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2025 NRNP 6540 Final Exam Questions with
Correct Answers – Gen 4 Walden University NP
Exam Prep (100% Verified Content)
- Dan is 70 years old and has been having frequent bouts of kidney stones. They are painful, and he has had one procedure done for nephrolithiasis. Dan asks the nurse practitioner if there is anything he can do to prevent these. He says his brother also has them, so he wonders if it is just familial. How does the nurse practitioner respond? Select all that apply.
- Increase the amount of fluids you drink daily.
- Avoid eating foods such as dairy, spinach, and nuts.
- Some medications can contribute to stone formation.
- Kidney stones are not familial.
- Report signs of possible urinary tract infections to a physician for treatment. - - correct ans- - 15. Answer: 1, 2, 3, 5 Page: 270 Feedback
A major contributing factor to the development of calculi is decreased fluid intake leading to a high concentration in urine.
Certain food substances that augment the formation of kidney stones include dairy products, chocolate, green leafy vegetables (calcium oxalate stones), and eggs, fish, poultry, peanuts, and wheat (cystine stones).
Certain medications, such as triamterene, indinavir, acetazolamide, acyclovir, and sulfa can contribute to the development of nephrolithiasis.
Family history has also been found to contribute to stone formation, as well as increased oxalate absorption.
Chronic urinary tract infections may be precursors to struvite stone formation.
- The genitourinary and reproductive systems undergo many age-related changes. Which of the following statements is true about these changes?
- The older male patient undergoes more gradual changes than does the older female patient.
- The older female patient undergoes more gradual changes than does the older male patient.
- Older male and female patients undergo the same changes.
- The older male patient undergoes less gradual changes than those of the older female patient. - - correct ans- - 1. Answer: 1 Page: 281 Feedback
This statement is correct. Older male patients undergo more gradual changes than those of older female patients.
Older male patients undergo more gradual changes than those of older female patients.
Older male patients undergo more gradual changes than those of older female patients.
Older male patients undergo more gradual changes than those of older female patients.
- Breast discharge
- Breast mass
- Breast redness - - correct ans- - 3. Answer: 3 Page: 286 Feedback
Other than a mass in the breast, there are no other early signal symptoms.
Other than a mass in the breast, there are no other early signal symptoms.
Breast mass is the only early signal symptom of breast cancer.
Other than a mass in the breast, there are no other early signal symptoms.
- Which of the following conditions presents nonproliferating lesions and does not affect future cancer risk?
- Atypical lobular hyperplasia
- Fat necrosis
- Radial scar
- Papilloma - - correct ans- - 4. Answer: 2 Page: 287 Feedback
Atypical lobular hyperplasia is a proliferating lesion with atypia and has an increase in cancer risk of four to five times.
Fat necrosis is a nonproliferating lesion and does not affect future cancer risk.
Radial scar is a proliferating lesion without atypia and has an increase in cancer risk of approximately one to two times.
Papilloma is a proliferating lesion without atypia and has an increase in cancer risk of approximately one to two times.
- Mr. Angulo is an 89-year-old patient who was recently an inpatient for pneumonia and was bedridden for 1 week. He is now presenting dysuria, suprapubic tenderness accompanied by fever, and increased confusion. Based on his recent history, which of the following conditions may be developing?
- Cystitis
- Distended bladder
- Prostate stones 4.Subacute prostatitis - - correct ans- - 5. Answer: 1 Page: 289 Feedback
Symptoms are indicative of cystitis, and because the patient was bedridden and may have had placement of a catheter, this increases the likelihood.
Untreated symptomatic cystitis does not lead to prostatic cancer or vaginitis, but it can lead to sepsis.
- Women developing ovarian cancer may be asymptomatic, making it hard to detect until the condition has worsened. Which of the following is the best initial diagnostic tool for suspected ovarian cancer?
- Transvaginal ultrasonography
- Pelvic examination
- Laparoscopy
- Complete blood count (CBC) - - correct ans- - 7. Answer: 1 Page: 294 Feedback
Transvaginal ultrasonography is the best initial study for suspected ovarian cancer.
Pelvic examination gives limited diagnostic results, as ovarian enlargement cannot always be palpated.
Laparoscopy is performed after a histopathological tissue report has been confirmed.
A CBC is also part of the initial evaluation, but secondary to transvaginal ultrasonography.
- Prostate cancer is the most common and leading cause of cancer death in men. Which of the
following statements is true about prostate cancer?
- There is usually a sudden onset of pain in the early stages.
- Asian men are at highest risk for developing prostate cancer.
- Development of prostate cancer has been linked with prior vasectomy.
- There are usually no symptoms with early disease. - - correct ans- - 8. Answer: 4 Page: 299 Feedback
There are usually no symptoms with early disease.
African Americans have the highest incidence of prostate cancer in the world, with Asian and Hispanic men at lower risk than white men.
No link has been determined with prior vasectomy.
Once symptoms occur, there is usually progression of the disease.
- A nurse practitioner is performing an annual checkup for a female patient. In the physical examination of the breast, for which of the following should the nurse practitioner assess? Select all that apply.
- Temperature
- Symmetry
- Dimpling
- Proper support - - correct ans- - 10. Answer: 1, 3, 4 Page: 280, 281 Feedback
A patient should be asked if she is experiencing any breast pain and should point out the location. Description of the pain is also important.
Breast atrophy is an observation to be made by the nurse practitioner and not a question to be asked of the patient.
A patient should be asked if she has observed any rash on or around the breast. Also ask about onset, location, and sensations of the rash.
Patients should be asked if there was any breast trauma, as this could lead to injury of the breast.
Asking about the use of proper support may be helpful for some individuals, but it is not generally a question that is asked during the breast examination.
- When other symptoms are presented with atrophic vaginitis, a biopsy is used as the diagnostic test to rule out which of the following diagnoses? Select all that apply.
- Urinary tract infection (UTI)
- Sexually transmitted infection (STI)
- Squamous cell hyperplasia
- Lichen sclerosis
- Lichen planus - - correct ans- - 11. Answer: 3, 4, 5
Page: 282 Feedback
UTI presents with the symptom of pain with urination and is usually treated with an antibiotic. No biopsy is indicated to diagnose.
STIs present symptoms of pruritis, burning, and a thick white discharge. No biopsy is indicated to diagnose.
Squamous cell hyperplasia presents symptoms of pruritus, which results in scratching and inflammatory changes in squamous cells of the vulvar area. These are seen on a biopsy.
Lichen sclerosis presents with whitish lesions on the vulva and squamous cells. A biopsy is needed to diagnose.
Lichen planus shows papular, purple lesions that are pruritic and thought to be immunological in origin. A biopsy is needed to diagnose.
- Jessie is a 54-year-old patient with a history of atrophic vaginitis. Which of the following should be included in her patient education? Select all that apply.
- Use of over-the-counter (OTC) medications for pain and discomfort.
- Use of water-soluble lubricants.
- Benefits of regular sexual activity.
- Identifying and addressing age-related changes.
- Benefits of sexual-aid stimulators. - - correct ans- - 12. Answer: 2, 3, 4
Page: 285 Feedback
Addressing postmenopausal obesity by encouraging healthy eating and exercise can reduce the risk factor of breast cancer.
Minimizing alcohol intake can help reduce the risk of developing breast cancer.
Early menarche is a nonmodifiable risk factor of breast cancer.
Menopause hormone therapy is a modifiable risk factor for breast cancer. Patients need to be informed about the risk of using combined estrogen and progestin menopause hormone therapy.
Ethnicity is a nonmodifiable risk factor, along with age and family history.
- Which of the following are the main laboratory clinical manifestations of cystitis? Select all that apply.
- White blood cell (WBC) count
- Bacteriuria
- Pyuria
- Fungi
- E. coli - - correct ans- - 14. Answer: 2, 3 Page: 289
Feedback
WBCs, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. Increased or decreased WBC count can indicate infection but is not the main laboratory clinical manifestation of cystitis.
Bacteriuria is the presence of bacteria in urine and is one of the main laboratory clinical manifestations of cystitis.
Pyuria is the presence of pus in the urine and is one of the main laboratory clinical manifestations of cystitis.
The presence of fungi does not lead to a diagnosis of cystitis.
The presence of E. coli is not a main laboratory clinical manifestation of cystitis. E. coli is a bacterium found in the environment, foods, and intestines of people and animals.
- Marie, 63 years old, is presenting with symptoms of postmenopausal bleeding and is diagnosed with endometrial cancer. Other than gender and age, which of the following can be contributing factors in the development of endometrial cancer? Select all that apply.
- Diabetes
- Use of tamoxifen
- Use of hormonal contraception
- Obesity
- Lynch syndrome - - correct ans- - 15. Answer: 1, 2, 4, 5 Page: 292, 293
Aging often brings about a decrease in height, resulting from a decrease in the length of the trunk with respect to the length of the extremities.
An older person may tilt the head backward to compensate for the bend in the thoracic spine, producing the typical posture of those in this age group.
Because of the loss of subcutaneous fat caused by aging, bony prominences became more noticeable.
Without continued use, muscles stiffen and ROM becomes impaired as an older person continues to age.
- While conducting a thorough examination of the musculoskeletal system, the patient asks why such detail is necessary. Which of the following is the nurse practitioner's best response?
- I don't want to miss any signs of something serious.
- The purpose of conducting this examination is to regulate your medications.
- I am looking for symptoms that form a pattern.
- This is routine for all patients over 65 years of age. - - correct ans- - 2. Answer: 3 Page: 305 Feedback
The nurse practitioner is seeking symptoms that form a pattern, and in the thorough examination to do that, she will find any abnormalities or areas of concern.
Medications will be taken into consideration after examination findings.
A goal of the nurse practitioner in gathering information from the older adult is to try and determine if there is a pattern of symptoms.
In an adult over 65 years old who is not presenting any musculoskeletal issues, this type of examination may not be necessary.
- Mrs. Wilbur reports the presence of pain in her lower and upper back. The nurse practitioner responds by doing which of the following?
- Determining where the pain is coming from.
- Ignoring any history of injury.
- Ruling out the presence of anything inflammatory.
- Determining that this pain does not affect activities of daily living (ADLs), as the patient came in independently. - - correct ans- - 3. Answer: 1 Page: 305 Feedback
Initially, the nurse practitioner will need to determine if the presenting symptoms arise from the joints, tendons, muscles, or periarticular structures, such as bursae.
Past trauma may now be manifesting itself as an articular degeneration. Because patients who have had a structural deformity or amputation typically place excessive strain on the joints for years, as older individuals they may now experience degeneration of the bone and surrounding musculature.
Inflammatory and noninflammatory conditions can coexist in patients.
It is important to ask questions and determine how the pain and stiffness are affecting function and quality of life, regardless of how it appears.
- Gout
- Rheumatoid arthritis (RA)
- Muscle weakness from a systemic condition
- Osteoarthritis (OA) - - correct ans- - 5. Answer: 3 Page: 307 Feedback
Because gout is an inflammatory disease that results in deposits of sodium urate crystals in the joints, periarticular tissues, and kidneys, and because the patient is only having a problem with one joint, it is not likely that gout is the diagnosis.
RA is a chronic systematic inflammatory process evidenced by symmetrical polyarthritis; it is the most common inflammatory arthropathy.
To determine if a patient is having true muscle weakness, the patient should perform against the examiner's resistance. One side should be compared to the other and a numerical value for tested muscle strength recorded. Flexor and extensor muscles should be tested for strength.
OA encompasses both symptoms and the structural remodeling of articular cartilage with inflammation of synovitis and ligament.
- Mrs. Cameron is a 72-year-old woman who comes to see her nurse practitioner for pain in her right thigh. The nurse practitioner assesses that Mrs. Smith has bruises on her thigh and muscle weakness distally, near the knee. The nurse practitioner suspects which of the following?
- Musculoskeletal lesions
- Tendon rupture
- Gout
- Arthritis - - correct ans- - 6. Answer: 2 Page: 306 Feedback
Patients with presentation of soft tissue syndromes should be asked about the origin of the presentation of bruising. The pain may be related to an event.
Ecchymosis in the area of a joint may be indicative of tendon rupture.
Gout is polyarticular in older adults.
Arthritis is an ongoing synovial membrane attack that results in synovial proliferation; pannus formation; and destruction of bone, cartilage, and ligaments, leading to joint damage and deformity.
- The nurse practitioner calls Mr. Smith to come into the examining room. As he is coming in, the nurse practitioner observes his gait to assess for musculoskeletal conditions. One abnormal sign is:
- Unbalance in gait.
- Lack of a lurch.
- Symmetrical leg movement.
- Ability to sit in and get out of a chair without using arms. - - correct ans- - 7. Answer: 1 Page: 306
