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NURS 623 EXAM 3: MENTAL HEALTH & GI: QUESTIONS
AND ANSWERS
- Which of the following dietary instructions should be given to a patient with GERD? A) Eliminate coffee. B) Drink peppermint tea to relieve stomach distress. C) Recline and rest after meals. D) Limit the amount of antacids. -- Correct Answer ✔✔ A
- The patient with GERD should be instructed to eliminate which of these activities? A) Swimming B) Weight lifting C) Golfing D) Walking -- Correct Answer ✔✔ B
- The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:
A) 1 month B) 3 months C) 6 months D) 12 months -- Correct Answer ✔✔ C.
- The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants? A) SSRIs are more effective than TCAs. B) SSRIs take less time to work than TCAs. C) SSRIs have a more favorable side-effect profile than TCAs. D) SSRIs are not lethal in overdose. -- Correct Answer ✔✔ A
- A patient is seen with complaints of diarrhea. Which of the following should be included in the patient's differential diagnosis? A) Gastroenteritis B) Inflammatory bowel disease C) Lactase deficiency D) All of the above -- Correct Answer ✔✔ D
- A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be? A) Obtain a complete history.
C) Cholecystitis D) Appendicitis -- Correct Answer ✔✔ C
- A 46-year-old female patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient? A) CBC with differential B) Urine human chorionic gonadotropin C) Barium enema D) Computed tomography of the abdomen -- Correct Answer ✔✔ B
- A patient is seen with complaints of diarrhea. Which of the following should be included in the patient's differential diagnosis? A) Gastroenteritis B) Inflammatory bowel disease C) Lactase deficiency D) All of the above -- Correct Answer ✔✔ D
- Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? A) High fiber diet B) Tylenol with codeine C) Daily laxatives D) All of the above -- Correct Answer ✔✔ A
- A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? A) Very early B) 3 to 4 hours after perforation C) Late in inflammation D) Appendicitis never presents with vague pain. -- Correct Answer ✔✔ A
- Which of the following is most effective in diagnosing appendicitis? A) History and physical B) Sedimentation rate C) Kidney, ureter, and bladder x-ray D) Complete blood count (CBC) with differentials -- Correct Answer ✔✔ A
- The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? A) "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." B) "You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication." C) "You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain." D) "It is important to take NSAIDs on an empty stomach in order to increase absorption." -- Correct Answer ✔✔ A
B) Recommend that the infant be treated with phototherapy 10 minutes a day until the bilirubin level is back to a normal range C) Refer the infant to a neonatologist as soon as possible D) Refer the infant to the neonatal intensive care unit -- Correct Answer ✔✔ A
- You suspect an enterobiasis infection in a 6-year-old girl. Which of the following tests would you recommend? A) Stool culture and sensitivity B) Stool for ova and parasites C) The scotch tape test D) Hemoccult test -- Correct Answer ✔✔ C
- The span of the normal adult liver is: A) 15 to 18 cm in the midclavicular line B) 6 to 15 cm in midclavicular line C) 2 to 6 cm in the midsternal line D) 4 to 8 cm in the midsternal line -- Correct Answer ✔✔ B.
- If left untreated, Zollinger-Ellison syndrome can cause which of the following? A) Severe ulceration of the stomach or duodenum B) Toxic megacolon C) Chronic diarrhea D) Malabsorption of fat-soluble vitamins -- Correct Answer ✔✔ A
- All of the following may help relieve the symptom(s) of gastroesophageal reflux disease (GERD) except: A) Losing weight B) Stopping caffeine intake C) Chewing breath mints D) Stopping alcohol intake -- Correct Answer ✔✔ C
- A 33-year-old man is diagnosed with a mild case of Clostridium difficile infection of the colon. The patient reports a history of hospitalization the previous month. Which of the following regimens is the preferred treatment? A) Metronidazole (Flagyl) 500 mg orally TID x 10 to 14 days B) Azithromycin 250 mg orally once daily x 5 days (Z-Pack) C) Vancomycin 125 mg orally QID x 10 to 14 days D) Treatment with antibiotics is not recommended -- Correct Answer ✔✔ C
- Cullen's sign is most commonly associated with which of the following? A) Acute pancreatitis B) Myocardial infarction C) Acute pyelonephritis D) Preeclampsia -- Correct Answer ✔✔ A
- While reviewing some lab reports, the nurse practitioner notes that one of the results for her teenage male patient is abnormal. The liver function tests are all normal except for a slight elevation in the alkaline phosphatase level. The patient is a member of a soccer team and denies any recent injury. Which of the following statements is true?
She has noticed that his symptoms are worse after eating large amounts of crackers, cookies, and breads. She denies seeing blood in the boy's stool. Which of the following conditions is most likely? A) Amebiasis B) Malabsorption C) Crohn's colitis D) Celiac disease -- Correct Answer ✔✔ D
- The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: A) Cholecystitis B) Acute appendicitis C) Inguinal hernia D) Gastric ulcer -- Correct Answer ✔✔ B
- When a patient is suspected of having acute pancreatitis, initial testing should include all of the following except: A) Electrolyte panel B) Serum amylase level C) Serum lipase level D) Barium swallow -- Correct Answer ✔✔ D
- A new patient is being interviewed by the nurse practitioner. The patient reports that she had a gastrectomy procedure 5 years ago to treat severe obesity. Currently, her body mass index (BMI) is 25 and the patient denies complications from the procedure. The nurse practitioner is aware that the patient is at higher risk for which of the following disorders?
A) Folate deficiency anemia B) B12-deficiency anemia C) Iron-deficiency anemia D) Normocytic anemia -- Correct Answer ✔✔ B.
- A 42-year-old obese white man presents to the clinic with a history of recurrent heartburn. He is diagnosed by the nurse practitioner with gastroesophageal reflux disease (GERD). Symptoms are occurring at least 4-5 times per week. Which of the following drug classes is preferred initially to treat symptoms of GERD? A) Histamine-2 receptor antagonist B) Proton-pump inhibitor C) Antibiotic D) Antiviral -- Correct Answer ✔✔ B
- You would associate a positive iliopsoas muscle test result with which of the following conditions? A) Left cerebral vascular accident B) Urinary tract infection C) Heel fractures D) Acute appendicitis -- Correct Answer ✔✔ D
- All of the following are true statements about diverticula except: A) Diverticula are located in the colon
A) Diarrhea with blood mixed in the stool B) Diarrhea and/or constipation C) Abdominal pain relief after defecation D) Mucus with stools -- Correct Answer ✔✔ A
- Which of the following laboratory tests is the most sensitive test for evaluating an active Helicobacter pylori infection of the stomach or duodenum: A) Helicobacter pylori titer B) Fasting gastrin level C) Upper GI series D) Urea breath test -- Correct Answer ✔✔ D.
- Which of the following is a true statement regarding acute gastritis? A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder B) Chronic lack of dietary fiber is the main cause of the disorder C) The screening test for the disorder is the barium swallow test D) The gold standard to evaluate the disorder is a colonoscopy -- Correct Answer ✔✔ A.
- Grey-Turner's sign is highly suggestive of which of the following conditions? A) Acute pancreatitis B) Acute appendicitis C) Acute diverticulitis D) Gastric cancer -- Correct Answer ✔✔ A
- A 74-year-old man presents with recurrent abdominal cramping and pain associated with diarrhea that occurs from four to five times per day. He reports that currently he is having an exacerbation. The stools are bloody with mucus and pus. The patient reports that he has lost weight and is always fatigued. The patient denies recent travel or outdoor camping. Which of the following conditions is most likely? A) Giardiasis B) Irritable bowel syndrome (IBS) C) Diverticulitis D) Ulcerative colitis -- Correct Answer ✔✔ D
- Which of the following laboratory values may be elevated on the liver function panel of patients who are alcohol abusers? A) Serum GGT (gamma glutamyl transaminase) B) Serum creatinine C) Serum bilirubin D) Blood urea nitrogen -- Correct Answer ✔✔ A
- During a routine physical exam of an 82-year-old woman, the nurse practitioner palpates an irregular mass on the midabdomen that is not tender and is about 2 cm in size. Which of the following is the best initial imaging test to further evaluate the abdominal mass? A) CT scan of the abdomen B) KUB study C) Abdominal ultrasound D) MRI of the abdomen -- Correct Answer ✔✔ C
- Rovsing's sign is associated with which of the following?
A) Physiological jaundice is the most common type of jaundice in infants B) The level of unconjugated bilirubin is increased in the newborn's body C) Phototherapy is usually indicated for these infants D) It starts on the second to fourth day of life -- Correct Answer ✔✔ C
- What is the best description of Cullen's sign? A) The onset of hyperactive bowel sound before the onset of ileus B) A reddish-purple discoloration that is located on the flank area C) A bluish discoloration or bruising that is located on the umbilical area D) The acute onset of subcutaneous bleeding seen during acute pancreatitis -- Correct Answer ✔✔ C
- Symptoms suggestive of ulcerative colitis include all of the following except: A) Bloody diarrhea mixed with mucus B) Nausea and vomiting C) Weight gain D) Abdominal pain -- Correct Answer ✔✔ C
- An 8-month-old girl is brought by her grandmother to see the nurse practitioner because of intermittent, random episodes of vomiting, abdominal bloating, currant jelly stools, and irritability with poor appetite. The infant is trending in the 10th percentile on the growth chart and appears lethargic. During the abdominal exam, a sausage-like mass is palpated on the right side of the abdomen. The infant's presentation is highly suggestive of which condition? A) Lactic intolerance B) Intussusception C) Inflammatory bowel disease
D) Irritable bowel syndrome -- Correct Answer ✔✔ B
- A 4-week-old boy is seen in the family practice clinic for a complaint of forceful vomiting that occurs immediately after feeding. The vomitus is composed of infant formula and is not bilious. The infant is bottle-fed with infant formula that was recommended by the pediatrician. The mother reports that the infant seems hungry and sucks on the bottle without any problems. His birth weight was 7 lbs, 5 oz (3. kg). The current weight is 7 lbs (3.2 kg). Which of the following clinical findings is an important clue regarding the possible cause of the infant's vomiting? A) Irritable and crying infant B) Sunken anterior fontanel and dry lips C) Positive rooting reflex D) Round olive-like mass located in the right upper quadrant of the abdomen -- Correct Answer ✔✔ D
- Which of the following is an accurate description of eliciting Murphy's sign? A) On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle B) Bend the patient's hips and knees at 90 degrees, then passively rotate the hip externally, and internally C) Ask the patient to squat, then place the stethoscope on the apical area D) Press into the abdomen deeply, then release it suddenly -- Correct Answer ✔✔ A
- Extreme tenderness and involuntary guarding at McBurney's point is a significant finding for possible: A) Acute cholecystitis
- A 38-year-old male veteran is diagnosed with posttraumatic stress disorder (PTSD). He attends group therapy sessions once per week, but reports that his symptoms remain the same. He is requesting treatment for his condition. Which of the following is the first-line medication for PTSD? A) Selective serotonin reuptake inhibitors (SSRIs) B) Benzodiazepines C) Tricyclic antidepressants (TCAs) D) Selective norepinephrine reuptake inhibitors (SNRIs) -- Correct Answer ✔✔ A.
- Which of the following is most likely to cause delirium? A) Insomnia B) Multiple brain infarcts C) Malnutrition D) Acute infection -- Correct Answer ✔✔ D
- The first-line treatment consideration for managing delirium caused by acute alcohol withdrawal includes: A) Intubation B) Benzodiazepines C) Avoidance of physical restraints to decrease agitation D) Antipsychotics -- Correct Answer ✔✔ B
- A 68-year-old woman is suspected of having Alzheimer's disease. Which of the following is the best initial method for assessing the condition?
Select All That Apply A) CT scan of the brain B) Folstein Mini-Mental State Exam C) Patient history obtained from family members and close friends D) EEG (electroencephalography) -- Correct Answer ✔✔ B, C
- A nurse practitioner is evaluating an 80-year-old woman who is a resident of a long- term care facility. She instructs the patient to remember the words orange, house, and world. A few minutes later, the patient is asked to recall these three words. Which of the following tests is being described? A) Lachman test B) Neurological exam C) Romberg test D) Mini-Mental State Exam -- Correct Answer ✔✔ D
- An 87-year-old man is being seen at the health clinic. He tells the nurse practitioner that his grandson locks him in the bedroom when the grandson goes out of the house and sometimes withholds food from him if he does not give the grandson spending money. The patient appears frail, with poor grooming, and has a strong odor of urine on his clothing. Which of the following is the best action for the nurse practitioner to take? A) Report the patient's grandson for elder abuse to the state protective health services B) Speak to the grandson and educate him about the importance of proper grooming for his grandfather
