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NSG 6420 Midterm Exam Questions and Answers 2024
Question 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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/
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.
- A common auscultatory finding in advanced CHF is: (Points : 2)
Systolic ejection murmur
S3 gallop rhythm
Friction rub
Bradycardia
Question 10.
- Which of
the following
symptoms is
common with
acute otitis
media? (Points :
Question 15.
- Helicobacter pylori is implicated as a causative agent in the development of duodenal or
gastric ulcers. What teaching should the nurse
practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2)
It is highly contagious and a mask should be worn at home.
Treatment regimen is multiple lifetime medications.
Treatment regimen is multiple medications taken daily for a few weeks.
Treatment regimen is complicated and is not indicated unless the patient is
symptomatic.
Question 16.
- The best evidence rating drugs to consider in a post myocardial infarction
patient include: (Points : 2)
ASA, ACE/ARB, beta-blocker, aldosterone blockade
ACE, ARB, Calcium channel blocker, ASA
Long-acting nitrates, warfarin, ACE, and ARB
ASA, clopidogrel, nitrates
Question 17.
- The most common cause of eye redness is:
(PointsConjunctivitis : 2)
Acute glaucoma
Head trauma
Corneal abrasion
Question 18.
- A specific exam used to evaluate the gall bladder is: (Points : 2)
Psoas sign
Obturator sign
Cullens sign
Murphy’s sign
Question 19.
- An 82-year-old female presents to the emergency department with epigastric pain and
weakness. She admits to having dark, tarry
stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-
medicates daily with ibuprofen, naprosyn, and
aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor.
Fecal occult blood test is positive. A likely etiology
of the patient’s problem is: (Points : 2)
Mallory-Weiss tear
Esophageal varices
Gastric ulcer
Colon cancer
Question 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.
- 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.
- 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.
- 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.
- 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
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.
- 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.
- (*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.
- A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This
could be due to: (Points : 2)
Exercise-induced cough
Bronchiectasis
Alpha- 1 deficiency
Pericarditis
Question 32.
- (*There are multiple questions on this exam related to this 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.
Of the following lab studies, which would provide little help in determining
your differential diagnosis? (Points : 2)
Abdominal plain
films Liver function
tests Amylase/lipase
Urinalysis
Question 33.
- A 22-year-old female comes to your office with complaints of right lower quadrant
abdominal pain, which has been worsening over the
last 24 hours. On examination of the abdomen, there is a palpable mass and rebound
tenderness over the right lower quadrant. The clinician
should recognize the importance of: (Points : 2)
Digital rectal examination
Endoscopy
Pelvic examination
Urinalysis
Question 34.
- A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple
air-fluid levels in the bowel. This is a diagnostic
finding found in: (Points : 2)
Appendicitis
Cholecystitis
Bowel Obstruction
Diverticulitis
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased
NSG 6420
Midterm
Exam
Questions and
Answers 2024
