NR511 FINAL EXAM MARCH 2020

 

                The most cost-e?ective screening test for determining HIV status is which of the following?

                Western blot

Enzyme-linked immunosorbent assay Venereal Disease Research Laboratory test Viral load

               

 

 

Question 2.         Which blood test is a nonspecific method and most helpful

for evaluating the severity and course of an inflammatory process?

                Erythrocyte sedimentation rate

White blood cell count Polymorphonuclear cells

 

C-reactive protein (CRP)

 

 

               

 

 

Question 3.         Cocaine acts as a stimulant by blocking the reuptake of

which neurotransmitter?

                GABA Acetylcholine Dopamine Serotonin

               

 

 

Question 4.         Mrs. Thomas was seen in the o?ce complaining of pain and

point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that di?erentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:

                                Ecchymosis, edema, and erythema over the lateral epicondyle

   Pain at the elbow with resisted movements at the wrist

and forearm

Inability to supinate and pronate the arm

Inability to flex or extend the elbow against resistance

 

 

Question 5.         Which of the following statements concerning the

musculoskeletal examination is true?

                                  The uninvolved side should be examined initially and then compared to the involved side.

   The part of the body that is causing the patient pain should be examined first.

When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain.

Radiographs should always be obtained prior to

examination so as not to cause further injury to the patient.

               

 

 

Question 6.         Which of the following signs or symptoms indicate an

 

inflammatory etiology to musculoskeletal pain?

                Decreased C-reactive protein

Hyperalbuminemia Morning sti?ness Weight gain

               

 

 

Question 7.         Which causes the greatest percentage of mammalian bites?

                                  Dogs  Cats

   Humans  Rodents

               

 

 

Question 8.         A 48-year-old woman is seen in the clinic with complaints of

prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?

                Transvaginal ultrasound

Endometrial biopsy MRI

Abdominal computed tomography scan               

 

 

Question 9.         A diabetic patient asks the clinician why he needs to check

his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?

                “Control of glucose will help postpone or delay

complications.”

“Regularly checking blood sugar will help establish a routine.”

“Monitoring glucose will promote a sense of control.”

All of the above                 

 

Question 10.      A 25-year-old patient presents to the clinic with fatigue, cold

 

intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular sti?ness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?

                Serum calcium TSH

Electrolytes

Urine specific gravity       

Question 11.      Which of the following medications for type 2 diabetes

mellitus should not be prescribed during pregnancy?

                Insulin Metformin Glucotrol Precose

               

 

 

Question 12.      During a DRE on a 75-year-old man, the clinician suspects

the patient has prostate cancer. What physical finding should make the clinician suspicious?

                An enlarged rubbery gland

A hard irregular gland A tender gland

A boggy gland     

Question 13.      Eddie, age 4, presents to the ED with a live insect trapped in

his ear canal causing a lot of distress. What should be your first step?

                Remove the insect with tweezers.

Immobilize the insect with 2% lidocaine. Sedate Eddie with diazepam.

Shine a light in the ear for the insect to “find its way out.”            

 

 

Question 14.      What is the most common cause of microcytic anemia?

                Anemia of chronic disease

Sideroblastic anemia Iron-deficiency anemia Thalassemia

               

 

 

Question 15.      An 82-year-old man is seen in the primary care o?ce with

complaints of dribbling urine and di?culty starting his stream. Which of the following should be included in the list of di?erential diagnoses?

                Benign prostatic hyperplasia (BPH)

Parkinson’s disease Prostate cancer

All of the above                 

Question 16.      Early rheumatoid disease is characterized by:

                                Pain and swelling in both small and large peripheral joints

Rigid joints with diminished range of motion

Joint swelling and immobility on rising A cardiac rub or pulmonary friction rub

               

 

 

Question 17.      A 70-year-old female has fallen 2 weeks ago and developed

immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?

                                  Make an immediate referral for an orthopedic evaluation without further assessment.

   Tell her that it takes time for these bruises to improve, so she should be patient.

Obtain a wrist x-ray and place her wrist in a splint or

 

prescribe a splint.

   Send her to the emergency room for reduction of this obvious wrist fracture.

               

 

 

Question 18.      The criteria for diagnosing generalized anxiety disorder in

the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:

                1 month 3 months

6 months

12 months   

Question 19. A 60-year-old man presents with an enlarged scrotum. The

clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

                The scrotum will be dark.

The scrotum will appear light pink or yellow. The scrotum will appear milky white.

The internal structures will be clearly visible.

               

 

 

Question 20.      According to Kübler-Ross, the stages of grief occur in which

order?

                Anger, denial, depression, bargaining, acceptance

Anger, denial, bargaining, acceptance, depression Denial, anger, depression, bargaining, acceptance Denial, anger, bargaining, depression, acceptance

               

 

 

Question 21.      Reuben, age 24, has HIV and just had a routine viral load

test done. The results show a falling viral load. What does this indicate?

                  A favorable prognostic trend

 

Disease progression

The need to be more aggressive with Reuben’s medications

   The eradication of the HIV

               

 

 

Question 22.      The exanthem of Lyme disease is:                           Erythema infectiosum

Laterothoracic exanthem Erythema migrans Morbilli exanthem

               

 

 

Question 23.      You have detected the presence of crepitus on examination

of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:

                Articular Inflammatory Nonarticular A and B

               

 

 

Question 24.      What is the recommended daily calcium intake for adults

over the age of 50 with low bone mass?

                1,200 mg/day 1,000 mg/day

1,300 mg/day

1,500 mg/day      

Question 25.      When assessing a woman for infertility, which of the

following tests should be done first?

                Analysis of partner’s sperm

Magnetic resonance imaging (MRI) Hysterosalpingogram

 

   Estrogen level                 

Question 26.      Which type of burn injury results in destruction of the

epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

                  Superficial burns

   Superficial partial-thickness burns   Deep partial-thickness burns

   Full-thickness burns      

Question 27.      A 23-year-old sexually active woman presents for her first

Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?

                Human papillomavirus (HPV)

Endometrial hyperplasia Vagismus

Polycystic ovarian syndrome      

 

 

Question 28.      As a rule of thumb, the estimated level of hematocrit is how

many times the value of the hemoglobin?

                Two Three Four Five

               

 

 

Question 29.      Sam is a 25-year-old who has been diagnosed with low

back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

 

                Morning sti?ness and limited mobility of the lumbar spine

Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain

   Fever, chills, and elevated erythrocyte sedimentation rate

   Pathologic fractures, severe night pain, weight loss, and fatigue

 

               

 

 

Question 30.      A 30-year-old man is seen with a chief complaint of loss of

libido. Which of the following laboratory tests would help establish a diagnosis?

                Testosterone level Prostate-specific antigen

Nocturnal penile tumescence and rigidity Prolactin level

               

 

 

Question 31.      The clinician prescribes glipizide (Glucotrol) for a diabetic

patient. Which statement made by the patient would indicate that your teaching has been e?ective?

                “I’ll take my pill at least 30 minutes before breakfast.”

“I’ll take my Glucotrol before bedtime.”

“It is important to take my medication right after I eat.” “Since I only like to eat two meals a day, I can take the pill

between my meals.”     

 

 

Question 32.      In the United States, what is the second most common

connective tissue disease and the most destructive to the joints?

                Osteoarthritis

Systemic lupus erythematosus (SLE) Rheumatoid arthritis

Sjögren’s syndrome         

 

Question 33.      The e?ectiveness of benzodiazepines in treating anxiety

disorders suggests that which of the following neurotransmitters plays a role in anxiety?

                  Acetylcholine

   Gamma-aminobutyric acid (GABA)   Dopamine

   Serotonin          

Question 34. A 14-year-old male is seen with complaints of severe

testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?

            Refer to a urologist immediately.

   Obtain a computed tomography (CT) scan.   Instruct the patient to elevate the scrotum.   Prescribe ibuprofen.

               

 

 

Question 35.      Which of the following medications can cause

hyperglycemia?

                Prednisone Metformin Synthroid Cephalexin

               

 

 

Question 36.      During treatment for anaphylaxis, what site is used for the initial injection of epinephrine?

                IV

Abdomen

Upper lateral thigh Deltoid

               

 

 

Question 37. It is important to educate patients with depression and their

family members about reporting signs of increasing depression and suicidal thoughts. This is especially true

 

during which time period?

                Before the initiation of treatment

1 to 2 weeks after the initiation of treatment When switching to a di?erent medication

1 to 2 weeks after tapering o? medications

 

               

 

 

Question 38.      What is the most common cause of secondary amenorrhea?

                Pregnancy

Pituitary dysfunction Inadequate estrogen levels Genetic disorders

               

 

 

Question 39.      Which of the following is the only drug for bulimia approved

by the U.S. Food and Drug Administration?

                                  Sertraline  Fluoxetine  Citoprolam   Imipramine

               

 

 

Question 40.      The goals of the 15-minute hour approach include:                          Enhance self-esteem, expand behavioral repertoire,

prevent dire consequences, and reestablish premorbid levels of functioning

   Emerge with a higher level of functioning and commitment to long-term psychotherapy

   Accept need for antidepressant therapy and psychiatric referral; share concerns with primary care clinician

Improve family functioning and sexual performance as well as accept need for antidepressant medication

               

 

 

Question 41.      John is a 16-year-old boy who presents to the emergency

room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it

 

completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

                Valgus stress test

McMurray circumduction test Lachman test

Varus stress test               

Question 42.      The cardinal subjective symptom of sickle cell crisis is which

of the following?

                Pain Nausea

Light-headedness Palpitations

               

 

 

Question 43.      A 25-year-old woman is seen in the clinic complaining of

painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?

                Pelvic inflammatory disease

Endometriosis

Sexually transmitted infections Ovarian cyst

               

 

 

Question 44.      Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?

                Tick

Brown recluse spider Wasp

Stinging caterpillar            

 

Question 45.      Janet is a 30-year-old who has recently been diagnosed with

 

a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

                  Gastrocnemius  weakness

   A reduced or absent ankle reflex   Numbness in the lateral foot

   Paresthesia of the perineum and buttocks       

 

 

Question 46.      A 21-year-old woman is seen in the clinic requesting birth

control pills. Which of the following tests is essential before prescribing any oral contraceptive?

                  Pregnancy test

   Complete blood cell count   Thyroid-stimulating hormone   Urine dip for protein

               

 

 

Question 47.      A patient with type 2 diabetes comes to the clinic after

reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?

                Ketoacidosis Cirrhosis

Hypoglycemic episodes All of the above

               

 

 

Question 48.      The clinician has chosen to prescribe an SSRI instead of a

tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?

                SSRIs are more e?ective than TCAs.

SSRIs take less time to work than TCAs.

SSRIs have a more favorable side-e?ect profile than TCAs.

SSRIs are not lethal in overdose.

 

               

 

 

Question 49.      Which type of bone marrow transplant is obtained from an

identical twin?

                Autogenic Autologous Allogeneic Syngeneic

               

 

 

Question 50.      Pink, cherry red tissues and skin may result from which type

of poisoning?

                Arsenic Lead

Carbon monoxide Strychnine

               

 

 

Question 51.      Basic human needs are identified as:                      Autonomy and feeling valued by others

Exhilaration and productivity Spirituality

Career success and material rewards     

 

 

Question 52.      The clinician sees a patient who is 5 feet tall and weighs 150

pounds. How would the clinician classify this patient?

                Overweight Mild obesity

Moderate obesity Morbid obesity

               

 

 

Question 53.      A 22-year-old male is seen in the clinic because he found a

hard lump in his testicle when performing testicular self-

 

examination (TSE). Which of the following should be included in the list of di?erential diagnoses?

                Testicular cancer Inguinal hernia Varicocele

All of the above                 

Question 54.      What is the treatment of choice for a patient diagnosed with

testicular cancer?

                Radical orchidectomy

Lumpectomy Radiation implants All of the above

               

 

 

Question 55.      Which method is used to remove heavy metals, such as

lead, that are ingested as poisons?

                Chelation Dialysis Gastric lavage

Bowel irrigation                 

Question 56.      A 58-year-old woman presents with a breast mass. Which of

the following responses by the clinician would be most appropriate?

                “It is probably just a cyst because that is the most

common breast mass.”

“We will order a mammogram and ultrasound to help establish a diagnosis.”

“We will go ahead and schedule you for a biopsy because

that is the only way to know for sure.”

   “Because your lump is painful, it is most likely not cancer.”

               

 

 

Question 57.      A 36-year-old woman is seen with complaints of vaginal

itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?

                  Fluconazole

   Estrogen vaginal cream   Metronidazole

   Doxycycline      

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