2025 Dunphy Final Clinical Exam NURS 671 - In-
Depth Study Guide, Key Concepts, Expert
Answers, and Success Strategies With 120
Questions
1. A patient is diagnosed with GERD, and their endoscopic report reveals the
presence of Barrett's epithelium. Which of the following should the PCP
include in the explanation of the pathology report?
a. This is premalignant tissue
b. This tissue is resistant to gastric acid
c. This tissue supports healing of the esophagus
d. All of the above
Correct answer: d. All of the above
Rationale: Barrett's esophagus is a condition that arises due to chronic acid exposure,
and it often involves cellular changes in the esophagus lining, making it premalignant.
This epithelium can be more resistant to acid, and it may support some healing of the
esophagus as the cells adapt to the constant acid exposure.
2. Which of the following dietary instructions should be given to a patient with
GERD?
a. Eliminate coffee
b. Drink peppermint tea to relieve stomach distress
c. Recline and rest after meals
d. Limit the amount of antacids
Correct answer: a. Eliminate coffee
Rationale: Coffee can relax the lower esophageal sphincter and worsen GERD
symptoms, so it is best to avoid. Peppermint can also relax the sphincter, reclining after
meals can exacerbate reflux, and antacids should be used cautiously but are not the
main dietary focus.
3. The patient with GERD should be instructed to eliminate which of these
activities?
,a. Swimming
b. Weight lifting
c. Golfing
d. Walking
Correct answer: b. Weight lifting
Rationale: Weight lifting and heavy physical exertion can increase intra-abdominal
pressure, worsening GERD symptoms by promoting acid reflux. Other activities like
swimming, golfing, and walking typically do not have the same impact.
4. A patient is diagnosed with giardia after a backpacking trip in the mountains.
Which of the following would be an appropriate treatment?
a. Vancomycin
b. PCN
c. Metronidazole
d. Bactrim
Correct answer: c. Metronidazole
Rationale: Metronidazole is the drug of choice for giardia, a parasitic infection often
acquired in the wilderness. Vancomycin and penicillin are used for bacterial infections,
and Bactrim is used for a range of infections but is not effective against giardia.
5. A 22-year-old is seen complaining of vague belly pain. This type of pain is
seen at what point in appendicitis?
Correct answer: Very early
Rationale: Early appendicitis often presents with vague, generalized abdominal pain
before it localizes to the right lower quadrant.
6. The NP suspects a patient has a peptic ulcer. Which of the following items
on the history would lead the NP to this conclusion?
a. Use of NSAIDs
b. Cigarette smoker
c. Ethanol consumption
d. All of the above
Correct answer: d. All of the above
Rationale: All of these factors—NSAID use, smoking, and ethanol consumption—are
, risk factors for peptic ulcers. They contribute to increased gastric acid production and
impaired mucosal defenses.
7. A patient is seen with dark-colored urine, and the urine dipstick reveals a
high level of bilirubin. Which of the following could be the cause of the
problem?
a. Increased breakdown of RBCs
b. Inadequate hepatocyte function
c. Biliary obstruction
d. All of the above
Correct answer: c. Biliary obstruction
Rationale: Biliary obstruction prevents the normal flow of bile, causing conjugated
bilirubin to accumulate in the bloodstream and be excreted in the urine. This leads to
dark-colored urine. Hemolysis or liver dysfunction can also increase bilirubin, but
biliary obstruction is most directly associated with this finding.
8. A 21-year-old student presents with complaints of fatigue, headache,
anorexia, and a runny nose, all of which began about 2 weeks ago. She
started taking vitamins and OTC cold preparations but feels worse. The
smell of food makes her nauseated. Her boyfriend had mono about a month
ago, and she wonders if she might have it also. Exam reveals cervical
adenopathy and an enlarged liver and spleen. Which of the following labs
would be most helpful in the differential diagnosis at this point?
a. Stool culture
b. Liver enzymes
c. Antihepatitis D virus
d. TSH
Correct answer: c. Antihepatitis D virus
Rationale: The patient's symptoms suggest infectious mononucleosis (mono), and the
lab test for the Epstein-Barr virus (EBV) or anti-hepatitis D virus would be helpful in
differentiating the cause. Liver enzymes could be elevated in mono, but anti-Hepatitis D
virus would better identify the infectious agent.
9. On further questioning, the 21-year-old patient with complaints of fatigue,
headache, anorexia, and a runny nose explains that she is sexually active
only with her boyfriend, does not use injectable drugs, and works as an aide
Depth Study Guide, Key Concepts, Expert
Answers, and Success Strategies With 120
Questions
1. A patient is diagnosed with GERD, and their endoscopic report reveals the
presence of Barrett's epithelium. Which of the following should the PCP
include in the explanation of the pathology report?
a. This is premalignant tissue
b. This tissue is resistant to gastric acid
c. This tissue supports healing of the esophagus
d. All of the above
Correct answer: d. All of the above
Rationale: Barrett's esophagus is a condition that arises due to chronic acid exposure,
and it often involves cellular changes in the esophagus lining, making it premalignant.
This epithelium can be more resistant to acid, and it may support some healing of the
esophagus as the cells adapt to the constant acid exposure.
2. Which of the following dietary instructions should be given to a patient with
GERD?
a. Eliminate coffee
b. Drink peppermint tea to relieve stomach distress
c. Recline and rest after meals
d. Limit the amount of antacids
Correct answer: a. Eliminate coffee
Rationale: Coffee can relax the lower esophageal sphincter and worsen GERD
symptoms, so it is best to avoid. Peppermint can also relax the sphincter, reclining after
meals can exacerbate reflux, and antacids should be used cautiously but are not the
main dietary focus.
3. The patient with GERD should be instructed to eliminate which of these
activities?
,a. Swimming
b. Weight lifting
c. Golfing
d. Walking
Correct answer: b. Weight lifting
Rationale: Weight lifting and heavy physical exertion can increase intra-abdominal
pressure, worsening GERD symptoms by promoting acid reflux. Other activities like
swimming, golfing, and walking typically do not have the same impact.
4. A patient is diagnosed with giardia after a backpacking trip in the mountains.
Which of the following would be an appropriate treatment?
a. Vancomycin
b. PCN
c. Metronidazole
d. Bactrim
Correct answer: c. Metronidazole
Rationale: Metronidazole is the drug of choice for giardia, a parasitic infection often
acquired in the wilderness. Vancomycin and penicillin are used for bacterial infections,
and Bactrim is used for a range of infections but is not effective against giardia.
5. A 22-year-old is seen complaining of vague belly pain. This type of pain is
seen at what point in appendicitis?
Correct answer: Very early
Rationale: Early appendicitis often presents with vague, generalized abdominal pain
before it localizes to the right lower quadrant.
6. The NP suspects a patient has a peptic ulcer. Which of the following items
on the history would lead the NP to this conclusion?
a. Use of NSAIDs
b. Cigarette smoker
c. Ethanol consumption
d. All of the above
Correct answer: d. All of the above
Rationale: All of these factors—NSAID use, smoking, and ethanol consumption—are
, risk factors for peptic ulcers. They contribute to increased gastric acid production and
impaired mucosal defenses.
7. A patient is seen with dark-colored urine, and the urine dipstick reveals a
high level of bilirubin. Which of the following could be the cause of the
problem?
a. Increased breakdown of RBCs
b. Inadequate hepatocyte function
c. Biliary obstruction
d. All of the above
Correct answer: c. Biliary obstruction
Rationale: Biliary obstruction prevents the normal flow of bile, causing conjugated
bilirubin to accumulate in the bloodstream and be excreted in the urine. This leads to
dark-colored urine. Hemolysis or liver dysfunction can also increase bilirubin, but
biliary obstruction is most directly associated with this finding.
8. A 21-year-old student presents with complaints of fatigue, headache,
anorexia, and a runny nose, all of which began about 2 weeks ago. She
started taking vitamins and OTC cold preparations but feels worse. The
smell of food makes her nauseated. Her boyfriend had mono about a month
ago, and she wonders if she might have it also. Exam reveals cervical
adenopathy and an enlarged liver and spleen. Which of the following labs
would be most helpful in the differential diagnosis at this point?
a. Stool culture
b. Liver enzymes
c. Antihepatitis D virus
d. TSH
Correct answer: c. Antihepatitis D virus
Rationale: The patient's symptoms suggest infectious mononucleosis (mono), and the
lab test for the Epstein-Barr virus (EBV) or anti-hepatitis D virus would be helpful in
differentiating the cause. Liver enzymes could be elevated in mono, but anti-Hepatitis D
virus would better identify the infectious agent.
9. On further questioning, the 21-year-old patient with complaints of fatigue,
headache, anorexia, and a runny nose explains that she is sexually active
only with her boyfriend, does not use injectable drugs, and works as an aide
