NSG6420 Quiz 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. Question : 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. Question : 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:
Exercise stress test
Myocardial perfusion imaging
Question 4. Question : 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
Question 5. Question : 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. Question : What is the most common valvular heart disease in the older adult?
: Aortic regurgitation
Question 7. Question : 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:
Mitral valve prolapse
Congestive heart failure
Points Received: 2 of 2
Question 8. Question : 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. Question : 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. Question : A common auscultatory finding in advanced CHF is:
: Systolic ejection murmur
S3 gallop rhythm
Question 11. Question : Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of:
All of the above
Question 12. Question : The best way to diagnose structural heart disease/dysfunction non-invasively is:
: Chest X-ray
Question 13. Question : 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:
A and B
Question 14. Question : 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
Question 15. Question : 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
Question 16. Question : 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. Question : 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. Question : 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
Question 19. Question : 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:
Question 20. Question : 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:
NSG6420 QUIZ 2
1. Question : 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
Question 2. Question : In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of:
: Bacterial sinusitis
Question 3. Question : A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with antibiotics to prevent complications and to shorten the course of disease. Which of the following antibiotics should be considered when a patient is allergic to Penicillin?
Question 4. Question : Presbycusis is the hearing impairment that is associated with:
: Physiologic aging
Question 5. Question : Epistaxis can be a symptom of:
All of the above
Question 6. Question : 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
Question 7. Question : A 26 year old patient presents with cough and general malaise for 3 days. They note that their eyes have been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel miserable’ and demand something to make them feel better. What would be the best first plan of treatment?
: Saline nasal spray for congestion and acetaminophen as needed for pain.
Z-pack (azithromycin) for infection and Cromolyn nasal for congestion
Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion
Cephalexin for infection and Cromolyn ophthalmic for congestion
Question 8. Question : 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 9. Question : Dizziness that is described as “lightheaded” or, “like I’m going to faint,” is usually caused by inadequate cerebral perfusion and is classified as?
Question 10. Question : It is important to not dilate the eye if ____ is suspected.
Acute closed-angle glaucoma
Chronic open-angle glaucoma
Question 11. Question : Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any history of headaches or migraines. What would the most likely diagnosis be?
: Vestibular neruitis
Benign paroxysmal positional vertigo
Benign hypertensive central vertigo
Question 12. Question : Which of the following patients with vertigo would require neurologic imaging?
: A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not disappear when she focuses.
A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix-Hallpike maneuver.
A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test is positive.
A 28-year-old otherwise well woman with new onset constant vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze is fixed.
Question 13. Question : A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with:
: Bacterial conjunctivitis
Question 14. Question : In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness?
: History of prior red-eye episodes
Grossly visible corneal defect
Question 15. Question : A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation?
Question 16. Question : 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 17. Question : You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions?
: Ménière’s disease
Benign paroxysmal positional vertigo
Transient ischemic attack (TIA)
Question 18. Question : 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
Question 19. Question : Rheumatic heart disease is a complication that can arise from which type of infection?
: Epstein-Barr virus
Group A beta hemolytic streptococcus
Question 20. Question : A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered?
: Mono spot
All of the above
NSG6420 QUIZ 3
1. Question : Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?
: Seasonal allergies
Question 2. Question : A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be?
: Observation and reassurance
Treatment with an antibiotic such as amoxicillin
Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate
Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler.
Question 3. Question : Emphysematous changes in the lungs produce the following characteristic in COPD patients?
: Asymmetric chest expansion
Increased lateral diameter
Increased anterior-posterior diameter
Question 4. Question : When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction:
: No palpable vibration is felt
Decreased fremitus is felt
Increased fremitus is felt
Vibration is referred to the non-obstructed lobe
Question 5. Question : Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma?
: Clear, watery nasal drainage with nasal turbinate swelling
Pharyngeal exudate and lymphadenopathy
Clubbing, cyanosis and edema.
Diminished lung sounds with rales in both bases
Question 6. Question : Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?
: Computed tomography (CT) scan
Chest X-ray with PA, lateral, and lordotic views
Positron emission tomography (PET) scan
Question 7. Question : A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:
: Exercise-induced cough
Question 8. Question : 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:
Question 9. Question : 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
Question 10. Question : A cough is described as chronic if it has been present for:
: 2 weeks or more
8 weeks or more
3 months or more
6 months or more
Question 11. Question : Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze?
: Chest X-ray
Methacholine challenge test
Spirometry, both with and without bronchodilation
Question 12. Question : In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include:
: Symptoms daily with nighttime awakening more than 1 time a week. FEV1 >60%, but predicted <80%. FEV1/FVC reduced 5%
Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 >80% predicted. FEV1/FVC normal
Symptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 >80% predicted. FEV1/FVC normal
Symptoms throughout the day with nighttime awakenings every night. FEV1< 60% predicted. FEV1/FVC reduced >5%
Question 13. Question : The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home:
: Age over 40
Fever greater than 101
Tachypnea greater than 30 breaths/minute
Question 14. Question : Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistent asthma, the preferred option for maintenance medication is:
: High-dose inhaled corticosteroid and leukotriene receptor antagonist
Oral corticosteroid—high and low dose as appropriate
Short acting beta2 agonist inhaler and theophylline
Low dose inhaled corticosteroid and long acting beta2 agonist inhaler
Question 15. Question : A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:
: Can be treated as an outpatient
Requires hospitalization for treatment
Requires a high dose of parenteral antibiotic
Can be treated with oral antibiotics
Question 16. Question : Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?
: Fever of 102
Infiltrates on chest X-ray
Pleural effusion on chest X-ray
Elevated white blood cell count
Question 17. Question : A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:
: Barrel-shaped chest
Prolonged capillary refill
Question 18. Question : Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:
: Legionnaires’ disease
Question 19. Question : A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:
: Lung cancer