Download NUR 654 Final Exam Study Set and more Exams Nursing in PDF only on Docsity!
NUR 654 Final Exam Study Set
questions with correct answers
A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? - correct answer - Pituitary tumor resection A patient has unexplained weight loss and the provider notes increased skin pigmentation on light- exposed skin folds along with darkened palmar creases. Which laboratory tests will the provider order vs NOT order - correct answer -ORDER: Serum ACTH, Serum electrolytes, TB skin testing NOT: Serum cortisol T or F: Patient wishes related to palliative care should be discussed at the initial visit and updated at preventive visits - correct answer -T T or F: A patient on chemo has a high temperature and absolute neutropenic count >500,000 needs immediate ER workup - correct answer -T Radiation therapy can be used for all of the following in cancer treatment EXCEPT - correct answer - Treatment of side effects of chemo T or F: SIADH is an oncological emergency requiring urgent oncologic care - correct answer -T What is an effective pharmacologic medication to treat non-cancer chronic pain? - correct answer - Ibuprofen T or F: The most common sites for breast CA metastasis include lymph, lungs, liver, bone, and brain - correct answer -T What is an FDA approved treatment for osteoporosis? - correct answer -Biphosphonate therapy
T or F: Bone density improvement is the primary goal of biphosphonate treatment? - correct answer -F (it is to slow the progression of disease) An elevated serum alkaline phosphate (SAP) may include all of the following EXCEPT - correct answer - Hypothyroidism T or F: Xray findings associated with Paget's disease can show enlargement of bone and specific deformities (long bone bowing) - correct answer -T Symptoms of Cushing's Syndrome include - correct answer -Amenorrhea T or F: Pituitary tumor resection may be first line treatment for Cushing's Syndrome if indicated - correct answer -T Addison's Disease may cause which of the following lab abnormalities? - correct answer -Elevated ACTH (not hypokalemia, hypernatremia, or elevated cortisol) T or F: A patient with suspected hirsituism should be referred to endocrinology for an evaluation - correct answer -T A positive Trousseau's sign occurs with which serum abnormality? - correct answer -HYPOcalcemia Which of the following can cause hypocalcemia? - correct answer -Vit D Deficiency, hypomagnesemia T or F: Low serum albumin may lower serum calcium - correct answer -T Which can cause hyperkalemia in a patient with normal renal function? - correct answer -Adrenocorticol deficiency T or F: Medical management of primary hyperparathyroidism involves close monitoring of calcium, creatinine, and bone density - correct answer -T
T or F:A Bartholin Gland cyst is always infectious - correct answer -F Differential diagnosis to consider in a case of mastitis that is worsening despite a course of cephalosporin antibiotics - correct answer -inflammatory breast carcinoma Diagnostic work-up for unilateral breast pain in a postmenopausal woman should include - correct answer -bilateral mammogram T or F: Female patient found to have BRCA1 and BRCA2 mutation may be offered prophylactic mastectomy and oophorectomy - correct answer -T Chronic pelvic pain in women may be related to all EXCEPT - correct answer -hepatitis (faulty posture, interstitial cystitis, physical abuse are causes) Severe primary dysmenorrhea in a young adult may be treated with - correct answer -combination oral contraceptives Most common cause of dyspareunia in the premenopausal patient - correct answer -endometriosis Follow-up for abnormal pap involving a low grade intraepithelial lesion will include - correct answer - colposcopy with biopsy T or F: Outpatient management of PID with fever will include administration of Rocephin IM, Doxycycline and metronidazole for 14 days - correct answer -T Risk factors for PID include all EXCEPT - correct answer -Tubal sterilization (it includes age under 25, smoking, and vaginal douching) T or F: BV presents with white non-inflammatory discharge, clue cells, and a positive KOH whiff test - correct answer -T
Treatment for asymptomatic gonorrhea exposure includes - correct answer -empiric ceftriaxone and azithromycin T or F: Men under 50 years with erectile dysfunction are at higher risk for CV disease - correct answer -T Benefit of a liquid based medium in performing the pap includes - correct answer -Allowing for testing HPV, gonorrhea, and chlamydia in the same test T or F: Most HPV infections resolve spontaneously without causing cancer - correct answer -T Follow-up recommendation for a pap results of atypical squamous cells of underdetermined significance
- correct answer -repeat cytology in 12 months T or F: All UTIs in male patients are considered complicated - correct answer -T Purpose of conducting interview prior to beginning neuropsychological evaluation in older adult that may have dementia - correct answer -to assess ability to cooperate with testing T or F:Disease modulating therapy drugs in MS will NOT reduce the exacerbation rate - correct answer -F (it is to prevent flares) Which criteria may be considered to help diagnose Parkinson's Disease? - correct answer -presence of two cardinal signs which improve with levodopa T or F: Carbamazepine may be used to treat both focal epilepsy as well as complex partial seizures - correct answer -T An adolescent with a body weight of 82% of expected, throwing up and refusing food - correct answer - anorexia nervosa T or F: Physical manifestation of GAD often includes HA or IBS - correct answer -T
Toddler with hitting and biting at daycare and tantrums at home shortly after sibling born - what will NP do? - correct answer -engage patient in positive parenting strategies to facilitate appropriate child coping Which drug to treat focal epilepsy and complex partial seizures - correct answer -carbamazepine A patient reports restlessness, fatigue, difficulty concentrating - what other things to ask about? - correct answer -HA and bowel habits Patient reports recurrent HA 1-2 times per month - weather changes, or changes in sleep patterns - correct answer -triptans - migraines School aged with frustration doing tasks - correct answer -GAD Conducting interview before doing neuropsych testing, why? - correct answer -Determine if they are able to concentrate and answer questions Patient with Alzheimers taking Donezepil to treat - increased social withdrawal - initial step to manage? - correct answer -Encourage activity and exercise NP performing emotional health check of an 18 month old through - correct answer -Observation of the child with the caretakers in structured vs unstructured situations A patient with Parkinson's Disease has been taking Sinemet with increased dyskinesia - what medication to take - correct answer -Amantadine A patient with dementia has agitation and visual hallucinations and is given haloperidol with worsening of symptoms - what is the likely cause? - correct answer -Lewy Body Dementia A 35 year old patient has a sudden asymmetric smile, drooping, tearing, unilateral full face paralysis - what will the initial intervention be? - correct answer -Prescribe oral prednisone (bell's Palsy)
An elderly patient with depression and possible Alzheimer's Disease with family history - no memory loss right now - what is the initial treatment? - correct answer -trial of antidepressants All of the following are Parkinson's Disease symptoms EXCEPT - correct answer -hyperphonia A teen with major depressive disorder is prescribe fluoxetine as initial treatment - what other treatment is necessary first line? - correct answer -CBT A patient is experiencing recurrent cluster headaches - what is the abortive therapy? - correct answer - 100% O A 4 year old patient is having trouble adjusting to a new day care - what will you do first? - correct answer -Ask the parents if the child is slow to warm up to other new situations A 13 year old with mild depression for a few weeks presents now with new boundless energy - what are you considering? - correct answer -Bipolar disorder A spouse of a patient with ALS is asking about the goals of long term management for his chronic condition - correct answer -Preventing malnutrition is key What is the most important role of the primary care provider in cancer management? - correct answer - Counseling about healthy practices to reduce risk factors A patient has a history of migraines with aura and requests oral contraceptives to prevent pregnancy. Which type of contraceptive will the provider recommend? - correct answer -Progestin only A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? - correct answer - pituitary tumor resection When should palliative care be initiated? - correct answer -when a patient is diagnosed with a serious disease
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? - correct answer -Inappropriate secretion of PTH along with hypercalcemia An adolescent female reports moderate dysmenorrhea with periods and tells the primary care NP that 400mg of ibuprofen every 6-8 hours is not controlling her pain. What will the NP recommend? - correct answer -taking naproxen 500mg initially, then 250mg every 6-8 hours A woman who is taking oral contraceptive pills (OCPs) to prevent pregnancy calls the provider to report forgetting to take the pills for 4 days. She has not had sexual intercourse during that time. What will the provider recommend? - correct answer -Resume the pills and use a backup method the remainder of the cycle A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? - correct answer -adrenocortical deficiency A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? - correct answer -Annual monitoring of calcium, creatinine, and bone density a patient has low serum calcium associated with low serum albumin. what is the recommended treatment for this patient - correct answer -vitamin D and calcium supplementation a patient has bone pain and laboratory testing reveals an elevated serum alkaline phosphate. which test can help distinguish paget's from malignant bone disease - correct answer -bone radiography A woman who has had routine Pap tests all of her adult life has an abnormal Pap with low-grade intraepithelial lesion. What will the provider tell her about this result? - correct answer -colposcopy with biopsy if necessary A 40 year old patient with primary hyperparathyroidism has increased serum calcium 0.5mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? - correct answer -Annual monitoring of calcium, creatinine, and bone density
Which is true about hypoactive sexual desire in older men? - correct answer -men with hypoactive sexual desire may still have normal excitement and orgasm A patient diagnosed with multiple sclerosis and begins disease modulating therapy drugs. As a part of counseling about this therapy the provider will tell the patient that this regimen will - correct answer - reduce the exacerbation rate What is true about HPV infection in women - correct answer -most HPV lesions will resolve spontaneously without causing cancer The primary care NP attempts to learn more about the emotional health of an 18 month old child through which assessment strategy - correct answer -observation of the child with caretakers in structured and unstructured environments What is the medical diagnostic term used to identify transgender patients? - correct answer -Gender dysphoria A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? - correct answer -headaches and bowel habits A 16 year old female has primary amenorrhea. A pregnancy test is negative. Further testing reveals a normal TSH and an elevated prolactin level. Which test will the provider order next? - correct answer - MRI A 35 year old patient reports suddenly experiencing an asymmetric smile along with drooping and tearing in one eye. The patient has a history of a recent viral illness but is otherwise healthy. During the exam the provider notes that there is unilateral full face paralysis on the right side. What is the initial intervention for this patient? - correct answer -prescribe oral prednisolone A 67 year old female patient reports vulvar pruritis and dyspareunia. The provider notes white papules on the vulva with thinning of the epithelium. What condition does the provider suspect? - correct answer -Lichen sclerosis
An 18 year old sexually active young female reports vaginal discharge and moderate vulvovaginal irritation. The exam reveals a white, noninflammatory discharge adhering to the vaginal walls, clue cells on micro exam and a positive KOH whiff test. What will the provider do next? - correct answer -Prescribe Metronidazole 500mg x 7 days An adolescent takes ibuprofen, acetaminophen, and a TCA to treat phantom limb pain and reports that the medications are no longer effective. What will the NP do? - correct answer -refer to pain management specialist A previously healthy 22 year old female reports pain in the rectovaginal area that occurs with sexual intercourse. What is the most likely cause of the patient's discomfort? - correct answer -endometriosis A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. how will the PCP manage this situation? - correct answer -refer the child to a mental health specialist for evaluation and treatment Which underlying cause is related to chronic pelvic pain in women? - correct answer -interstitial cystitis An asymptomatic female learns that her boyfriend has gonorrhea and asks about antibiotics. what will the PCP recommend? - correct answer -Empiric ceftriaxone and azithromycin A patient being treated for cancer has had chemotherapy within the past two weeks and comes the clinic with a fever of 38.5. What is the initial action? - correct answer -obtain a STAT CBC w/ diff A woman who has just weaned her infant from breastfeeding develops signs of mastitis and is treated with antibiotics. At a follow up visit the provider notes marked breast edema and erythema of the affected breast. What will the provider do next? - correct answer -refer for immediate biopsy A 30 year old male patient as a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. What type of UTI does this represent? - correct answer -Complicated A Female patient is identified as having the BRCA mutation and she asks which intervention will reduce her risk of breast cancer the most? - correct answer -prophylactic mastectomy and oophorectomy
A young female has a pap test which reveals atypical squamous cells of undetermined significance. what will the next step be in managing this patient? - correct answer -repeat cytology in 12 months Postmenopausal woman reports unilateral breast pain that she describes as sharp and burning and localized to one area. A breast exam reveals no dimpling, discharge, or masses, which test will the provider order - correct answer -bilateral mammogram A 16 year old patient with primary dysmenorrhea has taken NSAIDs and COX-2 inhibitors without relief. What will suggest? - correct answer -combined oral contraceptive A complete blood count on a 12 month old infant reveals microcytic hypochromic anemia with a hemoglobin of 9.5g/dL. the infant has mild pallor with no hepatosplenomegaly. The FNP suggests - correct answer -Iron deficiency anemia The mother of a 3 day old newborn reports that her infant nurses every 4 hours during the day and sleeps 6 hours at night. What will provider recommend? - correct answer -awakening the baby every 3 hours to nurse A provider is caring for a couple who are trying to conceive. To most accurately evaluate ovulation and luteal surge in the woman what test will the provider recommend? - correct answer -urinary luteal hormone home kit Which types of lymphomas typically have an aggresive presentation? - correct answer -diffuse large B cell lymphoma A 60 year old female has recently lost weight a physical exam reveal beefy red, sore tongue, with no neurological fidnings. Based on these findings what will the provider anticipate findings in lab tests? - correct answer -low hemoglobin and elevated MCV A pregnant woman in first trimester who is overweight has no previous medical history of hypertension or diabetes. Her initial screening exam reveal a BP of 140/90 and a fasting glucose of 128. What will the provider do? - correct answer -Monitor blood pressure and fasting blood glucose closely
A patient reports mild fatigue and palpitation. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present? - correct answer - decreased hematocrit A couple who has been trying to conceive for over 9 months asks the provider about artificial reproductive therapy. When discussing risks and benefits associated with these methods, what will the provider include? - correct answer -increased premature births An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother? - correct answer -to use a breast pump to increase her milk supply A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth, and breast tenderness. What will the provider recommend? - correct answer -warm packs and increased frequency of nursing A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a family history of bleeding disorders. The patient reports no female relatives who has excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both has post-surgical complications related to bleeding. Based on this history which diagnosis is possible? - correct answer - Hemophilia The FNP providers primary care for a 30 month old child who has sickle cell anemia who has had one dose of 23-valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child? - correct answer -administer an initial meningococcal vaccine The NP is examining a 5 year old child who has had recurrent fevers, bone pain and recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A CBC shows thrombocytopenia, anemia, and an elevated WBC count. The NP will refer this child to a specialist for - correct answer -bone marrow biopsy The FNP reviews hematology reports on a child with beta thalassemia minor and notes a Hgb level of 8g/dL. What will the NP do? - correct answer -evaluate serum ferritin
A female patient has lower abdominal pain, nausea, and vomiting and reports missing a period 3 weeks prior. The patient reports using an IUD for contraception. A serum b-hCG is 1500mIU/mL. What will the provider do based on these findings? - correct answer -perform a transvaginal ultrasound The FNP performs a well baby examination on a 4 month old infant who is exclusively breastfed and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the NP recommend? - correct answer -elemental iron supplementation of 1mg/kg/day until cereals are added A patient who is taking prednisolone 20mg daily to treat polymyalgia rheumatica reports blurred vision. What will the provider do? - correct answer -Refer to a rheumatologist immediately The primary care NP examines a child who has had stiffness and warmth in the right knee and left ankle for 7-8 months but no back pain. The NP will refer the child to a rheumatology specialist for evaluation of - correct answer -oligoarticular JIA A patient is treated for a UTI and 3 weeks later presents with pain and swelling of one knee and in one hand along with inflammation in both eyes. What will the provider suspect as the cause of these symptoms? - correct answer -reactive arthritis A homeless patient who has HIV infection has been on antiretroviral therapy (ART) for 18 months and has had normal CD4 counts and viral loads for the past year. What will the provider recommend - correct answer -continue monitoring viral load and CD4 counts every 3-4 months A patient reports a history of recurrent lower back pain for 6 months. The patient describes the pain as a deep ache and stiffness that is worse upon wakening and improves after walking. Which assessment would NOT be helpful to make a clinical diagnosis of ankylosing spondylitis? - correct answer -Noting the degree of cervical kyphosis The parents of a school age child who is diagnosed with oligoarticular JIA asks the primary care NP what exercises the child may do to help reduce symptoms. What will the NP recommend? - correct answer - swimming A patient has a palpable purpural rash. The finding is most consistent with - correct answer -small vessel vasculitis
A pregnant woman tests positive for HIV infection. What will the provider recommend? - correct answer -Treatment with highly active antiretroviral therapy Which patient with documented HIV infection may be classified as having AIDS? - correct answer -a patient with tuberculosis An 8 year old child is diagnosed with SLE and the child's parents asks if there is a cure. What will the NP tell the parent? - correct answer -periods of remission occur but there is no permanent cure A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the provider order initially to manage this patient's symptoms? - correct answer -changing to a COX-1 inhibitor medication A child has a fever and arthralgia. The NP learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the NP order? - correct answer -ASO titer Which are symptoms of RA that distinguish it from osteoarthritis? - correct answer -symmetric, tender, swollen joints A child has a high fever, bilateral conjunctivitis, and a desquamating rash and is presumed to have a vasculitic disease. What is the likely treatment for this child? - correct answer -Aspirin and IV immunoglobulin The primary care NP is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthritis. If the child will take 4 doses per day, what is the max amount the child will receive per dose? - correct answer - 250mg The NP is reviewing the rheumatology plan of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the NP teach the family to help minimize flaring of episodes? - correct answer -Use UVA and UVB sunscreen daily
