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NURS 623 EXAM 3 REVIEW QUESTIONS WITH COMPLETE
SOLUTIONS
- Which hepatic enzyme is increased with viral hepatitis, drug or chemical associated hepatitis or non alcoholic fatty liver disease? A) AST B) BUN C) ALT D) CRP -- Correct Answer ✔✔ C. ALT (Alanine aminotransferase)
- ALT usually increases higher than AST by greater than ten times the ULN in what conditions: A) Alcoholism B) Viral, drug or chemical associated hepatitis C) Septicemia D) HIV/AIDS -- Correct Answer ✔✔ B. Viral, drug or chemical associated hepatitis
- ALT usually increases higher than ALT at 3 times ULN in what conditions: A) Septicemia B) HIV/AIDS C) Non alcoholic fatty liver disease D) Chronic alcoholism -- Correct Answer ✔✔ C. Non Alcoholic Fatty Liver Disease
- Which hepatic enzyme is elevated with alcoholic hepatic injury and in acetaminophen overdose: A) ALT B) AST C) CRP D) GGT -- Correct Answer ✔✔ B. AST (Aspartate aminotransferase)
- The AST & ALT levels are markedly elevated over 20 times the ULN in which condition: A) Liver transplant rejection B) Hepatitis C exacerbation C) Acetaminophen overdose D) Acute liver trauma -- Correct Answer ✔✔ C. Acetaminophen overdose
- AST is usually higher or lower than ALT in alcoholic hepatic injury: A) AST is higher than ALT B) ALT is lower than AST -- Correct Answer ✔✔ A. AST is higher than ALT
- What is the proper order of assessing the abdomen? A) inspection, auscultation, percussion, palpation B) auscultation, percussion, palpation, inspection C) palpation, inspection, auscultation, percussion D) percussion, palpation, inspection, auscultation -- Correct Answer ✔✔ A. inspection, auscultation, percussion, palpation
- When percussing the abdomen, hyperresonance is present: A) After eating a large meal B) When there is gaseous distention C) During the second trimester of pregnancy
- 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 B) Urine HCG C) Barium enema D) CT -- Correct Answer ✔✔ B. Urine HCG
- A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical exam is remarkable for left lower quadrant (LLQ) tenderness. Which of the following should be considered in the differential diagnosis at this time? A) Endometriosis B) Colon Ca C) Diverticulitis D) All of the above -- Correct Answer ✔✔ D. All of the above
- You assess for Cullen's sign in Dan, age 62, after surgery. Cullen's sign may indicate: A) Cholecystitis B) Appendicitis C) Intra-abdominal bleeding D) Prostatitis -- Correct Answer ✔✔ C. Intra-abdominal bleeding
- Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant (RUQ) pain, abdominal cramping, nausea, and vomiting. Your differential diagnosis might be: A) Diverticulitis B) Gastritis C) Cholecystitis D) Appendicitis -- Correct Answer ✔✔ C. Cholecystitis
- What is the most common cause of constipation? A) Holding of bowel movements B) Medication side-effect
C) Dietary choices D) Lack of dietary fiber -- Correct Answer ✔✔ D. Lack of dietary fiber
- A patient is seen in the office and is complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? A) Lisinopril B) Coreg C) Linzess D) Pepto-bismol -- Correct Answer ✔✔ D. Pepto-bismol
- Which of the following pharmacological agents used to treat constipation may cause flatulence and bloating and requires adequate fluid intake? A) Lamictol B) Linzess C) Bulking agents D) Senna cot -- Correct Answer ✔✔ C. Bulking agents
- Which laxative is safe for long-term use? A) Senna cot B) Magnesium citrate C) Methylcellulose (Citrucel) D) Milk of magnesia -- Correct Answer ✔✔ C. Methylcellulose ( Citrucel)
- Simon states that he is worried because he has a bowel movement only every third day. Which response to best? A) There is no such thing as a "normal pattern of defecation." B) The accepted normal bowel pattern for people ages less than 65 years is once daily C) You should have a bowel movement at least every other day D) Do not worry. We only get concerned if you have had not had a bowel movement after seven days. -- Correct Answer ✔✔ A. There is no such thing as a " normal pattern of defecation."
D) Anger, denial, depression, bargaining, acceptance -- Correct Answer ✔✔ B. Denial, anger, bargaining, depression, acceptance
- Mr. Wright is an 85 y/o & newly diagnosed with colon cancer & surgery is indicated. He is mentally alert, however he is refusing to give consent for surgery. As his primary care provider you A) Insist he listen to the advice of the surgeon B) Respect his wishes C) Order a psychiatric consult D) Call his family to have them persuade patient to proceed with surgery -- Correct Answer ✔✔ B. Respect his wishes
- Janet is 30y/o woman who has been diagnosed with a herniated disc at the L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? A) Paresthesia of the perineum & buttock B) A reduced or absent ankle reflex C) Numbness in the lateral foot D) Gastrocnemius weakness -- Correct Answer ✔✔ A. Paresthesia of the perineum & buttock
- A 63 y/o man is seen in the clinic with a chief complaint of nocturia. Which of the following should be your differential diagnosis? A) Urethral polyp B) Benign prostatic hypertrophy C) Psychogenic nocturia D) Irritative posterior urethral lesion -- Correct Answer ✔✔ B. Benign prostatic hypertrophy
- It is important to educate patients with depression & their family members about reporting signs of increasing depression & suicidal thought. This is especially true during which period?
A) 1 to 2 weeks after the initiation of treatment B) 1 to 2 weeks after tapering off medications C) When switching to a different medication D) Before the initiation of treatment -- Correct Answer ✔✔ A. 1 to 2 weeks after the initiation of treatment
- The clinician has instructed Scott a 25 y/o patient with low back strain to use NSAIDS to manage his symptoms of pain & discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDS to manage pain? A) You should start with the lowest dose that is effective in managing your pain in order to avoid developing tolerance to the medication B) It is important to take NSAIDs on an empty stomach in order to increase absorption C) You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control you pain D) You should start with the lowest dose that is effective in managing your pain, because long term use of NSAIDs can result in gastrointestinal disorders, such as ulcers & hemorrhage -- Correct Answer ✔✔ D. You should start with the lowest dose that is effective in managing your pain, because long term use of NSAIDs can result in gastrointestinal disorders, such as ulcers & hemorrhage
- What is the treatment of choice for testicular cancer? A) Radiation implants B) Lumpectomy C) Radical orchiectomy D) All the above -- Correct Answer ✔✔ C. Radical orchiectomy
- Which of the following test is most specific to the diagnosis of RA? A) Abnormally high ESR B) Positive ANA titer C) Elevated levels of rheumatoid factor
- Which of the following statements is true concerning the treatment of fibromyalgia syndrome? A) Fibromyalgia syndrome can be difficult to manage requiring a variety of approaches & multiple medications B) All of the answers C) There is currently no cure for the disorder, however, patients should be made aware that symptom relief is possible D) Treatment is directed toward controlling discomfort improving sleep & maintaining function -- Correct Answer ✔✔ B. All of the answers
- Women are at the highest risk for developing postpartum depression for up to how long after child birth? A) 1 month B) 2 weeks C) 3 months D) 6 months -- Correct Answer ✔✔ D. 6 months
- A patient with complaints of diarrhea is seen. Which of the following should be included in the differential diagnosis list for a patient with diarrhea? A) Lactase deficiency B) Inflammatory bowel disease C) Gastroenteritis D) All of the other answers -- Correct Answer ✔✔ D. All of the other answers
- Which of the following is considered the first-line treatment for panic disorder? A) Tricyclic antidepressants B) Cognitive behavioral therapy C) SSRIs D) Benzodiazepines -- Correct Answer ✔✔ B. Cognitive behavioral therapy
- What is the best way to promote personal behavior change in your patient? A) Prescribe a health promotion treatment plan B) Write an order for treatment plan C) Stress compliance with your treatment plan D) Discuss choices with your patient and let him or her decide what will work best -- Correct Answer ✔✔ D. Discuss choices with your patient and let him or her decide what will work best
- Which of the following tests is considered the "gold standard" for definitively diagnosing osteoporosis? A) MRI B) Urinary N-telopeptide assay C) Bone alkaline phosphatase levels D) Bone mass density measurement by densitometry -- Correct Answer ✔✔ D. Bone mass density measurement by densitometry
- Which of the following statements is true concerning the management of the client with a herniated disc? A) Muscle relaxants & narcotics can be used to control moderate pain, should be discontinued after 3 wks. of use B) Intolerable pain for more than a 3 month period is an indication for referral for possible surgical intervention C) An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred D) All of the answers -- Correct Answer ✔✔ B. Intolerable pain for more than a 3 month period is an indication for referral for possible surgical intervention
- A 22 y/o is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? A) Late in inflammation B) 3 - 4 hrs. after perforation C) Appendicitis never presents with vague pain
B) Previously undiagnosed cognitive impairment that requires further evaluation C) That a history of alcohol use or abuse should be explored D) A syncopal episode requiring a cardiovascular & neurological evaluation -- Correct Answer ✔✔ D. A syncopal episode requiring a cardiovascular & neurological evaluation
- A diagnosis of__ should be considered in an 82 y/o woman with a new onset of urinary incontinence coupled with an acute change in mental status. A) Spinal cord compression B) Dementia C) Kidney stone D) Delirium -- Correct Answer ✔✔ D. Delirium
- Which of the following data are indicative of testicular torsion? A) Swollen scrotum with "red dot sign" B) Absent cremasteric reflex C) Testicle very low in the scrotum D) Pain relieved on testicular evaluation -- Correct Answer ✔✔ B. Absent cremasteric reflex
- John is a 16 y/o boy presents to your office after hurting his knee in a football game. He described twisting his knee & then being able to extend it completely. John tells you he heard a pop when the injury occurred & has been experiencing localized pain. You suspect a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? A) Lachman test B) Vulgus stress test C) McMurray circumduction test D) Varus stress test -- Correct Answer ✔✔ C. McMurray circumduction test
- Mary is a 49 y/o avid hiker who complains of a flu-like illness including fever, chills, & myalgia after returning from a weekend trip to New England. She tells you she has a rash which was initially a red spot that grew in size on her right leg. What disease are you considering? A) Lyme disease B) Rocky Mountain spotted fever C) Viral syndrome D) Relapsing fever -- Correct Answer ✔✔ A. Lyme disease
- The clinician is caring for Diane that is a 22 y/o woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle & that the decision to obtain radiographs is dependent on the exam & Diane's description of her injury. Which of the following clues in Diane's exam or history would alert the clinician to the need for obtaining radiographs? A) All of the other answers B) If crepitation occurs with palpation or movement of the ankle C) If she was not able to bear weight right after the injury D) If the ankle developed marked swelling & discoloration after the injury -- Correct Answer ✔✔ A. All of the other answers
- Diagnosis for acute gouty arthritis is best confirmed by A) MRI of affected joint B) Elevated CRP C) Elevated WBC D) Analysis of aspirate from affected joint -- Correct Answer ✔✔ D. Analysis of aspirate from affected joint
- A 45 y/o patient presents with a chief complaint of generalized abdominal pain. Her physical exam is remarkable for left LLQ tenderness. Which of the following should be considered in the differential diagnosis? A) Diverticulitis B) Endometriosis
A) Prolactin level B) Noctural penile tumescence & rigidity C) PSA D) Testosterone level -- Correct Answer ✔✔ D. Testosterone level
- The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis A) Gram positive cocci B) Gram negative bacillus C) Gram positive bacillus D) Gram negative cocci -- Correct Answer ✔✔ B. Gram negative bacillus
- Patients with gluteus medius or deep trochanteric bursitis typically present with A) Sciatic nerve pain B) Limited knee ROM C) None of the answers D) Increased pain from resisted hip abduction -- Correct Answer ✔✔ D. Increased pain from resisted hip abduction
- An 82 y/o man is seen in the primary care office with complaints of dribbling urine & difficulty starting his stream. Which should be included in the differential diagnosis? A) BPH B) All of the answers C) Parkinson's disease D) Prostate CA -- Correct Answer ✔✔ B. All of the answers
- Osteoporosis is more common in individuals A) Of African ancestry B) who are obese C) with type 2 diabetes D) with a long history of RA -- Correct Answer ✔✔ D. with a long history of RA
- One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure? A) Fascia B) Bone C) Synovium D) Tendons -- Correct Answer ✔✔ C. Synovium
- Mrs. Allen is a 60 y/o woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast CA associated with hormone replacement therapy & is wondering what else is available to her. The clinician explains that biphosphonates are another class of drugs used in the prevention & treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking biphosphonates? A) There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying B) This class of drugs can be taken any time of the day without regard to meals C) None of the answers D) Taking biphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs -- Correct Answer ✔✔ A. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying
- The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least A) 12 months B) 1 month C) 3 months
D) All of the answers -- Correct Answer ✔✔ A. High fiber diet
- The clinician has chosen to prescribe a 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 take less time to work than TCAs B) SSRIs have a more favorable side-effect profile than TCAs C) SSRIs are not lethal in overdose D) SSRIs are more effective than TCAs -- Correct Answer ✔✔ D. SSRIs are more effective than TCAs
- Which of the following tests yield the greatest amount of information in a patient with acute lumbar radiculopathy A) Lumbosacral radiograph series B) Bone scan C) ESR measurement D) MRI -- Correct Answer ✔✔ D. MRI
- A 34 y/o male presents to the office with complaints of new onset of right elbow pain & forearm weakness. He normally plays golf 1-2 times per month, however, he has recently returned from a vacation which included 36 holes of golf per day. Symptoms began on the last day of his vacation. He is a vegetarian & does not drink alcohol. On exam he has full ROM, although he has pain localized to inner aspect of the humerus. Considering the onset of symptoms, which of the following is likely your initial diagnosis? A) Medial epicondylitis B) Nerve impingement syndrome C) Cervical ruptured disc D) Gouty arthritis -- Correct Answer ✔✔ A. Medial epicondylitis
- A 52 y/o heavy drinker with history of gastric ulcer is diagnosed with acute gouty arthritis. The best option for treatment of symptoms is
A) ASA
B) NSAIDs C) Local corticosteroids & ASA D) Local corticosteroid injection -- Correct Answer ✔✔ D. Local corticosteroid injection
- Mrs. Smith age 92 lives independently in her own apartment. Her daughter is concerned about her mother's nutritional intake. As an NP you are aware there are physiologic changes that may affect food intake of the older adult. These include A) Diminished taste, senile entropion & thickened saliva B) Xerostomia, dysphagia & temporomandibular joint degeneration C) 3 Diminished taste, missing teeth, & presbycusis D) Xerostomia, endentulousness, keratinization -- Correct Answer ✔✔ B. Xerostomia, dysphagia & temporomandibular joint degeneration
- Mr. Jackson is a 55 y/o recently diagnosed with osteoarthritis. The clinician has explained to r. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence & mobility, minimizing disability, & preserving quality of life. Mr. Jackson explains to the clinician that has first choice would be to use complementary therapies to control his condition & asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response of the clinician? A) "It would be crazy to use complementary therapies to treat a serious condition" B) "Complementary therapies should only be considered if surgical interventions are not successful" C) "I would be happy to discuss all the treatment options available to you. Complementary therapies such as acupuncture, acupressure, & tai-chi are being studied for the use in the treatment of osteoarthritis & have shown promise when used with standard medical therapy." -- Correct Answer ✔✔ C. "I would be happy to discuss all the treatment options available to you. Complementary therapies such as acupuncture, acupressure, & tai- chi are being studied for the use in the treatment of osteoarthritis & have shown promise when used with standard medical therapy."
