Medical Case Studies: Diagnosis and Treatment of Various Conditions, Exams of Nursing

Download Medical Case Studies: Diagnosis and Treatment of Various Conditions and more Exams Nursing in PDF only on Docsity! a. Antibiotic eye drops Nasolacrimal duct b. probing c. Systemic antibiotics *d Warm compresses . NRNP 6531 MIDTERM EXAM QUESTIONS AND ANSWERS BEST GRADED A+ CORRECT/VERIFIED ANSWER NEW UPDATE 2024 An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend? A patient diagnosed with alopecia is noted to have scaling on the affected areas of the scalp. Which confirmatory test(s) will the provider order? A female patient is diagnosed with androgenetic alopecia. Which medication will the primary health care provider prescribe? a. Anthralin Cyclospori b. ne c. Finasteride *d Minoxidil . Mikey is a 19 y/o male who is brought to the clinic because he has a fever, sore throat, pain on swallowing and mildly enlarged submandibular nodes The most likely organism causing Mikey’s infection is: *True False d. relief. d. Viral A retinal detachment would be identified by a shower of floaters with the addition of sudden flashes of light. A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o’clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What information will the provider provide the patient about this lesion? A primary care provider may suspect cataract formation in a patient with which finding? Aaron an 18 y/o male comes to the clinic with the following symptoms: nasal Good hand A. washing B. Adequate rest C. Zinc Lozenges *D All the above . E. A & B only True * False stuffiness, sneezing, scratchy irritated throat and hoarseness. He also complains of a low-grade fever and a cough that he has had for the past 4 days. Prevention of Aaron’s condition would include which of the following: Bryce is a 17 y/o male who comes to the clinic with chief complaint of ear sudden onset of pain, popping noises, and muffled hearing. During the ear exam the NP notices that the TM has ruptured. The most likely diagnosis is: Koplik spots on the buccal mucosa are pathognomonic for mumps. Mikey is a 19 y/o male who is brought to the clinic because he has a fever, sore throat, pain on swallowing and mildly enlarged submandibular nodes. The most likely diagnosis for Mikey is: A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step? Angie is a new NP who just finished her FNP program. She is having a difficult time finding an FNP position in the rural area where she lives. So, since she was an ER nurse prior to her graduate program she decides to go back to the ER as an APRN. Does she meet the competency requirements for such a position? Epidemiological a. studies b. Experimental design *c Qualitative studies . Randomized clinical d. trials Associations with area a. hospitals b. Costs of ambulatory care *c Ease of access to care . The ratio of providers to d. patients False Which is the most appropriate research design for a Level III research study? What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy? Mandates for communication among primary caregivers and a. hospitalists Penalties for failure to perform medication reconciliations at time b. of discharge *c Reduction of payments for patients readmitted within 30 days . after discharge Requirements for written discharge instructions for patients and d. caregivers A. CNM B. CRNA C. APN D. CNS The Consensus Model for APRN regulation consists of which of the following roles? *True False *True False When assisting with a skin biopsy of a patient suspected of having bullous pemphigoid (BP) lesions, what will the practitioner do? b. Punch biopsy c. Shave biopsy d. Wide excision biopsy . *a Excisional Rules proposed by the various State Boards of Nursing must be approved by the state Legislatures. In reviewing the Total Percentage of Body surface area for adult burn patients each, leg, arm and head are noted evaluated at 9%. What is the initial approach when obtaining a biopsy of a potential malignant melanoma lesion? a. Avoid contact with the infected lesions. Elicit a positive Nikolsky sign to confirm the b. diagnosis. *E All the . Above A, B & C F. only A progesterone-only contraceptive is most beneficial for treating a. acne. Combined oral contraceptives are effective for non-inflammatory b. acne only. Oral contraceptives are effective because of their androgen c. enhancing effects. *d Yaz, Ortho Tri-Cyclen, and Estrostep, are approved for acne . treatment. Ashley a 24 y/o female comes to the clinic with the following chief complaint: “I have these reddish/purple raised patches all over my skin. On physical exam the NP notes that the lesions are erythematous with discrete borders that are irregular, oval or round. The most likely diagnosis based on the physical exam is: A. Seborrheic *A First degree . burn Second degree B. burn Third degree C. burn Fourth degree D. burn The most common type of melanoma in African Americans and Asians is: A. Basal Cell carcinoma B. Actinic Keratosis * Acral Lentiginous C. Melanoma Toxic Epidermal D. Necrolysis Olga was making French fries for her kids and gets splashed with hot oil. At the clinic the NP notes that she has red colored skin with superficial blisters and pain where the oil splashed. The most likely diagnosis is: Patty comes to the clinic with these soft fatty cystic lesions on her neck, trunk and arms. The keratoses *B Urticaria . C. Xanthelasma D. Melasma A. Nevi Acanthosis B. Nigricans * Acrochordon C. D. Cherry Angioma most likely diagnosis is: During a total body skin examination for skin cancer, the provider notes a raised, shiny, slightly pigmented lesion on the patient’s nose. What will the provider do? A patient is seen in the clinic for patches of hair loss. The provider notes several well- demarcated patches on the scalp and eyebrows without areas of inflammation and several hairs within the patch with thinner shafts near the scalp. Based on these findings, which type of alopecia is most likely? *a Alopecia areata further care. *<14 0/9 0 <13 0/8 0 <15 0/9 0 <15 0/8 0 An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? According to the JNC 8 guidelines the hypertension treatment goal for patients 60 years and younger should be: . Anagen b. effluvium Cicatricial c. alopecia Telogen d. effluvium Add a beta blocker to the patient’s A. regimen. *B Admit to the hospital for evaluation and . treatment. Increase the dose of the thiazide C. medication. D. Prescribe a calcium channel blocker. Admit the patient to the hospital for evaluation and a. treatment. *b Consult with the cardiologist to determine appropriate . diagnostic tests. c. Continue to monitor the patient every 3 years. A young adult patient is diagnosed with a mitral valve prolapse. During a routine 3-year health maintenance exam, the provider notes an apical systolic murmur and a mid-systolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What action will the provider take? a. Digital subtraction angiography *b Doppler ankle, arm index . c. Magnetic resonance angiography Segmental limb pressure d. measurement A. Ventricular Tachycardia B. Pulsus paradoxus Atrial Fibrillation\ Atrial * C. Flutter D. None of the above An elderly adult patient without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms? Ashley is a 47 y/o female who comes to the clinic with a chief complaint of sudden onset of palpitations and a feeling of weakness and dizziness. Additionally she notes that she has dyspnea on exertion. On the physical exam the NP notes that he HR is 120 bpm and her BP drops to 98/60. The NP after running an EKG and noting no discrete p waves and irregularly irregular rhythm diagnoses her as having: I n performing a follow-up exam on a patient the NP discovers that the C. Stage I D. Stage II *A Mitral . Regurgitation B. Aortic Stenosis C. Mitral Stenosis Aortic D. Regurgitation patient has a new murmur. The murmur is best heard at the apex of the heart, radiates to the axilla, and is a loud blowing and high- pitched murmur. This type of murmur is associated with which of the following conditions: Angus is a 73 y/o male who comes to the clinic with the chief complaint of: chest pain, palpitations, exercise intolerance, intermittent periods of dizziness. Past medical records indicate that he has an enlarged heart. His diagnosis is: a. Exercise is contraindicated for life. Exercise may resume when symptoms b. subside. *c He may resume exercise in 6 months. . d. He must be symptom-free for 1 year. Dorsiflexion of the foot that produces lower leg pain is termed Homan’s Sign. *True False surgical consult. . Order a CBC, type and crossmatch, electrolytes, and renal a. function tests. b. Perform an ultrasound examination to evaluate the cause. c. Schedule the patient for an aortic angiogram. *d Transfer the patient to the emergency department for a A patient who is an avid long-distant runner is diagnosed with viral myocarditis. What will the provider tell this patient when asked when resuming exercising is permitted? A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action? Which test is diagnostic for diagnosing myocarditis? *A CHF . Left Ventricular Hypertrophy B. (LVH) C. Right sided heart failure D. None of the above Vitamin A Vitamin C *Vitamin K Vitamin D *A Bronchitis . her warfarin: Sam is a 19 y/o male who comes to the clinic with a chief complaint of several weeks of fatigue and non-productive paroxysmal coughing. He initially had a sore throat, some rhinitis and low-grade fever. His likely diagnosis is: A. Strep pneumonia *B Pneumococcal . pneumonia C. Mycoplasma pneumonia D. Moraxella catarrhalis True *False Mike is a 56 y/o male who lives in an abandoned building. With about 40 other street people. He comes to the clinic with a social worker who describes his symptoms as: a cough, dyspnea, pleuritic chest pain, fever and tachypnea. Your physical exam notes that he has some consolidation in the lower lobes with an audible friction rub. Given Mike’s diagnosis the most likely causative agent is: Artie is a 21 y/o male who comes to the clinic with a chief complaint of paroxysmal coughing without an apparent cause. He states that this has been going on for about 15 days. He initially had a mild fever, and a runny nose. First line treatment for Artie would include macrolides. Mike is a 22 y/o male who comes to your clinic with a 5-day history of cough without sputum production. He states that his cough is worse in the morning and he has some hoarseness, post-nasal drip and a low- grade fever. Mike has otherwise been healthy Atypical Pneumonia (Walking B. pneumonia) C. Allergic Rhinitis Community acquired bacterial D. pneumonia A. Pneumonia B. Sinusitis C. COPD All the D. Above *E A & B only . *a ACE inhibitor medication use . b. Chronic obstructive pulmonary Differentials for Mike might include which of the following: A nonsmoking adult with a history of cardiovascular disease reports having a chronic cough without fever or upper airway symptoms. A chest radiograph is normal. What will the provider consider initially as the cause of this patient’s cough? A. Rest B. Mucolytics * Antibiotics C. Increased fluid D. intake. a. Damage to the alveolar wall *b Destruction of alveolar . architecture Mild alteration in lung tissue c. compliance Mismatch of ventilation and d. perfusion Mike is a 22 y/o male who comes to your clinic with a 5-day history of cough without sputum production. He states that his cough is worse in the morning and he has some hoarseness, post-nasal drip and a low- grade fever. Mike has otherwise been healthy Treatment for Mike’s condition would include all the following except: Which is characteristic of obstructive bronchitis and not emphysema? A patient diagnosed with chronic obstructive pulmonary disease Forced expiratory time b. maneuver c. Lung radiograph *d Spirometry for FVC and . FEV1 *a Ipratropium . bromide b. Pirbuterol acetate Salmeterol c. xinafoate d. Theophylline reports daily symptoms of dyspnea and cough. Which medication will the primary health care provider prescribe? A young adult patient develops a cough persisting longer than 2 months. The provider prescribes pulmonary function tests and a chest radiograph, which are normal. The patient 24-hour esophageal pH a. monitoring *b Methacholine challenge . test c. Sputum culture d. Tuberculosis testing a. Coagulation studies *b Computed tomography . (CT) Fiberoptic c. bronchoscopy d. Needle biopsy denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough? A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated? A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms? Debulking the A. liver B. Chemotherapy C. Liver transplant *D All the Above . E. A & B only When he came in a week ago he complained of a “sour” taste when he belched, and severe pain in his stomach. A serum fasting gastrin level was drawn and sent to the lab. The results were 300 pg/ml. Treatment for Danny would include which of the following: *a H. . pylori infection b. NSAID use Parasite c. infestation Viral d. gastroenteritis *a Alcoholism . b. Hepatitis C Hepatocellular c. carcinoma Right-sided heart d. failure A 50-year-old, previously healthy patient has developed gastritis. What is the most likely cause of this condition? A patient is diagnosed with fibrotic liver disease; a liver biopsy shows micronodular cirrhosis. What is the most common cause of this form of cirrhosis? Jeremy is an 18 y/o male who comes to the clinic with a chief complaint of periumbilical pain. Over the past 24 hours he has had bouts of nausea and diarrhea and pain at McBurney’s point. The NP diagnoses him as having: Acute A. cholecystitis Acute B. Diverticulitis * Acute C. Appendicitis Acute D. Pancreatitis Irritable bowel A. syndrome *B Duodenal ulcer . Jeremiah, a 47 y/o male presents to the clinic with episodic gastric pain he describes as gnawing and burning. He notes that the pain is temporarily relieved by food or antacids but return in full force after a couple of hours. He notes that his stools are “tarry” and he sometimes has coffee colored vomit. On this basis the NP provides a diagnosis of: *True False Avoiding saturated fats and red a. meat *b Consuming a diet high in fiber . Taking an anticholinergic c. medication Using bran to replace high-fiber d. foods Amylase and Lipase are sensitive tests used to assess for pancreatitis. A patient with a history of diverticular disease asks what can be done to minimize acute symptoms. What will the provider recommend to this patient? Jeremiah, a 47 y/o male presents to the clinic with episodic gastric pain he describes as gnawing and burning. He notes that the pain is temporarily relieved by food or antacids but return in full force after a couple of hours. He notes that his stools are “tarry” and he sometimes has coffee colored vomit. Jeremiah is determined to have H. pylori positive ulcers which treatment would be indicated? c. Open cholecystectomy *d Laparoscopic cholecystectomy . Empirical treatment with antibiotics *Hospitalization for emergent treatment Prescribing ursodeoxycholic acid Supportive care with close follow- A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms? A. Single Therapy of Ranitidine B. Single Therapy of Omeprazole Triple therapy of: Clarithromycin, * C. amoxicillin, PPI D. None of the above A. Serology B. Urea Breath Test Upper endoscopy and biopsy of * C. tissue D. Stool antigen Acute acalculous a. cholecystitis b. Chronic cholelithiasis *c Common bile duct . obstruction d. Infectious cholecystitis Jeremiah, a 47 y/o male presents to the clinic with episodic gastric pain he describes as gnawing and burning. He notes that the pain is temporarily relieved by food or antacids but return in full force after a couple of hours. He notes that his stools are “tarry” and he sometimes has coffee colored vomit. The Gold Standard for diagnosing Jeremiah’s problem is: A patient has sudden onset of right upper quadrant (URQ) and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? An adult patient reports intermittent, crampy abdominal pain with vomiting. The provider notes marked abdominal distention and hyperactive bowel sounds. What will the provider do initially? up