Clinical Case Studies in Various Medical Conditions, Exams of Nursing

Download Clinical Case Studies in Various Medical Conditions and more Exams Nursing in PDF only on Docsity! AANP AGPCNP PRACTICE Questions with Answers 2024 An 88-year-old presents with right-side weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? Left-sided or right-sided CVA? \ n ✔LEFT-SIDED CVA Which of the following signs/symtpoms are often associated with headahces due to intracranial tumor? 1) pain worse laying down, focal neurological signs 2) Hyperflexia, personality change 3) acute onset: hours to days 4) pupillary constriction; stupor \ n ✔1) pain worse laying down, focal neurological signs Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? 1) Timolol 2) Gentamicin ophthalmic 3) Cromolyn optha 4) Olopatadine \ n ✔2) Gentamicin ophthalmic (Genoptic) A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step to be taken in order to make a diagnosis? 1) Xray of shoulder 2) Palpate structures around the shoulder. 3) MRI of shoulder 4) EMG \ n ✔2) palpate structures A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? 1) Changing to Ortho-Novum 1/35 2) Discontinue use 3) Providing reassurance 4) Double dose-for two days \ n ✔3) provide reassurance According to the Report of the U.S. Preventive Services Task Force, which of the following is NOT a current recommendation guideline for preventive care in elderly female patients? 1) Mammogram and clinical breast exams 2) Fecal Occult blood test and/or sig 3) Rubella serology or vaccination history 4) Pnuemo and influenza vaccines \ n ✔3) Rubella serology or vaccination history 87 y/o NH patient is drowsy and barely responsive. Temp 95, BP: 110/70, Pulse 60, R 10. The best action is to: 1) initiate passive warming 2) apply a rebreather 3) Perform fluid replacement 4) initiate active warming \ n ✔1) initiate passive rewarming A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you educate this patient on recognizing the signs and symptoms of hypoglycemia? 1) Edema 2) Tachycardia 3) palpitations 4) sweating \ n ✔4) sweating A 65-year-old overweight patient is diagnosed with plantar fasciitis. Initial therapy of NSAIDs, stretching, ice, and rest has proven ineffective after 3 weeks. The best follow-up plan of care would be to: 1) stop NSAID, apply a heel cup and encourage exercise and wt loss. 2) continue NSAID, apply an arch support and encourage wt loss and exercise 3) continue NSAID, xray and add a short-leg night splint 4) COntinue NSAID, xray and add a metatarsal bar \ n ✔2) continue NSAID, apply an arch support and encourage wt loss and exercise Fundoscopic exam of Hypertensive patient. 1) nicking of arteriols and viens, and small retinol hemorrages 2) drusen bodies and pale retina 3) pale macula and swollen disk margins 4) microaneurysms and optic disc cupping \ n ✔1) nicking of arteriols and viens, and small retinol hemorrages Which of the following is a common presenting feature of hyperthyroidism in the elderly? 1) elevated TSH 2) Thyroid enlargement 3) atrial fibrillation A 58-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? 1) Polymyalgia rheumatica 2) polymyositis 3) osteoarthritis 4) Fibromyalgia \ n ✔1) polymyalgia rheumatica An 85-year-old male relates that on the way to his annual physical examination, he suffered a sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." All of the following would be included in the differential diagnosis EXCEPT: 1) opthalmolic migraine 2) retinal detachment. 3) diabetic retinopathy. 4) TIA \ n ✔3) diabetic retinopathy A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose monitoring reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: 1) insulin resistance 2) the Somogyi effect. 3) needing more insulin in the mornings 4) Need to increase insulin at night \ n ✔2) Somogyi effect In a healthy elder, which of the following TRADITIONALLY defines a positive urine culture? 1) ≥100,000 colonies/mL of a single organism 2) ≥10,000 colonies/mL of a single organism 3) ≥100,000 colonies/mL of a two or more organisms \ n ✔≥100,000 colonies/mL of a single organism A 55-year-old patient exhibits a verified serum calcium level of 13 mg/dL [normal = 8.9-10.2 mg/dL]. The next step in determining the presence of pathology is to order a: 1) BUN and serum creatinine. 2) 24 hour urine 3) parathyroid hormone level. 4) thyroid panel \ n ✔3) parathyroid hormone level An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting symptoms are constant, severe, and accompanied by nausea and vomiting. She denies experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min; and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic, cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely diagnosis is: 1) acoustic neuroma 2) vestibular neuritis. 3) vertibailar insufficiency 4) TIA \ n ✔2) vestibular neuritis When initiating thyroid hormone replacement in the older adult, care must be taken to evaluate the patient's: 1) coronary status. 2) weight 3) renal function 4) mental state \ n ✔1) coronary status Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? 1) Prostate-specific antigen (PSA) 2) Urinalysis and urine culture 3) Scrotal massage and urine sample 4) CBC with diff \ n ✔2) urinalysis and urine culture Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? 1) Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus, many white blood cells 2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells 3) Squamous epithelial cells with stippling appearance and indistinct borders, many lactobacillus rods, few white blood cells \ n ✔2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells Which of the following physical findings would best alert a nurse practitioner to the probability of a herniated lumbar disc? 1) Positive Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 90° 2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° 3) Negative Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 80° \ n ✔2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° An 87-year-old obese female presents with complaints of calf pain in her right leg. The patient reports that the pain is increased with ambulation and has been increasing over the past 24 to 48 hours. The patient denies the following: any recent injury to the leg, smoking, or recent surgery. To assess this patient's symptoms, you would initially assess: 1) calf circumference and perform Doppler studies. 2) popliteal pulses and Doppler studies 3) Femoral pulses and skin temperature 4) Patrick's signs and popliteal pulses \ n ✔1) calf circumference and perform Doppler studies What type of exercise would you recommend for a 74-year-old patient with hypertension and degenerative joint disease (DJD)? 1) Stationary bike 2) Aqua exercises 3) aerobic walking \ n ✔2) Aqua exercises Trigeminal neuralgia 1) electric shock like unilateral pain 2) jaw pain extending to the neck 3) Bilateral burning pain \ n ✔1) electric shock like unilateral pain A manifestation of autonomic neuropathy in a 70-year-old patient with diabetes mellitus is: 1) tremors. 2) orthostatic hypotension. 3) hypertension 4) color blindness \ n ✔2) orthostatic hypotension The most common fluid and electrolyte imbalance in patients over 65 years of age is: Pulmonary status findings of increased total lung capacity and residual volume in a 74-year-old patient are indicative of: 1) emphysema. 2) COPD 3) chronic bronchitis 4) Asthma \ n ✔1) emphysema A 65-year-old patient with hypertension and associated angina requests a flu vaccine. The patient had a pneumococcal vaccine 10 years ago. The most appropriate plan of care would include: 1) influenza vaccine, 0.5 mL IM, 2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. 3) pneumococcal vaccine, 0.5 mL IM. \ n ✔2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. An 87-year-old patient is being treated for major depression with a selective serotonin reuptake inhibitor. Which of the following would have the greatest probability of remaining in the serum long after being discontinued? 1) Celexa 2) Prozac 3) Paxil 4) Zoloft \ n ✔2) Fluoxetine (Prozac) Age-related macular degeneration leads to which of the following? 1) Loss of central vision 2) Loss of peripheral vision 3) hemianopsia bilateral \ n ✔1) loss of central vision The approved therapeutic International Normalized Ratio (INR) for a patient on warfarin (Coumadin) therapy for atrial fibrillation is: 1) 1.0-2.0 2) 2.0-3.0 3) 2.5-3.5 \ n ✔2) 2.0-3.0 A 57-year-old patient presents for a physical examination. The patient has been in good health, takes no medications, has a family history of hypertension and heart disease, denies alcohol use, and has never smoked. The patient's last tetanus booster was 9 years ago. Which of the following vaccines is indicated at this time? 1) TD 2) Influenza 3) PNA 4) Hep B \ n ✔2) Influenza A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100° (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: 1) NPO, BARIUM enema 2) low fiber diet and referral to GI 3) clear liquids and oral antibiotics. 4) admit to hospital \ n ✔3) clear liquids and oral antibiotics. A frail elder who is on total bed rest suddenly develops urinary and fecal incontinence. This condition is frequently an indication of: 1) dementia. 2) fecal impaction. 3) cholecystitis. 4) parkinsons. \ n ✔2) fecal impaction. A 65-year-old female with diabetes mellitus presents for a routine follow up. BP is 142/88, Hgb A1c is 8.4%, fasting blood glucose is 160 mg/dL, and microalbumin is 60 mg/L (normal < 30 mg/L). In addition to changing the diabetes medications, the nurse practitioner would also ensure that the patient is taking: 1) nifedipine 12.5mg daily 2) Amlodipine 10mg daily 3) benazepril, 10 mg daily. 4) atenolol 25mg BID \ n ✔3) benazepril, 10 mg daily. A 67-year-old patient with type 2 diabetes mellitus, congestive heart failure (CHF), and mild coronary artery disease is currently taking digoxin, 0.25 mg daily; hydrochlorothiazide, 25 mg daily; glipizide, 10 mg daily; and atorvastatin (Lipitor), 20 mg h.s. Which of the following is an accurate statement regarding this regimen? 1) Glipizide will deplete potassium stores 2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. 3) atorvastatin will worsen the diabetes \ n ✔2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. An 18-year-old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? 1) Amoxicillin 2) Diphenhydramine 3) Doxycycline 4) erythromycin \ n ✔1) Amoxicillin Therapy for temporal arteritis would include: 1) Tylenol with codiene 2) ibuprofen 800mg TID 3) prednisone, 60 mg daily PO and re-evaluate in 1 month. \ n ✔3) prednisone, 60 mg daily PO and re-evaluate in 1 month. In addressing suspected domestic violence in an adult relationship, it is appropriate to: 1) just do a physical assessment, not social 2) make an assessment of battering. 3) avoid making a battering assessment, it is legal \ n ✔2) make an assessment of battering. Over the past 6 months, a nurse practitioner has been treating a 62-year-old construction worker for chronic/recurrent right biceps tendonitis. He has had good and bad days, but seems to respond well to NSAIDs and muscle relaxants. Today he returns to the clinic after feeling a "snapping" sensation in his right upper arm while lifting a cinder block. To aid in diagnosis, the nurse practitioner would evaluate: 1) Right shoulder ROM, and strength 2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. 3) radial pulses and right biceps tendon 4) right supination/pronation \ n ✔2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. Which of the following accurately describes the phenomenon of isolated systolic hypertension, as opposed to isolated diastolic or combined systolic/diastolic hypertension, in the elderly? 1) Considered a significant risk factor for MI or stroke 2) demonstrated to be related to smoking 3) Occurs primarily in men 4) Not considered to be a major risk \ n ✔1) Considered a significant risk factor for MI or stroke An 87-year-old long-term care facility resident was hospitalized for an abdominal surgery procedure, and the incision has become infected with methicillin-resistant Staphylococcus aureus (MRSA). The hospital is planning to return the patient to the same facility, which has no private rooms. According to CDC guidelines, the alternative placement would be to: 1) inform the hospital that the patient will have to go to another facility. 2) have the patient share a room with a resident who also has MRSA. 3) have the patient share a room with a resident who has VRSA. 4) Delay discharge until the wound is clear \ n ✔2) have the patient share a room with a resident who also has MRSA.