NSG 6420 / NRSG 6420 Mid Term Exam | NSG6420 Practicum I Family Health: Adults and Gerontology South University

CLICK HERE: NSG 6420 / NRSG 6420 Mid Term Exam | NSG6420 Practicum I Family Health: Adults and Gerontology South University

NRSG 6420 Mid Term

 

Question 1.

1. Your patient has been using chewing tobacco for 10 years. On physical examination,

you observe a white ulceration surrounded by

erythematous base on the side of his tongue. The clinician should recognize that very

often this is: (Points : 2)

Malignant melanoma

X Squamous cell carcinoma

Aphthous ulceration

Behcet's syndrome

 

Question 2.

2. Which of the following would be considered a "red flag" that requires more

investigation in a patient assessment? (Points : 2)

Colon cancer in family member at age 70

Breast cancer in family member at age 75

X Myocardial infarction in family member at age 35

All of the above

 

Question 3.

3. The pathophysiological hallmark of ACD is: (Points : 2)

Depleted iron stores

X Impaired ability to use iron stores

Chronic uncorrectable bleeding

Reduced intestinal absorption of iron

 

Question 4.

4. It is important to not dilate the eye if ____ is suspected. (Points : 2)

Cataract

Macular degenerationX Acute closed-angle glaucoma

Chronic open-angle glaucoma

 

Question 5.

5. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing.

The patient reports a smoking history of 2 packs of

cigarettes per day since age 16. This would be recorded in the chart as: (Points : 2)

50 x 2-pack years

X 100-pack years

50-year, 2-pack history

100-pack history

 

Question 6.

6. When teaching a group of older adults regarding prevention of gastroesophageal

reflux disease symptoms, the nurse practitioner will include

which of the following instructions? (Points : 2)

Raise the head of the bed with pillows at night and chew peppermints when

symptoms of heartburn begins.

Raise the head of the bed on blocks and take the proton pump inhibitor

medication at bedtime.

Sit up for an hour after taking any medication and restrict fluid intake.

X Avoid food intolerances, raise head of bed on blocks, and take a proton pump

inhibitor before a meal.

 

Question 7.

7. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue,

and unintentional weight loss. At times he is constipated

and other times he has episodes of diarrhea. His physical examination is

unremarkable. It is important for the clinician to recognize the

importance of: (Points : 2)

CBC with differential

Stool culture and sensitivity

Abdominal X-ray

X Colonoscopy

 

Question 8.

8. Dan G., a 65-year-old man, presents to your primary care office for the evaluation

of chest pain and left-sided shoulder pain. Pain begins

after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10

during activity, otherwise 0/10. Began a few months ago,

intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain

is retrosternal, radiating to left shoulder, definitely

affects quality of life by limiting activity. Pain is worse today; did not go away after he

stopped walking. BP 120/80. Pulse 72 and regular. Normal

heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses

would be most likely? (Points : 2)

Musculoskeletal chest wall syndrome with radiation

Esophageal motor disorder with radiation

Acute cholecystitis with cholelithiasis

X Coronary artery disease with angina pectoris

 

Question 9.

9. A common auscultatory finding in advanced CHF is: (Points : 2)

Systolic ejection murmur

X S3 gallop rhythm

Friction rub

Bradycardia

 

Question 10.

10. Which of the following symptoms is common with acute otitis media? (Points : 2)

X Bulging tympanic membrane

Bright light reflex of tympanic membrane

Increased tympanic membrane mobility

All of the above

 

CLICK HERE: NSG 6420 / NRSG 6420 Mid Term Exam | NSG6420 Practicum I Family Health: Adults and Gerontology South University

Question 11.

11. Rheumatic heart disease is a complication that can arise from which type of

infection? (Points : 2)

Epstein-Barr virusDiphtheria

X Group A beta hemolytic streptococcus

Streptococcus pneumoniae

 

Question 12.

12. In examining the mouth of an older adult with a history of smoking, the nurse

practitioner finds a suspicious oral lesion. The patient has

been referred for a biopsy to be sent for pathology. Which is the most common oral

precancerous lesion? (Points : 2)

Fictional keratosis

Keratoacanthoma

Lichen planus

X Leukoplakia

 

Question 13.

13. Jenny is a 24 year old graduate student that presents to the clinic today with

complaints of fever, midsternal chest pain and generalized

fatigue for the past two days. She denies any cough or sputum production. She states

that when she takes Ibuprofen and rest that the chest

pain does seem to ease off. Upon examination the patient presents looking very ill. She

is leaning forward and states that this is the most

comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and

regular. Upon auscultation a friction rub is audible. Her lung

sounds are clear. With these presenting symptoms your initial diagnosis would be:

(Points : 2)

Mitral Valve Prolapse

Referred Pain from Cholecystitis

X Pericarditis

Pulmonary Embolus

 

Question 14.

14. Which of the following findings should trigger an urgent referral to a cardiologist

or neurologist? (Points : 2)

History of bright flash of light followed by significantly blurred visionX History of transient and painless monocular loss of vision

History of monocular severe eye pain, blurred vision, and ciliary flush

All of the above

 

Question 15.

15. Helicobacter pylori is implicated as a causative agent in the development of

duodenal or gastric ulcers. What teaching should the nurse

practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2)

It is highly contagious and a mask should be worn at home.

Treatment regimen is multiple lifetime medications.

X Treatment regimen is multiple medications taken daily for a few weeks.

Treatment regimen is complicated and is not indicated unless the patient is

symptomatic.

 

Question 16.

16. The best evidence rating drugs to consider in a post myocardial infarction patient

include: (Points : 2)

X ASA, ACE/ARB, beta-blocker, aldosterone blockade

ACE, ARB, Calcium channel blocker, ASA

Long-acting nitrates, warfarin, ACE, and ARB

ASA, clopidogrel, nitrates

 

Question 17.

17. The most common cause of eye redness is: (Points : 2)

X Conjunctivitis

Acute glaucoma

Head trauma

Corneal abrasion

 

Question 18.

18. A specific exam used to evaluate the gall bladder is: (Points : 2)

Psoas sign

Obturator sign

Cullens sign

X Murphy's sign

 

Question 19.

19. An 82-year-old female presents to the emergency department with epigastric pain

and weakness. She admits to having dark, tarry

stools for the last few days. She reports a long history of pain due to osteoarthritis. She

self-medicates daily with ibuprofen, naprosyn, and

aspirin for joint pain. On physical examination, she has orthostatic hypotension and

pallor. Fecal occult blood test is positive. A likely etiology

of the patient's problem is: (Points : 2)

Mallory-Weiss tear

Esophageal varices

X Gastric ulcer

Colon cancer

 

Question 20.

20. Which of the following is not a contributing factor to the development of

esophagitis in older adults? (Points : 2)

X Increased gastric emptying time

Regular ingestion of NSAIDs

Decreased salivation

Fungal infections such as Candida

 

CLICK HERE: NSG 6420 / NRSG 6420 Mid Term Exam | NSG6420 Practicum I Family Health: Adults and Gerontology South University

Question 21.

21. Susan P., a 60-year-old woman with a 30 pack year history, presents to your

primary care practice for evaluation of a persistent,

daily cough with increased sputum production, worse in the morning, occurring over

the past three months. She tells you, "I have the

same thing, year after year." Which of the following choices would you consider

strongly in your critical thinking process? (Points : 2)

Seasonal allergies

Acute bronchitis

Bronchial asthma

X Chronic bronchitis

 

Question 22.

22. A 59-year-old patient with history of alcohol abuse comes to your office because of

'throwing up blood". On physical examination, you note

ascites and caput medusa. A likely cause for the hematemesis is: (Points : 2)

Peptic ulcer disease

Barrett's esophagus

X Esophageal varices

Pancreatitis

 

Question 23.

23. Which disease process typically causes episodic right upper quadrant pain,

epigastric pain or chest pain that can last 4-6 hours or less,

often radiates to the back (classically under the right shoulder blade) and is often

accompanied by nausea or vomiting and often follows a

heavy, fatty meal. (Points : 2)

Acute pancreatitis

Duodenal ulcer

Biliary colic

X Cholecystitis

 

Question 24.

24. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating

to his back. He was mowing his lawn. He reports the pain

lasting for about 8 minutes and went away after sitting down. What is his most likely

diagnosis based on his presenting symptoms? (Points : 2)

Acute MI

GERD

Pneumonia

X Angina

 

Question 25.

25. In addition to the complete blood count (CBC) with differential, which of the

following laboratory tests is considered to be most useful in

diagnosing ACD and IDA? (Points : 2)Serum iron

Total iron binding capacity

Transferrin saturation

X Serum ferritin

 

Question 26.

26. If it has been determined a patient has esophageal reflux, you should tell them:

(Points : 2)

They probably have a hiatal hernia causing reflux

They probably need surgery

They should avoid all fruit juices

X Smoking, alcohol, and caffeine can aggravate their problem

 

Question 27.

27. Which of the following imaging studies should be considered if a pulmonary

malignancy is suspected? (Points : 2)

X Computed tomography (CT) scan

Chest X-ray with PA, lateral, and lordotic views

Ultrasound

Positron emission tomography (PET) scan

 

Question 28.

28. 2. (*There are multiple Questions on this exam related to the following scenario. Be

sure to read the whole way through to the Question.)

Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of

an appendectomy, presenting with an acute onset of

significant right upper-quadrant abdominal pain and vomiting. His pain began after a

large meal, was unrelieved by a proton-pump inhibitor,

was unlike his previous episodes of heartburn, but upon Questioning, reports milder,

prodromal episodes of similar post-prandial pain. His

pain seems to radiate to his back. Despite a family history of cardiac disease, he

reports no classic anginal signs or chest pain. He furthermore

denies respiratory or pleuritic signs and denies fever, night sweats, and unintendedweight loss. Finally, there are no dermatologic signs, nor

genitourinary symptoms.

When all lab work is returned within normal limits, what is the most practical imaging

study to order, considering cost, availability, and sensitivity?

(Points : 2)

Abdominal upright and flat plate x-ray

Abdominal MRI

Abdominal CT scan with contrast

X Abdominal ultrasound

 

Question 29.

29. Emphysematous changes in the lungs produce the following characteristic in

COPD patients? (Points : 2)

Asymmetric chest expansion

Increased lateral diameter

X Increased anterior-posterior diameter

Pectus excavatum

 

Question 30.

30. (*There are multiple Questions on this exam related to the following scenario. Be

sure to read the whole way through to the Question.)

Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history

of an appendectomy, presenting with an acute onset

of significant right upper-quadrant abdominal pain and vomiting. His pain began after

a large meal, was unrelieved by a proton-pump inhibitor,

was unlike his previous episodes of heartburn, but upon Questioning, reports milder,

prodromal episodes of similar post-prandial pain. His pain

seems to radiate to his back. Despite a family history of cardiac disease, he reports no

classic anginal signs or chest pain. He furthermore

denies respiratory or pleuritic signs and denies fever, night sweats, and unintended

weight loss. Finally, there are no dermatologic signs, nor

genitourinary symptoms.The chosen imaging study reveals: "GB normal in size without wall-thickening, but

with 5-6 stones with shadowing. Common bile duct not

dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal."

What is the most effective therapeutic/management

option at this point? (Points : 2)

Trial of ursodiol

'Watchful waiting'

Surgical consult

X HIDA scan

 

CLICK HERE: NSG 6420 / NRSG 6420 Mid Term Exam | NSG6420 Practicum I Family Health: Adults and Gerontology South University

Question 31.

31. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion.

This could be due to: (Points : 2)

Exercise-induced cough

Bronchiectasis

X Alpha-1 deficiency

Pericarditis

 

Question 32.

32. (*There are multiple Questions on this exam related to this scenario. Be sure to

read the whole way through to the Question.)

Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history

of an appendectomy, presenting with an acute onset

of significant right upper-quadrant abdominal pain and vomiting. His pain began after

a large meal, was unrelieved by a proton-pump inhibitor,

was unlike his previous episodes of heartburn, but upon Questioning, reports milder,

prodromal episodes of similar post-prandial pain. His

pain seems to radiate to his back. Despite a family history of cardiac disease, he

reports no classic anginal signs or chest pain. He furthermore

denies respiratory or pleuritic signs and denies fever, night sweats, and unintended

weight loss. Finally, there are no dermatologic signs, nor

genitourinary symptoms.Of the following lab studies, which would provide little help in determining your

differential diagnosis? (Points : 2)

Abdominal plain films

Liver function tests

Amylase/lipase

X Urinalysis

 

Question 33.

33. A 22-year-old female comes to your office with complaints of right lower quadrant

abdominal pain, which has been worsening over the

last 24 hours. On examination of the abdomen, there is a palpable mass and rebound

tenderness over the right lower quadrant. The clinician

should recognize the importance of: (Points : 2)

Digital rectal examination

Endoscopy

X Pelvic examination

Urinalysis

 

Question 34.

34. A nurse practitioner reports that your patient's abdominal X-ray demonstrates

multiple air-fluid levels in the bowel. This is a diagnostic

finding found in: (Points : 2)

Appendicitis

Cholecystitis

X Bowel Obstruction

Diverticulitis

 

Question 35.

35. Your patient is a 78-year-old female with a smoking history of 120-pack years. She

complains of hoarseness that has developed over

the last few months. It is important to exclude the possibility of: (Points : 2)

Thrush

X Laryngeal cancerCarotidynia

Thyroiditis

 

Question 36.

36. Functional abilities are best assessed by: (Points : 2)

Self-report of function

X Observed assessment of function

A comprehensive head-to-toe examination

Family report of function

 

Question 37.

37. Essential parts of a health history include all of the following except: (Points : 2)

Chief complaint

History of the present illness

X Current vital signs

All of the above are essential history components

 

Question 38.

38. An 86-year-old patient who wears a hearing aid complains of poor hearing in the

affected ear. In addition to possible hearing aid

malfunction, this condition is often due to: (Points : 2)

Acoustic neuroma

X Cerumen impaction

Otitis media

Ménière's disease

 

Question 39.

39. Upon assessment of respiratory excursion, the clinician notes asymmetric

expansion of the chest. One side expands greater than the other.

This could be due to: (Points : 2)

X Pneumothorax

Pleural effusion

Pneumonia

Pulmonary embolism

Question 40.

40. When interpreting laboratory data, you would expect to see the following in a patient

with Anemia of Chronic Disease (ACD): (Points : 2)

X Hemoglobin <12 g/dl, MCV decreased, MCH decreased

Hemoglobin >12 g/dl, MCV increased, MCH increased

Hemoglobin <12 g/dl, MCV normal, MCH normal

Hemoglobin >12 g/dl, MCV decreased, MCH increased