N675 FINAL EXAM / N675 FINAL EXAM ., Exams of Nursing

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Week 1 – EENT

A primary care provider notes painless, hard lesions on a patient’s external ears that expel a white crystalline substance when pressed. What diagnostic test is indicated? Rheumatoid factor Endocrine studies Biopsy of the lesions Uric acid chemical profile

A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient? Oral hygiene measures Nystatin oral suspension Surgical excision Oral acyclovir

A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient’s symptoms? Prescribe empiric penicillin Perform a rapid antigen detection test Refer to an otolaryngologist Order an antistreptolysin O titer

A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient complains of blurred vision, haloes around lights, and vomiting. It began yesterday evening. On exam, the eye is red, tender and inflamed. The cornea is hazy and pupil reacts poorly to light. The most likely diagnosis in this patient is: Macular degeneration Acute angle glaucoma Increased intracranial pressure Detached cornea

A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.) CBC with platelets

Metronidazole Clindamycin

What are factors associated with acute suppurative parotitis? (Select all that apply.) Anticholinergic medications Diabetes mellitus Radiotherapy Hypervolemia Allergies

A 39 year old has a sudden onset of painful right red eye. He reports sensitivity to light and the sensation of a foreign body, though his history for a foreign body is negative. He does not wear contact lenses. How should the NP manage this? Observe for 24 hours if visual acuity is normal Treat for bacterial conjunctivitis Treat for viral conjunctivitis Refer to ophthalmology No clear diagnosis can be made from signs/symptoms, but there are several red flags. collectively the red flags necessitate a referral. There is no mention of eye discharge necessary for conjunctivitis. Red flags present point more towards active corneal process although glaucoma should also be a differential.

A 17-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely/most common? Concurrent URI Fever Difficulty hearing TV Tragal pain

A patient has an initial episode otitis external associated with swimming. The patient’s ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered? Cipro HC Neomycin Fluconazole Vinegar and alcohol

A patient has gingival inflammation with several areas of separate ulceration and a small amount of purulent discharge. What is required to diagnose this condition? Culture and sensitivity Tzank smear Physical examination Microscopic exam of oral scrapings

A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider? Recommend oral antiseptic rinses and follow up in one week Perform an incision and drainage of the edematous tissue Prescribe amoxicillin and refer to a dentist in 2 to 3 days Refer to an oral surgeon for emergency surgery

A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood red area. What is this termed? Conjunctivitis Glaucoma Acute iritis Subconjunctival hemorrhage

Which physical examination finding suggests viral rather than bacterial parotitis? Unilateral edema of parotid glands Enlargement and pain of affected glands Gradual reduction in saliva production Clear discharge from Stensen’s duct

A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention at this time? Immobilize the child’s head and neck and call 911 Turn the child’s head to the side to prevent aspiration of blood Place nasal packing in both nares to stop the bleeding Apply ice to the injured site to prevent airway occlusion

Topical corticosteroids Cool compresses Surgical drainage

A NP preforms a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be? Cotton wool spots Hemorrhages Exudates Microaneurysm

The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient? Administer empiric intravenous antibiotics and steroids Obtain an immediate consultation with an otolaryngologist Perform a thorough examination of the oropharynx Have the child lie down and administer high-flow, humidified oxygen

A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment? Prescribe analgesics and follow up in 1 to 2 days Order antibiotic ear drops if signs of infection occur Refer the patient to an otolaryngologist for evaluation Reassure the patient that this will heal without problems

Papilledema is noted n a patient with a headache. What is the importance of papilledema in this patient? it is not related to the headache this is a common finding in patients with headache it is an incidental finding in patient with migraines It could be an important finding in this patient

A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient? Intranasal steroids

Antihistamine sprays Intranasal comolyn Oral antihistamine

A patient with gingival inflammation with several areas of separated ulceration and a small amount of purulent discharge. What is required to diagnose this condition? Microscopic exam of oral scrapings Physical examination Tzank smear Culture and sensitivity

A 70 year old male has a yellowish, triangular nodule near the iris. This is probably: A chalazion A pinguecula A stye Subconjunctival hemorrhage.

A 32-year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. 6 weeks ago, she was treated with amoxicillin for a URI. It cleared without incident. Which be recommended today? Prescribe amoxicillin again Do not prescribe an antibiotic, only a decongestant as indicated Prescribe amoxicillin-clavulanate today Prescribe a decongestant and an antihistamine

A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient’s vital signs are normal. What is the most likely diagnosis for this patient? Allergic rhinitis Acute sinusitis Viral rhinitis Chronic sinusitis

The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. Based on the most likely diagnosis, what should the NP tell the caregivers about this condition?

A patient has two palpable, tender, left preauricular nodes that are about 0.5cm in diameter. What condition might this be associated with? Ear infection Conjunctivitis Ulceration on the tongue Sore throat

A kindergarten teacher was diagnosed with acute streptococcal pharyngitis. On exam, her throat is bright red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrates. The patient has a significant sulfa allergy and thinks she is also allergic to penicillin. Which with the following is the best treatment choice? Levofloxacin Amoxicillin– clavulanic acid Trimethoprim– sulfamethoxazoleClarithromycin

During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely? Corneal arcus Pterygium Chalazion Pinguecula

Group A strep pharyngiitis: Can be accompanied by abdominal pain Group A strep is usually accompanied by multiple symptoms with abrupt onset. GI symptoms are common such as nausea, vomiting, no abdominal pain. Inflamed uvula is not common

A 70 year old male patient complains of a bright red colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a recent URI. The only medicine he is taking is aspirin 1 tablet daily. Which of the following actions is appropriate follow up for this patient? Refer the patient to an opthalmologist Refer the patient to an optometrist

Prescribe an ophthalmic antibiotic solution Advise the patient that the condition is benign and will resolve spontaneously

A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms?

1. Herpes simplex virus
2. Bacterial infection
3. Candida albicans
4. Human papillomavirus

A patient diagnosed with strep throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable?

1. Different macrolide antibiotic should be prescribed
2. Penicillin or cephalosporin with beta-lactamase coverage should be considered
3. The patient should wait another 24 hours for improvement
4. That antibiotics should be changed to a first generation cephalosporin

A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend for this patient?

1. Consultation for immunotherapy
2. Oral antihistamines each morning
3. Oral decongestants as needed
4. Daily intranasal steroids A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient
5. Assess airway safety and vital signs
6. Clear the blood with suction to identify site of bleeding
7. Apply firm, continuous pressure to the nostrils
8. Have the patient sit up straight and tilt the head forward

A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood red area. What is this termed?

1. Acute iritis
2. Conjunctivitis

A 58 year old farmer presents with a wedge shaped, pinkish, clear growth on the nasal side of his eye. He states that it has been present for a while, but only recently began to feel as if a foreign body was in his eye. This is probably a: Pterygium Xanthelasma Stye Pinguecula

A 39 year old has a sudden onset of painful right red eye. He reports sensitivity to light and the sensation of a foreign body, though his history for a foreign body is negative. He does not wear contact lenses. How should the NP manage this? Treat for viral conjunctivitis Refer to ophthalmology Treat for bacterial conjunctivitis Observe for 24 hours if visual acuity is normal No clear diagnosis can be made from signs/symptoms, but there are several red flags. collectively the red flags necessitate a referral. There is no mention of eye discharge necessary for conjunctivitis. Red flags present point more towards active corneal process although glaucoma should also be a differential

A child has recurrent impaction of cerumen in both ears and the parent asks what can be done to help prevent this. What will the provider recommend? Removing cerumen with a cotton-tipped swab Try thermal-auricular therapy when needed Use an oral irrigation tool to remove cerumen Clean the outer ear and canal with a sof t cloth

A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding? Speech reception test Impedance audiometry Pure tone audiogram Tympanogram

A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination reveals slight redness in the ear canal with a clear odorless fluid. This is suggestive of:

Otitis externa Ear pain when pinna is pulled or tragus is pushed is indicative of otitis externa. Clear fluid is not indicative of pus formation such as with ruptured tympanic membrane.

A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis? Vertigo with changes in head position Facial palsy and vertigo Fluctuating hearing loss and tinnitus Spontaneous horizontal nystagmus

A 20-year-old male of Hispanic descent who reports a history of a cold that resolved 2 weeks ago except for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies fever. The patient tells you that he is very allergic to Keflex and erythromycin. Vital signs are stable except temperature is 99.2°F. Which showed the following conditions is most likely? Fever secondary to previous viral URI Hay fever Acute bronchitis Acute sinusitis

Acute otitis media can be best diagnosed by identifying which otic characteristic(s)? Cloudy, bulging TM with impaired mobility Opacity and erythema of the tympanic membrane Decreased mobility of the tympanic membrane Marked redness of the tympanic membrane Cloudy, bulging TM with impaired mobility is the best predictor for AOM. Decreased mobility of TM can be a result of fluid behind the TM, as in middle ear effusion.

A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient’s tympanic membrane. What is the initial action? Ask the patient about previous problems with that ear.

During an eye exam of a 50 year old hypertensive patient who is complaining of an onset of a severe headache, you find that the borders of the disc margins on both eyes are blurred. What is the name of this clinical finding?

Unilateral cataracts

Papilledema is noted in a patient with a headache. What is the importance of papilledema in this patient? It could be an important finding in this patient it is an incidental finding in patient with migraines this is a common finding in patients with headache it is not related to the headache Papilledema could represent swelling of the optic nerve head and disc secondary to increased intracranial pressure (ICP). The cardinal symptom of ICO is a headache; papilledema is a secondary finding. It is not a common finding in patient with general headache

A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary at this time? Urgent drainage of the mass CT scan of facial structures Ice packs to reduce facial swelling Surgery to reduce the nasal fracture

Week 2 – Pulmonary

A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? Empiric treatment with a macrolide antibiotic

A 22 year old tall, thin and athletic man comes into your primary care clinic complaining of pain with breathing and progressively worsening shortness of breath. In order of sequence, what will be your next steps? -Obtain more history, auscultate the lungs and send pt to the ER for a stat CXR and further evaluation. -Obtain more history, and immediately send him to the ER

A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms? Infection

Patients with pneumonia reports that he has rust-colored sputum. With pathogen should the nurse practitioner suspect? Streptococcus pneumoniae Clinical description of mucus does not really help and clinical decision making regarding pneumonia, but certain clinical characteristics are associated with specific types of pneumonia. Scant or watery sputum is associated with atypical pathogens like mycoplasma and clamydophila. Thick, discolored sputum may be associated with bacterial pneumonia.

A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Complete blood count

A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication Administer LAIV influenza vaccine Perform a nasal swab for RT-PCR assay

Which patient might be expected to have the worst FEV1? Patient with bronchiolitis A controlled asthma patient A 65 her old with emphysema A 60-year-old with pneumonia Forced expiratory volume in 1 second (FEV1)is the worst in patients with obstructive disease such as emphysema. An FEV1 should not be performed in patients with pneumonia and bronchiolitis because they would have diminished respiratory capacity related to the infection

What does peak flow meter measure? Peak flow capacity Oxygen saturation Exercise capacity Expiratory flow

A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend’s nitroglycerin during one episode. What is the most likely cause of this chest pain? orrect! Esophageal pain Pleural pain Cardiac pain Aortic dissection pain

A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. The patient’s lungs are clear and oxygen saturations are 97% on room air. What will the provider recommend? Empiric antibiotics to treat a possible secondary infection Referral to a specialist for evaluation and treatment Correct! Symptomatic treatment with close follow up in clinic Admission to the hospital for treatment of complications

Hemoptysis can be confuse with other bleeding disorder. To narrow down your differential diagnosis, it is important to evaluate and obtain these pertinent data regarding your patient's history of: (Choose all that apply) sequence of birth number of soda intake per day Correct! occupational and environmental exposures travel history

A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient? Admit to the hospital with specialist consultation Prescribe an oral corticosteroid medication

Give epinephrine injections and monitor response Administer three more nebulizer treatments and reassess

What is the most common complication of influenza? Bacterial pneumonia Cough Bronchitis You Answered Viral pneumonia

A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient? Oseltamivir Whoever put this answer its incorrect the correct answer is Azithromycin

The most common cause of bloody expectorant in primary care are due to the following: GERD and esophagitis Acute bronchitis and Pneumonia URI and Asthma AAA and varices Buttaro, Chapter 108 Hemoptysis, pg 471

An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? Spirometry Allergy testing