NSG 6420 Midterm Exam with Answers, Quizzes of Nursing

Download NSG 6420 Midterm Exam with Answers and more Quizzes Nursing in PDF only on Docsity! NSG 6420 Midterm Exam with Answers 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        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       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       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 degeneration       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      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.     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      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      Coronary artery disease with angina pectoris Question 9. 9. A common auscultatory finding in advanced CHF is: (Points : 2)        Systolic ejection murmur       S3 gallop rhythm        Friction rub        Bradycardia Question 10. 10. Which of the following symptoms is common with acute otitis media? (Points : 2)      Bulging tympanic membrane Question 20. 20. Which of the following is not a contributing factor to the development of esophagitis in older adults? (Points : 2)        Increased gastric emptying time        Regular ingestion of NSAIDs        Decreased salivation        Fungal infections such as Candida 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        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        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        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        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        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        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)        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 angina 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. 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        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        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        HIDA scan 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)