walden nurs6531 midterm exam graded 2019

•             Question 1          When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?                                     

Answers:              

Yes

No

                                               

•             Question 2          The most common cancer found on the auricle is:                                           

Answers:             Actinic keratosis

Basal cell carcinoma

                Squamous cell carcinoma

                Acral-lentiginous melanoma

               

•             Question 3          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

Antihistimines

                Steroids

                Anticholinergics

•             Question 4          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          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          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/diff

                Erythrocyte sedimentation rate

                Abdominal ultrasound

CT scan

 

•             Question 7          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          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          A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different 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        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        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        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        Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected 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        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        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?                                         

Answers:             Congestive heart failure

Varicose veins

                Deep vein thrombosis

                Arterial insufficiency

                                               

•             Question 17        Which statement below is correct about pertussis?                                        

Answers:              

It is also called whooping cough

                It begins with symptoms like strep throat

                It lasts about 3 weeks

                It occurs most commonly in toddlers and young children

•             Question 18        Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?                                         

Answers:              

Pneumonia

                Asthma

                Sinusitis

                Pertussis

•             Question 19        A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?                                          

Answers:             Diverticulosis

                Diverticula

Diverticulitis

                Diverticulum

•             Question 20        Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?                                            

Answers:             Varicella

                  Herpes zoster

                Syphilis

                Rubella

                                               

•             Question 21        A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:                                  

Answers:             Alcohol

Gallstones

                Medications

                Pregnancy

•             Question 22        When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?                                           

Answers:             Order abdominal x-rays

Order an abdominal ultrasound

                Refer the patient to a surgeon for evaluation

                Prescribe pain medication

•             Question 23 A false-positive result with the fecal occult blood test can result from:                                         

Answers:             ingestion of large amounts of vitamin C

a high dietary intake of rare cooked beef

                a colonic neoplasm that is not bleeding

                stool that has been stored before testing

                                               

•             Question 24  A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:                                           

Answers:             Colonoscopy

Small bowel follow-through

                Barium enema

                CT abdomen

                                               

•             Question 25        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        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        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        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        An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:                                

Answers:             Esophageal cancer

 

                Chest pain

 

                GERD

 

                 

A and C

 

                All of the above

                                               

•             Question 30        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        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 32        The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?                                               

Answers:             Scalp

 

                Nails

 

                Feet

 

                 

B and C

 

                All of the above

                                               

•             Question 33        An adult presents with tinea corporis. Which item below is a risk factor for its development?                     

Answers:              

Topical steroid use

 

                Topical antibiotic use

 

                A recent laceration

 

                Cold climates

                                               

•             Question 34        A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?                                   

Answers:             Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours.

 

                 

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

 

                Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction.

 

                Order stool cultures.

                                               

•             Question 35        Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?                                    

Answers:             Aspirin

                NSAIDs

                Opioids

                 

Antihistamines

                                               

•             Question 36        Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:                                             

Answers:             Peripheral edema

 

                 

Weight gain

 

                Shortness of breath

 

                Nocturnal dyspnea

                                               

•             Question 37        A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?                                               

Answers:             Ibuprofen

                Erythromycin

                 

Amoxicillin

                Acetaminophen

                                               

•             Question 38        A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?                                         

Answers:             “Are you wearing your usual shoes?”

 

                “Do you also have chest pain when you have leg pain?”

 

                 

“Is your leg pain relieved by rest?”

 

                “Do you ever have the same pain in the other leg?”

                                               

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

Answers:             Erythromycin

 

                 

Clarithromycin (Biaxin)

 

                Doxycycline (Vibramycin)

 

                Penicillin

                                               

•             Question 42        Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?                                       

Answers:              

Powders

 

                Gels

 

                Creams

 

                Lotion

                                               

•             Question 43        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        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?                                          

 

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        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