Clinical Case Analysis: Various Medical Conditions and Treatments, Exams of Nursing

Download Clinical Case Analysis: Various Medical Conditions and Treatments and more Exams Nursing in PDF only on Docsity! NR 511 Final Exam (Latest 2023 / 2024): Differential Diagnosis & Primary Care Practicum – Chamberlain College of Nursing Janet is a 30 year old woman who has been recently diagnosed with a herniated disc at the level of L5- S1. She is currently in the emergency room with suspician of cauda equna compression. Which of the following is a sign or symptom of cauda equina compression? a. gastrocnemius weakness b. reduced or absent ankle refles c. numbness of the lateral foot d. paresthesia of the perineum and buttocks - ANSWERS-d. paresthesia of the perineum and buttocks The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson's Criteria. In order to plan care, the clinician understands that this criteria score has which of the following meanings? a. a high mortality rate b. an increased chance of recurrence c. 7% chance of the disease becoming chronic d. all of the above - ANSWERS-a. a high mortality rate Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load What does this indicate a. a favorable diagnostic trend b. disease progression c. the need to be more aggressive with Reuben's medications d. the eradication of the HIV - ANSWERS-a. a favorable diagnostic trend Which is the differentiating symptom mbetween labyrinthitis and vestibular neuritis? a. symptoms with vestibular neuritis are usually acute in onset, whereas with labyrinthitis the onet is more gradual b. hearing loss may be associated with vestibular neuritis, but not with labyrinthitis c. symptoms with labyrinthitis are usually acute in onset, ,whereas with vesticular neuritis the onset is more gradual d. hearing loss may be associated with labyrinthitis ,but not with vestibular neuritis. - ANSWERS-d. hearing loss may be associated with labyrinthitis ,but not with vestibular neuritis. A 27 year old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection. what are some additional symptoms consistant with a diagnosis of lower UTI? a. back and abdominal pain b. fever, chills, costovertebral angle (CVA) tenderness c. blood in urine and frequency d. foul-smelling discharge, perineal itch - ANSWERS-c. blood in urine and frequency The differential diagnosis for vertigo can be classified into which of the following categories: a. peripheral vestibular disease b. CNS disorders c. Systemic disorders d. all of the above - ANSWERS-d. all of the above Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? d. basal skin lesion - ANSWERS-b. actinic keratosis Which obstructive lung disease is classified as reversible? a. Asthma b. Chronic bronchitis c. Emphysema d. COPD - ANSWERS-a. Asthma Which of the following is an example of an articular structure a. bone b. synovium c. tendons d. fascia - ANSWERS-b. synovium Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation? a. posterior dislocations are more common than anterior dislocations b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses - ANSWERS-b. there is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses Which of the following statements is true concerning the management of the client with a herniated disc? a. muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use b. an epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. c. intolerable pain for more than 3 months is an indication for surgical intervention d. all of the above - ANSWERS-c. intolerable pain for more than 3 months is an indication for surgical intervention After 6 months of synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies? a. elevated TSH b. normal TSH c. low TSH d. undetectable TSH - ANSWERS-b. normal TSH The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit? a. thryoid stimulating hormone (TSH) and free T4 b. TSH and thyrotoxin antibodies •High sensitivity thyroid stimulating hormone TSH and free T4 • Free T4 and serum calcium - ANSWERS-a. thryoid stimulating hormone (TSH) and free T4 Cat bites are commonly associated with which of the following pathogens? a. pasteurella multocida b. vibri vulnificus c. group B streptococcus d. Group A beta hemolytic streptococcus - ANSWERS-a. pasteurella multocida The 56 year old man with chronic prostatitis should be treated with trimethoprim 80mg- sulfamethoxazole 400 (TMP-SMX, Bactrim) for how long? a. 3-7 days b. 14-21 days c. 3-6 weeks d 6-12 weeks - ANSWERS-d 6-12 weeks The A in SNAPPS stands for Assessment a. true b. false - ANSWERS-b. false A patient is diagnosed with Giardia after backpacking trip in the mountains. Which of the following would be the appropriate treatement? a. Vancomycin b. Penicillin c. Metronidazole d. Bactrim - ANSWERS-c. Metronidazole The most cost effective screening test to determine HIV status is which of the following? a. western blot b. enzyme-linked immunosorbent assay (ELISA) c. venereal disease research laboratory test (VDRL) d. Viral load - ANSWERS-b. enzyme-linked immunosorbent assay (ELISA) The clinician sees a patient who is 5 feet tall and weighs 150 pounds (:BMI 29.3). How would the clinician classify this patient? Which of the following information is essential before prescribing Bactrim DS to a 24 year old woman witht urinary tract infection? a. last menstrual period b. method of birth control c. last unprotected sexual contact d. all of the above - ANSWERS-d. all of the above A 22 year old male is seen in the clinic because he found a hard lump in his testicle during a testicular self exam (TSE). which of the following shoud be included in the differential diagnosis. a. testicular cancer b.. inguinal hernia c. varicocele d. all of the above - ANSWERS-d. all of the above Which of the following dietary information should be given to a patient with gastroesophageal reflux disease (GERD)? a. eliminate coffee b. drink peppermint ice to relieve stomach distress c. recline and rest after meal d. limit the amount of antacids - ANSWERS-a. eliminate coffee Which of the following are predisposing factors for pyelonephritis? a. pregnancy d. dehydration c. smoking d. alkaline urine - ANSWERS-d. alkaline urine A patient is seen in the clinic with right upper quadrant pain (RUQ) that is radiating to the middle of the back. The clinical suspects acute cholelithasis. The clinician should expect with of the following laboratory findings? a. Decreased alanine anminotransferase (ALT) and aspartate aminotransferase (AST) b. elevated alkaline phosphatase c. elevated indirect biliruben d. decreased white blood cell (WBC) count - ANSWERS-b. elevated alkaline phosphatase A 25 year old patient presents to the clinic with fatigue, cold intolerance, weght gain and constipation for the past 3 months. On physical exam, the clinican notices a sinus bradycardia, muscular stiffness, coarse dry hair and a delay in relaxation in deep tendon reflexes (DTR's). Which of the following tests should be ordered next? a. Serum Calcium b. Thyroid Stimulating Hormone (TSH) c. electrolytes d. urine specific gravity - ANSWERS-b. Thyroid Stimulating Hormone (TSH) You are preforming muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete range of motion with gravity eliminated. Which numeric grade of muscle strength would you give this patient? a. 1 b. 2 c. 3 d. 4 - ANSWERS-b. 2 The patient is diagnosed with overactive bladder (OAB). Which of the following instructions should be given to this woman? a. Limit the amount of water that you drink b. eliminate caffeine from your diet c. wear panty liners d. all of the above - ANSWERS-b. eliminate caffeine from your diet A 28 year old patient is seen in the office with colicky abdominal pain, particularly with meals. She has frequent constipation, flatulence and abdominal distention. Which of the data makes a diagnosis of diverticulitis unlikely? a. her age b. frequent constipation c. flatulence d. colicky abdominal pain - ANSWERS-a. her age Treatment for epididymitis includes which of the following? a. warm sitz baths b. scrotal elevation c. masturbation d. all of the above - ANSWERS-b. scrotal elevation Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition? a. there are round hypopigmented macules on his back b. there are red papules on his face c. there are crusted placques in Josh's groin area d. there are white streaks on his neck - ANSWERS-a. there are round hypopigmented macules on his back a. HSV Type 2 b HIV c Pneumonia d. Syphilis - ANSWERS-b HIV Mrs. Gary is a 55 year old woman who presents with tightness, pain and limited movement in her right shoulder. She denies any history of trauma. Her exam reveals a 75% reduction in both active and passive range of motion of the right shoulder. Mrs. Gray is also experiencing tenderness with motion and pain at the deltoid insertion. HEr medical history is significant for type 1 DMm and HTN. HEr social history reveals that she is a secretary ant that she is right handed. Based on her exam and medical history, you suspect adhesive capulitis or "frozen shoulder" Which clue in Mrs. Grays history supports the diagnosis? a. history of hypertension b. her affected shoulder is also her dominant hand c. her history of diabetes - ANSWERS-c. her history of diabetes A 63 year old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? a. Psychogenic nocturia b. Urethral polyp c. Irritative posterior urethral lesion d. Benign prostatic hypertrophy - ANSWERS-d. Benign prostatic hypertrophy Joyce is seen in the clinic complaining of vague symptoms of feeling nervous and irritable, and that her hair will not hold a curl anymore. On physical exam, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis could be which of the following? • Myxedema • Cushing's Syndrome • Pan-hypopituitism • Thyrotoxicosis - ANSWERS-• Thyrotoxicosis As diabetic retinopathy progresses, the presence of "cotton wool" spots can be detected. Cotton wool spots refer to: a) Venous beading. b) Retinal hemorrhage. c) Nerve fiber layer infarctions. d) Blood vessel proliferation - ANSWERS-c) Nerve fiber layer infarctions. Which of the following instructions should be given to a patient with nephrolithasis? a. take ibuprofen 600mg every 8 hours b. take tums for upset stomach c. drink more black tea d. increase intake of vegetables like spinach - ANSWERS-a. take ibuprofen 600mg every 8 hours Joyce is taking a long-acting beta agonist for her moderate persistent asthma. What additional medication should she be taking? a. Inhaled corticosteroid (Flovent) b. Leukotriene receptor antagonist c. Systemic corticosteroid (Prednisone) d. Methyl xanthenes (Theophylline - ANSWERS-a. Inhaled corticosteroid (Flovent) You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: A. Articular B. Inflammatory C. Nonarticular D. A and B - ANSWERS-A. Articular Harvey has a rubbery, smooth, round mass on his chest which is compressible and has a soft to very firm texture. What do you diagnose this as? a. Lipoma b. Nevi c. skin tag d. Adenoma - ANSWERS-a. Lipoma The patient with Gastroesophageal reflux disease (GERD) should be instructed to eliminate which of these activities? a. Swimming b. weight lifting c. Golfing d. Walking - ANSWERS-b. weight lifting ...responded to antibiotic therapy. Which of the following actions should be taken next? a. send a urine specimen for microscopy looking for fungal colonies b. increase the dose of the antibiotic c. order a cystoscopy d. order a different antibiotic - ANSWERS-a. send a urine specimen for microscopy looking for fungal colonies Cydney was just diagnosed with mild, intermittant asthma. Which if the most appropriate medication for her? a. short acting beta-agonist as needed b. short acting beta-agonist twice a day c. long acting beta agonist as needed b. postural tremor c. intention tremor d. medication-induced tremor - ANSWERS-c. intention tremor Ian, age 62, presents with a wide, diffuse area of erythematous skin on his left lower leg that is warm and tender to palpation. There is some edema involved. You suspect: a. Necrotizing fasciitis. b. Kaposi's sarcoma. c. Cellulitis. d. A diabetic ulcer. - ANSWERS-c. Cellulitis. Parkinsons disease is a progressive neurological disorder that is associated with which type of tremor? a. resting tremor b. postural tremor c. intention tremor d. medication induced tremor - ANSWERS-a. resting tremor Which information should be included when you are teaching your patient about the use of nicotine gum? a. the gum must be correctly chewed to a softened state then placed in the buccal mucosa b. patients should not eat for 30 minutes prior to or during the use of the gum c. initially, one piece is chewed every 30 minutes while awake d. acidic foods and beverages should be encouraged during nicotine therapy - ANSWERS-a. the gum must be correctly chewed to a softened state then placed in the buccal mucosa Severe pain associated with acute otitis media signifies perforation of the tympanic membrane. a. true b. false - ANSWERS-b. false Jason, aged 62, has obstructive sleep apnea. What do you think is one of his contributing factors? a. He is a recovering alcoholic of 6 years. b. His collar size is 19 inches. c. He is the only person in his family who has this. d. He is extremely thin. - ANSWERS-b. His collar size is 19 inches. The "B" in the ABCDEs of assessing skin cancer represents: a. biopsy b. best practice c. boundary d. border irregularity - ANSWERS-d. border irregularity The patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication? a. diarrhea b. Parkinson's disease c. closed-angle Glaucoma d. Breast cancer - ANSWERS-c. closed-angle Glaucoma A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinican expect as a manifestation of the disease? a. sinus bradycardia b. atrial fibrillation c. supraventricular tachycardia d. U-waves - ANSWERS-a. sinus bradycardia Tori is on systematic antifungals for a bad tinena infection. You understand that serum labs should be monitored for: a. renal failure b. hepatotoxicity c. electrolyte imbalance d. leukocytosis - ANSWERS-b. hepatotoxicity Which of the following signs or symtoms indicate an inflammatory etiology to musculoskeletal pain? a. decreased C-reactive protein b. hyperalbuminemia c. morning stiffness - ANSWERS-c. morning stiffness A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? a. very early b 3-4 hours after perforation c. late in inflammation d. appendicitis never presents with vague pain - ANSWERS-a. very early A patiennt presents to the clinicians office with a sore throat, fever of 100.7 and tender anterior cervical lymphadenopathy. The clinican suspects strep throat and performs a rapid strep test that is negative. What would the next step be? What is the recommended calcium intake for adults over the age of 50 with low bone mass? a. 1200mg/day b 1000mg/day c. 1300mg/day d. 1500mg/day - ANSWERS-d. 1500mg/day A 14 year old is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? a. obtain a scrotal ultrasound b. obtain a computed tomography scan (CT) c. instruct the patient to elevate the scrotum d. send the patient to the Emergency room - ANSWERS-c. instruct the patient to elevate the scrotum d. send the patient to the Emergency room All students are subject to review of clinical logs to ensure that they have received a well-rounded experience a. true b. false - ANSWERS-a. true A 30 year old patient presents with pain on urination. The urine microscopy of unspun urine showed greater than 10 leukocytes/ml and a dipstick was possible for nitrates. What is the probable diagnosis? a. lower urinary tract infection b. chlamydia infection c. candidiasis d. pyelonephritis - ANSWERS-b. chlamydia infection Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? a. vasomotor rhinitis b. rhinitis medicamentosum c. atophic rhinitis d. viral rhinitis - ANSWERS-a. vasomotor rhinitis John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? a. valgus stress test b. McMurray circumduction test c. Lachman's test d. Varus stress test - ANSWERS-b. McMurray circumduction test Your patient has decided to give Chantix a try to quit smoking. YOu are discussing his quit date, and he will begin taking the medication starting tomorrow. When should he plan to quit smoking? a. he should stop smoking today b. he should stop smoking tomorrow c. his quit date should be in one week d. he will be ready to quit after the first 30 days - ANSWERS-c. his quit date should be in one week The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinicans response should include which of the following data? a. RAI prevents the peripheral conversion of T4 to T3 b. RAI binds to free T4 c. RAI destroys thyroid tissue d. RAI reduces freely circulating iodine - ANSWERS-c. RAI destroys thyroid tissue Not sure of the question...something about the oral mucosa membranes a. vincents stomatitis b. allergic stomatitis c. apthous stomatitis d. herpetic stomatitis - ANSWERS-a. vincents stomatitis