gets much
worse when she lies down. The most likely cause of her dyspnea
is Ans✓✓✓ Cardiac
A 65-year-old female is evaluated for dyspnea, chronic cough, and mucoid sputum
for the past 4 months. She has noticed that she has to walk slower than she used
to and has to stop to catch her breath after walking 5 to 6 city blocks. The patient
has a 40 pack-year history of cigarette smoking but quit smoking 1 year ago. She is
otherwise healthy. On physical examination, vital signs are normal. Breath sounds
are decreased, but there is no edema or jugular venous distention. What is the
next best test you would order to make a diagnosis? Ans✓✓✓ Obtain spirometry.
A 65-year-old male is evaluated in a follow-up examination for worsening dyspnea
and chronic cough productive of mucoid sputum for the past 6 months. Was
diagnosed with (COPD) 3 years ago, and uses inhaled albuterol as needed. The
patient has a 40 pack-year history of cigarette smoking but quit smoking 8 months
ago. On physical examination, vital signs are normal and the patient is not in any
respiratory distress. Breath sounds are decreased, but there is no edema or
jugular venous distention. Spirometry shows a forced expiratory volume in the
first second (FEV1) of 58% of predicted with no reversibility and an FEV1/forced
,vital capacity (FVC) ratio of 65%. His COPD symptoms seem poorly controlled and
he has had one exacerbation in the past year. A chest radiograph is obtained and
shows mild hyperinflation. Which of the following is the most appropriate therapy
for this patient? Ans✓✓✓ Add a long-acting inhaled bronchodilator.
A 65-year-old male with Parkinson disease comes to your clinic after a 6-week
hospitalization for aspiration pneumonia. He has had worsening mobility in the
past year and uses a wheelchair. He developed a stage 3 heel pressure injury.
Vascular was consulted and determined that he had adequate arterial flow for
wound healing. They recommended wet to dry dressings TID. The wife has been
providing his rehabilitative care at home. She notes that the wet to dry dressings
are painful to the patient. She gives him oxycodone before dressing changes. The
wound has moderate foul-smelling drainage, wet necrotic slough that does not
obscure the wound base, and mild erythema. The wife notes that her husband
has increasing pain over the past few days and bleeds easily with dressing
changes. He has had no fever, chills, or other systemic symptoms. Which of the
following signs or symptoms would suggest that a wound is infected? Ans✓✓✓ a.
Increasing pain
b. Foul-smelling drainage
c. Necrotic tissue
d. Erythema
e. All of the above
A 65-year-old man is hospitalized with sudden onset chest pain but has a negative
cardiac workup. You notice pink eroded papules along the left sternum and left
flank that abruptly stop at the midline, where he thinks electrical leads were
placed. He thinks these painful and somewhat itchy bumps are increasing in
number. He is afebrile, otherwise stable, and has no other complaints. Which of
the following is the most appropriate next step? Ans✓✓✓ Empiric valacyclovir.
, A 65-year-old otherwise healthy woman presents to the office with dysphagia
that has been ongoing for nearly a year. She states that sticky foods, such as rice
and tougher foods, such as beef or chicken, can transiently get stuck in her
esophagus. She has had to vomit food out because it would not pass with time or
by drinking water. She has had no weight loss and her symptoms have not been
particularly progressive in nature. She has never had an endoscopy, but is up-to-
date with her health care maintenance, including colon cancer screening. no
significant family history of gastrointestinal (GI) diseases or malignancies.
Her examination is notable only for conjunctival pallor. Laboratories are
significant for a microcytic anemia. A barium esophagram is performed, which
reveals a thin, smooth, transverse filling defect in the midesophagus.
Which of the following complications is this patient most at risk for? Ans✓✓✓
Achalasia
A 70-year-old man undergoes an upper endoscopy for the evaluation of
dyspepsia. He has a large nonbleeding ulcer and biopsies reveal the present of
Helicobacter pylori infection. He is given a 10-day course of clarithromycin,
tetracycline, and omeprazole twice daily. His symptoms resolve. A urea breath
test performed 2 weeks later is positive for H. pylori.
Which of the following is the best next step in management of this patient?
Ans✓✓✓ Treatment with bismuth, metronidazole, tetracycline, and omeprazole
for 14 days
A 70-year-old patient has scattered nummular plaques with thick scale on his
shins that are extremely pruritic. He also has very dry skin. Skin scraping is
negative for dermatophyte. He had already completed a course of oral antifungal
medication prescribed to him by an urgent care physician. Assuming this is
nummular eczema, which of the following topical medication and vehicle is the
best choice? Ans✓✓✓ Triamcinolone 0.1% ointment
