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NSG6420 week 4 quiz 4- 8

week 4

Week 4 quiz

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1. Question : Which of the following is the most important question to ask during cardiovascular health history?

Number of offspring

Last physical exam

Sudden death of a family member

Use of caffeine

Question 2. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:

Women with ischemic heart disease many times do not present with chest pain

Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction

Elderly patients have the most severe symptoms

A & B only

 

Question 3. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include:

Echocardiogram

Exercise stress test

Cardiac catheterization

Myocardial perfusion imaging

 

Question 4. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be:

Mitral Valve Prolapse

Referred Pain from Cholecystitis

Pericarditis

Pulmonary Embolus

Question 5. Which symptom is more characteristic of Non-Cardiac chest pain?

Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm

Pain tends to occur with movement, stretching or palpation

Pain usually lasts less than 10 minutes and is relieved by nitroglycerine

Pain is aggravated by exertion or stress

Question 6. What is the most common valvular heart disease in the older adult?

Aortic regurgitation

Aortic stenosis

Mitral regurgitation

Mitral stenosis

Question 7. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:

Angina

Pericarditis

Mitral valve prolapse

Congestive heart failure

Question 8. The aging process causes what normal physiological changes in the heart?

The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis

Cardiology occurs along with prolapse of the mitral valve and regurgitation

Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves

Hypertrophy of the right ventricle

Question 9. 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; 8/10 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?

Musculoskeletal chest wall syndrome with radiation

Esophageal motor disorder with radiation

Acute cholecystitis with cholelithiasis

Coronary artery disease with angina pectoris

Question 10. A common auscultatory finding in advanced CHF is:

Systolic ejection murmur

S3 gallop rhythm

Friction rub

Bradycardia

Question 11. Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of:

Anemia

Anxiety

Hyperthyroidism

All of the above

Question 12. The best way to diagnose structural heart disease/dysfunction non-invasively is:

Chest X-ray

EKG

Echocardiogram

Heart catheterization

Question 13. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with:

Pneumonia

Pleuritis

Pneumothorax

A and B

Question 14. A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?

Arterial insufficiency

Femoral vein thrombus

Venous insufficiency

Peripheral neuropathy

Question 15. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?

Femoral vein thrombosis

Femoral artery thrombus

Venous insufficiency

Musculoskeletal injury

Question 16. Your 54 year old patient, Mr. A, presents to your clinic with a 2 day history of severe shoulder pain. On initial assessment you note that in addition to shoulder findings his blood pressure on the ‘good’ arm is 162/100. You review his history and on his last visit his blood pressure was 120/70. He has a medical history of sleep apnea and has used anabolic steroids when body building as a younger adult. In addition to caring for Mr. A’s chief complaint of shoulder pain, you also:

Start a thiazide diuretic, discussing the importance of adherence

Discuss with him his new diagnosis of hypertension and the importance of taking medication.

Schedule a follow up appointment after pain has subsided to take additional blood pressure readings

Start an ACE inhibitor because with his history he may also be diabetic.

Question 17. You decide to order labs today to help with the diagnosis and management of hypertension in Mr. A. Which of the following labs are indicated to assist in the medical management of Mr. A if he meets the diagnostic criteria for hypertension?

Serum Sodium

Thyroid function tests

Fasting serum cholesterol panel

Complete liver function enzyme panel

Question 18. Lifestyle modifications reduce blood pressure, enhance antihypertensive medication efficacy, and decrease cardiovascular risks. Which lifestyle change will decrease blood pressure the most?

Physical activity

Dietary sodium reduction

DASH diet

Weight reduction

Question 19. Mr. A returns to your clinic and a diagnosis of hypertension is made. He is started on a diuretic and counseled on lifestyle modifications including increasing activity and smoking cessation. On his next visit you note that his blood pressure remains elevated. Before referring to a specialist you should do all of the following except:

Assure medications are at appropriate dose

Identify any underlying medical condition that requires treatment

Review diet with Mr. A and refer to dietician if it is diet problematic

Determine he has ‘white coat’ hypertension because his home readings are also elevated

 

 

Question 20. Mr. A has many issues that seem to be interfering with his health outcomes. In order to negotiate and formulate a patient-centered management plan you take the time to gather more information. This can be started by asking the following question:

What do you think caused your hypertension and how has it affected your life?

I see that you are 20 pounds overweight — do you exercise?

Does you wife help you to manage your diet and medication?

Taking your blood pressure everyday is important so that I can see what happens each day. Do you do this?

Week 5 mid-term quiz

1. Question : Which of the following symptoms is common with acute otitis media?

Bulging tympanic membrane

Bright light reflex of tympanic membrane

Increased tympanic membrane mobility

All of the above

Question 2. The cytochrome p system involves enzymes that are generally:

Inhibited by drugs

Induced by drugs

Inhibited or induced by drugs

Associated with decreased liver perfusion

Question 3. In AR disorders, carriers have:

Two mutated genes; one from each parent that cause disease

A mutation on a sex chromosome that causes a disease

A single gene mutation that causes the disease

One copy of a gene mutation but not the disease

Question 4. 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:

CBC with differential

Stool culture and sensitivity

Abdominal X-ray

Colonoscopy

Question 5. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?

History of bright flash of light followed by significantly blurred vision

History of transient and painless monocular loss of vision

History of monocular severe eye pain, blurred vision, and ciliary flush

All of the above

Question 6. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of:

Bacterial sinusitis

Allergic rhinitis

Drug abuse

Skull fracture

Question 7. 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:

Mallory-Weiss tear

Esophageal varices

Gastric ulcer

Colon cancer

Question 8. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:

Thrush

Laryngeal cancer

Carotidynia

Thyroiditis

Question 9. 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:

Malignant melanoma

Squamous cell carcinoma

Aphthous ulceration

Behcet’s syndrome

Question 10. The best way to diagnose structural heart disease/dysfunction non-invasively is:

Chest X-ray

EKG

Echocardiogram

Heart catheterization

Question 11. (*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?

Abdominal plain films

Liver function tests

Amylase/lipase

Urinalysis

Question 12. The pathophysiological hallmark of ACD is:

Depleted iron stores

Impaired ability to use iron stores

Chronic unable bleeding

Reduced intestinal absorption of iron

Question 13. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?

Pulmonary edema

Heart failure

Pulmonary embolism

Pneumonia

Question 14. 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:

50 x 2-pack years

100-pack years

50-year, 2-pack history

100-pack history

Question 15. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to:

Acoustic neuroma

Cerumen impaction

Otitis media

Ménière’s disease

Question 16. Which symptom is more characteristic of Non-Cardiac chest pain?

Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm

Pain tends to occur with movement, stretching or palpation

Pain usually lasts less than 10 minutes and is relieved by nitroglycerine

Pain is aggravated by exertion or stress

Question 17. Aortic regurgitation requires medical treatment for early signs of CHF with:

Beta blockers

ACE inhibitors

Surgery

Hospitalization

Question 18. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion?

Fictional keratosis

Keratoacanthoma

Lichen planus

Leukoplakia

Question 19. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?

Hemoglobin and Hematocrit

Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)

Serum ferritin and Serum iron

Total iron binding capacity and transferrin saturation

Question 20. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:

Women with ischemic heart disease many times do not present with chest pain

Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction

Elderly patients have the most severe symptoms

A & B only

Question 21. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD?

Identification of a fluid wave

Positive Murphy’s sign

Palpable spleen

Midepigastric pain that is not reproducible with palpation

Question 22. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):

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

Question 23. Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except:

Sore throat

Fever

Weight loss

Headache

Question 24. Epistaxis can be a symptom of:

Over-anticoagulation

Hematologic malignancy

Cocaine abuse

All of the above

Question 25. In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen?

Left upper quadrant

Right upper quadrant

Left lower quadrant

Right lower quadrant

Question 26. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:

Angina

Pericarditis

Mitral valve prolapse

Congestive heart failure

Question 27. The first assessment to complete related to the eyes is:

Eye lids

Visual acuity

Extraocular movements

Peripheral vision

Question 28. Rheumatic heart disease is a complication that can arise from which type of infection?

Epstein-Barr virus

Diphtheria

Group A beta hemolytic streptococcus

Streptococcus pneumoniae

Question 29. 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:

Digital rectal examination

Endoscopy

Pelvic examination

Urinalysis

Question 30. Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following?

Sinus pain, increased vascular permeability, and bronchodilation

Bronchospasm, vascular permeability, and vasodilatation

Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction

Vasodilatation, bronchodilation, and increased vascular permeability

Question 31. Which of the following is the most common cause of heartburn-type epigastric pain?

Decreased lower esophageal sphincter tone

Helicobacter pylori infection of stomach

Esophageal spasm

Peptic ulcer disease

Question 32. Which of the following statements is true concerning anti-arrhythmic drugs?

Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile.

Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality.

Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.

Anti-arrhythmic therapy should be initiated in the hospital for all patients.

Question 33. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with:

Pneumonia

Pleuritis

Pneumothorax

A and B

Question 34. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment?

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 35. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?

Clinical practice guideline

Clinical decision rule

Clinical algorithm

Clinical recommendation

Question 36. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?

Femoral vein thrombosis

Femoral artery thrombus

Venous insufficiency

Musculoskeletal injury

Question 37. What is the most common valvular heart disease in the older adult?

Aortic regurgitation

Aortic stenosis

Mitral regurgitation

Mitral stenosis

Question 38. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:

Pneumothorax

Pleural effusion

Pneumonia

Pulmonary embolism

Question 39. 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:

Appendicitis

Cholecystitis

Bowel Obstruction

Diverticulitis

Question 40. According to the Genetic Information Nondiscrimination Act (GINA):

Nurse Practitioners (NPs) should keep all genetic information of patients confidential

NPs must obtain informed consent prior to genetic testing of all patients

Employers cannot inquire about an employee’s genetic information

All of the above

Week 6 quiz

1. Question :Which ethnic group has the highest incidence of prostate cancer?

 

Asians

Hispanics

African Americans

American Indians

 

Question 2.Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals?

Every 6 months

Yearly

Every 2 years

Every 2 to 4 years

 

 

 

Question 3. Your 55-year-old male patient presents to your office with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately?

 

Ultrasound of the abdomen

Abdominal X-ray

Digital rectal examination

Spiral CT scan

 

Question 4. The most common complication of an untreated urinary obstruction due to a ureteral calculus is:

 

Ureteral rupture

Hydronephrosis

Kidney mass

Renal artery stenosis

 

Question 5. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is:

 

Lower urinary tract infection

Nephrolithiasis

Hydronephrosis

Pyelonephritis

 

 

Question 6. On a physical examination for employment, a 45-year-old male shows no significant findings and takes no medications. Past medical history and surgery are unremarkable. On urinalysis, hematuria is present. The urinalysis is repeated on another day and still reveals microscopic hematuria. It is important to recognize that painless hematuria can be diagnostic of:

 

Urinary tract infection

Bladder cancer

Nephrolithiasis

Pyelonephritis

 

Question 7. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should:

 

Refer the patient for transrectal ultrasound guided prostate biopsy

Obtain an abdominal X-ray of kidneys, ureter, and bladder

Recognize this as a normal finding that requires periodic follow up

Obtain urine culture and sensitivity for prostatitis

 

 

Question 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except:

Increased estrogen production’s influence on the bladder and ureter

Decline in bladder outlet function

Decline in ureteral resistance pressure

Laxity of the pelvic muscle

 

Question 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is not a potential side effect of this procedure?

 

Urinary incontinence

Impotence

Dribbling urine

Selected low back pain

 

Question 10. Your 77-year-old patient complains of frequent urination, hesitation in getting the stream started, and nocturnal frequency of urination that is bothersome. On DRE, there is an enlarged, firm, non-tender, smooth prostate. The clinician should recognize these as symptoms of:

 

Urethritis

Benign prostatic hyperplasia

Prostatitis

Prostate cancer

 

Question 11. Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate:

 

Upper urinary tract infection

Normal bacteriuria

Lower urinary tract infection

Urethritis

 

 

Question 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/ml. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 ml; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 ml; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age-associated change?

 

PSA level of 3.3 ng/ml

Decreased bladder capacity

Involuntary detrusor contradictions

Increased postvoid residual urine volume

 

 

Question 13. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination?

 

Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigued.

Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis.

Thorough abdominal and gynecological exam to rule out masses and identify any tenderness.

A rectal examination to rule out colon cancer as a secondary site for breast cancer.

 

Question 14. A 27-year-old male comes in to the clinic for symptoms of dysuria, urinary frequency, as well as urgency and perineal pain. Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate. The clinician should recognize these as signs of:

 

Prostatitis

Prostate cancer

Urethritis

Benign prostatic hyperplasia

 

 

Question 15. Which of the following males would be at greatest risk for testicular cancer?

John, a 52-year-old, married African American Attorney who lives in Detroit, MI

Jacob, a 22-year-old, homosexual male, who works as an accountant, resides in Cumming GA, and has a history of cryptorchidism

Andy, a 27-year-old, Caucasian, single male who resides in Waukesha, WI and works as a maintenance mechanic

Ryan, a 34-year-old healthy, married man from Sweden, who works as a tered Nurse in Boston, MA

 

 

 

 

 

Question 16. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is:

 

Lower urinary tract infection

Pyelonephritis

Nephrolithiasis

Hydonephrosis

Question 17. Which of the following disorders can cause urinary incontinence?

Cystocele

Overactive bladder

Uterine prolapse

All of the above

 

Question 18. Your 18 year old sexually active patient presents with sudden right sided groin pain that is sharp and constant. Inspection of his genitals reveals a swollen and erythematous right scrotum. His right testicle is exquisitely tender, swollen and has no palpable masses. Elevation of the testis results in no reduction in pain. The left scrotum and the testicle are normal. Epididymis and other scrotal contents were within normal limits. The scrotum does not transilluminate. Cremasteric reflex is present on the left side but absent on the right. There is no penile discharge, inguinal lymphadenopathy, or hernias.

Based on the history and physical exam your immediate concern is for:

 

Torsion

Infection

Cancer

Rupture

 

 

 

Question 19. The Prehn sign is utilized to distinguish epididymitis from testicular torsion. Epididymitis is considered when the Prehn sign is positive. When is the Prehn sign determined to be positive?

 

Pain is relieved by lifting of the testicle.

Tenderness is limited to the upper pole of the testis.

Lightly stroking or pinching the superior medial aspect of the thigh causes testicular retraction.

A small bluish discoloration is visible through the skin in the upper pole.

 

 

 

 

Question 20. Which of the following exam findings makes the diagnosis of testicular tumor more likely?

 

A scrotal mass that is accompanied by exquisite tenderness.

Testicular swelling is mostly fluid and transilluminates easily

A testicular mass that is non-tender to palpation

Dilated and tortuous veins in the pampiniform plexus

Week 7 quiz

1. Question : When a patient presents with a skin-related complaint, it is important to first:

 

Fully inspect all skin lesions before asking the patient how the lesion in question developed

Obtain a full history about the development of the skin lesion prior to the physical examination

Complete a full physical examination of the body prior to inspecting the skin lesion

Examine the skin lesion without hearing a health history in order to not prejudice the diagnosis

 

 

Question 2. Which of the following dermatological conditions results from reactivation of the dormant varicella virus?

 

Tinea versicolor

Seborrheic keratosis

Verruca

Herpes zoster

 

 

Question 3. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that:

All symptoms should disappear within three days

Oral medications can dramatically reduce the duration and intensity of his symptoms

He has chickenpox and can be contagious to his grandchildren

He has a sexually transmitted disease

 

Question 4. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him?

Ignore the lesion, as it is associated with aging.

Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion.

Perform a biopsy or refer to a dermatologist.

Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away.

 

 

Question 5. The appearance of a 2-10 cm. herald patch with subsequent development of parallel oval lesions on the trunk in a christmas tree distribution involving the upper arms and upper legs are common in:

Pityriasis Rosea

Shingles

Psoriasis

Lymes Disease

 

 

 

Question 6. Mr. Fitzgerald is a 68-year-old previously healthy man with a history of significant sun exposure who presents with a progressively enlarging 18 x 16 mm erythematous pruritic oval patch on his left forearm that has been present for three to four years. Your differential would include all of the following EXCEPT:

Fungal skin infection

Eczema

Seborrheic Keratosis

Squamous cell carcinoma of the skin

 

Question 7. What kind of lesions are caused by the herpes simplex virus?

 

Scales

Vesicles

Plaques

Urticaria

 

Question 8 Among the following conditions, which needs to be treated with systemic antifungal agents?

 

Tinea pedis/tinea magnum

Tinea corporis/tinea cruris

Tinea capitis/Tinea unguium (onychomycosis)

Tinea pedis /tinea faciale

 

 

Question 9. Which lesions are typically located along the distribution of dermatome?

 

Scabies

Herpes zoster

Tinea

Dyshidrosis

 

 

Question 10. A smooth round nodule with a pearly gray border and central induration best describes which skin lesion?

 

Seborrheic keratosis

Malignant melanoma

Herpes zoster

Basal cell carcinoma

 

 

 

 

 

Question 11. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin?

 

Cellulitis is two times more common in women

Facial cellulitis is more common in people >55

There is low incidence of cellulitis in patients with diabetes

Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency

 

 

 

 

 

Question 12. Folliculitis is most commonly due to:

 

Contact dermatitis

Varicella zoster

Dermatophytes

Staphylococcal infection

 

 

 

 

 

Question 13. The anti-inflammatory properties of topical corticosteroids result in part from their ability to induce vasoconstriction to the small blood vessels in the upper dermis. Of the following, which is the most potent topical corticosteroid?

 

Hydrocortisone 2.5%

Triamcinolone acetonide 0.1%

Betamethasone dipropionate 0.05%

Alclometasone dipropionate 0.05%

 

 

 

 

Question 14. Which of the following descriptions accurately documents cellulitis?

 

Cool, erythematous, shiny hairless extremity with decreased pulse

Scattered, erythematous ring-like lesions with clear centers

Clearly demarcated, raised erythematous area of face

Diffusely inflamed skin that is warm and tender to palpation

 

 

 

 

 

Question 15. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with:

 

Melanoma

Basal cell carcinoma

Leukoplakia

Senile lentigines

 

Question 16. Which of the following descriptions best illustrates assessment findings consistent with tinea capitis?

 

Circular erythematous patches with papular, scaly annular borders and clear discharge

Inflamed scaly dry patches with broken hairs

Web lesions with erythema and scaling borders

Scaly pruritic erythematous lesions on inguinal creases

 

 

 

 

Question 17. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a:

 

Bacterial folliculitis

Basal cell carcinoma

Bullous impetigo

Epidermoid cyst

 

 

 

Question 18. Patient presents with complaint of a “swollen node” under his arm. The area is tender and the node has progressed in size over the past few days. Which of the following should be included in your differential diagnosis?

 

Hidradenitis suppurativa

Epidermoid cyst

Furuncle

Both A and C

 

 

Question 19. A patient suffered a laceration of the shin three days ago, and today presents with a painful, warm, red swollen region around the area. The laceration has a purulent exudate. The clinician should recognize that the infected region is called:

 

Contact dermatitis

Folliculitis

Hidradenitis suppurativa

Cellulitis

 

Question 20. A woman complains of malaise and arthralgias. You note a butterfly-shaped, macular, erythematous rash across her cheeks and nose. These conditions are common in:

Psoriasis

Lichen planus

Systemic lupus erythematosus

Erythema nodosum

Week 8 quiz

1. Question : Which of the following best describes the pain associated with osteoarthritis?

Constant, burning, and throbbing with an acute onset

Dull and primarily affected by exposure to cold and barometric pressure

Begins upon arising and after prolonged weight bearing and/or use of the joint

Begins in the morning and limits continued ambulation

 

 

Question 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include:

 

Recommending she increase her dietary intake of Calcium and Vitamin D

Ordering once a year bisphosphonate and a proton pump inhibitor

Participate in a fall prevention program

Dual-energy X-ray (DEXA) scan and updating immunizations

 

Question 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items:

 

Green leafy vegetables

Beer, sausage, fried seafood

Sugar

Gluten and bread items

 

 

Question 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses:

 

Osteoarthritis

Rheumatoid arthritis

Fibromyalgia

Polymyalgia rheumatica

 

 

Question 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of:

 

Osteoarthritis

Rheumatoid arthritis

Scleroderma

Sarcoidosis

 

 

Question 6. Which of the following statements about osteoarthritis is true?

 

It affects primarily weight-bearing joints

It is a systemic inflammatory illness

The metacarpal phalangeal joints are commonly involved

Prolonged morning stiffness is common

 

 

Question 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk):

 

Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days

Doxycycline 100 mg twice daily for 5 days

Prednisolone 35 mg four times a day for 5 days

Ice therapy

 

 

Question 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems:

 

Fibromyalgia

Sarcoidosis

Systemic lupus erythematosus

Rheumatoid arthritis

 

 

Question 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect?

 

Beta blocker

ACE inhibitor

Statin medication

Metformin

 

 

 

 

Question 10. A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis?

 

Joint infection

Chondromalacia patella

Prepatellar bursitis

All of the above

 

Question 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical examination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate:

 

Knee ligament injury

Osgood-Schlatter disease

Prepatellar bursitis

Chondromalacia patella

 

 

Question 12. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon?

 

Straight leg raising sign

Lumbar herniated disc on X-ray

Loss of left sided patellar reflex

Urinary incontinence

 

Question 13. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of:

 

Carpal tunnel syndrome

Osteoarthritis of the wrist

Epicondylitis

Cervical osteoarthritis

 

Question 14. Which of the following describes the pathology of De Quervain’s tenosynovitis?

 

Irritation of a tendon located on the radial side of the wrist, near the thumb

Impingement of the median nerve, causing pain in the palm and fingers

Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist

Ulnar nerve compression at the olecranon process

 

Question 15. What is the most common cause of hip pain in older adults?

 

Osteoporosis

Osteoarthritis

Trauma due to fall

Trochanteric bursitis

 

 

 

Question 16. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an X-ray of the feet be ordered?

 

Yes, there is tenderness over the fifth metatarsal

No, there is not tenderness over the navicular bone

Yes, the patient cannot bear weight on the foot

A and C

 

 

Question 17. 38-year-old Asian male, Mr. Chen, with past medical history significant for prehypertension who has recently taken up softball presents with three to five weeks of shoulder pain when throwing overhead. Ice minimally alleviates pain. Medications: Naproxen minimally alleviates shoulder pain. Allergies: Penicillin-associated rash. Family history: Brother has rheumatoid arthritis.

 

Which of the following musculoskeletal causes of shoulder pain would merit urgent diagnosis and management?

 

Adhesive capsulitis

Septic subacromial bursitis

Impingement of the supraspinatus tendon

Calcific tendinopathy

 

 

 

 

Question 18. If Mr. Chen had restricted passive as well as active ROM of the shoulder, what problems involving the shoulder might you consider?

 

Adhesive capsulitis

Rotator cuff tear

Tendinopathy of the long head of the biceps

Rotator cuff impingment

 

 

 

Question 19. What is the essential dynamic stabilizer of the shoulder joint?

 

Labrum

Rotator muscle group

Glenohumeral ligaments

Teres major muscle

 

 

 

 

Question 20. Given Mr. Chen’s repetitive overhead activities, some injury to his rotator cuff muscle group is most likely. Of the following exam findings, which one would not support the diagnosis of rotator cuff tendinopathy?

 

Positive Apley’s Scratch test

Weakness and pain with empty can testing

Limited active ROM

Inability to raise arm above his head

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