NURS 6531 MIDTERM EXAM / NURS6531 MIDTERM EXAM (2 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 200 Q & A)
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:
Basal cell carcinoma
Squamous cell carcinoma
· 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
· 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:
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:
Common pink eye
· 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?
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:
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
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?
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?
· 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
Deep vein thrombosis
· 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?
· 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
· 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:
Systolic heart failure
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:
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
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
· 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:
Shortness of breath
· 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?
· Question 41
Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?
· 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
· 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:
Group A beta hemolytic streptococcus
· Question 47
Which of the following is not a symptom of irritable bowel syndrome?
Cramping and abdominal pain
· 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
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?
Calcium channel blocker
· Question 50
The differential diagnosis for a patient complaining of a sore throat includes which of the following?
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:
· 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 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
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
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?
· 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
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?
· 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?
· 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?