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?

         

Yes

  

No

· 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?

         

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?

         

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:

         

CBCdiff
 

  

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
 

  

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:

         

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?

         

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:

         

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?

         

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?

         

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?

         

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:

         

Alcohol
 

  

Gallstones
 

  

Medications
 

  

Pregnancy

· 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:

         

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:

         

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
 

  

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?

         

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?

         

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?

         

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?

         

Aspirin

  

NSAIDs

  

Opioids

  

Antihistamines

· 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?

         

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?

         

“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?

         

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? 

         

Erythromycin
 

  

Clarithromycin (Biaxin)
 

  

Doxycycline (Vibramycin)
 

  

Penicillin

· Question 42

       

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

         

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:

         

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?

         

 Ursodiol
 

  

 Ibuprofen
 

  

Prednisone
 

  

 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
 

  

Diuretic

· Question 50

       

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

         

Gonococcal infection
 

  

Thrush
 

  

Leukoplakia
 

  

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
 

  

Chemosis
 

  

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

  

Rhabdomyolysis

· 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?

         

Cataracts
 

  

Glaucoma
 

  

Retinal detachment
 

  

Iritis

· 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

  

Eczema

  

Psoriasis

  

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

  

Glaucoma

  

Corneal abrasion

  

Retinoblastoma

· 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