Download CEA Week 3 Full Length Practice Exam and more Exams Nursing in PDF only on Docsity!
Week 3 Full Length Practice Exam
Attempt History
Attempt Time Score LATEST Attempt 1 180 minutes 122 out of 150
Score for this quiz: 122 out of 150
Submitted Jan 26 at 2:45pm This attempt took 180 minutes.
Question 1
1 / 1 pts
An older adult with diabetes mellitus presents with leg cramps. She states that the cramps as worst when walking to the supermarket. If she stops to rest, the pain subsides. The nurse practitioner knows that this patient needs a workup for: Popliteal aneurism Intermittent claudication Deep vein thrombosis Benign nocturnal leg cramps
Question 2
1 / 1 pts
Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the EKG. Which region of the heart is most likely involved? Correct! Inferior Wall The inferior wall, fed by the right coronary artery is commonly associated with these symptoms. Remember right equals rate as it is the blood supply for the SA and AV nodes in most patients. Dyspepsia is common in RCA territory injury due to vagal stimulation not typical of other areas.
Question 3
1 / 1 pts
Recommendation for lipid check in adolescent with type 1 DM? Correct! 1 year Remember than with pediatric patients with diabetes, the easiest way to remember the evaluation schedule is to perform lipid checks is with annual physicals. Question 4
1 / 1 pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and pallor. What is the most likely diagnosis? Deep vein thrombosis ect! Acute arterial occlusion Cellulitis Peripheral artery disease Question 5
1 / 1 pts
An adult patient recently placed on angiotensin-converting enzyme (ACE) inhibitor for hypertension returns with a report of a dry, persistent cough. On examination, no indication of a respiratory problem is noted. Which of the following is the most appropriate intervention? Correct! Switch to an angiotensin II receptor blocker Obtain a chest X-ray with posterior-anterior and lateral views Continue the ACE inhibitor and prescribe a mild antitussive
Myocardial infarction (MI) Correct! Stroke The patient with a history of atrial fibrillation for over 48 hours without anticoagulation is at risk of an embolic stroke, secondary to mobilization of a thrombus (90% of which occur in the left atrial appendage). A patient exhibiting signs of a stroke such as unilateral weakness and slurred speech, in addition to being evaluated for stroke with cranial imaging to rule out a hemorrhagic etiology, should also be evaluated for a cardiac etiology as noted above with an echocardiogram. Question 8
1 / 1 pts
What is the key long-term benefit of using carvedilol for patients with coronary artery disease and heart failure with reduced ejection fraction (HFrEF)? Reduction in cardiac output Increase in libido Baseline reduction of blood pressure Correct! Potential increase in ejection fraction EF increase is a key reason for using carvedilol over metoprolol for patients with low EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output should only improve with long term use, not decrease, and beta blockers may reduce blood pressure slightly, but that is not their key long-term benefit. In fact, they are not even considered for routine anti- hypertensive management per JNC-8 guidelines. Question 9
0 / 1 pts
A grade III/VI, low-pitched, diastolic, rumbling murmur heard at the apex, and best heard in the left lateral decubitus position, is most indicative of which of the following types of valve problem? Aortic stenosis Correct Answer Mitral stenosis You Answered Aortic regurgitation Mitral regurgitation Question 10
1 / 1 pts
What is the chamber which directly pumps blood into the ascending aorta? Right Atrium Left Atrium Right Ventricle Correct! Left Ventricle In the pathway of cardiac blood flow, the aorta is directly after the left ventricular outflow tract. Question 11
1 / 1 pts
Glucose is only one of the parameters that needs to be followed in DKA. It takes longer for ketones to clear than glucose to normalize. Insulin drip should be continued until ketonemia has resolved and the anion gap has closed. If IV insulin is discontinued prematurely the patient may have rebound acidosis. Bicarbonate replacement has been controversial in DKA. Question 13
1 / 1 pts
Classic findings in a patient with a pheochromocytoma include which of the following? Depression Postural hypotension Correct! Paroxysmal symptoms Generalized anxiety Patient symptoms will be paroxysmal rather than constant due to the intermittent secretion/surge of catecholamines Question 14
1 / 1 pts
Pheochromocytoma is best diagnosed by which of the following tests: Plasma metanephrines with blood pressure values Correct! 24-hour urine for catecholamines/metanephrines and plasma metanephrines Blood pressure values and adrenal CT/MRI
Adrenal CT/MRI Pheochromocytoma is catecholamine producing tumor. Must have diagnostics that reveal increased levels of catecholamines. A negative test virtually excludes pheochromocytoma. Question 15
1 / 1 pts
A 48-year-old female presents with a history of hypothyroidism controlled with levothyroxine (Synthroid). She reports that she has been taking excessive amounts of the drug over the past year, to control her weight. This behavior can cause or aggravate which of the following conditions? Bradycardia Thyroid malignancy Correct! Osteoporosis Migraine headaches Overuse of levothyroxine is not associated with thyroid malignancy or migraine headaches, it is more likely to cause tachycardia rather than bradycardia. Osteoporosis is associated with overuse of levothyroxine. Question 16
1 / 1 pts
An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association, the nurse practitioner would recommend that the next follow-up appointment be scheduled for:
Which of the following is at highest risk for type II diabetes? Correct! An adult woman with a BMI of 34 who just delivered a baby weighing 10 lbs A 63-year-old Hispanic male with a BMI of 23 who works as a carpenter A 51-year-old black female with a BMI of 22 who walks daily at least 30 minutes A 77-year-old Caucasian male with a BMI of 27 who is sedentary Of these options, an adult woman with a BMI of 34 who just delivered a baby weighing 10 lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2 diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14 years after pregnancy compared to women who give birth to babies of average gestational age (AGA). This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure, and family history of diabetes. Question 19
0 / 1 pts
A patient presents for recheck of their thyroid-stimulating hormone (TSH). The patient was started on levothyroxine (Synthroid) 50 mcg 8 weeks ago. Today the TSH is 10. μU/mL [normal = 0.4-2.5 μU/mL]. Based on this lab work, which is the most appropriate action? You Answered Decrease levothyroxine (Synthroid) to 25 mcg daily. Correct Answer Increase levothyroxine (Synthroid) to 75 mcg daily. Change to Armour Thyroid 50 mcg daily.
Keep levothyroxine (Synthroid) at 50 mcg daily. The patient has been initiated on a reasonable starting dose with levothyroxine and given the appropriate 6 to 8 week timeline to evaluate for response. As the patient has not yet seen a decrease in their TSH down to a normal range, it would be suggestive that they are not yet at an appropriate dose of levothyroxine, and this would need to be increased. To further evaluate this, T3 and three T4 should be evaluated and would more accurately quantify their response. Question 20
1 / 1 pts
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating the patient? Correct! Screen for hormone deficiencies Repeat MRI in 3 months Start Cabergoline Refer to surgery Initial work up includes hormone testing. Cabergoline is the treatment for prolactinoma. Surgery consult is indicated when there are VF deficits and/or abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning. Adenomas >1 cm with no VF deficit or abutment/compression of optic nerves or chiasm require a follow up MRI at 6 months. Question 21
1 / 1 pts
An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice cream only. The family is concerned about the patient not getting enough nutrition. The NP:
Question 23
1 / 1 pts
A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause? Increased absorption of calcium Decreased pancreatic secretions Increased bile secretion Correct! Decreased bowel muscle tone The frail, elderly patient will typically have their GI track decrease bile secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation, however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit time, thereby increasing the drying of stool in the large intestine which leads to constipation Question 24
1 / 1 pts
The management of COPD in the elderly is best guided by: arterial blood gases. radiologic imaging. Correct! symptomatology. spirometry.
Symptomatology is what guides COPD management since the severity and frequency of symptoms will warrant changes and additions to medications as exacerbations present. Although very useful tool for chronic management and baseline status, spirometry does not typically dictate therapy, rather diagnose the disease state itself. Our blood gases may be used for clinically correlate severity during an exacerbation, and radiologic imaging may showcase severity of stable chronic finding such as somatic, lung tissue or bullae. Question 25
1 / 1 pts
Which is best performed to assess the risk for fall in an 88-year old adult? Clock-drawing test Correct! Get up and go test Global screening assessment PHQ-2 questionnaire This question is asking you if you understand the different screening to available for Mobility and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no clinical significance to mobility. The “get up and go” test is the only option that is a mobility test of these four. Question 26
1 / 1 pts
The most specific indicator of the presence of ascites is: A positive Murphy test Correct!
Decreased production of gastric acid Increased salivation Decreased incidence of gallstones Increased esophageal emptying Normal GI changes with aging include decreased production of gastric acid, increase incidence of gallstone, decreased salivation, and decrease esophageal emptying. Question 29
1 / 1 pts
Where can Crohn’s disease be located within the GI tract and how does it present (continuous or patchy)? In the colon only and patchy Correct! Patchy inflammation throughout the small bowel and colon In the esophagus and stomach only In the colon continuous throughout Crohn’s disease unlike UC is a patchy inflammation that can be found throughout the small bowel and colon. Question 30
1 / 1 pts
A 43-year-old male with past medical history significant for GERD, smoking, and obesity presents to your clinic for worsening GERD symptoms, he has been taking protonix
40mg daily with no improvement. What imagining/diagnostic would be warranted for this patient. MRI Correct! EGD Barium x-ray ERCP Due to this patient’s underlying history of GERD, and risk factors of obesity and smoking he should be screened for Barrett's esophagus. This would be done by performing an EGD Question 31
0 / 1 pts
The most common side effect of the oral ribavirin used in the treatment of hepatitis C is: hypothyroidism. Correct Answer depression. You Answered hemolytic anemia. weight gain. It is important to note that ribavirin will not treat hepatitis C unless it is taken with another medication called pegylated-interferon α (PEG-IFNα). This therapy is not considered evidence based anymore due to better options now available and the
intermittent acetaminophen intake Correct! chronic alcohol intake Chronic alcohol intake and the damage to the liver is more causative and predictive to liver failure than exercise (or lack therof), fluid intake levels (which more affect hydration status, and acetaminophen intake which is noted to be only intermittent. Question 34
1 / 1 pts
Anorexia nervosa occurs most commonly in which of the following? Individuals from large families Correct! High-level athletes Individuals with many friends In adolescents of higher social-economic status Anorexia is more common in high performers, who feel a need to be socially accepted. Of these options, high-level athletes are the only ones who fit this mold. Adolescence of higher, social economic status are less likely because they don’t usually have a difficulty being accepted in society, and individuals with many friends likewise are more accepted. Individuals from large families are also less likely to lack social engagement due to a larger support system. Question 35
1 / 1 pts
A 38-year-old male presents to the clinic with complaints of abdominal pain, intermittent diarrhea, and has a positive occult blood. A stool culture is done which does not show any organism growth. Which labs could be performed to provide further diagnostic information?
CEA
CMP
Correct! CRP and Fecal calprotectin Sed rate CRP and fecal calprotectin, are typically performed, if elevation is seen in these two levels, then an ileocolonoscopic is warranted for further workup and biopsy Question 36
1 / 1 pts
The nurse practitioner is caring for an acutely-ill 92 year old ICU intubated patient not responding to the best available care after a perforated gastric ulcer who underwent surgical exploration and washout two weeks ago. They have gone into ventricular tachycardia twice this morning and resuscitated with the use of DC cardioversion and IV amiodarone. Subsequent labs reveal profound lactic acidosis and they are not expected to survive the day due to a presumed diagnosis of mesenteric infarct. Before the first surgery, the patient told you and the family they did not want to undergo extreme measures to sustain their life and would like to “go out with some dignity”. Which of the following would NOT be an appropriate consult to make at this time? Correct! Surgical consult for emergent abdominal re-exploration All options are appropriate Chaplain services to address any spiritual preferences or needs
