NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University

Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest)

· Question 1


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:


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?









· 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?


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?


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:




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:


Purulent drainage






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:


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:


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?




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:


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?


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?


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?


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?


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?


Congestive heart failure


Varicose veins


Deep vein thrombosis


Arterial insufficiency

· Question 17


Which statement below is   correct about pertussis?


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?









· 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?









· 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?




Herpes zoster





· Question 21


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









· Question 22


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


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:


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:




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:


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?


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:


“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:


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:


Esophageal cancer


Chest pain




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?


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?


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?








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?


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?


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?









· Question 36


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


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?









· 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?


“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?


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?




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? 




Clarithromycin (Biaxin)


Doxycycline (Vibramycin)



· Question 42


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









· 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:


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? 


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?








 Surgery is the only answer

· Question 46


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:


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?


Painful diarrhea


Painful constipation


Cramping and abdominal pain


Weight loss

· Question 48


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?


Any recent trauma


Difficulty swallowing


 Stiffness in the right shoulder


Change in sleeping habits

· Question 49


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?


ACE Inhibitor


Beta Blocker


Calcium channel blocker



· Question 50


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


Gonococcal infection






B only


A, B, and C

· Question 51


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:


Rhus dermatitis


Ophthalmic zoster




Optic neuritis

· Question 52


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?


Serologic markers for hepatitis


Serum bilirubin


Serum cholesterol with HDL and LDL


A liver biopsy

· Question 53


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:


A drug interaction


Hepatic dysfunction


Hypersensitivity to lovastatin



· Question 54


Treatment of acute vertigo   includes:


Bedrest and an antihistamine


Fluids and a decongestant


A sedative and decongestant


Rest and a low sodium diet

· Question 55


Treatment of H.pylori includes   which of the following?


Proton pump inhibitor


Antibiotic therapy


Bismuth subsalicylate


A and B


A, B, and C

· Question 56


Carl, age 78, is brought to the   office by his son, who states that his father has been unable to see clearly   since last night. Carl reports that his vision is “like looking through a   veil.” He also sees floaters and flashing lights but is not having any pain.   What do you suspect?






Retinal detachment



· Question 57


In order to decrease deaths   from lung cancer:


All smokers should be screened annually


All patients should be screened annually


Only high risk patients should be screened routinely


Patients should be counseled to quit smoking

· Question 58


John, age 33, has a total   cholesterol level of 188 mgdL. How often should he be screened for   hypercholesterolemia?


 Every 5 years


Every 2 years


Every year


Whenever blood work is done

· Question 59


Mort is hypertensive. Which of   the following factors influenced your choice of using an alpha blocker as the   antihypertensive medication?


Mort is black


Mort also has congestive heart failure


 Mort has benign prostatic hyperplasia


 Mort has frequent migraine headaches

· Question 60


John, age 59, presents with   recurrent, sharply circumscribed red papules and plaques with a powdery white   scale on the extensor aspect of his elbows and knees. What do you suspect?


Actinic keratosis






Seborrheic dermatitis

· Question 61


Harriet, a 79-year-old woman,   comes to your office every 3 months for follow up on her hypertension. Her   medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium   1500 mg daily. At today’s visit. Her blood pressure is 17089. According to   JNC VIII guidelines, what should you do next to control Harriet’s blood   pressure?


Increase her Lisinopril to 20mg daily


Add a thiazide diuretic to the Lisinopril 5mg daily


Discontinue the Lisinopril and start a combination of ACE Inhibitor     and calcium channel blocker


Discontinue the Lisinopril and start a diuretic

· Question 62


An active 65-year-old man under   your care has known acquired valvular aortic stenosis and mitral   regurgitation. He also has a history of infectious endocarditis. He has   recently been told he needs elective replacement of his aortic valve. When he   comes into the office you discover that he has 10 remaining teeth in poor   repair. Your recommendation would be to:


defer any further dental work until his valve replacement is completed


instruct him to have dental     extraction done cautiously, having no more than 2 teeth per visit removed.


suggest he consult with his     oral surgeon about having all the teeth removed at once and receiving     appropriate antibiotic prophylaxis


coordinate with his cardiac and oral surgeons to have the tooth     extractions and valve replacement done at the same time to reduce the risk     of anesthetic complications.

· Question 63


Appropriate therapy for peptic   ulcer disease (PUD) is:


Primarily by eradication of infection


Based on etiology


Aimed at diminishing prostaglandin synthesis


Dependent on cessation of NSAID use

· Question 64


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?


A calcium channel blocker


A beta blocker


An ACE Inhibitor


No hypertension medication   

· Question 65


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?


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


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


Viral conjunctivitis




Corneal abrasion



· Question 67


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?


Pharmacological therapy