NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
A 14-year-old boy presents with symptoms of fatigue and oliguria with cola-colored urine, following
streptococcal pharyngitis two weeks ago. Physical examination reveals elevated blood pressure and
swelling in the hands and feet. Urinalysis shows proteinuria and hematuria with red blood cell casts.
What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus - (answer) Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal infection. The reaction that occurs as
a result of streptococcal infection is the result of an abnormal immunologic response, resulting in
damage to the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria, hypertension, and
edema of the face and extremities. Urinalysis reveals red blood cells, mild proteinuria, and red blood cell
casts. Pediatric patients usually have depressed C3 complement levels. In adults, elevation of creatinine
levels is more common. Management of postinfectious glomerulonephritis is supportive, with water and
salt restriction. Calcium channel blockers or ACE inhibitors may be used in cases of severe hypertension.
More than 90% of children achieve full recovery; complete remission in adults is 26-56%, depending on
age and other comorbidities.
A 23-year-old woman presents to the clinic with a history of debilitating, unilateral headaches that only
occur shortly before her period and take her several days to recover. Which one of the following triptans
has been found to be effective in preventing these kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan - (answer) Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been found to be effective in
preventing menstrual migraine if taken around-the-clock starting two days before menses and
continuing for a total of five to six days. Menstrual migraines are migraine headaches that occur
exclusively near the time of menses. Triptans are drugs specific to migraine treatment and bind to
serotonergic receptors. They are considered first-line treatment for moderate to severe migraines or for
mild-to-moderate migraine headaches that have failed other analgesics. Triptans have vasoconstrictive
properties so their use is contraindicated in those with ischemic heart disease, stroke, uncontrolled
hypertension, or basilar migraine
,NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
A 55-year-old woman with restless legs syndrome presents with worsening leg symptoms described as
crawling and fidgeting over the past 4 weeks. Her symptoms have been interfering with her quality of
sleep. When asked about medications, she reports only taking pramipexole 0.5 mg (normal dose range:
0.125-0.5 mg) in the evenings. Which of the following is the most appropriate next step in management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology - (answer) Order a CBC
Restless legs syndrome is a condition characterized by sensory disturbances and an irresistible urge to
move the legs during periods of rest. Patients will often report disturbed sleep patterns and daytime
sleepiness. Certain conditions can predispose individuals to developing the syndrome, such as family
history of restless legs syndrome, Parkinson disease, pregnancy, iron deficiency anemia, or diabetic
peripheral neuropathy
A 42-year-old woman presents to the office with double vision and eye pain. She reports these
symptoms started 4 days ago, and she experienced a similar episode around 3 months ago. She reports
pain and blurring of vision in her left eye. She has no significant past medical history and takes no
medications. On physical examination, her vital signs are normal. A focused neurologic examination
reveals that the patient cannot fully adduct her left eye while at the same time you notice nystagmus on
abduction of the right eye. There is dysmetria with finger-nose testing in the right arm. What would be
the first test to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
Visual evoked potentials - (answer) Magnetic resonance imaging of the brain with and without contrast
The first test to order in the above patient who is suspected of having multiple sclerosis (MS) would be a
contrast-enhanced MRI of the brain. She is presenting with what appears to be optic neuritis along with
examination findings of internuclear ophthalmoplegia
A 68-year-old man presents to the clinic with difficulty swallowing. He reports that this symptom started
3 months ago and has progressively worsened. He describes a feeling of food sticking in his throat after
,NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
he eats solid foods, but he has no issue with liquids or soft foods, such as yogurt. He reports no recent
weight loss, anorexia, chest pain, throat pain, nausea, or vomiting. Which of the following findings in this
patient's history would increase suspicion for the likely cause of this patient's dysphagia?
Family history of asthma
Personal history of gastroesophageal reflux disease
Personal history of liver cirrhosis
Recent personal history of influen - (answer) Personal history of gastroesophageal reflux disease
Esophageal stricture refers to abnormal narrowing of the esophageal lumen (≤ 13 mm in diameter),
which typically presents as progressive dysphagia with solid food. Other symptoms may include weight
loss, food impaction, odynophagia, and chest pain. The most common cause of esophageal stricture is
longstanding gastroesophageal reflux disease (GERD)
A 35-year-old woman presents to the clinic with a chief complaint of dyspepsia and epigastric fullness.
Which additional finding would warrant further testing for Helicobacter pylori infection?
Heartburn and acid regurgitation
History of gastric bypass surgery
Short-term NSAID use
Unexplained iron deficiency anemia - (answer) Unexplained iron deficiency anemia
Helicobacter pylori infection interferes with the absorption of oral iron and can result in iron deficiency
anemia. In patients with dyspepsia, unexplained iron deficiency anemia warrants further evaluation for
Helicobacter pylori infection.
A 63-year-old man with a 40-year history of alcohol and tobacco abuse presents with solid food
dysphagia. The patient has also had a 21 lb weight loss over the past 7 months. Which of the following
studies should be performed for a definitive diagnosis?
Barium esophagram
Chest X-ray
CT Scan
Endoscopy - (answer) Endoscopy
, NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
Endoscopy with biopsy establishes the diagnosis of esophageal carcinoma with a high degree of
reliability when biopsy is included as part of the procedure. Esophageal cancer commonly develops in
persons between 50 and 70 years of age. The overall incidence ratio of men to women is 3:1. There are
two histological types: Squamous cell carcinoma and Adenocarcinoma. Chronic alcohol and tobacco use
are strongly associated with an increased risk of squamous cell carcinoma
A 49-year-old woman presents with headaches that occur nearly every afternoon since she switched
jobs 6 months ago. She describes squeezing pain at her forehead, accompanied by fatigue and poor
concentration. Her exam is normal except for posterior neck tenderness, which she attributes to stress at
work. Which of the following interventions would be most helpful to this patient?
Headache abortive therapy with sumatriptan
Headache prevention with amitriptyline
Headache prevention with daily verapamil
High dose prednisone taper - (answer) Headache prevention with amitriptyline
Amitriptyline would be most helpful for headache prevention in this patient who is describing tension-
type headaches. Tension headaches are very common and tend to present as a bilateral headache in a
band-like distribution with pain in the frontal and occipital regions. It is the most common type of
primary headache. A physical exam may reveal focal areas of tenderness at the posterior neck, where
pain and stiffness radiate upward causing pain at the back of the head and a vice-like discomfort around
the skull. Neurologic exams should be normal. Tension headaches frequently occur during times of stress
A 39-year-old man presents to the clinic for a follow-up on his Achilles tendonitis. He states that the
prescribed diclofenac was not helping, so he also took ibuprofen for added pain relief. The provider is
concerned for drug-induced nephrotoxicity. He has no previous history of kidney disease. Which of the
following would indicate an urgent nephrologist referral?
GFR of 28 mL/min
Serum creatinine of 1.01 mg/dL
Urine albumin of 25 mg/mmol
Urine RBC of 10/hpf - (answer) GFR of 28 mL/min
A 24-year-old woman presents with dysuria, urgency, and urinary frequency for the last three days.
Today, she developed nausea, flank pain, and a fever. What is the most likely diagnosis?
ANSWERS
A 14-year-old boy presents with symptoms of fatigue and oliguria with cola-colored urine, following
streptococcal pharyngitis two weeks ago. Physical examination reveals elevated blood pressure and
swelling in the hands and feet. Urinalysis shows proteinuria and hematuria with red blood cell casts.
What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus - (answer) Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal infection. The reaction that occurs as
a result of streptococcal infection is the result of an abnormal immunologic response, resulting in
damage to the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria, hypertension, and
edema of the face and extremities. Urinalysis reveals red blood cells, mild proteinuria, and red blood cell
casts. Pediatric patients usually have depressed C3 complement levels. In adults, elevation of creatinine
levels is more common. Management of postinfectious glomerulonephritis is supportive, with water and
salt restriction. Calcium channel blockers or ACE inhibitors may be used in cases of severe hypertension.
More than 90% of children achieve full recovery; complete remission in adults is 26-56%, depending on
age and other comorbidities.
A 23-year-old woman presents to the clinic with a history of debilitating, unilateral headaches that only
occur shortly before her period and take her several days to recover. Which one of the following triptans
has been found to be effective in preventing these kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan - (answer) Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been found to be effective in
preventing menstrual migraine if taken around-the-clock starting two days before menses and
continuing for a total of five to six days. Menstrual migraines are migraine headaches that occur
exclusively near the time of menses. Triptans are drugs specific to migraine treatment and bind to
serotonergic receptors. They are considered first-line treatment for moderate to severe migraines or for
mild-to-moderate migraine headaches that have failed other analgesics. Triptans have vasoconstrictive
properties so their use is contraindicated in those with ischemic heart disease, stroke, uncontrolled
hypertension, or basilar migraine
,NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
A 55-year-old woman with restless legs syndrome presents with worsening leg symptoms described as
crawling and fidgeting over the past 4 weeks. Her symptoms have been interfering with her quality of
sleep. When asked about medications, she reports only taking pramipexole 0.5 mg (normal dose range:
0.125-0.5 mg) in the evenings. Which of the following is the most appropriate next step in management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology - (answer) Order a CBC
Restless legs syndrome is a condition characterized by sensory disturbances and an irresistible urge to
move the legs during periods of rest. Patients will often report disturbed sleep patterns and daytime
sleepiness. Certain conditions can predispose individuals to developing the syndrome, such as family
history of restless legs syndrome, Parkinson disease, pregnancy, iron deficiency anemia, or diabetic
peripheral neuropathy
A 42-year-old woman presents to the office with double vision and eye pain. She reports these
symptoms started 4 days ago, and she experienced a similar episode around 3 months ago. She reports
pain and blurring of vision in her left eye. She has no significant past medical history and takes no
medications. On physical examination, her vital signs are normal. A focused neurologic examination
reveals that the patient cannot fully adduct her left eye while at the same time you notice nystagmus on
abduction of the right eye. There is dysmetria with finger-nose testing in the right arm. What would be
the first test to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
Visual evoked potentials - (answer) Magnetic resonance imaging of the brain with and without contrast
The first test to order in the above patient who is suspected of having multiple sclerosis (MS) would be a
contrast-enhanced MRI of the brain. She is presenting with what appears to be optic neuritis along with
examination findings of internuclear ophthalmoplegia
A 68-year-old man presents to the clinic with difficulty swallowing. He reports that this symptom started
3 months ago and has progressively worsened. He describes a feeling of food sticking in his throat after
,NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
he eats solid foods, but he has no issue with liquids or soft foods, such as yogurt. He reports no recent
weight loss, anorexia, chest pain, throat pain, nausea, or vomiting. Which of the following findings in this
patient's history would increase suspicion for the likely cause of this patient's dysphagia?
Family history of asthma
Personal history of gastroesophageal reflux disease
Personal history of liver cirrhosis
Recent personal history of influen - (answer) Personal history of gastroesophageal reflux disease
Esophageal stricture refers to abnormal narrowing of the esophageal lumen (≤ 13 mm in diameter),
which typically presents as progressive dysphagia with solid food. Other symptoms may include weight
loss, food impaction, odynophagia, and chest pain. The most common cause of esophageal stricture is
longstanding gastroesophageal reflux disease (GERD)
A 35-year-old woman presents to the clinic with a chief complaint of dyspepsia and epigastric fullness.
Which additional finding would warrant further testing for Helicobacter pylori infection?
Heartburn and acid regurgitation
History of gastric bypass surgery
Short-term NSAID use
Unexplained iron deficiency anemia - (answer) Unexplained iron deficiency anemia
Helicobacter pylori infection interferes with the absorption of oral iron and can result in iron deficiency
anemia. In patients with dyspepsia, unexplained iron deficiency anemia warrants further evaluation for
Helicobacter pylori infection.
A 63-year-old man with a 40-year history of alcohol and tobacco abuse presents with solid food
dysphagia. The patient has also had a 21 lb weight loss over the past 7 months. Which of the following
studies should be performed for a definitive diagnosis?
Barium esophagram
Chest X-ray
CT Scan
Endoscopy - (answer) Endoscopy
, NUR 524 EXAM 3 NEWEST 2024 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
Endoscopy with biopsy establishes the diagnosis of esophageal carcinoma with a high degree of
reliability when biopsy is included as part of the procedure. Esophageal cancer commonly develops in
persons between 50 and 70 years of age. The overall incidence ratio of men to women is 3:1. There are
two histological types: Squamous cell carcinoma and Adenocarcinoma. Chronic alcohol and tobacco use
are strongly associated with an increased risk of squamous cell carcinoma
A 49-year-old woman presents with headaches that occur nearly every afternoon since she switched
jobs 6 months ago. She describes squeezing pain at her forehead, accompanied by fatigue and poor
concentration. Her exam is normal except for posterior neck tenderness, which she attributes to stress at
work. Which of the following interventions would be most helpful to this patient?
Headache abortive therapy with sumatriptan
Headache prevention with amitriptyline
Headache prevention with daily verapamil
High dose prednisone taper - (answer) Headache prevention with amitriptyline
Amitriptyline would be most helpful for headache prevention in this patient who is describing tension-
type headaches. Tension headaches are very common and tend to present as a bilateral headache in a
band-like distribution with pain in the frontal and occipital regions. It is the most common type of
primary headache. A physical exam may reveal focal areas of tenderness at the posterior neck, where
pain and stiffness radiate upward causing pain at the back of the head and a vice-like discomfort around
the skull. Neurologic exams should be normal. Tension headaches frequently occur during times of stress
A 39-year-old man presents to the clinic for a follow-up on his Achilles tendonitis. He states that the
prescribed diclofenac was not helping, so he also took ibuprofen for added pain relief. The provider is
concerned for drug-induced nephrotoxicity. He has no previous history of kidney disease. Which of the
following would indicate an urgent nephrologist referral?
GFR of 28 mL/min
Serum creatinine of 1.01 mg/dL
Urine albumin of 25 mg/mmol
Urine RBC of 10/hpf - (answer) GFR of 28 mL/min
A 24-year-old woman presents with dysuria, urgency, and urinary frequency for the last three days.
Today, she developed nausea, flank pain, and a fever. What is the most likely diagnosis?
