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NURS 6531 / NURS6531 Final Exam

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Nurs 6531 Final Exam

Question 2

In the outpatient office setting, the most common reason for a malpractice suit is failure to:

 

Properly refer
 

 

Diagnose correctly in a timely fashion
 

 

Obtain informed consent
 

 

Manage fractures and trauma correctly

Question 3

Reed-Sternberg B lymphocytes are associated with which of the following disorders:

 

Aplastic anemia
 

 

Hodgkin’s lymphoma
 

 

Non Hodgkin’s lymphoma
 

 

Myelodysplastic syndromes

Question 4

The initial clinical sign of Dupuytren’s contracture is:

 

Pain with ulnar deviation
 

 

Painless nodule on palmer fascia
 

 

Pain and numbness in the ring finger
 

 

Inability to passively extend finger

Question 5

Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia?

 

Musculoskeletal pain
 

 

Difficulty sleeping
 

 

Depression
 

 

Fatigue

Question 6

A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition?

 

Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am.
 

 

Instruct the child’s parents on physical activities to help weight loss. 
 

 

Increase the evening insulin dose and check CBG at 2:00 am. 
 

 

Refer the child for instruction on a strict diabetic diet.

Question 7

The 4 classic features of Parkinson’s disease are:

 

Mask-like facies, dysarthria, excessive salivation, and dementia.
 

 

Tremor at rest, rigidity, bradykinesia, and postural disturbances. 
 

 

Depression, cognitive impairment, constipation and shuffling gait. 
 

 

Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy.

Question 8

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

 

You must initiate the plan of care for the patient

 

The physician must be on-site and engaged in patient care
 

 

 You must be employed as an independent contractor
 

 

You must be the main health care provider who sees the patient

Question 9

The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is:

 

Rest from activities which may further stress the bone. 
 

 

Daily passive range of motion exercises. 
 

 

Continuation of the patient’s routine physical activities. 
 

 

Application of ice after activity.


Question 10

Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester?

 

Trimethoprim-sulfamethoxazole
 

 

Erythromycin
 

 

Cefuroxime
 

 

Levofloxacin

Question 11

Which is the most common cause of end-stage renal disease in the United States?

 

Diabetic nephropathy
 

 

Chronic renal failure secondary to vascular disorders
 

 

Acute tubular necrosis
 

 

Kidney trauma

Question 12

A typical description of a tension headache is:

 

Periorbital pain, sudden onset, often explosive in quality, and associated with nasal stuffiness, lacrimation, red eye, and nausea. 
 

 

Bilateral, occipital, or frontal tightness or fullness, with waves of aching pain. 
 

 

Hemicranial pain that is accompanied by vomiting and photophobia. 
 

 

Steadily worsening pain that interrupts sleep, is exacerbated by orthostatic changes, and may be preceded by nausea and vomiting.

Question 13

 A patient taking levothyroxine is being over-replaced. What condition is he at risk for?

 

Osteoporosis
 

 

Constipation
 

 

Depression
 

 

Exopthalmia

Question 14

Which of the following medications increase the risk for metabolic syndrome?

 

Antihistamines
 

 

Proton pump inhibitors
 

 

Protease inhibitors
 

 

A and C
 

 

All of the above

Question 15

You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the:

 

Lateral meniscus
 

 

Cruciate ligament
 

 

Medical meniscus
 

 

Collateral ligament

Question 16

A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is:

 

Gout
 

 

Epicondylitis
 

 

Osteoarthritis
 

 

Lyme disease

Question 17

The organism most often associated with prostatitis is:

 

Klebsiella
 

 

Neiserria gonorrhoaes
 

 

Chlamydia trachomatis
 

 

E.Coli

Question 18

Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?

 

Prescribe systemic antibiotics
 

 

Prescribe antibiotic ear drops
 

 

Prescribe nasal steroids and oral decongestants
 

 

Refer him to an ear, nose, and throat specialist

Question 19

Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?

 

Depression
 

 

Panic disorder
 

 

Anxiety
 

 

Post-traumatic stress disorder

Question 20

What diabetic complications result from hyperglycemia?

1.        

1.        

      1.  Retinopathy
      2.  Hypertension resistant to treatment
      3. Peripheral neuropathy
      4.  Accelerated atherogenesis

 

1, 2, 3

 

2, 3, 4

 

1, 3, 4

 

1, 2, 4

Question 21

Prolonged PT suggests:

 

Platelet abnormality
 

 

Abnormality in intrinsic coagulation pathway
 

 

Abnormality in extrinsic coagulation pathway
 

 

None of the above

Question 22

The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are):

 

Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs. 
 

 

History of significant trauma relative to the patient’s age. 
 

 

Decreased reflexes, strength, and sensation in the lower extremities. 
 

 

Patient report of pain with the crossed straight leg raise.

Question 23

A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:

 

Underweight
 

 

Normal weight
 

 

Overweight
 

 

Obese

Question 24

Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?

 

“Caffeine has not effect on osteoporosis.”
 

 

“A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”
 

 

“Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.”
 

 

“Caffeine increase bone resorption.”

Question 25

Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?

 

Start him on an ACE Inhibitor
 

 

Start him on a diuretic
 

 

Have him monitor his blood pressure at home
 

 

Try nonpharmacological methods and have him monitor his blood pressure at home

Question 26

Diagnostic radiological studies are indicated for low back pain: 

 

Routinely after 3 weeks of low back pain symptoms. 
 

 

To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain. 
 

 

When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection. 
 

 

As a part of a pre-employment physical when heavy lifting is included in the job description.

Question 27

Risk factors for Addison’s disease include which of the following?

 

Tuberculosis
 

 

Autoimmune disease
 

 

AIDS
 

 

All of the above

Question 28

A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is:

 

Consult with a physician


 

 

A 14 day course of ciprofloxacin

 

To obtain blood cultures from separate site



 

 

Obtain urine cultures, CBC, and initiate antibiotic therapy

Question 29

A patient has just been diagnosed with Bell’s palsy. He is understandably upset and has questions about the prognosis. You response should be:

 

Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard
 

 

Unfortunately there is no cure but you have a mild case
 

 

The condition is self-limiting and most likely complete recovery will occur
 

 

With suppressive drug therapy you can minimize the symptoms

Question 30

After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured?

 

 An enzyme-linked immunosorbent assay titer

 

A urea breath test

 

A rapid urease test
 

 

A repeat endoscopy

Question 31

A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?

 

Obtain a thorough history and physical, and check serum cortisol and ACTH levels. 
 

 

Obtain a diet history and check CBC and FBS. 
 

 

Provide nutritional guidance and have the patient return in 1 month. 
 

 

Consult home health for intravenous administration of fluids and electrolytes.

Question 32

The most common symptoms of transient ischemic attack (TIA) include:

 

Nausea, vomiting, syncope, incontinence, dizziness, and seizure. 
 

 

Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes. 
 

 

Headache and visual symptoms such as bright spots or sparkles crossing the visual field. 
 

 

Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness

Question 33

Which patient would benefit most from screening for type 2 diabetes?

 

A 30 year old female with unintended weight loss.
 

 

A 25 year old male with family history of type 1 diabetes 
 

 

An obese female with recurrent vaginitis
 

 

A 50 year old hyperlipidemic male

Question 34

An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus, has fasting glucose values 180 to 250 mg/Dl. What is the most appropriate initial treatment to consider?

 

A low-calorie diet and exercise
 

 

Sliding-scale NPH insulin every 12 hours
 

 

An oral hypoglycemic agent
 

 

Sliding-scale regular insulin every 6 hours

Question 35

 A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be:

 

Trimethoprim-sulfamethoxazole for 3 days
 

 

Ciprofloxacin for 7-10 days
 

 

Trimethoprim-sulfamethoxazole for 14 days
 

 

Ciprofloxacin for 3 days

Question 36

The most reliable diagnostic indicator of gout is:

 

Monosodium urate (MSU) crystals in the synovial fluid.
 

 

Tophi visible over joints or in connective tissue. 
 

 

Elevated serum uric acid level. 
 

 

Abrupt onset of single joint inflammation and pain.

Question 37

 A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?

 

Thiazide diuretic
 

 

Insulin
 

 

Famotidine (Pepcid)
 

 

Albuterol

Question 38

Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:

 

HbA1C

 

2-hour 75 gram oral glucose tolerance test
 

 

C-peptide level
 

 

A and B
 

 

All of the above

Question 39

Diagnostic evaluation of hypothyroidism reveals:

 

Elevated TSH and decreased T4
 

 

Decreased TSH and increased T4
 

 

Decreased TSH and decreased T3
 

 

Elevated TSH and increased T4

Question 40

The most effective intervention(s) to prevent stroke is (are):

 

81 mg of aspirin daily
 

 

Carotid endarterectomy for patients with high-grade carotid lesions
 

 

Routine screening for carotid artery stenosis with auscultation for bruits
 

 

Smoking cessation and treatment of hypertension

Question 41

Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following?

 

Maintain moderate bed rest for 3-4 days
 

 

Call the office for narcotics if there is no relief with the NSAID in 24-48 hours
 

 

Begin lower back strengthening exercises depending on pain tolerance
 

 

Wear a Boston brace at night

Question 42

The cardinal sign of infectious arthritis is:

 

Affected joint is painful at rest, with movement and weight bearing
 

 

Rapid onset that wakes the patient during the night
 

 

Long history of severe pain with associated joint swelling
 

 

None of the above

Question 43

Which appropriate test for the initial assessment of Alzheimer’s disease provides the performance ratings on 10 complex, higher order activities?

 

MMSE
 

 

CAGE questionnaire
 

 

FAQ – Functional Activities Questionnaire 
 

 

Holmes and Rahe social readjustment scale

Question 44

A patient exhibits extrapyramidal side effects of antipsychotic medications. Which of the following symptoms would lead you to look for another diagnosis?

 

Akathisia
 

 

Dystonia
 

 

Parkinsonism
 

 

Hallucinations

Question 45

Urine cultures should be obtained for which of the following patients?

 

Suspected urinary tract infection in pregnancy
 

 

Febrile patients
 

 

Young men
 

 

All of the above

A 65 year old patient complains of recurrent bilateral temporal headaches, malaise, muscle aches, and low grade fever. The headache is described as superficial tenderness rather than deep pain. Giant cell arteritis is suspected. Appropriate treatment is:

 

Refer for temporal artery biopsy and initiation of oral prednisone. 
 

 

Aspirin or acetaminophen every 4 hours as needed for pain and fever. 
 

 

A daily β-blocker such as propranolol.
 

 

CT scan of the head and lumbar puncture for CSF evaluation.

Question 47

Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further?

 

Scoliosis
 

 

Osteoarthritis
 

 

Spinal stenosis
 

 

Herniated nucleus pulposus

Question 48

Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect?

 

Acute otitis media
 

 

Chronic otitis media
 

 

External otitis
 

 

Tempomandibular joint syndrome

Question 49

Which history is commonly found in a patient with glomerulonephritis?

 

Beta-hemolytic strep infection
 

 

Frequent urinary tract infections
 

 

Kidney  stones
 

 

Hypotension

Question 50

 A 27 year old female patient with epilepsy is well controlled with phenytoin (Dilantin). She requests information about contraception. The nurse practitioner should instruct her that while taking phenytoin:

 

The effectiveness of an oral contraceptive may be reduced. 
 

 

She should use a very low dose estrogen oral contraceptive. 
 

 

She should use another anticonvulsant along with the phenytoin.
 

 

Bilateral tubal ligation is recommended.

 

Question 51

Which of the following is a contraindication for metformin therapy?

 

Insulin therapy
 

 

Creatinine > 1.5
 

 

Edema
 

 

None of the above

 

Question 52

Microalbuminuria is a measure of:

 

Total urinary protein. 
 

 

Late renal compromise in a diabetic patient. 
 

 

Early glycemic abnormality. 
 

 

Protein lost into the urine.

 

Question 53

The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy:

 

A dipstick strip done during routine urinalysis in the office
 

 

A 24-hour urine collection
 

 

An early morning spot urine collection
 

 

A serum albumin test

 

Question 54

A nurse practitioner diagnoses a 60 year old male with balanitis. Which disease is commonly associated with balanitis?

 

Congestive heart failure (CHF)
 

 

Dyslipidemia
 

 

Erectile dysfunction (ED)
 

 

Diabetes mellitus (DM)

 

Question 55

A patient with HIV infection has a fever of unknown origin (FUO). Which of the following is a possible cause of FUO in a patient with HIV?

 

drug fever
 

 

  upper respiratory infection
 

 

  nothing specific, this is a systemic disease manifestation
 

 

urinary tract infection

 

Question 56

A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that:

 

The patient should start anticoagulant therapy immediately.
 

 

Hereditary thrombophilia does not always require anticoagulation therapy.
 

 

Women of childbearing age cannot take anticoagulant therapy.
 

 

Genetic and risk management counseling are recommended.
 

 

B and D

 

Question 57

In which of the following presentations is further diagnostic testing not warranted?

 

Bilateral gynecomastia in a pre-pubertal male of average weight; Tanner stage 1
 

 

Bilateral gynecomastia in a 13 year old male with normal testicular size and volume
 

 

Recent onset gynecomastia in a 20 year old male with breast tenderness
 

 

Unilateral breast mass which is 5 centimeters in diameter

 

Question 58

How do you respond when Jessica, age 42, asks you what constitutes a good minimum cardiovascular workout?

 

Exercising for at least 30 minutes every day
 

 

Exercising a total of 2 hours per week
 

 

Exercising for at least 20 minutes, 3 or more days per week
 

 

Exercising for at least 30 minutes, 5 days per week

 

Question 59

The most accurate measure of diabetes control is: 

 

Avoidance of micro- and macro-vascular complications. 
 

 

Insulin sensitivity. 
 

 

Early morning glucose levels. 
 

 

HgbA1c

 

Question 60

Which of the following statements about multiple sclerosis (MS) is correct?

 

MS is a chronic, untreatable illness that is almost always fatal. 
 

 

MS is a disease of steadily progressive and unrelenting neurologic deterioration. 
 

 

MS is a chronic, treatable illness with unknown cause and a variable course. 
 

 

Patients with MS who take active steps to improve their health have the best cure rate.

 

Question 61

Risk factors for prostate cancer include all of the following except:

 

Family history
 

 

Benign prostatic hypertrophy
 

 

African American race

 

Age

 

Question 62

Which of the following symptoms suggests a more serious cause of back pain?

 

Pain associated with coughing or sneezing
 

 

Pain associated with muscle spasm
 

 

Pain associated with lying down at night
 

 

Pain associated with negative straight leg raise

 

Question 63

Potential side effects of levofloxacin include which of the following?

 

Confusion
 

 

Hypoglycemia
 

 

Achilles tendon rupture
 

 

All of the above

 

Question 64

Diagnostic evaluation for urinary calculi includes:

 

Urinalysis and culture
 

 

Non contrast CT
 

 

Serum calcium
 

 

All of the above

 

Question 65

Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?

 

Hypertriglyceridemia and low high-density lipoprotein (HDL)
 

 

Gestational diabetes and polycystic ovarian syndrome
 

 

Hispanic, African-American, Native-American, and Pacific Islander ethnicity
 

 

Postprandial hypoglycemia

 

Question 66

Establishment of a definitive diagnosis of osteomyelitis requires:

 

A known causative injury such as a puncture wound, bite, or decubitus ulcer. 
 

 

Biopsy of culture of the pathogen from blood or bone aspirate. 
 

 

Visualization of purulent material draining into soft tissue. 
 

 

Lucent areas identified on plain x-ray

 

Question 67

A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioner’s recommendation?

 

Advise the patient to stop the antidepressant medication

 

Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication
 

 

Recommend that the patient continue the antidepressant medication for at least 4 more months
 

 

Discuss with the patient the need to take the antidepressant medication indefinitely

 

Question 68

A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient’s TSH?

 

1 week
 

 

2 weeks
 

 

4 weeks
 

 

8 weeks

 

Question 69

Which of the following is the most common complication of the myelodysplastic syndromes?

 

Fatigue
 

 

Cardiomyopathy
 

 

Falls
 

 

Bleeding

 

Question 70

A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?

 

Prescribe an alpha adrenergic blocker
 

 

Recommend saw palmetto
 

 

Prescribe an antibiotic
 

 

Refer to urology

 

Question 71

 What is the most common cause of Cushing’s syndrome?

 

Excessive ACTH production
 

 

Administration of a glucocorticoid or ACTH
 

 

Pituitary adenoma or a non-pituitary ACTH-producing tumor
 

 

Autonomous cortisol production from adrenal tissue

 

Question 72

A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects:

 

Arthritis
 

 

Ulnar neuritis
 

 

Septic arthritis
 

 

Olecranon bursitis

Question 73

What information should patients with diabetes and their families receive about hypoglycemia?

 

Hypoglycemia is a rare complication. 
 

 

Hypoglycemia requires professional medical treatment. 
 

 

Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly. 
 

 

Hypoglycemia occurs only as a result of insulin overdose.

 

Question 74

Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?

 

Apples
 

 

Peppermint
 

 

Cucumbers
 

 

Popsicles

 

Question 75

Which drug category contains the drugs that are the first line Gold standard therapy for COPD?

 

Corticosteroids
 

 

Inhaled beta-2 agonist bronchodilators
 

 

Inhaled anticholinergic bronchodilators
 

 

Xanthines

 

Question 76

Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?

 

Doxycycline 100 mg qd
 

 

Nitrofurantoin 100 mg qd
 

 

Bactrim DS qd
 

 

Erythromycin qd

 

Question 77

Legal authority for advanced practice nursing rests with:

 

The Health Care Financing Administration
 

 

Federal statutes
 

 

State laws and regulations
 

 

Certifying bodies

 

Question 78

The primary goals of treatment for patients with alcohol abuse disorder are:

 

Reduction in withdrawal symptoms and reduction in desire for alcohol
 

 

Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol
 

 

Abstinence or reduction in use, relapse prevention, and rehabilitation
 

 

Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment

 

Question 79

Other than smoking cessation, which of the following slows the progression of COPD in smokers?

 

Making sure the environment is free of all pollutants
 

 

Eliminating all pets from the environment
 

 

Engaging in moderate to high levels of physical activity
 

 

Remaining indoors with air conditioning as much as possible

 

Question 80

A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is:

 

cryptococcosis
 

 

toxoplasmosis
 

 

cryptosporidiosis
 

 

cytomegalovirus

 

Question 81

Central obesity, “moon” face, and dorsocervical fat pad are associated with:

 

Metabolic syndrome
 

 

Unilateral pheochromocytoma
 

 

Cushing’s syndrome
 

 

None of the above

 

Question 82

Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet?

 

Wash your feet with cold water daily
 

 

See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily
 

 

Go to a spa and have a pedicure monthly
 

 

See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes; inspect your feet daily for lesions; apply lotion to dry areas

 

Question 83

 The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:

 

Oral ciprofloxacin (Cipro)
 

 

Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
 

 

Oral trimethoprim-sulfamethoxazole (Bactrim DS)
 

 

Intramuscular penicillin

 

Question 84

What intervention does the American College of Rheumatology recommend as first line therapy for osteoarthritis?

 

Extensive diagnostic work-up
 

 

NSAIDs at therapeutic doses
 

 

Early joint replacement
 

 

Exercise and weight loss

 

Question 85

Which of the following characteristics are associated with prepatellar bursitis?

 

Pain with weight bearing
 

 

Pain with range of motion of the knee
 

 

Repetitive knee trauma
 

 

All of the above

 

Question 86

 A 26 year old female presents with elbow pain that is described as aching and burning. There is point tenderness along the lateral aspect of the elbow and painful passive flexion and extension. She reports she has been playing tennis almost daily for the past month. The most likely diagnosis is:

 

Radial tunnel syndrome
 

 

Ulnar collateral ligament sprain
 

 

Olecranon bursitis
 

 

Lateral epicondylitis

Question 87

Potential causes of hypocalcemia include which of the following?

 

Vitamin D deficiency
 

 

Chronic kidney disease
 

 

Malnutrition
 

 

All of the above

 

Question 88

Diagnostic confirmation of acute leukemia is based on:

 

Bone marrow aspiration and biopsy
 

 

Pancytopenia
 

 

Hyperuricemia
 

 

All of the above

 

Question 89

A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?

 

Alprazolam or diazepam
 

 

Venlafaxine or buspirone
 

 

Trazodone or sertraline
 

 

Venlafaxine or hydroxyzine pamoate

 

Question 90

A 15 year-old female patient is 5 feet tall and weighs 85 pounds. You suspect anorexia and know that the best initial approach is to:

 

discuss proper nutrition
 

 

tell her what she should weight for her height and suggest a balanced diet
 

 

speak to her parents before going any further
 

 

confront her with the fact that you suspect an eating disorder

Question 91

A patient complains of generalized joint pain and stiffness associated with activity and relieved with rest. This patient history is consistent with which of the following disorders?

 

Bursitis
 

 

Paget’s disease
 

 

Fibromyalgia
 

 

Osteoarthritis

 

Question 92

At what age is screening most likely to detect scoliosis?

 

4 to 6 years
 

 

8 to 10 years
 

 

12 to 14 years
 

 

18 to 20 years

 

Question 93

A positive drawer sign supports a diagnosis of:

 

Sciatica
 

 

Cruciate ligament injury
 

 

Meniscal injury
 

 

Patellar ligament injury

 

Question 94

The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:

 

Acetaminophen or an NSAID
 

 

A muscle relaxant as an adjunct to an NSAID
 

 

An oral corticosteroid and diazepam (Valium)
 

 

Colchicine and an opioid analgesic

 

Question 95

A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:

 

Primary hyperparathyroidism is treated with Vitamin D restriction
 

 

Primary hyperparathyroidism is treated with parathyroidectomy
 

 

Primary hyperparathyroidism is treated with daily magnesium
 

 

Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

 

Question 96

What information should a 42 year old patient with newly diagnosed diabetes receive about exercise?

 

Buy good walking shoes with support and a flexible sole. 

 

Exercise at least 5 days per week. 
 

 

Snack before exercise. 
 

 

Do not exercise if your blood sugar is greater than 180 mg/dL

 

Question 97

A 30 year old female patient presents to the clinic with heat intolerance, tremors, nervousness, and weight loss inconsistent with increased appetite. Which test would be most likely to confirm the suspected diagnosis?

 

A serum thyroid stimulating hormone (TSH) level
 

 

Follicle stimulating hormone (FSH)
 

 

A urine drug screen
 

 

The Hamilton Anxiety Scale

 

Question 98

Which of the following set of symptoms should raise suspicion of a brain tumor?    

 

Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances. 
 

 

Vague, dull headaches that are accompanied by a reported sense of impending doom. 
 

 

Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia. 
 

 

Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.

 

Question 99

Which factors are associated with high risk for foot complications in a patient with diabetes mellitus?

1.       Obesity

2.       Abnormal nails

3.       Abnormal gait

4.       Poorly controlled lipids

 

1, 2, 3

 

2, 3, 4
 

 

2, 3
 

 

1, 4

 

Question 100

Which of the following patients most warrants screening for hypothyroidism?

 

A young adult female with postpartum depression lasting 2 weeks. 
 

 

A patient taking thyroid replacement preparation. 
 

 

A 40 year old male with unexplained tremors. 
 

 

An elderly female with recent onset of mental dysfunction.

 

Question 101

Which of the following accounts for half of the bladder tumors among men and one-third in women?

 

Cigarette smoke, both active and passive inhalation
 

 

Chemicals from plastic and rubber

 

Chronic use of phenacetin-containing analgesic agents
 

 

Working long hours and not voiding often

 

FINAL SCORE 83/100

 

 

 

 

 

 

 

 

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[Solved] NURS 6531 / NURS6531 Final Exam

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Nurs 6531 Final Exam Question 2 In the outpatient office setting, the most common reason for a malpractice suit is failure to: Properly refer Diagnose correctly in a timely fashion Obtain informed consent Manage fractures and trauma correctly Question 3 Reed-Sternberg B lymphocytes are associated with which of the following disorders: Aplastic anemia Hodgkin’s lymphoma Non Hodgkin’s lymphoma Myelodysplastic syndromes Question 4 The initial clinical sign of Dupuytren’s contracture is: Pain with ulnar deviation Painless nodule on palmer fascia Pain and numbness in the ring finger Inability to passively extend finger Question 5 Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia? Musculoskeletal pain Difficulty sleeping Depression Fatigue Question 6 A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition? Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am. Instruct the child’s parents on physical activities to help weight loss. Increase the evening insulin dose and check CBG at 2:00 am. Refer the child for instruction on a strict diabetic diet. Question 7 The 4 classic features of Parkinson’s disease are: Mask-like facies, dysarthria, excessive salivation, and dementia. Tremor at rest, rigidity, bradykinesia, and postural disturbances. Depression, cognitive impairment, constipation and shuffling gait. Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy. Question 8 What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare? You must initiate the plan of care for the patient The physician must be on-site and engaged in patient care You must be employed as an independent contractor You must be the main health care provider who sees the patient Question 9 The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is: Rest from activities which may further stress the bone. Daily passive range of motion exercises. Continuation of the patient’s routine physical activities. Application of ice after activity. Question 10 Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester? Trimethoprim-sulfamethoxazole Erythromycin Cefuroxime Levofloxacin Question 11 Which is the most common cause of end-stage renal disease in the United States? Diabetic nephropathy Chronic renal failure secondary to vascular disorders Acute tubular necrosis Kidney trauma Question 12 A typical description of a tension headache is: Periorbital pain, sudden onset, often explosive in quality, and associated with nasal stuffiness, lacrimation, red eye, and nausea. Bilateral, occipital, or frontal tightness or fullness, with waves of aching pain. Hemicranial pain that is accompanied by vomiting and photophobia. Steadily worsening pain that interrupts sleep, is exacerbated by orthostatic changes, and may be preceded by nausea and vomiting. Question 13 A patient taking levothyroxine is being over-replaced. What condition is he at risk for? Osteoporosis Constipation Depression Exopthalmia Question 14 Which of the following medications increase the risk for metabolic syndrome? Antihistamines Proton pump inhibitors Protease inhibitors A and C All of the above Question 15 You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: Lateral meniscus Cruciate ligament Medical meniscus Collateral ligament Question 16 A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is: Gout Epicondylitis Osteoarthritis Lyme disease Question 17 The organism most often associated with prostatitis is: Klebsiella Neiserria gonorrhoaes Chlamydia trachomatis E.Coli Question 18 Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? Prescribe systemic antibiotics Prescribe antibiotic ear drops Prescribe nasal steroids and oral decongestants Refer him to an ear, nose, and throat specialist Question 19 Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis? Depression Panic disorder Anxiety Post-traumatic stress disorder Question 20 What diabetic complications result from hyperglycemia? 1. 1. 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis 1, 2, 3 2, 3, 4 1, 3, 4 1, 2, 4 Question 21 Prolonged PT suggests: Platelet abnormality Abnormality in intrinsic coagulation pathway Abnormality in extrinsic coagulation pathway None of the above Question 22 The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are): Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs. History of significant trauma relative to the patient’s age. Decreased reflexes, strength, and sensation in the lower extremities. Patient report of pain with the crossed straight leg raise. Question 23 A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as: Underweight Normal weight Overweight Obese Question 24 Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? “Caffeine has not effect on osteoporosis.” “A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.” “Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.” “Caffeine increase bone resorption.” Question 25 Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be? Start him on an ACE Inhibitor Start him on a diuretic Have him monitor his blood pressure at home Try nonpharmacological methods and have him monitor his blood pressure at home Question 26 Diagnostic radiological studies are indicated for low back pain: Routinely after 3 weeks of low back pain symptoms. To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain. When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection. As a part of a pre-employment physical when heavy lifting is included in the job description. Question 27 Risk factors for Addison’s disease include which ...
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