Walden NUrs6531 midterm exam 2019

Question 1

A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

Question 2

Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:

Question 3

Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?

Question 5

Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?

Question 6

Risk factors for acute arterial insufficiency include which of the following?

Question 7

What is the Gold standard for the diagnosis of asthma?

Question 8

Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?

Question 9

Amaurosis fugax is described as a:

Question 10

Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:

Question 11

Which of the following patient characteristics are associated with chronic bronchitis?

Question 13

John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?

Question 14

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?

Question 15

Expected spirometry readings when the patient has chronic emphysema include:

Question 16

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

Question 17

A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?

Question 18

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

Question 19

A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should:

Question 20

An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent?

Question 21

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:

Question 22

Treatment of H.pylori includes which of the following?

Question 23

Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?

Question 24

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

Question 25

Your patient Jerry has gout. What do you suggest?

Question 26

A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:

Question 27

Martha had a less than 7% value on her Schilling test. What medication do you anticipate she might need?

Question 28

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:

Question 29

Which statement below is correct about pertussis?

Question 30

An AST that is more than twice the level of ALT is suggestive of:

Question 31

Your 31-year-old patient, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?

Question 32

Acute rheumatic fever is an inflammatory disease which can follow infection with:

Question 33

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

Question 34

Of the following, the patient who should be referred for periodic colonoscopy is the patient with:

Question 35

Which type of lung cancer has the poorest prognosis?

Question 36

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:

Question 37

Treatment of acute vertigo includes:

Question 38

Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?

Question 39

A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Question 40

Of the following choices, the least likely cause of cough is:

Question 41

An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:

Question 42

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:

Question 44

The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?

Question 45

Group A ?-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?

Question 46

Which of the following statements about malignant melanomas is true?

Question 47

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

Question 48

Appropriate therapy for peptic ulcer disease (PUD) is:

Question 50

A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?

Question 51

Risk factors for acute otitis media (AOM) include all of the following except:

Question 52

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?

Question 53

The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:

Question 54

A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?

Question 55

The most common cancer found on the auricle is:

Question 57

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?

Question 58

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

Question 59

Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?

Question 61

An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis?

Question 62

Impetigo and folliculitis are usually successfully treated with:

Question 63

Which of the following color changes in a pigmented lesion suggests malignant transformation?

Question 64

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?

Question 65

A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:

Question 66

An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:

Question 67

When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

Question 68

Sandra has celiac disease. You place her on which diet?

Question 69

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

Question 71

The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?

Question 74

A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?

Question 75

A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests:

Question 77

A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial treatment option for this patient?

Question 78

Which of the following is not a risk factor for coronary arterial insufficiency?

Question 79

A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include:

Question 80

Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Question 81

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?

Question 82

A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:

Question 83

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

Question 86

Which of the following is a secondary cause of hyperlipidemia?

Question 87

What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?

Question 88

In order to decrease deaths from lung cancer:

Question 89

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be:

Question 90

A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:

Question 92

The differential diagnosis for a patient complaining of a sore throat includes which of the following?

Question 93

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

Question 96

A false-positive result with the fecal occult blood test can result from:

Question 97

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?

Question 98

A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:

Question 100

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?