nrnp6665 midterm exam 2022 100% graded

 

•             Question 1

 

 

0              out of 0 points

 

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

•             Question 2

 

The most common cancer found on the auricle is:

Basal cell carcinoma

Squamous cell carcinoma

Acral-lentiginous melanoma

•             Question 3

 

 

1              out of 1 points

 

 

 

 

 

 

 

 

 

 

 

 

 

0 out of 1 points

 

Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Answers:             Xanthines

 

Antihistimine

s Steroids

Anticholinerg ics

•             Question 4

0 out of 1 points

A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?

 

 

Answers:             Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet.

 

Order a topical hemorrhoid cream along with a stool softener.

 

 

Refer the patient for a barium enema and sigmoidoscopy.

 

Refer the patient for a surgical hemorrhoidectomy.

•             Question 5

0              out of 1 points

Which of the following patient characteristics are associated with chronic bronchitis?

 

 

Answers:

 

Overweight, cyanosis, and normal or slightly increased respiratory rate

 

Underweight, pink skin, and increased respiratory rate

 

Overweight, pink skin, and normal or slightly increased respiratory rate

 

Normal weight, cyanosis, and greatly increased respiratory rate

•             Question 6

1              out of 1 points

A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:

 

Answers:             CBC/dif

 

Erythrocyte sedimentation rate

 

Abdominal ultrasound

 

 

 

CT scan

•             Question 7

1 out of 1 points

A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

 

 

Answers:

 

 

 

Purulent drainage

 

Tearing Photophobia

A positive fluorescein stain

•             Question 8

1 out of 1 points

A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:

 

 

Answers:             Viral conjunctivitis Common pink eye

 

Gonococcal conjunctivitis

 

Allergic conjunctivitis

•             Question 9

0 out of 1 points

A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 diferent thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:

 

 

Answers:             A common case of shingles and prescribe an analgesic and an antiviral agent

 

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

 

 

 

Herpes zoster and consider that this patient may be immunocompromised

 

A recurrence of chickenpox and treat the patient’s symptoms

•             Question 10

 

 

Which type of lung cancer has the poorest prognosis?

 

 

Answers:             Adenocarcinoma

 

Epidermoid carcinoma

 

 

Small cell carcinoma

 

Large cell carcinoma

•             Question 11

 

0              out of 1 points

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1              out of 1 points

 

An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3– 4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:

 

Answers:             Acute diarrhea

 

 

Chronic diarrhea Irritable bowel

 

Functional bowel disease

•             Question 12

1 out of 1 points

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

 

Answers:             An allergic reaction

 

Relapsing polychondritis

 

Lymphocytoma cutis

 

 

 

Systemic lupus

erythematosus

•             Question 13

1 out of 1 points

Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

 

 

Answers:             Chronic sinusitis

 

 

Acute bronchitis Bacterial pneumonia

Acute exacerbation of chronic bronchitis

•             Question 14

0 out of 1 points

 

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations afect her activities and they occur at least twice weekly and may last for days. She is afected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

 

Answers:             Mild intermittent

 

Mild persistent

 

 

 

Moderate

persistent

•             Question 15

0 out of 1 points

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

 

Answers:

Penicillin V 500 milligrams PO every 8 hours for 10 days

 

Ampicillin 250 milligrams PO twice a day for 10 days

 

Clarithromycin 500 milligrams po daily for 7 days

None of the above

•             Question 16

0 out of 1 points

A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?

 

 

insufficiency

Answers:             Congestive heart failure

 

 

 

 

 

Varicose veins

Deep vein thrombosis

Arterial insufficiency

•             Question 25

1              out of 1 points

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

 

 

Answers:             Mitral regurgitation

 

 

 

Systolic heart failure

 

Cardiac myxoma

 

Diastolic heart failure

•             Question 26

1 out of 1 points

Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?

 

 

Answers:

Multilobar involvement on chest x-ray with the inability to take oral medications

 

Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home

 

Sputum and gram positive organisms

 

A complete blood count showing leukocytosis

•             Question 27

0              out of 1 points

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:

 

 

Answers:             “It is the most common cause of death in patients with skin cancer.”

 

 

 

“It can be cured with surgical excision or radiation therapy.”

 

“It is a slow growing skin cancer that rarely undergoes malignant changes.”

 

“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”

•             Question 28

1              out of 1 points

Expected spirometry readings when the patient has chronic emphysema include:

 

Answers:             Decreased residual volume (RV)

 

Increased vital capacity (VC)

 

Increased forced expiratory volume (FEV-1)

 

 

 

Increased total lung capacity (TLC)

•             Question 29

1 out of 1 points

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the diferential diagnosis for this patient’s dysphagia is:

 

 

Answers:             Esophageal cancer

 

Chest pain GERD

 

A and C

 

All of the above

•             Question 30

0              out of 1 points

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?

Answers:             Squamous cell carcinoma

 

 

 

Malignant melanoma

 

A common nevus

 

Basal cell carcinoma

•             Question 31

1              out of 1 points

Which of the following is not a goal of treatment for the patient with cystic fibrosis?

 

Answers:             Prevent intestinal obstruction

 

Provide adequate nutrition

 

Promote clearance of secretions

 

 

 

Replace water-soluble

vitamins

•             Question 39

 

Which of the following statements about malignant melanomas is true?

 

Answers:             They usually occur in older adult males

The patient has no family history of melanoma They are common in blacks

 

The prognosis is directly related to the thickness of the lesion

•             Question 40

 

1              out of 1 points

 

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?

 

Answers:             Asthma Nocturnal

 

allergies

 

Valvular disease

 

 

 

Heart failure

•             Question 41

0              out of 1 points

Which antibiotic would be the most efective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

 

 

Answers:             Erythromycin

 

 

Clarithromycin (Biaxin)

 

Doxycycline (Vibramycin)

 

Penicillin

•             Question 42

1              out of 1 points

Which of the following dermatologic vehicles are the most efective in absorbing moisture and decreasing friction?

 

 

Answers:

Powde rs

 

Gels

 

 

Cream s

 

Lotion

•             Question 43

1 out of 1 points

A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:

 

 

Answers:

Squamous cell carcinoma

 

Basal cell carcinoma

 

Malignant melanoma

 

Acne vulgaris

•             Question 44

1 out of 1 points

An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?

 

Selected

Answer:               Compare the patient’s blood pressure lying first, then sitting, and then standing.

 

Answers:             Assist the patient to a standing position and take her blood pressure.

 

Assess the patient’s cranial nerves.

 

 

 

Compare the patient’s blood pressure lying first, then sitting, and then standing.

 

Compare the amplitude of the patient’s radial and pedal pulses.

•             Question 45

1 out of 1 points

What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?

Answers:

Ursodiol Ibuprofen

Prednisone

 

Surgery is the only answer

•             Question 46

0 out of 1 points

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

 

 

Answers:             Staphylococcus aureus

 

Group A beta hemolytic streptococcus

 

Haemophilus influenza

 

 

 

Pseudomonas aeruginosa

 

•             Question 47

 

Which of the following is not a symptom of irritable bowel syndrome?

Answers:             Painful diarrhea Painful constipation

Cramping and abdominal pain

 

 

Weight loss

•             Question 48

 

 

0              out of 1 points

 

 

 

 

 

 

 

 

 

1              out of 1 points

 

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

 

Answers:

Any recent trauma Difficulty swallowing

Stifness in the right shoulder

Change in sleeping habits

•             Question 49

0              out of 1 points

Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?

 

Answers:             ACE Inhibitor

 

 

 

Beta Blocker

 

Calcium channel blocker

 

Diuretic

•             Question 50

1              out of 1 points

The diferential diagnosis for a patient complaining of a sore throat includes which of the following?

 

Answers:             Gonococcal infection

 

Thrush Leukoplakia B only

 

A, B, and C

•             Question 51

0 out of 1 points

A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

 

Answers:             Rhus dermatitis

 

 

 

Ophthalmic zoster

 

Chemosis

 

Optic neuritis

•             Question 52

0              out of 1 points

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?

 

Answers:

Serologic markers for hepatitis Serum bilirubin

Serum cholesterol with HDL and LDL

 

A liver biopsy

•             Question 53

1              out of 1 points

A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect:

 

Answers:             A drug interaction

 

Hepatic dysfunction

 

Hypersensitivity to lovastatin

 

 

 

 

Rhabdomyolysis

•             Question 54

 

Treatment of acute vertigo includes:

 

 

1 out of 1 points

 

Answers:

 

 

 

Bedrest and an antihistamine

 

Fluids and a decongestant

 

A sedative and decongestant

 

 

 

Rest and a low sodium diet

•             Question 63

 

 

Appropriate therapy for peptic ulcer disease (PUD) is:

 

use

Answers:             Primarily by eradication of infection

 

 

Based on etiology

 

Aimed at diminishing prostaglandin synthesis

 

Dependent on cessation of NSAID use

•             Question 64

 

0              out of 1 points

 

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?

 

 

Answers:             A calcium channel blocker

 

A beta blocker

 

 

 

An ACE Inhibitor

 

No hypertension medication

•             Question 65

1 out of 1 points

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?

 

Answers:             It is important to “undercode” so that one does not get charged with Medicare fraud

The practice of “overcoding” is essential in this age of decreasing reimbursements

 

 

Failing to bill for billable services will lead to unnecessarily low revenues

Time spent with the patient is a very important determinant of billing

•             Question 66

1 out of 1 points

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?

Answers:             Viral conjunctivitis

Glaucoma

Corneal abrasion

 

 

Retinoblastom

 

a

•             Question 67

0 out of 1 points

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

 

Answers:             Pharmacological therapy

 

A labyrinthectomy

 

 

 

A vestibular neurectomy

 

 

Wearing an earplug in the ear with the most hearing loss

•             Question 68

 

Which of the following is not a risk factor for coronary arterial insufficiency?

 

 

Answers:             Hyperhomocystein emia

 

Smoking Genetic factors

 

Alcohol ingestion

•             Question 69

 

1              out of 1 points

 

An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both

 

eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?

 

Answers:

Allergic conjunctivitis

 

Bacterial conjunctivitis

 

Gonococcal conjunctivitis

 

Viral conjunctivitis

•             Question 70

0 out of 1 points

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most efective in keeping him symptom-free?

 

Answers:             A long-acting bronchodilator

An inhaled corticosteroid and cromolyn

 

Theophylline and a short acting bronchodilator

 

 

 

A bronchodilator PRN and an inhaled

corticosteroid

•             Question 71

0 out of 1 points

Acute rheumatic fever is an inflammatory disease which can follow infection with:

 

Streptococcus

 

 

Answers:

 

 

 

Group A Streptococcus

 

Staphlococcus areus

 

Β-hemolytic Streptococcus

 

 

 

Streptococcus pyogenes

•             Question 72

 

 

 

 

0              out of 1 points

 

A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:

 

Answers:             Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days

 

Order mandibular x-rays and question the patient about physical abuse

 

Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic

 

 

 

Initiate a parenteral antibiotic and consider hospital admission

•             Question 73

1 out of 1 points

If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:

 

Answers:

 

Iritis Allergic

conjunctivitis

 

 

 

Viral conjunctivitis

Bacterial conjunctivitis

•             Question 74

 

 

 

 

 

1              out of 1 points

 

The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:

 

mg/dL

Answers:             160

mg/dL

 

130

mg/dL

 

 

 

100

mg/dL

 

70

mg/dL

•             Question 75

1 out of 1 points

A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:

 

 

Answers:             Referral for surgical intervention such as a partial or complete fundoplication

 

Dependent upon how sever the practitioner believes the condition

 

To repeat the 8 week course of drug therapy while continuing lifestyle modifications

 

 

 

Investigation with endoscopy, manometry, and/or pH testing

•             Question 76

0 out of 1 points

Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?

 

Answers:             Under 3 years of age

 

Preschool children

 

 

 

6 to 12 years of age

 

 

Adolescents

•             Question 77

 

The most appropriate treatment for a child with mild croup is:

 

Answers:             A bronchodilator An antibiotic

 

 

 

0 out of 1 points

 

A decongestant

 

 

 

A cool mist

vaporizer

•             Question 89

1              out of 1 points

 

Of the following choices, the least likely cause of cough is:

 

Answers:             Asthma

 

Gastroesophageal reflux

 

 

 

Acute pharyngitis

Allergic rhinitis

•             Question 90

1 out of 1 points

The most common correlate(s) with chronic bronchitis and emphysema is(are):

 

Answers:             Familial and genetic

factors

 

 

 

Cigarette smoking Air pollution

Occupational environment

•             Question 91

0 out of 1 points

Which choice below is least efective for alleviating symptoms of the common cold?

 

 

Answers:

 

 

 

Antihistamines

 

Oral decongestants

Topical decongestants

Antipyretics

•             Question 92

0              out of 1 points

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?

 

 

Answers:             Diets with markedly reduced intakes of sodium may be associated with other beneficial efects beyond blood pressure control

 

Sodium restriction can cause serious adverse efects

 

A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable

 

 

 

Seventy-five of sodium intake is derived from processed foods

•             Question 93

1              out of 1 points

Which of the following heart murmurs warrants the greatest concern?

Answers:             Systolic murmur

 

Venous hum murmur

 

 

 

Diastolic murmur

 

Flow murmur

•             Question 94

1 out of 1 points

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?

Answers:             Hordeolum; treat with a topical antibiotic and warm compress Conjunctivitis; treat with topical antibiotic and warm compresses

 

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

 

Chalazion; refer to an ophthalmologist for incision and drainage

•             Question 95

1 out of 1 points

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

Answers:

Inferior wall

 

Anterior wall

 

Apical wall Lateral

 

wall

•             Question 96

0 out of 1 points

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:

 

 

Answers:

Acute otitis media (AOM)

 

Otitis media with efusion

 

Mucoid otitis media

 

Serous otitis media

•             Question 97

0              out of 1 points

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:

 

Answers:             inguinal hernia

 

 

 

epigastric hernia

 

umbilical hernia

 

incisional

 

hernia

•             Question 98

1              out of 1 points

A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?

 

Answers:

Omeprazole Ranitidine An antacid

None of the above

•             Question 99

1 out of 1 points

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

 

Answers:

Quit smoking

 

Maintain aggressive hypertension therapy

 

Stick to a low-fat, low-sodium diet

 

Continue with his exercise program

•             Question 100

1 out of 1 points

 

Risk factors for acute arterial insufficiency include which of the following?

 

Answers:             Recent myocardial infarction

 

Atrial fibrillation Atherosclerosis

 

 

 

All of the above

•             Question 101

 

Impetigo and folliculitis are usually successfully treated with:

 

 

Answers:             Systemic antibiotics

 

 

Topical antibiotics

 

Topical steroid creams

 

Cleansing and debridement