NR511 Week 8 Final Exam
NR 511 Week 8 Exam
Question 1. The most cost-e?ective screening test for determining HIV status is which of the following?
Enzyme-linked immunosorbent assay
Venereal Disease Research Laboratory test
Question 2. Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?
Erythrocyte sedimentation rate
White blood cell count
C-reactive protein (CRP)
Question 3. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?
Question 4. Mrs. Thomas was seen in the o?ce complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that di?erentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
Ecchymosis, edema, and erythema over the lateral epicondyle
Pain at the elbow with resisted movements at the wrist and forearm
Inability to supinate and pronate the arm
Inability to flex or extend the elbow against resistance
Question 5. Which of the following statements concerning the musculoskeletal examination is true?
The uninvolved side should be examined initially and then compared to the involved side.
The part of the body that is causing the patient pain should be examined first.
When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain.
Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.
Question 6. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
Decreased C-reactive protein
Question 7. Which causes the greatest percentage of mammalian bites?
Question 8. A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?
Abdominal computed tomography scan
Question 9. A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
"Control of glucose will help postpone or delay complications."
"Regularly checking blood sugar will help establish a routine."
"Monitoring glucose will promote a sense of control."
All of the above
Question 10. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular sti?ness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
Urine specific gravity
Question 11. Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?
Question 12. During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?
An enlarged rubbery gland
A hard irregular gland
A tender gland
A boggy gland
Question 13. Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step?
Remove the insect with tweezers.
Immobilize the insect with 2% lidocaine.
Sedate Eddie with diazepam.
Shine a light in the ear for the insect to "find its way out."
Question 14. What is the most common cause of microcytic anemia?
Anemia of chronic disease
Question 15. An 82-year-old man is seen in the primary care o?ce with complaints of dribbling urine and di?culty starting his stream. Which of the following should be included in the list of di?erential diagnoses?
Benign prostatic hyperplasia (BPH)
All of the above
Question 16. Early rheumatoid disease is characterized by:
Pain and swelling in both small and large peripheral joints
Rigid joints with diminished range of motion
Joint swelling and immobility on rising
A cardiac rub or pulmonary friction rub
Question 17. A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
Make an immediate referral for an orthopedic evaluation without further assessment.
Tell her that it takes time for these bruises to improve, so she should be patient.
Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint.
Send her to the emergency room for reduction of this obvious wrist fracture.
Question 18. The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:
Question 19. A 60-year-old man presents with an enlarged scrotum. The linician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?
The scrotum will be dark.
The scrotum will appear light pink or yellow.
The scrotum will appear milky white.
The internal structures will be clearly visible.
Question 20. According to Kübler-Ross, the stages of grief occur in whichorder?
Anger, denial, depression, bargaining, acceptance
Anger, denial, bargaining, acceptance, depression
Denial, anger, depression, bargaining, acceptance
Denial, anger, bargaining, depression, acceptance
Question 21. Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?
A favorable prognostic trend
The need to be more aggressive with Reuben's medications
The eradication of the HIV
Question 22. The exanthem of Lyme disease is:
Question 23. You have detected the presence of crepitus on examination
of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
A and B
Question 24. What is the recommended daily calcium intake for adults
over the age of 50 with low bone mass?
Question 25. When assessing a woman for infertility, which of the following tests should be done first?
Analysis of partner's sperm
Magnetic resonance imaging (MRI)
Question 26. Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?
Superficial partial-thickness burns
Deep partial-thickness burns
Question 27. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?
Human papillomavirus (HPV)
Polycystic ovarian syndrome
Question 28. As a rule of thumb, the estimated level of hematocrit is how many times the value of the hemoglobin?
Question 29. Sam is a 25-year-old who has been diagnosed with low
back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
Morning sti?ness and limited mobility of the lumbar spine
Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
Fever, chills, and elevated erythrocyte sedimentation rate
Pathologic fractures, severe night pain, weight loss, and fatigue
Question 30. A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?
Nocturnal penile tumescence and rigidity
Question 31. The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been e?ective?
"I'll take my pill at least 30 minutes before breakfast."
"I'll take my Glucotrol before bedtime."
"It is important to take my medication right after I eat." "
Since I only like to eat two meals a day, I can take the pill between my meals."
Question 32. In the United States, what is the second most common connective tissue disease and the most destructive to the joints?
Systemic lupus erythematosus (SLE)
Question 33. The e?ectiveness of benzodiazepines in treating anxiety isorders suggests that which of the following neurotransmitters plays a role in anxiety?
Gamma-aminobutyric acid (GABA)
Question 34. A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?
Refer to a urologist immediately.
Obtain a computed tomography (CT) scan.
Instruct the patient to elevate the scrotum.
Question 35. Which of the following medications can cause hyperglycemia?
Question 36. During treatment for anaphylaxis, what site is used for the initial injection of epinephrine?
Upper lateral thigh
Question 37. It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?
Before the initiation of treatment
1 to 2 weeks after the initiation of treatment
When switching to a di?erent medication
1 to 2 weeks after tapering o? medications
Question 38. What is the most common cause of secondary amenorrhea?
Inadequate estrogen levels
Question 39. Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration?
Question 40.The goals of the 15-minute hour approach include: Enhance self-esteem, expand behavioral repertoire,
prevent dire consequences, and reestablish premorbid
levels of functioning
Emerge with a higher level of functioning and commitment to long-term psychotherapy
Accept need for antidepressant therapy and psychiatric referral; share concerns with primary care clinician
Improve family functioning and sexual performance as well as accept need for antidepressant medication
Question 41. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
Valgus stress test
McMurray circumduction test
Varus stress test
Question 42. The cardinal subjective symptom of sickle cell crisis is which of the following?
Question 43. A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?
Pelvic inflammatory disease
Sexually transmitted infections
Question 44. Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?
Brown recluse spider
Question 45. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
A reduced or absent ankle reflex
Numbness in the lateral foot
Paresthesia of the perineum and buttocks
Question 46. A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?
Complete blood cell count
Urine dip for protein
Question 47. A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
All of the above
Question 48. The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?
SSRIs are more e?ective than TCAs.
SSRIs take less time to work than TCAs.
SSRIs have a more favorable side-e?ect profile than TCAs.
SSRIs are not lethal in overdose.
Question 49. Which type of bone marrow transplant is obtained from an identical twin?
Question 50. Pink, cherry red tissues and skin may result from which type of poisoning?
Question 51. Basic human needs are identified as:
Autonomy and feeling valued by others
Exhilaration and productivity Spirituality
Career success and material rewards
Question 52. The clinician sees a patient who is 5 feet tall and weighs 150 ounds. How would the clinician classify this patient?
Question 53. A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self- examination (TSE). Which of the following should be included in the list of di?erential diagnoses?
All of the above
Question 54. What is the treatment of choice for a patient diagnosed with testicular cancer?
All of the above
Question 55. Which method is used to remove heavy metals, such as lead, that are ingested as poisons?
Question 56. A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?
"It is probably just a cyst because that is the most common breast mass."
"We will order a mammogram and ultrasound to help establish a diagnosis."
"We will go ahead and schedule you for a biopsy because that is the only way to know for sure."
"Because your lump is painful, it is most likely not cancer."
Question 57. A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?
Estrogen vaginal cream
Question 58. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
"You should start with the lowest dose that is e?ective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage."
"You should start with the lowest dose that is e?ective in managing your pain to avoid developing tolerance to the medication."
"You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain."
"It is important to take NSAIDs on an empty stomach in order to increase absorption."
Question 59. A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury?
A partial fracture
Question 60. Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea?
Question 61. Which of the following may be used to evaluate a person's suicide risk?
Question 62. One of the initial steps in assessing patients withmusculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
Question 63. After returning from visiting his grandchildren in England, George, age 59, complains of a flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering?
A viral syndrome
Rocky Mountain spotted fever
Question 64. A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
Question 65. Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal?
Question 66. After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?
Question 67. A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
No treatment at this time
Diet and exercise for 6-week trial
Diet, exercise, and oral medication
Diet, exercise, and exogenous insulin
Question 68. Which of the following should be considered in a patient presenting with erectile dysfunction?
All of the above
Question 69. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome.
Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel.
Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel.
An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel.
Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance.
Question 70. A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?
Question 71. Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
The goal of treatment is to prevent flexion and extension movements of the wrist.
Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position.
Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection.
All of the above
Question 72. Mr. S presents in the clinic with pain, tenderness, erythema,and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
Elevated uric acid level
Elevated blood urea nitrogen
Decreased urine pH
Decreased C-reactive protein
Question 73. Which of the following data is indicative of testicular torsion?
Absent cremasteric reflex
Pain relieved on testicular elevation
Testicle very low in the scrotum
Swollen scrotum with "red dot sign"
Question 74. A patient with type 2 diabetes asks the clinician why she
needs to exercise. In order to answer her, the clinician must understand that exercise has what e?ect on the patient with type 2 diabetes?
Reduces postprandial blood glucose
Reduces triglycerides and increases high-density lipoprotein (HDL)
Reduces total cholesterol
All of the above
Question 75. A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
Question 76. What is the most common cause of generalized musculoskeletal pain in women ages 20 to 55?
Chronic fatigue syndrome (CFS)
Fibromyalgia syndrome (FMS)
Question 77. If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do?
Stop the warfarin for 1 week, and then repeat the INR.
Withhold one or more days of anticoagulant therapy.
Restart therapy at a lower dose immediately.
The prothrombin time and INR should be reevaluated within 1 month of the dosage adjustments.
Question 78. A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes?
Pelvic inflammatory disease
Oral contraceptive use for 15 years
Diet high in soy protein
Question 79. Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible.
Treatment is directed toward controlling discomfort, improving sleep, and maintaining function.
Fibromyalgia syndrome can be di?cult to manage, requiring a variety of approaches and multiple medications.
All of the above
Question 80. The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis?
Question 81. Which household solution should be used to clean a bathroom if sharing with a friend who has HIV?
50% bleach and 50% vinegar
Nine parts H2O to one part bleach
The friend must have his or her own bathroom.
Question 82. Sandra is 42 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit?
Acute lymphocytic leukemia
Acute myelogenous leukemia
Chronic myelogenous leukemia
Chronic lymphocytic leukemia
Question 83. Which of the following is identified as an eating disorder in which a person craves food substitutes, such as clay, ice chips, and cotton, and is considered an objective finding associated with severe iron deficiency?
Question 84. The clinician suspects that a client seen in the o?ce has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
High sensitivity thyroid-stimulating hormone (TSH) and free T4
Free T4 and serum calcium
Free T3 and T4
TSH and thyroxin antibodies
Question 85. The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been e?ective?
"As long as I don't need glasses, I don't have to worry about going blind."
"I know I need to have my eyes checked every year."
"My optometrist checks my eyes."
"I will see my eye doctor when my vision gets blurry."
Question 86. Triggering factors for acute exacerbations of which of the following conditions include exposure to ultraviolet (UV)-B and UV-A rays?
Question 87. Which of the following characteristics separates anaphylaxis from a vasovagal reaction?
Question 88. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most e?ective in treating osteoarthritis. What would be the most appropriate response from the clinician?
"Complementary therapies should be considered only if surgical interventions are not successful."
"I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition."
"I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy."
"It would be crazy to use complementary therapies to treat such a serious condition."
Question 89. One benefit of motivational interviewing (MI) is:
It assumes that ambivalence is a normal part of the change process.
It can be utilized during routine o?ce visits.
It is a therapeutic technique which is not necessarily time intensive.
All are benefits of MI.
Question 90. What percentage of burns is involved using the rule of nines
if both front legs are burned?
Question 91. Women are at the highest risk for developing postpartum
depression for up to how long after childbirth?
Question 92. Which statement about HIV postexposure prophylaxis (PEP)
for health-care workers is the most accurate?
PEP should be started within hours of exposure.
PEP should be started within 72 hours of exposure.
Renal and hepatic function tests should be done 6 weeks after beginning PEP.
PEP will prevent potential hepatitis C infection if present.
Question 93. The clinician is caring for Diane, a 22-year-old woman who
presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x- ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane's description of her injury. Which of the following clues in Diane's examination or history would alert the clinician to the need for obtaining radiographs?
Inability to bear weight immediately after the injury
Development of marked ankle swelling and discoloration after the injury
Crepitation with palpation or movement of the ankle
All of the above
Question 94. A vegetarian patient with gout asks the clinician about food
he should avoid. The clinician should advise the patient to avoid which of the following foods?
Question 95. A patient with a basilar skull fracture may experience an
impaired downward gaze or diplopia from which a?ected cranial nerve?
Question 96. A patient presents to the clinician after experiencing four
episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack?
All of the above
Question 97. Which test is used to confirm a diagnosis of epididymitis?
Gram stain of urethral discharge
Complete blood cell count with di?erential Ultrasound of the scrotum
Question 98. BATHEing the patient refers to:
A technique used in primary care to get the patient to accept the need for psychological or psychiatric referral
A technique used to facilitate cultural understanding
A technique used to perform psychotherapy
A technique that is a quick screen for psychiatric issues and interventions for psychological problems
Question 99. BATHEing the patient is an advanced practice nursing
intervention that allows the practitioner to:
Develop a therapeutic relationship without "owning" the patient's problem
Conduct psychological counseling within the context of the primary care encounter
Focus on the "process" and not the assessment
Make the patient and family happier
Question 100. A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses?
All of the above